Tuesday, March 29, 2011

ADHD, Mood Dysregulation, and Micronutrients

What is patently obvious to anyone who has spent more than 10 minutes studying nutrition literature is that any truly effective nutritional intervention will have to be pleiotropic.  That is, muti-faceted.  Adding one isolated mineral or vitamin or spice or whatever on its own is rarely going to hold up to population-wide study, or, as Kurt Harris would say, "no magic foods."  The probable exceptions to this rule in mild conditions are fish oil and magnesium - but that is likely because they are so incredibly vital to health, and so horribly deficient in the SAD.  So I'll grant that a simple magnesium tablet (or hard water) will help cardiac function and anxiety when added to a diet of ho-hos and cheese curls and cola.

Anyway, very recently some psychologists in Christchurch, New Zealand put out this paper (tweeted by Jamie Scott), Effect of Micronutrients on Behavior and Mood in Adults with ADHD: Evidence From an 8-Week Open Label Trial With Natural Extension.  They did something rather sensible - they tested a multimineral/multivitamin.  Here is their perfectly sensible reasoning:  "this approach of using one ingredient at a time may be too simplistic, as interventions of single ingredients may actually upset nutritional balances, creating deficiencies of other nutrients…. therefore, a more effective nutritional intervention to evaluate for mental or physical health may be one containing a broad array of balanced nutrients."  Hallelujah.  I'm not sure how these psychologists keep getting research funding, seeing as how sensible they are, but we have this paper and let's run with it.  Of course, a natural foods nose to tail diet and swimming in the ocean and/or drinking mineral water will give us all the micronutrients we need.  But y'all know that already.

Another cool thing about this paper is that the researchers studied adults with ADHD.  And adults with ADHD tend to be complicated.  See, once you've managed to spend a majority of your life fighting inattention and hyperactivity when everyone else seems to be able to just sit down and do your taxes like you are supposed to, you are liable to be stuck with some ancillary depression or anxiety from the level of stress and frustration that develops from dealing with ADHD.  In fact, 75% of adults with ADHD have an additional psychiatric diagnosis.

In this open-label study, 14 medication-free adults with ADHD and mood issues (episodic symptoms of irritable, low, or elevated mood) were given a supplement called EMPowerplus.  Here's the ingredient list.  This multi is rather expensive (a two month supply at 8 capsules daily is about $75) and was studied previously in bipolar disorder.   In the ADHD study, the participants started of with 5 capsules daily (divided into three doses) and eventually increased to 15 capsules daily (which takes you to > $70 a month for the pills).  My grassfed beef + organ meat and tallow order is just a bit less than $100 a month for the whole family (including shipping), and I get lots of steak included.  Just sayin'.

The results of the trial were impressive.  After 8 weeks, there were significant improvements in all ratings (patient, clinician, and an observer) of mood instability, hyperactivity, quality of life, anger and aggression.  Inattentiveness (the primary ADHD symptom and the basic neurological issue) improved, but remained elevated compared to ratings of people without ADHD.  The study participants were told how to get the supplement, and 7 of the original bought EMPowerplus and kept taking it - after two months their measures continued to improve.  Those who came off the supplement either maintained their initial improvement, or began to regress.  2 participants on EMP+ were also able to quit smoking.  Intriguing!

Perhaps even more interesting is that two of the participants entered the trial with severe Obsessive Compulsive Disorder symptoms, and their OCD symptoms remitted by the end of the trial.  Anyone who treats OCD will understand that OCD is tough tough tough, and in general the gold standard is intensive behavioral therapy plus (typically) the highest available dose of an SSRI that won't take full effect for three months.  The fact that a (I'm hoping, considering the price) pharmaceutical grade multi could ameliorate OCD symptoms, even in a couple of case studies, is amazing.

The discussion in this paper is impressive, and once again far too sensible for standard academia.  Must be that grassfed meat they have available at the supermarket down in New Zealand.  The researchers suggest that neurotransmitter synthesis, second messenger signaling, and the efficiency of brain energetics could all be impacted by our crappy diets (hey, that's the whole thesis of my blog!).  There is evidence that nutrient content of the food supply has diminished over the past 50 years (which is why I subscribe to a summer CSA box from local  farmers who are Joel Salatin acolytes and add organic seashell mineral mush to the fertilizer.)  The researchers were also very fair about the limitations of the trial - it was exceedingly small and open-label with no control.  Basically a wee pilot study, proving nothing, but (hopefully) to be used evidence to apply for much larger (expensive) randomized controlled trials from which we could actually glean some sensible data.

As if that will ever happen.

In the mean time, I will go straight to the fallback of an evolutionary diet plus sensible additions such as dark chocolate.  Just as expensive, perhaps, but a lot tastier.


  1. Great find! Hopefully this article will spur some research, somewhere, by someone who acknowledges the power and validity of this sensible approach.

    Btw, I would think polygenic would be more accurate than pleiotropic as an analogical description for studying the concurrent effects of many nutrients on a single disorder or suite of traits (e.g., ADHD, OCD, depression, etc.). Of course, it's a bit of both. Studies that focus on a single nutrient can find pleiotropic effects (one nutrient having multiple effects) whereas studying multiple nutrients in tandem is a polygenic approach (many nutrients affecting a single variable, e.g., a phenotype). Of course it is both.

  2. No, it is absolutely true that I don't know what pleiotropic means, but that I do like the sound of the word.

  3. Out of curiosity, where do people go to find grass-fed beef? Especially people who live in more benighted burgs like Detroit?

  4. Yup, it's got a ring of scientific mystery about it. I cover both concepts in my comparative psychology class which I'm teaching this quarter.

  5. this post just shows that conventional medicine and doctors still have no clue what can be done with a carefully formulated supplement stack. i can formulate a combination of OTC supplements and vitamins that blows pretty much any standard medication you may routinely use for your patients out of the water - for a fraction of the costs, and side effects. btw, just the fact that the multi contains phenylalanine makes the whole study completely worthless. and - the fact that you haven't noticed and/or mentioned this, pretty much proves my point ;)

  6. Qualia phenylalanine was studied in isolation and found not to be effective. (Wood, Reimherr, Wender) -it's mentioned in the paper ;)

    Famous J - you can go to Texasgrassfedbeef or eatwild. I get mine from Paidom.com.

  7. I'm always skeptical about multi-vitamins, but I guess not all multis are the same. Would superfood powder made from ground-up or freeze-dried organic plants, seaweeds, mushrooms and fruits have the same or perhaps better effects? I'm really curious to know.

  8. A friend recommended your blog, we're grain free right now to help with my daughter's autism. In the process of helping her, I've found it's helped me a lot too- specifically the GAPS diet with a high quality probiotic. I have tricho if I'm not on GAPS+probiotic, and have ADD symptoms as well.

    We've also found success using specific amino acids. I haven't tried a ton of vitamins, there's so much to try it takes a while to get to all of it! ;)

    I'm looking forward to reading more here after the kids are in bed :)

  9. A must read book covering EMPowerPlus..."Too Good to be True? Nutrients Quiet the Unquiet Brain". I read, I cried, I read some more, and cried right up to the end.

  10. I started taking emPower Plus for bi-polar after a dozen psychiatric drugs didn't help. The depression and mania went away over a period of 5 months, and it is now six years later with no recurrence of symptoms. I suspect but have no way of knowing for sure if it was the emPower Plus that did the trick. I discontinued my medications a few months after I cleared up, and I still take the emPower Plus, but at a much lower dose than the folks Truehope recommend.

  11. It this was an open label study, how reliable is it? It doesn't seem that there have been any randomized controlled trials with this multi (empowerplus). It's really expensive and a lot of people with very serious mental illness are taking it. Too bad there isn't better research data as to its effectiveness (beyond open label trials and personal feedback from patients and doctors).