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INTERVIEW: Bernard Gesch on Nutrition and Behavior
In September 2009, the journal Science featured the work of British researcher Bernard Gesch of the University of Oxford, who is investigating the effects of nutrition on criminal behavior. He has generously agreed to share information about his findings and exciting new research with Crime Times.
How did you first become interested in the link between diet and behavior problems?
It was following the evidence of my own eyes. I had been involved in a nationally influential initiative that seemed to improve the management of juvenile offenders, but we never got down to why some young people offend and others don’t. Later I ran a center that was used by courts as an alternative to custody. Some of our clients would turn up with bags of sweets and be almost uncontrollable. For some this was their only meal. So we started to prepare a meal together so that they would settle down, and it seemed to work great. We typically learned more about the youngster during the meal than during our formal offending program afterwards.
With the help of Professor Derek Bryce Smith, Dr Damien Downing, and Dr David Horrobin, this gradually turned into a full-blown dietary analysis intervention package that was offered to the courts. The courts responded very favorably and it became national news. Most importantly I saw such positive changes in many of our clients that it motivated me to pursue this.
Can you summarize your findings to date?
We founded the charity Natural Justice to continue this work with an empirical study to test if nutrition was a cause of offending behavior. I began work in 1992 with colleagues to design a double-blind RCT [placebo-controlled randomized trial].
A prison is a good place to do this as behavior is closely monitored and all food sources are known. Aylesbury housed particularly violent long-term prisoners, so this was chosen as the site for our study.
We had the advantage of being able to look at criticisms of previous work so we could address them. Researchers like Stephen Schoenthaler were generous with their advice. Organizations such as the Wacker Foundation kindly helped fund the study.
We established that the prisoners made poor food choices, so we wanted to test what would happen to their behavior when nutrients were reinstated to government recommended levels. We used placebos or food supplements that contained broadly the daily requirements of vitamins, minerals, and essential fatty acids.
We found that those who consumed the active capsules committed 26% fewer offences than those taking placebos. Compared to baseline there were 37% fewer serious offences such as violence. Bear in mind that this was in a high-risk population that typically had intractable problems of violence. As a consequence we took these findings to numerous statistical experts to review them before publishing them in 2002.
Our other finding was that our well-validated self-reported measures of anger, aggression, malaise, depression and anxiety were unresponsive to the changes observed in actual offences between groups over time. It seemed to be an anomaly, but other teams have now replicated this observation.Traits such as aggression are often reported as violence. That is fine if they can be shown to relate to the incidence of violence, which is a series of events. We found otherwise. We are now firmly of the view that event-based analysis is the way forward.
More recently we have done work to assess the dietary intakes of children in the care system, and as we would predict, their diets are worse than the prisoners. This is being written up.
Can you describe your new study? Do you have any preliminary findings you can report?
The new study is around five times larger than Aylesbury, is based in three prisons, and is funded by the Wellcome Trust and run from Oxford University. It is designed to be conclusive and to explore how such effects on behavior are mediated and which nutrients are involved.
We will monitor offences again as well as incidents of self-harm. We are conducting pre-post tests of frontal lobe mediated tasks such as impulse control, stop-go, and risk taking. These are done on computerized test batteries developed at Cambridge University and the Institute of Psychiatry. We will also collect pre-post blood samples to allow us to relate changes in blood nutrient levels with changes in behavior and other cognitive outcomes. The challenge is to do all of this without disrupting the prison regime! So far, so good.
Unpicking effect is not as simple as it seems. A pharmacological approach would be to provide one isolated nutrient, but in a dietary intervention, the participant also consumes nutrients in the diet. Unless you monitor the dietary baselines, you do not know if other nutrients are changing or if the effect you observe is in part due to lack of other nutrients in the baseline diet.
Our approach to this is to ensure that the active group consume physiological dosages of all the essential nutrients and then build up a picture of effect as follows: That there is evidence of nutritional deficiencies at baseline (from blood). That nutritional deficiency is linked to poor dietary intakes (from seven-day food diaries). That nutritional indices are improved by supplementation (compare pre-post blood). That the rate of improvement in nutritional indices will predict a reduction in the rate of disciplinary incidents (difference in pre-post blood nutrient status related to behaviors). Hopefully this will give us data with which to advise dietary standards of the effect of nutrients on behavior.
We have a number of other studies designed for schools and crime in the community, but as ever the limiting factor is finding the funds.
What specific dietary changes do you implement in your interventions?
We use broad-spectrum food supplements as they facilitate a placebo control and provide the daily requirements of vitamins, minerals, and essential fatty acids.
The Aylesbury study was designed before the omega-3 story began to emerge. We provided 80% omega-6 and 20% omega-3. The current study provides around one gram of EPA and DHA, which is 80% omega-3, plus a small amount of omega-6 for the GLA. The vitamin package is based around 100% of the daily requirements. The mineral composition is similarly based around the daily requirements with the exception of magnesium, calcium, and phosphorus. For the current study we increased the magnesium to provide 300mg, which is the daily requirement.
Are prisoners initially enthusiastic about participating?
Overall, we consistently manage to recruit around 75% of the population. That is a healthy figure as some also decide not to join, which is their right.
The prisoners are often surprised at the outcome. In the first study, the prisoners did not guess better than random which group they were in.
How do prison staff members feel about the changes they see in the prisoners?
There is often a mixture of enthusiasm and cynicism among the prison staff. You get a lot of anecdotes about changes in prisoner behavior during the clinical work, but we will only know where we stand once the blind is broken.
A few weeks into the Aylesbury study, the officers were surprised at how quiet the prison was. The number of alarms had dropped dramatically— so much so that the principal officer who coordinated responses to alarms complained that he was bursting out of his trousers as he had been getting so little exercise!
Is this intervention cost-effective?
Very much so. The Economist reported that it would cost about 0.2% of the cost of using prison. This low-cost, low-risk approach contrasts with typical rollouts of criminal justice programs that can cost £100Ms and are often found to be ineffective, such as cognitive training in our prison system.
Are you seeing increased interest in your work on the part of government officials or law enforcement officials?
Attitudes are definitely changing now. I cannot pretend it has been easy or the future will be without frustration. Nevertheless, none of us work in this field to boost our egos; we do it because we believe this work is important.
As our understanding of the neuroscience of behavior advances, some of the assumptions that underpin criminal justice are becoming increasingly untenable. We often describe crime as brainless, but we should not take that literally!
For additional information, see Crime Times, 2002, Vol. 8, No. 3, Page 1.
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