Why is it so hard to control our appetites? A doctor’s struggles with giving up sugar

I was possessed by the desire to eliminate sugar from my diet after the first year of the coronaviruses. It probably wasn't the best time to add a new challenge to my life. My wife and I were struggling to provide for our three young kids. My elderly parents lived out of state and needed a number of reminders that the restrictions on the spread of the H1N1 flu were not lifted for new Bollywood movie releases.

We were looking for masks and trying to make sense of government guidelines about when to wear them. In addition, as a doctor, I was seeing patients in clinic at a time dominated by medical uncertainty, when personal protective equipment was scarce, and my hospital, facing staff shortages, was providing training videos and tip sheets to specialists. It would have been enough to focus on avoiding the virus and managing all this. Cutting processed sugar seemed to be an opportunity to reestablish order to the daily scrum, or at least to the body that entered it each day.

The stress of clinical practice during the Pandemic was taking its toll on my body. Maybe it was all the death in the air, but I felt like the narrator in The God of Small Things. Not young. Maybe doing away with sugar could slow things down. Maybe it will take me back to the days when I went sugar-free in college.

My friends called my lifestyle joyless. I was compelled by the literature about the effects of added sugar. I decided to study the problem to see if I could pull something like this off again.

I began the coursework required to sit for a medical-board exam on dietetics, metabolism and appetite, in what was arguably an act of masochism. I thought I would get to my goal by earning another qualification. I would attend virtual lectures and read board-review books in order to understand the metabolism of the body. I was immersed in the science of exercise, nutrition and appetite. This knowledge did not change my eating habits. Cupcakes and ice cream did not call to me any less. Lay's potato chips were the first to be made back in the 1960s, and big food corporations were winning the bet. I was reaching for Double Stuf Oreos while flipping through my medical textbooks and scarfing chocolate bars, even as I answered my practice-exam questions.

My body did not want to be disciplined by my intellectual skills. I passed the board examination, but my appetite for sugar didn't change. When I started, I had a few questions. Was sugar a problem? I wondered if I had internalised hangups about desire from the culture. Why did my soul feel so sick after my first attempt at quitting, when I tried it again? I've been sugar-free for a year now, but what does that mean?

I turned to Plato for some answers. The stomach was the place of desire in his body map. Courage rested in the chest while reason resided in the head. It was up to reason and courage to elevate the individual in this architecture. The thought was that if we could just rule our stomachs, we might be able to hold our heads up high. The good life for the Greeks was dependent on the right moral posture.

Early medical science in the west was based on Plato's work. It was agreed that eudaimonia could be realised by moderation of appetites. He believed the heart was the most intelligent organ. The heart was a central place in the body, controlling other organs. The brain and lungs were cooling the heart. Reason flowed where the heart was.

Five hundred years later, the Greek anatomist and surgeon Galen challenged the central idea of the heart but still believed in Plato's idea of the soul. He painstakingly tried to stitch the divided parts of the soul together in his treatises, which were suffused with Platonic assumptions. In On the Doctrines of Hippocrates and Plato, Galen claims to have proof that the forms of the soul are more than one. These facts can be proven scientifically.

The best state is when reason is in charge, the spirited part is obedient, and the appetitive part is strong.

Is it a bad idea to tame appetite? Sigmund Freud wondered if desire could ever be easily controlled. Freud sketched a three-part atlas of the self and its desires, instead of tossing Plato's map aside. For Freud, appetites could not be overcome. There was no perfect harmony or permanent equilibrium. In Freud's idea of the self, anxiety for order was above the ego. The tether that consciousness could never escape was called appetite.

There was something talismanic about my focus on sugar. Liberty is seen as the ability to say yes to things. To open the door or the window. The power to say no is part of that freedom. I felt powerless in the face of my cravings. I had to answer the knock at the door of appetite if it was a tap on the window of impulse. This felt terrible. Why couldn't I say no? Why was it so painful?

I don't pretend to understand my motives. There were a few currents that were worth watching. Not being able to say no to sugar sometimes felt like a form of bondage to the demands of the body, the very body that I was eager to assert power over, particularly during a global health crisis that was damaging bodies everywhere. Could I not control myself if I couldn't control the plague? I wonder if this insistence on regulating appetite was a way of denying mortality in the midst of its excess. I would like to believe that there was more separation between me and other types of pandemic deniers. Were we all dealing with the inexorability of our decay in different ways?

Maybe. There was something else on my mind. The inability to resist sugar cravings seemed to be a victory of the past. It felt like the triumph of the memory of pleasure over real satisfaction. It was important to say no to that memory because it felt like the only way to say yes to imagination.

It felt like a way to stop being beholden to an old storehouse of desires and aversions. The ability to refuse to reach for the cookie was a way to break free from the impulse to reach for patterns of the past, from the compulsion of replicating yesterday at the expense of tomorrow. The trick of habit is to convince us that we are reaching forward even when we are not. The less we are able to refuse, the more automated we become.

Modern medicine took what Freud left of the self. Materialist models hold more sway today than Freud's theory did. There is a mix of neural circuits and pathways in the literature on appetite. If there was a moral aspect of appetite for ancient philosophers and physicians, it isn't readily apparent in the language of contemporary scientific literature.

There are some positives to this development. In the modern era, medicine's tradition-bound framing of appetite as a moral problem has been demoralising for patients, who often felt objectified, policed and discriminated against by institutions that sermonise about appetite. In and out of medicine, the stigmatisation of appetite is still pervasive. The scientific literature has lost an explicit moral charge.

Since Freud's theories, appetite has been atomised by medicine into a problem of fighting the body's tendency toward eating. The pursuit of better and longer lives has led to the study and treatment of appetite problems. The study of digestion and appetite in the laboratory moved hunger from the moral arena to a biochemical one. The ancient impulse to locate the appetite persisted in both experimental physiology and clinical medicine. There were lines drawn and defended between diseases of the stomach and the psyche.

What was at stake in the outcome? It was the first step in a series of steps that would lead to its regulation. Medicine's mission to uncover the mechanisms of appetite, despite the deletion of the soul from scientific databases, cannot escape Plato's legacy. We seem unable to resist the desire to control our appetite.

If I could have simply walked away after a few bites, I wouldn't have felt the need to go all-or-nothing with sugar. I wouldn't stop even after I was full. Pleasure would turn into pain. There is pleasure in abundance and overdoing a thing. I found myself going past that threshold.

While studying for the board exam, I was using various apps and devices to keep track of my body. I used a smart watch to log my steps. I was using a app that kept track of calories and I was scheming how much I could eat to stay under the limit. It felt joyless and anxiety-ridden when logging and calculating. I would explain to my friends and family that I was just entering my data in the middle of a meal. There was a lot of data.

I switched to an app with more of a behavioural focus because I grew weary of all the inputting. The app still had me tracking calories, but it also came with recipes, a personal coach and courses. The courses gave me the chance to chat with a coach and get some clarity on my goals. The coach would give tips to overcome obstacles. I went through the app's courses and answered its behavioural questions. I was able to go sugar-free for a few weeks, but after a couple of months, the coaching advice seemed more and more generic, and the courses were too simplistic when I was already studying for my exam. I reverted to simply recording calories after losing interest.

I passed the exam without much to show for my changes to my diet. I needed a different way to hold myself accountable. I stumbled upon an app that was on a mission to disrupt diet culture and make our relationship with food, nutrition and ourselves healthier for good. It promised live coaching calls with a certified nutritionist, shared recipes, and even offered to tailor my coaching with a vegetarian dietician. It didn't ask you to enter food items into a database. It was all for you to send pictures of your food. It felt different than tapping numbers into a screen.

The slogan of the app was 100% accountability and0% judgment. It was the judgement that I came for. The killer feature was the fact that my nutritionist would actually see what I was eating. I answered a question about my diet. I made it clear to my nutritionist that I wanted to go sugar-free. She didn't endorse the goal, but she did acknowledge that it was important to me and that she hoped I would get to the point where a more balanced approach would suffice. I told her we would see. I promised to take a photo of every meal. She reminded me that there were not good and bad foods.

It has been a year since I downloaded the app. Every day since then, I have taken a photo of the food I've eaten, whether it's a salad or a veggie burger. I have been sugar-free in every one of those pics. I have eaten more vegetables and greens and fruits than I have in my life. I make sure my plates are balanced. I take care to take pictures that look nice. If she sees a salad with asparagus and garlic balsamic drizzle andavocado, she will approve her words and raise her hands. I will take another shot if the lighting isn't quite right or the framing isn't right. It has been satisfying to put up a cache of sugar-free images on the app. It has been satisfying to avoid feeling like the guy who said he would go sugar-free only to end up sending in pictures of donuts and cookies. The prospect of someone else seeing photos of what I'm eating makes the potential pain of falling short feel more serious than the pleasure of eating sweets. I stopped eating sugar. It is still working. Was this all it took?

The persistent effort to control appetite, replicated across many cultures and times, shows how vigorously it resists that very control. The untamable quality of the constraints on appetite is underscored by the seemingly endless proliferation of them.

The training of appetite can function as an ascetic practice. Flood argues that the subjectivity of the individual is amplified by the negation of desire.

The conscious subject is made more vivid by the fact that hunger unsatiated allows the self to be felt more acutely. The appetite unfulfilled creates the conditions for self-awareness. This is seen in the figure of the ascetic, one who has lost appetite and lost his immortality, in seeming contradiction.

Science aims more concretely to hack or at least short-circuit a physiological truth if philosophy is after theoretical victories. An operation that cuts the stomach into two parts, leaving one functional thumb-size pouch alongside a larger remnant, and reconstructs separate intestinal systems for each segment to restrict the amount of food that can be eaten is called gastric bypass surgery. The brain-gut divide is much more porous than previously thought, and this surgery builds on that by shrinking the stomach to make the mind feel less satisfied. The recipients of the surgery do well in the short term, with reduced appetite, marked weight loss, better control of diabetes and improved health markers. The percentage of patients who fail to achieve half of their excess weight loss is as high as 34%.

Studies suggest that an influx of appetite-reducing hormones decreases patients' urge to eat. There are questions about the duration and effectiveness of those salutary hormonal changes. For a lot of patients, even a small reduction in the stomach's size doesn't give them complete freedom from their appetite. This fact is not entirely surprising, given what is known about the multiple neuroendocrine nodes that govern appetite, but it poses a dilemma for medical science: can appetite, as Freud asked in his own way, ever be fully controlled? Is it a wonder that patients turn back to more personal strategies to pursue the work that prescriptions and sutures leave undone?

I don't understand why teaming up with a nutritionist on an app worked so well. Is sharing pictures of my food with friends and family effective? Probably not. The issue seemed to be related to epistemology. My friends and family don't know me as well as I do, so they wouldn't have been a good audience. The stories we can tell about one another are shaped by the knowledge of what happened in the past. The app created a gap into which both of us could step because my nutritionist was reviewing pictures of my meals from god. It was within this gap that my future self could intercede in the present with less inertia than before. The illusion that daily life could not come to fruition was provided by the app. There is a space for imagination.

I wondered about the future of this illusion as my sugar-free streak continued. Was it a rare example of tech living up to its promise of liberation? Was this an instance of the digital panopticon determining our ability to imagine ourselves, revealing just how far-reaching its gaze is? I began to think about how long I needed to keep eating this way. The cravings that had been so loud at my door at the start of the epidemic have been quietly shuffled from leg to leg outside it. I could still hear their shoes creaking, but they couldn't force their way in. It seemed like things were a little too quiet.

The Greeks sought to regulate appetite in pursuit of the good life, and perhaps what is sought after today is a facsimile of it. It's not a better way to live, we're just looking for a less painful way to work and die. A more charitable and poetic possibility is that the constraint of appetite continues to appeal because it provides the same sense of structure to selfhood that metre does to a poem: a limit against which to construct narrative unity of the psyche.

As fascinating as it is to think about this question, even more essential ones loom in the writings of a writer who provides a counterbalance to the obsession with appetite restriction in societies. I'm thinking of Beloved, which tells the story of human beings struggling for survival in the face of slavery. Morrison uses the language of food and appetite to show the struggle of sating the self, as well as the confusion between hunger and history.

I was in the middle of trying to quit sugar when I was struck by this resonance. Morrison's characters think about what it would mean to satisfy what the narrator calls their "original hunger", and whether doing so is even possible. They imagine getting to a place beyond appetite, but are also compelled by history to consider the price of doing so.

The consequences of self-abnegation, which Plato doesn't seem to fully consider, are becoming a costly exercise in self-abnegation. Morrison is skeptical of the metaphysicians who would have us eat less. Morrison seems to be willing to reach for hunger, though it may be dangerous. Morrison casts her faith in the human ability to embrace the beautiful, blood-colored dilemma of incarnation, because she believes that both the risk of self-destruction posed by contact with the original hunger and the anguish of self-denial created by leaving it unrecognised, can be mitigated.

A scent from the pantry hit me like it hadn't been there in a while. My wife baked cookies for our kids. I didn't mind the sweets around the house. They might have been made of stone. I found myself at the pantry door at the end of the day. Minutes passed. I opened the container and breathed. My mouth was filling with water. I could taste the cookies. The chocolate melted at the back of the tongue. I remember soaking a cookie in milk. The part of my brain that was humming was eager to duplicate the memories of sugar, butter and dough on the cortex. The pain of not being able to stop was already bad. I opened the app on my phone after picking up the cookie, having built nearly a year's worth of muscle memory. I centered the cookie in the glowing frame and was about to send it when I saw the screen and thought to myself, "what would my nutritionist think?"

Despite a few close calls, my streak is still intact. I am eating well balanced, sugar-free meals and haven't counted a calories in more than a year. The future version of me is getting closer with each picture I take, even though the cravings that were troubling me aren't gone. The spiritual and physical acuity that comes with ascetic practice is what I feel. I feel a bit uneasy about neglecting Morrison's original hunger, with all its attendant risks and possibilities. I think about how I have sacrificed memory at the altar of imagination because I know that imagination can end up being less than it should be. I remind myself that Morrison's visions may be too large for us. We haven't arrived at the place they come from. At least not yet.

The essay in this article was published in the Virginia Quarterly Review.