Evolutionary Psychiatry

The hunt for evolutionary solutions to contemporary mental health problems.

Can A Multivitamin Help Treat ADHD?

Evidence that micronutrient deficiencies can affect ADHD symptoms

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I admit, I'm biased.  I already believe that our modern diets are nutrient-deficient and that these deficiencies affect the way our brain works.  Over the past year I've collected a good deal of evidence to suggest my supposition is correct, but I'm still open to being proven wrong.  And, frankly, a lot of studies over they years of vitamins and minerals and whatnot have been disappointing. Remember how vitamin E failed to improve dementia? (Of course, vitamin E comes in more varieties than you think, and if you supplement heavily with one variety, your body might not get enough of some other vital varieties - frankly these sorts of complications are why I prefer to get my nutrients from real food).  

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 multi-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.

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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 (I have no affiliation with this supplement company and have never bought it or tried it - in fact a quick google search shows the company was successfully sued by Health Canada, so maybe get your multi elsewhere?).  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 (which hasn't been extensively studied, but I consider the "null hypothesis" from which other diets must prove superiority) plus sensible additions such as dark chocolate. Just as expensive, perhaps, but a lot tastier.

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Copyright Emily Deans, M.D.

Emily Deans, M.D., is a psychiatrist with a practice in Massachusetts.

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