The Placebo Effect (It's Not Just In Your Head...)

The placebo effect refers to when your mind triggers real and measurable changes in your body, simply because you believe a treatment will work. Even if what you're receiving is inert or in simple terms, it's when your mind convinces your body that a fake treatment is the real thing, leading to genuine changes in your physiology that can be as effective as an actual medical treatment. You're basically gaslighting your brain into doing what it would if you were taking a real drug or medicine. But on the flip side of that is the less talked about, but just as powerful, no SIBO, the fact that you can almost think of as the evil twin to the placebo effect, where negative expectations cause worse outcomes or worse side effects just based on what you believe is happening. Now, the placebo effect is one of the most replicated and recognized effects that's been discovered in science. So in this episode, we're gonna explore both placebo and no SIBO, talking about how beliefs and expectations can alter pain, hormone production, recovery, performance, and more, and then how you can actually harness and use this for positive outcomes in different areas in your life. But before that, if you have not yet, join FS Premium. What are you doing if you're not there yet? You get access to every single one of our complete 12 week training programs that are programmed out into Google Sheets to track and guarantee that you are making progress and it's just $5 a month. On top of that, you get tons of extra perks like bonus episodes every single Friday AMA style where we're answering your questions and it takes less than 60 seconds to sign up. We'll leave a link to do that in the show notes down below if you wanna sign up before the intro is over. - And if you haven't already, you could go ahead and give us a rating on whatever platform you are listening to. 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Disputting research together for an episode of a freak you out because that's what happened to me for this one. - Sometimes, yeah, I think the placebo effect in general has always freaked me out a little bit because I feel like at the placebo effect, how you could fall victim to it in your everyday life without even knowing it too, like not just in research, which obviously we can talk about in depth, but I don't know, like making things up in your head, like doing it subconsciously and then, I don't know, believing it's true, I don't like it, I don't like it. - I think everyone does it, that's the scariest part, everyone does it, probably unintentionally for the most part. I didn't pay attention to the mindset thing for the longest time because it does sound a little woo-woo, the whole, you know, if you believe it, you can achieve it, a lot of attraction. Like there's a lot there, but it's terrifying when you can see how impactful your mindset is. It is crazy that people aren't paying more attention to it, but this is one of those episodes that hasn't happened to me in a long time, we're putting together research, kind of scared the crap out of me. And my brain was not shutting up last night, trying to go to bed, I couldn't stop thinking about it. It's terrifying, 'cause not even just the placebo, but I think what people don't talk about a much the no-cebo, the negative things that can happen from your own thoughts. That's where, whenever around people that, and we'll talk about certain personality traits, but more often than not pessimistic individuals, or that's how they approach everything in life. And it scares you to realize how many things that's impacting for them, personally, and making their life worse. It's terrifying when you think about that. But the no-cebo, maybe it's just me and my little bubble, I feel like it's not talked about as much. - No, I don't think so either. - Now, I think we're gonna start off here by going over what placebo is, where in clinical trials, a placebo is an inactive treatment, like a sugar pill or a saline injectant, it's given to one group while another group gets the real treatment. That's what a placebo is. The placebo effect is observed if people taking that inner treatment experience improvement just because they believe they were getting the real treatment. But it's not just in their head. Brain imaging studies show that patients experience real measurable changes in their brain chemistry and physiology, areas that regulate pain, stress, and mood light up just as they would after an active medication. So that's what the effect is. If you think about it more like this, like how most drugs work is what by basically sending a signal or flipping a switch in a certain part of your body or brain, like to release or block certain chemicals, hormones, or neurotransmitters, and then triggering a cascade that changes how your body functions. So the placebo effect works on that same system, only instead of a drug flipping that switch, your brain is basically doing it on its own with its own power because of your belief. That's where you're basically gaslighting yourself. And in cases where you can do this, the brain sends the same instructions to the body to release this, to suppress that, to calm that system down. And you end up with many of the exact same physiological outcomes, too. The difference is just with placebo, the signal starts in your mind instead of a molecule like a drug or medicine. And I was trying to find where this really came from because it's been noticed for centuries. Like people have known about it for centuries, even though it might not have been recorded. But where I was looking for documentation, one of the earliest and more famous observations I found was during World War II that I thought was really, really cool. It was where an American medic, his name was Henry Beecher, ran out of morphine for wounded soldiers on the battlefield. And he resorted to just injecting them with saline while telling them it was the painkiller. And to his astonishment, about 40% of the soldiers reported relief as if they had received real morphine. And this discovery then spurred him and others to study it more systematically after the war. And by the 1950s, it was Beecher's research. It was called the powerful placebo. Suggested that across many illnesses, a significant portions of patients improved from just believing that they were treated. So this is when people really started to pay more and more attention to it, past just thinking of it as like a cool trick. But I was seeing more anecdotes and self-reports dating back centuries, if not over a thousand years, when people had noticed this, right? This has been around forever. Now, what's the no-seeable effect for people unfamiliar? - Yeah, I also think that this is so fascinating. But the no-seeable effect is when your negative expectations or beliefs about a treatment, a situation, can cause actually harmful or unpleasant effects, even though the treatment itself is inactive or it is harmless. So if you expect something to make you feel worse, your body can actually make that happen in general terms. So it's kind of like the opposite of the placebo effect. And also, like this can be really scary, because-- - This is what sounds more scary. - Yeah, let me go through how this works because it's easy to hear that and be like, oh yeah, like if I think something bad is happening to me because of something, there's no way that like it's easy to brush off as not actually happening. Does that make sense? - Yeah, I feel like a lot of people would almost justify it as them being cautious. - I'm being cautious because I'm assuming that the worst case scenario is gonna happen. So if the worst case doesn't happen, I'll be better than that. I used to think like that for a lot of things, but that's how I see it justified a lot. - Yeah, so there's like different levels to this in terms of explaining the mechanism. I think it's important to understand to see how this actually happens. But the first step would be at a cognitive level. So you have this negative expectation. You'd have this trigger. So it could be negative information, a verbal suggestion. So a drug may cause nausea. Or this food is going to cause inflammation or you have a prior like bad experience in the past. And then in your brain, we have three different regions involved in processing this information. So your prefrontal cortex is going to generate this expectation and attention toward a threat. So you're perceiving this as a threat. And then another, it's called the abbreviation is ACC, just another part of your brain. We'll process the emotional significance of the pain or discomfort associated with this perceived threat. And then your insula, a part of your brain, will integrate the interoceptive awareness. So this is how you feel your body's internal state. And the outcome of doing all of that is the brain will predict an adverse event and begin preparing the body accordingly. So that's the first step. So this is all going on at a cognitive level. And this is all really quick. Happens really fast. And then going into the neurobiological level, this is the brain activation. So we have what your brain predicts according to the threat. And then we're actually, what are we activating in our brain? So you have your pain and sensory pathways. So these three parts of your brain will signal, even in the absence of an external cause. So they don't need this external cause to be happening. It can be how you perceive it in your brain. Functional MRI studies show increased activation in these areas where people expect pain. So if you're expecting pain from something, you will see these areas activated, even if you are not experiencing the pain itself. The expectation can trigger the activation of these brain centers, even without the pain happening. That's crazy. Sorry, I just think that that's crazy. And then you'll also see neurotransmitter changes. So CCK, which plays a central role in increased pain. So when it releases, it will enhance anxiety and facilitate pain transmission through the spinal cord and brain. Blocking CCK receptors, so with a drug or something, can reduce nocebo effects in studies. So sometimes they will use that. But if you are, CCK will be released when these pathways are activated in the brain. And then you'll also have dopamine. So they'll be reduced dopamine activity in the nucleus acumbus, which has been observed during nocebo responses. And this is associated with reduced reward expectancy. So when this is like dopamine, you think of dopamine. And it's like, that's your reward pathway. It's like that high. So if dopamine production is reduced, you're not going to be feeling that positive. I don't know. You think of something like you're doing things to release dopamine. OK, if dopamine is reduced, then we are not going to be associating whatever the event that is happening with some sort of reward or positive outcome in the end. Drive to do it. Yeah, and then also endorphins, which is like you could think of those as your brain's natural pain killer, so to say, are inhibited during the nocebo effect. So this can lead to increased pain perception. Again, we're using pain as an example here. But so that's what's happening at the neurobiological level. The whole point of this, you don't have to understand all these names and things, but just to say that there is a mechanism associated with this. There's a lot more complex than just saying, so if you think something bad is going to happen and actually does, if you think something is going to make you nauseous, it actually will. It's like, there's a system in place here as to why that is happening. It's not just pulled out of thin air. Then at the hormonal and autonomic level, so the autonomic portion of your nervous system, the hypothalamus will release CHR, which is hormone. And that's going to stimulate the pituitary gland to release a CTH, and you'll end up releasing cortisol. So cortisol production is going to be increased. So this is going to increase stress, vigilance, inflammation sensitivity, worsening of perceived symptoms. So when cortisol is like rapidly increase in acute situation, it's just, it's a sign, okay, my body's kind of going into this fighter flight mode. And that's what I'm getting into next. The sympathetic nervous system will activate your fighter flight mode. So your heart rate's going to increase, blood pressure, sweating, muscle tension. We talked about this, I think, last week. But you'll have this like physiological response, and this is all occurring in steps. So this is step three. As a result to what we were talking about in the beginning. So if they think something bad is going to happen, all starts with a thought. This is all starting with a thought, a perceived threat that isn't actually there. We are getting into this actual physiological, negative response to something. That to me is crazy. So that is what is going on when you see this no-cebo effect. And that's just an example of the mechanism behind it. But there are so, we'll get into more examples of it. But it is scary. - It's nuts, because that's the same thing. I mean, it works same thing in reverse, but almost, it's funny, because a lot of those same systems, right? That's how placebo works on top of it. Expectation is the driving force behind both of these. Expectation, that's what you need to take away from this. Expectation, what you expect to happen. It's almost reminding me of the term self-fulfilling prophecy. Have you heard that before, where people are just, they say they're a self-fulfilling prophecy. If you think your relationship's going to end, it probably will. Like what you expect to happen oftentimes does. It's absolutely insane. If you firmly believe a pill or procedure or help, your brain will trigger real changes as if the real treatment were administered to kick those off. And I noticed the strongest overlap between medication and placebo. It was strongest in systems where the brain itself plays a major regulatory role. So things like pain perception, mood and anxiety, motor controls, hormonal or immune responses, where the brain is more responsible than like the body, if that makes sense. That's where I noticed the strongest connection between where placebo has the largest effects. So for example, and this goes in reverse, I think pain is a really easy place to look at, because everyone knows what that feels like. And just expecting pain relief, it can cause your brain to act in reverse. Instead of shutting down like no SIBO as you were just saying, it can cause your brain to release those feel good neurotransmitters, like endorphins, serotonin, dopamine, all these chemicals that reduce and improve your mood, reduce your pain, where studies have been showing this over and over again with actual brain scans, where people believe they're getting a pain reliever, just a sugar pill. The brain's pain processing regions quite down and endogenous opioids or endorphins are released. It mimics the effect of actual pain killer drugs. And I noticed three main areas that this happens, are at least three lenses we want to look at this through, that impacts the placebo. There's classical conditioning. Then there's the brain circuitry and neurobiology, which we're talking about. And then the actual context of treatment that is often also not talked about. So when we look at classical conditioning, this is where past experiences can condition us to respond to placemos. So like if you've taken a certain pill or pain in the past and it worked repeatedly, your body can essentially learn that routine. So later taking a similar looking pill, even if it's a placebo, might trigger the conditional response of that pain relief just through conditioning. And this is in both humans and animals, researchers appeared in nerd substances with real drugs to create conditioned placebo responses over and over and over again. In one cool example, this is where it has immunosuppressive responses. This is what I thought was cool. Where patients received a distinctive tasting drink, along with an immunosuppressive drug, or a medication that reduces and controls the activity of your immune system, when later given that drink without the drug inside of it, they still showed suppression in their immune systems. They think of it like orange soda. They basically drank that and their immune system was suppressed. So their body had been trained to respond to the expectation alone. I think anyone who's on a certain dose of medication, maybe ADHD medication, or something that they can almost expect or have done a hundred times, you can forget that you didn't take a medication and still feel the effects that you did. Has that ever happened to you? Here's the thing. Here's. I, as someone with ADHD who can't remember if I took it all the time, because if I don't know, I'm not taking it again. Because just in case I took it and then I'm double stacking my Adderall, no, I'm not doing that. I at least do this once or twice a week. So the amount of times that I just have not taken my medication, but have convinced myself that I have, if I don't know, the answer is I took it because I'm not taking it again. So I'm just like, well, must have taken it. And I can't, did I, I don't know. Can you tell really the difference sometimes where you would feel the same effects regardless of if you took it? It kind of depends on the day. So how much work I have to do and how focused I have to be. But yeah, it is crazy to me. I think this is a funny thing of people who actually have ADHD, like actually have it and are prescribed it and use it as prescribed. I, the amount of people that have shared this sentiment with me, I forget to take my meds all the time. And there's so many people that are like, oh my God, are you, the withdrawals? Don't you just experience the worth the draws? I'm like, no, 'cause I don't, I don't think I don't. I'm chill, I don't know. Maybe my brain is just messed up, but like I also don't take a super high dose, but I just don't know. So I'm like, yeah, whatever, just number 10, like I took it. - When I wake up in the morning, I just usually slam a pre-workout. It would be 5, 30 in the morning. And there's been mornings where I forgot to take it, but didn't realize it. Like in my brain, I just check off the few things I do in the morning, and I'm at the gym. And I didn't realize until after the workout that I completely forgot my pre-workout. And I had a great workout, my focus, my energy was high. On other days where I intentionally already remember, not intentionally, but remember that I forgot it. Like driving to the gym, I'm like crap. I totally forgot to take it this morning. I have a terrible workout. I'm exhausted. I'm like barely dragging through. It's weird how that expectation works. So there's just a conditioning response to all of these things that does train your brain. But then there's that circuitry, brain, biology aspect of it, where just as the opposite of the nocebo, it still works in the same systems. Like most of those frontal brain regions, where all of this works. Now the prefrontal cortex is where I saw a lot of this take place where in essence, and I'm not a neurobiologist, so I'm not going to pretend to give an elongated drawn out response to what this is. But the prefrontal cortex from what I can understand is basically what can connect and tell and orchestrate a lot of other places and parts of the brain to suppress or quiet down or to do certain things. That's what it's more responsible for. And that's what you see in placebo on top of it all. And the coolest part to me is people still think of placebo as just this imagined benefit that you're getting for a lot of the time. But when you look at the involvement in pain, right? This is with pain pathways, motor pathways is also very common. But when you look at people who are told they're receiving a pain killer and they're actually just getting saline injections, you notice their brain's release actual endorphins, the body's own natural opioids, that bind to the same receptors that are drugs like morphine or oxycodone target, and their pain dramatically drops. That's almost expected. But I think the coolest part is that when you give those same people naloxone, which is a drug that blocks opioid receptors, the placebo effect completely disappears. So when you block those receptors, no matter how hard they believe it, it disappears. So it really tells us that this pain relief, it's not imagined. It's pharmacological just produced by the brain. - Yeah. - Not a pill. The brain literally created its own pain killer triggered by belief. And what you were saying with dopamine, I saw a lot of this research done in Parkinson's disease, 'cause I actually had not realized how much of Parkinson's disease and so many symptoms were caused by low dopamine production in certain regions of the brain and how much they have to do with like motor control and moving and being able to just simply write something down with a pen has so much to do with dopamine in the brain. That's the craziest part. Just expecting therapeutic injection caused these patients' brains to produce actual dopamine. Sometimes nearly as much as the actual dose of medication, what, and you actually see temporary improvements in motor systems like tremors and movement in these Parkinson's patients. So it's not imaginary. Placebo is not just this fake thing going off. Like it is just as real as these drugs, which I don't think a lot of people give it credit for. - Yeah. - Right? - Yeah, this is another reason why I like, I don't even know if this is in line with the topic specifically, but why I will, this is my bias, right? I am not gonna pull a study that says, women have a higher pain tolerance than men. This is just my bias, what I see in my everyday life and stuff. So this is just my thoughts and personal opinion. Yeah, but I think one of, I think one of the reasons if we're trying to get like to a mechanistic level, I think women's cycles and how we have been taught from such a young age to push aside that pain because we still have to, we still have to go to school, we still have to go to work regardless of every single month. We get our cycle and it can be really, the pain scale is different for everyone, but there is always a level of pain and discomfort that we just have to push aside. So it's like, and that's mental. Like that starts out as mental. Okay, like it can't, this cannot interfere. So I'm not gonna let it interfere. That's a mental game you have to play. And I think that that can be part of the reason why we can handle pain better. - Yeah, but you have more control over it 'cause you've practiced more. Basically, like you've gotten more practice to it. I also think, again, I don't have a lot to top my head either. I think there's quite a bit of research showing that we're on average, have a much higher pain tolerance. I would wanna check that 'cause I don't have a specific, PMID to drop, but I know I've heard that quite a few times. So I wouldn't be shocked if it was very represented. But the piece too that a lot of people forget to talk about is the ritual in the context of the treatment when it comes to placebo. Or it's not only the pill or injection, it's everything around it as well, like the environment and procedure of treatment that contributes significantly to this effect. So going to a clinic, seeing doctors in white coats, the act of swallowing a pill at set times, this whole ritual sends signals to the brain that I am being cared for. I am receiving treatment. And this can significantly reduce stress that enhances the body's healing responses on its own, but also in line with actual treatment. This is where they talk about how important in medical school the patient provider relationship is. The patient provider relationship is so important, which is funny because I know it's talked about, I know it's focused on in medical school, but I think everyone's been to doctors offices before, where they're like, I feel like they must have brushed over this section 'cause the patient provider relationship is dog shit. I think everyone's been there before, not overwhelmingly, hopefully for most people, but it is funny with how much it impacts this, like how warmth, empathy, and confidence from a practitioner directly strengthens the patient's belief in that therapy. And that can have a direct impact on the placebo effect. It's actually an adjacent effect called the placebo augmentation effect, right? Where it's known that caring, reassuring doctors, they can make even real medications work better by reducing that anxiety. And of course, there's individual differences when it comes to placebo, not everyone responds equally to this. And that's the probably hardest part to study in research, but even then research has shown that certain personality traits, like optimism, for example, different genetic factors and previous experiences can all influence someone's susceptibility to this placebo effect. For example, genetic differences affecting dopamine or endorphin receptors might make someone inherently stronger to respond to placebo, or people with high levels of stress or skepticism see dampened placebo responses, like we were talking about before, probably seeing a lot more no-cebo than anything. And this is where part of the art in healthcare and coaching, we can even notice, is finding ways to maximize positive expectation for each individual that they work with. I tell this to new coaches all the time, how you set expectations can literally be the difference between your client making an insane transformation or progress, or them quitting and failing in the first month. Simply just how you set expectations, how you surround that, how you talk about that, makes such an insane difference in the outcome. And it's not talked about nearly as much as it should be. Why do you think it's not talked about as much? It's like that piece of it. The communication aspect, the setting expectations. I feel like people brush that part over when we shouldn't. - Are you thinking about in the healthcare setting itself? Are you in healthcare settings in coaching with a doctor, with, you know what I'm saying, with anything where you're giving treatment? - I think specifically in the American healthcare system, it's a time issue. Unfortunately, the standard of, it gets different when you're going outside of the standard of a primary care setting, but the primary care healthcare system is based off of like number of clients you can see in a day. And you have a certain number that you have to hit. And there is not, time does not always allow for it. Every practitioner is going to be different in terms of what they prioritize within that a lot of time. But I think that's why in a primary care setting, a lot of things can get, especially the type of communication, it can seem very transactional with little humanity involved. When you get into more specialized practices, it can be different, but that's just a general statement. You can experience this with any healthcare provider. But I also just feel like the education system and how it is prioritized for doctors in terms of like, yes, bedside manner and that the proct, like patient care relationship, it's taught, but I mean, how much of a priority is it? Is it one class and medical school? It's probably out of all of the other things. And like in medical school, when you're just taught to regurgitate all this information and shove all this information and you have no time to exist as a human, that's not going to be. - You're not going to give as much effort to that class as? - So it kind of comes down to the person and what they value as a provider. And so that gets hard. I'm just thinking about like, you look at hospice care and I'm sure there's a lot of research on this. And elderly or just people who are sick, who put off going to hospice, because once you go into hospice, the rate in which people who have been dying forever and then they go to hospice and they die, it's this acceptance. It's this acceptance piece in the amount of people, do you think about all these cases of people who should have? They physiologically should have died so long ago, but they have been holding on and then they accept it and they die. That has been something that has always blown my mind. It's all in your head. Like that is all, there are so many parts of. Like I think about my family members or friends I know that have gone through chemo and the different experiences that people, like my loved ones have had going through chemotherapy treatment, a lot of it being mindset-based. Of course, the type of cancer and how it works, I'm not talking about that, but just how they move through it and how it affects them their day-to-day life, everything so mental. But that can be placebo and no-sebo in terms of the heightened effects, like negative effects of it, and the positive effects that may not actually be. There's no reason why the chemo should be working better, but because of what's going on in your brain, how you experience the negative symptoms of chemo can be less than. - Absolutely. - I just feel like. - Yeah. - Which now, I think that we kind of understand what it is, let's go into some real life examples, like where you see this actually showing up. Outside of just, I took a pill and I felt less pain. That's what I think it starts to get cool. So let's go into the real life stuff. Let's start no-sebo. Where have you seen this or where can people see this? - I really want to talk about it in health and fitness, because obviously that's applicable. But first piece being food sensitivities. So food sensitivities, we have talked about a lot in terms of, there's no real general definition of a sensitivity. It's not a formal diagnosis, like there's intolerances, there's allergies, a sensitivity is, there's no definition for it. It's just thrown out there all the time. And some people might experience bloating after eating a food or a bit like digestive discomfort, because they do believe it is bad for them. They believe that this food is going to, is bad for their gut or it's going to make them bloated, and they've convinced themselves of that. And they experience the symptoms of it, even though they, what it is is harmless. Good study, I wanted to talk about this. There's actually a lot of research on this for gluten and non-sealiac gluten sensitivity. So if you sealiac disease, it's like you cannot have gluten. Non-sealiac gluten sensitivity is, if you don't have sealiac disease, but you feel like when you eat gluten, you may experience the symptoms that are similar to sealiac disease, which it's, again, is non-sealiac gluten sensitivity and actual thing. There's no form, it's not a formal diagnosis. But this study, and it was published in the Lancet, and this was done, I want to say it was done recently. It was a double blind placebo controlled trial published in February of 2024. They randomly assigned people to one of four groups based off of the expectancy to eat gluten-containing or gluten-free bread in the actual intake of gluten-containing or gluten-free bread, and whether or not they would experience symptoms from it. You kind of can understand these groups better when I explain the outcome. But the two groups of participants who expected gluten, regardless of whether or not they actually consumed it, were more likely to report symptoms. So the groups that thought that they were going to be eating gluten, they reported the highest symptoms. There was a group of people who did have sealiac disease, and so they also compared it to that. But these people with non-sealiac gluten sensitivity, they didn't have sealiac disease, they experienced the most symptoms, and they also reported that they believed they would. - That's crazy. - That is like the belief factor, and this was statistically significant, this again, this is why this was a really significant study because it was a double blind placebo controlled study, regardless of whether or not they consumed it. They were more likely to report symptoms, and then the group that didn't even consume it, who thought that they would have symptoms, they reported the most symptoms in the questionnaire out there. That's crazy, that's crazy. So there's more research being done on this now, especially for sealiac disease, but this is extrapolated so much outside of just sealiac disease. The negative beliefs or expectations about food, exercise, health, can cause real symptoms or poor outcomes, even without any physical cause, like the constant exposure to fear-based nutrition messaging, so gluten is inflammatory gluten-spatch for your gut health. This seed oils are inflammatory, seed oils are killing you, sugar destroys your gut. Can condition people, Tony was talking about this, like classical conditioning, this happens with the no-sealiac effect as well, to actually feel sick or sluggish after eating certain foods, even though those foods are harmless. Your brain is actually making changes to make your body feel that way, even when there is no harm coming from the food that you are eating. The brain's expectation of harm from the food or whatever can trigger gut distress, fatigue, brain fog, through stress and the gut brain access. So you will see this a lot in terms of symptoms in your gut, which I talked about a lot in the gut health episode, but it's like, your mindset about food, this is why a lot in a lot of eating disorder treatment, a huge part of treatment is mindset. We are not going to look at foods as good versus bad. We are going to sit down and look at our meal and be indifferent towards the food, so we are not creating an extreme response on either end. I try to teach people to practice indifference towards the majority of food. You can't be like, oh, these are my favorite foods. I love these foods. These foods are like, make me feel like really good. No, it's more so the indifference of like, this is not an all or nothing thing. It's impossible for this food to have this extreme of an effect, so I'm still going to be indifferent towards it. But most studies also show that perceived food intolerances not diagnosed like a lactose intolerance often have a psychological, not a physiological cause. So it's just. That's right. If people are ever wondering like, why do we talk so much about this just almost debunking this fear-based content? A people with seed oils are inflammatory and they'll cause this and this and this or sugar does X. And people almost get upset sometimes at us for justifying it or saying that we're almost promoting these quote-unquote unhealthy foods. You're promoting seed oils, you're promoting sugar, you're promoting X, Y, Z. No, why we're so passionate about it? Not just in this podcast, but even in a lot of our content outside of the podcast on social media is based around debunking people who are trying to do this because it is real. - Yeah. - Thinking that seed oils are going to kill you, being convinced of that, crazy of a thought, when there's an abundance of research showing the exact opposite that seed oils have zero outcomes on your health. They do not impact your health compared to any other fat source. Why we talk about that over and over and over again is because it shows up in people's lives for changing people's health to believe the wrong thing. - Yeah, and then you have the people like the, I don't know if he doesn't anymore, Paul Saladino, who says, "Kale is killing you, vegetables are toxic." They are manipulating you. They are playing into, he's a smart guy. That he is a very smart guy. I would argue, which is why it gets very conflicting and why it's really difficult and why he's still successful and still around. Very smart guy. We'll never say Paul Saladino isn't. But people like this play into the role, clash of classical conditioning plays into human behavior and how we receive information and what we choose to watch and consume and take into our everyday lives. He is repetitive. He says the same extreme thing over and over and over again. If you are constantly hearing that and it is making you fearful and you are constantly seeing that, it doesn't just have to be coming from him. But if that's what you're for, you page is, that's going to affect how you respond to foods. And that piece that I'm going to sound like such a, I think about this often, I'm going to sound like such a conspiracy theorist but just getting out into a broader sense. I think about this all the time with politics and our political system and how government officials, people in a position of political power manipulate society using classical conditioning and it drives, it terrifies me. It terrifies me and the media terrifies me. It's this repetition. You see all of these news outlets, whether you're blue or red, they will talk about the same story but they will say it differently but each red news outlet is saying the same exact extreme thing and each blue news outlet is saying the same exact extreme thing and you are hearing it over and over and over. - But it's always being framed as negative too. It's always being framed as negative. - And it's fear based, it is fear based and it is repetition. That is classical conditioning. - Every. - And that's fear is being like, "Do please just stop watching the news." - Yeah. - And I don't care. Just please stop watching the news. It is poisoning your brain. Legitimately, that does sound, you're right. It sounds off the cuff. A little conspiracy theory. That's what it sounds like online. No, it's real. Like you are, you're nail on the head, conditioning your brain to think a certain way which will lead your body and physiology to respond in certain ways. It's real. - Yeah, I also see this in like, it's the delivery, oh God, if this is gonna be super, are we gonna have to cut this out? I don't know, but you see it in certain religions. I see it specifically a lot in how the Baptist church will deliver their sermons. People are taught how they deliver it. You'll hear it and if you've ever been to them, the tone of voice is very similar. How words are enunciated, how you pause, how you say the same thing over and over again, the words you choose to repeat, that is scary. You hear that every single week, or if you hear that every single day on every single, and I'm not just talking about if you're listening to a sermon given, this can be anything. Listening to the news. If you are listening to your parents try and push a belief on you, it's repetition. It's how it's delivered. It's how it makes you fearful of a certain outcome. And sorry, that was just a tangent, but I think about that shit all the time. In every area of life, in terms of how you can be influenced and how other people can try and manipulate you subconsciously. - That's where this prepping for this episode kept me up last night, is because I think I inherently knew it, but hadn't spent that much time thinking about it recently and going through all of these examples, you're like, oh my god, where does this end? And it doesn't, it basically doesn't then. - If I want to go on another specific example of something that has nothing to do with nutrition and health, but as someone who was in a super abusive relationship for three years, and you think about the people of like, how do they not just get out of this? How do you not, I mean, I even look back at myself and I'm like, damn, why did take you three years to leave? Like to get help, it's like when you are dating an abusive narcissist who uses classical conditioning on you, especially, I mean, I'm 17 years old, a lot more impressionable. The repetition, the fear-based conversation, everything being rooted in fear. So now every single one of my behaviors is, I am doing this with the worry that this person is going to react this way. I have to act like this to prevent this threat from happening or I've already convinced myself that this is going to happen. So I'm going to do this, this and this. And if there is an element of classical conditioning in relationships as well, that can be very, very toxic. And it's hard to get out of this. - Even scary because in it, it is easy on the outside looking in being like, that is such an easy decision. Leave this person or whatever it is looking back hindsight, if you see a friend that's going through it too, it's easy because you're only going through the thoughts. That's what you're going through. But it's in that person's body, they feel it. The physical body is responding to this. And that's why it's always nice to give grace to people who are going through it. It's not an easy decision. It's not as easy as if you were on the outside because it is in your physical body. It's nuts, but that was a good example of it. One of my favorite examples was the sham surgery for knee pain where researchers tested legitimate arthroscopic knee surgery for osteothorosis against a placebo surgery, placebo surgery, where one group of patients got a real procedure cleaning out the knee joint while the other group underwent a legitimate sham surgery where the doctors made small incisions but did nothing internally. They just made incisions, sewed them back up for the heel. So when you wake up, you got that surgery, right? The patients were blinded so they did not know if they got the real surgery. But astonishingly, over two years follow up, the placebo surgery group improved identically, just as much as the group who got the actual surgical treatment reporting in equal pain relief and equal functional improvement on average. Meaning not just their perceived, they thought it hurt less, they could functionally move as good as the actual surgery group. And at some sex points, the sham surgery patients even reported less pain than those who got the real surgery, published in the New England Journal of Medicine. And the lead researcher bluntly stated, this is my favorite quote, it appeared that the entire driving force between this billion dollar knee surgery injury is the placebo effect, is what the lead researcher bluntly stated at the end. That was one of those examples that it's like, what the, is happening? I love that people go extreme as like, yeah, let's do a placebo surgery. You know what I'm saying, how do you get that approved? Let's do a placebo surgery. So it's surgery, it's pain, it's nutrition. It's in so many different areas. We've talked about it a hundred times, which is why I'm not bringing it up again, the famous mindset of her milkshake. You remember that one? Where they gave two groups of people, the identical milkshake, but their bodies physically produced different hormonal responses based on what they were told they were getting. One was said, oh, this is a healthy meal replacement, super low calorie, the other was super decadent, super high calorie. It was the same milkshake, but their bodies responded hormonally vastly different based on what they thought they were doing. Like hormonal production, that's not fake. That's not, I thought this happened. Your hormones literally changed based on expectation. There's so many cool examples. I learned the term placebo doping in putting this together. Have you heard that before? - No, I don't think so. - placebo doping. Okay, so placebo doping, where the placebo effect increases things like one rep max strength, endurance and more, then people thinking they had actually taken anabolic steroids. So it improves strength, endurance, performance, all of these things, and pretty insane responses. One study in the Journal of Sports Sciences I found, they gave participants capsules that they were told contained a new potent fast-acting anabolic steroid. It was really just a sugar pill. And within a single week, these are already trained athletes, not people brand new to the gym. So this should be even more impressive to you. Already very trained athletes. Within one week of taking the pill, the athletes increased their one rep maxes by an average of four to five percent across all major lifts they tested. The bench press, the squat, the dead lift. Some even improved his eyes 10% within a week in their one rep max strength. And the funniest part, when they were later told that the pills were fake, their performance immediately dropped back down to baseline. Immediately dropped back down to baseline. - Yeah, that's crazy. - I like that term, placebo doping. Five to 10% in a one rep max. If it was someone who was brand new to the gym who doesn't really understand their form, their technique how close to failure, you know, that would be something I'm like, okay, you could point some massive flaws in that study. These were trained athletes who had been training for years, some jumped up to 10%. It's crazy. It's absolutely crazy. There's pain relief, there's performance. And I would even argue probably in the reverse, I'm imagining with no SIBO, if you think that you're performing worse. And that's where we've talked about sleep trackers being a good and a bad thing. And now I try to trick mine like if War Ring tells you, you got a terrible night sleep. A lot of the times if you listen to that, you will feel worse the next day, just because you're thinking you will. - Yeah. - That's a big pushback with a lot of these health trackers. It's like, yo, you're undercover. You didn't sleep last night. And sometimes you can't fight that. Like you're going to be exhausted if you sleep for 30 minutes one night and you're up for seven hours rolling around. But that's where a lot of people, if you don't control your thoughts around it, it can really negatively impact you. You have a much worse day because you are told you're going to. - I think about this a lot. And like we've talked about this before in our recovery episode, but like injury recovery. Mindset is so, so, so important. Because like athletes and research who have expected a slower recovery or re-injury after a setback tend to actually recover more slowly. And that's why like the, like, I mean, that's a lot of what sports psychologists work on is re, like, with athletes after an injury because of the rehab mindset is so, so, so important to get you back to like where you were before you got injured, but also how that recovery process goes, the success of it. - Yeah, the recovery process is crazy. That's why I don't know if I told this on the podcast, my rule of thumb on or ring is whenever it tells me I got a crappy night sleeper, it says take it easy, right? That's what it says on or take it easy today. I made a dumb rule where I have to set a mandatory PR in the gym, that day no matter what I'm doing. I have to PR something that's my mental trick. But that's, it's stupid and it's ridiculous, but it freaking works. I get more ant for those workouts. I'm not joking. The nights that I get the worst sleep, it's not a repetitive thing. I'm sure if it was like every single night this would not be happening, but one night a week if I sleep terribly, 10 times out of 10, that will be the best lift of the week. It's so stupid. 'Cause your mindset matters. You can tell, you can basically, you can gaslight yourself, you're like, no. - Yeah. - This is how it works, like, that's how it goes down. It's crazy. Are there any more examples you can think of before we go into how to take this away, how to get practical takeaways? How do you implement this into your real life? Any more that you can think of before going into that? - No, I feel like that's, I mean, kind of the big ones that I have down. - They're all crazy, but it's all cool, right? Everything we're talking about is very cool, but can you use the placebo effect deliberately to improve your health, to improve your performance? And the answer is yes, to an extent. To an extent, the important part. And we're gonna break this down into a few different domains, I think, from like a clinical medical practice to your personal health and fitness routines. And then we have a lot of coaches that listen to, so I think in like a coaching and athletic standpoint as well, it's very important. I think in medical treatment, doctors don't and ethically should not lie to their patients. That's right, I think that's something you gotta understand. But that's where your mind might wonder, it's like, "Why don't you just gas light your patients?" If you're a doctor, if they believe you, they can't lie to patients, right? That's ethically you should not do that. So the classic model of trick someone into a placebo cure isn't very realistic in real care, but this is where we talked about how there are ways to enhance the placebo component of every treatment through how the doctor patient interaction is done. And there are many real studies that show physicians who exude warmth and confidence and empathy boost patient outcomes, even if the treatment is the same. And this isn't just because of the placebo augmentation effect that we talked about, but also because when you're working with someone warm and empathetic that you trust, you just naturally reduce the no-cebo effect along with it, right? So it's not the placebo that's pushing it, but it just reduces all the negative thoughts that might creep into your brain because the person you're talking to is confident. If the doctor can honestly say, "I believe this treatment is going to help you a lot," just that positive framing can increase the patient's expectation of the benefit leading to better results without any deception. So that's how it can ethically be done in like a medical practice. And similarly, when we talk about side effects, to avoid more of the no-cebo, instead of saying this drug often causes terrible headaches and fatigue in many people, a more balanced explanation that you could frame it is a few patients, maybe one in 10, have reported mild headaches, but most people tolerate this medicine really, really well. If you feel any discomfort, let's talk about it in fine different ways to manage it. You said the same thing, and that's where I'm like, you know, how a lot of doctors, it is a time thing. And that's where I do feel bad for a lot of doctors is because it's just, there's not enough doctors in too many people to manage. Like I can't judge them for not being able to spend an hour with each patient. That's impossible, but just simply reframing things that cost the same amount of time can be done that manages it so, so well. A lot of this honestly is just reminding me of different communication courses and books I've read for like relationships and communication, right? Like how you frame things, going into a conversation with your boyfriend, your girlfriend, your spouse, your whatever, how you frame them, how you approach them, how you bring things up. Oh my God, does it dictate the outcome? More than people realize it's like laughably, right? I can think back to when I was younger and had zero concept of communication and framing and all this stuff. I was like, why would I have all these dumb, just incessant endless fights with like a partner? Then I would always blame them obviously, but then looking back I'm like, oh, I'm an idiot. It's because I had zero clue. I was young, so I forget myself. But same thing, it's a lot of that. Now when it comes to in-person health and fitness, I think this is where a lot of people like us and they're listening to this, like how can we use this outside of a clinical setting is that you can be your own placebo facilitator. And this doesn't mean by just tricking yourself or gaslighting yourself, but rather by purposefully and intentionally cultivating positive expectations in what you do. For instance, if you're starting a new workout program, adopting a new mindset of this training is going to make me feel stronger and get me better progress. Just adopting that and giving yourself some real reasons behind that. I think is huge, right? Part of this is just basic psychology because you're more likely to stick with it. But as we've seen, it can also subtly improve your physiology each session. It can lower your perceived exertion, even me believe to better hormonal responses in some cases, expecting certain things. Like if you're starting after our full body episode, I think we did a great way framing it on expectations. So many people going into trying something new, a new style of programming. Expect, okay, this should give me better recovery. This should give me bigger jumps on strength. And a lot of the times I'm not saying it's all placebo, but it goes hand in hand and really helps with that. Like how you enter this is huge. It's huge. And interestingly, in a Harvard health article that I cited some earlier research on, it suggested just being fully engaged in healthy activities, like eating, right? Like exercise, like yoga, meditation, anything else. And just giving them your full attention can actually provide some of the same benefits as the placebo effect. And the more meaning and the more positive belief that you attach to these healthy habits, the more you can get out of them. So not just starting a program at the gym and trying to go through the motions, but being there. That's where it sounds a little woo-woo, I know, but being there, being present, having certain beliefs and actually knowing why you were doing that. Like having intention behind it, does that make sense? Oh, for sure. Yeah. That makes such a difference. Yeah. I mean, it's going to also work a lot for people who have issues with like food fears. Like we talked about this in the clean eating thing. Like sitting down with food that you think you have convinced yourself you cannot eat because something bad is going to happen if you eat it, whatever that may be. I was like, I don't know, whatever the food is. Like getting that food before you eat it, it's like mentally going through it. And this, like, this food is going to give me any-- whatever, like saying, like, in your head, we're counting like the positive things that are going to come from eating this food. Or just like the positive things that are going to come from overcoming the fear of this food. And like really, like convincing yourself and you have to give yourself the proof that nothing bad happens, so you gotta get there somewhere. And it sounds stupid and sounds dumb, but it's very, very impactful. And it shouldn't be this framing of like, oh, this food is just like magical and amazing. No, it's got to be something realistic because we're not trying to jump from one extreme to the other. But some people really, really struggle with this, like, with certain foods that they have come in themselves, they cannot eat. They're like, you literally have a reaction, if you're presented with it. And that's no way to live. It's crippling. And I know that could probably be hard for some people. If they don't understand why it's actually not that way. And I think that's what we do a good job or try to do when we talk about the clean eating episode. We just did a perfect example of this, actually. Now we were basically just dismembering the argument of clean eating, how it's basically BS for five different reasons I think we did. But it's important to understand why, because I could not just convince myself of something that I don't know why. That I would feel like I'm lying to myself if that makes sense. Like if I've seen a hundred videos saying seed oils are bad, and none that explains to me why they're not, I can't just gaslight myself into telling, oh, these aren't gonna hurt me. 'Cause everything I've seen is told me they will, if that makes sense. So that's where it's tricky because it does take more effort. You're not just lying to yourself and saying this isn't true. You need to have reasons to believe it. Like you need to understand why this food sugar is not killing you at the dose that you're doing it in. So it is important to dig a little bit deeper because if you try just to lie to yourself, it's not gonna work and you're just gonna dismiss the whole thing in my opinion. At least that's how I see it, right? Is that how you see it? - Yes, yeah, for sure. - Yeah, it reminds me to, did you remember, did you ever do any dums, like psychological sports rituals? Like when you played volleyball, did you do anything like a lucky show? - Oh my god, yeah. - Before a game or things like that. That's what this reminds me of the most. What did you remember what you did? - Well, for me, it was more so like what I would do before I served a volleyball in a game. I don't know if this is my OCD, but like I'd have to bounce it three times and then tap my knuckles on it twice. - But yeah, and here's the funniest part. I bet if we tested you back then, and I had you serve a hundred times doing that and a hundred times without it, I bet your serves doing that would be better than the serves without it. - Yeah. - That's the funniest part. Like it's a real thing. Some people that they have lucky socks, like under whatever, these little pregame rituals, they're funny, but they are essentially what? Many placebo's. They don't directly improve skills, but the belief when I do this, I perform well, makes it true. And this is even present when you look at professional sports, like a professional high performance setting, like in the NFL, the NBA, Doc Rivers, he coached the Celtics. I don't know if you know him. He coached the Celtics. He would use visualization techniques with his team before each game, having them imagining executing certain plays in high pressure conditions, walking through how it would feel, the smells they would smell, the sounds they would hear. All of this would be a part of these preparations, and it was instrumental in how he was a good coach, one part of it. But why a lot of coaches in professional settings do this, because it legitimately makes changes. And that's the coolest part I think about this, is all this woo-woo little traditional whatever ritual stuff it is, there is science behind it. It's not an automatic switch every time, but there is science behind it. Now, I guess here's the only ritual I think that might not work, is if you're watching your sports team, like when I was watching the Broncos play this weekend, on the TV and me, like not eating during the third quarter, no food, no drink, that's a ritual. If I do, they just bomb it. There's probably no science behind that, just why I cleared that. But if you're involved, but do we talk about avoiding this no-cebo, like real life implications on this? - Yeah, this one's, I feel like this one's a little bit harder, because I feel like with the no-cebo, a lot more of it is oftentimes unconscious, and so you have, in your everyday life, it's like very much so awareness, so like being aware of this, and what the no-cebo is, like is the biggest piece, because I feel like people don't even know. Like the please-cebo fact, I feel like a lot more people are aware of, I feel like this, the no-cebo also falls into, a lot of, can fall into a lot of like actual beliefs, and what you have thought is true for so long, and it can be a lot more rooted in like your subconscious thought, so I feel like that's where it can be a bit hard, but like just really this education piece of like understanding. That expectation can create symptoms will reduce their impact, so like understanding that piece is really important, because like the awareness will help you separate real effects from those generated by the anticipation of the effects. So it's this like conscious mental game that you have to play with yourself, and especially when it comes to things in your life that like you start to do just because, I don't know if this makes sense, but if you have things that you find yourself doing, oh, I've heard this a lot, or I've seen this a lot, and I've started to adopt this into my everyday life, is this doing anything for me? Is this adding value or taking away like from your life? Like certain things you're gonna do, and they may not be like causing, I don't know, it could be harm, but it's not causing harm to you, but if there is something that is like, you feel like you're experiencing a significant negative impact from it, but you're not fully convinced yourself that this might be the reason, like dive deeper into that, especially when it comes to food and health and fitness, if you're like, oh no, like every single time I eat a carrot, I feel like I'm gonna die. Okay, well, why is that? That was just a random example. But like things like that in your life that you could pick out that seem pretty extreme, it's just to be more aware of it, and it's, I think also help like tracking experiences objectively to see patterns rather than assuming the worst. So maybe you do have this preconceived notion that you're sensitive to gluten. Maybe you do that, you do feel that way, or maybe you never thought you were sensitive to gluten, but you start seeing things on social media and these people are telling you you're sensitive to gluten. All right, let's track how I feel after I eat gluten every single time. Let's actually do that. This is gonna be more effective when the no-cebo isn't in place yet. So if you're kind of-- - Yeah, I can almost see that working against in certain situations. - Yeah, yeah. No, so this is gonna work like when you're presented with something that may cause the no-cebo effect where you haven't already rooted into, okay, I haven't established that the gluten is the problem. It's kind of like, oh, if you get this thought, maybe I'm just, maybe it should just cut out gluten because I'm sensitive to it. That, you're at that mindset. Well, first, let's see. Like, first, let's actually give myself some data to show that the gluten is the problem. So that can be helpful, but it has to be, the timing is important. - Yeah, 'cause I'm like, I can see a lot of people going into that and almost then expecting to notice something bad. - Yeah. - Or be the little, you know, over watching where it's like, I feel this weird thing in my stomach that you probably always had there regardless, but now that you're just hyper aware and paying attention to it, you don't most think that that's the case, for sure. And I really get another huge one is going to be, being really cautious of fear-based messaging. So like, limiting exposure to super alarmist or extremist media messaging, health and fitness messaging, like that is rooted in fear. Like, don't let that become something that you're mindlessly consuming 'cause you don't realize how that taps into how you view whatever that fear-based messaging is, how you take that with you, how you subconsciously start to believe that to be true as well. So I really think that like, media literacy is just important in general, but in terms of like, how, where you are going to get your information, like, it's just so, so, so important that the messaging is not rooted in fear. And if you are kind of already falling, like, you've felt like, okay, you're listening to this and you're like, I think I might have fallen victim to no SIBO and XYZ in my life. Go, if that's the case, go back to where you first started to adopt this belief, this mindset, say, I'm gonna give a food, for example, 'cause I think example is important. Go back to where you started to get into your head that seed oils were the cause of your inflammation or when you ate seed oils, you didn't feel good after. Go back to that source and go back to that messaging because again, you can't, it's not like I'm, this is going to fix it, but starting to be more like aware of, okay, maybe this is just the no SIBO effect. I'm gonna start including maybe some more seed oils into my diet slowly changing my mindset a bit about them and adding that repetition. You're still, it's not like it's gonna be easy over, like, over time it will help, but I think going back to the source of where you receive that information is gonna be really important. - 'Cause a lot of times where that initial seed was planted, it wasn't very well rooted. Like the information was not well rooted, it was just more of a comment that was made or a myth that was made up. You know what I'm saying? Like where you originally first found that thought, a lot of the times probably won't have a lot of substantial backing to it. And that might help you unravel your thought process behind it because you're like, wait a second. The only way I think this is because of this and this is kind of baseless and meaningless. That is probably a strong scary exercise to do, but strong exercise to do. - Yeah, I could be really helpful. - That's where I know I don't show up about it, but meditation for me really helped me be more aware of my thoughts and my feelings, especially when it came to that. Because if you would have asked me in my early 20s, if I was a positive person, and I'd say overwhelmingly yes. I thought I was a very positive person, but that's also when I was struggling the most in my life with depression, these deeper episodes that I'd go through. And when I started to meditate and pay more attention to my thoughts and what I'm thinking and why I'm thinking and where it came from and what I'm feeling, that's when I realized how much of my subconscious was just assuming negative stuff about every situation that I would go into in the world. And so many people do that where it is not it. You're not consciously thinking these things. You might think that you're not a negative person, even though everyone around you might be able to see it easier. But you know, everyone's got those people in their lives where you would be like, yeah, that's a negative person. I bet they don't think that way for the most part. That's what helped me just be more aware. So I feel like something that helps you just pause and not just be like, oh, that's my thought, but where'd that come from as a thought pops up. I'm starting to use this after putting this together in just my expectations for everything. If I'm not the most social person, but I've got a big dinner I'm going to, normal me would probably not just straight up bitching complain about it, but start to set myself up for a little bit more. I'm going to miss out on sleep because of this. I'd rather be home. I'm going to be missing. Just already start listing the things that I'd rather be doing or what's not going to be done. When I'm like, I don't know any of that. I don't know I'm going to have a bad time. It could be the best time ever. Zero data could predict if it's going to be a good or bad time. I'm planting those ideas myself. And that's not worth it. So it really is in how you show up in everything you do with both placebo and nocebo. But especially nocebo is what I see so many people fall to trapped into. So that's the one I feel like you should be the most careful for because doing damage is what you want to avoid at all costs. Terrifying. We just gave you something to think about at night. Any notes you want to add on top? Third, do we tie a bow on that for now? I think we tie a bow on that for now. Let's tie a pretty little bow. No, nothing else. I like that. Let's do it. Let's tie a bow. Don't go get a sham knee surgery to prove it. Just take our word for it. Everybody in premium. We'll talk to you on this Friday for this week's ANA. Everybody else will be back next Monday with a fresh new episode. Talk to you soon. Love you. Bye. Bye.