A bad diet may lead to bad health for many inner-city kids. And it may also lead to bad behavior.
That's the conclusion of some public health experts who are advocating for vitamins and other nutritional supplements to curb youth violence and to increase learning. The controversial idea is getting a fresh hearing in Baltimore, where advocates for the disadvantaged are considering testing it on city kids.
If it's proven that a tablet a day can tick up test scores and dial down violence, it could be a cheaper and easier means of improving a lot of young lives than costly and labor-intensive treatments, according to the Abell Foundation, which wants to determine whether a Baltimore study would be worthwhile.
"We wanted to see what the scientific view was at this point in time," said Robert C. Embry Jr., foundation president. "It seemed like there was something there worth exploring."
Embry passed the latest data on the issue to the Johns Hopkins University's Bloomberg School of Public Health, where a team will be assembled in the fall to consider the scientific studies and the outlines of a possible study, perhaps in city schools.
Some Baltimore schools, like many others in urban school systems, suffer with low test scores and chronic violence — though the number is down from previous years, there were more than 11,000 suspensions last school year for fighting and other offenses. A city schools spokeswoman had no comment about a possible study because officials had not been approached about participating or seen the Abell report. But Edie House-Foster said she recognized the link between proper nutrition and learning and said the sometimes poor eating habits of students were being addressed in the cafeteria and classroom.
As for supplements, Abell reports that there is a lot of suspect research, some funded by the $60 billion supplements industry. But there also are many encouraging studies that seem to show in prisons and school systems that the vitamins, minerals and fatty acids can help curb bad behavior and improve mood and learning.
Critics say the issue is complex and suggest consistent and better meals would be a more appropriate answer than supplements that may not have an effect or may make some children sick. And even scientists involved in credible supplement research say that more study is needed to show the overall effects on behavior and learning.
In previous studies, other elements could have influenced results. For example, government research has shown that hunger can influence academic performance, so it may be hard to separate supplements' effect when regular meals are also provided. And without baseline information on deficiencies in each child, the specific effects of supplementation also are hard to measure.
But the Abell report points out that the cost of youth violence and aggression reached $156 billion in 2006, and Embry said possible solutions need examining.
The foundation report found promising studies published in the last decade in peer-reviewed journals including the American Journal of Clinical Nutrition, the Journal of Alternative and Complementary Medicine, the British Journal of Psychiatry, Aggressive Behavior and the American Journal of Psychiatry.
For example, they found that after being given supplements, kids in Leavenworth, Kan., improved their math and English test scores and were disciplined less, kids in Australia and Indonesia had "significant increases" on tests for verbal learning and memory, and in Phoenix, Ariz., school kids got into fewer fights and engaged in less disrespectful behavior.
British prisoners given supplements were involved in 35 percent fewer disciplinary infractions and Dutch prisoners were involved in 34 percent fewer incidents in a similar study.
Joseph E. Hibbeln, a commander in the U.S. Public Health Service, has been studying the impacts of omega-3 fatty acids for two decades and has no doubt of nutritional deficiencies' role on the mind. He notes the brain is primarily made up of fats that must be obtained from the diet.
"The composition of kids' brains are directly dependent on what their mothers ate and what they're eating," said Hibbeln, a physician, psychiatrist and biochemist and acting chief of the section on nutritional neuroscience at the National Institute on Alcohol Abuse and Alcoholism.
He said that the human diet had long included large amounts of omega-3 rich fish because it was available. But in the last 50 to 60 years, the diet has shifted to more fast food that contains cheaper omega-6 rich oils. In the same time, rates of depression and homicide have risen in the United States and other countries, suggesting a correlation.
So, many researchers began studying the connection between omega-3s, vitamins and other nutrients and brain performance. He said there are four areas of study: violence, hyperactivity, academic performance and mood disorders.
He said the studies have shown the strongest link to mood disorders and depression, and he believes omega-3 supplements may work just as well as anti-depressants. Studies have shown promise in areas but are less conclusive, he said.
"But from my estimation, there's no harm in trying supplements," he said. "You're not going to hurt anything by ensuring added nutrition for the brain, and this could be a really cost effective policy."
No doubt, many children in Baltimore lack proper nutrition, which officials at the Health Department and schools have been seeking to tackle through a number of programs.
Health department officials point to a 2007 survey conducted by the U.S. Centers for Disease Control and Prevention showed that: three-quarters of city high schoolers ate less than the daily recommended amount of fruits and vegetables, 22 percent did not eat fruit and half did not eat a green salad in the week before the survey, more than a third drank a soda a day and about a quarter were slightly or very overweight. Many of the city results were below national averages.
In city schools, spokeswoman House-Foster said "nutrition and learning go hand in hand," and officials have been looking at improving the cafeteria menus by adding more fresh fruits and vegetables, whole grains and vegetarian options. There also are other programs such as a city farm where kids can learn about healthy foods.
"It's been on our agenda," she said. "Each year we try and ratchet it up one more step. Each year we want to do more to help the kids and families understand the link between good nutrition and learning."
Ethics and clinical experts in Baltimore suggested in the Abell report that any study of these kids be done when they were young and the benefits could be greatest but that the benefits and risks such as nausea and conflicts with current medication be fully explained to participants. They also suggested convening a panel to discuss the issues and design an ideal study. Abell has asked Hopkins' Bloomberg school to do this, but officials there declined to comment because they will not begin forming the panel until fall.
If the logistics of a proper scientific study are worked out, and safety issues are measured for individual students, at least one local school operator said she'd be interested in participating. Muriel Berkeley, president of the Baltimore Curriculum Project, a nonprofit that runs four city charter schools, has witnessed food make a difference in student behavior.
As a third grade teacher years ago, she said, she and other teachers discovered one bright little boy was behaving badly after eating sugar. They spoke to his mother, modified his diet, and the problems disappeared. When they reappeared one day, they noted the date — it was Halloween.
"That's just one anecdote, and not scientific, but it showed me that it makes a difference," she said of proper nutrition. "When the kids are eating well, they come to school healthy and ready to learn."
At one of Berkeley's schools, Hampstead Hill Academy, officials have introduced nutrition classes where students learn what to eat for good health and how to prepare it. They also help grow healthy food in a school garden. Such classes are ramping up at her other schools, too.
But until each Baltimore City student can be taught about proper nutrition and is motivated to eat well, supplements may be a solution, she said.
"I'd absolutely like to hear about it," she said.
Abell's full report can be found at http://www.abell.org.