The New Order

The photo shows actor-rapper Yasiin Bey (Mos Def) being force-fed, as a protest against procedure at Guantanamo Bay Prison. Force-feeding was not uncommon in Gitmo, and the medical profession disgraced themselves – as they often do – by agreeing to participate in this barbaric practice. It is a form of torture, although there may be very few exceptions where it might conceivably be justified (1, 2).

Food can be torture, then, but it is many other things too. It is nutrition, of course, and pleasure, but there is more to it. Almost all religions have food laws of one sort or another, all of them equally arbitrary and all intended to maintain or at least reflect in-group / out-group boundaries. Diet connects to culture, to who we think we are, who we aspire to be, and to social control.

In the second half of the 19^th century, for example, prisons were routinely constructed with gardens in which prisoners were required to work to grow their own food. Victorian workhouses, asylums and orphanages were planned in the same way.

This prison design served several purposes.

Money was involved – the costs of feeding inmates were reduced – but the criminal justice system also had a moral component. Reforming the criminal character involved inculcating the work ethic, which generally meant hard labour. This required strength and stamina which necessitated, in turn, an adequate diet.

It was a balancing act. Prison governors had to provide a diet with enough calories so that prisoners wouldn’t waste away, as cheaply as possible, but at the same time good enough to prevent their charges from becoming ill from malnutrition (3, 4).

The authorities knew that well-fed prisoners were better-behaved prisoners (3, 4), and understood that if they were healthy enough to find work once they’d served their sentence they would be less likely to re-offend.

When you review prison menus from that period, therefore, they don’t look too bad (5).

As well as their home-grown produce, prisoners were variously allocated rations of whole meal bread, meat, cheese, fish and, perhaps surprisingly, up until the end of the 19th century, lobster (6), which was regarded as a poverty food (7). Stirabout (un-sweetened) was a staple too (8) – there was concern that menus should not be so good as to encourage ex-cons to re-offend!

Improvement of character via good nutrition is a relatively benign form of social control, and it worked well enough (9). All of this was air-brushed into history, unfortunately, by the pharmaceutical industry.

In 1951 Rhône-Poulenc, a French company better known for its chocolate products and now subsumed into the multi-national Aventis, developed chlorpromazine. Known as the liquid cosh, this was the first of the anti-psychotic drugs that transformed psychiatric wards and prison mess halls, bringing an eerie calm to previously troubled waters.

In the 1960’s I worked part-time at the then astonishingly baroque Royal Edinburgh Hospital, and vividly remember lines of inmates performing the thorazine shuffle on their way to the canteen. Long-term damage wreaked on the brains of those coshed into acquiescence was already starting to emerge, including tardive dyskinesia and, probably, dementia (10).

Administering these drugs wasn’t as overtly violent as force-feeding, but seemed to me to be an even greater violation of autonomy. I had started to drift from the mainstream – I was attending Ronnie Laing’s lectures and reading Thomas Szasz and Ivan Illich – and in retrospect, the neuroleptics were a stepping stone towards the pharmaco-nutrition I practice today.

Coming back to food as a social agent, I believe we have much to learn from the Victorians.

The incidence of violence appears to be currently increasing in society at large (11, 12), and in prison (13, 14). Between 2001 and 2018, for example, the population in US state prisons increased by 1%, while prison deaths rose by 44% (13, 14).

My hypothesis is that general deterioration in the public diet (ie 11, 12, 15) has made some contribution to this; and that in prisons, where allocated costs for food fall far below the minimum required to meet nutritional basics (16-18), dysnutrition has been particularly important in driving violence, self-harm and recidivism.

Evidence comes from prison studies where enhanced nutrition has been shown to generate better behavior. One of the first was the Aylesbury trial (19), led by my friend Bernard Gesch, in which inmates were given vitamins, minerals and omega-3 fatty acids. Over 24 months the prisoners who received active supplements committed 37% fewer violent offenses than those in the placebo group, and 26% fewer offenses overall.

It is only fair to say that while some research teams reported similarly positive findings (ie 20, 21), others did not (22, 23). The diversity of trial results reflects different trial designs, nutritional interventions and baselines, and in my view the evidence that poor diet facilitates poor behavior via inter alia neuroinflammatory stress and reduced impulse control (11, 24-27) remains persuasive.

The Gassen et al paper (27) is a particularly interesting read, with a perspective derived from evolutionary immuno-neurology, risk-sensitive foraging theory and overall energy management. It fits nicely with preclinical research which shows that when ghrelin is produced by an empty stomach, hunger is induced and impulse control falls (28). This is why you shouldn’t go shopping for food when hungry.

The dazzling Lawrence Stern was referring to this when he suggested, in the first and perhaps the most amusing of self-reflexive novels, that important decisions should be made only after combining pre- and post-prandial cogitation (29).

And it is not just directly food-related endocrine shifts that affect us; new science indicates that changes in the colonic microbiota, which are modified by our eating habits, also impact on decision-making (30). This takes us back to crime, and punishment …

The Victorian prison system was an experiment, a new departure in which nutritionally informed diet decisions were part of a project designed to reduce criminality by reducing repeat offending rates. It worked substantially (9), and we should try to re-capture it.

I am not suggesting that we restore Victorian nutrition to the prison system. Have you seen the price of lobster lately? But there is room, clearly, for pharmaco-nutritional intervention.

Starting with the Balance test, inmates with particularly high omega 6:3 ratios and low 3 indices should receive omega 3’s (31, 32), blended with the amphiphile polyphenols which are required to develop the biofunctionality of the omega 3 PUFA’s (33, 34). I predict that this will substantially improve prisoner behaviour.

Given the substantial numbers of prisoners with both affective disorders and neurodevelopmental problems (35, 36), the use of saffron would make ethical and medeconomic sense also (37-39). The expected reduction of anxiety, depression and aggression (40) provides additional justification for this approach, and would help to make prisons function more safely and more effectively.

Some may feel that prison is not meant to be pleasant, but it should be noted that this approach will likely reduce the high incidence of PTSD both during incarceration and after release (41, 42). The latter of these was a study in mice, but if mice extrapolate to men then polite society will benefit also.

Yasiin Bey samples from Gillo Pontecorvo’s rivetting 1966 documentary, Battle of Algiers, which shows how Algeria freed itself from the prison of French colonialism. It is still relevant today.

Next week: How to Make your own Mounjaro.

References

1. Brockman B. Food refusal in prisoners: a communication or a method of self-killing? The role of the psychiatrist and resulting ethical challenges. J Med Ethics. 1999 Dec;25(6):451-6. 
2. Bouali W, Gniwa RO, Ben Soussia R, Zarrouk L. Hunger strike in prison: medical, ethical and legal aspects. Tunis Med. 2021 Novembre;99(11):1045-1054. English.
3. Price K, Godfrey B. Victorian systems will not solve modern prison health problems. Lancet. 2019 Jan 26;393(10169):312-313.
4. Carpenter KJ. Nutritional studies in Victorian prisons. J Nutr. 2006 Jan;136(1):1-8.
5. https://www.theprison.org.uk/intro/food.shtml
6. https://12tomatoes.com/victorian-prison-food/
7. https://gizmodo.com/lobsters-were-once-only-fed-to-poor-people-and-prisoner-1612356919
8. Michelle Higgs, Prison Life in Victorian England (Stroud: The History Press, 2013), Chapter 7
9. Jonas K, Abi-Dargham A, Kotov R. Two Hypotheses on the High Incidence of Dementia in Psychotic Disorders. JAMA Psychiatry. 2021 Dec 1;78(12):1305-1306. 
10. https://drpaulclayton.eu/blog/hothead/
11. https://drpaulclayton.eu/blog/class-health-and-universe-25/
12. Gibson T. Reasons for Increased Violence in Jails/Prisons. https://www.fdle.state.fl.us/FCJEI/Programs/SLP/Documents/Full-Text/Gibson,-Trenten-paper.aspx#:~:text=So%20why%20have%20prisons%2Fjails,kept%20up%20with%20the%20population.
13. Wang L, Sawyer W. Prison Policy Initiative 2021. https://www.prisonpolicy.org/blog/2021/06/08/prison_mortality/
14. Serchen J, Atiq O, Hilden D; Health and Public Policy Committee of the American College of Physicians. Strengthening Food and Nutrition Security to Promote Public Health in the United States: A Position Paper From the American College of Physicians. Ann Intern Med. 2022 Aug;175(8):1170-1171.
15. Serving Time: Prisoner Diet and Exercise. National Audit Office, 2006. https://www.nao.org.uk/reports/serving-time-prisoner-diet-and-exercise/
16. Broken Plate 2020: the state of the nation’s food system Technical Report. https://foodfoundation.org.uk/sites/default/files/2021-10/Technical-Report-2020_2.pdf
17. UK National Statistics, 2021. Food Statistics in Your Pocket, Table 1.7. https://www.gov.uk/government/statistics/food-statistics-pocketbook/food-statistics-in-your-pocket#:~:text=Since%202000%20food%20and%20non,prices%20is%20published%20by%20ONS%20.
18. Gesch CB, Hammond SM, Hampson SE, Eves A, Crowder MJ. Influence of supplementary vitamins, minerals and essential fatty acids on the antisocial behaviour of young adult prisoners. Randomized, placebo-controlled trial. Br J Psychiatry. 2002 Jul;181:22-8.
19. Schoenthaler SJ, Bier ID. The effect of vitamin-mineral supplementation on juvenile delinquency among American schoolchildren: a randomized, double-blind placebo-controlled trial. J Altern Complement Med. 2000 Feb;6(1):7-17.
20. Raine A, Leung CC, Singh M, Kaur J. Omega-3 supplementation in young offenders: a randomized, stratified, double-blind, placebo-controlled, parallel-group trial. J Exp Criminol 16, 389–405 (2020).
21. de Bles NJ, Rius-Ottenheim N, Geleijnse JM, van de Rest O, Bogers JPAM, Schat A, Nijman HLI, van den Berg D, Joos L, van Strater A, de Ridder T, Stolker JJ, van den Hout WB, van Hemert AM, Giltay EJ. Effects of multivitamin, mineral and n-3 polyunsaturated fatty acid supplementation on aggression among long-stay psychiatric in-patients: randomized clinical trial. BJPsych Open. 2022 Feb 3;8(2):e42.
22. Zaalberg A, Nijman H, Bulten E, Stroosma L, van der Staak C. Effects of nutritional supplements on aggression, rule-breaking, and psychopathology among young adult prisoners. Aggress Behav. 2010 Mar-Apr;36(2):117-26. 
23. Choy O. Nutritional factors associated with aggression. Front Psychiatry. 2023 Jun 21;14:1176061.
24. Prescott SL, Logan AC, D’Adamo CR, Holton KF, Lowry CA, Marks J, Moodie R, Poland B. Nutritional Criminology: Why the Emerging Research on Ultra-Processed Food Matters to Health and Justice. Int J Environ Res Public Health. 2024 Jan 23;21(2):120.
25. Steele CC, Pirkle JRA, Kirkpatrick K. Diet-induced impulsivity: Effects of a high-fat and a high-sugar diet on impulsive choice in rats. PLoS One. 2017 Jun 29;12(6):e0180510. 
26. Gassen J, Prokosch ML, Eimerbrink MJ, Proffitt Leyva RP, White JD, Peterman JL, Burgess A, Cheek DJ, Kreutzer A, Nicolas SC, Boehm GW, Hill SE. Inflammation Predicts Decision-Making Characterized by Impulsivity, Present Focus, and an Inability to Delay Gratification. Sci Rep. 2019 Mar 20;9(1):4928.
27. Anderberg RH, Hansson C, Fenander M, Richard JE, Dickson SL, Nissbrandt H, Bergquist F, Skibicka KP. The Stomach-Derived Hormone Ghrelin Increases Impulsive Behavior. Neuropsychopharmacology. 2016 Apr;41(5):1199-209. 
28. https://www.gutenberg.org/files/1079/1079-h/1079-h.htm
29. Falkenstein M, Simon MC, Mantri A, Weber B, Koban L, Plassmann H. Impact of the gut microbiome composition on social decision-making. PNAS Nexus. 2024 May 14;3(5):pgae166.
30. Rowbotham J. Turning Away from Criminal Intent: Reflections on Victorian and Edwardian strategies to promote resistance among petty offenders. (2009). Theoretical Criminology 13(1)
31. Fido D, Heym N, Bloxsom CAJ, Hunter KA, Gregson M, Sumich A. Don’t slap the fish: The relationship between dietary omega-3 intake and physical aggression is mediated by motor inhibition in response to distressed faces. Personality & Individual Differences (2021),169, 110062
32. Meyer BJ, Byrne MK, Collier C, Parletta N, Crawford D, Winberg PC, Webster D, Chapman K, Thomas G, Dally J, Batterham M, Farquhar I, Martin AM, Grant L. Baseline omega-3 index correlates with aggressive and attention deficit disorder behaviours in adult prisoners. PLoS One. 2015 Mar 20;10(3):e0120220.
33. https://drpaulclayton.eu/blog/fish-oil-upgrade-to-snake-oil/
34. https://drpaulclayton.eu/blog/thanks-for-all-the-fish/
35. McCarthy J, Chaplin E, Underwood L, Forrester A, Hayward H, Sabet J, Young S, Asherson P, Mills R, Murphy D. Characteristics of prisoners with neurodevelopmental disorders and difficulties. J Intellect Disabil Res. 2016 Mar;60(3):201-6. 
36. Young S, González RA, Mullens H, Mutch L, Malet-Lambert I, Gudjonsson GH. Neurodevelopmental disorders in prison inmates: comorbidity and combined associations with psychiatric symptoms and behavioural disturbance. Psychiatry Res. 2018 Mar;261:109-115.
37. Blasco-Fontecilla H, Moyano-Ramírez E, Méndez-González O, Rodrigo-Yanguas M, Martin-Moratinos M, Bella-Fernández M. Effectivity of Saffron Extract (Saffr’Activ) on Treatment for Children and Adolescents with Attention Deficit/Hyperactivity Disorder (ADHD): A Clinical Effectivity Study. Nutrients. 2022 Sep 28;14(19):4046. 
38. Seyedi-Sahebari S, Farhang S, Araj-Khodaei M, Akhondzadeh S, Naseri A, Sanaie S, Frounchi N. The Effects of Crocus sativus (Saffron) on ADHD: A Systematic Review. J Atten Disord. 2024 Jan;28(1):14-24.
39. Baziar S, Aqamolaei A, Khadem E, Mortazavi SH, Naderi S, Sahebolzamani E, Mortezaei A, Jalilevand S, Mohammadi MR, Shahmirzadi M, Akhondzadeh S. Crocus sativus L. Versus Methylphenidate in Treatment of Children with Attention-Deficit/Hyperactivity Disorder: A Randomized, Double-Blind Pilot Study. J Child Adolesc Psychopharmacol. 2019 Apr;29(3):205-212.
40. Shafiee M, Arekhi S, Omranzadeh A, Sahebkar A. Saffron in the treatment of depression, anxiety and other mental disorders: Current evidence and potential mechanisms of action. J Affect Disord. 2018 Feb;227:330-337.
41. Facer-Irwin E, Blackwood NJ, Bird A, Dickson H, McGlade D, Alves-Costa F, MacManus D. PTSD in prison settings: A systematic review and meta-analysis of comorbid mental disorders and problematic behaviours. PLoS One. 2019 Sep 26;14(9):e0222407.
42. Mokhtari Hashtjini M, Pirzad Jahromi G, Meftahi GH, Esmaeili D, Javidnazar D. Aqueous extract of saffron administration along with amygdala deep brain stimulation promoted alleviation of symptoms in post-traumatic stress disorder (PTSD) in rats. Avicenna J Phytomed. 2018 Jul-Aug;8(4):358-369.