A cat gazing at an image of itself in a mirror. What's reflected back is a lion.

Reframing Your Reality: Part 2

We often assume that we see ourselves and the world around us as reality. But psychologist Alia Crum says that our perceptions are always filtered through our mindsets — and these mindsets shape our lives in subtle but profound ways. In the second of two episodes, Alia explains how our beliefs about food and exercise affect our bodies.

If you haven’t listened to the first part of our conversation with Alia Crum, we suggest you start there.

Research:

Stress, Mindsets, and Success in Navy SEALs Special Warfare Training, by Eric N. Smith, Michael D. Young, and Alia J. Crum, Frontiers in Psychology, 2020.

Changing Patient Mindsets About Non-Life-Threatening Symptoms During Oral Immunotherapy: A Randomized Clinical Trial, by Lauren C. Howe et al., The Journal of Allergy and Clinical Immunology: In Practice, 2019.

Increasing Vegetable Intake by Emphasizing Tasty and Enjoyable Attributes: A Randomized Controlled Multisite Intervention for Taste-Focused Labeling, by Bradley P. Turnwald et al., Psychological Science, 2019.

Learning One’s Genetic Risk Changes Physiology Independent of Actual Genetic Risk, by Bradley P. Turnwald et al., Nature Human Behaviour, 2018.

Beliefs About Stress Attenuate the Relation Among Adverse Life Events, Perceived Distress, and Self-Control, by Daeun Park et al., Child Development, 2018.

Reading Between the Menu Lines: Are Restaurants’ Descriptions of “Healthy” Foods Unappealing?, by Bradley P. Turnwald, Dan Jurafsky, Alana Conner, and Alia J. Crum, Health Psychology, 2017.

Perceived Physical Activity and Mortality: Evidence From Three Nationally Representative U.S. Samples, by Octavia H. Zahrt and Alia J. Crum, Health Psychology, 2017.

Adaptive Appraisals of Anxiety Moderate the Association Between Cortisol Reactivity and Performance in Salary Negotiations, by Modupe Akinola et al., PLOS One, 2016.

Evaluating a Mindset Training Program to Unleash the Enhancing Nature of Stress, by Alia Crum, Academy of Management Annual Meeting Proceedings, 2011.

Mind Over Milkshakes: Mindsets, Not Just Nutrients, Determine Ghrelin Response, by Alia J. Crum, William R. Corbin, Kelly D. Brownell, and Peter Salovey, Health Psychology, 2011.

Mind-Set Matters: Exercise and the Placebo Effect, by Alia J. Crum and Ellen J. Langer, Psychological Science, 2007.

The transcript below may be for an earlier version of this episode. Our transcripts are provided by various partners and may contain errors or deviate slightly from the audio.

Shankar Vedantam: This is Hidden Brain. I'm Shankar Vedantam. In the 1997 drama, Life is Beautiful. Roberto Benigni plays an Italian bookshop owner. He is Jewish. And during the Holocaust, the Nazis deport him and his small son to a concentration camp.

Surrounded by squalor and fear, the father has a choice. He can tell his young son the truth, that they have been captured by evil people and are likely facing death or he can make up a fantastic story to cover up the horrors of the concentration camp. As the guards bark instructions in German and go over the punishments that await the prisoners, the former bookshop owner explains to his son that they are only playing an elaborate game. It's designed to put players through a series of difficult challenges, painfully little food, cramped quarters, even violence. The goal is to survive these challenges, ideally without crying or making a fuss. The winner gets a prize that sounds amazing to the little boy. He gets to ride a tank. Life is Beautiful went down to win a raft of awards, including a best actor Oscar for Roberto Benigni. Millions laughed and wept as they heard the story of the brave father who reinvented reality to help his son survive the Holocaust.

Today on Hidden Brain, we continue our exploration of when and how much our perceptions of reality shape how we think and what we feel. This is part two of our story. If you haven't heard the first episode, I strongly recommend you go back and start there. In that episode, we saw how mindsets affect our minds. Today, the effect that mindsets have on our bodies. One of Alia Crum's earliest introductions to mindsets came not from psychology, but from medicine. For centuries now, medical professionals have observed that when patients get help from a dedicated and trusted doctor, it isn't just the doctor's cures that make patients better. The expectations that patients have, their trust in their physicians and the rituals embedded in the art of medicine all play a role in outcomes. At Stanford University, Alia, today studies the effects that our mindsets have on us, but she says many of her findings can be traced back to that insight for medicine.

Alia Crum: Our work was very much inspired by research in medicine on the placebo effect. And now in medicine, you think about the placebo effect as just sort of this magical or mysterious response to a sham pill or fake procedure. But if you think about it, what's actually going on there is a physical change in response to the pure belief that you are going to heal or feel less pain or feel less anxiety, or have better sleep. And we have lots of data on placebo effects because they're viewed as being so relevant that we need to control for them in every single pharmaceutical trial.

Shankar Vedantam: The placebo effect is so well recognized in medicine that when someone invents a new drug, the Food and Drug Administration says it isn't enough to give the drug to patients and show they got better. They may have gotten better because they thought they would get better, the placebo effect. So companies testing drugs have to give it to two groups of people, both of whom think they're getting the drug. Only one gets the real medication. The other gets a placebo, a pill that has no chemical effects on the body. Presumably, both groups are influenced by the placebo effect. So if patients in the drug arm of the study do better than patients in the placebo arm, we say the drug works. Of course, the more accurate way to describe this would be to say the drug has effects that go above and beyond the placebo effect. Across many different fields of medicine, scientists often find that promising drugs fail to do better than the placebo effect. The same number of patients recover when they're given sham medications compared to when they're given actual medications.

Alia Crum: So our work has tried to move beyond the placebo effect. To try to think about, if our beliefs about treatment matter. If the belief that this treatment is going to work, or this treatment is going to be harmful, have an effect on our reality. What other mindsets might be at play in medicine?

Shankar Vedantam: One of those mindsets has to do with how we think about side effects.

Alia Crum: What we've also learned is that you can have mindsets about the meaning of side effects in the context of a treatment. And this becomes really important because whenever you get a new drug or therapy, you're told, "Well, here are all the side effects that's going to go along with that." And what often happens is that when people experience those side effects, they feel concerned. They feel like, "Maybe this is harmful or maybe the treatment is not working. Or maybe my condition is particularly severe, resistant to treatment." And what we realize is that in some cases, there's a totally different mindset about the meaning of side effects that you could have. For example, when you take a vaccination, the experience of side effects like fever or fatigue or pain at the injection site are actually signs that the vaccine is working, that it is boosting your immune system to learn what it would be like if it were to encounter this virus and therefore those symptoms are not negative signs of harm. They're, in fact, signs that the treatment is working and your body is getting stronger.

Shankar Vedantam: One of your studies looked at peanut allergies and found that the treatment mindset could change the way patients were thinking about their allergies. Tell me about that work, Alia.

Alia Crum: So food allergies are a major problem in the US and it's growing. So I imagine a lot of your listeners have children or know children with food allergies, allergies to peanuts or other nuts, milk, egg, and so forth. And they're very debilitating. You are constantly worried that you're going to have exposure to the thing that your child's allergic to and therefore you need to go to great lengths to avoid those things. And the presence of that allergen can cause major reactions and anaphylaxis and in some cases, even death. So these allergies cause a lot of anxiety. Fortunately, there are great treatments for them that are being developed. Canadore here at Stanford has done a number of clinical trials showing that oral immunotherapy can be highly effective for getting children to become tolerant to their former allergen and oral immunotherapy is essentially the process of taking small but gradually increasing doses of the thing you're allergic to. Teeny, teeny, teeny, tiny doses of peanut protein, for example. That gradually increase over six or seven months to the point where then these kids are able to tolerate peanuts. So I was having a conversation with Kari and she confided in us that they were having a lot of issues, either getting people into the trials or having them drop out in part because the kids were experiencing side effects and it made sense. They were taking the things that they were allergic to and they were having these reactions. But what she shared with us was that they were afraid of these reactions, but they need not be. Because of this controlled method they were being exposed to them in a way that their bodies were actually learning how to tolerate peanuts or the allergen. If you go to the gym to work out, you might feel some pain or discomfort. You might feel soreness a day or two after, but that was part of the process. That's how you grow your muscles stronger. If you don't get sore, you're probably not getting stronger and so that was a real aha. And we thought, "This is our realm. This is psychology." So we thought, what could we do to kind of piggyback onto this treatment to design an intervention that would help improve the experience and potentially even outcomes of these children going through this treatment? So what we did was we took 50 children, adolescents, and their parents going through the treatment so they were all getting the same exact treatment. It was this seven month oral immunotherapy, gradually increases of peanuts. And what we did was we randomized half of them into a treatment as usual conditions, so they were told you might have side effects. These are the things you need to worry about and seek out extra care. These are the things that are fine, but then we randomized half into our intervention condition. And that was a condition in which we informed them that these side effects were signs that the treatment was doing its job. That their bodies were getting stronger and that they were becoming tolerant to peanuts. So we created that mindset through verbal information that the providers and the healthcare teams shared with their patients. We also changed what we put on the pamphlets that were given to the kids. We had the kids do some exercises where they wrote a letter to themself three months from now saying, "What should you tell yourself when you experience a symptom?" And they were to write things like it's a positive sign and so forth. So we did a lot of things to create this mindset.

What we found was that the kids with the symptoms of positive signals mindset is that those kids had far less anxiety throughout the treatment. Their parents had far less anxiety throughout the treatment, which if you're a parent with a kid with allergies you know that this matters. That was interesting. But we also found that they had fewer symptoms not early on when the doses were small, but as they were leading towards the end of treatment. When they were supposed to be done with treatment and tolerant to peanuts, they had fewer symptoms at that point in time. And most interesting of all, we found that the treatment was in fact, more effective for them, at least as measured by IgG four levels, which is a biological marker, an immune marker of allergic tolerance. So this change in mindset, again here, same exact treatment objectively doing the same exact thing. The only thing that changed were their mindsets about the meaning of symptoms and that mindset made all the difference. It made the treatment more enjoyable, more tolerable, and ultimately more effective.

Shankar Vedantam: How much of the mechanism do you think is actually about the nature of anxiety, which is that it's one thing to be stressed and it's another thing to be anxious about being stressed and in some ways I think what the mindset is doing here is it's relieving some of the anxiety. So you still have the difficulty of the treatment for peanut allergies, the fundamental challenges are not changing but your own anxieties about those challenges are changing. How much of a role do you think that's playing in the outcomes we're seeing Alia?

Alia Crum: I think it is playing a substantial role, but I don't think it's making all the difference. So it's not just, and we tested this, you look at mediation models or models in which you asked, does the change in anxiety explain the changes in the IgG four levels? And it might explain some of it, but it's never all of it. And so what I think is going on here is, again, the effects of mindset are manifold. They're multiple, as we talked about, it's changes in attention. And as you've mentioned here, it's changes in affect or emotion in this case, maybe reductions in anxiety. But it also changes your motivation. So you're more motivated or activated to do healthier things. So they might have actually been more healthy in their life, engaged in healthier behaviors. We didn't measure that, but I wouldn't be surprised if that were the case.

And then lastly, it confers changes in your physiology. So based on these prediction processing models, if you think your body is strong, that you're going to be healthy, that you're going to be okay when you're exposed to peanuts. That sends a whole different message to your body about what it needs to freak out about or prioritize. To be honest with you, we're really just diving down into that question now of how exactly does that mindset lead to changes in physiology. And yes, one mechanism is anxiety and emotion, but we also think there's more cognitive prediction, relevant mechanisms that connect those predictions to the physiology in the body as well.

Shankar Vedantam: All of us see every day how the mind affects the body. When we are nervous, we might feel our hands trembling. Angry thoughts can change blood flow to our arms and legs and face. Excitement can make our hearts pound and our breath quicken. When we come back, more evidence that what happens in the mind doesn't stay in the mind. You're listening to Hidden Brain. I'm Shankar Vedantam.

This is Hidden Brain. I'm Shankar Vedantam. In her days as a college athlete, Alia Crum spent years feeling like she never got enough exercise and also worrying that she was overeating or not eating the right foods. No matter how hard she worked to get ready for athletic competition, Alia felt like she was not doing enough. It was an enormous source of unhappiness and dissatisfaction in her life. More recently, like millions of other Americans, the Stanford psychologist sent out for some genetic tests. She wanted to know more about two genes that predisposed people to not exercising enough and overeating.

Alia Crum: One is the CREB1 gene, and one is the FTO gene. And the FTO gene was thought to increase your risk for obesity because if you have the risk allele of this gene, you would generally feel less full after you eat. And if you feel less full after you eat, you can imagine you eat more so forth, gain weight over time, therefore increases your risk for obesity. The CREB1 gene was thought to increase risk for obesity through changing our physiological response to exercise. So people who have the risk allele of the CREB1 gene basically feel hotter or less efficient cardiovascularly when they exercise. Basically, exercise is harder and therefore you're less likely to do it, over time you might gain weight and become more at risk for obesity.

Shankar Vedantam: When Alia got back her test results, she found she had the protective version of one gene and the riskier version of the other.

Alia Crum: I actually had the protective allele for the exercise gene, which made a lot of sense to me. And I also found that I had the risk allele for the food related gene, which immediately made a lot of sense to me. I started thinking back to all those times that I would eat and eat and eat and not feel full.

Shankar Vedantam: Alia thought back to her college days. She remembered how she would exercise and exercise and then exercise some more. Well, that now made total sense. She had a genetic variant that predisposed her to find exercise relatively easy and enjoyable. The gene that predisposed her to overeating, well that made perfect sense too. Alia felt she now had an explanation for her own behavior. Then she stopped herself. She was a mindsets researcher. Were the genetic tests actually telling her important information or were they simply a way for her to engage in storytelling to allow her mindsets to find confirmation for her preexisting beliefs?

Alia Crum: When you get this information, you immediately make up a story that helps explain it like I did. It was like, "That makes sense." But then I also as we've talked about, it changed my attention. I retrieved experiences that confirmed this genetic profile. I also, as I got this information, then I started noticing when I was eating. Because I'm at risk for this FTO gene, I'm probably not going to feel so full. And then I would notice myself not feeling so full. So you can start to see and I noticed myself how this information was influencing my life, shaping my attention, shaping how I felt when I ate. I started getting more anxious, "God, am I going to feel less full when I eat," and so forth. On the protective side, it was also confirming. I would go out and exercise and say, "This makes sense. I'm feeling good."

Shankar Vedantam: How could she tell if the way she was feeling was because of her genes or because of her mindsets? The only way to answer that question was to run an experiment.

Alia Crum: So to test this in this study, we recruited participants to a study at Stanford, which they were told they were going to learn their genetic profiles and specifically learn information that would tell them what kind of exercise and diet routines would be most useful. And we had no problem recruiting for this study, at least in the Bay Area here, people were just jumping at the chance to get this personalized information to help them know whether they should have low carb or high carb or aerobic or anaerobic exercise. That was interesting first, people were really excited to get this information. And then what we did was we brought them into our lab and we had them run a treadmill task. So this was a very controlled treadmill task where they're on a treadmill, they run at a comfortable pace. And then we gradually increase the treadmill each minute up to a point where they cannot run anymore because it's too hard.And during that, we are measuring their physiological measures of their cardiovascular capacity so we're looking at their metabolic exchange rate. That's essentially how quickly they're able to convert oxygen to carbon dioxide. And we're also looking at their ventilation capacity. So how much air can they pump through their lungs per minute? And then they came back one week later and they were asked to run the same exact task. So we knew what their rate was. We knew what their incline was and we had them run it again. Only this time, before they got on the treadmill, we said, "We have some interesting information from your genetic profile." We had taken samples earlier and had actually figured out what their genes were. And so we had their actual genetic risk profile and then we told them what it was. But the catch was, we didn't exactly do this honestly for everyone.

Shankar Vedantam: To put it more bluntly, Alia and her colleagues lied to some of the volunteers. Some of the people who had the protective version of the exercise related gene were told they had the risky version of that gene. Some were told the truth.

Alia Crum: So you have of the people who are protected, half are told they're protected and half they're told that they're at risk. And of the people who are at risk, half they're told they're at risk and half they're told they're protected.

Shankar Vedantam: If genes were primarily responsible for how much people were able to tolerate difficult exercise, the lie should have had no effect. People with the risky version of the exercise related gene should have been able to tolerate less strenuous workouts. On the other hand, if mindsets were responsible for outcomes, you would expect that the lie would make a big difference. People with the former the gene that predisposed them to inactivity, but who thought they had the gene that allowed them to work out hard would score well on the treadmill task. By this point, you're not going to be surprised at what Alia found.

Alia Crum: What we found was that information changed their physiology on the same exact treadmill task in ways that conferred the risk information that was given to them. So people who were told they were at risk, regardless of whether or not they were at risk, actually reduced the rate at which they were able to convert oxygen into carbon dioxide and reduced the amount of air they were able to produce through their lungs. In fact, well that was a reduction of two liters per minute, which is a significant amount, compared to their own baseline levels. So the same people doing the same task, simply based on what they were told, changed how they responded physiologically in this case.

Shankar Vedantam: I need to stop here to underline this. It wasn't just that people who thought they had bad genes started exercising less hard. They were able to exercise less hard than they themselves had done one week earlier. The genetic information had not provided them with insight that liberated them. It had put them in a box. Their lungs performed less well because their mindsets had changed for the worse. The exact same thing happened when Alia told volunteers about a gene that predisposed people to overeating.

Alia Crum: So we ran a similar designed study, but with the FTO gene. In this paradigm, they came to the lab, they did the genetic test. Then they drank a milkshake. They were more lucky to be in the milkshake study than the exercise study. They drank a milkshake and we measured blood samples of gut peptide that's related to satiety and we measured them at baseline. And then they came back one week later, drank the same exact milkshake. And here again, immediately before drinking that milkshake, we gave them their information about the FTO gene and the risk that conferred.

Shankar Vedantam: And what did you find?

Alia Crum: And here again, we found that learning their genetic risk changed their blood levels, their gut peptide levels of this satiety inducing hormone in ways that conferred that risk.

Shankar Vedantam: Millions of Americans, as I said, have taken genetic tests in cases where those tests have allowed them to take protective measures against various medical ailments. That's obviously a good thing. But lots of people have also received bad news about various genes. Bad news that they can do nothing about. What are the risks this information has reshaped their mindsets and their bodies for the worse. In another study, Alia has found that if there are some people heard by believing they are not cut out for exercise, others like Alia herself in college, are affected by the belief that they are not getting enough exercise, even when they are.

Alia Crum: The idea for this study actually came from professor Ellen Langer, who was a mentor of mine as an undergrad at Harvard. And this was when I was playing hockey. And as we talked about having that feeling of never getting enough exercise. And I remember going to a lab meeting one day with Ellen, and I sort of told her that I was on the hockey team and that I had just come from a workout or something. And she was like, "Exercise. That's just a placebo effect."

And Ellen was like this, she's one of these people who's very provocative, but also very wise. And I remember that phrase, that saying, just sort of shocking me. I was like, "Wait, what? Exercise is not a placebo. This is very serious. What you're doing and how much you're doing it matters." And that was like, wait a second. We know very well that the effects of drugs are in part driven by placebos, by the belief in them. And we've shifted as a society towards relying on behavioral medicine, exercise, diet, reducing stress to improve our health. Why wouldn't it be the case that the placebo like effect, the placebo effect if you will, or the belief effect. Why wouldn't it play a role too, in determining the benefit of health behaviors, like exercise, diet, and stress. So when I started to think about it, I realized this wasn't such an outrageous thing to say, but nobody had looked into that.

And the reason was we don't have placebo exercise. It's not as easy as giving somebody a sugar pill with the belief that it's a real medication. So we had to design a study that essentially mirrored the concept of doing the exact same thing, but just changing your belief about it. And what we came up with was to work with a group of women who were cleaning hotel rooms. So these were housekeepers and they were getting an extraordinary amount of physical activity every day in their jobs. They were on their feet all day long, pushing carts, changing linens, vacuuming, you name it. It's tough to quantify the exact amount, but it was clear that they were getting above and beyond the surgeon general's requirements were, which were at the time to accumulate 30 minutes of moderate physical activity per day. So it's clear that they were getting the exercise they needed to be healthy, to have a healthy weight, a healthy heart, healthy mental health, and so forth.

But what was interesting about these women is that they were not aware of it. So when we asked them, we said, "Hey, do you get regular exercise? Yes or no." And two thirds of them said, no. And then we asked them, "How much exercise do you get on a scale of zero to 10?" And the third of them said zero. They said, "Nothing, I get no exercise at all."

Shankar Vedantam: Because they were thinking of getting exercise, actually going to a gym or running on a treadmill, as opposed to the work they were doing every day.

Alia Crum: Exactly, they had this in their heads. The mindset that exercise is the Zumba class or the spin class or running, that it wasn't their work. And they would go home at the end of the day, exhausted and tired and sore, but they had the mindset that their work was just that, hard, thankless, tiresome work. And so what we wanted to see was what would happen if we could change that, if we could instill in them the mindset that their work was good exercise. And it was so easy to do, that was what was so neat about this study was I got to go into these hotels. We worked with seven hotels, some in the Boston area and some in Colorado. And I went in and all I did was say, "Hey, the work you are doing is good exercise. It meets the surgeon general's requirements. And as a result, you should be receiving these benefits, a healthy heart, a healthy weight and so forth."

Now we gave this information, but we did it in a strategic way. We did it in a randomized control trial in which we randomized only half of them to receive that at one time. So we were able to compare the group of women who received that information versus the group of women who didn't receive it yet. We gave it to them after the end of the study. And what we found was that simply informing them that their work was good exercise, led to changes in their health. They had a reduction in weight. They showed a reduction in systolic blood pressure. We didn't report it in the paper, but we also showed improvements in their mental health, better body image, better self-esteem and so forth. And it makes sense. You can think about, if your whole life is defined in one way, and then you learned that you can view it in a whole different way and that way makes you feel better about yourself, you can see how the whole game would really change for them.

Shankar Vedantam: It's really profound though. The idea that these women were doing the same work there, or if you will, doing the same exercise before and after. And just thinking about what they were doing differently transforms biological markers of their health. It's actually quite astonishing.

Alia Crum: It was astonishing to me at the time. The more research I've done in this area, you come to realize that we really shouldn't be astonished by this for reasons you've pointed out and that we've discussed. It's our brain's whole job is to prepare, prioritize, and regulate the internal body based on what it believes to be true about the external environment. And so if you change that, it just changes how our body's being regulated. And I think we need to move, I've moved. And I think it would benefit our society as a whole to move from being less wowed by this research more to, this is something to be expected. Our brain is an organ in the body. You change that, you change our mental framework. We should expect that it will change our physiology.

Shankar Vedantam: Well, I want to talk about one other study of yours that I think did have a big wow factor when it first came out. And that was your milkshake study. Tell me about that study, Alia.

Alia Crum: So in this study, we gave people the same exact milkshake at two different time points. It was about a 350 calorie, modest amount of sugar milkshake. But at one time point, we told people it was an indulgent shake, 620 calories, high fat, high calorie, high sugar. And at the other time point, we told them it was 140 calories, light and fit diet shake. We called it the senses shake. And what we found was that even though they were drinking the same exact milkshake at both time points, their bodies responded differently. We were measuring their gut peptide levels. In this case, we were looking at ghrelin, which is a hunger and metabolism regulating hormone. And what we found was that when they thought they were eating an indulgent milkshake, their ghrelin levels dropped at a threefold rate compared to when they thought they were consuming the sensible shake.

Shankar Vedantam: In other words, when they thought they were having the indulgent milkshake, they felt fuller compared to when they thought they were having the healthy milkshake.

Alia Crum: Physiologically, they felt more satiated.

Shankar Vedantam: What do you think the study is telling us, Alia. On the one hand, I do think it's astonishing. I think people would be surprised to learn the very same milkshake and have different effects on your hormones, depending on how you think about them. But I'm wondering what you make of this. And also what you make of this in the light of your own concerns about your own food consumption and how you thought about food.

Alia Crum: So the first thing to realize in this study is that our body's response to food is not merely the product of the actual objective qualities of the nutrients. It's also a product of what we believe and expect about those nutrients. So the fact that it's a combination of those things, the objective reality of what we're eating and our beliefs about what we're eating. That alone is groundbreaking. It's like, "Wow, we haven't been thinking about that." We spend so much time talking about calories in, calories out or high carb, low carb, keto, not keto, whatever the fad diet of the month is. It's all about the objective qualities of the food. And we've done almost nothing to think about the role our beliefs and mindsets and experience might play in shaping our body's response to that food. That's one thing. But the second thing we learned in this study was actually most profound, for me, at least.

And that is that the manner in which our mindsets mattered was actually the exact opposite of how I thought it would play out. So I went into this study thinking, I bet we're going to see some physiological effects, because I'd seen it before with placebo effects and with the exercise room attendant study and so forth. So I thought we might get something, but I just assumed that the better mindset to be in was the mindset that you were eating sensibly, that you were eating a health shake. And I thought that will confer healthier outcomes. And what we found was that it was the exact opposite.

So assuming you want to maintain or lose weight, you would want to actually have your ghrelin levels drop at a greater rate after you eat food. Why? Because that will make you feel more physiologically satiated and it will also raise metabolism to burn the nutrients that were just ingested. And what we found was that when people thought they were eating healthy, in this case, it conveyed a sense of sensibility or in fact, a lack of calories, a sense of not enough. That sent signals to the body that they weren't getting enough so they felt less physiologically satiated. And we don't know because we didn't test people over a long period of time, but that could have influenced metabolism in ways that slowed metabolism, led to weight gain versus weight loss. So that was a huge "aha" for me.

Shankar Vedantam: And in some ways this is so diametrically opposed to the way we talk about food in general. We talk about healthy food as being virtuous, as being sensible, as being not very tasty, but really, really good for you. And we talk about unhealthy food as being wow, really sinfully delicious and so amazing and so rich and tasty. And in some ways we're talking about things backward.

Alia Crum: That's exactly right. And then once you see it, you see it everywhere. Every time you say it's healthy, at least in our culture in the US and gradually across the whole world. The assumption is that it's not filling, not indulgent, not tasty and kind of in some cases disgusting and depriving. And those beliefs, those associations with healthy food, don't just lead to us not wanting to eat those things, changing our behavior. But what we showed in this study is that they might also be influencing our physiology in ways that keep us from getting the benefits of eating healthy foods.

Shankar Vedantam: When we come back, applying the signs of mindsets in our own lives.

Alia Crum: The words like succulent, mouthwatering, creamy, dirty, naked, spell binding. Those don't describe the dish. They're just flare.

Shankar Vedantam: You're listening to Hidden Brain. I'm Shankar Vedantam.

This is Hidden Brain. I'm Shankar Vedantam. Some weeks ago, I found myself at a Mexican restaurant. I was looking through the cocktails and came by a margarita called "La Pinata". A pinata of course is a decorated toy, hung from a ceiling that kids break open by whacking with a stick. "Sounds good," I thought and ordered the drink. When I glanced over to the healthy side of the menu, nothing was called "La Pinata". They were sober salads, gentle greens and virtuous vegetables. I thought back to that menu after I talked with Stanford psychologists, Alia Crum. Why do unhealthy foods get the cool names? Why do healthy foods get boring names?

Alia Crum: We ran a linguistic study with Dan Jurafsky, who's a linguist here at Stanford. Where we analyze the language used to describe items on chain restaurants in America like Chili's and Applebee's and Outback Steakhouse. And we looked at the language used to describe items on the regular menu and compared that to the language used to describe the items on the designated healthy menu. It's either its own page or marked by a little green leaf or something. And essentially what we found there is that the language, the words used to describe the healthy foods was far less appealing than the words used to describe the normal dishes. So it was far less exciting, words like crazy or spell binding. Far less sort of provocative words like dangerous, dirty, or naked. Far less indulgent words like bliss, succulent, mouthwatering. And this was really interesting because we weren't maybe not surprised by that.

We're like, "How are healthy foods described?" Well, they're used with very nutritious words, like wholesome, or nutritional or perhaps fresh words like fresh or freshly. But they're not often described with these exciting descriptors. That was not all that surprising. What was interesting is that when we looked at these words, almost none of them said anything about the dish itself. So it wasn't like the indulgent words had to be reserved for the hamburger and not for the low fat trout dish. The words like succulent, mouthwatering, creamy, dirty, naked, spell binding. Those don't describe the dish, they're just flare. So what would happen? Could we actually use those same words to describe healthy foods? And so we did this at Stanford and we later replicated it at several different universities around the US. We took the vegetable dish that they were serving to their students and we had them prepare it the same exact way.

This was over the course of a 10 week quarter. We had them prepare it the same exact way, but we randomized how it was labeled. So sometimes it was labeled just very basic. So it would be carrots or beets. Sometimes it was labeled healthy, so lighter choice beets with no added sugar. And sometimes it was labeled in the indulgent way. So dynamite chili, lime season beets, or zesty, twisted, citrus carrots, something like that. We just used the same words that are used on these chain restaurants out in America, selling less healthy items. And what we found was that when the vegetables were labeled with indulgent descriptors, people chose them and consumed them at a far greater rate. The studies differed but the average was about a 30% increase in vegetable consumption.

Shankar Vedantam: In some ways this speaks to your own challenges in thinking about food, going back to your college days earlier, where you were asking yourself, am I eating too much or am I eating right in terms of my athletic endeavors? And in some ways this turns things on its head, does it not? In terms of how we should think about food and our diet choices?

Alia Crum: I had a really unhealthy relationship with food when I was in college and it was characterized by this constant feeling like I should eat the healthy foods, but it's not what I really wanted to eat. And so I would go through these patterns of eating healthy, eating healthy, eating healthy, and then kind of breaking that and having overeating. And I actually went through a short period of bulimia because of that approach. And this insight, this aha changed me forever. It changed me in a sustained way. I'm changed to this day. And it was this realization that the mindset that I'm in has an impact. So if I'm feeling like I'm not getting enough or that I'm restricting my food, that mindset alone might be working against me, might be counteracting my hard efforts at dieting or eating healthy. And then the other thing that made me realize was, what's the goal of eating.

The goal of eating is to feel like you're eating enough, to feel like you're eating indulgently. That you're feeling satisfied, that you're feeling good with what you eat. So that became the goal for me. And it didn't mean I just threw all caution to the wind and ate only milkshakes and fries. In fact, I found that I didn't actually crave those things when I wasn't trying to avoid them. If I went about life with the goal of what can I eat that will actually make me feel satisfied, feel that sense of enough and that was the goal. I would choose things naturally that were healthier and not all the time. Sometimes I would choose a hamburger, but that's what felt right for me. And it was freeing and it was profound. It really truly was the study that changed me most on my journey.

Shankar Vedantam: When I think about the public health messages we often have around food and exercise. So many of the healthful messages have a punitive edge to them. We tell people there's an obesity epidemic in America or around the world. We need to eat healthier. Bad things are going to happen to you if you don't eat healthier. Social media is full of examples of healthy people working out and running 20 miles every day. And we make comparisons to those people. And in some ways I'm not sure all of this really squares with your work on mindsets in terms of what's actually going to move the needle for ordinary people who might not have time to work out three hours every day.

Alia Crum: So we know that food, eating healthy and getting good amount of exercise is good for us. But all these messages telling people what to do often just make people feel badly about what they're doing. And what we've learned as psychologists is that feeling like you're not getting enough, does not motivate you, most people at least, to get more. In some cases it often leads to giving up or letting go or deciding you really don't care about being healthy. So we need to find that line between informing people about the value of these behaviors, but also instilling mindsets that actually make people feel like they identify with those behaviors and they want to do those behaviors. How can we make healthy eating pleasurable, indulgent? How can we make exercise feel inviting and inspiring? Those are the questions. And I think our country, our world would be better served if we could focus our time, money, effort, and energy on instilling those mindsets rather than reminding people time and time again that they're not enough.

Shankar Vedantam: Alia, is it pains to remind people, especially those who have just heard about the power of mindsets, not to go overboard with these insights. It's one thing to say, doctors and public health experts should pay attention to mindsets when they communicate health information. It's another thing entirely to say that mindsets are the only thing that matter.

Alia Crum: The best mindset to be in when you have cancer is not, "I don't have cancer or cancer is nothing." It's, "Cancer is manageable." That's a different mindset that has more adaptive outcomes, at least that we've seen. When it comes to healthy food, it's not just, "I'm eating healthy." It's actually, "That mindset is counterproductive." Why? Well, think back to how that mindset influences your attention, your behavior, your emotions and physiology. If you can figure that out. And then you'll realize what mindset is most effective. So the effects of mindsets is very sophisticated and we are really just at the tip of the iceberg of understanding which mindsets matter. Why do they matter? How much do they matter? And when do they not matter? And again, I think before we know all of that, a good way to sort of approach this is to always do both. So if I get sick, I don't just change my mindset. I go to the doctor where appropriate. I take medications where appropriate. I do the physical things to make me better, but I also focus on my mindset.

Shankar Vedantam: Alia Crum is a psychologist at Stanford University. She studies the power of mindsets to shape the way we experience and respond to the world. Alia, thank you so much for joining me today on Hidden Brain.

Alia Crum: Thanks so much, Shankar. It's been such a pleasure.

Shankar Vedantam: Hidden Brain is produced by Hidden Brain Media. Our audio production team includes Bridget McCarthy, Annie Murphy Paul, Kristin Wong, Laura Kwerel, Ryan Katz, Autumn Barnes and Andrew Chadwick. Tara Boyle is our executive producer. I'm Hidden Brain's executive editor. Our unsung hero is Alexandra Gloner, and our advertising partner, Stitcher Media. She helps us keep track of our podcast metrics, weekly and monthly downloads and other forms of engagement. This is extremely important because it is the clearest way for us to tell what episodes resonate with you, what themes and topics strike a chord. AJ, as she is called, is conscientious and helpful and her insights have helped improve our work. If there are Hidden Brain episodes you especially love, AJ might well have been the unsung hero who helped us dream up the topic. Thank you, AJ. If you like this episode and would like us to produce more shows like this, please consider supporting our work. Go to support.hiddenbrain.org. Again, if you would like to help support the show you love, go to support.hiddenbrain.org. I'm Shankar Vedantam. See you soon.


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