The Benefit of Nutritional Therapy for Schizophrenia

What is schizophrenia?

Schizophrenia is a highly complex mental health condition that affects 21 million people worldwide and 1-3 in every 100 people within the UK . The condition encompasses a collection of different mental disorders causing two main groups of symptoms known as positive and negative. The positive group includes symptoms such as paranoia, hallucinations, changes in personality and delusions, and the negative group includes symptoms like lethargy, apathy, social withdrawal, impaired attention and anhedonia (inability to experience pleasure). The result of both is often a lifetime of suffering for not just the person experiencing schizophrenia but also family and friends, as well as engendering a high societal burden with the estimated total financial cost of £11.8 billion per annum in England alone. 

Traditional Treatment

Due to the variety of presenting symptoms, schizophrenia has been considered a spectrum disorder that is a complex interplay between a range of altered physiological mechanisms. Since the 1990s, psychiatrists began to introduce medication called atypical antipsychotics, which all share the common ground of targeting serotonin and dopamine receptors, and whilst they have shown to be effective in reducing psychosis symptoms in most people, one-third of the patient group find that they are not effective. Moreover, the side effects of medication can be severe and debilitating causing symptoms such as movement disorders, cognitive impairment, weight gain, sedation and diabetes. These often require further pharmacological treatment and can lead to a discontinuation of medication, which can consequently lead to subsequent relapse. Some research has even concluded that long-term use of atypical antipsychotics can induce brain shrinkage over time and have also been shown, for many, to be ineffective for treating the negative symptoms. Negative symptoms of schizophrenia are not well known or spoken about as much as the positive symptoms. We often hear about the dramatic symptoms of hallucinations, delusions etc, but research has shown that the social exclusion, lethargy and depression that are associated with the negative symptoms can often be more disabling for the person’s quality of life, preventing them from having long-term relationships, employment and financial stability. 

How nutritional therapy can help

Nutrient therapy for schizophrenia, and other mental health disorders, is an area that is poorly understood. However, health practitioners adopting this strategy as a method to help improve symptoms associated to mental health disorders, as well as reducing side effects of medication, have had positive results. This type of strategy aims to target the underlying drivers of symptoms, such as poor methylation, severe oxidative stress and atypical immune-mediated responses. Due to the nature of schizophrenia’s heterogeneity and our fundamental nature as human beings of being unique biochemically-speaking, there is no one-size-fits-all approach in nutritional therapy. However, It is a low risk strategy which can complement pharmacological interventions without negatively interacting with medication. 

Common underlying drivers:

1. Poor Methylation

Methylation is a biochemical system that each of our cells in our body undertakes to complete a range of complex reactions for processes such as synthesising DNA, regulating our genes, synthesising neurotransmitters, regulating our hormones and many more. In those with certain genetic variations of methylation, high levels of homocysteine, a metabolite protein that can be found in the blood, are often found in many patients with schizophrenia. Homocysteine is produced by the metabolism of an amino acid called methionine and is in normal circumstances recycled back into the methylation cycle to be converted back into methionine. At high levels, homocysteine has been shown to cause oxidant stress, fibrin deposition (leading to atherosclerosis), cytokine release, inflammation and other mechanisms. The recycling process of homocysteine is dependent on a variety of co-factor nutrients, which are in turn dependent on your dietary intake, lifestyle and genetic factors. Those with deficiencies in nutrients such as folate and B6 have been shown to benefit from supplementation, helping to reduce homocysteine and therefore decrease factors such as oxidative stress, which has shown to play a role in the symptoms of schizophrenia. 

2. Oxidative Stress

Oxidative stress, a process that occurs when the balance between cellular defense mechanisms and endogenous Reactive Oxygen Species (ROS) and Reactive Nitrogen Species (RNS) becomes compromised, has been found to be present in high levels in those with this mental health condition as well as others. Oxidative damage to DNA, lipids and proteins can negatively impact the functioning of cells, specifically leading to membrane dysfunction, which can alter the structure, fluidity, permeability and capacity for optimal signal transduction. Antioxidants such as N-Acetyl Cysteine (NAC), Alpha Lipoic Acid (ALA) and vitamins C and E, have been researched as adjunct therapies for schizophrenia and shown positive results. Studies have demonstrated how these antioxidants can help support Glutathione production in the brain, another antioxidant that is a powerful free radical scavenger, found to be lower in patients with schizophrenia. Both NAC and ALA proved to help support attenuate side effects of medications as well as decrease the severity of negative symptoms. 

3. Gluten Sensitivity and Allergy

In a study carried out in 2006, it was revealed that patients with autoimmune diseases such as celiac disease and rheumatoid arthritis were 45% more at risk of having schizophrenia. A number of studies have found positive outcomes for patients on an exclusion diet where gluten has been eliminated. It is thought that by excluding gluten-containing foods, the health of the intestinal mucosa is restored, thereby reducing permeability in the digestive tract and preventing immune-mediated responses that lead to psychological symptoms. There is a subset of schizophrenic patients where a dramatic reduction, and in some even full remission of symptoms, has been recorded after removing gluten from the diet. 

Aside from these specific dietary strategies, there have been a number of others researched such as vitamin D, omega 3 fatty acids and L-Theanine, which have also shown to have positive results. It is clear that due to the multifactorial nature of schizophrenia’s underlying drivers, which can be different from one person to the next, there cannot be a no one-size-fits-all approach in treating this condition. A more integrative, holistic strategy whereby nutrition and supplementation are offered as adjunct therapies alongside pharmacological treatment, could be a very effective and inexpensive way of helping to improve not only the patient’s quality of life but also for those that are caring for them.