In my 30 years of practice, I have seen many of my patients embrace change only to revert back to old unhealthy behaviors. The fact is, that our genes are not very responsible for our health. Almost 90% of our most typical modern diseases like obesity are caused by what I term lifestyle behaviors. Change usually comes about through motivation. If there is little motivation, there will be little change, bigger motivation, greater chance of change. Certain drugs like heroin that immediately stimulate the brain’s built-in reward system cause some individuals to keep seeking the drug. This is a simple explanation of an intrinsic reward. Other behaviors are not directly tied to the reward center of the brain. They are known as extrinsic rewards. Extrinsic rewards are learned associations to intrinsic rewards. Working hard on a project for weeks is an example. You work hard on a project for your boss for weeks and then receive a bonus paycheck after you finish the project. You may now associate hard work with a monetary reward.

In real life, most examples are not so simple. A real-life example in my practice would be when someone comes in with a painful tooth. The toothache is resolved and the patient is rewarded with a good night’s sleep. Then they get the bill; a negative association. They start to think of the time expended for the appointments which is another negative. Depending on the individual, one of two things may happen. The first is that they NEVER want to experience the pain again, and use the motivation to change their diet and oral hygiene routines. The second thing that may happen is that they avoid dental appointmnets due to the time and expense.

In my personal experience with real patients, both of the above scenarios are encountered routinely, and both never last. The patient that decided not to come back ultimately returns with a broken tooth. The motivated patient stops eating better, stops flossing, and starts to miss some cleanings. Why? Using “chance” more than “change”.

The underlying neuronal reward system is mainly non-conscious. The patient simply acted more by “instinct”. There was no concrete plan to sustain the new lifestyle choice, so ultimately we drift into different behaviors.

Neuroplasticity is the term we use when describing our brains and their ability to change and grow, no matter how old we are. Science has found that we can build and strenghten new pathways in our brains and make them permanent. Think of a dirt bike trail; at first, there are no clear ways to get through the trees, eventually the trail becomes more and more defined. Ultimately there are embankments troughs. Even when abandoned, the track would persist.

How do we create permanent changes to our brains so that new behaviors become permanent and automatic? We need a plan. We cannot assume motivation alone can sustain the change. Picture driving home. A very complex set of behaviors becomes almost non-conscious. There is constant feedback, even when we are unaware. If we make a wrong turn, we won’t get home. When we get home, we are rewarded. Not so with diet and lifestyle. If we eat two slices of cake, there does not seem to be any consequence, only a reward of sweet deliciousness.

The events that can lead to behavioral changes are called triggers. To change a bad habit, you must have a specific reminder to do something different each time, otherwise you won’t change. Enter triggers. We must use ONE trigger exlusively to remind us of our new choice. Another way to look at triggers, is to use the IF/THEN rule. For instance, IF I go to the supermarket, THEN I won’t go in the middle aisles where all of the junk food is. This is a concrete plan that you make with yourself, and practice it routinely. After a while it will become your new norm.

The second way to build upon your IF/Then rule is to attach it to an existing time. An example is making your half-day friday at work your shopping day. Your new rule is: on Fridays I will go shopping after work at noon. You just attach your IF/Then rule to it. This is just simple “scheduling”. It is so simple, you probably said “duh” to yourself as you read it. The truth is, not many people schedule simple tasks into their life. It really works! you can use the calendar in your smart phone to set up recurring tasks like shopping on Friday at noon.

The last technique is known a stacking. It is similar to scheduling in some ways. It is attaching your IF/THEN rule to another behavior. A simple one is I will brush my teeth after I have my morning coffee. Most of us have routines, coffee as the first thing each day is almost universal. Once again, you can set an alarm in your smart phone calendar. Since you are probably leaving for work at the same time each day, set an alarm to remind yourself to brush after you have finished your coffee. Simple and dffective. It takes on average 66 days to make a new behavior a habit. I recommend keeping the reminders and rules around for much longer- 6 months to a year as a matter of fact. The mirror in the bathroom is a good place to put a sticky not with your IF/THEN rule. Most people keep their phone on them, so reminders in your calendar app usually work.

One final note. Keep things simple and don’t try to entirely upend your life. Too much is too much! Small consistent changes can have tremendous impact on your health. Read my recipe post to learn more.