Wednesday, December 13, 2017

Comments by Julia Rucklidge, PhD

Showing 30 of 30 comments.

  • You raise a very important point – the cost. Believe me, that is at the forefront of the research. The ONLY way to have governments or health insurance take a treatment seriously and consider funding it is to have research clinical trials. And as we have pointed out so many times, the only way to have those trials taken seriously is to conduct them independent of the companies that make the products. That’s why we do what we do. You have to understand that drugs are equally expensive (if not more so if one takes into account the negative effects on income, contribution to physical health issues etc) but we often don’t appreciate the expense because accessing drugs is often covered by our public health care system (at least it is in Canada and NZ). So the fact that the government might pay 400 dollars an hour for a patient to see a psychiatrist is not factored into the cost when comparing meds to nutrients. The fact that even with medications someone is unable to work is not factored into the cost of the medications. And then if the drug causes an arrhythmia, then the cost associated with investigating that (several thousand) is not factored into the cost of the drug. When nutrients work, these costs are unlikely to arise.

    Also, we are not convinced that the testing (like for methylation) is at a stage where it is that useful. Others might disagree, but the research is not as advanced as we might like to think it is. We are looking into that issue right now in NZ and might have further information on the topic in a year or so. Understand that we have not ONLY studied the truehope products, there are others we have also studied that don’t differentiate on their B12, like Daily Essential Nutrients. Whether both forms are needed is up for debate.

    With more data, we can then lobby governments and politicians to consider covering this as part of the health care system. At this point in time, we have chosen to allow Big Pharma to monopolize treatment options for families. So how do we change the system and include nutrition as part of our care of those who are ill? Because ultimately the fact that drugs are covered and nutrients aren’t is what makes this option appear so unaffordable. We can’t realistically ask the companies to give it away for free! I am not involved in the costs and not here to defend the costs, but generally as a consumer, we know that cheaper products tend to have cut corners.

  • Thanks for your comment. I wouldn’t just recommend a plant based diet as the research doesn’t just support that approach for wellness. Indeed, there is a a large body of literature supporting the Mediterranean diet as protective for developing mental illness as well as a potential way forward to treat mental illness. I encourage you to look at Felice Jacka, Sanchez-Villegas and Akbarely’s work on this diet and its relationship to mental health. Of course this diet includes fish and meat. Also a study came out suggesting that some meat is good for your mental health, Felice Jacka documented that Women Who Cut Out Red Meat Twice As Likely To Suffer Anxiety/Depression – see: http://www.karger.com/Article/Abstract/334910.

    Based on all my readings on diet, I don’t believe there is a one size fits all. Different people seem to benefit from different dietary patterns. It is important that we tell the public about what the research says, and that would include the studies you point out but not solely confined to those. Thanks Julia

  • I didn’t reply about your question on side effects. Evidence for our studies comes from the lack of difference in side effects being reported between placebo groups and active groups. If there were side effects to be associated with the active form, then there would be a group difference. There isn’t.

  • Thanks to everyone for reading the post. For those who are complaining that this is just one unblinded study of 17 adults and therefore we cannot make any inferences from it, I encourage you to read ALL of the studies on nutrients that have targetted psychological symptoms and then realise that we keep observing these similar findings over and over and over again, in all kinds of different designs, samples, countries. The design used in this study is actually a very robust design and well accepted in the scientific field. I encourage those who are sceptical of it to contact Neville Blampied directly to have a debate about the validity of the design and also to read the article in its entirety. We have written in previous blogs about the evidence for using micronutrients to assist with psychological symptoms and the third video on our series posted on Mad in America does go through all the evidence to date. For those sceptics, please watch the series in its entirety and then come back to us about whether there really is no evidence for this approach as a viable way forward for some people.

  • Thanks for asking. The effect size pre to post 8 weeks for sleep was 3.45. Note that this is not controlling for a placebo as there was no placebo arm. The true effect size of nutrients is likely lower but given how large the mean change was, it is likely still a large effect.

  • Thank you radames for bringing to attention the problems of megadoses as well as taking an ingredient on its own, which we identified as practices we don’t typically endorse. The man who overdoses on selenium, took 10g on its own. That would be a level that is above the upper limit for that ingredient. Indeed it is 100 times the current stipulated level. We are asking the NZ government to allow ingredients to be purchased at levels that are higher than currently listed, but of course not in toxic levels! We have issues with the doses listed, as they do not reflect the science and our knowledge of how nutrients work together. Most things are toxic if consumed at a high enough level.

    Regarding your comment about “no repeatable scientific study that shows benefit of any supplement”, we respectfully ask that you read our blogs where we have documented the evidence to date and have pointed out the published scientific literature supporting broad spectrum micronutrients as efficacious in the treatment of health issues. We have also addressed the studies that suggest that taking supplements shorten our lifespan. I encourage you to read them!

    We certainly agree that supplements should contain what they say they contain, that is not the issue we have raised regarding the legislation.

  • Thanks for your comments BPD transformation. It is indeed ironic, and we are aware of the issues you raise. We are stuck between a rock and a hard place as in order to get this line of research accepted and become a part of mainstream medicine, or even have it funded, and not viewed as quackery, then it can be necessary to use a common language to a certain extent. One battle at a time.

  • Thanks for the comment, the problem isn’t with the Bill per Se (although defining an NHP as something that doesn’t contain a medicine is in my view problematic as discussed in the article). I agree, it is important that there is evidence to back claims. The problem is with the permitted ingredient list where the government has taken a one ingredient approach to regulating products, specifying upper doses that may be reasonable if consumed alone, but are not reasonable when consumed in combination with other ingredients.

  • Thank you for your comments and spending the time looking at our raw data! We completely agree with you on the points you raise retiming of registration and indeed, in the article, we divided up retrospective registration into different time frames in Table 1 for the very reason that we thought if a research group had registered a month after the trial started the likelihood of changing POMs as a result of seeing results was highly unlikely, as you state. And indeed there were 7 trials registered within one month and 14 within 1 to 6 months. However, almost half of the retrospectively registered trials were registered between 1 and 5 years after patient recruitment had started. At this point could they be influenced by data already collected? We would hope not if the trials were fully blinded although we know that patients often can figure out what group they are in based on side effect profile. Does that influence investigators? We don’t know.

    We are completely sympathetic to a late registration within months of starting a study. This has happened in my lab in the days of not knowing about trial registration and during the disruption of the Canterbury earthquakes when our department was closed for 3 months. There can be benign reasons for it! However, I would then never have thought to submit this work to a journal stipulating prospective trial registration as a condition of publication!

    What we would simply ask for is that the journals be transparent about their procedures. Given the bleak history of trials in psychiatry, it is important that journals take measures to ensure that we can trust what is currently published and if they deviate, they simply let the reader know by ensuring it is stated in the article.
    Amelia developed amazing detective skills as part of this study. We were surprised at the changes that were happening in the registry for prospectively registered trials. Some were benign changes, others were less so. We didn’t look at this for those that were retrospectively registered. Perhaps we should have!
    A good question about whether they were double blind or not. Trials did not have to be double blind to be included although many were. That would have been a good point to make in our discussion. Thanks for that observation.

  • Dear Slaying_the_dragon_of_psychiatry:
    Sorry for the slow response, I was pondering on your perspective. I hear what you’re saying, that some of the symptoms that are being targeted by nutrients shouldn’t be the target at all. I appreciate that there are lots of faults in the psychiatric system. And that you are challenging whether vitamins as a treatment reinforce the current paradigm rather than challenge it.

    We think that there might be room for a different perspective: that *some* people are not functioning to their optimum because of suboptimal nutrition.

    Some of the work I have been involved in addresses suffering that has arisen from environmental catastrophe. I live in Christchurch, a city that was hit with thousands of earthquakes over a year, causing huge damage, huge suffering and challenges to many to cope. We have used nutrients successfully to help some people cope post earthquake without medications. Better nutrition, less inequity, addressing poverty, a different social environment might address these symptoms similarly. But I am delighted that a simple approach helped many.
    I agree that people can often heal themselves on their own. Our research supports that. We can’t and don’t want to supplement the whole population. We are showing that nutrients /food can heal but better yet, might prevent problems from developing in the first place that bring about suffering.

    But I hear you challenging the research I do on psychiatric diagnoses like ADHD, a diagnosis I think I understand you wish to eliminate entirely. It would take a book to have a discussion on this point. But our research brings attention to a fundamental issue that plagues our society: access to good nutrition. If good nutrition can help kids learn better, then that speaks to the nutrional quality of our food supply. Or that some need more nutrients than is currently available to them. Exposing that has to be a step in the right direction. It shifts the blame from the genetic makeup of the kid or bad parenting to an environmental issue that may or may not interact with genetics. We can debate whether the symptoms in themselves should be a problem, but we do know kids who have those symptoms have a less than desirable trajectory in many cases. It would be nice to change that path.
    There are many battles to be fought, but battles need to be chosen carefully.

  • Dear MIA readers, thank you for all the interesting comments. We are, however, always struck by the huge number of negative comments we receive on our blogs. Our research confirms what many of you are saying: there is suffering that can be alleviated by means other than medications.

    Our research happens to show this with nutrients. Please do not assume that we don’t think other treatments aren’t valuable, or that there aren’t other factors that play a role in how well people recover from trauma, or that we shouldn’t focus on the nutrient density of the food we ingest. We completely agree that these factors and others are vital to healing our bodies and our brains.

    We hope our work results in fewer medications and more of a focus on lifestyle modification, diet, exercise, and other treatments that carry fewer side effects and hopefully can do some good. Our studies and those of others support the huge potential of nutrition as a viable and primary way forward for many but not all. So if we could put aside our differences in the terms we use, and focus on the suffering of so many people, then hopefully we can all agree that to find alternatives to our current approaches has got to be a good thing.

    For those who ask about the research to support nutrients as a primary treatment of symptoms, please see our earlier blogs where we provide the research and the references for those interested.

  • HI – some came up and provided some support for Lieberman and thanking him for his service to the profession. But one member of the audience started his question saying that we do need to agree that the medications can cause intolerable side effects and then went on to ask Lieberman about SPECT scans. Lieberman stopped him there and asked him if he knew of Dr Daniel Amen. The member of the audience said, yes, he had heard of him. Dr Lieberman then said something like: “Dr Amen is a fraud and I refuse to engage in any further discussion on this topic.” End.I was shocked at his blanket dismissal and refusal to answer a question.

  • Dear B, sorry I did reply to this query but somehow it never got posted. Shall try again.
    I don’t manufacture the products but understand that the manufacturers do consider these interactions that can usually be dealt with based on how the mineral is chelated and the balance of the minerals with each other.
    As for doing blood/urine analysis, my research has shown that it isn’t that useful, at least not to identify what your nutrient needs might be. Using serum blood markers to determine whether someone is deficient in a nutrient to prevent them from consuming nutrients unnecessarily, would be ideal but we have shown that not having a deficiency doesn’t actually mean you won’t benefit from a nutrient. See a related paper http://www.ncbi.nlm.nih.gov/pubmed/24374068 on moderators of treatment outcome using micronutrients. Scientists wonder if we all have our own individual nutrient requirements such that those levels aren’t always useful to determine what one person might need for optimal functioning. Also serum nutrient levels don’t tell us what a metabolically active organ like the brain is actually using and requiring. I encourage you to read the article I just referred to so you can read at great depth some of the limitations of using serum markers to determine what someone might require nutritionally. Having said that, nutrient biomarkers could be useful for detecting toxicity but it would be very expensive to monitor every nutrient in your blood. Also, hard to define what is toxic?
    We are interested in hair analysis and we are collecting data at that at present.
    As for the safety of the individual ingredients – most of the studies that report safety concerns, tend to study the one ingredient on its own so we don’t know if we can extrapolate those concerns to multi-ingredient formulae. It is something we need to continue to research.

  • Thanks for all the comments and support of this work. In reply to “B”, we are certainly aware of the literature showing that medications can affect nutrient levels and so your observations are quite accurate. We have blogged quite extensively on the query you have on why we would use a broad spectrum of nutrients and do hope you read some of our past blogs where we address these most important issues about magic bullets. While it may seem unspecific to give a broad array of nutrients, it actually makes perfect sense physiologically. Our bodies work best when presented with a broad array of nutrients as they work synergistically. Ultimately though, the best evidence to determine whether it is a viable way forward is to test them in controlled conditions. And that is what we and others have done for over a decade. The data we and others have collected show that nutrients ARE an effective way to change psychiatric symptoms (in people who present with psychiatric symptoms, this is an important distinction, some studies show they don’t work but those researchers studied people without psychiatric symptoms so there is very little room to observe benefit), so there is evidence to support these ideas.
    As for the issue of safety, with any treatment for a serious condition one has to weigh the risks and benefits and decide whether it is a good way forward. Please read this blog where we discuss issues of safety in depth: https://www.madinamerica.com/2013/09/supplements-simply-creating-expensive-urine/
    I hope you find it helpful. We have published safety data in these two articles:
    http://www.biomedcentral.com/1471-244X/11/62/
    http://bjp.rcpsych.org/content/204/4/306.long
    Both articles are available for free.

    In reply to Maria, we couldn’t agree more that there are of course other environmental factors that contribute to the expression of mental illness and we certainly don’t disregard these very important factors.

  • Dear ( )
    Your comment and that of Slaying_the_Dragon_of_Psychiatry, raise the issue that while nutrition can be beneficial, our focus is woefully mislaid as we are targeting symptoms and disorders that are a myth and therefore not in need of treatment.

    We agree that there are significant challenges to the diagnostic system that we have today. When we see people get well and feel better and go to work and enjoy relationships, families and children, we see them get well across all categories of illness and all symptoms, suggesting that the diagnostic categories are not independent of each other. And so we do see significant problems with the current disease model, just as you do.

    However, to take down the disease model, our current health care model, our current reliance on nutrient depleted food and the general dismissal of using nutrients to improve the health of many, is asking a lot of a single 18 minute talk. There are many TEDx opportunities in there for others!

    By the way, although we never think of our nutrition research as ‘the medical model,’ we do think of it as a biological model. We wonder if that offends anyone. Nutrients are the building blocks of our cells (e.g., omega 3s are critical for cell walls) and our cell functioning (e.g., minerals and vitamins are critical to the neurotransmitters being synthesized and being able to function). So nutrition is a biological factor. But there are so many other factors that contribute to mental problems (poor family relationships, lack of economic wellbeing, abuse and trauma, etc, etc, etc.). So even though nutrition is biologically relevant, there are so very many other important factors that determine our mental health. And if we *really* want to solve a huge portion of the problem — let’s just get rid of poverty and war.

  • In response to the desire for researchers to study nutrients and not brands…that would be an ideal situation but not one that I have come across yet. I can envision that being achieved if one had massive amounts of grant funds and could invest in the development of the nutrient complex alongside developing the best way to ensure maximal absorption etc. wouldn’t that be nice if that kind of money was available for nutrition research?

    As for using serum blood markers to determine whether someone is deficient in a nutrient to prevent them from consuming nutrients unnecessarily, again, ideal but we have shown that not having a deficiency doesn’t actually mean you won’t benefit from a nutrient. See a related paper http://www.ncbi.nlm.nih.gov/pubmed/24374068 on moderators of treatment outcome using micronutrients. Scientists wonder if we all have our own individual nutrient requirements such that those levels aren’t always useful to determine what one person might need for optimal functioning. Also serum nutrient levels don’t tell us what a metabolically active organ like the brain is actually using and requiring. I encourage you to read the article I just referred to so you can read at great depth some of the limitations of using serum markers to determine what someone might require nutritionally.

    I am sorry I misunderstood your comment about benefiting from nutrients, I am delighted you are trying to figure out whether these nutrients can be helpful.

  • 1) we are going to have to disagree on that one. “Trollo” commented that all products have research, I replied.
    2) sounds like we share some similar perspectives.
    3) The single ingredient method of treating mental illness hasn’t actually yielded huge benefits in the ADHD world (see Rucklidge, J. J., Johnstone, J., & Kaplan, B. J. (2009). Nutrient supplementation approaches in the treatment of ADHD. Expert Review of Neurotherapeutics, 9(4), 461-476.). Hence why a different approach is required. Of course maybe not all these ingredients are necessary, but we need to start somewhere, I would love to see other researchers tackle this issue and certainly different doses and products and more comparison studies. This is actually far more challenging to do that it sounds. Imagine the number of studies you would need to do! It sounds like you are quite passionate about the problems, be a part of the solution.
    4)Thanks for the advice. They don’t control my research (no input into design, data analysis, writing it up…the first copy of the study that the company would have seen was the final version that is available through the BJP website) and equally I can’t control what they post on their website.

    In reply to Trollo: I am a psychologist keen to study existing treatments and evaluate their effectiveness for mental illness, not a manufacturer of nutrients. I am not in a position to put together a formula for research. Figuring out why something works is certainly an area of research I am keen to see explored. These studies take time. If you can receive benefit from cheaper sources of nutrients, that’s fantastic. I am delighted to hear you are using nutrients to alleviate suffering. Please do let us know what you have been using so that we can study it!

  • I would love it if every big vitamin mineral complex had a study associated with it but that simply isn’t the case. Especially for treating symptoms of mental illness. Sadly many people market their products without any published research on it. We reviewed this literature in another blog and there are only about 20 products give or take that have had at least one study done on it for the treatment of mental health symptoms. That’s it…and some of those studies aren’t RCTS.

    As for your question about how could it be that one product can be effective for so many different disorders. Great question and I can only speculate as to the answer. We have come to believe because of the DSM that psychiatric disorders are discrete entities with different causes for each one of them. But that hasn’t yet been proven. Yes they talk about genetics but that research is very weak and hasn’t been able to find a specific gene for a specific disorder. If we turn it upside down and consider that perhaps we all express vulnerabilities differently then we can be open to the idea that one treatment might actually have an effect on many different symptoms. We certainly have seen in our work a over and over that when someone gets better it isn’t specific to a disorder, anxiety gets better, mood gets better. So I think this belief that each disorder is going to have a specific treatment may be propagated by our one drug one disease model of thinking. And let’s face it, that hasn’t actually been that successful. Think about when your body gets run down, you express that differently from your spouse, friends, children. Some get headaches, others sore throats, others irritable. But the treatment of the run down immune system could have benefit on all those different symptoms.

    I agree that different people have different nutritional needs and therefore there is a bit of a shot gun approach to this. We would love to be at the point of individualized health care but it is just not that easy. For this work, first we see whether it does actually work, then start figuring out whether it can be fine tuned. We aren’t there yet.

    As for the comment that a professor should stay away from doing this work…who else is going to do it? We are independently assessing claims. Surely that is the role of the scientific community. Just because it is controversial, doesn’t mean we should stay away from it! Otherwise we will only have safe science and how much progress will we make then?

  • Thanks for your comments. It is a reasonable question to know how this product compares with other micronutrient formulae. There is virtually no research that has compared different micronutrient formulae to see if one might be better than another. There is some research that suggests that dose is important. And that is probably one distinction between this product and those purchased over the counter as well as probably the breadth of nutrients used. While we have to study one product to study an idea, we can’t extrapolate these data to other micronutrient formulae unless they have been directly compared. So it is important, in order to make an informed decision about how to treat psychiatric symptoms, to know what nutrients we used and in what dose they were given (and the only way to do that it to name the product!). If you read our other blogs, we do discuss these issues in great depth. Please also see Bonnie Kaplan’s comment addressing the issue you raise about conflicts of interest. As for the safety of the individual ingredients – most of the studies that report safety concerns, tend to study the one ingredient on its own so we don’t know if we can extrapolate those concerns to multi-ingredient formulae. It is something we need to continue to research. In the end, this study is discussed and made available to the public to evaluate and consider the risks and benefits within the context of their situation. However, I urge you to read the entire article published in the British Journal of Psychiatry before drawing conclusions about the science and how seriously you should take it. Your concerns about the specific ingredients chosen should be taken up with the manufacturer although I believe that the more recent changes to the formula have addressed the concerns you raised.

  • Hi good question. It all has to do with how likely it is to get a sample to study. So many people with depression or other mood disorders are medicated and we certainly don’t advocate for someone to come off a treatment to be in a trial. So it makes it really hard to study depression. In christchurch, the diagnosis of ADHD in adults has been controversial and so many go untreated, hence why we had a population of people who might not be receiving care in the community…someone really needs to study it in people with just depression…

  • Hi Michael, thanks for your challenging thoughts on ADHD. But I am unclear, are you anti diagnosis or are you more anti the treatments that go with the diagnosis? You do give some compelling arguments about why there are significant problems with the diagnosis but you and I know that for the most part, mental health professionals are diagnosing it in about 5% of children so they are able to appreciate that there are extremes to the behaviours described in the DSM and it is those children who more typically get identified.

  • Hi David, thanks for this post. I sometimes think about the ethics of compulsory treatment.

    I should mention, as someone who lives in New Zealand, I can’t say that I have seen any significant behaviour change in the prescribing of the psychiatrists here. As for a debate about the uses of medications for young people, let me tell you of one encounter I had. One psychiatrist told me that a patient who refuses medications for her bipolar must be incompetent as someone who is competent would realise that the medication was in her best interest….that was a couple of years ago now but post 2008. Julia