Diet, nutrition and schizophrenia – are you what you eat?

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    It’s been known for a long time that what a person eats and drinks can have a significant impact on their physical health. The connection between diet and nutrition and someone’s mental well-being, however, is only just starting to be understood.1 
     
    This article looks at why diet and nutrition are important in relation to schizophrenia, why adopting healthier eating behaviours is important, and presents current advice on what people living with schizophrenia should and perhaps should not eat.


    Defining diet and nutrition

    First, what’s the difference between diet and nutrition? Diet refers to the foods and drinks that someone ingests on a regular basis whereas nutrition refers more to the quality or kind of those foods or drinks. 1 

    A ‘balanced diet’ is one that includes a wide variety of foods in the right proportions so that you maintain a healthy body weight.2

    Nutrition is more about whether the food is fresh or processed, contains essential vitamins and minerals, is low or high in fat, protein or carbohydrates, and is high or low in calories.1 Nutrition also considers how food has been produced and how it is eaten.1


    Dietary patterns and eating habits

    Studies have shown that some people with schizophrenia have poor dietary patterns and eating habits when compared with the general population.3,4 
     
    This may include eating more sugary or fatty foods, which are often high in calories, rather than choosing healthier options such as fresh fruit or vegetables.3 Moreover, it may include skipping meals such as breakfast, preferring convenience foods over home-made cooking, eating snacks in the evening rather than eating a proper meal, and eating too quickly.3 
     
    This is important because over time this will lead to a poor nutritional state, which in turn is linked to 
    being overweight, obesity, type 2 diabetes, heart disease, stroke, and cancer.4,5 Even more importantly for those with schizophrenia, poor nutrition can affect brain function,5 and a poor nutritional state has even been linked to the development of psychosis.3
     
    Eating a healthy diet is therefore an important lifestyle component for those living with schizophrenia, together with performing suitable levels of physical activity, stopping smoking, and moderating alcohol intake.   


    Are vitamin and mineral supplements good for schizophrenia?

    There is some evidence to suggest that certain vitamin and mineral deficiencies may be important in people with schizophrenia and that reversing these deficiencies may be benefical.
     
    Of all the vitamins, the most beneficial appear to be the B vitamins, notably B6, B9 (folate) and B12, although vitamins C, D, and E, have been linked to improved symptoms and better cognitive function.3,7 
     
    Among the minerals, zinc has been shown to be beneficial in reducing both the positive and negative symptoms of schizophrenia.3,7 


    What should you eat if you have schizophrenia?

    There is no specific schizophrenia diet, and the consensus is to follow dietary recommendations for the general population.2,3,6 This includes eating at least five portions of fruit and vegetables a day, basing meals on starchy carbohydrates, such as potatoes or rice, and including some protein, such as fish, meat or alternatives, beans and pulses.2,6 
     
    Importantly, it includes cutting down on foods high in sugar, fat and salt, 2,6 a recommendation that is supported by a recent analysis of all available studies looking at diet and nutrition in schizophrenia.According to this research, food to avoid includes refined sugar, sugar-sweetened drinks and confectionary, as well as refined grain products such as sugary cereals, white bread, and pasta.
     
    Conversely, foods to consider including more of in the diet are3 

    All fruits and vegetables, which are a good source of vitamins C and E, and folate (vitamin B9). Fruits that may have specific benefits in schizophrenia are berries and grapes, while vegetables include asparagus, artichokes, broccoli, Brussel sprouts, lettuce, onions, okra, and spinach.

    Foods containing high amount of fibre such as whole grains, legumes, nuts, and seeds. 

    Fish and seafood which are not only high in protein but also contain high levels of omega-3 fatty acids, vitamins B6 and B12, and zinc. 

    Lentils and beans, which are a good source of folate. 


    Time to change your diet?

    We’re only at the beginning of understanding how nutrition affects our mental health and more research needs to be done. If a change to the diet sounds like a good idea for you or a loved one, then remember that you have the support of your healthcare team if you need it. They may be able to suggest simple behavioural changes such as eating three meals a day or be able to refer you to a   nutritionist who specializes in mental health issues. 
     
    Finally, before taking any supplements, be sure that they will not affect any medications that you may be taking – always check with a doctor or pharmacist first.  

    References

    1. Mental Health Foundation. Food for thought: Mental health and nutrition briefing. March 2017.
    2. NHS. Eat well. March 2019.
    3. Aucoin M, LaChance L, Cooley K, Kidd S. Diet and psychosis: a scoping review. Neuropsychobiology. 2020:79(1);20–42. 
    4. Dipasquale S, Pariante CM, Dazzan P, et alThe dietary pattern of patients with schizophrenia: a systematic review. J Psychiatr Res. 2013;47(2):197–207.
    5. CDC. Poor nutrition factsheet. Accessed December 2021.
    6. Living with schizophrenia. Healthy living: schizophrenia and diet. Accessed December 2021.
    7. Firth J, Stubbs B, Sarris J, et alThe effects of vitamin and mineral supplementation on symptoms of schizophrenia: a systematic review and meta-analysis. Psychol Med. 2017;47(9):1515–27.
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