Before we start looking at current trials using nutrients to treat mental health outcomes, we thought we would revisit the past once more to see how knowledge gained by our predecessors may be helpful for our current challenges.
As part of our training to become researchers, both Bonnie and Julia were taught about many scientific studies conducted prior to the existence of research ethics committees. There are quite a few that are notorious for how they treated humans and animals, and it is obvious that they would never get approved by an ethics committee in this day and age. These types of experiments can’t be replicated, nor would we want to, given the suffering involved with no foreseeable benefit; however, we can still learn a lot from them, particularly about the role that nutrition plays in mental health. One of those studies was the Minnesota Starvation Experiment.
The Minnesota Starvation Experiment was conducted at the University of Minnesota during the Second World War, between November 19, 1944 and December 20, 1945. The main goal of the study was to determine the physiological and psychological effects of severe and prolonged dietary restriction.
The study was developed in coordination with the Civilian Public Service (CPS), an organization that provided conscientious objectors in the United States an alternative to military service during World War II. Out of 400 volunteers, Ancel Keys, the primary investigator, chose 36 men. The study was divided into three phases:
- A 12 week control phase where physiological and psychological observations were made to establish a baseline for each person;
- A 24 week starvation phase, over which period the caloric diet of each subject was dramatically reduced causing each participant to lose approximately 25% of their pre-starvation body weight; foods consisted of potatoes, rutabagas, turnips, bread and macaroni.
- A recovery phase where various rehabilitative diets were used to renourish the volunteers
In 1950, Ancel Keys and his colleagues published the results of the Minnesota Starvation Experiment in a two-volume, 1,385 page text entitled The Biology of Human Starvation (University of Minnesota Press).
Here is a summary of what they found:
- Prolonged semi-starvation produced significant increases in depression, hysteria and hypochondriasis (a focus on somatic concerns) as measured by the MMPI (a test of personality)
- Most participants experienced periods of severe emotional distress and depression and grew increasingly irritable
- Some individuals engaged in self-mutilation (these days we call this self-harm, often seen in people struggling with regulating their emotions) – apparently one person cut off three fingers with an axe although it was unsure if this was deliberate or accidental
- Many appeared apathetic and lethargic with a diminished sexual interest
- Volunteers showed signs of social withdrawal and isolation
- Participants reported a decline in concentration, comprehension and judgment capabilities
For those of you who work in the field of mental health, many of these symptoms will sound familiar – they are symptoms of anxiety and mood disorders as well as symptoms of eating disorders. It really should not be a surprise to this audience that the brain’s functioning is highly compromised when the body is being starved of food (and nutrients). What we wonder is whether eating a diet of primarily highly processed foods low in nutrients has similar effects.
In addition to the work of Keys, many of you may also know of the role of poor nutrition and starvation in the expression of mental health symptoms from tragic naturalistic experiences of famine. The Dutch Hunger Winter Famine, caused by a Nazi blockade of occupied western Holland from October 1944 to May 1945 (around the time that Ancel Keyes was deliberately semi-starving conscientious objectors to the war), taught us a lot about the importance of good nutrition during pregnancy. There have now been a number of publications looking at the long-term effect that this famine had on the offspring of women exposed to the famine during pregnancy. For example, Susser and colleagues looked at the impact that this acute food deprivation during the first trimester of pregnancy had on the risk of developing schizophrenia in the offspring. They tracked the rate of hospitalizations for schizophrenia between 1978 and 1989 and determined there was a two-fold increase in schizophrenia in both men and women exposed to the prenatal famine as compared with an unexposed birth cohort. This finding has since been replicated based on data collected after the China Famine in the late 1950s.
If we do eat nutrient-deficient food (either due to starvation or food choices), does the brain receive what it needs to function effectively and optimally? Could some of our current population be suffering from the effects of semi-starvation?
For those who would like to read further
Keys, A.; Brožek, J.; Henschel, A.; Mickelsen, O.; Taylor, H. L. (1950). The Biology of Human Starvation (2 volumes). St. Paul, MN: University of Minnesota Press, MINNE edition. ISBN 978-0-8166-7234-9.
Susser ES, Lin SP. Schizophrenia after prenatal exposure to the Dutch Hunger Winter of 1944-1945. Arch Gen Psychiatry 1992 Dec;49(12):983-988.
Susser E, Neugebauer R, Hoek HW, et al. Schizophrenia after prenatal famine. Further evidence. Arch Gen Psychiatry 1996 Jan;53(1):25-31.
Another great post!
Great article! I hope this information gets to audiences that support the food banks that serve many people who receive disability payments. I also commented on MIA’s facebook page, and found other good information there.
I’m so grateful you wrote about Keys’ study. It is such an important piece of research that many people do not know about.
I wish you had made the connection between the findings in Keys’ work and the Maudsley Method for treating anorexia. Supported by research – including Keys – Maudsley holds, among other things, that in many instances weight loss causes anorexia nervosa, rather than anorexia nervosa causing weight loss. This is a subtle distinction, but it is incredibly important in terms of informing effective treatment.
Maudsley is now recognized as the most effective treatment for child and adolescent anorexia nervosa. Much of its effectiveness stems from the fact that it recognizes that starving people are often not capable of making rational choices or using sound judgment, and as a result it removes all responsibility for making food choices (what, when and how much to eat) from the suffer. This is a radical departure from “old school” methods for the treatment of eating disorders that were often predicated on the suffered “wanting” or “deciding” to seek recovery for him or herself.
Thank you MIA for introducing more people to the foundational research driving new developments in evidence based care!
“Maudsley holds, among other things, that in many instances weight loss causes anorexia nervosa, rather than anorexia nervosa causing weight loss. This is a subtle distinction, but it is incredibly important in terms of informing effective treatment.”
I believe “anorexia nervosa” is just a quack psychiatric label for the serious life problem of obsessive self starvation. The logic of saying “Weight loss causes anorexia” could just as easily be applied to “weight gain causes overeating”. Or hair growing “causes” obsessional hair pulling.
“Much of its effectiveness stems from the fact that it recognizes that starving people are often not capable of making rational choices or using sound judgment, and as a result it removes all responsibility for making food choices (what, when and how much to eat) from the suffer. This is a radical departure from “old school” methods for the treatment of eating disorders that were often predicated on the suffered “wanting” or “deciding” to seek recovery for him or herself.”
Fat people who eat too much, perfect weight people who use drugs too much, are all labeled “incapable of responsibility”. In all the cases of obsessional self starvation aka “anorexia” I’ve looked at its clear that people eventually have to change their habits to solve the problem. Taking responsibility away, indoctrinating people with obsessional habits to believe they are passive victims of an active disease, I believe is responsible for robbing hope from the person labeled “anorexic”, stealing their potential reserves of self mastery and possibly being responsible for their ultimate doom. I think the people with the actual problems, and not the faux scientists who slap labels on the problems are the people I’ve learned the most from in this area:
A boy who had eating problems and got labeled “anorexic” says:
“‘I was never a fat child. But with things going on in my life that I couldn’t do anything about, like bullying at school, I realised the one thing I could control was what I ate.”
A young woman labeled “anorexic” says:
“‘I found it quite easy to lose weight and I felt in control of something in my life.
‘I’d been bullied at school and I’d been in an unhealthy relationship. These two things, I think, had knocked my confidence.'”
A victim of a horrible crime recounts what led to her obsession with starving herself:
“A FORMER policeman’s child-sex-abuse victim has broken down while telling a judge how the assaults drove her to anorexia, which became her friend and “loved me”. ”
Then there’s the way people in the middle ages viewed self starvation, a religious obsession this time:
And blaming speculative biological hypotheses hasn’t helped this young girl’s problems here, the former “Britain’s fattest teenager”, spirals into self starvation after a “medical” fix to her obesity, gastric banding:
“‘It is not surprising she has swapped one emotional relationship with food for another.
“‘Perhaps, subconsciously, Malissa is so afraid of becoming obese again, she is stopping herself from eating.'”
Complex behavior also shows the difference between someone with scurvy and someone getting a psychiatric label slapped on them, here is a person labeled “anorexic”, someone some of you would say has a nutritionally impaired brain that doesn’t “function effectively”. I’d say she’s demonstrated she can make a plaster cast just as well as the most dogmatic fitness and nutrition nut. People who declare brains as globally functioning not optimally sure do pick and choose which human actions to blame on the “disease” from a vast array of human behavior the person engages in.
“Later, she created a plaster cast of her thighs. Like many others with anorexia, she had thought her legs were too big; now she could see how thin she had become.”
As for the two studies cited about the prenatal nutritional hypothesis of what causes people to be labeled without any biological test with the “schizophrenia” label by psychiatrists who have shown it is a virtual crap shoot whether the most deeply disturbed detainees in mental “hospitals” get the Schizophrenia label slapped on them, the Schizoaffective label slapped on them, the Bipolar 1 label slapped on them, the Brief Reactive Psychosis label slapped on them…. I think the fact that the Dutch famine studies come from the Nazi era is ironic. The prejudice to prove the most distressed in society to be biological defectives is strong in this world. As strong as scientific racism was at its height.
Drawing a line between Dutch women starved while pregnant by a Nazi blockade and neural tube defects including spina bifida and anencephaly is one thing. Drawing a line between that and the behavior of a 20 year old adult that gets labeled subjectively irrational and will have one of many guesswork psychiatric labels slapped on it, is just offensive in its ignorance. It is the ideology of people who have already seen a disease where there has never been proven to be one, people who are addicted to the word “clinical” and swim in a sea of accouterments of science.
Then there is the fact that young people whose mothers suffered under a Nazi blockade and famine, might be said to be people who come from families that have suffered extreme psychological trauma and distress.
I read the dutch famine-blaming study you cited. Decades after the fact they went back to psychiatric records and even merely prescriptions for neuroleptics, and trusted that the Dutch doctors slapped the appropriate ICD label on the distressed young person that got the psychiatric label when they became a detainee in a “hospital”. It’s a study of who’s mother was in a Nazi famine, and who grew up to get a particular psychiatric label slapped on them. The psychiatric label slapped on them in one snapshot of time, is assumed to tell the story of a genuine “disease” that was set in motion by lack of folate or some bizarre extrapolation like this. The outcomes and later success or continued problems of this sample of people believed to have come out of the womb as inferior defective human bodies is not investigated.
If famine causes adults to have mental breakdowns that get labeled “schizophrenia”, and if this was set in train while they were in the womb, why isn’t Africa teeming with world record levels of people being labeled “schizophrenic”? Why didn’t Bob Geldof raise money for all the famine induced “schizophrenics” that should be in Africa if your theory is true?
Has the dead-end research into blaming parental nutrition for the complex phenomena that gets labeled madness led to any objective predictive scientific tests that pregnant mothers can take? no. Has it led to any advice that can be given to mothers so they can eat right to avoid their child being born normal and later in life being labeled abnormal by a psychiatrist who can’t prove their biology is diseased? no.
At least most of the other authors on MIA wouldn’t compare our experiences to spina bifida.
Is it good to eat right? yes. Is it speculation to simply label every culturally frowned upon and described as “irrational” behavior cased by the body? yes.
Are the millions of human beings who have been imprisoned by psychiatry and forcibly meddled with, with guesswork combinations of what quacks call “treatments” just walking neural tube defects? that folate will fix? No.
After countless cadavers of people sliced up and studied where these dead people in life had a psychiatric label slapped on them from a book of labels, no biological disease has been found.
With real neural tube defects, the clear biological disease provided the first impetus for studying nutrition.
I’m not a birth defect, and neither were any of the unfortunate people born to mothers who suffered under the Nazis in the Dutch blockade famine. We are people who came into this world fully formed, not meeting any disease criteria when born, I’d say when a baby comes into the world and there isn’t any disease the mother should be relieved. If that child grows up and in adulthood suffers a crisis of mental overwhelm and gets handed over to the “brain disease” diagnosers who don’t even examine brains for a living, only someone blinded by science starts looking through the entrails of a poo the mother took while pregnant 22 years ago. The people who conducted these studies on the Dutch Nazi famine are very strange people. I label their behavior out of order.
What I’d like to do, is get the person who did the Dutch famine study you cited, get them out of their ivory tower, invite them down to the solitary confinement cell I was incarcerated in, get them to look in my eyes while I’m being held down and forcibly injected with tranquilizer drugs against my will, really look in my eyes, and tell me that their Dutch famine study is going to help me. I’d ask them to tell me why they think a label slapped on my within the first 15 minutes that came from either the ICD or the DSM explains the problems in my life and justifies those problems being treated as identical to all the other millions of people who’ve had that label slapped on them. I’d ask the researcher if she was interested in what happened in my life in the weeks leading up to me becoming very overwhelmed with life and being cornered like an animal in an institution run by people who think a book of labels is the first go to thing for human distress. I’d ask the researcher if maybe she thought some people’s labeling was influenced by the way they reacted to human rights abuses. Maybe the ones who got the most outraged at being treated like a criminal got a more severe label? got labeled more “agitated”, more “psychotic”? I’d ask the researcher if she could save me from my attackers and get the door unlocked and get the strangers to stop coming into the cell and injecting me.
The researcher would then ask me if there had been a blood sample kept from the early 80s when my Mother was pregnant with me.
Are you kidding me?
The Ancel Keys who invented the low-fat-diet/saturated-fat-kills mess? The guy who is jointly responsible for the unhealthy food we eat today (high in poly unsaturated omega-6 fatty acids)?
Glad to see someone else noticed this too. There are major problems with the nutritional paradigm that Ancel Keys championed, which has become so well entrenched and remains mostly unquestioned. I have to admit I see parallels between the current ‘accepted’ nutritional philosophy (food pyramid, or plate, or whatever it is now) and the struggle to correct and change the harm being done via labeling and diagnosing human suffering as “mental illness”.
I’ve been coping with depression for nearly two years. I know that it is due to what’s going on in my life. I’ve had periods of situational depression before like most people.
I will say that finally rejecting the “low fat” diet mantra, getting rid of processed and sugary foods and all grain products seems to have made a huge difference in my quality of life, both physiologically and mentally.
I eat a lot of pastured proteins and a lot of saturated fat from animal and vegetable sources, as well as a variety of whole foods like vegetables. I am able to get away with whole fat dairy daily. For the past year, I’m the healthiest I’ve been in well over 20 years.
As for starvation, I wonder if the authors have read any literature on intentional fasting? I decided to try it for a number of reasons, one of which was autophagy but in my case as well to get a handle on my relationship to emotional eating/self-comfort (led to weight gain and additional mental misery), which has always been an issue in my life.
I’ve been able to go on planned water fasts for as long as 5 days, and I hope to complete a 10 day fast in the coming months. I might do it once a month, so by no means do I have a so-called ‘eating disorder’. I am not doing it because I think my body is unacceptable or to lose weight.
The times I’ve fasted have brought me to some very zen-like states of mind that I found extremely valuable, and did a lot of journal writing that I look back on with wonder: many profound insights into my life that are not normally easy for me to access.
Now my normal daily eating window is usually 8 hours, between noon and 8 or 9 at night. I typically don’t eat breakfast because I’m simply not hungry. Lunches and dinners work well, and I don’t need to snack. Several times the business of life just gets in the way, and I’ll unintentionally find myself having fasted for 24 hours. I received shocked reactions from family members once when I casually let it slip that “Yes, I’m looking forward to dinner! I just realized I haven’t eaten since yesterday so I’m famished!” They couldn’t believe I wasn’t irritable, grumpy, tired – and was actually quite energetic and in a great mood when they saw me (at the 25+ hour mark since my last meal).
Apparently, our bodies can do quite well in a vastly different nutritional paradigm than what we were told to do while growing up: “Make sure you eat 3 squares a day, low fat of course, and have healthy low-fat snacks in between meals – or you will become overweight, unhealthy and will be tired and grumpy all the time too!”
One of my family members continues to be amazed but suspicious that I eat so differently, and do so well. She’s always on the lookout for a low-fat but sugary (bread product, fruit, etc) snack between meals. I’m never hungry for one, and she chides me that by ‘starving myself’ my metabolism is going to stay out of whack and cause all sorts of health problems. Yet I’m in better physical shape than she is.
It’s been an amazing journey of self-discovery – learning that not only do I still love food as much as I always have, but I’m no longer a slave to it. I’ve found better ways of using it for both health and enjoyment. Giving myself permission to enjoy saturated fats as much as I want, and weaning myself off sugar, was the first step in a hugely important component of my self-care toolbox as I cope with the other problems in my life that are contributing to feeling depressed.
I believe if I was still eating the low-fat, high carb diet and feeling hungry on it all the time, my ability to ‘sit with’ and go through this depression would be far less tolerable to me right now.
I fasted every couple of years and most of the time I felt really energized, calm and happy. When I went on a gluten-free diet a year ago I felt quite similar. My theory is, that the main cause of the mood change was not the fasting itself (not eating any food), but not eating any gluten containing food.
I believe optimizing nutrition can help much more than any psychiatric drug.
“Some individuals engaged in self-mutilation (these days we call this self-harm, often seen in people struggling with regulating their emotions)”
‘Regulating emotions’ is code for the Borderline Personality Disorder smear and just because diagnostic systems decided to place that action within that diagnosis and make it part of the qualifying criteria that does not mean that self-harm is synonymous with BPD. In the UK people [predominantly women] can get saddled with that diagnosis purely on the basis of 1] history of self-harm 2] any known history of child abuse to the degree that now anyone who self-harms is highly likely to get that diagnosis even if they don’t “fit” any of the remaining diagnostic criteria, or in addition to any other ‘illness’ diagnosis specifically to ‘cover’ that action. It’s the hearing voices means Schizophrenia equivalent so it is not helpful to imply that self-harm is often seen ‘in people struggling with regulating their emotions’.
People self-harm and can have no diagnosis or ANY diagnosis from the DSM/ICD, it is not a diagnosis specific act no matter how much psychiatry tries to enforce this.
This reminds me of the extensive nervous system in the intestines — how highly related the brain and intestines are! Here are excerpts from a public radio interview with two Peace Awardees from an African Peace Conference (minutes 10-18): http://archive2.capradio.org/news/insight/2013/04/25/insight-042513
“There is almost zero programming about your health on television, in terms of the food that you eat. Almost all of it is stuff that’s terrible for you. And most of it is laden with chemicals that you can’t digest… The body sees it as toxic, so it wraps these chemicals in fat… and you start to become obese… you cannot pursue life, liberty and the pursuit of happiness, if you don’t have health… One of the things that is happening with the fast food and processed food industry is that we are largely dependent on the crops of wheat and corn… both have a protein… [that] needs to be soaked for 12 to 18 hours before the human body can digest it. But because we’re processing the food so fast, we don’t have time to do it. So we grind it to dust that we call flour… Well, that flour is indigestible… it actually attacks the intestine walls after you eat it, which is why we’re having this huge increase in something that’s called leaky gut syndrome… and undigested food goes into the bloodstream. And the body reacts to that as a toxin. So you have this incredible increase in food allergies that have come about because of the processing of the food… it has chemicals in it that are not food. And those chemicals attack our bodies over time.”
I’m sure nutrition is important but it seems not too illuminating to put wholesale starvation and sub-optimal “food choices” in the same box without more explanation than is given here. What exactly is the rationale for thinking the two things might have similar effects? Organisms of all sorts can adapt, to varrying degrees, to nutrient deficiencies, but when you take the calories away I would think just about everything in the body and mind is going to suffer. The suggestion here seems a little like suggesting that needing a tune-up for your car will have the same results as having no gas in the tank.