Quick Hit Summary

A placebo is a phony substance that is given to someone who believes it to be the real thing. A placebo effect occurs when a phony substance gives the user the same results one would expect from the “true” substance. Clever marketing campaigns increase the likelihood of a placebo. Many worthless supplements provide amazing results simply due to the placebo effect. Not everyone will respond to the placebo effect; 2 individuals can take the same "shady" product and only one may benefit.

The Placebo Effect

In previous articles, I’ve discussed the importance of researching nutritional supplements prior to buying them. When scrutinized by the savvy eye, many supplements fail to live up to their marketing hype. Heck, even products that contain legitimate ingredients can be a cause for concern when packaged as part of a propriety blend (Proprietary Blends – Deception or Protection?). I know all the readers here at CasePerformance.com are well educated and would never fall for any of these tricks! However, maybe one of your workout partners is less informed.

Figure 1 Are you scratching your head over the amazing results obtained by a friend after taking a bogus supplement?

Let’s pretend that you’ve been lifting with Jack/Jill since you were in your mid 20’s. You’re now approaching your upper 30’s. Things are still going well for the both of you, albeit your training intensity and max strength levels have taken a bit of a hit. One day, Jack/Jill walks into the weight room and boasts about a new supplement he/she’s taking. Not thinking much of it, you nonchalantly say “cool” and continue your workout. However, over the course of the next two weeks, Jack/Jill lifts with the vigor of someone still in their 20’s. Like any inquiring mind, you ask, “What is the name of that product you’re taking?"

Jack/Jill replies, “Ultra-Jacked Muscle Extreme. I saw an advertisement for it while reading the most recent issue of Muscle Mania Express. You should see the before and after photos of those who’ve already used the supplement. The strength gains and body composition changes made by those promoting the product was incredible! After seeing the ad, I bought a 2.5 lb container for $55. It has done wonders for both my energy levels and ability to recover between workouts."

{Please note that Ultra-Jacked Muscle Extreme and Muscle Mania Express are both fictitious names that I created for this article}

Sounds impressive but you’ve never heard of it before. Upon returning home, you make use of the skills learned in one of your favorite CasePerformance articles (Evaluating Dietary Supplements) and research the ingredients of Ultra-Jacked Muscle Extreme. Upon careful review, you realize that many of the ingredients included in the supplement are not supported by scientific literature. The product does contain creatine monohydrate. However, upon looking at the supplement label a little closer you notice that the recommended daily serving contains only 1.5 grams of creatine monohydrate, far less than the amount used in supportive scientific research studies. You say to yourself, “This supplement is complete CRAP! How the heck is Jack/Jill training with such intensity? Is Ultra-Jacked Muscle Extreme secretly laced with steroids?"

I’ll let you in on a little secret to help you understand what is probably going on in your friend’s case. He/she is likely to be experiencing the placebo effect. What the heck is this you ask? Read on and find out!

The Placebo Effect and Nutritional Supplements

A placebo is a phony substance that is given to someone who believes it to be the real thing. For instance, let’s say I gave you 2 pills and informed you that they were both caffeine energy pills, even though one was simply filled with indigestible fiber. The capsule containing fiber would be the placebo. Now if you took the fiber pill (thinking it was a “true” energy pill) and experienced a great boost in energy, you’d be a victim of the placebo effect. In other words, despite taking a phony pill, you got the same physical and perceptual response that you were expecting to receive from the energy pill. Placebos can be extremely powerful, mimicking the physical effects of a true substance all the way down to the hormonal level¹. Talk about the power of thought taking over the body! Don’t believe me? Take a look at these research studies.

Study #1

In a study completed Pollo et al., 22 recreationally active college men had the work output of their quadriceps (front thigh muscles) measured on 2 separate occasions². During the first session, participants completed leg extensions (intensity set at 60% of 1 rep max) until failure. 3 days later, the procedure was repeated. However, 11 of the participants were given a placebo caffeine supplement. Additionally researchers suggested to those receiving the placebo caffeine that it would enhance performance. At the end of the trial, it was found that those who thought they were receiving the high dose caffeine experienced an 11% greater work output during the 2nd session. In contrast, no significant differences in work output were noted between sessions amongst those who failed to receive the placebo caffeine pills.

Study #2

The affects of steroid placebos on muscle strength levels in 11 national level power lifters was assessed by Maganaris et al³. In their study, athletes were given what they thought were “fast acting” steroids prior to performing the traditional power lifts on 2 separate occasions. Compared to baseline measurements, which were obtained 1 week prior to the first trial, maximum lifts increased as follows:

• Bench Press- 3.5%
• Dead Lift- 4.2%
• Squat- 5.2%

Figure 2. Think about increasing this guy's max deadlift by 4.2%. You're probably looking at a strength gain of 35+ lbs. Pretty impressive gains for a "fake" pill.⁹

All participants received the placebo steroids again prior to a 2nd testing session, which was completed 1 week following the 1st. However, just prior to the start of the 2nd session, 6 participants were informed that they had received placebo steroid pills the entire time. During the ensuing max rep tests their bench, dead lift and squat performance all returned to baseline levels. On the other hand, the group who still thought that they were receiving true steroids maintained their strength gains.

The above studies are only a small sampling of the current research demonstrating the presence of a placebo effect⁴⁵. I could pull up 100 similar peer reviewed journal articles demonstrating similar results.

Tricks Manufactures Use to Take Advantage of the Placebo Effect

As seen above, many companies take advantage of the placebo effect. Rather than provide legit, research backed supplements, they sell products consisting of nothing more than questionable ingredients. Don’t get me wrong, the “magical” blend may contain a couple quality ingredients (ie- creatine monohydrate, etc). This inclusion will often be noted on their product labels with phrases such as, "Containing Superior Forms of Creatine" or similar sales pitch lines. Yet, unbeknownst to the consumer, the amount may fall well below the scientifically proven effective daily dose. Unfortunately, sell happy distributors take advantage of this naivety, perpetuating the myth of the product’s effectiveness. Thus, the stage is set for the placebo effect to take hold simply due to consumer expectations.

Another trick commonly used to encourage a placebo effect are “miracle” before and after photos. Here’s little secret… most of these “miracle” photos have been digitally altered to enhance muscle definition, etc. Besides digitally altering the photos, it’s common to have the “before” photos shot in poor lighting whereas “after” photos usually have great lighting. These same advertisements also give the false impression that the supplement alone caused the magnificent body transformations. Yet, quite often, the users are taking a large medley of supplements. In particular, I know of a popular fat burning supplement that was routinely advertised in popular magazines 3-5 years ago. As it turns out, the endorsing model took multiple supplements (including steroids) to help him achieve his amazing body transformation.

Manufacturers also increase the likelihood of the placebo effect taking hold by adding a little CNS stimulant (caffeine, etc) to a product to give users a buzz/high. I’ve seen this in various pre-workout “shooters” that are promoted for their ability to enhance the ensuing training session. Individuals feel the effects of caffeine and believe that it’s a sign that their $50 supplement must be working. Don’t get me wrong, I’m not trying to knock caffeine. There is plenty of research out there supporting it’s ergogenic (performance enhancing) benefits⁶. However, rather than taking a $50 supplement, one could have gotten the same effect by taking a much cheaper caffeine product. Ok, Ok, this is not necessarily a placebo effect, since the caffeine is truly working. However, it’s a shady trick manufactures use that I feel is worth mentioning.

So what’s the big deal about experiencing placebo effects?

If they increase physical performance, equal to the real stuff, what’s the big deal? The bottom line is all that matters, right? I have two issues with this line of thinking:

1) The placebo effect does not work in everyone.⁵ In other words you have “responders” and “non-responders.” Additionally, just because the placebo effect occurs for you while taking one junk supplement (unknowingly of course), it does not mean that it will occur while taking another product. Thus, you can spend $50+ on a given item without experiencing any sort of training/physique improvement.

2) The ethics/integrity of any manufacturer, who puts out shady products, crossing their fingers on a placebo effect, has to be questioned.

A Potential Upside in the Placebo Research

There is an upside to the placebo research. Studies examining this effect clearly demonstrate the power of the mind. In order to experience such drastic improvements in performance, despite taking phony substances, individuals apparently hold an untapped reservoir for extreme physical performances. How can we dip into this pool to enhance our training sessions? One way is via mental strategies such as visual imagery⁶ or simply “psyching up”⁷ prior to competition.

Great Supplements Do Exist!

Up to this point, I’ve painted a somewhat gloomy picture of the supplement industry. Please realize, I'm not a cynical, jaded individual. MANY GREAT SUPPLEMENTS DO EXIST! I’m a fan of various ones myself that are supported by both research along with personal experience while using them (creatine, etc). I just want want to stress the importance of doing your homework on a particular supplement or purchasing it from someone who has already done the leg work. Again, I’d like to refer you back to my Evaluating Dietary Supplements article if you need help on evaluating products yourself.

Bottom Line

Many supplement manufacturers, with questionable integrity, take advantage of the placebo effect by selling questionable supplements solely through clever marketing campaigns. Despite scientific evidence clearly refuting the supplement’s efficacy, many elite and recreational athletes will swear by it. Don't misunderstand the point of this article. Many great supplements do exist. One just has to be willing to do a little homework to figure out which ones are supported by science.

There is a positive upside for athletes that has come from research studying the placebo effect. It’s clear that an amazing capacity of physical strength/performance is locked within everyone’s head. Take advantage of this via mental imagery, psyching up, etc.

As this article comes to a close, I’ll leave you by simply saying:

The placebo effect is alive and well in the supplement industry. Don't be a victim, do your homework!

References

¹ Benedetti F, Pollo A, Lopiano L, Lanotte M, Vighetti S, Rainero I. Conscious expectation and unconscious conditioning in analgesic, motor, and hormonal placebo/nocebo responses. J Neurosci. 2003 May 15;23(10):4315-23.

² Pollo A, Carlino E, Benedetti F. The top-down influence of ergogenic placebos on muscle work and fatigue. Eur J Neurosci. 2008 Jul;28(2):379-88.

³ Maganaris CN, Collins D, Sharp M. Expectancy effects and strength training: do steroids make a difference? Sport Psychologist 2000; 14 (Pt 3): 272-8

⁴ Beedie CJ, Foad AJ. The placebo effect in sports performance: a brief review.Sports Med. 2009;39(4):313-29.

⁵ Enck P, Benedetti F, Schedlowski M. New insights into the placebo and nocebo responses. Neuron. 2008 Jul 31;59(2):195-206.

⁶ Goldstein ER, Ziegenfuss T, Kalman D, Kreider R, Campbell B, Wilborn C, Taylor L, Willoughby D, Stout J, Graves BS, Wildman R, Ivy JL, Spano M, Smith AE, Antonio J. International society of sports nutrition position stand: caffeine and performance. J Int Soc Sports Nutr. 2010 Jan 27;7(1):5.

⁶ Yue G, Cole KJ. Strength increases from the motor program: comparison of training with maximal voluntary and imagined muscle contractions. J Neurophysiol. 1992 May;67(5):1114-23.

⁷ Tod DA, Iredale KF, McGuigan MR, Strange DE, Gill N. "Psyching-up" enhances force production during the bench press exercise. J Strength Cond Res. 2005 Aug;19(3):599-603.

⁸ Created by Ilyushka88. Accessed June 15, 2010 from:http://commons.wikimedia.org/wiki/File:Q5.png

⁹ Created by Rhodney Carter. Accessed September 18, 2010 from: http://commons.wikimedia.org/wiki/File:Bar_bending.jpg