The placebo effect defies the mainstream medical understanding of the relationship between mind and body and its role in health and disease. In this episode we discuss what placebo (and its lesser known twin, nocebo) can teach us about the human capacity for self-healing, and how we can harness that power to optimize our health.
In this episode, we cover:
2:45 The latest study revealing the power of placebo, nocebo, and belief in healing
8:57 Does the placebo effect really show measurable results in humans?
23:25 The little known “nocebo effect” and how it impacts your health
27:47 Harnessing the body’s amazing capacity to self-heal
Links We Discuss:
- JAMA study: Lessons From Recent Research About the Placebo Effect—From Art to Science
- JRSM study: The power of context: reconceptualizing the placebo effect
- SCD Lifestyle article: The power of social interaction on healing
Full Text Transcript:
Steve Wright: Hi, and welcome to the Revolution Health Radio Show. I’m Steve Wright from SCDlifestyle.com, and with me is Chris Kresser, health detective and creator of ChrisKresser.com. How are you doing, Chris?
Chris Kresser: I’m pretty good, Steve. How are you?
Steve Wright: I’m doing good, as well. You had a big week, didn’t you?
Chris Kresser: Yeah, it’s crazy. We moved. We moved last Friday. Still in Berkeley, but we’re up in the Berkeley Hills now, and it’s really nice. I’m really happy to be here. I’m looking out right now from my office into the redwood trees and overlooking Wildcat Canyon back in Tilden Park, so it’s really peaceful, quiet; air is cleaner. It kinda feels almost like living in the country, but we’re only 5 minutes away from all the good stuff. But I’m surrounded by cardboard boxes, and it’s crazy moving with a 7-month-old baby. I wouldn’t recommended it, ha-ha! So I’m pretty beat, but it was a good move, and we’re happy to be here.
Steve Wright: Awesome, so you’re literally moving up in the world! I like it.
Chris Kresser: Ha-ha, I guess you could say that!
Steve Wright: Yeah, nobody likes moving. I’ve moved way too much in the last three years, and it’s — Getting out of the boxes, I think, is the worst.
Chris Kresser: Yeah!
Steve Wright: They linger.
Chris Kresser: It’s so much easier packing them than unpacking them for some reason, at least for me, and in our last place because we knew it was temporary, we had some boxes that were still unpacked before we moved again, so I really do not want to do it again any time soon.
Steve Wright: Is there any research regarding human behavior and unpacking boxes?
Chris Kresser: Ha-ha, I don’t know.
Steve Wright: The pain scale?
Chris Kresser: I think moving has got to be up there — I think it is actually one of the top five stressors.
Steve Wright: I believe it.
Chris Kresser: Yeah, so, glad to be done with it.
Steve Wright: All right, great. Well, you kinda threw a curveball at me this week, so what did you want to talk about this week?
Chris Kresser: You know I like doing that, Steve.
Steve Wright: Yeah, yeah, spring training’s just starting. I’ve been working on my swing, man.
The latest study revealing the power of placebo, nocebo, and belief in healing
Chris Kresser: Ha-ha, yeah, so we were gonna do a 100% Q&A episode this time, and I like doing those, but also, as I’m sure a lot of you know, I like sometimes just riffing on a particular topic. And there’s one topic that really fascinates me, and it has for a long time, even before I went into medicine as a career, and I saw an editorial in the Journal of the American Medical Association on this topic, and it inspired me to want to spend some time talking about it. So, the topic is placebo, or the placebo effect, nocebo, which some of you might not have heard of, and the power of belief in healing. And I want to kind of talk about the specifics of placebo and nocebo because I think they’re interesting, but more particularly, I want to talk about them as a way of getting at the role of belief and the mind and our attitude in the healing process, which I think is what’s most important about all of this stuff. And the more I work with patients and the more I observe myself and my own experience, the more convinced I am of the role of mind in healing, the importance of the mind in healing, and that it’s the thing that most of us tend to neglect. It’s so much easier to take a new supplement or even to change the diet than it is to make changes in our behavior and our beliefs and our way of interacting with the world and ourselves, our relationship with ourselves and our relationship with others, that I think in a lot of cases that I see in my patient population and even in my own journey with healing and health, it’s something that tends to get left behind or at least diminished, and I think that that can be a problem or it can be something that holds us back from being as healthy as we possibly can. So, I just want to share this recent study and then some older studies that I reviewed and some other information about it that I think would be interesting. Then we can talk a little bit more about what the significance of all of this is in terms of healing and health.
So, this article in JAMA was specifically focused on the role of the clinician and the clinical ritual in the healing process, and there was a commentary about it on one of the blogs I follow, Dr. Sharma, and the first line of that commentary was, “Witch doctors were onto something.” And the idea is that the clinical encounter between the doctor and the patient turns out to have a real, measurable, objective effect on the treatment, and we’ve seen — Neuroimaging studies have been done now in the past decade that have shown activation of neural pathways in the brain involving endorphins and dopamine that are elicited when subjects receive a placebo, and that’s especially true when they think that they’re getting an active ingredient. And even effective drugs benefit from this effect, so authors of the study describe examples of other studies where the effectiveness of a drug, like for pain or anxiety, is greater when the subject knows they’re getting the drug than if it’s administered to them without their knowledge, so that’s fascinating. So, like, they’ll give a patient a pain-relieving drug, you know, in an open way, so hand them the drug, they know they’re receiving the drug, they know they’re taking the drug. But if they give the patient that same drug and they deliver it via a pump that hidden behind a screen so the patient does not know when or if they’re getting the active drug, that same exact dosage of the drug will have much less of an effect. So, of course, this completely suggests that the context of the healing encounters — so the delivery of the medication, the patient’s association with the medication, everything they’ve read about it or heard about it or seen on TV, and they’re friends have told them about it, or the doctor telling them that it’s gonna be effective when he gives it to them — that those aspects of the clinical encounter are as important and perhaps in some cases more important than the actual ingredients of the drug themselves. And so, I’m gonna quote from the study. They said: “Positive beliefs about future outcomes, especially when connected with an intervention recommended by a clinician, may trigger those outcomes. Moreover, much of medical practice consists of repeated rituals that may create conditioned responses that can be reactivated in the future by placing the patient in a similar environment. In conscious persons, conditioning overlaps with learning, thus creating positive expectancies.” So, in other words, just the ritual of going to the doctor and getting a prescription or a diagnosis or the doctor telling you that you’re going to get better can have a real, measurable, biological effect on healing. And we also know that the healing power of simply providing a positive experience to the patient should never be underestimated. Quoting again, they say: “…inviting and listening carefully to the patient’s story of illness experience, or offering a satisfying explanation for the patient’s distress, expressing care and concern, communicating positive expectations for therapeutic benefit, and helping the patient to feel more in control of life in the face of illness.” All of these things contribute to healing and to a positive clinical encounter.
Does the placebo effect really show measurable results in humans?
Chris Kresser: So, there are a lot of ideas about what the placebo effect is. And you know, for a long time it was thought that it was just all in the patient’s mind, so to speak, so there weren’t any objective or measurable effects associated with it. It was just the patient believing that they were better and that belief was all that there was to it. And then there have been a bunch of studies that have shown, no, there actually are measurable biochemical effects that can be elicited by taking placebo. So, it’s kind of mixed and it depends to some extent on what condition is being treated. For example, there was a recent study on asthma treatment, and they separated the patients into two groups. One group got an albuterol inhaler, which is, you know, the typical treatment. And the other got a placebo inhaler, so it was just a fake inhaler with nothing in it. So, the placebo inhaler had no measurable effects on lung function, but when it came to patient-reported outcomes, it was equally as effective as albuterol in relieving discomfort and self-reported asthma symptoms. So, in other words, the placebo inhaler was just as effective as the drug version in helping people feel better, which I think is really interesting.
Steve Wright: That’s really interesting because that’s, I mean, that’s your breathing, right? So, that would suggest that maybe they feel less stressed once they take the inhaler, because I have asthma, or I have chronic, you know, like, exercise-induced asthma, so I know the feeling, and that’s really interesting.
Chris Kresser: Yeah, it really makes me think a lot about not only just what’s happening physiologically, because they didn’t see a measurable effect on lung function, but the subjective experience of the lung function was different and it was improved with the placebo. So, it implies that it’s not just that there is an objective aspect to illness and to health that can be measured, but there is also a subjective aspect to health and illness that really is difficult to measure. At least we don’t know how to measure it yet. And that makes me think of — and this might be a little bit of a tangent, but we’ll get back to it — You take, you know, I’ve often talked about the importance of having a purpose and of patience in the healing process, and I think part of what that’s about for me is that if you’re dealing with a chronic illness and all you do is focus on your illness and trying to get well and that consumes you and that constitutes the bulk of your experience on a day-to-day basis, I think that patient is not gonna do as well as someone who is struggling with a chronic illness but is, you know, able to still devote themselves to something that they care about, whether that’s a cause or work that they believe in or, you know, relating to friends or taking care of their family or whatever it is. And I think that subjective experience of how they live with that illness and how they experience the illness on a day-to-day basis has a really significant effect on, you know, compared to just the objective things that we can measure about the illness itself.
So, getting back to the placebo, there have been some other pretty interesting studies that I just want to go through quickly. One recent study used placebo to reduce the active dose of steroids needed to successfully treat psoriasis, which is an inflammatory skin condition, by about 50% to 75%. So, the researchers in this study wanted to determine if a drug’s therapeutic effect could be triggered by the qualities that are associated with that drug, like the shape or the color, smell, packaging, as well as the administration of it by an authority figure in a white lab coat, and this has been known for a while, that these factors do play a role in the placebo effect. The theory is that these — it’s kind of like a Pavlov response, so the repeated associations of drugs with all of these features of how they’re administered creates a conditioned response, you know, like the ringing of the bell and the salivation, and the therapeutic effects of a drug are caused not by the ingredients of that drug alone, but by the stimuli associated with the rituals of giving the drug. And so, the researchers looked at about 50 patients with mild to moderate psoriasis, and one group got a full dose of steroid cream with every dose, and the other group got a full dose only 25% to 50% of the time, and then they got a placebo cream, just like a moisturizer, the other 50% to 75% of the time. And guess what? Both groups improved by the same amount, and there was no difference in relapse between the two groups. And the dose that the second group was receiving was theoretically not even enough to be effective. It was below the active dose of the drug, and they still improved to the same degree as the other group of patients that was receiving the full dose of the drug.
There’s another study where patients who were in a lot of pain after wisdom tooth extraction got just as much relief from a fake application of ultrasound as patients who got the real ultrasound as long as both the patient and the therapist thought that the machine was on. And it didn’t work the same way if one or the other knew that it was fake. It’s pretty well known now, as I just mentioned, that the color of pills affects the outcome of a treatment, and that effect is widespread across all different cultures. For example, in Italy blue placebos make really good sleeping pills for women, but they had the opposite effect on men. Like, they actually gave men worse insomnia. And they were really trying to figure out why this would be until somebody pointed out that the Italian soccer team’s color is blue and, you know, Italian men are crazy for soccer, it gets them really excited, so the theory was that the association of Italian men with blue was as a really stimulating color, and that actually affected the outcome or the effect of these placebo treatments.
Steve Wright: That’s interesting, because I thought of Viagra.
Chris Kresser: Right. So that’s the US association, right? So, it would work differently here. Yellow pills are known to make the most effective antidepressants. It’s kind of, you know, giving you a little dose of sunshine. And red pills are more stimulating. Green pills, in general, reduce anxiety. White pills, especially those that are labeled as antacids right on the pill themselves, have a greater effect on ulcers than other colors of pills or pills that aren’t labeled as antacids. Placebos that are taken four times a day give more relief than those that are taken only twice a day. So, just the ritual of swallowing a pill has some effect. Placebos that are stamped with widely recognized trademarks, you know, names that we know of, companies, are more effective than generic placebos. And pills — speaking of Viagra, Steve — pills with clever names have been shown to increase effectiveness. Like, Viagra implies both vitality and a Niagara Falls’ worth of sexual performance. That was certainly intentional when they named it that way. And interestingly enough, the placebo effect is not limited to pills or medicines. There’s a Dr. Bruce Moseley, an orthopedic surgeon, I think he’s in Seattle, and he’s performed studies doing placebo surgery, which is also referred to as “sham surgery.” And he took 180 patients who needed knee surgery, and he put them into three groups. Two groups received the actual surgery, and I think there was some variation in those two groups; I can’t remember what it was. And the third group received a sham surgery. So, what they did is they went through the whole routine, so they opened up the knee, and then they just, like, I think, sprayed it with a little bit of water or they did something that kind of — You know, they went through the ritual that they normally go through, and the patients in the third group who didn’t get the actual knee surgery improved just as much as in the first two groups.
Steve Wright: Did they know they were part of a study?
Chris Kresser: Yeah, they did, and this brings up a whole other interesting topic: the ethical questions about placebo use in clinical practice. And you know, a lot of doctors actually admit to giving placebo to patients, especially patients that are requesting, you know, drugs that aren’t really indicated in a particular situation, like an antibiotic for a cold or something like that, and there’s been a real debate about whether that’s ethical, you know, to give somebody a placebo when you tell them that you’re giving them a drug. And I don’t really want to get into that whole discussion now, but there have been a lot of new techniques in the research to deal with that question. But a lot of these studies, they know there’s a placebo arm, but they don’t know whether they’re receiving the placebo or not, so it’s double blind.
Steve Wright: I don’t know. I guess I wouldn’t sign up for a —
Chris Kresser: A sham surgery!
Steve Wright: A placebo knee replacement! I feel like surgery is at another level compared to taking pills.
Chris Kresser: Yeah, isn’t that interesting, though? I mean, there is speculation about why, you know, how could that happen, and certainly just cutting the knee would initiate an inflammatory reaction in the body and a self-healing response that could have a significant impact, but you might not expect that impact to be as significant as going in and actually repairing the ligaments in the knee.
Steve Wright: Yeah.
Chris Kresser: But I remember reading about that study when it came out, and it was actually — I think there was even, like, a documentary or at least a short news feature about a guy who was in the third group, and he was in a wheelchair before he went into the hospital. He couldn’t even walk, he was so out of it, and then in the show, you know, they show him after the surgery and he’s out in the backyard playing basketball with his son, and they talked to him about it, and he — You know, some people were actually quite angry, even if they were better, but he had had kind of like a revelation or an epiphany because it totally changed the way he looked at healing and his own body’s capacity to heal itself, and it inspired him to really have a much deeper respect for the body’s capacity for self-healing, and he was ecstatic that he had been through that experience. But, yeah, people have different responses.
Steve Wright: That’s really amazing. So, in any of these studies that you looked at, did they ever measure — like, for instance, in the albuterol one — did they ever measure, like, cytokines or any IL-6 markers to see if placebo versus active treatment actually lowered stress at a physiological level?
Chris Kresser: Yeah, they do. Some of the more recent studies do measure those markers, and I mentioned the neuroimaging study that looked at levels of dopamine and endorphins, so those are, you know, real biochemical markers that are changing. That’s pretty recent, you know, maybe in the last 10 years that that’s been happening. The older studies didn’t tend to look at those things or report on them. I don’t know of a study specifically about placebo measuring cytokines and other markers of stress, but certainly one of the main theories about how placebo effect works is that it works by regulating the hypothalamic-pituitary-adrenal axis, mitigating the impacts of stress on the body and, you know, decreasing that stress response.
Steve Wright: Yeah, because it would make sense, I mean, when you talk about the pattern of if your preconditioning before this has been that you go to an office and talk with a doctor and he gives you a pill and then, you know, it’s happened a few times before that after you take that pill you get good results, that when you do that same pattern again, you’ll expect the same results, which should lower your overall stress around the situation probably.
Chris Kresser: That’s right, and so it has, like, a cascade of effects, as you’re pointing out. So, it’s the expectation that you’re gonna get well, which itself seems to help people to get well, and then it’s the conditioned response where you’ve been through this ritual of action several times and it’s had a certain result at the end of all of those actions, and so that’s more likely to happen again, and then there’s just the impact of the reduction of stress that comes from going to the doctor, having a positive interaction, and you know, maybe getting a diagnosis or an explanation for how you feel and some reassurance that it can be dealt with.
The little-known “nocebo effect” and how it impacts your health
Chris Kresser: Now, of course, there’s another side of this coin, right? The other side of the coin is the nocebo effect, which is the sort of evil twin of the placebo effect. Have you ever heard of the nocebo, Steve?
Steve Wright: No, I have not heard of the nocebo.
Chris Kresser: Yeah, it’s interesting because it’s not very well known compared to placebo, but it describes the opposite of what we’ve been talking about so far. So, placebo refers to the benefits produced by a treatment that should have no effect, but the nocebo effect is just the opposite. And of course, this has been well known outside of the medical community for a very long time. It’s even in our language, like, if you say the phrase “scared to death” or “worried sick.” The phenomenon of voodoo death in traditional cultures is pretty well documented. I mean, we don’t understand how it works, but it’s true that in certain traditional cultures a medicine man or a witch doctor or whatever you want to call it will put a hex on somebody in the tribe or in another tribe, and then that person when they know that the hex has been put on them, they die of fear, essentially. But in a more modern context, there are still plenty of examples of it. In the Framingham Heart Study, which I’m sure a lot of people have heard of, the longest running study on heart disease that’s been done so far, women who believed that they were prone to heart disease were nearly four times as likely to die as women with similar risk factors who didn’t hold the same views. So, just the belief that they were going to get it, you know, they died four times as often as, or died earlier than women who didn’t. And that’s just an association. There’s no causality there, of course, but it’s interesting.
Steve Wright: Yeah, that opens a whole door to should you get your genetics tested or not.
Chris Kresser: Yeah. We can talk a little bit about that too. In studies done of people going into surgery who want to die, like to reconnect with a loved one, so you know, maybe they’ve been married for 50 years and their partner dies and then they’re having a surgery and they really want to die because they’re so sad, close to 100% of those patients will die in surgery. Men taking a commonly prescribed prostate drug who were informed that it might cause sexual dysfunction were twice as likely to become impotent. And there are a lot of studies like this, where they’ll take two groups of people, they’ll give them a drug, and in the one group they don’t say anything about it, and in the other group they read them the list of side effects. And the group that has been informed about the side effects, they’re way more likely to experience all of those side effects. One of my favorite nocebo studies was a study that happened in Japan, and they took 57 high school boys and tested for their sensitivity to allergens, and they filled out questionnaires about past experiences with plants, including lacquer trees, which cause itchy rashes that are pretty similar to what poison oak or poison ivy do here. And the boys who reported having severe reactions to this tree were blindfolded, and then the researchers brushed one arm with leaves from a lacquer tree, but they told the boys that they were chestnut tree leaves. And then they stroked the other arm with chestnut tree leaves, but they said that that foliage actually came from a lacquer tree. And within minutes, the arm that the boys believed to have been exposed to the lacquer tree began to react even though it was the chestnut tree, and it turned red and they developed a bumpy, itchy rash. And in most cases, the arm that had contact with the actual lacquer tree did not react. That’s just amazing to me!
Steve Wright: Ha-ha, I want the video!
Chris Kresser: Yeah, it’s almost hard to believe, but all of these studies are reported in peer-reviewed journals and, you know, it’s —
Steve Wright: I don’t care. I want the video.
Chris Kresser: Ha-ha, OK. It sounds fantastic, but this is the power of belief in healing and disease.
Harnessing the body’s amazing capacity to self-heal
Chris Kresser: So, what does all of this mean for clinicians and patients? For patients, I think it means that, like I just said, I would hope it gives us an appreciation of the body’s innate ability to heal itself. And one paper I like referred to this as the “endogenous health care system,” so it’s our — I mean, it’s pretty miraculous actually. The more you understand about the body and how it works and how the immune system works, the more miraculous it seems. Like, every moment as we’re sitting here and breathing and recording this podcast, walking down the street, whatever it is, the body is just constantly healing itself, without our awareness or conscious control at all. And you know, in our culture and particularly in the last hundred years, there’s been such a huge focus on science and technology in medicine, and I think we’ve forgotten about the amazing capacity of the body to heal itself. So, that’s something whenever I read about this stuff, the placebo and nocebo, that’s kind of what I come away with, is just a renewed appreciation of that. But also, though, it means that it’s really important, I think, for patients to believe in what they’re doing. And as we’ve discussed, just having the expectation that what you’re doing is going to work actually makes it more likely to work. And you know, some people might be saying: Well, sure, I get that, but how can I manufacture that? Like, it’s hard to just pull that out of nowhere, and a lot of these things that we’ve been talking about are deeply conditioned responses that are outside of our conscious control, and it is hard to manufacture, but I think there are some ways that you can avoid interfering with that. And one of the main ways to interfere with that system of expectation and belief is information overload. So, these days, you know, any particular perspective that you adopt or embrace, you can get on the Internet and within 5 minutes you can find about 50 other perspectives that conflict with it. And I see people in my practice and, of course, on my blog who are just paralyzed with, you know, as my dad would say, the paralysis of analysis. There are just so many completing points of view, so many different perspectives, and they all conflict, and then the person just gets literally paralyzed and can’t move forward and doesn’t know to do. And so, I think one of the things as a patient if you’re under somebody’s care, one of the best things to do is just to put your faith in whomever you’re working with at least for a period of time, and stick with it, and kind of — I wouldn’t say keep your head down, but you know, like, try to resist the impulse to going on the Internet and poking a bunch of holes in whatever it is that you’re doing because that’s probably not going to benefit you.
Steve Wright: Yeah, I think you hit on the key right there, which is if you’re working with a doctor or specialist or whoever you’re working with, coach, if you come in with the mindset that everything that they say you want to find out if it’s true, then you’re always gonna be looking to find the opposite. You’re never gonna look for the info that might back up the person that you’ve entrusted with your health and your money. So, you want to be very careful of that, because I find a lot of people, get a lot of emails from people who are in that paradigm.
Chris Kresser: Yeah, it’s a hard road, that one, and I mean, I understand. I’m very, ha-ha, I’m not the sort of person who just accepts what people tell me, and so I completely relate to that impulse, and I think it’s an important impulse and one that we should — that in certain contexts is really crucial to engage, but I also know that I work with — You know, sometimes I’ll hear from patients, you know, I’ll do an initial consult, and they’ll call me up, and they’ll say: Yeah, you know, I’m dealing with this, this, and this, and my doctor says this, and I have an holistic MD and he says that, and my chiropractor says that, and you know, and now I’m calling you and I want to start working with you. And my response is usually: What is it that’s not working for you? They’re like: Oh, well, it’s OK, but I just kind of want to get a different perspective. And 9 times out of 10, I’ll tell those patients to just go back to what they’re doing with their other practitioner and give it a shot, and really stick with what they’re saying, you know, for a period of time, not forever, and just do it, instead of constantly looking for the next thing because, again, while I understand that, I understand the urgency if you’ve been sick for a long time, it sucks, nobody likes that, they want to start feeling better as soon as possible, but I think this is where patience and a little bit of faith and commitment come into it, because otherwise you end up digging a bunch of shallow wells and you never hit water.
Steve Wright: Yeah, I couldn’t agree more, and if I could take a second to do my own little riff here, because this is a topic that really hits home with me, is that I hear from a lot of people who are still in a lot of pain, and they can hardly get by on a daily basis, and they have several people in their life that they’re taking advice from on their health, and it makes since to me what you’re talking about, Chris, with people who would call you and say: I have all of these people in my life that are giving me advice, and I’m not getting anywhere. And I think really what it comes down to is instead of trying to poke holes in the recommendations of the various people in your life that are trying to help you, is that you need to properly evaluate whether those people need to be giving you advice and learn to fire who is not giving you advice that’s working for you after you’ve properly tried what they’ve done. Don’t pick and choose treatment A from so-and-so, treatment B from so-and-so, and then, you know, number two from other guy that you read about on the Internet. You know, try a treatment from someone and do it fully like they asked you to do it, but even before you do that, vet who these people are. You know, if you’re trying to lose weight and you’re taking advice from someone who’s overweight, maybe you want to look somewhere else. So, that’s something that I get a lot on our blog, and so I just want to throw that out there.
Chris Kresser: Yeah, exactly. And you know, I just want to be clear. This isn’t a criticism, and if it were, I’d be criticizing myself because early on, you know, when I first got sick and I got back from Indonesia, where it all started for me, I was in a real hurry to get well, you know, because understandably I was in a lot of pain and discomfort, and I was young, and I just wanted to get on with my life. And so, I did that. I played that game early on, where I was kind of balancing from one practitioner to the next, and if a few weeks went by and I wasn’t better, I’d go on to the next person, or even while I was working with one person, I was already researching for the next person. And I can say from direct experience that that didn’t turn out very well. You know, that period of time was really stressful for me and not very effective in terms of my own healing process. And yet, I look back on it and I think, well, I was just doing what, you know, it was pretty natural for me to do that at that point, and I’m not judging myself and I don’t judge any other people for doing that. I’m just maybe trying to share a little bit of my experience personally and also working with patients that if possible, you know, like you said, sticking with a particular approach, and not doing the kind of buffet style of treatment, and giving it enough time to work. I alluded to that before when I said that patience and having a purpose, I think, are two of the most underrated qualities we can have in terms of our journey towards health. If we just stick with it and give it enough time to work before we do that evaluation, I think that can be really helpful.
Steve Wright: I just want to jump in real quick and say that I didn’t mean to say the same thing that you said, and I did the exact same thing that you have done as well and jumped through many different doctors and everything, and I’ve been through that spiral as well, so what I’m curious to hear from your perspective is that same person that we both were who, you know, they’re not sure who to listen to or they’re not getting results fast enough for them, what questions should they be asking? Because I feel like it’s a question problem, that when I was younger I wasn’t asking the right questions from the medical people that I was talking to.
Chris Kresser: Yeah, that’s a great question. I think some of it boils down to strategy and approach. Like, my belief is that it’s always best, if possible, to get to the underlying cause of a problem and address it at that level. And I want to know, if I’m working with a practitioner myself, I want to know if that’s their approach. You know, I want to know that the things that they’re doing are geared towards getting to the deepest level possible of what the disharmony is and addressing it at that level instead of just, you know, I have this symptom. OK, you take that supplement or drug. I have that symptom. You take that supplement or drug. So, asking questions about if you’re given a diagnosis, OK, well, why? What’s causing that? Do you have any ideas or thoughts about why that might be happening? Just being inquisitive and trying to get to the bottom of it. And if your practitioner gets defensive when you ask those kinds of questions, then that’s probably not the best person to work with. In general, I think for me, as a practitioner and having been on the other side of it, being able to have kind of a collaborative relationship is really important, and that means feeling free to ask questions like that without fearing the practitioner getting really defensive, you know, or just shutting down. That’s important. I think some of the more obvious things like being in alignment with some of the patient’s own beliefs and perspectives. Like, you know, if you’re someone who really has had a fantastic experience on the Paleo/Primal type of diet and you go to a doctor and he or she suggests you go on a raw food diet, you know, that may not be the best practitioner for you. I don’t know. What else comes up for you, since you’ve been through that?
Steve Wright: I think for me, one of the questions I always want to know is when have they seen this problem before or how many other people like me have they treated.
Chris Kresser: Um-hum, that’s definitely a good one.
Steve Wright: I’m always looking to, like you said, ask a deeper question, like, you know, once they give you an answer: Oh, it’s your tonsils or something. OK, well, what is it about my tonsils? or something like that. And then the other thing that I always ask is if they say take, you know: My advice for you is to take this pill or this supplement, and it’s always: OK, is there another option, and is there a benefit to the other option? Because I feel like, for the most part, even if you ask me for advice, I would give you what I believe is the best option, and I might not tell you about some other ideas that could work as well just because I’m vetted in this one idea, and so I think it’s really natural for all humans to give advice that way, so I kind of want to also know from them what else might work for me because it’s still my choice whether I do it or not, so I might want to, you know, look at options A through C and then choose them, because I’ve done that before on medications and chosen B instead of A even though the practitioner wanted to go with A.
Chris Kresser: Yeah, I mean, that’s all important stuff, and it just, I think, boils down to a gut feeling too is really something that’s guided me. If you trust your intuition, I mean, if red flags are going up in the initial consult or the conversation or you feel at any time really uncomfortable with the relationship, I think that’s something to pay attention to as well. So, I want to just briefly mention the other side of it for what all this stuff we’ve been talking about means for clinicians, because I know we have a lot of people who listen to the show who work with patients or clients in some way or another. And for me as a practitioner, all of this stuff means that the way that I interact with patients, the attention I give them, the way that I listen, and even the rituals that I go through may be just as important as the, you know, nutritional recommendations or supplements and things that we prescribe. And in fact, there’s a guy named Ted Kaptchuk who was — he started out in Chinese medicine, but now he’s a researcher on placebo at Harvard, which is an interesting career path. But he’s argued that the placebo response should actually be renamed and it should be called “contextual healing,” and he defines it as that aspect of healing that’s produced, activated, or enhanced by the context of the clinical encounter. And scientific medicine is mostly focused on how effective a treatment intervention is, but this really obscures the fact that the technological tools of medicine, whether we’re talking about drugs or surgery or something else, are always applied in some context, and that context actually does contribute significantly to a therapeutic benefit. And that’s always been referred to as, you know, maybe the art of medicine, and I think early generations of doctors were aware of it, the kind of Norman Rockwell painting type of doctor. You know, he did house calls and really spent a lot of time with patients and was, I think, really much more aware of the art of medicine and, you know, also aware of the science but appreciated both. And I think that art of medicine has become a lost art in the last few decades, and we’ve focused too much on science and technology. I mean, and that kind of shows up in the language that we use to talk about placebo and words like inert or inactive or dummy or sham, and that’s partly due to the inconvenience of placebo for drug companies because drug companies have to prove that their drug is more effective than placebo in order for it to be approved, and so placebo is a big thorn in their heel, but I think there’s a great opportunity for celebrating placebo more as a reflection of the body’s ability to self-heal, and instead of trying to get rid of it like the drug companies are busy doing in trials, to use it more as a springboard for studying these self-healing abilities more thoroughly, and that’s what I’m really interested in, and that’s why I wanted to do this show. So, I know this was kind of maybe out on a limb for some people, and some of you might not share my fascination with this subject, so I’m sorry you had to endure this, but I hope it was useful, and I hope it inspires something for you or triggers some thought process that leads to, you know, more awareness and more health and healing.
Steve Wright: Yeah, I think it’s gotta be somewhere in everyone’s mind because the shelf space in a bookstore dedicated to these types of books is about the same as almost any other health book, you know, when you split them into the books that are all about believing in healing and those types of spiritual healing stuff. It’s a huge section, so there’s a lot to this, and I think it’s really, really interesting.
Chris Kresser: All right, well, let’s stop there. I think, you know, we’re coming up on an hour, and just going into questions about nuts and phytic acid and stuff doesn’t seem quite right at the moment, ha-ha.
Steve Wright: Well, I think, did you mention that there are three ways to avoid interfering with your body’s natural ability to heal?
Chris Kresser: I probably did, but I don’t — I think the main one that I was getting at was just reducing information overload.
Steve Wright: OK.
Chris Kresser: Like, you know, and we spent quite a bit of time talking about that, so I don’t think we need to rehash it. Sticking, making a commitment to whomever you’re working with for enough time, and that’s kind of amorphous. What is enough time? I wish I could give you a number, because it really varies depending on how long you’ve been ill and what your condition is, but I’m talking probably more about months than I am about weeks. So, that could be number two. I think just doing what we can to maintain that belief in what we’re doing and put our faith in someone or something while we’re doing it and just stick with that for a period of time.
Steve Wright: Gotcha. OK.
Chris Kresser: Anything else?
Steve Wright: Yeah, the only other point that I think was really important that you hit on was — and the reason why it’s important is because I was this person and I think there are probably a lot of listeners who have been this person in the past — is the person who is completely consumed by their problems, who has, you know, hours of time on their hands, and they go about researching this day in and day out, and they forget a lot of the things that you were talking about, like maybe having hobbies and a purpose and, you know, family and friends that you go see. We tend to get really consumed in finding the answer and sometimes put off social interaction and stuff, and I’ve seen a lot of studies on social interaction that that can be so beneficial in healing, and I think it comes down to that stress again, so I think that’s definitely one to avoid if you can, even when the pain’s there, to try to go to the family gatherings, try to get out of the house if you can, even though it’s gonna be a little different and you might not be in the best head space to get out there, it’s really important.
Chris Kresser: Yeah, I agree, and the reason I started laughing there for a little bit was that I sent a bunch of — I wanted to get some papers on — I’ve read some of those studies, Steve, on the benefit of positive social interaction. I think you guys wrote an article about that a while back that I tweeted out. And I sent some links to get the full text of some of those papers to Mat LaLonde, and he called me a dirt-worshiping hippie. Ha-ha! But it’s true! That stuff is in the scientific literature, and it’s real, it’s completely documented, and I mean, speaking personally, I think when things really turned around for me was when I — You know, the first couple of years when I was sick, I was that guy too. I was spending most of my time trying to figure out how to get well, and it was all-consuming, and it was really unhealthy. And I decided at some point to go back and study medicine so I could help other people who were dealing with similar stuff, and that’s when things really turned a corner for me. And now especially, like, the more I do this work and the more I tune into this sense of purpose, the better my health is, and of course, the happier too, and it all, it becomes like there’s momentum there, and it just keeps improving and improving. So, it’s easier said than done. You know, I know when I was in that place I wanted to have a purpose and I wanted to do all those things and I was finding it difficult, but I think at least aspiring to that and being aware of it can really help.
Steve Wright: Yeah, I think you’re right. Awareness is the first step.
Chris Kresser: OK, everybody, so thanks for listening and sorry we missed a show. It was because of the move, and we’ll be back on our normal schedule now.
Steve Wright: Yeah, thanks everyone. And if you’re new to the Paleo Diet or you’re just interested in optimizing your health, check out Beyond Paleo. It’s a free 13-part email series on burning fat, boosting energy, and preventing and reversing disease without drugs. To sign up, go to ChrisKresser.com and look for the big red box. Chris and I want to thank you for listening today and staying with us through voodoo dolls and all kinds of topics. You can keep sending us your questions at ChrisKresser.com using the podcast submission link. If you enjoyed listening to the show, head over to iTunes and leave us a review.
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