Monday, 2 March 2020

The need to take nocebo effect seriously?

Nocebo comes from the Latin noceo, to harm and means "I shall harm" whereas placebo means "I shall please." I will start this post by looking at the placebo effect - and by way of introduction here is my minute long film of David Hamilton at Trew Fields last year (i).

Author David Hamilton PhD does lots more on his website about the placebo (ii) and in his great talks - he will be at Trew again this year (iii). In one post he writes:"The fact that you take a medicine tells me that on some level you must believe in it or expect it to work, or you believe in the doctor who prescribed it, or even in the improvement you’ve heard about in other people. This belief, or expectation, activates the placebo effect. Of course, the drug works too but your mind can enhance it….. or suppress it.”

He cites some incredible examples - well worth reading his article and books if you haven’t heard some of the amazing studies (ii). Basically we have far more ability to affect our health through our thinking than we might have believed in the past. Many of us know that the biggest challenge with illness is in tapping into this latent power within us. We also know that medical staff can help or hinder, even when they don’t know they are doing it. The power of the mind is absolutely key - and why I meditate daily and have explored the work of people like David Hamilton and Joe Dispensa - I do hope to blog on it soon but that part of my journey has not been so easy!

One great must-see TEDx talk I watched was Dr Kelly McGonigal, ‘How to Make Stress Your Friend’ (iv): in this she quotes the study that showed that there were more deaths among people who were listed as ‘high stress’ than in those listed as ‘low stress’. 

I get that, but wait! Scientists also asked whether these folk believed that stress is bad for them or not. This made all the difference; the death rate in the low stress group among those folk who believed stress was bad for them was higher than the death rate in the high stress group among the people who didn’t believe stress was bad for them. Kelly McGonigal asks if we can conclude that the 15th leading cause of death in the US (in the year the study was conducted) was actually the belief that stress is bad for you?!

Dr Kelly McGonigal's talk and her useful article (v) looks at what we can do to make stress a friend; when I first heard it I hugely welcomed the shift in thinking around stress. 

So we know a placebo makes people better, but a question I’ve asked myself is whether I spend enough time thinking about the nocebo effect - ie the effect that makes people worse if they believe something is harmful for them. If we believe stress is bad for us then this can act like a nocebo effect when we’re under stress, resulting in the effect of the stress being even worse.

How often does the nocebo effect play a role? In my last blog I covered the impact of hormones on me (vi) and I’ve started on a blog looking at the impact of a course of radiotherapy (that blog soon). Is this dangerous? 

Jo Lawrance cartoon
Having researched and 
read about what the side effects could be could I be planting a seed in my mind….. encouraging them to appear? I certainly have seen the effect on myself around food in the past and possibly still at times now. The healthy diet I am on can mean when I do stray a bit from the ‘rules’ imagine the food doing harm. I think it was David Hamilton in one of his talks, who asked if when we eat a healthy diet but believe a small diversion from that diet is bad then will this will have a negative consequence? And similarly if we are eating an unhealthy diet but believe it is good for us will we then have positive consequences? What role do our beliefs play? 

Take my recent blog on gluten (vii) - gluten is clearly a thing and can have serious impacts on some - but in addition to that how much is it also about what we believe? Certainly belief plays a role as one of the studies I quoted in that blog illustrated - but how much of a role?

Update 28/07/20: 
David Hamilton writes; "PCDR stands for Placebo Controlled Dose Reduction. It is where a drug is gradually replaced by a placebo by making incremental reductions in the drug while making incremental increases in the placebo." He looks at how the mind can boost and suppress the immune syste:

Gluten free and tumeric marmalade
Gluten free and tumeric marmalade
Where does that leave me?

Well I’m still going to blog on the side-effects of radiation but maybe I should warn folks about reading any of it if they are going for treatment?! What impact has my research into the side effects had on my own experiences. Strangely I have gone into all the treatments with a belief that I won’t have any serious side effects. I am fortunate to have a largely optimistic view of life and this usually plays out very well indeed! I know I've done lots to maximise my fitness and out me in the best position for any treatment. However despite this I sadly I do have some nasty short-term side-effects from the treatment. I guess my positive beliefs might have lessened those?

I guess it is about creating peace of mind rather than anxiety. In terms of food, I now (mostly) don’t get worried when I step away from my super-healthy diet. I eat a well balanced, largely plant-based food with almost no dairy and no refined sugars. I have very occasional fish and pasture-fed organic meat, nearly daily espressos (viii) and occasional glass of red wine. I believe this is a healthy approach; a good approach. Believing that must be good!

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