Placebo and Nocebo Effect in Nutrition

We all know of the placebo effect – where a sugar pill improves symptoms or has healing effects. Often said to be “all in the mind” – which it isn’t by the way. Taking a placebo and believing it will work, has physiological effects from changing the way neurons fire (pain relief), change your blood pressure, and can cause warts to disappear. It’s not just a psychological thing, it has physical implications too.

What’s less well-known is the nocebo effect. The dark side of placebo. This again comes from clinical drug trails, where rather than sugar pills having a beneficial effect, the mere mention of side-effects leads them to manifest in physical form. The nocebo effect isn’t random, it occurs when, for example, someone is told a drug has nausea as a side-effect, and even though they’ve been given a sugar pill they soon start to experience nausea, because they’re expecting it.

How does this fit into nutrition?

Gluten of course! Tell someone with enough conviction that gluten is what’s causing all their symptoms, and they may feel those symptoms when they eat gluten, regardless of whether they’re intolerant or not. I experienced this myself – thanks to reading a bunch of crap advice online I became convinced that any bloating or gas or fatigue or any symptoms of that kind I was experiencing were all due to eating gluten. Even though they weren’t. At all. But it got to the point where I’d eat bread and feel bad afterwards. That makes me sad.

Gluten is a particularly good example here as it’s an easy culprit that tends to be at the forefront of people’s minds, and therefore all it takes is a simple suggestion and a nocebo effect could be born. Not necessarily, but the potential is there. This then leads to an individual feeling they have to make drastic lifestyle shifts that are completely unnecessary.

The nocebo effect also allows quacks and charlatans to prey on people’s worries about food sensitivities. Rather than giving sensible advice to reduce stress, eat more slowly, chew more (all common and simple solutions to gut symptoms), food intolerances are diagnosed, giving the potential for a whole host of income streams: meal plans, supplements, detox protocols and so on.

I by no means wish to belittle the power of the placebo and nocebo, and find phrases such as “it’s all in your head” unhelpful as to the individual experiencing it, it’s very real. It also does not mean you are a gullible person if you experience a placebo or nocebo effect – the concept of a “placebo personality” type has been tested and not found. It is experienced on a case-by-case basis.

But, having said that, being aware of the existence of the nocebo, and its potential place in nutrition, allows us to take a step back and take a more objective look at what is happening to our bodies. Rather than jumping to a simple conclusion, it’s far more helpful to be wary and sceptical, lest you end up cutting things out of your diet for no reason! Especially bread. Bread is life.