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Issue #31 (May 2017)

From the Editor

Volume 1

One of the most common complaints we hear about doctors is a perceived lack of nutrition knowledge. Which is somewhat true, at least to a certain extent.

But there’s also another side to this story.

Believe it or not, nutrition isn’t the only determinant of health. For sure, a somewhat healthy diet is very strongly correlated to good health. But bad health can be brought on by loads of different factors, ranging from genetic conditions to infection to injury. And what happens when you face these problems? You go to a doctor, who can have highly specialized knowledge in things ranging from pediatric anesthesiology to endovascular surgical neuroradiology. Keeping up to date on the latest nutrition studies isn’t always the most important thing for a particular doctor.

That being said, nutrition knowledge can’t hurt, so why don’t doctors spend more time learning about it? Well, let’s start with the massive information overload during medical school and residency. Joe Q. Public usually has much more time on his hands to read about nutrition than a medical student or resident, and hence has a chance of knowing more about a particular nutrition issue than the doctor they are seeing.

And therein lies a major source of dissatisfaction with our healthcare system. Only a relatively small percentage of doctors go on to practice any form of preventive medicine, and non-preventive medicine simply pays more money due to involving more procedures. It may sound like a conspiracy theory, but there’s really no way around it: those who perform procedures don’t have an incentive to push preventive care (on average), especially with our screwed up health insurance system providing additional complications.

This also happens to be a perfect time to increase nutrition literacy. Research has found in the past couple decades that nutrition plays a part in more than just chronic disease prevention. Providing quality nutrition to hospital patients improves outcomes, nutrition modifies the response to surgery and some medications, and gut health is involved in a seemingly neverending list of conditions.

So what can we do about it? Well, it depends on how you define “we”. Being involved in evidence-based nutrition is part of fighting the good fight. Beyond that, things have to change in our healthcare system in general. Which is beyond difficult, but also one of the worthiest of challenges. Incentivizing doctors to look at the broader picture of health would take a lot of changes, across a variety of different organizations both public and private. But bringing up nutrition in a smart but respectful way with your doctor is a mini-step that can’t hurt. Nobody can deny the importance of nutrition for health these days, and you never know which conversation will spur someone’s curiosity, and maybe even turn nutrition into a lifelong passion.

Kamal Patel,
Editor-in-chief, Nutrition Examination Research Digest

Volume 2

When you hear about a cool new supplement, a specific part of your brain starts firing at regular intervals. That part continues to light up, ever stronger, until you take the supplement and feel better.

This part of the brain, the ‘placebum callosum’, is responsible for the placebo effect.

Just kidding. Kind of.

There is no one section of the brain that explains the placebo effect. But the above made-up brain-related mumbo-jumbo doesn’t sound that surprising, because the placebo effect is usually brought up in very simplistic terms. “Oh, that’s just the placebo effect!” That old bugaboo that you have to control for in trials, which stupid people get duped by, and smart people bring up whenever they can.

If only the placebo effect was that simple. We know that, quite often, the placebo effect is stronger than an actual intervention effect. Anecdotally, I’ve encountered many people who are totally unversed in life sciences, who placebo themselves regularly (for example, with energy crystals), and who actually experience benefit.

How can that be? Well, just because an effect is called a PLACEBO effect doesn’t mean that it’s not a tangible, felt effect. After all, it’s not called the placebo non-effect.

There’s also a gray area between the placebo effect and other psychological effects. For example, when doctors exhibit characteristics of caring, such as putting a hand on your shoulder or asking earnest questions, it can actually make you feel measurably better. Is this a placebo? Eh … not in the traditional sense, but it can be coupled to a placebo. Like if a doctor was caring, and gave you a sugar pill, you may feel better than if a non-caring doctor gave you a sugar pill. And if the doctor was mean, you might even experience side effects from the sugar pill.

A question usually comes up when discussing placebos: can we harness the power of placebos for good? The above scenario applies well to direct care, but not so much to supplements. For supplements, just being aware of the placebo effect is probably the most important thing, and general awareness in the population would absolutely decimate the supplement industry and save billions for consumers.

There is a further step that a few crazy people, such as myself, have taken. That involves doing a controlled trial on yourself, in order to eliminate the placebo effect. Take a supplement, find one that looks like it or cap inert placebos yourself, tell a friend to assign you an intervention, and voila … you’ve got the world’s smallest controlled trial.

In absence of that craziness, just be on the lookout for placebos and their nocebo cousins. They can hide out where you’d least expect, and have almost certainly infiltrated your circle of friends and family.

Kamal Patel,
Editor-in-chief, Nutrition Examination Research Digest

See other articles in Issue #31 (May 2017) of Study Deep Dives.