Our last blog reported on a study that found that a combination of micronutrients was effective in reducing aggression in children struggling with behavioural problems. Given that this finding replicated several previous studies over the last two decades, we wondered why the cumulative results weren’t impacting clinical practice.
Julia’s lab just published still another study in the Journal of Child Psychology and Psychiatry confirming the importance of nutrients in reducing aggression, this time in children presenting with ADHD.
So what did this latest study find?
- In this trial, 93 children identified with ADHD symptoms aged 7-12 were randomly assigned to take either micronutrient (vitamins and minerals) or placebo capsules for 10 weeks. None of the children were taking medications at the time of the study (such as stimulant medications). Neither clinicians nor families knew whether the child was taking micronutrients or placebo.
- The children, their parents, teachers, and study clinicians all provided information about the children’s ADHD symptoms, mood, behaviour, aggression, ability to regulate emotions, and general day to day function.
- Micronutrients were safe and well tolerated by the children. No serious side effects were reported, and there were no differences in side effects between those taking the micronutrients and those taking the placebo. Blood screening did not reveal any concerns about the safety of the nutrients.
- Inattention and overall functioning, as rated by clinicians, improved more in children who took micronutrients than in those who took placebo capsules. There were no group differences in hyperactivity/impulsivity.
- Across all raters (parents, teachers, and clinicians), there was greater improvement in ratings of emotion regulation and aggression for those children randomized to the active ingredients as compared with the children who were taking placebo capsules.
- In summary, the children who took micronutrients in this study experienced symptom improvement across a range of areas (including mood, sleep, aggression, emotion regulation, attention, and anxiety) with few side effects, making this a good treatment option for some children.
It is important to know that a number of the findings (although not all) replicated a study Julia’s lab published in 2014 investigating the use of a very similar compound of micronutrients in adults with ADHD. In both the adult and the child study, about half of the participants taking the active ingredients were identified as much to very much improved by the clinicians. This means that the clinicians observed substantial and noticeable improvement across a range of symptoms with significant benefit on overall functioning. A further 30 per cent showed a milder improvement, whereas the remaining 20% showed no benefit. Both studies showed that inattention symptoms seemed to benefit from nutrient treatment more than symptoms of hyperactivity/impulsivity. Both studies showed a positive effect of micronutrients on mood. And both studies showed the remarkable consistency across raters on improved regulation of emotions.
The effect of the micronutrients on what are usually termed “core ADHD symptoms” (hyperactivity, impulsivity and inattention) was less consistent. There was a bigger effect in the adult ADHD trial than the child one, perhaps because the main raters in the adult trial were the participants themselves whereas in the child trial, the main raters were the parents. We wonder whether the benefits experienced in regulation of emotions were influencing the adults to report greater improvements in their “core” ADHD symptoms. Having spoken to countless people over the years who have taken the micronutrients, we feel we can confidently conclude that the effect of the micronutrients is one of mood stabilization, which we believe then can lead to reduced aggression, feelings of inner calm, better sleep and over time, better cognitive functioning.
For parents wondering whether to choose micronutrients or medications to treat ADHD, consider the following:
- If you are looking for a treatment that has a quick impact (within a few hours), micronutrients will simply not work as quickly as stimulants. Stimulants show much larger and powerful changes in core ADHD symptoms in the short term. Stimulants can exert very strong effects on behaviour and very quickly, whereas the effects of micronutrients are more subtle, but grow over time with longer exposure to them.
- Fewer kids with ADHD benefited from the micronutrient treatment than what has been reported in the medication literature; however, for those children who did benefit, the effects were substantial and profound and observed broadly across all areas of functioning, effects usually not reported in the stimulant literature. This news story reports on the dramatic changes in one child’s behaviour with micronutrients.
- The side effect profile for micronutrients appears to be better, with no substantial effects reported on sleep or appetite, unless they are taken too close to bedtime as B vitamins tend to energize. We also observed a trend indicating more height growth in the children who were exposed to the nutrients as compared to the placebo.
- There are more pills to take if going down the micronutrient route. Some families found it difficult to ensure long-term compliance with taking the pills three times a day.
- We often hear anecdotally that children are healthier (skin conditions clear up, fewer colds, fewer infections, better sleep) when taking additional nutrients to their diet. We are not aware of any studies that report these health benefits for children on standard medications and have never heard any anecdotal reports of better health with stimulants.
- There is no rebound with micronutrients: irritability tends to get better, not worse with nutrients.
- In our research, teachers did not report any changes in core ADHD symptoms on nutrients whereas research has shown repeatedly strong effects based on teacher ratings when children receive stimulants. Teachers did identify improved regulation of behaviour and reduced aggression in those children randomized to the micronutrients. Research has suggested that children with poor emotion control have poorer long-term outcomes. If we can exert a positive effect on these symptoms, then we hope we can influence better long-term outcomes. Only further research will confirm these expectations.
- The cost of micronutrients is usually footed by the family, whereas the cost of medication is often covered by the public health care system or insurance plans. We see this discrepancy as an opportunity to lobby the governments to open up plans beyond medications. Is it time that the pharmaceutical companies lose their monopoly on tax payer funded treatments?
- Given the lower risks associated with micronutrients, perhaps a good route to consider would be to try micronutrients first, and if they don’t work, consider alternatives.
This research, alongside the many other studies documenting the substantial benefit of nutrients, put nutrition squarely and centrally on the map as one of the first things to consider when addressing mental health issues. Over and over again, we have shown that additional nutrients positively affect behaviour and mental states. Perhaps it is time to consider whether our diets or even our food supply is adequately meeting the metabolic needs of our very hungry brains?
For those readers who cringe and react to our work because we treat “mental disorders” that they consider don’t exist, please note that we are suggesting we give NUTRIENTS to children FIRST rather than what is currently the treatment of choice, stimulant medications. Over 4 million children are currently on stimulant medications in the US alone. That is the population of New Zealand! Hopefully, we can all agree that nutrients not only would likely be less harmful, but they may also assist with a healthier developmental outcome. Who doesn’t want better regulated emotions?
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.