We thank Dr. Rebecca Carey for her essay, so well-grounded in the scientific literature on gut and brain. With respect to her personal experience with her son, we are delighted that he is doing so well. The two of us could easily submit hundreds of other personal stories that are similar, describing lives transformed by broad-spectrum micronutrients (minerals and vitamins). But we won’t.
Instead, we would like to elaborate on a topic that is embedded in Rebecca’s essay: how very challenging it is for all of us interested in non-drug treatments to talk about nutrient formulas without sounding as if we are promoting commercial products.
The two of us writing this blog have been studying the two Alberta formulas, EMPowerplus and Daily Essential Nutrients (DEN), for many years. These formulas are similar in terms of their breadth, and both were developed for mental health and have been evaluated for mental health by scientists who are not funded by the companies. We have studied a few other formulas as well. But really, what we have been studying is the following concept: because the brain needs a broad spectrum of micronutrients for optimal metabolic function, we should treat brain health problems with that whole spectrum.
To study that concept, we need good broad-spectrum formulas, and neither of us is interested in going into the business of producing natural health products. What might surprise readers is how few nutrient formulas that supposedly target symptoms of mental health problems have been studied by independent scientists.
Is treating brain health with a broad spectrum of micronutrients a novel concept? It turns out that it is relatively new. When Bonnie and her colleagues reviewed about a century of research on micronutrients and mental health, they found that modest mental health benefits had been shown from treatment with some isolated nutrients.1 But it was not until about 15 years ago that research began on broad-spectrum micronutrient (BSMN) formulas, largely (but not exclusively) because of the Alberta companies. And in fact, the fallacy of looking for a single nutrient (or, magic bullet, as we have called it) has been a huge obstacle to research on nutrition and mental health.2
So why is there any problem with studying a bunch of micronutrients together, in a commercially available formula? As long as our studies are not funded by companies, and companies have no control over our research, our analyses, and the publication of our results, why are we accused of being biased? It is this principled position of staying arm’s length from commercial entities, now held by all the scientists studying the Alberta BSMN formulas, that sets us apart from how research has typically been conducted within psychiatry for so many years.
But no matter how often we report that we have no conflict of interest, we are falsely accused of being affiliated with one of the Alberta companies that developed the BSMN formulas for mental health, or of promoting their products.3 We have both had to endure various accusations, and even our universities being asked to provide evidence that we do not have any conflicts of interest. In all cases we have been exonerated of all accusations. In other words, we report we have no conflict of interest, and our readers and listeners call us liars.
We used to get upset personally: being accused of lying is not fun. But now we realize the very sad truth of such unfounded accusations: we are living in an era in which drug companies have so totally corrupted scientists and clinicians that our audience members cannot believe that there is any other way to ‘do business’ in the scientific world.
Bonnie remembers a time when drug companies were NOT responsible for educating physicians about medications, did NOT provide free food at medical rounds to entice more medical attendees, did NOT offer clinicians free trips to the Bahamas to hear a lecture on a new psychiatric medication, and did NOT offer money to scientists to allow their names to be listed as authors on papers they did not write about clinical trials that they did not conduct. But now, we have had 50 years of this corruption by pharmaceutical companies, and (as readers of MIA know all too well) the result is 50 years of experimenting by drug companies and psychiatrists on people with mental health challenges. As detailed in Bob Whitaker and Lisa Cosgrove’s latest book Psychiatry Under the Influence, physicians sadly receive much of their information on drugs directly from the pharmaceutical companies, highlighting the fact that these companies have essentially usurped education of physicians. It has been a huge betrayal of everything embodied in the term ‘evidence-based medicine.’
We live in a funny world, where it is okay to mention drug names (either a brand name or its generic equivalent), and even names of psychotherapeutic methods (CBT, Open Dialogue), but as soon as you start to talk about nutrition, people become uncomfortable with using product names. Yet if we researchers do not specify the names of the formulas we study, then people may conclude that all formulas are similar. The formulas are not all the same, and readers need to know what is scientifically supported. Yes, it is true that you can buy cheaper nutrient formulas from a grocery store, but as Julia’s research team demonstrated,4 most over-the-counter products do not provide the nutrients in adequate doses or adequate breadth to meet the needs of a nutrient-depleted brain.
So the formulas are not the same, and the Natural Health Product (NHP) companies are not the same either. Bonnie once approached a very well-known NHP company with the suggestion that she do a study of one of their formulas that she had heard was helpful for stress and anxiety. She was rebuffed by the director of their scientific division who said (and this truly is a direct quote): “Why would we want to study it? We are making money.”
Other than the two Alberta companies, we know of no other NHP company that has chosen to direct all their energy and resources into creating a product for people with mental health problems. Their call centers demonstrate that fact: when the founding partners realized that psychiatrists would only rarely support patients who wanted to try BSMN treatment, they established telephone support lines to help people who were often desperately trying to get off of psychiatric medications that were causing them so many health problems. Yet instead of celebrating these companies in the world of mental health, we seem to scorn them. These two companies are tiny family-based entities, essentially nonprofit, and they have just one goal: to change the way people with mental disorders are treated.
We understand that people are uncomfortable if they erroneously think we are promoting a particular product. But we need to ask this question: who benefits from misleading people into thinking that just any nutrient formula will do? The answer, of course, is that the only ones who will benefit are the drug companies who make psychiatric medications. Because countless people have tried unsuccessfully to resolve their mental health challenges by buying one-a-day vitamin formulas at Costco, and the failure of their efforts inevitably leads them back to medication.
We do not mean to suggest that failure to achieve mental health wellness with nutrients in pill form is entirely due to taking the ‘wrong’ formula. Many people taking the Alberta formulas do not benefit either. There are many causes of psychiatric symptoms, and suboptimal nutrition is only one of them. But the fact remains that the Alberta formulas (DEN and EMPowerplus) are the most studied formulas in the world for the treatment of mental illness. This is such an important point. Do we not want our public to pay attention to the quality of science behind a treatment? Don’t we always talk about evidence-based medicine? By constantly dancing around the product names, we are, as Rebecca identifies, doing a disservice to those who need accurate information.
There are now about 35 peer-reviewed publications evaluating the use of these formulas for mental health, with many more in the pipeline; readers can request a list of the articles by emailing either one of us: Kaplan@ucalgary.ca or email@example.com
- Kaplan BJ, Crawford SG, Field CJ, Simpson JSA. Vitamins, minerals, and mood. Psychol Bull. 2007; 133(5): 747-60. ↩
- Rucklidge JJ, Johnstone J, Kaplan BJ. Single bullet madness – why do we continue to perpetuate this fallacy? (letter). Br J Psychiatry. 2013; 203 154-5. ↩
- Rucklidge JJ, Frampton CM, Gorman B, Boggis A. Authors’ reply. The British Journal of Psychiatry. 2015; 207(5): 460-. ↩
- Rucklidge JJ, Harris AL, Shaw IC. Are the amounts of vitamins in commercially available dietary supplement formulations relevant for the management of psychiatric disorders in children? N Z Med J. 2014; 127(1392): 73-85. ↩