Think Sick—Be Sick: The Nocebo Effect

Some call it the “placebo’s evil twin.” But the nocebo effect is real, and it really can make you sick. While a placebo effect (Latin for “I shall please”) refers to health benefits produced by a treatment that should have no effect, people experiencing a nocebo effect (Latin for “to do harm”) experience the opposite. They presume the worst health-wise, and that’s what they get.

A nocebo response occurs when the suggestion of a negative effect leads to an actual negative outcome. Patients who expect distressing side effects before taking a medication or from a procedure are more likely to develop them. But the nocebo effect is more than just the power of suggestion—it can lead to actual physical consequences. The stress alone created by the nocebo effect can actually have a long-lasting impact on a person’s overall health.

Why are we even talking about the nocebo effect? Why would anyone want to put someone in a negative frame of mind that can result in an adverse effect on health and well-being? Well . . . we do it to ourselves all the time. We tell ourselves, “It’s too hard to find time to become more physically active.” We tell ourselves, “We can’t lose weight; that we’ve tried and failed too many times.” We tell ourselves, “We are destined to be the way we are,” and we give up. All this negative self-talk becomes self-fulfilling.

But consider what happens when we practice positive self-talk. When we tell ourselves, “I am worth it. I can do this. I can make this happen,” guess what? We are, we can and we do.

Here’s one final question—or three: What do we do once we understand the placebo / nocebo effects and problems? Will we adjust our expectations accordingly? Can we defeat the effects of negativity by simply being aware of them? Maybe it all comes down to “mind over mind”—think well, be well.

I “Kid” You Not

The percentage of children who are obese has more than doubled, and among adolescents the rates have more than tripled since 1980. Obesity is a risk factor for chronic health conditions such as type 2 diabetes, heart disease and metabolic syndrome. So, what does this have to do with breakfast cereals?

If you have kids, if they eat cereal, and if that cereal is directly marketed to kids, keep reading.

A recent study finds kids’ cereals contain 85 percent more sugar, 65 percent less fiber and 60 percent more sodium than adults’ cereals. The report by Yale University's Rudd Center for Food Policy and Obesity was funded by Robert Wood Johnson Foundation and the Rudd Foundation.

The worst offenders:

1. Reese’s Puffs

2. Corn Pops

3. Lucky Charms

4. Cinnamon Toast Crunch

4. Cap’n Crunch (tied)

6. Trix

6. Froot Loops (tied)

6. Fruity and Cocoa Pebbles (tied)

9. Cocoa Puffs

10. Cookie Crisp

In case we didn’t already suspect, we now find that the least healthy breakfast cereals just happen to be the cereals most marketed to children. In fact, children are exposed to marketing of highly-sugared cereals more than for any other packaged food—to the tune of more than $156 million a year. The average preschooler sees 642 cereal ads each year, with most ads promoting those cereals with the worst nutritional ratings (and these are just the ads on television). The average child on the internet spends an average of 23.7 minutes per visit on General Mills’ Millsberry.com website, which boasts an average of 767,000 young visitors per month.

Now, you might be thinking something like “my kids won’t eat cereal that isn’t a pretty color with a cute name or funny shape.” Research shows they will. In a related study, Yale researchers found kids tend to eat about one serving (one cup) of low-sugar cereal, while those eating highly-sweetened cereals ate an average of two servings (two cups)—BUT—they rated the taste of both types equally high.

You might also be thinking, “this is just cereal. Big deal.” It actually is a big deal. Due to their earlier stage in cognitive development, children are more influenced by marketing. It’s harder for children to distinguish differences between entertainment and marketing content on television. In addition, lifelong taste preferences are established in childhood.

Yes, we’re focusing here on cereal, but we’re also talking marketing and influencing behavior. What if we tried to influence more positive behaviors and choices? Shouldn’t foods marketed to children be held to a higher standard? Doesn’t it make sense that this might be a good place to begin to address the causes of and ways to prevent childhood obesity? Here’s the kicker: Why don’t we?

Bad Mood, Food . . . and Stress

We all live hectic, busy lives. It seems almost as if our very culture and society prime us for self-neglect—rewarding us for being constantly on the go, hard at work, and for placing ourselves last in the chain on our list of things to pay attention to every day.

The result—stress and mood swings, sometimes from bad mood to worse mood. And herein lies the “food connection,” both good and bad. Can what you eat affect your mood? Can your diet be part of the equation to reduce stress?

Think about what you eat and how it makes you feel. This is what we call mindful behavior. Omega-3 fatty acids, magnesium, tryptophan, folate and other B vitamins, low glycemic foods, and (yea! even chocolate) have all been studied to determine their impact on mood. These are the same nutrients and foods that are part of a healthy diet. And, we all know, or should know, that when you eat a healthy diet, your body benefits. Eating fruits, vegetables, nuts and whole grains throughout the day fuels your body and helps keep your blood sugar at a healthy level. You’re getting vitamins, minerals, antioxidants and phytonutrients, and you’re not getting them from a pill.

There’s more at work—combining healthy, simple carbohydrates and proteins enhances the availability of serotonin in your brain, a neurotransmitter said to have a calming effect, influencing mood, appetite, sleep, memory and learning, temperature regulation, and some social behavior. It can also affect the functioning of the cardiovascular system, muscles, and various elements in the endocrine system (in fact of our 40 million brain cells, most are influenced directly and indirectly by serotonin). So now you receive an additional mood boost by just knowing you are taking care of yourself out there in the “food chain.”

Now turn it around and think about those foods and behaviors you associate with a stressed-out lifestyle. Does this sound familiar? Someone you might know at work, sleep-deprived, gulping down caffeine and shoveling in fast food and snacks from vending machines, all the while on the run? Now you have a vicious cycle of stress, food and mood. Stress leads to sleeping less, which leads to more caffeine and sugar for a quick fix, followed by the unavoidable crash and need for another fix. Add to the mix skipping regular meals, substituting “real” food with packaged or fast food, and no time or energy for physical activity. The toll is physical and mental stress. And so the cycle continues.

Most of us have been there. But have most of us figured out how to break out of this cycle? Have you? We’d like to hear from you.

Brain Snacks: A Few Nourishing Thoughts

Americans spent $11 billion last year in the self-help market. We think we’re buying solutions. We hope we’re improving ourselves. What we’re buying a lot of is—image. The image of who we want to become.

People spend a lot of time working on developing strengths, correcting weaknesses and learning new skills. And, while all of these things are valuable and necessary to realize that image of who we want to become, it's important not to forget about nourishing and investing in our own health and wellness (something we know a little about)—and we don’t need to spend anywhere close to $11 billion to do just this.

So, here are a few “brain snacks” with some nourishing tips:

• Americans consume an average of 250 more calories per day than they did two decades ago. That's 26 extra pounds to burn off every year just to stay even.
• People tend to eat an average of 28 percent more calories when snacking on low-fat foods. Low fat is not necessarily low calorie. When food marketers eliminate the fat, they often make up for it with sugar.
• Americans are swallowing on average 22 teaspoons of sugar each day. Most women should be getting no more than 6 teaspoons a day, or 100 calories, of added sugar—the sweeteners and syrups that are added to foods during processing, preparation or at the table. For most men, the recommended limit is 9 teaspoons, or 150 calories.
• A 12 oz. can of sweetened soda contains 150 calories and 10 teaspoons of sugar that do nothing at all to satisfy hunger.
• Just one can of soda a day can pile on 15 pounds in a single year. The average American drinks about 2 cans of soda per day. By cutting soda and those 300 calories, you could save 8,400 calories in four weeks—and lose about 2.4 pounds. And, this means you haven’t consumed the equivalent of nine cups of sugar!
• You would have to walk 10 miles a day to lose the same weight as reducing your food intake by 1,000 calories.
• Cutting just 100 calories per meal (as few as two to three bites) can prevent the average American’s annual two pound weight gain.
• All calories and all fats are not created equal. Foods with good fats, such as avocados, walnuts and salmon, can be beneficial and help stave off hunger without clogging your arteries.
• If we retain only an extra 50 calories per day, it can lead to an extra 5 pounds of weight gain per year (25 pounds in 5 years).

We can all do this much. And, at the same time we’re improving our health, we’re proving to ourselves that we have control over who and what we hope to be. You can’t buy the solution—but you can create it yourself. And that truly is a nourishing thought.

Changing the Status Quo . . . Taking Control . . . and “Diabesity?”

We all agree health care costs are out of control. Many also agree, so is health care itself. But health—that’s another story. To greater and lesser degrees, we do have control over our own health. This brings us to what we are calling: Diabesity. And this is only one example of a mostly preventable chronic illness.

Type 2 diabetes is a chronic disease which, through its complications, has a serious impact on the quality of life of individuals and their families through premature illness and death. Diabetes is closely related to obesity and overweight which now affects more than 65 percent of our population, meaning it has a major effect on both individual and national productivity. It is also largely preventable.

Population Health Management points out that twenty-four million Americans have diabetes or pre-diabetes, at a cost to our nation of an estimated $218 billion. About 25 percent of Americans with diabetes aren’t even aware they have the disease. In fact, undiagnosed diabetes now costs us $18 billion each year. As for pre-diabetes (precursor to type 2 diabetes), the numbers are also staggering: Pre-diabetes affects an estimated 57 million Americans and costs our nation more than $25 billion a year in increased medical costs.

• Each day in the United States, there are 4,100 new diabetes cases and 810 deaths from the disease. Also every day, about 230 diabetes patients suffer amputations, 120 suffer kidney failure and 55 go blind. (Dr. Robert E. Ratner of the MedStar Research Institute in Washington)
• More than 80% of people with diabetes are overweight or obese. (CDC)
• Obesity is the second leading cause of preventable death in the U.S. (CDC)
• The incidence of diabetes has increased by 6 percent annually for the past decade. (American Diabetes Association)
• Annually, an employee with diabetes will cost $13, 243 on average, while an employee without diabetes costs only $2,560 on average. (Diabetes America)
• A weight gain of 11 to 18 pounds increases a person's risk of developing type 2 diabetes to twice that of individuals who have not gained weight. (CDC)
• Among the controllable risk factors for Type 2 diabetes are obesity, high blood pressure, abnormal cholesterol levels and physical inactivity. (NIDDK)

So, here’s the real rub. We’re not picking on people with diabetes—we’re talking about actions we can all take to control health care costs and our own health—and avoiding type 2 diabetes is a great place to start. Type 2 diabetes can be largely prevented by losing weight through improved nutritional choices, and increased physical activity. As for prevention spending—A study by the National Changing Diabetes® Program found the federal government spent nearly $80 billion more on those with diabetes than those without the disease, and only $4 billion of that was spent on prevention and health promotion.

This is a good example of when maintaining the status quo is not a good thing. It’s also a good example of what a really big change we can make—all by ourselves—no government, no policy intervention, no lobbyists—just each one of us. Are you with us?

Broccoli—The Bi-Partisan Vegetable

OK. The bi-partisan tag might be stretching it a little, but this seems to be an era of extreme partisanship, so, stay with me here, this is kind of fun. Like many things in life, we love it, we hate it, we tolerate it, we ignore it. Yes, we even shun it and speak ill of it. But, no matter how you feel about it—that doesn’t change the fact that it’s good for you. You can eat it raw, with dip, stir-fried, steamed, roasted, in a frittata, in a casserole, in soup, hot or cold. There’s something here for everyone. And, no matter how you eat it, here’s what broccoli offers:

• It packs the most nutritional punch of any vegetable.
• It encourages production of enzymes which protect blood vessels.
• These same enzymes reduce high levels of molecules which cause cell damage.
• Broccoli helps the body produce the protein, thioredoxin, which protects against cell damage in the heart.
• It contains sulforaphane, a compound found to be effective in triggering this protection process and increases the activity of a group of enzymes in our bodies that squelch cancer-causing agents.
• Broccoli is a high fiber vegetable. Half of its fiber is insoluble and half is soluble, helping to meet our needs for both types of fiber
• Broccoli provides a high amount of vitamin C, which aids iron absorption in the body, prevents the development of cataracts, and also eases the symptoms of the common cold.
• The potassium in broccoli aids those battling high blood pressure, while its large amount of calcium helps combat osteoporosis.
• The substances responsible for the green and purple colors of broccoli, vitamin C, beta-carotene and other vitamins and minerals, particularly selenium, copper, zinc and phosphorus, are great immune-strengtheners.
• Due to its high fiber content and low sugar, broccoli helps fight the war on diabetes. The fiber helps keep blood sugar low and as a result insulin can be kept to a minimum.

What’s not to love?

So, to recap, on the one hand we have a vegetable that really is good for us—and has proven protective health benefits. It’s relatively inexpensive as vegetables go, and as long as it’s not overcooked (lightly steamed or raw is best), it truly “reaches across the table.”

It’s not an exciting or glamorous food—but it’s a great food choice. Working more of these “good” choices into our diets will go far in our quest to live healthier lives, and ensure our children live healthier and longer lives.

I’m not saying broccoli is the answer to health care reform, but I am saying it’s something we can all embrace for the health benefits. Whatever our political differences, broccoli is beyond doubt, a bi-partisan vegetable. Like it or not, I think we can all agree on that. So, bring on broccoli reform.

Oil and Water Don’t Mix

Tap water or bottled water? Is there a difference? Well, bottled water is convenient, easy to carry around and shows you are a health-conscious person. You also have to pay for it, and the trendy plastic container. Depending on how much water you drink, it can run you several hundred dollars a year—or more. On the other hand, you have tap water. Tap water is kind of boring, and you have to use a glass to drink it, then you have to wash the glass. It’s also free and has passed strict national, state and local quality guidelines.

If you choose Coca-Cola’s Dasani or Pepsi’s Aquafina water you get tap water with minerals added in—water from the bottling plant’s municipal water source. So, other than the cost and the fact that you’re really drinking tap water with a fancy name is there a downside to drinking bottled water? Actually—maybe.

The well-known environmental group, Natural Resources Defense Council (NRDC) tested 1,000 bottles of water over a 4-year period. They found that 22 percent of the brands tested contained, in at least one sample, chemical contaminants at levels above state health limits.

And then there’s the water / oil connection.

Most plastic water bottles are made with polyethylene terepthalate (PET). To make PET, you need oil. About 17 million barrels of oil a year are used to make those disposable water bottles. And, research from the Container Recycling Institute shows that about 86 percent of the 30 billion PET water bottles sold every year end up in the trash, taking somewhere between 400 and 1,000 years to degrade.

So back to the original question—it seems as if there are actually some big differences between drinking bottled and tap water—other than the fact that a lot of the water itself is pretty much the same. My take: I’m happy washing the glass.