9

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Beware the nocebo effect?

Answered on August 19, 2014
Created March 04, 2010 at 11:19 PM

The placebo effect is a self-fulfilling prophecy wherein you believe something will make you better (such as an inert pill), and you feel better. The flip side of this is the "nocebo" effect--if you think something will harm you, it will ( http://www.washingtonpost.com/ac2/wp-dyn/A2709-2002Apr29 ). Are paleos prone to nocebo effects? If we worry too much about our occasional deviations and cheats (such as nightshades or a glass of wine), will our negative expectations make matters worse?

Addendum: To go beyond yes/no questions, how can we care enough about our chosen lifestyle to adhere to it, while staying positive and empowered and avoiding nocebo effects when we don't?

7df8f3cc7f1475c3ecbbd4a4feb87d04

(514)

on July 16, 2010
at 09:24 PM

On the other hand, no food is perfect, I'm sure you could find some toxin or other in everything, if you looked hard enough. And we come into contact with so many other toxins in our daily life, I doubt that whatever nicotine is in that potato could make such a great difference to the average person, in the great scheme of things. I think that here, the "don't sweat the small stuff" principle applies. Of course, it is tricky sometimes to determine what is "small stuff" and what would count as bigger stuff. Someone needs to study the severity of effects of the toxins nightshades contain.

5ebeec76e20738d0a17cd724d64b1e0f

(1922)

on March 06, 2010
at 10:22 PM

As with any toxin-containing food (potatoes contain nicotine, as do all nightshades), occasional, infrequent use in small quantities is probably OK in an otherwise healthy population (which rules out most Americans). However, for long-term, regular use in quantity, I think he's wrong. He may not notice the effects, but that doesn't mean they aren't there. Many people consume gluten or sugar, or smoke or drink or use drugs and don't notice any ill effects, either.

Fa47fe5368e66325865f60a928609145

(961)

on March 06, 2010
at 05:21 PM

As I understand it, orthorexia goes far beyond valuing your health into a more obsessive area.

6426d61a13689f8f651164b10f121d64

(11488)

on March 06, 2010
at 02:27 PM

Good points, Rick. I don't deny physiologic sensitivities, and I acknowledge your counterexamples to my examples. However, most people do not have physiologic sensitivity to wine or nightshades. As a counter-counterexample, Richard Nikoley, of "Free the Animal", has re-incorporated potatoes into his diet, with no apparant ill effects. Is he wrong, or is he an adapable omnivore enjoying a healthy lifestyle?

6b73f0c4b971e2dde7147920e329fe7f

(2041)

on March 05, 2010
at 01:46 AM

This is not aimed at you, but I object to psychiatrists labeling value of one's health as an eating disorder, orthorexia.

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5 Answers

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9
03aeff8d87a3b53a449b5b8e9158da98

(3268)

on March 05, 2010
at 12:22 AM

Interesting point. Part of capturing the benefits of the hunter-gatherer physiology is avoiding stress, so obsessing about "deviations" is itself a deviation! haha

8
70d9359a2086e890a4c3bccb2ba8a8cb

(2254)

on March 05, 2010
at 04:46 PM

This is an interesting issue. I've been battling with it ever since I started taking a serious interest in the effect of the food I eat on my health. More recently, I've become increasingly aware of the importance of other factors such as controlling stress (and now the nocebo effect), on health and so have made an effort to reduce unnecessary stress as much as possible.

The result is that I live in a delicate balance of worry/perfectionism vs. a more lax and accepting attitude. In other words, I tend to oscillate between periods where the negative (i.e. worry) predominates, and others where I decide I've been fretting too much and I should relax and enjoy. So there are times where I'm more careful with the things I eat and buy (no factory chicken, remove fat from non-grassfed meat, no nuts, no fruit whatsoever, no chocolate, etc.), followed by times where I let myself drift towards whatever feels good or whatever I can afford, with minimal guilt. After a few weeks the guilt increases and I tighten up again, and so on. Always within a paleo framework, though.

The placebo effect is widely accepted as being a real phenomenon, so I don't see why the nocebo effect would be any less significant.

I am pretty convinced that our mental attitudes and expectations can directly affect our physical wellbeing. Stress can definitely make you ill, whether the source is your negative bank balance or the fact that you just ate a piece of farmed salmon laced with sugary soy sauce. If the physical effect is strong enough, it could cancel any positive effects you might otherwise be getting from an even moderately healthy diet. Most likely this effect varies hugely between people and depending on circumstances, making it impossible to predict.

In summary, my philosophy is: avoid danger to a reasonable extent, but once it's done don't fret about it. Just learn from it, make the best of it and move on. Damage control. It's all about the balance. Maximise the positive (make reasonable efforts to eat the healthiest diet you can), minimise the negative (don't worry yourself sick about the bits that you can't control or the occasional mistakes you make).

3
0bc6cbb653cdc5e82400f6da920f11eb

(19235)

on April 26, 2010
at 11:43 AM

DISCLAIMER: Food allergies and intolerances are real and many people become paleo for these very real biological effects. My girlfriend is celiac and even a minute amounts of gluten unknowingly eaten causes severe stomach aches, so I understand this.

However I think the nocebo effect is little known and probably common when it comes to food. Unfortunatly it does not require a strong belief to cause it, orthorexia is not necessary. Simply being told something is bad for you and can cause some particular effects is enough to triggert those effects in some people. The nocebo effect is real and the physiological effects than resulting symptoms are comepletely real, not imagined, they can be measured in the body. One way to be sure an effect is actually related to a food is if you eat it unknowingly and feel ill afterwards.

A large percentage of the population now report having food sensitivities in surveys. In scientific studies on food hypersensitivities most of these people, when they are tested blindly (they do not know they are eating the food) do not react to their allergic food.

Vegetarians may get unpleasent reactions after eating meat.

Vegans after eating meat and dairy.

Raw foodists after eating cooked food.

Paleo people after eating grains.

Zero carb people after eating anything but meat.

In my opinion some of these result from the food and some do not, it is hard to untangle the two. Beware of symptoms after eating foods you think "should" be bad for you.

3
5ebeec76e20738d0a17cd724d64b1e0f

on March 06, 2010
at 12:12 PM

It sounds like the argument here is: "don't worry so much about what you eat." Worry and stress is one thing, but one can eat in a principled way without worrying or stress.

For example, one of my principles is that I don't eat anything with sugar in it. I don't worry about it; I just don't do it. If I did accidentally eat some, I wouldn't stress out about it; I would just try to learn from the experience and make sure it didn't happen again.

For some people, small amounts of unhealthy foods cause real symptoms that are unpleasant: fatigue, brain fog, etc. There are good biological reasons for this, and very often the foods are ingested with the expectation that it will be a pleasant experience, not a bad one (no fear). For example, I had a glass of wine once, after not having had any alcohol for a couple of years, and had night sweats afterward. Along similar lines, if you've been on Paleo for some time, in or near ketosis, and then suddenly have a big bolus of carbs, you're likely not going to feel so hot.

BTW, if you're sensitive to nightshades, occasional cheats can completely prevent you from escaping their effects, since it can take several months for immune system effects to completely wear off, and even small amounts can cause symptoms to recur.

5ebeec76e20738d0a17cd724d64b1e0f

(1922)

on March 06, 2010
at 10:22 PM

As with any toxin-containing food (potatoes contain nicotine, as do all nightshades), occasional, infrequent use in small quantities is probably OK in an otherwise healthy population (which rules out most Americans). However, for long-term, regular use in quantity, I think he's wrong. He may not notice the effects, but that doesn't mean they aren't there. Many people consume gluten or sugar, or smoke or drink or use drugs and don't notice any ill effects, either.

6426d61a13689f8f651164b10f121d64

(11488)

on March 06, 2010
at 02:27 PM

Good points, Rick. I don't deny physiologic sensitivities, and I acknowledge your counterexamples to my examples. However, most people do not have physiologic sensitivity to wine or nightshades. As a counter-counterexample, Richard Nikoley, of "Free the Animal", has re-incorporated potatoes into his diet, with no apparant ill effects. Is he wrong, or is he an adapable omnivore enjoying a healthy lifestyle?

7df8f3cc7f1475c3ecbbd4a4feb87d04

(514)

on July 16, 2010
at 09:24 PM

On the other hand, no food is perfect, I'm sure you could find some toxin or other in everything, if you looked hard enough. And we come into contact with so many other toxins in our daily life, I doubt that whatever nicotine is in that potato could make such a great difference to the average person, in the great scheme of things. I think that here, the "don't sweat the small stuff" principle applies. Of course, it is tricky sometimes to determine what is "small stuff" and what would count as bigger stuff. Someone needs to study the severity of effects of the toxins nightshades contain.

1
E91fd339d760ed76cc72570a679ebf5a

(2369)

on March 05, 2010
at 12:00 AM

Yes. I would imagine that anyone who becomes orthorexic about a certain way of eating would be prone to this.

6b73f0c4b971e2dde7147920e329fe7f

(2041)

on March 05, 2010
at 01:46 AM

This is not aimed at you, but I object to psychiatrists labeling value of one's health as an eating disorder, orthorexia.

Fa47fe5368e66325865f60a928609145

(961)

on March 06, 2010
at 05:21 PM

As I understand it, orthorexia goes far beyond valuing your health into a more obsessive area.

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