Scientific Nutrition Update 36: The Placebo Effect

In this episode I get to rant about something I have always found very interesting, the placebo effect.  This effect is so much larger and more important than is often realized.  

Script (Remember I ad-lib and often leave parts blank because I know what I want to say):

For today’s episode I am going to talk about the placebo effect.  Now most people know what the placebo effect is, they realize that it is when you receive a beneficial effect from a treatment because you believe it will be beneficial, even if the treatment itself is otherwise worthless.  The reason the placebo effect is so powerful in my opinion is it serves as a way for us to get a better understanding of study design, the power of psychology in medicine, and the reason many alternative medications have incredible healing effects.  Also before I continue, there is some debate in philosophy whi

 

Placebo’s have always fascinated me because they can have quite incredible effects, and they should in theory if we were completely rational beings they would have no effect.  It’s this weird effect, and I love it. The effect is actually often more complex than we realize, it can include the ritual of taking the medication, can involve the relationship with the practitioner, and even just the act of being assessed for a medical condition can have an effect.  The reason this is so important is because we need to realize what role our own psychology plays in so much of our health. This part is often ignored, discarded, and overlooked, and when I say our psychology I do not just mean mental illness, although that is not excluded, I mean our internal frameworks, ideas, beliefs, scripts, and desires.  All of these affect our health and need to considered as part of a complete health framework.

 

For example if we take a look at Parkinson’s disease, which is a disease where placebos have been proven effective for a while now, we can actually see a release of substantial dopamine when they are given a placebo.  Since Parkinson’s disease is a disease that literally makes it so that your dopamine producing neurons do not produce enough dopamine, you could almost imagine the headlines running in those bad science blogs I rail against saying, “Placebo effective treatment for Parkinson’s Disease.”  These effects are not negligible.

 

There was a study done that looked at Irritable Bowel Syndrome that actually looked at how different components affected it and we could actually see that a placebo was significantly better than nothing, and that a placebo with a supportive practitioner relationship was even more beneficial than that.  It is important to understand how large these effects can be because it gives us a better understanding of the way placebo effects need to be isolated from active effects.

 

These are very real effects, you can see how the brain responds as if it was given fluoxetine when given placebo because of the belief.  These are very real physiological effects which can be observed. This is not just in your head. It is real. One of the most dangerous side effects of opioids is the respiratory depression they induce, and amazingly enough placebos can actually induce this very same effect.  When given with the expectation that is an opioid patients suffer from similar respiratory depression and we see significant activation of the endogenous opioid system. The placebo effect is big guys.

 

There is another reason I wanted to make this very clear.  These effects are quite large. I also occasionally review supplements, compounds, and things based on their effect on me.  I always try to make it clear that it is just my experience, but it is important to realize that there is a significant chance that there is a placebo effect that is playing into those effects.

 

In conclusion, it is important for studies to be controlled so that we can compare the effect to placebo, and it is important when considering my reviews or anyone else’s that they may be subject to the placebo effect.  

Bibliography (I may not directly address these studies in the episode but I looked at them and thought they might be valuable):

http://science.sciencemag.org/content/293/5532/1164.full?casa_token=e2fs8hElW5UAAAAA:gfUx-zSzT6BSnWAYe9_k0KG3_1QkmqhzEHmwBtwOzDBSlEvBWjkj2iFgefDsxSc06bkGgXB5IkVVJQ

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2364862/

https://www.researchgate.net/profile/Daniel_Moerman/publication/11462443_Deconstructing_the_Placebo_Effect_and_Finding_the_Meaning_Response/links/09e4150b600debe4d8000000.pdf

https://www.researchgate.net/profile/Daniel_Moerman/publication/11462443_Deconstructing_the_Placebo_Effect_and_Finding_the_Meaning_Response/links/09e4150b600debe4d8000000.pdf

https://www.myptsd.com/gallery/-pdf/1-43.pdf

https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.159.5.728

http://www.jneurosci.org/content/25/45/10390

https://s3.amazonaws.com/academia.edu.documents/49296884/s0304-3959_2897_2900016-x20161002-6016-1g1t5gw.pdf?AWSAccessKeyId=AKIAIWOWYYGZ2Y53UL3A&Expires=1524496533&Signature=4v%2Bc0zvo7pN3LUH700Cpgr6yQ5E%3D&response-content-disposition=inline%3B%20filename%3DClassical_conditioning_and_the_placebo_e.pdf

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