Harnessing the Placebo Effect: If You Care, You’ll Lie to Me

TAGS: steroid placebos, ergogenic, mental capability, placebo effect, elitefts.com, Scott Stevenson, programming, athletic training, strongman, diet, muscle, strength, strength training, training, Nutrition


columnist author photo

What would you say if I told you that there is a singular technique for improving athletic performance in just about any way you want? You want more strength, more endurance, greater pain tolerance? You name it and you can have it. I’m talking about one simple strategy, a magic bullet, that you can use to break past previous performance barriers whatever your chosen sport. Perhaps best of all (I know what you’re thinking), this performance panacea is undetectable through any form of (body fluid analysis-based) drug screening ever.

Such a “super supplement” exists, but it isn't a drug, technically speaking. Like many things in life, it’s a matter of what you make of it. I’m referring to a placebo, the famous “sugar pill” that is used as a “control” condition in many scientific experiments to account for the general effects of administering a substance or treatment.

Experiments and Mind Tricks

From a scientific perspective, placebos are designed to parcel out the impact of a treatment per se (the placebo effect) from the specific effects of the (experimental) treatment under investigation (1, 2). This is important in clinical medicine because, depending on how it's presented, the placebo effect may account for 50 percent of how well something as simple as a pain pill works and the more an individual believes that he has received a medication (real or not), the greater the effect (3).

From a psychological perspective, one can conceptualize the placebo effect as a matter of what one expects to happen, a self-fulfilling prophesy of sorts or “expectancy” that can be conditioned such that one simply believes he is more capable (4, 5). Indeed, it seems that we are quite amenable to placebo, and this is a function of a variety of psychosocial and physiological factors (6–10).

For instance, advertising may be responsible for the recent increased effectiveness of placebos in treating depression (11, 12). The simple power of suggestion can dictate whether the same (otherwise) inert placebo is perceived as a sedative or a stimulant (1, 13–15). Placebo effects have distinct biological manifestations, too, perhaps the most studied of which are pain-reducing effects that can be reversed by drugs that block our bodies’ natural opiates (6).

One’s personal experiences, positive or negative, can strongly diminish or enhance a given placebo effect (2, 16, 17). That is, placebo effects can be so strongly conditioned (9, 16–18) that some would call them learned responses (19).

A photo posted by Kevin McHugh (@mchuge655) on

Consider this for a moment. Could it be that one’s previous positive experiences with a supplement, brand or manufacturer might self-perpetuate as a placebo effect over time, even if product quality and efficacy deteriorate? Veterans of the health, fitness, strength and power communities have probably known a company (or two) with initially good products and customer loyalty that “goes sour” and starts cutting corners to increase profit margin. 

So How Good Are These Lies?

How strong is the placebo effect, really? Two recent meta-analyses (a statistical procedure for evaluating multiple studies in a given area all at once) both found that placebos can have a substantial effect on human performance (1, 20). In fact, one meta-analysis found that compared to control condition (no supplement at all), there was no statistical difference between the effects of nutritional placebo and the actual nutritional supplement being tested (20).

In other words, in the context where supplements are being provided, in some cases, both placebo (active ingredients or not) and real nutritional supplement may be equally ergogenic compared to getting no supplement at all. Heck, another meta-analysis suggests that “placebo” may account for about half of the psychological benefits of exercise training in general (21).

OK Then Lie to Me

It’s thought that an athlete’s particular knowledge of a supplement or drug may amplify associated placebo effects and that placebo effects may be greater in those less trained (22). Let’s take carbohydrates, a well-documented ergogenic aid during endurance exercise (23) such as cycling bouts (“time trials”) lasting about an hour (24–26).

As it turns out, simply telling cyclists that they are drinking a carbohydrate supplement improves performance during this kind of exercise test, perhaps even more so when they're provided a placebo than when given a real carbohydrate [approximately 7 percent versus 2 percent power improvements (27)]. The placebo effect isn't as strong, however, in more advanced cyclists, who have more reliable performances overall (27). On the flip side, being told that one has received a placebo or was “blinded” (no knowledge) may actually eliminate the otherwise (potential) ergogenic effect of consuming real carbohydrates (27).

Similarly, caffeine has a well-documented track record as an ergogen (28), which makes it a good candidate for placebo effects. During an approximately one-hour cycling time trial, where caffeine increases cycling power (+3.5 percent ), receiving a placebo presented as a caffeine increased performance nearly as much (+2.6 percent) whereas the deflating (and truthful) news that one wasn't receiving caffeine produced a negative impact (i.e. nocebo) effect on power output [-1.9 percent (29)].

Even more fascinating is that there may be a dose-response curve to the placebo effect of caffeine. Being told that one was receiving caffeine at doses of 0, 4.5 and 9.0 g/kg produced ergolytic (-1.4 percent) and graded ergogenic (1.3 and 3.1 percent) effects, respectively, on 10-km cycling power output (30).

woman is examine a bottle of homeopathic medicine, placebo effect

Them Thar Steeroids Will Make You Strong for Sure!

And what about strength sports? How amenable are weight training athletes to placebo effects? (You probably already know the answer, but allow me to elaborate.) The members of a team of national level powerlifters (previously naïve to steroid use per official pre-competition statements) approached their coach about anabolic androgenic steroid (AAS) use, thus prompting an interesting study (31). (In case you’re wondering, the weakest of these athletes was 175 pounds with a mere 400-pound raw bench press.) After baseline testing, all lifters were given two “steroid” (placebo) pills just before a mock meet. This alone improved their big three total (bench, squat and deadlift) by approximately 40–80 pounds.During the next week, they all trained together as a team while continuing to take placebos that they believed were steroids. (They all reported enhanced training vigor while setting gym personal records.) Just before retesting, half of the team was given another “steroid” placebo dose.

Those athletes further increased their big three total by approximately 60–80 pounds over the pre-test. The rest of the competitors were told the truth about the placebo trickery just before retesting but were still given the option to take the placebo. (Most declined, of course.) Not surprisingly, the truth hurts. The lifters “in the know” only managed to improve their big three total by about 20–30 pounds even after a week of placebo-enhanced training.

So steroid placebos seem to work acutely, but what might the benefits be if one trains while “on” them? After four months of five days a week of weight training [which would minimize acute neural adaptations (32)], male varsity athletes at the University of Massachusetts were tested on the bench press, squat, military press and other exercises (33). Fifteen of these athletes volunteered for a seven-week “most improved lifter” contest, the winner of which would receive (you guessed it) anabolic steroids. During recruitment, the potential volunteers were given a formal presentation by the director of University Health Services on the positive physiological effects of AAS. With this in mind, strength gains were significant among those competing to win the anabolic prize. The lucky six winners were then given a coveted “10-mg dose of Dianabol” to use daily while training for a final test four weeks later.

At a time deep into the off-season when one might otherwise have expected strength gains to be leveling off, just the opposite happened. In just a month, the placebo-inspired athletes managed to more than triple the combined strength gains they made during the preceding seven-week contest on the squat, bench press and overhead press (33).

What’s the Best Lie to Tell?

What’s the most ergogenic way to create a placebo effect? Well, the effectiveness of a placebo seems to boil down to what the individual believes (7), which can be manipulated in various ways. A seasoned athlete may have considerable knowledge of a substance’s purported effects (such as in the steroid studies mentioned above), which could amplify the placebo effect (1, 22). (Recall also that highly trained athletes have more reliable performances, which may mean less potential for a placebo effect (27, 30, 34).) Placebos can be “designed” to impact performance to varying degrees and directions. The placebo effect is greatest when subjects are explicitly misinformed that the placebo is an active supplement or medication (1, 27, 35). This is especially true when the verbal suggestion is a strong one (35). Both positive and negative (nocebo) effects on performance and perception of effort are possible, depending on whether or not the subject/athlete is told that a substance should improve or impair performance (36, 37).

Of course, the placebo effect is reversible when the cat’s let out of the bag (22, 31). Placebo effects can be fine-tuned in various ways as well. The perception of pain during training can be dampened with an actual drug [morphine (18)] or a properly presented placebo (16), thereby “preconditioning” an athlete for a powerful placebo effect (no prohibited drug necessary) during competition where pain endurance could be at a premium (18). (Imagine any number of Strongman events here, for instance.)

Not surprisingly, administering a placebo via injection proved an effective means of ergogenesis in a recent study (38), but a hologram wristband (where the mechanism of action was ambiguous) proved useless (39). Even recovery effects may be placebo-mediated. Cold water immersion is a biologically feasible means of preventing post-exercise strength loss (40) but was no more effective than a carefully presented placebo treatment using thermoneutral, bubbly water that contained nothing more than regular old bath soap (41). 

A photo posted by @2xlpowerlifting on

It’s All in My Mind?

Exercise physiologists are known to sometimes refer to the brain as a “black box,” better left to exercise psychologists and motor control specialists to wonder about. However, the historical focus in the exercise physiology literature on a physical limitation to human performance and fatigue has been called into question recently (42). With several supporting lines of evidence, it has been suggested that the ultimate limitation to human performance is what might be even considered “emotion" (43), a product of the central nervous system acting as a “central governor” to prevent bodily self-harm during extreme physical efforts (44). Indeed, the efficacy of placebos, which act purely psychologically, supports the notion that peak physical performance may ultimately be limited by our minds (9, 45).

Lying Your Way to Victory?

A pair of recent studies revealed the attitudes of elite level coaches and athletes about placebos. Most coaches are aware of the placebo effect, have administered a placebo (especially at the international level) and feel that placebos should be used more widely. However, only 15 percent of coaches would use a placebo a second time without revealing the deception to the athlete (46). Similarly, most elite athletes recognize the power of placebos and would accept one from his/her coach and two-thirds of the athletes would even welcome a deceptive placebo if it were effective (47).

However, there are potential “risks” involved with administering placebos. Deception-based strategies aren't always ergogenic, even in carefully controlled scientific studies (48). If a placebo strategy were ineffective, this might engender negative (nocebo) perceptions that could condition an athlete negatively toward what might otherwise be an effective supplement or strategy. (Imagine the impact on an Ironman-level triathlete who develops a negative perception of the usefulness of carbohydrate supplementation.) More generally, athletes may resent being deceived, causing loss of trust that negatively affects coach-athlete interactions (2).

An Ethical Dilemma?

To placebo or not to placebo? That is perhaps a question each coach may ultimately have to answer individually. To facilitate that decision, one might ponder the following:

  • Given the potentially placebo-inducing advertising in the sport, health, and fitness industry (think sleazy advertising), should the coach consider it part of his job to influence his athlete’s perceptions of supplements?
  • Is lying to athletes morally defensible if one’s intentions are good, especially if most high level athletes are willing to be deceived if it would improve performance (47)?
  • If one could condition drug-like (analgesic) effects that persist in competition by delivering a placebo (without administering an illicit substance), should this be considered doping (18)?
  • Is the intrinsic value of training and competing—the deep satisfaction, personal growth and other internal goods an athlete gets from competition—inextricably linked to “unassisted” conscious awareness of one’s efforts, or does winning at all costs matter more so (regardless of deception)? (By extension, if one could win a competition only when in a state of hypnosis, performing the otherwise impossible, and have no recall of the event, would this degrade the value of the victory when waking up from the trance?)

As a closing comment, please feel free to contact us here at elitefts™ regarding our new Play-See-Go! line of nutritional supplements, engineered to enhance athletic and cognitive performance of any kind, under any and all circumstances. We will be providing customized, optimized and strategically designed ergogenic and/or nootropic solutions perfectly configured to match each athlete’s individual physiology and psychology. All of these products will taste and look just like table sugar. We guarantee it or your money back!


 

Screen Shot 2015-05-27 at 1.55.06 PM

Disclosure: Elitefts does not profit from the sales of The Fortitude Training eBook or traffic to Scott Stevenson's website. We choose to share his work, products, and services simply because we believe he is among the best coaches in the industry.  - Dave Tate


 

References

  1. Bérdi M, et al (2011) Placebo effects in sport and exercise: A meta-analysis. European Journal of Mental Health 2:196–212.
  2. Turner JA, et al (1994) The importance of placebo effects in pain treatment and research. JAMA 271(20):1609–14.
  3. Kam-Hansen S, et al (2014) Altered Placebo and Drug Labeling Changes the Outcome of Episodic Migraine Attacks. Science Translational Medicine 6(218):218ra5.
  4. Peck C, Coleman G (1991) Implications of placebo theory for clinical research and practice in pain management. Theor Med 12(3):247–70.
  5. Bandura A (1977) Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev 84(2):191–215.
  6. Price DD, et al (2008) A comprehensive review of the placebo effect: recent advances and current thought. Annu Rev Psychol 59:565–90.
  7. Beedie CJ (2007) Placebo Effects in Competitive Sport: Qualitative Data. Journal of Sports Science & Medicine 6(1):21–8.
  8. Fiorio M, et al (2014) Placebo-Induced Changes in Excitatory and Inhibitory Corticospinal Circuits during Motor Performance. The Journal of Neuroscience 34(11):3993–4005.
  9. Pollo A, et al (2011) Placebo mechanisms across different conditions: from the clinical setting to physical performance. Philos Trans R Soc Lond B Biol Sci 366(1572):1790–8.
  10. Piedimonte A, et al (2015) Placebo-induced decrease in fatigue: evidence for a central action on the preparatory phase of movement. Eur J Neurosci 41(4):492–7.
  11. Walsh BT, et al (2002) Placebo response in studies of major depression: variable, substantial, and growing. JAMA 287(14):1840–7.
  12. Robinson DS, Rickels K (2000) Concerns about clinical drug trials. J Clin Psychopharmacol 20(6):593–6.
  13. Frankenhaeuser M, et al (1963) Psychophysiological reactions to two different placebo treatments. Scandinavian Journal of Psychology 4(4):245–50.
  14. Blackwell B, et al (1972) Demonstration to Medical Students of Placebo Responses and Non-Drug Factors. The Lancet 299(7763):1279–82.
  15. Bootzin RR, et al (1976) The power of suggestion: another examination of misattribution and insomnia. J Pers Soc Psychol 34(4):673–9.
  16. Voudouris NJ, et al (1989) Conditioned response models of placebo phenomena: further support. Pain 38(1):109–16.
  17. Voudouris NJ, et al (1990) The role of conditioning and verbal expectancy in the placebo response. Pain 43(1):121–28.
  18. Benedetti F, et al (2007) Opioid-Mediated Placebo Responses Boost Pain Endurance and Physical Performance: Is It Doping in Sport Competitions? The Journal of Neuroscience 27(44):11934–9.
  19. Colloca L, Miller FG (2011) How placebo responses are formed: a learning perspective. Philosophical Transactions of the Royal Society B: Biological Sciences 366(1572):1859–69.
  20. Rawdon T, et al (2012) Meta-analysis of the placebo effect in nutritional supplement studies of muscular performance. Kinesiology Review 1:137–48.
  21. Lindheimer JB, et al (2015) Quantifying the Placebo Effect in Psychological Outcomes of Exercise Training: A Meta-Analysis of Randomized Trials. Sports Medicine 1–19.
  22. Kalasountas V, et al (2007) The Effect of Placebo-Induced Changes in Expectancies on Maximal Force Production in College Students. Journal of Applied Sport Psychology 19(1):116–24.
  23. Jeukendrup AE (2010) Carbohydrate and exercise performance: The role of multiple transportable carbohydrates. Curr Opin Clin Nutr Metab Care 13(4):452–7.
  24. Below PR, et al (1995) Fluid and carbohydrate ingestion independently improve performance during 1 h of intense exercise. Med Sci Sports Exerc 27(2):200–10.
  25. el-Sayed MS, et al (1997) Carbohydrate ingestion improves endurance performance during a 1 h simulated cycling time trial. J Sports Sci 15(2):223–30.
  26. Jeukendrup A, et al (1997) Carbohydrate-electrolyte feedings improve 1 h time trial cycling performance. Int J Sports Med 18(2):125–9.
  27. Clark VR, et al (2000) Placebo effect of carbohydrate feedings during a 40-km cycling time trial. Med Sci Sports Exerc 32(9):1642–7.
  28. Tarnopolsky MA (2008) Effect of caffeine on the neuromuscular system—potential as an ergogenic aid. Appl Physiol Nutr Metab 33(6):1284–9.
  29. Foad AJ, et al (2008) Pharmacological and psychological effects of caffeine ingestion in 40-km cycling performance. Med Sci Sports Exerc 40(1):158–65.
  30. Beedie CJ, et al (2006) Placebo Effects of Caffeine on Cycling Performance. Medicine & Science in Sports & Exercise 38(12):2159–64.
  31. Maganaris CN, et al (2000) Expectancy effects and strength training: do steroids make a difference? Sport Psychologist 14(3):272–8.
  32. Moritani T, deVries HA (1979) Neural factors versus hypertrophy in the time course of muscle strength gain. Am J Phys Med 58(3):115–30.
  33. Ariel G, Saville W (1972) Anabolic steroids; The physiological effects of placebos. Med Sci Sports 4(2):124–6.
  34. Beedie CJ, Foad AJ (2009) The placebo effect in sports performance: A brief review. Sports Med 39(4):313–29.
  35. Carlino E, et al (2014) The effects of manipulating verbal suggestions on physical performance. Zeitschrift für Psychologie/Journal of Psychology 222(3):154–64.
  36. Beedie CJ, et al (2007) Positive and negative placebo effects resulting from the deceptive administration of an ergogenic aid. Int J Sport Nutr Exerc Metab 17(3):259–69.
  37. Bottoms L, et al (2014) The placebo and nocebo effects on peak minute power during incremental arm crank ergometry. Eur J Sport Sci 14(4):362–7.
  38. Ross R, et al (2015) The Effects of an Injected Placebo on Endurance Running Performance. Medicine & Science in Sports & Exercise. Publish Ahead of Print.
  39. Brazier J, et al (2014) The effects of hologram wristbands and placebo on athletic performance. Kineziologija 46(1):109–16.
  40. Bleakley CM, Davison GW (2010) What is the biochemical and physiological rationale for using cold-water immersion in sports recovery? A systematic review. Br J Sports Med 44(3):179–87.
  41. Broatch JR, et al (2014) Post-exercise cold water immersion benefits are not greater than the placebo effect. Med Sci Sports Exerc 46(11):2139–47.
  42. Noakes TD, St Clair Gibson A (2004) Logical limitations to the "catastrophe" models of fatigue during exercise in humans. Br J Sports Med 38(5):648–9.
  43. Noakes TD (2012) Fatigue is a brain-derived emotion that regulates the exercise behavior to ensure the protection of whole body homeostasis. Frontiers in Physiology 3.
  44. Noakes TD (2011) Time to move beyond a brainless exercise physiology: the evidence for complex regulation of human exercise performance. Appl Physiol Nutr Metab 36(1):23–35.
  45. Carlino E, et al (2014) The effects of placebos and nocebos on physical performance. Handb Exp Pharmacol 225:149–57.
  46. Szabo A, Müller A (2015) Coaches' attitudes towards placebo interventions in sport. European Journal of Sport Science 1–8.
  47. Bérdi M, et al (2014) Elite athletes' attitudes towards the use of placebo-induced performance enhancement in sports. European Journal of Sport Science 15(4):315–21.
  48. Williams EL, et al (2014) Deception studies manipulating centrally acting performance modifiers: a review. Med Sci Sports Exerc 46(7):1441–51.

Screen Shot 2015-05-27 at 1.55.06 PM

Disclaimer: Elitefts does not profit from the sales of The Fortitude Training eBook or traffic to Scott Stevenson's website. We choose to share his work, products, and services simply because we believe he is among the best coaches in the industry.

Loading Comments... Loading Comments...