Sunday, May 1, 2011

Diet and Violence 2

Back in Diet and Violence, I presented evidence from two decently-sized randomized controlled trials of adding a multivitamin/multimineral/essential fatty acid supplement to normal prison fare. The trials were done about 8 years apart and in different countries, yet came out with a similar conclusion. Actual violent/discipline-requiring incidents committed by the prisoners who took the supplements was reduced by about 1/3 compared to pre-supplement days, and in one study the placebo-taking prisoners had an increase in violent events, whereas the other study showed just a small change on placebo.

My conclusion - practically speaking, I hope that prisoners in the US get a supplement (come to think of it, I have a friend who is a doctor in the prison system - but she was asking me what I thought about recommendations for vitamin D, so maybe the official guidelines aren't solid. Hmmm. Time to fire off a facebook message). I don't care if it is the best pharmaceutical grade supplement on the planet, a month of supplementation can't be more costly than a couple of days in prison. And total number of days in prison and parole and solitary and all those situations are in part determined by prisoner behavior, I imagine. I'm guessing that prisoners receive the most horrendous, cheap, grain-and-soy and margarine foods imaginable. We have to "get tough on crime" after all. Our tax dollars at work.

Of course I am being far too sensible - from the article about the pioneering diet and violence researcher Gesch in Science in 2009:
"Decades of studies by Schoenthaler and others have supported a connection between nutrition and violence, but for a variety of reasons—some scientific, others political—it hasn’t yet translated into policy."

But let's step back from pragmatism for a moment. Here's the real issue with the science I pursue, at least in the eyes of the medical establishment (also from the Science article):

“This field has seen a lot of exaggerated claims and not enough solid placebo-controlled research,” says Eugene Arnold, a psychiatrist and former director of the Nisonger Center at Ohio State University, Columbus. Studies have shown that “there clearly is a connection” between nutrients and behavioral disorders—for example, between nutrition and depression— but rigorous research has been the exception, he says. Most studies of the effects of nutrition on antisocial behavior are dismissed because of poor experimental design. And Arnold notes that misleading claims by the booming nutrient supplement industry have brought the taint of pseudoscience to those studying diet and behavior. “Even good scientists in this field have been treated as guilty by association,” he says.


Gesch began working with young offenders in the 80s as a social worker. He would invite groups over for home-cooked meals, (the goal being that the atmosphere would help them open up and share their troubles) and Gesch noticed that after a while, the kids would be "transformed...

...becoming healthier and often abandoning the antisocial behaviors that had gotten them into trouble. He began to believe that shedding their scattershot diets of junk food was central to the behavioral shift, perhaps even more so than the family-like socializing. "

Finally he was able to obtain funding for his 2002 study, now replicated, and at the same time Gesch gathered data for a second paper on how food choices of prisoners affected actual daily intake of nutrients. He found (not surprisingly) that, when they got the chance, prisoners would buy food like peanuts, chips, candy and cookies from the prison store, which would add to their daily intake of omega-6 oils, trans fats, grains, and sugar. In addition, though the prison diets were designed by institutional dietitians, most had suboptimal amounts of vitamin D (even compared to the lowly 400 IU recommended for people with little sun) and selenium, and the vegetarian and Muslim menus often had some suboptimal B vitamins and total calories.

Just want to mention here Schoenthaler's randomized controlled trial from 2000, of 80 six-twelve year old schoolchildren who had previously been disciplined at school in "working class" Hispanic neighborhoods of Phoenix - Schoenthaler notes that previous randomized controlled trials of supplementation of the RDA for prisoners resulted in a 40% decrease in number of violent acts - his results were a 47% decrease in violent acts among the supplemented kids compared to the placebo controls. I'd call that more replication. And a call for some serious multivitamin/multimineral/EFA supplementation action on a large scale in institutions such as prisons, especially where relatives are often not allowed to bring in outside food.

Of course, nutrition is only a part of the larger problem of violence and crime. But in institutions, it seems like a relatively 30-40% controllable part, if only common sense would prevail.

17 comments:

  1. That's a pretty powerful argument for the efficacy of nutrients in reducing hostility. And these supplements are probably sub-standard compared with what we're used to what with well-absorbed magnesium forms in sufficient amounts, and indeed enough vitamin d.

    The truly striking implication is the obvious answer to whether or not some of these prisoners would be prisoners in the first place if they just had adequate nutrition from childhood. Doesn't it follow that we as a society have some sort of obligation? I wonder.

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  2. as an undergrad i did a research paper on correlation between refined carbs and depression/anxiety. it blew me away how many studies were out there - correlations with not just d and a, but also schizophrenia. then in grad school for public health i took it further and did a paper on "refined carbohydrates as environmental toxin". i now have a fellowship with a non-profit that looks to address chronic disease via policy and environmental changes. it's as close as i could get to work with what the real problem is . . . it's encouraging to read this blog post of yours . . . thanks for your great blog and twitter feed . . . so helpful and informative.

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  3. It becomes very thorny very quickly, doesn't it? If nutrition affects behavior, particularly violent behavior, what do we as a society owe those given inadequate nutrition in youth? What do we owe those who choose to eat garbage? What to we legislate for school lunch, and do we blame school lunch for school violence? What is the interest of the publicly funded government?

    I tend to be on the libertarian side of things - let me decide for me, my children, and don't take my hard-earned money for grossly wasteful bureaucratic crap - yet if nutrition determines how we think, then can we rely on the judgment of the malnourished? I don't even want to go there… but the question is raised!

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  4. Great post as always. I'd perhaps like to suggest another layer to this whole question on diet and behaviour (and violence) in asking: what primary psychological processes are being affected by such nutritional supplementation? I haven't got any answers by the way. 'Speculation' might suggest attention and hyperactivity/impulsivity (based on the trials of fatty acids and dietary change in ADHD, etc) might have something to do with it but also perhaps 'empathy' - particularly given the recent book by Simon Baron-Cohen titled 'Zero degrees of empathy':
    http://www.guardian.co.uk/science/blog/2011/apr/27/simon-baron-cohen-empathy-evil
    (Note to self: I am not an enthusiastic follower of the empathy/autism relationship but do see some merit in empathy and the evil that men (and women) do).

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  5. Yes, unfortunately we could just as easily substitute the word "statins" for "vitamins" and we see the absurdity of making it compulsory. Although I don't think that it should be contentious to at least make vitamins available after an honest, open debate featuring all sides of the argument and made available for anyone who wants to hear it. It's just that those things don't seem to happen with nutritional policy. Sigh. Indeed, the question is raised and hard to answer.

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  6. Paul - I didn't "go there" due to lack of data - but to my mind you pose the lost interesting question of all. I hope to address that somewhat with the basic science frontal neural network posts upcoming.

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  7. Commit a crime, go to prison. I don't care what your diet was. Require *prisoners* to eat a healthy (i.e. no processed foods) diet with proper supplementation, sure. VOLUNTARILY spread the word on proper nutrition, sure. NO government programs or laws, because those *force* people to do things, and that's not acceptable.

    "We as a society" don't owe anybody anything except each of us individually respecting each others' rights. Once you go down the "society owes somebody" road, it ALWAYS becomes government forcing people to support whatever those currently holding power want to enforce, whatever anyone might think of it. Count me out.

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  8. Primacy of the individual; the problem is accurately and sufficiently informing said individuals to make their choices. How many are there diligently following a low fat high wholegrain diet ... having been 'informed'.

    And yes, thinking about how much effect it can have, and then on what our leaders eat ... mm ... best not go there.

    In fact, going there just a little ... it seems to me the last several decades have been marked by much international aggression predominantly western governments agains the rest, is this coincidental I wonder with the diets of such governments moving to less brain-healthy (and potentially violent) diets.

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  9. Piz - govt says "I'm gonna regulate what your kids eat" Me: "Hell no!".

    But, these young guys (and I have to say I've worked with more of the substance abuse side than the criminal side) have NO frontal lobes, and over the course of age 20-25, many of them manage to grow one... but by then, in the prison system, it is way too late. Makes one think, anyway. If we can rehabilitate 1/3 more easily with a multivitamin and some O3 - why not?

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  10. I certainly didn't mean anything compulsory, just that we should provide these sorts of things to growing children that might steer them in the direction of good behavior. If you leave it up to their parents then many will be malnourished, but if you make it an easy yes/no decision then you do a lot of good. I think that the use of vitamin and mineral supplements is pretty uncontroversial, certainly less controversial than relying on the SAD for your micronutrients, or so we would hope.

    It isn't that we "owe" anyone anything, but that we should consider ourselves obligated to take care of psychological infrastructure. You need to repair a bridge or it collapses, and likewise you need to keep a growing brain in decent condition or else you can't be surprised if that kid vandalizes your car, picks a fight at school or even worse when they're an adult.

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  11. It's a tough call. I don't want govt. telling me what to eat either. But then I can make an informed choice - more informed than most, and that includes govt. boffins. At the same time, I don't want to live in a deteriorating society full of scumbags, lacking so much in executive function & frontal lobe processing power, that they are on a hair-trigger all the time. If the govt. isn't telling them what to eat, then there is a vacuum for the food industry to take over. I'm happier for the govt. to regulate industry and tell them what they can & can't produce. Remove the choice from the people, i.e. you can eat anything you want as long as it is meat, chicken, fish, vegetables, fruit, nuts, seeds... Unfortunately, as it stands, industry tends to regulate govt. more than vice versa. And if I am going to get fleeced of money regardless of what I believe, then I'd rather the money be spent of giving violent prisoners good food, some supplements (and long acting contraception - but that is another argument for another day in another forum), than paying to lock them up forever.

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  12. In Norway we are "good" at regulation. I see no problems (except from getting it through) with a higher taxation on refined "goods" and sugars. (If I buy a bottle of wine in Norway approx. 70-75% of the price would be tax anyway due to politics, so why not for sweets... ) The problem would be to lower the price on real food.

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  13. Jamie - I completely agree - especially the long-term contraception point.

    Emily - your comment about rehabilitating frontal lobes sounds fascinating. I think one of the many problems with issues of mental ill health and behavioural dysfunction is that the popular perception is that it is all 'in the head' and not due to pathology in the nuts and bolts as say a 'cancer' or other 'physcial' problems are understood to be.

    I know from personal experience that it was the nuts and bolts that were wrong but even my close family thought I just need to 'get a grip'. Unless and until psychiatry and brain function (and dysfunction) are understood more widely, and here I mean particularly within the governing 'classes' it will be very difficult to get these kinds of changes implemented.

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  14. First time I've posted on your blog. I'd like to make a comment a la Ratty (hyperlipid). We have two rats named Statler and Waldorf. Statler and Waldorf have been raised on what we eat. They prefer a lower carb version of our diet, but that is their choice as rats. Anyone who is familiar with rat behavior will know that adult male rats fight. A lot. We've had many a ripped toenail or laceration in the past. But not these rats. These rats have never, ever fought. Not once. Sure, there's a squeak involved when steak is on the menu and they haven't eaten in a while. But not the "chaseyouaroundthecagesoIcaneatyourface" type of fights. The other, more violent rats had what Peter calls "crapinabag" diets. As a non-scientist, I am thoroughly convinced.

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  15. I thought of this post today as I drove to work and saw 9 police cars w/ lights flashing and 2 new vans parked in front of the local high school. Like many med schools, mine is in an inner city full of criminal activity and poverty. The closest food store is a 100% frozen and canned foods good store. The local grocery store has some fresh produce, though I don't blame them for not stocking it well- I rarely, if ever, saw people shopping in the fresh produce aisle when I used to go there. I remember being told that a large percentage of the local population is vitamin D deficient, and I really can't think of any decent sources of Omega 3 in the usual diet. I'm not saying a multivitamin would solve the crime problems in one of the worst cities in the country, but it's interesting to think about, especially when you think of the miscreants robbing and breaking into cars before they hit puberty...

    I haven't heard talk of it in a while, but everyone seemed shocked about the lack of looting in Japan after the Tsunami... Yes- there definitely are cultural/societal issues in play, but you gotta think that Japan is a society that, as a whole, has a fairly good amount of O3 in the diet!

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  16. Hopefully I might not late on posting this comment. Not specifically related to discussions but there is an interesting special edition of the British Journal of Criminology on violence with specific reference to a cousin discipline, evolutionary psychology. The content details are here: http://bjc.oxfordjournals.org/content/51/3.toc

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  17. As the wife of an inmate I can tell you that no matter how good the prisons' menus sound (they used to read them over the radio here to rile people up) that is generally not what the inmates are actually eating. My sister-in-law was a dietitian at one of the prisons so I have information from both sides. Substitutions are freely made of lesser amounts and nutritional value. The ability to add any kind of nutritional supplements (daily vitamin, etc)is severely restricted or totally forbidden.

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