Food for the Brain schizophrenia research project

I was concerned to see that Food for the Brain are say they are close to beginning their “MSc Research Project into a Nutritional Approach for the Treatment of Schizophrenia”. While I would welcome good quality research into nutrition and mental illness, the approach suggested by Food for the Brain is problematic. They argue that:

Since the core assumption is that there is no single biochemical imbalance that causes schizophrenia, the usual study design of testing a single intervention (double blind controlled clinical trial), is not applicable when it comes to complex nutrient interventions. Instead, the aim is to measure the effectiveness of the approach used at the Brain Bio Centre, both in correcting biochemical imbalances, and in restoring mental health. We hope to involve both recently diagnosed and long-term sufferers.

However, there are ways in which (aspects of) such research can still be blinded. For example, if pill-based approaches are used, nutritionists could ‘prescribe’ all patients a personal mix of pills; the control group would get placebos while the intervention group would get active pills. Even if some of the interventions (e.g. certain dietary changes) do not allow blinding, this is no reason why a control group should not be used. Unfortunately, badly designed research is more likely to give positive results: if this research project is insufficiently robust, even ‘positive’ results will not be credible. While there can be good reasons to use research structures other than the randomised controlled trial, Food for the Brain’s discussion of this research project does not make a strong case for such alternative approaches.

I would also be concerned about the ethics of this research. Firstly, doing bad research is ethically problematic in itself: it is not fair to participants, who volunteer their time and bodies to assist in your research; it also wastes funds and resources that could be used in better research. It is therefore very important that this research project should be as robust as possible. Secondly, some of the approaches suggested by Food for the Brain and the Brain Bio Centre have lacked a good evidence base; there are often concerns about using such approaches in vulnerable subjects, especially where they are potentially harmful.

Oddly, the Food for the Brain page promoting this research does not mention where it will be carried out, although it does say that

We have identified the researchers, research supervisors and collaborative university.

I wonder which university has decided to become involved in this. I do hope that they will ensure that the research is conducted to the highest possible standards.

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15 Comments

Filed under Food for the brain, Food for the brain foundation

15 responses to “Food for the Brain schizophrenia research project

  1. Fascinating. Do you think it might be Patrick’s friends over at the University of Bedfordshire? I suppose we can rule out Teeside..

  2. There’s no reason why you can’t do a blinded RCT of a nutritional intervention. Just give the control group an intervention as well, albeit one which according to your theory shouldn’t work.

    If you believe that eating more green vegetables cures schizophrenia, say, you could use as a control an intervention aimed at eating more brown bread. Or whatever.

    The patient is blinded because all they know is that they’ve been told to change their diet. Someone on the research team would have to know, but you could make sure the people responsible for evaluating patient symptoms, and analysing the data, are blind.

    • Thanks – good point, I expressed that badly. The example you give would allow blinding. Blinding dietary interventions can cause particular problems, though, which aren’t present with pills. For example, if you believed that avoiding gluten and casein cured schizophrenia, then those in the GFCF treatment group could very well figure out that this is thought by some vocal nutritionists etc. to be a cure for their condition. Also, if the ‘treatment’ diet is very strict (to the point of being potentially harmful) there would be ethical concerns about imposing a similarly strict diet on controls in the belief it would do them no good at all.

  3. nobby

    its been quite a while since i looked at a website and wanted to head butt my monitor in disgust but food for brain really takes the biscuit. like you said in your opening paragraph i too and many others would welcome quality research on nutrition and mental illness. Putting how the research is going to be conducted to one side the part that really got to me was how they define a diagnosis of schzophrenia. if this is your main focus of study then maybe you should at least get it right instead of making a list that looks like it came from answers that were asked in a survey for a question on family fortunes.

    just to clarify this point:

    “About one in a hundred people have schizophrenia, a diagnosis that is made on the basis of a collection of symptoms including:

    • Depression
    • Anxiety
    • Fears, phobias and paranoia
    • Disperceptions and thought disorders
    • Illusions and delusions
    • Auditory and visual hallucinations
    • Anti-social behaviour.

    A person labelled schizophrenic may have any or all of these, but at a level of severity that makes either them unable to cope or others unable to cope with them.” taken from the food for the brain website.
    http://www.foodforthebrain.org/content.asp?id_Content=1638

    and now a proper diagnosis criteria from the icd 10:
    Although no strictly pathognomonic symptoms can be identified, for practical purposes it is useful to divide the above symptoms into groups that have special importance for the diagnosis and often occur together, such as:

    (a) thought echo, thought insertion or withdrawal, and thought broadcasting;
    (b) delusions of control, influence, or passivity, clearly referred to body or limb movements or specific thoughts, actions, or sensations; delusional perception;
    (c) hallucinatory voices giving a running commentary on the patient’s behaviour, or discussing the patient among themselves, or other types of hallucinatory voices coming from some part of the body;
    (d) persistent delusions of other kinds that are culturally inappropriate and completely impossible, such as religious or political identity, or superhuman powers and abilities (e.g. being able to control the weather, or being in communication with aliens from another world);
    (e) persistent hallucinations in any modality, when accompanied either by fleeting or half-formed delusions without clear affective content, or by persistent over-valued ideas, or when occurring every day for weeks or months on end;
    (f) breaks or interpolations in the train of thought, resulting in incoherence or irrelevant speech, or neologisms;
    (g) catatonic behaviour, such as excitement, posturing, or waxy flexibility, negativism, mutism, and stupor;
    (h) “negative” symptoms such as marked apathy, paucity of speech, and blunting or incongruity of emotional responses, usually resulting in social withdrawal and lowering of social performance; it must be clear that these are not due to depression or to neuroleptic medication;
    (i) a significant and consistent change in the overall quality of some aspects of personal behaviour, manifest as loss of interest, aimlessness, idleness, a self-absorbed attitude, and social withdrawal.

    Diagnostic Guidelines
    The normal requirement for a diagnosis of schizophrenia is that a minimum of one very clear symptom (and usually two or more if less clear-cut) belonging to any one of the groups listed as (a) to (d) above, or symptoms from at least two of the groups referred to as (e) to (h), should have been clearly present for most of the time during a period of 1 month or more. Conditions meeting such symptomatic requirements but of duration less than 1 month (whether treated or not) should be diagnosed in the first instance as acute schizophrenia-like psychotic disorder and are classified as schizophrenia if the sumptoms persist for longer periods.

    Viewed retrospectively, it may be clear that a prodromal phase in which symptoms and behaviour, such as loss of interest in work, social activities, and personal appearance and hygiene, together with generalized anxiety and mild degrees of depression and preoccupation, preceded the onset of psychotic symptoms by weeks or even months. Because of the difficulty in timing onset, the 1-month duration criterion applies only to the specific symptoms listed above and not to any prodromal nonpsychotic phase.

    The diagnosis of schizophrenia should not be made in the presence of extensive depressive or manic symptoms unless it is clear that schizophrenic symptoms antedated the affective disturbance. If both schizophrenic and affective symptoms develop together and are evenly balanced, the diagnosis of schizoaffective disorder should be made, even if the schizophrenic symptoms by themselves would have justified the diagnosis of schizophrenia. Schizophrenia should not be diagnosed in the presence of overt brain disease or during states of drug intoxication or withdrawal.

    http://www.mentalhealth.com/icd/p22-ps01.html

    sry if its a little lengthy but i hope you see where i am coming from….. there is lots more on that site i could comment on especially the anti social behaviour symptom that really got to me, talk about stigmatisation.

    • It would be fascinating to know where Food for the Brain do take their information from…

      I have a head-shaped indent in my desk by now.

      • Pat Cull

        Food theory sounds a bit fishy to me. It’s been going on for years with no result. Though some of the poor sufferers must be hungry as they are on such low incomes.

      • truth_advocate

        jonhw
        October 19, 2009 at 11:10 pm
        *Dear chap, sorry to hear that you have a head-shaped indent in your desk now. You may want to make an appointment with a nutritionalist as I believe you are suffering from a vitamin deficiency. Or off course you can always visit an Orthodox Doctor who has only studied 2 hours on nutrition and who will only prescribe you toxic medications (drugs)… Would you like me to send you a western union money order to replace your desk, or I could possibly refer you to a psychiatrist who specialises in “afflictions of the mind”. Kind regards-truth_advocate ;-)

        • Hopefully a good medical doctor or psychologist would just point out that irritation can be part of a healthy life. Not everything needs to be medicalised or treated ;)

          Desk’s still usable, though thanks for the offer. Treatment Action Campaign would be a worthy recipient, if you have any money orders to send :)

  4. Cam

    Yet another attempt to dismiss a non-orthodox approach to treatment. My friend was diagnosed with depression and prescribed anti-depressants – they didn’t work and when she came off them she was very very ill – the doctors answer? just take more. For her the nutrition approach worked (I’m not saying it would for everybody) and she is now back to her old self. While I agree drugs do have their place in healthcare, they aren’t always the answer to everything and if this research is looking into another way of helping a person feel better (which may or may not work but neither do many drugs they test) then so be it. Furthermore, there is a GREAT DEAL of credible, peer-reviewed research on nutrition and mental health – it might be worth taking a look.

    • I’m in no way opposed to non-orthodox treatments (and have concerns about some common pharmaceutical treatments). I am all in favour of good research on nutrition and mental health. However – for the reasons given above – I have real concerns about this project.

      If you believe that nutrition and mental health is an important topic, surely you should also be strongly opposed to poor quality research?

  5. Pat Y

    Have you read the research project in the U.S. which shows changes in the bain structure? This confirms the neurotransmitter theory. There is also research that shows genetic changes. How does food fit in with these?

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