How To Leverage Placebo Effect For Yourself
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Placebo Effect: Making Things Work Since… Well, A Very Long Time Ago
The placebo effect is a well-known, well-evidenced factor that is very relevant when it comes to the testing and implementation of medical treatments:
NIH | National Center for Biotechnology Information | Placebo Effect
Some things that make placebo effect stronger include:
- Larger pills instead of small ones: because there’s got to be more going on in there, right?
- Thematically-colored pills: e.g. red for stimulant effects, blue for relaxing effects
- Things that seem expensive: e.g. a well-made large heavy machine, over a cheap-looking flimsy plastic device. Similarly, medication from a small glass jar with a childproof lock, rather than popped out from a cheap blister-pack.
- Things that seem rational: if there’s an explanation for how it works that you understand and find rational, or at least you believe you understand and find rational ← this works in advertising, too; if there’s a “because”, it lands better almost regardless of what follows the word “because”
- Things delivered confidently by a professional: this is similar to the “argument from authority” fallacy (whereby a proposed authority will be more likely trusted, even if this is not their area of expertise at all, e.g. celebrity endorsements), but in the case of placebo trials, this often looks like a well-dressed middle-aged or older man with an expensive haircut calling for a young confident-looking aide in a lab coat to administer the medicine, and is received better than a slightly frazzled academic saying “and, uh, this one’s yours” while handing you a pill.
- Things with ritual attached: this can be related to the above (the more pomp and circumstance is given to the administration of the treatment, the better), but it can also be as simple as an instruction on an at-home-trial medication saying “take 20 minutes before bed”. Because, if it weren’t important, they wouldn’t bother to specify that, right? So it must be important!
And now for a quick personality test
Did you see the above as a list of dastardly tricks to watch out for, or did you see the above as a list of things that can make your actual medication more effective?
It’s arguably both, of course, but the latter more optimistic view is a lot more useful than the former more pessimistic one.
Since placebo effect works at least somewhat even when you know about it, there is nothing to stop you from leveraging it for your own benefit when taking medication or doing health-related things.
Next time you take your meds or supplements or similar, pause for a moment for each one to remember what it is and what it will be doing for you. This is a lot like the principles (which are physiological as well as psychological) of mindful eating, by the way:
How To Get More Nutrition From The Same Food
Placebo makes some surprising things evidence-based
We’ve addressed placebo effect sometimes as part of an assessment of a given alternative therapy, often in our “Mythbusting Friday” edition of 10almonds.
- In some cases, placebo is adjuvant to the therapy, i.e. it is one of multiple mechanisms of action (example: chiropractic or acupuncture)
- In some cases, placebo is the only known mechanism of action (example: homeopathy)
- In some cases, even placebo can’t help (example: ear candling)
One other fascinating and far-reaching (in a potentially good way) thing that placebo makes evidence-based is: prayer
…which is particularly interesting for something that is fundamentally faith-based, i.e. the opposite of evidence-based.
Now, we’re a health science publication, not a theological publication, so we’ll consider actual divine intervention to be beyond the scope of mechanisms of action we can examine, but there’s been a lot of research done into the extent to which prayer is beneficial as a therapy, what things it may be beneficial for, and what factors affect whether it helps:
Prayer and healing: A medical and scientific perspective on randomized controlled trials
👆 full paper here, and it is very worthwhile reading if you have time, whether or not you are religious personally
Placebo works best when there’s a clear possibility for psychosomatic effect
We’ve mentioned before, and we’ll mention again:
- psychosomatic effect does not mean: “imagining it”
- psychosomatic effect means: “your brain regulates almost everything else in your body, directly or indirectly, including your autonomic functions, and especially notably when it comes to illness, your immune responses”
So, a placebo might well heal your rash or even shrink a tumor, but it probably won’t regrow a missing limb, for instance.
And, this is important: it’s not about how credible/miraculous the outcome will be!
Rather, it is because we have existing pre-programmed internal bodily processes for healing rashes and shrinking tumors, that just need to be activated—whereas we don’t have existing pre-programmed internal bodily processes for regrowing a missing limb, so that’s not something our brain can just tell our body to do.
So for this reason, in terms of what placebo can and can’t do:
- Get rid of cancer? Yes, sometimes—because the body has a process for doing that; enjoy your remission
- Fix a broken nail? No—because the body has no process for doing that; you’ll just have to cut it and wait for it to grow again
With that in mind, what will you use the not-so-mystical powers of placebo for? What ever you go for… Enjoy, and take care!
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Willpower: A Muscle To Flex, Or Spoons To Conserve?
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Willpower: A Muscle To Flex, Or Spoons To Conserve?
We have previously written about motivation; this one’s not about that.
Rather, it’s about willpower itself, and especially, the maintenance of such. Which prompts the question…
Is willpower something that can be built up through practice, or something that is a finite resource that can be expended?
That depends on you—and your experiences.
- Some people believe willpower is a metaphorical “muscle” that must be exercised to be built up
- Some people believe willpower is a matter of metaphorical “spoons” that can be used up
A quick note on spoon theory: this traces its roots to Christine Miserandino’s 2003 essay about chronic illness and the management of limited energy. She details how she explained this to a friend in a practical fashion, she gave her a bunch of spoons from her kitchen, as an arbitrary unit of energy currency. These spoons would then need to be used to “pay” for tasks done; soon her friend realised that if she wanted to make it through the day, she was going to have to give more forethought to how she would “spend” her spoons, or she’d run out and be helpless (and perhaps hungry and far from home) before the day’s end. So, the kind of forethought and planning that a lot of people with chronic illnesses have to give to every day’s activities.
You can read it here: But You Don’t Look Sick? The Spoon Theory
So, why do some people believe one way, and some believe the other? It comes down to our experiences of our own willpower being built or expended. Researchers (Dr. Vanda Siber et al.) studied this, and concluded:
❝The studies support the idea that what people believe about willpower depends, at least in part, on recent experiences with tasks as being energizing or draining.❞
Source: Autonomous Goal Striving Promotes a Nonlimited Theory About Willpower
In other words, there’s a difference between going out running each morning while healthy, and doing so with (for example) lupus.
On a practical level, this translates to practicable advice:
- If something requires willpower but is energizing, this is the muscle kind! Build it.
- If something requires willpower and is draining, this is the spoons kind! Conserve it.
Read the above two bullet-points as many times as necessary to cement them into your hippocampus, because they are the most important message of today’s newsletter.
Do you tend towards the “nonlimited” belief, despite getting tired? If so, here’s why…
There is something that can continue to empower us even when we get physically fatigued, and that’s the extent to which we truly get a choice about what we’re doing. In other words, that “Autonomous” at the front of the title of the previous study, isn’t just word salad.
- If we perceive ourselves as choosing to do what we are doing, with free will and autonomy (i.e., no externally created punitive consequences), we will feel much more empowered, and that goes for our willpower too.
- If we perceive ourselves as doing what we have to (or suffer the consequences), we’ll probably do it, but we’ll find it draining, and that goes for our willpower too.
Until such a time as age-related physical and mental decline truly take us, we as humans tend to gradually accumulate autonomy in our lives. We start as literal babies, then are children with all important decisions made for us, then adolescents building our own identity and ways of doing things, then young adults launching ourselves into the world of adulthood (with mixed results), to a usually more settled middle-age that still has a lot of external stressors and responsibilities, to old age, where we’ve often most things in order, and just ourselves and perhaps our partner to consider.
Consequently…
Age differences in implicit theories about willpower: why older people endorse a nonlimited theory
…which explains why the 30-year-old middle-manager might break down and burn out and stop going to work, while an octogenarian is busy training for a marathon daily before getting back to their daily book-writing session, without fail.
One final thing…
If you need a willpower boost, have a snack*. If you need to willpower boost to avoid snacking, then plan for this in advance by finding a way to keep your blood sugars stable. Because…
The physiology of willpower: linking blood glucose to self-control
*Something that will keep your blood sugars stable, not spike them. Nuts are a great example, unless you’re allergic to such, because they have a nice balance of carbohydrates, protein, and healthy fats.
Want more on that? Read: 10 Ways To Balance Blood Sugars
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Spark – by Dr. John Ratey
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We all know that exercise is good for mental health as well as physical. So, what’s so revolutionary about this “revolutionary new science of exercise and the brain”?
A lot of it has to do with the specific neuroscience of how exercise has not only a mood-boosting effect (endorphins) and neuroprotective effect (helping to guard against cognitive decline), but also promotes neuroplasticity… e.g., the creation and strengthening of neural pathways, as well as boosting the structure of the brain in some parts such as the cerebellum.
The book also covers not just “exercise has these benefits”, but also the “how this works” of all kinds of brain benefits, including:
- against Alzheimer’s
- mitigating ADHD
- managing menopause
- dealing with addiction
…and more. And once we understand how something works, we’re far more likely to be motivated to actually do the kinds of exercises that give the specific benefits we want/need. Which is very much the important part!
In short: this book will tell you what you need to know to get you doing the exercises you need to enjoy those benefits—very much worth it!
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The Power of Self-Care – by Dr. Sunil Kumar
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First, what this book is mostly not about: bubble baths and scented candles. We say “mostly”, because stress management is an important aspect given worthy treatment in this book, but there is more emphasis on evidence-based interventions and thus Dr. Kumar is readier to prescribe nature walks and meditation, than product-based pampering sessions.
As is made clear in the subtitle “Transforming Heart Health with Lifestyle Medicine”, the focus is on heart health throughout, but as 10almonds readers know, “what’s good for your heart is good for your brain” is a truism that indeed holds true here too.
Dr. Kumar also gives nutritional tweaks to optimize heart health, and includes a selection of heart-healthy recipes, too. And exercise? Yes, customizable exercise plans, even. And a plan for getting sleep into order if perchance it has got a bit out of hand (most people get less sleep than necessary for maintenance of good health), and he even delves into “social prescribing”, that is to say, making sure that one’s social connectedness does not get neglected—without letting it, conversely, take over too much of one’s life (done badly, social connectedness can be a big source of unmanaged stress).
Perhaps the most value of this book comes from its 10-week self-care plan (again, with a focus on heart health), basically taking the reader by the hand for long enough that, after those 10 weeks, habits should be quite well-ingrained.
A strong idea throughout is that the things we take up should be sustainable, because well, a heart is for life, not just for a weekend retreat.
Bottom line: if you’d like to improve your heart health in a way that feels like self-care rather than an undue amount of work, then this is the book for you.
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Reduce Your Stroke Risk
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❝Each year in the U.S., over half a million people have a first stroke; however, up to 80% of strokes may be preventable.❞
~ American Stroke Association
Source: New guideline: Preventing a first stroke may be possible with screening, lifestyle changes
So, what should we do?
Some of the risk factors are unavoidable or not usefully avoidable, like genetic predispositions and old age, respectively (i.e. it is possible to avoid old age—by dying young, which is not a good approach).
Some of the risk factors are avoidable. Let’s look at the most obvious first:
You cannot drink to your good health
While overall, the World Health Organization has declared that “the only safe amount of alcohol is zero”, when it comes to stroke risk specifically, it seems that low consumption is not associated with stroke, while moderate to high consumption is associated with a commensurately increased risk of stroke:
Alcohol Intake as a Risk Factor for Acute Stroke
Note: there are some studies out there that say that a low to moderate consumption may decrease the risk compared to zero consumption. However, any such study that this writer has seen has had the methodological flaw of not addressing why those who do not drink alcohol, do not drink it. In many cases, someone who drinks no alcohol at all does so because either a) it would cause problems with some medication(s) they are taking, or b) they used to drink heavily, and quit. In either case, their reasons for not drinking alcohol may themselves be reasons for an increased stroke risk—not the lack of alcohol itself.
Smoke now = stroke later
This one is straightforward; smoking is bad for pretty much everything, and that includes stroke risk, as it’s bad for your heart and brain both, increasing stroke risk by 200–400%:
Smoking and stroke: the more you smoke the more you stroke
So, the advice here of course is: don’t smoke
Diet matters
The American Stroke Association’s guidelines recommend, just for a change, the Mediterranean Diet. This does not mean just whatever is eaten in the Mediterranean region though, and there are specifically foods that are included and excluded, and the ratios matter, so here’s a run-down of what the Mediterranean Diet does and doesn’t include:
The Mediterranean Diet: What Is It Good For? ← what isn’t it good for?!
You can outrun stroke
Or out-walk it; that’s fine too. Most important here is frequency of exercise, more than intensity. So basically, getting those 150 minutes moderate exercise per week as a minimum.
See also: The Doctor Who Wants Us To Exercise Less & Move More
Which is good, because it means we can get a lot of exercise in that doesn’t feel like “having to do” exercise, for example:
Do You Love To Go To The Gym? No? Enjoy These “No-Exercise Exercises”!
Your brain needs downtime too
Your brain (and your heart) both need you to get good regular sleep:
Sleep Disorders in Stroke: An Update on Management
We sometimes say that “what’s good for your heart is good for your brain” (because the heart feeds the brain, and also ultimately clears away detritus), and that’s true here too, so we might also want to prioritize sleep regularity over other factors, even over duration:
How Regularity Of Sleep Can Be Even More Important Than Duration ← this is about adverse cardiovascular events, including ischemic stroke
Keep on top of your blood pressure
High blood pressure is a very modifiable risk factor for stroke. Taking care of the above things will generally take care of this, especially the DASH variation of the Mediterranean diet:
Hypertension: Factors Far More Relevant Than Salt
However, it’s still important to actually check your blood pressure regularly, because sometimes an unexpected extra factor can pop up for no obvious reason. As a bonus, you can do this improved version of the usual blood pressure test, still using just a blood pressure cuff:
Try This At Home: ABI Test For Clogged Arteries
Consider GLP-1 receptor agonists (or…)
GLP-1 receptor agonists (like Ozempic et al.) seem to have cardioprotective and neuroprotective (thus: anti-stroke) activity independent of their weight loss benefits:
Of course, GLP-1 RAs aren’t everyone’s cup of tea, and they do have their downsides (including availability, cost, and the fact benefits reverse themselves if you stop taking them), so if you want a similar effect from a natural approach, there are some foods that work on the body’s incretin responses in the same way as GLP-1 RAs do:
5 Foods That Naturally Mimic The “Ozempic Effect”
Better to know sooner rather than too late
Rather than waiting until one half of our face is drooping to know that there was a stroke risk, here are things to watch out for to know about it before it’s too late:
6 Signs Of Stroke (One Month In Advance)
Take care!
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10almonds Subcribers Take The Wheel!
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❓ Q&A With 10almonds Subscribers!
Q: What kind of salt is best for neti pots?
A: Non-iodised salt is usually recommended, but really, any human-safe salt is fine. By this we mean for example:
- Sodium chloride (like most kitchen salts),
- Potassium chloride (as found in “reduced sodium” kitchen salts), or
- Magnesium sulfate (also known as epsom salts).
Q: You talked about spearmint as reducing testosterone levels, what about ginseng for increasing them?
A: Hormones are complicated and often it’s not a simple matter of higher or lower levels! It can also be a matter of…
- how your body converts one thing into another
- how your body responds (or not) to something according to how the relevant hormone’s receptors are doing
- …and whether there’s anything else blocking those receptors.
All this to say: spearmint categorically is an anti-androgen, but the mechanism of action remains uncertain.
Panax ginseng, meanwhile, is one of the most well-established mysteries in herbal medicine.
Paradoxically, it seems to improve both male and female hormonal regulation, despite being more commonly associated with the former.
- It doesn’t necessarily increase or decrease testosterone or estrogen levels (but it can, even if indirectly)
- It does improve sexual function
- …and alleviates symptoms associated with conditions as varied as:
- Late-onset hypogonadism (common for men during the andropause)
- Benign prostate hyperplasia (again common for men during the andropause)
- …and also counteracts unwanted side-effects of finasteride. Finasteride is often taken by men as a hair loss remedy or, less often but critically, in the case of an enlarged prostate.
But it also…
- Alleviates symptoms of PCOS (polycystic ovary syndrome, which effects around 20% of women)
- May even be an effective treatment for PCOS (rat model only so far)
- It also may improve female reproductive fertility more generally (the studies are down to fruit flies now though)
Bottom line: Panax ginseng is popularly taken to improve natural hormone function, a task at which it appears to excel.
Scientists are still working out exactly how it does the many things it appears to do.
Progress has been made, and it clearly is science rather than witchcraft, but there are still far more unanswered questions than resolved ones!
Q: I like that the quizzes (I’ve done two so far) give immediate results , with no “give us your email to get your results”. Thanks!
A: You’re welcome! That’s one of the factors that influences what things we include here! Our mission statement is “to make health and productivity crazy simple”, and the unwritten part of that is making sure to save your time and energy wherever we reasonably can!
Q: Do you know if adrafanil is as good as modafinil? It seems to be a lot cheaper for the same result?
A: Adrafinil is the pro-drug of modafinil. What this means is that if you take it, your own liver will use it to make modafinil inside you. So the end result is chemically the same drug.
As to whether it’s as good, it depends what you need. It’s worth noting that anything that taxes liver function can be harmful if you take too much, and/or your liver is already strained for some reason.
If in doubt, consult a doctor! And if it’s something that’s accessible to you, a recent lipids test (a kind of blood test that checks your liver health) is always a good thing to have.
Q: Would love to see your take on polyphasic sleep!
A: Watch this space
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Take Care Of Your “Unwanted” Parts Too!
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Meet The Family…
If you’ve heard talk of “healing your inner child” or similar ideas, then today’s featured type of therapy takes that to several extra levels, in a way that helps many people.
It’s called Internal Family Systems therapy, often “IFS” for short.
Here’s a quick overview:
Psychology Today | Internal Family Systems Therapy
Note: if you are delusional, paranoid, schizophrenic, or have some other related disorder*, then IFS would probably be a bad idea for you as it could worsen your symptoms, and/or play into them badly.
*but bipolar disorder, in its various forms, is not usually a problem for IFS. Do check with your own relevant healthcare provider(s), of course, to be sure.
What is IFS?
The main premise of IFS is that your “self” can be modelled as a system, and its constituent parts can be examined, questioned, given what they need, and integrated into a healthy whole.
For example…
- Exile is the name given to parts that could be, for example, the “inner child” referenced in a lot of pop-psychology, but it could also be some other ignored and pushed-down part of oneself, often from some kind of trauma. The defining characteristic of an exile is that it’s a part of ourself that we don’t consciously allow ourselves to see as a current part of ourself.
- Protector is the name given to a part of us that looks to keep us safe, and can do this in an adaptive (healthy) or maladaptive (unhealthy) way, for example:
- Firefighter is the name given to a part of us that will do whatever is necessary in the moment to deal with an exile that is otherwise coming to the surface—sometimes with drastic actions/reactions that may not be great for us.
- Manager is the name given to a part of us that has a more nurturing protective role, keeping us from harm in what’s often a more prophylactic manner.
To give a simple illustration…
A person was criticized a lot as a child, told she was useless, and treated as a disappointment. Consequently, as an adult she now has an exile “the useless child”, something she strives to leave well behind in her past, because it was a painful experience for her. However, sometimes when someone questions and/or advises her, she will get defensive as her firefighter “the hero” will vigorously speak up for her competence, like nobody did when she was a child. This vigor, however, manifests as rude abrasiveness and overcompensation. Finally, she has a manager, “the advocate”, who will do the same job, but in a more quietly confident fashion.
This person’s therapy will look at transferring the protector job from the firefighter to the manager, which will involve examining, questioning, and addressing all three parts.
The above example is fictional and created for simplicity and clarity; here’s a real-world case study if you’d like a more in-depth overview of how it can work:
How it all fits together in practice
IFS looks to make sure all the parts’ needs are met, even the “bad” ones, because they all have their functions.
Good IFS therapy, however, can make sure a part is heard, and then reassure that part in a way that effectively allows that part to “retire”, safe and secure in the knowledge that it has done what it needed to, and/or the job is being done by another part now.
That can involve, for example, thanking the firefighter for looking after our exile for all these years, but that our exile is safe and in good hands now, so it can put that fire-axe away.
See also: On Being Reactive vs Being Responsive
Questions you might ask yourself
While IFS therapy is best given by a skilled practitioner, we can take some of the ideas of it for self-therapy too. For example…
- What is a secret about yourself that you will take to the grave? And now, why did that part of you (now an exile) come to exist?
- What does that exile need, that it didn’t get? What parts of us try to give it that nowadays?
- What could we do, with all that information in mind, to assign the “protection” job to the part of us best-suited to healthy integration?
Want to know more?
We’ve only had the space of a small article to give a brief introduction to Family Systems therapy, so check out the “resources” tab at:
IFS Institute | What Is Internal Family Systems Therapy?
Take care!
Don’t Forget…
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