Saturday, April 11, 2015

Placebo-Powered Turbo-Sprints - Study Confirms Possible Explanation for High Sales Ranks of Bullsh*t Supplements

If it's not cancer, but something as simple as exercise performance believing that a pill will fix it will often suffice to fix it ;-)
Have you ever wondered why people spend bazillions of dollars on scientifically disproven supplements and claim that they work? Well, if you have read my previous article on "brocebos", you may already know the answer: It's the placebo effect.

Now, Danilo V. Tolusso, C. and colleagues from the Green State University did not investigate the subtle ways in which ads, sponsored athletes and the price of a supplement enhance its "efficacy", but their study which was designed give us "a more realistic understanding of the placebo effect in a sport or exercise session" is still enlightening with respect to the powers of belief.
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Ten healthy, asymptomatic men (age = 22.2 ± 2.4, height = 1.8 ± .01 m, body mass = 81.2 ± 7.4 kg, body fat (%) = 8.1 ± 2.4) volunteered to participate in this no blind (if it was "blind" you could hardly have a good placebo effect ;-) study.
"To be included in this study,subjects must have reported performing sprint training or competition in an intermittent-type sport (e.g., basketball, football, tennis, soccer) at least two days per week. Prior to testing, subjects were instructed to refrain from drinking alcohol 24 hours and caffeine four hours before beginning physical activity. Subjects were also instructed to abstain from intense physical activities 48 hours before testing. Prior to each testing session, subjects were queried regarding adherence to the guidelines set for dietary intake and physical activity.

[...] The subjects must not have had a negative bias as to the effectiveness of ergogenic aids, as this may decrease the expectancy of the ergogenic aid to work and result in no placebo response. This was used as a criteria of exclusion to ensure that no subject had a preconceived bias against ergogenic aids (Tolusso. 2015)."
At the beginning of the study, all subjects were provided a brochure upon arrival to the laboratory. In the brochure the scientists claimed that the purpose of the study is to determine the impact of an "FDA approved substance has on performance during multiple sessions of repeated sprint work" (Tolusso.). The brochure contained an overview of previous research regarding the substance that they will be given- obviously one that was very beneficial.
How does "PLACEBO" work? This is how Tolusso et al. explain it: "In brief, the expectancy theory states that any resultant change in performance is largely mediated to the degree that an individual who was administered a treatment (i.e., placebo) believes it to be beneficial. Interestingly, improvements in performance are most commonly associated with the analgesic effect (i.e., pain mediating) that a placebo is known to induce, as research has confirmed that the anterior cingulate cortex, an area of the brain with a high concentration of opioid receptors, is similarly activated during placebo and opioid analgesia trials. This suggests that a placebo may elicit the same neural response associated with decreases in pain sensitivity owing to the binding of opioid receptors. This may yield increases in performance as studies have found that pain sensation can negatively impact performance" (Tolusso. 2015).
After the obligatory familiarization trial (obviously the whole study was designed as any good clinical study would be... well, with the exception of the blinding, obviously),  the subjects consumed 600 mL of the placebo beverage which contained nothing but distilled water and a commercially available, noncaloric, ‘water enhancer’ (sucralose + acesulfame-K) used to flavor the water. What is interesting is how this was done:
"The first dose of 600 mL was prepared in front of the subjects. Researchers extracted 1 mL of the ‘water enhancer’ from a beaker and extracted it into an Erlenmeyer flask containing approximately 600 mL of distilled water chilled to 10 ̊ C. The other doses of 150 mL were prepared beforehand, with the same concentration as the first dose. Subjects were informed the beverage they were consuming upon arrival and the additional doses of 150mL that they would be consuming during the sprinting trials were the same beverage and that they should expect the same ergogenic benefits listed in the expectancy brochure" (Tolussu. 2015). 
Immediately after ingestion of this 'powerful ergogenic' *rofl*, the subjects performed a standardized warm-up and three RAST protocols which consisted of 6x35m sprints + 10s active recovery in-between.
Figure 1: Overview of the study design (modified based on illustration from Tolusso. 2015).
After each RAST protocol, the subjects were allowed one minute passive recovery and had to rate their perceived exertion and pain on an RPE and VAS scale and were told to ingest more of their 'powerful' placebo super-supplement. To really mirror the typical supplement producer claim they were told to drink another serving after the workout, because beverage would promote overnight recovery (sounds familiar ;-).
Figure 2: Pretty neat performance gains (from Tolusso. 2015) for flavored water, right?
And guess what, it worked. As the data in Figure 2 tell you the subjects performed at significantly higher intensities (peak and mean power) "on" the powerful placebo supplement (the effect size is larger than with many "true" ergogenics in double-blind studies!); and that in the absence of any other significant difference in metabolic or perceptual strain (p > 0.05) - a fact that confirms the analgesic hypothesis (see lightblue box on the mechanism behind placebo effects in exercise science).
Brocebo? Add 10kg to Your Bench in Days with Sugar-Based "Anabolic Steroids". Old Study Shows, Many "Natural Anabolics" Could Work Solely via Placebo Effects | learn more.
Bottom line: I am not saying that your supplements don't work, but the fact that you or your bros feel much better "on" it is not exactly convincing evidence that a supplement works.

That being said, you may argue that it doesn't matter that it actually shouldn't work as long as it does work - who cares if the mechanism is psychological or physiological? I guess the people who produce and sell it don't and I am also quite sure that most of them are aware of that - I mean, why else would they pay MMA fighter and other pro-athletes to tell you that they use their supplements ;-) - what do you think, ha? | Comment on Facebook!
  • Tolusso et al. "The Placebo Effect: Influence on Repeated Intermittent Sprint Performance on Consecutive Days." Journal of Strength and Conditioning Research (2015): Ahead of print.