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Nutritional Management of Schizophrenia
Naturopathic Medical Research Clinic (N.M.R.C.)
12 Foxbar Rd., Unit #1
Copyright © 2002 by Raymond J. Pataracchia B.Sc., N.D.
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People with schizophrenia have peculiar nutritional profiles Schizophrenia may be caused by genetic predisposing factors or environmental influences. Nutritional methods described herein are guided by the principles of evidence-based-medicine.
Specific problems in neurotransmitter metabolism discussed below include:
vitamin B-3 dependency
high histamine metabolism
low histamine metabolism
metal metabolism abnormalities
specific essential fatty acid deficiencies
Nutritional supplementation and dietary interventions for these conditions is best done under the medical supervision of a licensed practitioner with strong foundations in nutritional (orthomolecular) medicine.
Nutritional needs of people with schizophrenia ultimately involve neurotransmitter issues of production, release, inhibition, transmission, and receptor formation. In schizophrenia, nutrition must also address neuron cell degeneration- an unfortunate common finding in chronic schizophrenia. Neurotransmitter metabolism is intricately involved with chemical reactions which are in turn dependent on vitamins, minerals, and other substances. When diet can not provide these missing nutritional substances, additional nutrient supplements become a necessity. Finding the ‘right nutrients’ is the quest and guiding principle of orthomolecular medicine, a form of nutritional medicine with a strong history in psychiatric patient management. These nutritional methods are implemented by the N.M.R.C.The N.M.R.C has a comprehensive model of wellness with an interest in mental illness prevention and promotion. The N.M.R.C. participated in an academic review on "wellness" in Canada (Jackson & Pulliam, 2002, federal report in draft).
Health insurance coverage for N.M.R.C. services are available through Maritime Life, Green Shield, Great-West, and other insurance providers. N.M.R.C. services are covered by most employment insurance providers. Extended health care packages (family and group rates) can often be included in health insurance policies from employers or insurance agents.
Nutritional protocols employed by the N.M.R.C. are similar to protocols used effectively by several orthomolecular psychiatrists throughout the world. The Canadian Schizophrenia Foundation (C.S.F.) and the International Society for Orthomolecular Medicine (I.S.O.M.) endorse evidence-based research and orthomolecular (nutritional) psychiatry.
Prognosis with Nutrition
The N.M.R.C. employs nutritional approaches for schizophrenia similar to those described by Dr. Abram Hoffer M.D., N.D., Dr. Carl C. Pfeiffer M.D. (now deceased), William J. Walsh (director of the H.R.I. and P.T.C.), and Dr. David Horrobin M.D. Prognostic outcomes for these practitioners/researchers are as follows:
Abram Hoffer (Hoffer, 1998):
nutritional treatment lasting
well & much improved
|sick 1 year
(or in 2nd or 3rd relapse)
|up to 1 year
|sick 2-5 years
||up to 5 years
|sick more than 5 years and
out of mental hospital
||5 or more
|sick more than 5 years and in
a mental hospital
||5 or more
Scale (Hoffer, 1994b):
symptoms and signs
|Ability to get on reasonably
well with family
|Ability to get on reasonably
well with the community
|Able to work at a job or to
be active in the same way as was the case before the illness
struck. If the patient never had been engaged in this kind
of activity they would be judged by the ability to perform
any useful work. The ability to pay income tax is an
important measure of recovery.
Able to work at a job or to be active in the same way as was the case before the illness struck. If the patient never had been engaged in this kind of activity they would be judged by the ability to perform any useful work. The ability to pay income tax is an important measure of recovery.
Carl Pfeiffer, in the 1970’s, reported B6 and zinc supplementation being 95% successful in the management of over 400 cases of pyrroluria-type schizophrenia (Pfeiffer, 1975). He also reported that lab-based orthomolecular nutritional protocols that alter neurotransmitter production (described here in the histamine imbalance section) can take 1 week to 1 year to take effect before symptoms start alleviating (Pfeiffer, 1970).William J. Walsh from the Pfeiffer Treatment Center (P.T.C.) reports: low histamine schizophrenic patients experience “major improvement within 6 weeks, but a year of treatment is commonly required before the last symptom (usually paranoia) can be overcome” (Walsh, 1991). High histamine treatment “requires great patience, because six to ten weeks are often needed before the beginning of significant improvement” (Walsh, 1991). These patients have depressive symptoms that begin to lift somewhere between 1-3 months; blank-mindedness symptoms that start leaving after 4-6 weeks but sometimes only after 4 months; obsessive symptoms that take somewhere between 3-6 weeks; compulsive symptoms that take 6-12 weeks; and phobic symptoms that take sometimes 1 year to dispel (Walsh, 1992)Most schizophrenic patients, according to referring psychiatrists, improve significantly following nutritional treatment, have less side effects from drugs, and are able to use lower doses of medications (Walsh, 1997b). Complete freedom from medications is not always possible for those with severe mental debilities (Walsh, 1997b). An outcome study of 150 schizophrenic patients from the P.T.C. reports best results for patients under age 40 (Walsh, 1997b).
Prognostic outcomes above are derived from patients who maintained regular medications until their biochemistry was balanced and remained stable for a couple of months, after which time regular medications were reduced (slowly) until none or very little medication was required.
Intervening with nutrition in the early stages improves the prognosis. Brain chemistry can be re-aligned more easily before this disease compromises brain cell structure. Therefore, the importance of early intervention cannot be over-emphasized.
Brain cell integrity must be addressed in medical practice to avoid regression of brain tissue. This is important because damaged brain cells cannot be repaired. Essential fatty acid studies (described herein) have yielded supportive evidence for their role in keeping neuron degeneration at bay and reducing psychotic symptoms.
Prognosis is improved with custom vitamin-mineral supplementation because it is easier to take these supplements and the ingredients are of higher quality then store bought forms. Store bought forms also have added ingredients that, in many cases, are contradictory to the supplement prescription.
Favorable prognostic outcomes and case studies from reputable scientists and practitioners in separate clinical settings are discussed in the following set of references-- Wenzel, 2001; Dardanelli & Del Pilar Garcia, 2001; Walsh, 2001; Wenzel, 2000; Hoffer, 1999a; Hoffer, 1999(Jun); Walsh, 1997b; Walsh, 1992; Walsh, 1991.
Vitamin B-3 Dependency
Niacin or niacinamide or niacin hexaniacinate are different forms of vitamin B3. Vitamin B3 can limit the conversion of norepinephrine to epinephrine (adrenaline). Excess adrenaline or excess catecholamines such as dopamine (implicated in the dopamine hypothesis of schizophrenia) are problematic as they can oxidize and form endogenous toxins. The brain with similar local reactions may fail to store excess catecholamines, a job normally reserved for neuromelanin, and hence allow free circulation of neurotoxins (Smythies, 2000; Hoffer, 1981; Hoffer, 1973). B3 dependent pathways in the body vent the biochemistry of the body away from the formation of oxidized catecholamines and toxic indoles. This might under certain circumstances contribute to synaptic deletion. Abnormalities in this neuromelanin storage pathway may be considered causative factors in schizophrenia or Parkinson's disease. This biochemical theory was the first presented in medical literature by Dr. Abram Hoffer M.D., Ph.D. and Dr. Humphry Osmond M.R.C.P., D.P.M. This theory is called the adrenochrome hypothesis.
Niacin also plays a role in the essential fatty acid metabolism of the brain, processes of which are disrupted in schizophrenia. Niacin and vitamin C (ascorbic acid) are centrally active in the brain as “niacinamide in the brain acts on the diazepine receptors, while ascorbic acid acts on the dopamine receptors, as do Haldol and other [neuroleptics or] tranquilizers” (Hoffer, 1989).The nutritional need/dependency versus deficiency (a less dependant state) for B3 may indeed exceed the need to address any other nutritional metabolic compromise as it is perhaps ultimately involved in the metabolism of the mind in people with schizophrenia.
Dr. Abram Hoffer and Humphry Osmond spearheaded this nutritional approach which includes appropriate sufficient doses of niacin. Other nutrients which complement ‘niacin therapy'The B3 approach has been clinically tested in several double blind placebo controlled trials and overall assessment of these sources reveals sufficient evidence in support of B3 therapy in the management of schizophrenia. The six double blinds done by Hoffer et al were the first double blind placebo controlled trials ever done in the history of psychiatry (Hoffer et al, 1957). The B3 therapy is discussed in detail in various journals and sources which I will list as a review of nutritional psychiatry along with a review of its effectiveness and proposed mechanisms of action-- Hoffer, 1999a; Hoffer, 1999b; Hoffer, 1999(Mar); Hoffer, 1998; Hoffer, 1994a; Hoffer, 1994b; Hoffer, 1994c; Hoffer, 1991; Hoffer, 1989; Hoffer, 1987; Hoffer, 1981; Hoffer, 1980; Hoffer, 1976; Hoffer, 1976a; Hoffer, 1973; Hoffer, 1967; Hoffer, 1967a; Hoffer & Osmond, 1966; Hoffer & Osmond, 1960; Hoffer et al, 1957. Dr. Abram Hoffer, M.D., N.D., has treated over 4000 patients with this approach and he now practices in Victoria, B.C., Canada.
What is histamine and why is it so important? Carl Pfeiffer studied more than 20,000 people with schizophrenia and determined that 90% of them fell into three bio-chemical subgroups: high histamine, low histamine, and pyrroluria - hence the term “The Schizophrenias” (Pfeiffer, 1970; Walsh, 1997b). Histamine is a reflection of neurotransmitter availability. Histamine is integral in balancing the electrical activity of the nucleus accumbens, which is an area of the brain responsible for behavioral responses, filtering incoming sensory information, and communicating with the hypothalamus, ventral tegmentum, and amygdala (Shoblock & O’Donnell, 2000; Otake & Nakamura, 2000; Chronister et al, 1982). A plethora of research has determined that people with schizophrenia have poor ability to filter incoming sensory information. It has also been reported that 15-20 % of people with schizophrenia have high whole blood histamine levels and another 30-40 % of people with schizophrenia have low whole blood histamine levels (Heleniak, 1999; Pfeiffer, 1988; Heleniak, 1985; Chronister & DeFrance, 1982; Rauscher et al, 1977; Pfeiffer, 1972a).
A person with schizophrenia who has high histamine is under-methylated (Walsh, PTC- Ref. B; Heleniak & Frechen, 1989). A person with schizophrenia who has low histamine is over-methylated (Walsh, PTC- Ref. B; Heleniak & Frechen, 1989). Taking detailed patient histories is key (Jackson et al, 1998; Edelman, 1996; Jaffe & Kruesi, 1992; Pfeiffer, 1988; Walsh, PTC - Ref B). People with high histamine have been found with typical symptoms of high intelligence, thought blanking, low grade hallucinations, and thought disorder, perfectionism, competititiveness, obsessions, compulsions, suicidal and seasonal depression, defiance, and phobia.
High histamine individuals are inherently high in folic acid. Although folic acid is used along with B-12 in the production of methoionline it is also involved in histamine production along with B-12. Consequently B-12 and folic acid are strictly avoided in high histamine patient care. These patients need to avoid multi-vitamins.
People with low histamine have been found with typical symptoms of under-achievement, more severe thought disorder and hallucinations, paranoid thoughts with less pronounced obsessions, suicidal depression, cyclic or suicidal depression, and anxiety. (Jackson et al, 1998; Edelman, 1996; Jaffe & Kruesi, 1992; Walsh, PTC - Ref. B).
Excess copper and zinc defiiciency, discussed below under heavy-metal overload, are typical low histamine traits that need to be addressed (Sandstead, 1994; Wallwork, 1987; Pfeiffer & Braverman, 1982; Walsh, PTC - Ref. B)
Metal imbalance is associated with schizophrenia, behavior disorders (including ADHD), and hormonal depression (Walsh, PTC- Ref.C).
Copper excess causes brain dopamine levels to rise in low histamine schizophrenia. “Copper poisoning with zinc deficiency will explain the present dopamine theory of simplistic schizophrenia since this condition occurs only in one-half of patients labeled schizophrenic”, that is, in low histamine schizophrenia (Pfeiffer, 1987b). Paranoia is also associated with elevated copper (Pfeiffer & Iliev; Walsh, 1997b). Copper oxidizes catecholamines such as dopamine and therefore propagates neurotoxin formation (compare "Niacin Section" above). Zinc imbalance is associated with central nervous system disorders such as schizophrenia and autism and several other pathologies (Walsh & Usman, 2001a; Ebadi, 1995; Walsh, PTC- Ref. C).
Some nutrients help remove heavy metals but environmental exposure must be addressed. This includes restrictions on diet and the elimination of environmental factors such as copper tea pots, copper sulphate (jacuzzi or swimming pool water), bad drinking water, prenatal vitamins, copper IUD’s, etc. (Walsh, PTC- Ref.B). Drugs such as neuroleptics, antibiotics, antacids, cortisone, tagamet, zantac, diuretics, and birth control pills, etc. may exacerbate copper overload.
According to Carl Pfeiffer, 30 - 50 % of people with schizophrenia have pyrroluria (Pfeiffer, 1975; Sohler et al, 1970; Pfeiffer, 1973). Dr. Abram Hoffer claims that perhaps 70% of acute schizophrenia cases have pyrroluria and that recovered patients have no pyrroluria (Edelman, 1996). What is pyrroluria and how is this related to brain function? In some people, one specific pyrrole, 2,4-dimethyl-3-ethylpyrrole, is produced in excess and excreted in the urine (Jackson et al, 1997; Pfeiffer, 1975; Sohler et al, 1974). 2,4-dimethyl-3-ethylpyrrole interacts with B6, zinc, and magnesium leaving these nutrients deficient (Jackson et al, 1997).
Pyrrole disorder individuals have problems forming serotonin, dopamine, GABA, norepinephrine, and glycine (Edelman, 1996). B6 is needed for proper brain detoxification. Zinc is essential in nerve development, intellectual function, serotonin formation, the regulation of mood, and the prevention of oxidative damage (Johnson, 2001; Sandstead, 1994; Pfeiffer, 1982).
Pyrrole disorder is a condition of the whole body with both physical and mental symptoms versus other nutritional bio-types of schizophrenia where there exists a typical resiliency to physical disease (Wenzel, 2000; Hoffer, 2000; Hoffer, 1994d). Pyrrole disorder is common in behavior disorders as well (Edelman, 1996).
Specific behaviors and physical symptoms are associated with pyrroluria (Edelman, 1996; Pfeiffer, 1975; Walsh, PTC- Ref.B). People with pyrroluria-type schizophrenia may have classic delusions, classic hallucinations, hallucinations, lethargy, high internal tension, stress intolerance, assaultive behavior, and unconstrained irritability (Edelman, 1996; Pfeiffer, 1975). They may experience a single convulsion on administration of neuroleptics – when first prescribed (Pfeiffer, 1975). They tend to have more intact insight and better mood regulation than other nutritional biotypes but their social withdrawal seems more prominent (Edelman, 1996; Pfeiffer, 1975). Physical symptoms of knee joint pain and fingernail white spots are also common in pyrroluria. Carl Pfeiffer and BioCenter Laboratory records from Wichita, Kansas, have noted an approximately 20% incidence of fingernail white spots and knee joint pain in people with schizophrenia (Jackson et al, 1997). They tend to be female and sometimes have "China doll” pallor (Edelman, 1996).
Essential Fatty Acid (EFA) Deficiency
EFA’s, including omega-3 and omega-6, are good fats, not saturated with hydrogen, and unfortunately, not readily provided in the American diet. 60 % of the dry weight of the brain is fat (Horrobin, 2000). William Walsh reports an integral need for appropriate EFA supplementation in schizophrenia, ADHD, and depression (Walsh, PTC- Ref.B). EFA’s are important components of nerve cell walls and are involved in neurotransmitter electrical activity and post-receptor phospholipid mediated signal transduction. Neuronal degeneration is found commonly among people with chronic schizophrenia as they have apparent increased phospholipid neuron membrane breakdown which concentrates in the frontal cortex and other areas of the brain (Gattaz et al, 1995). EFA’s offer a means of maintaining brain membrane structure and avoiding brain mass loss (Horrobin, 2000).Some specific EFA supplements are useful in schizophrenia and help to keep neuron degeneration at bay.
10%-15% of people with schizophrenia have cerebral/brain allergies (Pfeiffer, 1976). Cerebral allergies involve a gut reaction that ultimately perpetuates the release of brain toxins resulting in psychosis, malaise, etc. (Marz, 1997; Edelman, 1996).
Culprit foods and culprit environmental compounds have to been identified in schizophrenia. An investigative procedure called elimination dieting is important for diagnosis. Individualized nutritional guidelines derived from lab assessment and patient histories provide comprehensive programs of diet that can be essential in the management of schizophrenia.
Testing for overpopulated gut micro-organisms such as Candida albicans is a vital part of the assessment when cerebral allergies are suspected. Mal-absorption also has to be ruled out.
Hypoglycemia is the term that describes low sugar in the blood. Irritability, poor memory, “late afternoon blues”, poor concentration, tiredness, cold hands, muscle cramping, and “feeling better when fighting” are typical hypoglycemic symptoms (Wenzel, 2000). Hypoglycemia tends to be an aggravating factor in mental illnesses rather than a causative factor. The nutritional protocol for hypoglycemia involves dietary changes and supplement support. It is said that hypoglycemia is 100% treatable in compliant patients- emphasizing the need to adhere to the diet.
Classical HomeopathyClassical homeopathy is an alternative approach useful in the management of Schizophrenia. This approach is described at
Disclaimer: N.M.R.C. services are not offered as a cure-all replacement for standard treatment. Some patients require conventional treatment, some do better on nutritional treatment, and some require a skilful combination of both. Prescribed drugs can safely be maintained for the duration of all N.M.R.C. therapeutic interventions. Based on signs of clinical improvement, your medical practitioner can monitor drug withdrawal as this becomes another key component to recovery. Information herein is not intended for self-prescription or self-diagnosis and is not intended to replace the advice of a medical practitioner or health-care provider. The N.M.R.C. does not imply cure in any treatment protocols offered. This review is an independent appraisal of the literature and is offered as information, not advice. Nutritional prognosis described herein by other researchers and practitioners do not necessarily apply to N.M.R.C. services and are listed herein for your independent appraisal and assessment
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