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HOPE: On the Other Side of the Door

Oct 11, 2018

The focus is on food and diet at home as a way toward  balanced, healthful, meaningful, and respectful lives for the person living with Schizophrenia and their caregivers, too.

In psychiatric and neuroscience research it is clear that schizophrenia is caused by different problems in the mechanisms of brain function and brain anatomy.  One of particular note is inflammation in the brain. This can be thought of as an inappropriate immune response in the brain.  Some of the antipsychotic medications  side effects were reviewed again, as in a previous podcast.  Risk-Benefit analysis logic was reviewed:  There is a RISK that based upon positive symptoms (hallucinations & delusions) that a person may engage in harmful behaviors toward self or other people.  In many if not most cases this benefit outweighs the serious but lesser risk of the side effect of the medications.  

Changes in the way a person’s body processes food was one particularly important side effect.  This results in something called the “metabolic syndrome.”    It is a cluster of conditions —  increased blood pressure, high blood sugars, excess body fat around the waist, and abnormal cholesterol and / or triglyceride levels.  When they occur together they increase the risk of heart disease, stroke and diabetes.

Diabetes, type II used to be called “adult onset diabetes” is caused by  a person’s genetics and lifestyle including diet.   There is insulin resistance, and that means that your body does not respond to insulin which is a hormone that allows cells to take in sugar  (glucose) from the blood  as nutrition.  There can be excessive chronic thirst, frequent urination, and unexplained weight loss.  Later there are long term problems such as organ damage, particularly the kidneys and the eyes.  Healing cuts and wounds can be slow or impossible.

The Schizophrenia Care Project is setting up accountability groups to help folks actually use these diets in their day to day lives at home.  The hope is to make these accountability groups for Caregivers and folks living with schizophrenia fun and game-like.

First, become aware of what meals are served at home, and the eating habits and  snacking habits, of the loved one living with schizophrenia, is important.  A food and meal diary can be useful here.  Exercise levels may be low to start with because of both the so-called negative symptoms which involve lack of drive and initiative, and due to the sedating quality of some of the medications.  Regular mealtimes and eating moderate amounts of the healthiest foods is advised.  Bringing back the “family dinner time” home meal ritual is a way to keep positive meaning, health and respectfulness in people’s lives.

Second, if you have the luxury of getting a registered dietician’s services that would be great, and possibly the hospital dietician can give a consultation on the way back home.    Personal food likes and dislikes are important, note any food allergies.  The goal for the loved one living with schizophrenia is to enjoy and to live the best life possible.  Mealtime fellowship and good food is part of a good life. 

Brain research exists on inflammation & immune system over-reaction in a sub-set of people living with schizophrenia.  Aspirin and some other anti-inflammatory meds have been used as part of the treatment.   Check with your doctor about this for you.

The Mayo Clinic recommendations were reviewed for eating healthy carbohydrates, fiber-rich foods, heart-healthy fish, and the “good” fats.  Those things include starches and fruits, vegetables and whole grains, legumes (beans, peas and lentils).  Also, low fat dairy products are recommended….but some in the anti-imflammatory camp recommend no dairy at all.  Their recommendations also include fiber-rich foods such as nuts and legumes.  For meat eaters, heart healthy fish are a good alternative to high-fat meats.  Those fish include cod, tuna, halibut.  The ones rich in omega-3-fatty acids which promote heart health are salmon, mackerel, tuna, sardines and bluefish.

The good fats are monounsaturated and polyunsaturated fats that can lower cholesterol levels.  They include avocados, almonds, pecans, walnuts, olives.  Also oils such as canola, olive and peanut.

It is good to avoid saturated fats in animal proteins, beef, hot-dogs, sausage and bacon.  Also avoid trans-fats in processed food snacks, and baked goods made with shortening.  Limiting your cholesterol intake is another basic Mayo Clinic recommendation:  So you may wish to limit your eating liver, egg yolks, and organ meats.

The two foods most associated with inflammation are gluten and dairy (particularly high fat content dairy, such as certain cheeses).   Gluten, a wheat, barley and rye protein has received a lot of attention in recent years.  There is a serious condition affecting several different ethnic groups, not just those  folks of northern European descent.

Spice up your meals with turmeric.  This is common in Indian cuisine and it is a wonderful anti-inflammatory spice.  Also, yogurt, and pro-biotics have been shown to reduce stress and anxiety, which are very common concerns for those living with schizophrenia. Serotonin from the gut, from the intestines is key to avoid depressed mood states, which can be associated with schizophrenia, too.  So, probiotics are important.  “Nutritional psychiatry” has become a trend in recent years in the field; little by little psychiatrists are including diet as part of mental health. 

Sugars and sweeteners are a controversial area of interest.   Cane sugar, table sugar, beet sugar is “sucrose” made up of glucose and fructose.  Sucrose is broken down into those 2 sugars in the body.  Our normal human brain cells use glucose almost exclusively for energy and normal functioning.  The “high fructose corn syrup” has been outlawed in human foods in several European nations because it alters insulin metabolism, and causes more triglyceride and lipid formation by the liver, leading to metabolic syndrome. 

On Exercise:  A very basic exercise is walking.  It  is commonly recommended to walk for at least 20 minutes as a time, working up a light sweat as a simple form of aerobic exercise.  A nice family walk can help build rapport, help in bridge-building and lead to a meaningful and supportive home life or life in a board and care house or a group home.   Yoga style stretching is very popular these days, videos, classes and groups are readily available in many towns and cities.  Do exercises that  you & your family enjoy doing. 

Harm reduction was addressed.  Avoiding meats is recommended and any vegetarian restaurant will have balanced, healthy, tasty meals which are meat free  & fish free.  “Relative Risk,” is a phrase used by epidemiologists to describe an association between two things.  There may not be a scientifically known mechanism for one thing causing the other, but there is an association.  For example NIH, the National Institutes of Health, and the WHO, World Health Organization, and Harvard medical researchers show a clear and convincing association between eating meat and an increased colon cancer risk.  There is one meat related disease mechanism known:  the high fat content of meat and animal products increases certain hormone production in humans and thus increases the risk for breast and prostate cancer.  Group that eat very little or no meats have much lower rates of cancer, than groups that routinely consume meats.

The interview recapped and concluded with three recommendations:

  1. Enjoy regular meals together that contain plant based whole-foods, and by reducing or eliminating coffee, alcohol and nicotine consumption. Limit, reduce or eliminate sugars such as high fructose corn syrup and artificial sweeteners.
  2. Include moderate exercises, like walking, into the caregiving routine. These walks can be a time to build rapport and create meaningful lives with each other.
  3. Help your loved ones stay on their medications and to keep their doctors appointments.