Relapsed Schizophrenics: More Rapid Improvement on a Milk- and

Cereal-free Diet
F. C. DOHAN, J. C. GRASBERGER, F. M. LOWELL, H. T. JOHNSTON, Jnr. and ANN W. ARBEGAST
BJP 1969, 115:595-596.
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Brit. 3. PsychicS.(5969), 115, 595—6 ABSTRACT

Relapsed Schizophrenics: More Rapid Improvement on a

Milk- and Cereal-free Diet
By F. C. DOHAN, J. C. GRASBERGER, F. M. LOWELL, H. T. JOHNSTON, Jnr.,
and ANN W. ARBEGAST

Ir@rraoDtxrnoN discipline was attempted in all diet groups. Patients

A number of reports suggest that schizophrenia in open wards were offered the usual hospital diet.
and coeliac disease (gluten enteropathy) occur in the All patients received other prescribed treatments.
same individual more often than expected by chance. The effect of randomization was examined. The
The latter is an hereditary disease, with marked medians and upper ranges for chlorpromazine and
psychic and somatic symptoms which usually improve separately for thioridazine of the mean daily dose
when wheat gluten and its analogues in other cereals per man while in the locked ward were slightly
are not eaten. This possible relationship, and the lower for the cereal-free group of schizophrenics. The
high correlation of the per cent. changes in wheat median age was 38 years in each group and the
plus rye consumption with first admissions for distributions were approximately the same.
schizophrenia during World War II (unrelated to
availability of work, hospital beds and physicians or RESULTS
wartime status of the country), suggest that cereals Cereal-free v. High-cereal Diet: Schizophrenics
may also be involved in the pathogenesis of schizo Since release from a locked ward the day after
phrenia (Dohan, I, 2). admission is usually not due to improvement, our
analysis includes only those patients who were
SUBJECTS AND METHODS confined for more than one day. During period @,
Dietary studies to test this hypothesis were done 62 per cent. of the 47 schizophrenics assigned to the
in a locked psychiatric ward (male) where strict cereal-free diet, compared to 36 per cent. of the 55 on
control of access to foods was possible. The number of the high-cereal diet, were released before the end of
days each patient was confined to the locked ward the “¿median day―(day 7) for the combined groups
until release to an open ward (with “¿fullprivileges―) (p = 0.0091). The proportions released by the end of
provided an index of the rate of improvement, since day @,6, 8 and 9 were also significantby Fisher's
most patients were admitted to the locked ward exact probability test. The mean length of stay on the
because of recent worsening of symptoms and most locked ward was I7@3 days for the cereal-free group
were released when sufficiently improved for the and 30@6days for the high-cereal group.
staff to believe this to be safe and possibly beneficial. When divided into subgroups by temporal or
Diagnoses were based on the criteria of the American ordinal midpoints or according to each of the 3
PsychiatricAssociationDiagnosticand Statistical Manual, “¿modes―
of admission to the locked ward (27 “¿first
1952. admission―; 33 “¿readmission―; 42 “¿intrahospital
All patients
admittedto the lockedward during transfer from an open ward and return from trial
periodI (175days)were assignedby sodalsecurity visit―), or by each of the three treating psychiatrists,
number (odd or even) to either a milk- and cereal 57—67per cent. of the patients in the cereal-free sub
freeor a high-cerealdiet.Milk was eliminated groups were released by the end of day 7, compared to
because some coeliacpatientsdo not improve 32—41 per cent. of those on the high-cereal diet.
unless milk as well as cerealis omitted.The
high-cereal diet was the usual well-balanced hospital &cret Addition of Gluten to the Cereal-free Diet:
diet (including milk) modified by daily substitution Schizophrenics
of one or two wheat products (e.g. spaghetti for It was considered possible that the ward staff was
potatoes). During period 2(143 days), all patients were biased by knowing the diet of individual patients
randomly assigned either to the high-cereal diet or (although this knowledge was consistently denied),
to the cereal-free diet to which wheat gluten was or that psychological factors may have favourably
secretly added. Similar strict between-meals food affected the patients' behaviour. Therefore, without
595
596 RELAPSED SCHIZOPHRENICS

the knowledge of the ward staff or patients, about thesized for coeliac disease, deserve investigation.
19 g. of wheat gluten per man per day was added The irregular response of coeliac patients to ingestion
to the cereal-free diet during period 2. Durmg this or avoidance of gluten and the occasional severe
period, 19 of the 39 relapsed schizophrenics in the reaction to a small amount require consideration in
cereal-free plus gluten group and 22 of the 45 relapsed similar studies on schizophrenic patients.
schizophrenics in the high-cereal group were released
on or before the “¿median
day―of the combined SUMMARY
groups. It thus seems unlikely that non-specific Relapsed schizophrenic men randomly assigned to
psychological effects on patients or staff accounted for a milk- and cereal-free diet on admission to a locked
the more rapid release of the cereal-free group in ward were released to an open ward considerably
period I. more rapidlythan thoseassigneda high-cereal
diet
(p = 0.009). When gluten was secretly added to the
No Effect of Diet in Non-schizophrenics cereal-free diet this difference did not occur. Release
Of the 50 non-schizophrenics (mostly depressive of non-schizophrenic patients was not related to diet.
reaction, anxiety reaction, or chronic brain syndrome) These findings support the hypothesis that ingestion
randomized to the cereal-free or high-cereal diet of cereals may be pathogenic for those with the geno
during period @,half of each group were released type for schizophrenia. However, results such as
from the locked ward on or before the “¿median day―. these obviously require rigorous independent testing.
There was also no significant difference (p 0@15)
during period 2 in which 9 of the 23 non-schizo Aciwowi.anoaiz@rs
phrenics randomized to the cereal-free plus gluten We thankProf. JohannesIpsenforhelpinstatistical
diet and 15 of the 25 randomized to the high-cereal analysis and Mrs. Marie Robinson, Mrs. Emily Peters
diet were released on or before the “¿median
day―. and their associates
forco-operation
The workwas aided
by the Scottish Rite Schizophrenia Research Program,
the National Association for Mental Health, and the
DIscussIoN
NutritionFoundation.
These clinical studies support the hypothesis that
cereals play a role in the pathogenesis of overt symp REFERENCES
toms inthosewithan hereditary capacitytodevelop I. DOHAN, F. C. (i966). “¿Cereals and schizophrenia.―
schizophrenia (Dohan, @). Ifthisisconfirmed, many Actapsychiat.Scand.,42, 125—152.
non-specific (e.g. effect on phenothiazines) and 2. —¿ (i966). “¿Wartimechanges in admissions for
specific mechanisms, particularly those hypo schizophrenia.― Ibid., @,1—23.

F. C. Dohan, M.D., F.A.C.P., Associate, William Pepper Laboralo@yof Clinical Medicine, Hospital oft/se
University of Pennsylvania, Philadelphia, Pennsylvania 19104
J. C. Grasberger,M.D.,AssistantChiefofStaff(Psychiatry)
F. M. Lowell, M.D.,Psychiatrist
H. T. Johnston, Jr., Ph.D., Psychologist
Ann W. Arbegast, B.S., Assistant Chief; Dietetic Service Veterans
Administration Hospital, Coatesville, Pennsylvania 19320

(Received io June, 1968)