Tag: Research + Study

Supplements for Mental Health

write about mental health

We came across this topic some time back and thought it would be good inspiration for a NutriScape.NET article written from the dietitian’s point of view. Here are some quick snippets you can follow.


Nutrition Supplements Studied For Mental Health

Source: UCx: PSY01ucX Course: Mental Health and Nutrition

  1. Course
  2. Progress
  3. Dates
  4. Course Syllabus
  5. Food Diary
  6. Bibliography
  7. Discussion
  8. Nutritional Supplements, current location

Nutritional Supplements

The most frequent question I get asked is: based on all of this research, what micronutrient formula should I take?

Below, I have compiled a list of ALL the micronutrient formulas that have been studied to treat a psychiatric or psychological problem. Note I have not included those preparations used for prevention of cognitive decline.

Each product listed below has at least one positive RCT to support its use. I have cited all the research behind the products mentioned (it is listed in ascending date order). PLEASE NOTE I DO NOT RECEIVE ANY MONEY FROM ANY OF THE COMPANIES THAT SELL MICRONUTRIENT PRODUCTS.


1. EMPower™, EMPowerplus™, and EMPowerplus Advanced™ (EMP)

www.truehope.com

For: ADHD, mood dysregulation, PMS, symptoms associated with trauma, aggression, depression, stress, anxiety.

For those taking the current EMP formulation for improving mental health symptoms, the dose stipulated on the bottle is two capsules twice a day (the dose recommended for general health). However, the dose more typically used in current research is at least four capsules twice a day. For those using these products for assisting with managing stress, our research after the earthquakes and floods showed that a therapeutic dose may be lower, such as four a day.

Research
  • Kaplan, B. J., Simpson, J. S. A., Ferre, R. C., Gorman, C. P., McMullen, D. M., & Crawford, S. G. (2001). Effective mood stabilization with a chelated mineral supplement: An open-label trial in bipolar disorder. Journal of Clinical Psychiatry, 62(12), 936-944. 
  • Popper, C. W. (2001). Do vitamins or minerals (apart from lithium) have mood-stabilising effects? Journal of Clinical Psychiatry, 62(12), 933-935. https://www.psychiatrist.com/jcp/article/pages/2001/v62n12/v62n1203.aspx 
  • Kaplan, B. J., Crawford, S. G., Gardner, B., & Farrelly, G. (2002). Treatment of mood lability and explosive rage with minerals and vitamins: two case studies in children. Journal of Child and Adolescent Psychopharmacology, 12(3), 205-219. 
  • Simmons, M. (2003). Nutritional approach to bipolar disorder. Journal of Clinical Psychiatry, 64(3), 338.
  • Kaplan, B. J., Fisher, J. E., Crawford, S. G., Field, C. J., & Kolb, B. (2004). Improved mood and behavior during treatment with a mineral-vitamin supplement: an open-label case series of children. Journal of Child and Adolescent Psychopharmacology, 14(1), 115-122. 
  • Rucklidge, J. J. (2009). Successful treatment of OCD with a micronutrient formula following partial response to CBT: A case study. Journal of Anxiety Disorders, 23, 836–840.
  • Gately, D., & Kaplan, B.J. (2009). Database analysis of adults with bipolar disorder consuming a micronutrient formula. Clinical Medicine: Psychiatry. http://la-press.com/article.php?article_id=1384
  • Frazier, E.A., Fristad, M., & Arnold, L.E. (2009). Multinutrient Supplement as Treatment: Literature Review and Case Report of a 12-year-old Boy with Bipolar Disorder. Journal of Child and Adolescent Psychopharmacology, 19, 453-460.
  • Rucklidge, J. J., & Harrison, R. (2010). Successful treatment of Bipolar Disorder II and ADHD with a micronutrient formula: A case study. CNS Spectrums, 15(5), 289-295.
  • Mehl-Madrona, L., Leung, B., Kennedy, C., Paul, S. & Kaplan, B. J. (2010). A naturalistic case-control study of micronutrients versus standard medication management in autism. Journal of Child and Adolescent Psychopharmacology, 20(2), 95-103. https://www.ncbi.nlm.nih.gov/pubmed/20415604 
  • Rucklidge, J. J., Gately, D., & Kaplan, B. J. (2010). Database Analysis of Children and Adolescents with Bipolar Disorder Consuming a Micronutrient Formula. BMC Psychiatry, 10, 17. http://www.biomedcentral.com/1471-244X/10/74 
  • Rucklidge, J. J., Taylor, M. R., Whitehead, K. A. (2011). Effect of micronutrients on behaviour and mood in adults with ADHD:  Evidence from an 8-week open label trial with natural extension. Journal of Attention Disorders, 15(1), 79-91.
  • Rucklidge, J. J., Johnstone, J., Harrison, R. (2011). Effect of micronutrients on neurocognitive functioning in adults with ADHD and Severe Mood Dysregulation: A pilot study. Journal of Complementary and Alternative Medicine, 17(12), 1-7. https://www.ncbi.nlm.nih.gov/pubmed/22112202 
  • Rucklidge, J. J., & Blampied, N. M. (2011). Post earthquake functioning in adults with Attention-Deficit/Hyperactivity Disorder: Positive effects of micronutrients on resilience. New Zealand Journal of Psychology, 40(4), 51-57.
  • Rucklidge, J. J., Johnstone, J., Harrison, R., & Boggis, A. (2011). Micronutrients reduce stress and anxiety following a 7.1 earthquake in adults with Attention-Deficit/Hyperactivity Disorder. Psychiatry Research, 189, 281-287. doi:10.1016/j.psychres.2011.06.016   
  • Simpson, J. S. A., Crawford, S. G., Goldstein, E. T., Field, C., Burgess, E., & Kaplan, B. J. (2011). Systematic review of safety and tolerability of a complex micronutrient formula used in mental health. BMC Psychiatry, 11(62). http://www.biomedcentral.com/1471-244X/11/62 
  • Rodway, M., Vance, A., Watters, A., Lee, H., Bos, E., & Kaplan, B. J. (2012). Efficacy and cost of micronutrient treatment of childhood psychosis. BMJ Case Reports, 10.1136/bcr-2012-007213. https://doi.org/10.1136/bcr-2012-007213  
  • Rucklidge, J. J., Andridge, R., Gorman, B., Blampied, N., Gordon, H. & Boggis, A. (2012). Shaken but unstirred? Effects of micronutrients on stress and trauma after an earthquake: RCT evidence comparing formulas and doses. Human Psychopharmacology: Clinical and Experimental, 27(5), 440-454. https://www.ncbi.nlm.nih.gov/pubmed/22782571  
  • Frazier, E.A., Fristad, M.A. & Arnold, L.E. (2012). Feasibility of a nutritional supplement as treatment for pediatric bipolar spectrum disorders. Journal of Complementary and Alternative Medicine, 18, 678-85.
  • Harrison, R., Rucklidge, J. J., & Blampied, N. (2013). Use of micronutrients attenuates cannabis and nicotine abuse as evidenced from a reversal design: A case study. Journal of Psychoactive Drugs, 45(2), 1-11. https://www.ncbi.nlm.nih.gov/pubmed/23909004 
  • Frazier, E. A., Gracious, B., Arnold, L. E., Failla, M., Chitchumroonchokchai, C., Habash, D., & Fristad, M. A. (2013). Nutritional and safety outcomes from an open-label micronutrient intervention for pediatric bipolar spectrum disorders. Journal of Child and Adolescent Psychopharmacology, 23(8), 558-567. doi:10.1089/cap.2012.0098   
  • Rucklidge, J. J. (2013). Could yeast infections impair recovery from mental illness?  A case study using micronutrients and olive leaf extract for the treatment of ADHD and depression. Advances in Mind-Body Medicine, 27(3), 14-18. https://www.ncbi.nlm.nih.gov/pubmed/23784606 
  • Rucklidge, J. J., Blampied, N., Gorman, B., Gordon, H., & Sole, E. (2014). Psychological functioning one year after a brief intervention using micronutrients to treat stress and anxiety related to the 2011 Christchurch earthquakes: A naturalistic follow-up. Human Psychopharmacology: Clinical and Experimental, 29(3), 230-243. https://www.ncbi.nlm.nih.gov/pubmed/24554519  
  • Rucklidge, J. J., Frampton, C. M., Gorman, B., & Boggis, A. (2014). Vitamin-mineral treatment of attention-deficit hyperactivity disorder in adults: double-blind randomised placebo-controlled trial. British Journal of Psychiatry, 204(4), 306-315. https://doi.org/10.1192/bjp.bp.113.132126  
  • Rucklidge, J. J., Johnstone, J., Gorman, B., & Boggis, A., & Frampton, C. (2014). Moderators of treatment response in adults with ADHD to micronutrients: demographics and biomarkers. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 50, 163–171. https://www.ncbi.nlm.nih.gov/pubmed/24374068 
  • Gordon, H. A., Rucklidge, J. J., Blampied, N. M., & Johnstone, J. M. (2015). Clinically Significant Symptom Reduction in Children with Attention-Deficit/Hyperactivity Disorder Treated with Micronutrients: An Open-Label Reversal Design Study. Journal of Child and Adolescent Psychopharmacology, 25(10), 783-798. doi: 10.1089/cap.2015.0105 https://www.ncbi.nlm.nih.gov/pubmed/26682999 
  • Kaplan, B. J., Hilbert, P., & Tsatsko, E. (2015). Micronutrient treatment for children with emotional and behavioral dysregulation: a case series. Journal of Medical Case Reports, 9:240. http://www.jmedicalcasereports.com/content/pdf/s13256-015-0735-0.pdf
  • Kaplan, B. J., Rucklidge, J. J., Romijn, A. R., & Dolph, M. (2015). A randomized trial of nutrient supplements to minimize psychological stress after a natural disaster. Psychiatry Research, 228, 373-379. http://www.ncbi.nlm.nih.gov/pubmed/26154816  
  • Kaplan BJ, Leaney C, Tsatsko E (2016). Micronutrient treatment of emotional dyscontrol following traumatic brain injury: A case study. Annals of Psychiatry and Mental Health, 4(5): 1078. https://www.jscimedcentral.com/Psychiatry/psychiatry-4-1078.pdf 
  • Retallick-Brown, H., Rucklidge, J. J., & Blampied, N. (2016). Study protocol for a randomised double blind, treatment control trial comparing the efficacy of a micronutrient formula to a single vitamin supplement in the treatment of premenstrual syndrome. Medicines, 3, 32. http://www.mdpi.com/2305-6320/3/4/32  
  • Rucklidge, J. J., Frampton, C., Gorman, B., & Boggis, A. (2017). Vitamin-mineral treatment of ADHD in adults:  A one year follow up of a randomized controlled trial. Journal of Attention Disorders, 21(6), 522-532. http://journals.sagepub.com/doi/pdf/10.1177/1087054714530557  
  • Sole, E. J., Rucklidge, J. J., & Blampied, N. M. (2017). Anxiety and Stress in Children Following an Earthquake: Clinically Beneficial Effects of Treatment with Micronutrients. Journal of Child and Family Studies, 1-10. doi: 10.1007/s10826-016-0607-2 https://link.springer.com/article/10.1007%2Fs10826-016-0607-2  
  • Kaplan, B. J., Isaranuwatchai, W., & Hoch, J. S. (2017). Hospitalization cost of conventional psychiatric care compared to broad-spectrum micronutrient treatment: literature review and case study of adult psychosis. International Journal of Mental Health Systems, 11, 14. https://link.springer.com/article/10.1186/s13033-017-0122-x 
  • Mehl-Madrona, L., & Mainguy, B. (2017). Adjunctive Treatment of Psychotic Disorders with Micronutrients. Journal of Alternative and Complementary Medicine. 23(7): 526-533. http://online.liebertpub.com/doi/10.1089/acm.2016.0215 
  • Retallick-Brown, H., Blampied, N., & Rucklidge, J. J. (2020). A Pilot Randomized Treatment-Controlled Trial Comparing Vitamin B6 with Broad-Spectrum Micronutrients for Premenstrual Syndrome. Journal of Alternative and Complementary Medicine. doi:10.1089/acm.2019.0305. https://www.ncbi.nlm.nih.gov/pubmed/31928364 

2. Daily Essential Nutrients*™ (DEN)

www.hardynutritionals.com

For: ADHD, smoking cessation, emotional dysregulation, symptoms associated with trauma, aggression, depression, stress, anxiety

*Prior to 2013, there was just one formula and it was manufactured by TrueHope. From 2013 onward, Hardy Nutritionals produced Daily Essential Nutrients while TrueHope continued to produce EMP+. Therefore, the ingredients of DEN are very similar to EMP+ in both breadth and dose. Some modifications have been made to both formulas over the ensuing decade. For updated information on current formulas, see the manufacturers’ websites.

A full daily dose for improving psychiatric symptoms with DEN is four capsules three times a day (twelve/day) and this is the dose that has been the most used in the cited research. Hardy Nutritionals has a product called Optimal Balance® designed for people just seeking a little additional nutrient support to manage stress or insomnia. The typical daily dose is three twice a day (six/day).

DEN is a better choice than Optimal Balance® for those with more serious psychiatric problems and/or if taking the nutrients alongside psychiatric medications, where they may want to consult with the company product specialists regarding their own situation.

Research 
  • Lothian, J., Blampied, N., & Rucklidge, J. (2016). Effect of Micronutrients on Insomnia in Adults: A Multiple-Baseline Study. Clinical Psychological Science, 4(6), 1112-1124. https://doi.org/10.1177/2167702616631740  
  • Blampied, M., Bell, C., Gilbert, C., Boden, J., Nicholls, R., Rucklidge, J. J. (2018) Protocol for a Randomized Double Blind, Placebo Control Trial Exploring the Effectiveness of a Micronutrient Formula in improving symptoms of Anxiety and Depression. Medicines. 5(2), 56. http://www.mdpi.com/2305-6320/5/2/56  
  • Rucklidge, J. J., Eggleston, M., Johnstone, J. M., Darling, K., & Frampton, C. M. (2018). Vitamin-mineral treatment improves aggression and emotional regulation in children with ADHD: A fully-blinded, randomized, placebo-controlled trial. Journal of Child Psychology and Psychiatry, 59(3), 232-246. http://onlinelibrary.wiley.com/doi/10.1111/jcpp.12817/full 
  • Stevens, A., Rucklidge, J. J., Eggleston, M., Darling, K., & Kennedy, M. (2018). Methylomic changes in response to micronutrient supplementation and MTHFR genotype. Epigenomics, 10(8), 1201-1214. https://www.futuremedicine.com/doi/10.2217/epi-2018-0029 
  • Reihana, P., Blampied, N., & Rucklidge, J. (2018). Novel Mineral–Vitamin Treatment for Reduction in Cigarette Smoking: A Fully Blinded Randomized Placebo-Controlled Trial. Nicotine & Tobacco Research, 21(11), 1496-1505. https://doi.org/10.1093/ntr/nty168    
  • Rucklidge, J. J., Eggleston, M. J. F., Ealam, B., Beaglehole, B., & Mulder, R. T. (2019). An Observational Preliminary Study on the Safety of Long-Term Consumption of Micronutrients for the Treatment of Psychiatric Symptoms. Journal of Alternative and Complementary Medicine. doi:10.1089/acm.2018.0352 https://www.liebertpub.com/doi/10.1089/acm.2018.0352
  • Rucklidge, J. J., Eggleston, M., Johnstone, J. M., Darling, K., Stevens, A. J., Kennedy, M. A., & Frampton, C. M. (2019). Can we predict treatment response in children with ADHD to a vitamin-mineral supplement? An investigation into pre-treatment nutrient serum levels, MTHFR status, clinical correlates and demographic variables. Progress in Neuropsychopharmacology & Biological Psychiatry, 89, 181-192. https://www.sciencedirect.com/science/article/pii/S027858461830407X?via%3Dihub 
  • Borlase, N., Melzer, T. R., Eggleston, M. J. F., Darling, K. A., & Rucklidge, J. J. (2019). Resting-state networks and neurometabolites in children with ADHD after 10 weeks of treatment with micronutrients: results of a randomised placebo-controlled trial. Nutritional Neuroscience, 1-11. doi:10.1080/1028415X.2019.1574329 https://www.tandfonline.com/doi/full/10.1080/1028415X.2019.1574329 
  • Stevens, A. J., Purcell, R. V., Darling, K. A., Eggleston, M. J. F., Kennedy, M. A., & Rucklidge, J. J. (2019). Human gut microbiome changes during a 10 week Randomised Control Trial for micronutrient supplementation in children with attention deficit hyperactivity disorder. Scientific Reports, 9(1), 10128. doi:10.1038/s41598-019-46146-3 https://www.nature.com/articles/s41598-019-46146-3
  • Darling, K. A., Eggleston, M. J. F., Retallick-Brown, H., & Rucklidge, J. J. (2019). Mineral-Vitamin Treatment Associated with Remission in Attention-Deficit/Hyperactivity Disorder Symptoms and Related Problems: 1-Year Naturalistic Outcomes of a 10-Week Randomized Placebo-Controlled Trial. Journal of Child and Adolescent Psychopharmacology. doi:10.1089/cap.2019.0036 https://www.ncbi.nlm.nih.gov/pubmed/31343273
  • Johnstone, J. M., Leung, B., Gracious, B., Perez, L., Tost, G., Savoy, A., . . . Arnold, L. E. (2019). Rationale and design of an international randomized placebo-controlled trial of a 36-ingredient micronutrient supplement for children with ADHD and irritable mood: The Micronutrients for ADHD in Youth (MADDY) study. Contemporary clinical trials communications, 16, 100478-100478. doi:10.1016/j.conctc.2019.100478 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6859218/ 
  • Bradley, H. A., Campbell, S. A., Mulder, R. T., Henderson, J. M. T., Dixon, L., Boden, J. M., & Rucklidge, J. J. (2020). Can broad-spectrum multinutrients treat symptoms of antenatal depression and anxiety and improve infant development? Study protocol of a double blind, randomized, controlled trial (the ‘NUTRIMUM’ trial). BMC Pregnancy and Childbirth, 20(1), 488. https://doi.org/10.1186/s12884-020-03143-z  
  • Hughes, S., Rondeau, M., Shannon, S., Sharp, J., Ivins, G., Lee, J., Taylor, I., & Bendixsen, B. (2020). A Holistic Self-learning Approach for Young Adult Depression and Anxiety Compared to Medication-Based Treatment-As-Usual. Community Mental Health Journal. https://doi.org/10.1007/s10597-020-00666-9  
  • Rucklidge, J. J., Afzali, M. U., Kaplan, B. J., Bhattacharya, O., Blampied, F. M., Mulder, R. T., & Blampied, N. M. (2021). Massacre, Earthquake, Flood: Massacre, Earthquake, Flood: Translational science evidence that the use of micronutrients post-disaster reduces the risk of post-traumatic stress in survivors of disasters. International Perspectives in Psychology, 10(1), 39-54. https://doi.org/10.1027/2157-3891/a000003
NOTES on DEN and EMP:  Both are available as powders for mixing into juice, for those who cannot swallow capsules. Also, some people are very sensitive to the smell of dietary supplements. If the smell of the capsules is a problem, try keeping them in the fridge or freezer. Pre-pubertal children may take a lower dose (4 twice a day), although research studies have sometimes gone up to the full adult dose for treating childhood ADHD. As children enter their teenage years, research has shown that the dose may need to be increased to maintain symptom control.Finally, the doses mentioned above are mostly based on research with people who were not taking any psychiatric medications (e.g., antidepressants, anxiolytics, stimulants) because up to this point, most studies have excluded people taking these medications. The large number of pills does not imply that the micronutrient dosing is high. Many commercial products contain a broad spectrum of micronutrients in one or two capsules daily, but the nutrients are present in chemical forms that are poorly absorbed. One way to enhance bioavailability of the minerals is to deliver them in chelated forms (chelation promotes passage from the gut into the blood stream, where the minerals dissociate from the chelates), but the chelated minerals are bulky and cannot be condensed into one or two capsules. Furthermore, some broad-spectrum formulations also provide macro-minerals, such as calcium, magnesium, and phosphorus, which are often under-represented in diets and are required in much larger bulk quantities than micronutrients. Products containing chelated microminerals and bulky macrominerals require more pills each day, are more expensive, but will likely be more effective than regular formulations.

3. Brain Child Spectrum Support/ANRC Essentials 

http://www.brainchildnutritionals.com/spectrum-support-vitamins.html/  or  http://www.autismnrc.org/anrc-essentials  

For: autism

Professor Jim Adams at Arizona State University has conducted a number of studies using nutrients for the treatment of autism, using three products: Spectrum Support II/IIITM, SyndionTM, and ANRC Essentials PlusTM (a revised version of SyndionTM). Spectrum Support comes as a capsule or colloidal suspension–the standard dose is two capsules (or two teaspoons) twice a day. For ANRC Essentials PlusTM, the company provides information on how to gradually increase to the optimal dose based on body weight. The formula comes either as capsules or a powder to mix with your favorite juice (they suggest orange, mango, or cranberry). 

Research 
  • Adams, J. B., & Holloway, C. (2004). Pilot study of a moderate dose multivitamin/mineral supplement for children with autism spectrum disorder. Journal of Alternative and Complementary Medicine, 10(6), 1033-1039. http://online.liebertpub.com/doi/abs/10.1089/acm.2004.10.1033   
  • Adams, J. B., Audhya, T., McDonough-Means, S., Rubin, R. A., Quig, D., Geis, E., Gehn, E., Loresto, M., Mitchell, J., Atwood, S., Barnhouse, S., & Lee, W. (2011). Effect of a vitamin/mineral supplement on children and adults with autism. BMC Pediatrics, 11, 111. https://doi.org/10.1186/1471-2431-11-111  
  • Adams, J. B., Audhya, T., Geis, E., Gehn, E., Fimbres, V., Pollard, E., Mitchell, J., Ingram, J., Hellmers, R., Laake, D., Matthews, J., Li, K., Naviaux, J., Naviaux, R., Adams, R., Coleman, D., & Quig, D. (2018). Comprehensive Nutritional and Dietary Intervention for Autism Spectrum Disorder—A Randomized, Controlled 12-Month Trial. Nutrients, 10(3), 369. http://www.mdpi.com/2072-6643/10/3/369   

4.  Forceval

http://www.forceval.co.uk  

For: aggression in prisoners

Forceval is available in a capsule or in effervescent tablets and is a licensed medicine in the UK. The recommended dose is one capsule daily. The main target for the formula is to combat malnutrition. However, Forceval has been used along with fish oil for omega 3s to successfully reduce aggression in people incarcerated in prisons. There were no adverse reactions. 

Research
  • Gesch CB., Hammond SM, Hampson SE, et al. (2002). The British Journal of Psychiatry, 181(1) 22-28; doi: 10.1192/bjp.181.1.22

5. Bayer’s Berocca

http://www.berocca.com/en/home.php 

For: stress/anxiety

Berocca is the most studied B-complex formula for reduction of stress. It can be taken as a capsule or an effervescent tablet that you add to water. It has been studied primarily in people drawn from the general population. No concerning side effects have been reported. 

Research
  • Carroll, D., Ring, C., Suter, M., & Willemsen, G. (2000). The effects of an oral multivitamin combination with calcium, magnesium, and zinc on psychological well-being in healthy young male volunteers: a double-blind placebo-controlled trial. Psychopharmacology, 150(2), 220-225. https://doi.org/doi:10.1007/s002130000406    
  • Schlebusch, L., Bosch, B. A., Polglase, G., Kleinschmidt, I., Pillay, B. J., & Cassimjee, M. H. (2000). A double-blind, placebo-controlled, double-centre study of the effects of an oral multivitamin-mineral combination on stress. South African Medical Journal, 90(12), 1216-1223. https://www.ncbi.nlm.nih.gov/pubmed/11234653   
  • Kennedy, D. O., Haskell, C. F., Robertson, B., Reay, J., Brewster-Maund, C., Luedemann, J., Maggini, S., Ruf, M., Zangara, A., & Scholey, A. B. (2008). Improved cognitive performance and mental fatigue following a multi-vitamin and mineral supplement with added guarana (Paullinia cupana). Appetite, 50(2-3), 506-513. https://doi.org/10.1016/j.appet.2007.10.007 
  • Kennedy, D., Veasey, R., Watson, A., Dodd, F., Jones, E., Maggini, S., & Haskell, C. (2010). Effects of high-dose B vitamin complex with vitamin C and minerals on subjective mood and performance in healthy males. Psychopharmacology, 211(1), 55-68. https://doi.org/doi:10.1007/s00213-010-1870-3  
  • Rucklidge, J. J., Andridge, R., Gorman, B., Blampied, N., Gordon, H., & Boggis, A. (2012). Shaken but unstirred? Effects of micronutrients on stress and trauma after an earthquake: RCT evidence comparing formulas and doses. Human Psychopharmacology, 27(5), 440-454. https://doi.org/10.1002/hup.2246 
  • Scholey, A., Bauer, I., Neale, C., Savage, K., Camfield, D., White, D., Maggini, S., Pipingas, A., Stough, C., & Hughes, M. (2013). Acute effects of different multivitamin mineral preparations with and without Guarana on mood, cognitive performance and functional brain activation. Nutrients, 5(9), 3589-3604. https://doi.org/10.3390/nu5093589  
  • White, D., Cox, K., Peters, R., Pipingas, A., & Scholey, A. (2015). Effects of Four-Week Supplementation with a Multi-Vitamin/Mineral Preparation on Mood and Blood Biomarkers in Young Adults: A Randomised, Double-Blind, Placebo-Controlled Trial. Nutrients, 7(11), 5451. http://www.mdpi.com/2072-6643/7/11/5451   

6. Swisse Ultivite

http://www.swisse.com/au/vitamins-and-supplements/mens-health/73/swisse-mens-ultivite-f1  

For: stress

Swisse UltiviteTM is available in both a women and men’s version and is taken as one capsule daily with a meal. Several studies support its use for reduction of stress in otherwise healthy people. No side effects were reported. 

Research
  • Harris, E., Kirk, J., Rowsell, R., Vitetta, L., Sali, A., Scholey, A., & Pipingas, A. (2011). The effect of multivitamin supplementation on mood and stress in healthy older men. Human Psychopharmacology, 26(8), 560-567. https://doi.org/10.1002/hup.1245   
  • Harris, E., Macpherson, H., Vitetta, L., Kirk, J., Sali, A., & Pipingas, A. (2012). Effects of a multivitamin, mineral and herbal supplement on cognition and blood biomarkers in older men: A randomised, placebo‐controlled trial. Human Psychopharmacology: Clinical and Experimental, 27(4), 370-377. https://doi.org/10.1002/hup.2236  
  • Sarris J, Cox, KH M, Camfield DA, et al. (2012). Participant experiences from chronic administration of a multivitamin versus placebo on subjective health and wellbeing: A double-blind qualitative analysis of a randomized controlled trial. Nutrition Journal, 11, 110. http://doi.org/10.1186/1475-2891-11-110
  • Pipingas, A., Camfield, D. A., Stough, C., Cox, K. H., Fogg, E., Tiplady, B., Sarris, J., White, D. J., Sali, A., Wetherell, M. A., & Scholey, A. B. (2013). The effects of multivitamin supplementation on mood and general well-being in healthy young adults. A laboratory and at-home mobile phone assessment. Appetite, 69, 123-136. https://doi.org/10.1016/j.appet.2013.05.016
  • Camfield, D. A., Wetherell, M. A., Scholey, A. B., Cox, K. H., Fogg, E., White, D. J., Sarris, J., Kras, M., Stough, C., Sali, A., & Pipingas, A. (2013). The effects of multivitamin supplementation on diurnal cortisol secretion and perceived stress. Nutrients, 5(11), 4429-4450. https://doi.org/10.3390/nu5114429  
  • Macpherson, H., Rowsell, R., Cox, K. H., Scholey, A., & Pipingas, A. (2015). Acute mood but not cognitive improvements following administration of a single multivitamin and mineral supplement in healthy women aged 50 and above: a randomised controlled trial. Age (Dordr), 37(3), 9782. https://doi.org/10.1007/s11357-015-9782-0  

7. Blackmores Executive B

http://www.blackmores.com.au/products/executive-b-stress-formula 

For: stress

Blackmores is taken as one capsule twice a day with meals. One study showed improved work-related stress. It is also available as an immediate-release and sustained-release capsule. No side effects have been reported. 

Research
  • Stough, C., Scholey, A., Lloyd, J., Spong, J., Myers, S., & Downey, L. A. (2011). The effect of 90 day administration of a high dose vitamin B-complex on work stress. Human Psychopharmacology: Clinical and Experimental, 26(7), 470-476. https://doi.org/10.1002/hup.1229  

8. Enlyte

https://www.enlyterx.com/

For: depression

There has been one study using Enlyte to treat people with a variant of the MTHFR gene who also had major depression. The treatment consists of one capsule taken on an empty stomach. It is available by prescription and may be covered by insurance in the US. No reported side effects.

Research
  • Mech A, Farah A. Correlation of clinical response with homocysteine reduction during therapy with reduced B vitamins in patients with MDD who are positive for MTHFR C677T or A1298C polymorphism: a randomized, double-blind, placebo-controlled study. Journal of Clinical Psychiatry. 2016 May;77(5):668-71. doi:10.4088/JCP.15m10166. 

9. Optivite

www.optimox.com 

For: premenstrual symptoms

Optivite was first studied in the 1980s and as far as I am aware, there have been no new studies for the last two decades. The product is still available for purchase. The studies suggested between six and twelve capsules a day. The bottle recommends two-to-six tablets daily with meals. The main concern raised about taking a dose above ten capsules is that it delivers vitamin B6 in a range that can produce some neurological side effects, including tingling of limbs. Fortunately, the side effect is reversible once you stop taking the pills. 

Research
  • Chakmakjian, Z. H., Higgins, C. E., & Abraham, G. E. (1985). The effect of a nutritional supplement, Optivite for women, on premenstrual tension syndromes. II. Effect on symptomatology, using a double blind cross-over design. The Journal of Applied Nutrition, 37(1), 12-17. 
  • London, R. S., Bradley, L., & Chiamori, N. Y. (1991). Effect of a nutritional supplement on premenstrual symptomatology in women with premenstrual syndrome: a double-blind longitudinal study. Journal of the American College of Nutrition, 10(5), 494-499. doi:10.1080/07315724.1991.10718176 

Other publications:  reviews and letters to editors  

  • 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. 
  • Gardner, A., Kaplan, B. J., Rucklidge, J. J., Jonsson, B. H., & Humble, M. B. (2010). The potential of nutritional therapy. Science (letter), 327, 268.
  • Kaplan, B. J., Nikkel, G., Nikkel, B., & Rucklidge, J. J. (2013). Keeping Academic Psychiatry Relevant. British Journal of Psychiatry (letter). http://bjp.rcpsych.org/content/201/6/421/reply#bjprcpsych_el_53864 
  • Rucklidge, J. J., & Kaplan, B. J. (2013). Broad-spectrum micronutrient formulas for the treatment psychiatric symptoms: A systematic review. Expert Review of Neurotherapeutics, 13(1), 49-73.
  • Rucklidge, J. J., Johnstone, J., & Kaplan, B. J. (2013). Single bullet madness – why do we continue to perpetuate this fallacy? (letter). British Journal of Psychiatry, 203, 154-155. http://bjp.rcpsych.org/content/202/6/398/reply#bjprcpsych_el_54588
  • Popper, C. W. (2014). Single-Micronutrient and Broad-Spectrum Micronutrient Approaches for Treating Mood Disorders in Youth and Adults. Child and Adolescent Psychiatric Clinics of North America, 23(3), 591-672. doi:10.1016/j.chc.2014.04.001  
  • Rucklidge, J. J., Harris, A., & Shaw, I. (2014). Are the amounts of vitamins in commercially available dietary supplement formulations relevant for the management of psychiatric disorders in children? New Zealand Journal of Medicine, 127, 73-85. https://www.nzma.org.nz/journal/read-the-journal/all-issues/2010-2019/2014/vol-126-no-1392/article-rucklidge 
  • Rucklidge, J. J., & Mulder, R. T. (2015). Could nutrition help behaviours associated with personality disorders? A narrative review. Personality and Mental Health. http://onlinelibrary.wiley.com/doi/10.1002/pmh.1325/epdf 
  • Kaplan, B. J., Rucklidge, J. J., Romijn, A., & McLeod, K. (2015). The Emerging Field of Nutritional Mental Health: Inflammation, the Microbiome, Oxidative Stress, and Mitochondrial Function. Clinical Psychological Science, 3(6), 964-980. https://doi.org/10.1177/2167702614555413  
  • Sarris, J., Logan, A. C., Amminger, G. P., Balanzá-Martínez, V., Freeman, M. P., Hibbeln, J., Matsuoka, Y., Mischoulon, D., Mizoue, T., Nanri, A., Nishi, D., Ramsey, D. Rucklidge, J. J., Sanchez-Villegas, A., Scholey, A., Su, K. P., & Jacka, F. N. (2015). Nutritional Medicine as Mainstream in Psychiatry: A Consensus Position Statement from The International Society for Nutritional Psychiatry Research (ISNPR). Lancet Psychiatry, 2, 271-274. http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(14)00051-0/abstract 
  • Rucklidge, J.J., Kaplan, B. J., & Mulder, R. (2015). What if nutrients could treat mental illness? (Debate). Australia and New Zealand Journal of Psychiatry, 49(5), 407-408. http://anp.sagepub.com/content/49/5/407.full.pdf+html 
  • Sarris. J., Logan, A. C., Akbaraly, T. N., Amminger, G. P., Balanzá-Martínez, V., Freeman, M. P., Hibbeln, J., Matsuoka, Y., Mischoulon, D., Mizoue, T., Nanri, A., Nishi, D., Parletta, N., Ramsey, D., Rucklidge, J. J., Sanchez-Villegas, A., Scholey, A., Su, C., Jacka, F. N. (2015). The International Society for Nutritional Psychiatry Research (ISNPR) Consensus Position Statement: Nutritional Medicine in Modern Psychiatry (letter to editor). World Psychiatry, 14(3), 370-371. http://onlinelibrary.wiley.com/doi/10.1002/wps.20223/abstract  
  • Stevens, A., Rucklidge, J. J., & Kennedy, M. A. (2017). Epigenetics, nutrition and mental health. Is there a relationship? Nutritional Neuroscience, 21, 602-613. https://doi.org/10.1080/1028415X.2017.1331524 
  • Popper, C., Kaplan, B. J., & Rucklidge, J. J. (2017). Single and Broad-Spectrum Micronutrient Treatment in Psychiatric Practice. In Complementary and Integrative Treatments in Psychiatric Practice.  Edited by Patricia L. Gerbarg, M.D., Philip R. Muskin, M.D., Richard P. Brown, M.D. American Psychiatric Press, Washington, D.C (pp 75-101).
  • Rucklidge, J. J., Taylor, M. R., & Johnstone, J. (2018). Does diet and nutrition affect ADHD? Facts and clinical considerations for psychiatrists. Psychiatric Times, 35 (9). http://www.psychiatrictimes.com/special-reports/do-diet-and-nutrition-affect-adhd-facts-and-clinical-considerations 
  • Taylor, M.R., Chuang, C., Carrasco, K.D., Rucklidge, J. J. (2018). Dietary and Micronutrient Treatments for Children with Neurodevelopment Disorders. Current Developmental Disorders Reports, 5, 243-252. https://link.springer.com/article/10.1007/s40474-018-0150-5?wt_mc=Internal.Event.1.SEM.ArticleAuthorOnlineFirst&utm_source=ArticleAuthorOnlineFirst&utm_medium=email&utm_content=AA_en_06082018&ArticleAuthorOnlineFirst_20180916
  • Blampied, M., Bell, C., Gilbert, C., & Rucklidge, J. J. (2020). Broad spectrum micronutrient formulas for the treatment of symptoms of depression, stress and/or anxiety: a systematic review. Expert Review of Neurotherapeutics, 20 (4), 351–371. https://www.tandfonline.com/doi/full/10.1080/14737175.2020.1740595 
  • Johnstone, J., Hughes, A., Goldenberg, J. Z., Romijn, A. R., & Rucklidge, J. J. (2020). Multinutrients for the Treatment of Psychiatric Symptoms in Clinical Samples: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients, 12(11). https://doi.org/10.3390/nu12113394  
  • Rucklidge, J. J., Johnstone, J. J., & Kaplan, B. J. (2021). Nutrition is an essential foundation for optimizing mental health. Evidence Based Practice in Child and Adolescent Mental Health, 6(1), 131-154. http://dx.doi.org/10.1080/23794925.2021.1875342

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Add a Supplement When You are Stressed?

write about supplements

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So after every hurricane, or after every forest fire or earthquake, such as you have had, Julia, governments should be urging people not to resort to so-called comfort food, okay? And I know the people who are very upset, do not crave broccoli. But they really need to feed their brains and their bodies in moments of crisis, and our government should be giving that message. That is an extremely important global mental health issue.

1. EMPower™, EMPowerplus™, and EMPowerplus Advanced™ (EMP)

www.truehope.com

For: ADHD, mood dysregulation, PMS, symptoms associated with trauma, aggression, depression, stress, anxiety.

For those taking the current EMP formulation for improving mental health symptoms, the dose stipulated on the bottle is two capsules twice a day (the dose recommended for general health). However, the dose more typically used in current research is at least four capsules twice a day. For those using these products for assisting with managing stress, our research after the earthquakes and floods showed that a therapeutic dose may be lower, such as four a day.

Research
  • Rucklidge, J. J., & Blampied, N. M. (2011). Post earthquake functioning in adults with Attention-Deficit/Hyperactivity Disorder: Positive effects of micronutrients on resilience. New Zealand Journal of Psychology, 40(4), 51-57.
  • Rucklidge, J. J., Johnstone, J., Harrison, R., & Boggis, A. (2011). Micronutrients reduce stress and anxiety following a 7.1 earthquake in adults with Attention-Deficit/Hyperactivity Disorder. Psychiatry Research, 189, 281-287. doi:10.1016/j.psychres.2011.06.016   
  • Simpson, J. S. A., Crawford, S. G., Goldstein, E. T., Field, C., Burgess, E., & Kaplan, B. J. (2011). Systematic review of safety and tolerability of a complex micronutrient formula used in mental health. BMC Psychiatry, 11(62). http://www.biomedcentral.com/1471-244X/11/62 
  • Rucklidge, J. J., Andridge, R., Gorman, B., Blampied, N., Gordon, H. & Boggis, A. (2012). Shaken but unstirred? Effects of micronutrients on stress and trauma after an earthquake: RCT evidence comparing formulas and doses. Human Psychopharmacology: Clinical and Experimental, 27(5), 440-454. https://www.ncbi.nlm.nih.gov/pubmed/22782571  

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Research on Treating Mental Illness And ADHD with Nutrients

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And I counted the number of studies conducted all over the world; places like New Zealand, Australia,the UK, Canada and the US, on the broad spectrum micronutrient idea, and there are now over 50 RCTs,with 80 percent of those showing benefit of the micronutrients over placebo.For a psychiatric treatment, that’s a remarkable outcome. And it proves that the nutrientsare changing many people’s lives. Finally, a systematic review and meta-analysis can be doneacross several studies, in order to estimate how powerful the treatment is likely to be.A meta-analysis, in combining many studies, allows the much larger sample sizeto provide a better estimate of the overall effect. A recently-published meta-analysisthat I co-authored, confirms the consistent benefit of broad-spectrum micronutrientsfor improving overall functioning and reducing symptom impairment in individuals with ADHD.

Source

A meta-analysis, in combining many studies, allows the much larger sample sizeto provide a better estimate of the overall effect. A recently-published meta-analysisthat I co-authored, confirms the consistent benefit of broad-spectrum micronutrientsfor improving overall functioning and reducing symptom impairment in individuals with ADHD.So, in summary you can see the progression of science and the build-up of evidence acrossdifferent study designs. And collectively, this progression establishes the biological rationale,the strength of the association and clinical significance, the consistency of evidence acrosssites and different studies, the temporal sequence, that is that a must proceed b, and thevariety ofexperimental evidence.

There’s been a wealth of global research looking at the effectsof broad spectrum micronutrients on ADHD. All the experimental designs show substantial reductionin ADHD symptoms and other related behaviours, based on group data. This figure illustrates an exampleof an A, B, A, B design where the individual received the multi-nutrients for 8 weeks,stopped for eight weeks, went back on for eight weeks and then stopped completely. The red barsrepresent him off the micronutrients, and the green bars on the nutrients. And you canobserve the remarkable reversal of his symptoms, as well as on off control of them. And just note,the drop from a t-score of 80 to 40 is a change of four standard deviations in his ADHD symptoms.

ADHD symptoms were still variable in the first eight weeks,but for those who stayed on the nutrients for a year, over 70 percent were in remission, versusonly 40 percent who switched to medications, and 20 percent who were not on any intervention. Andremission means that the person no longer had the symptoms that would lead to a diagnosis of ADHD.So while the treatment takes a while to consistently reduce ADHD symptoms, after a yearthe benefit is considerable.

Source

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Demineralization of Soils

write about a food supply topics

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Do you want to learn more about how increased levels of carbon dioxide in the atmosphere is reducing the amount of nutrients in plants? This article discusses how future projections of carbon levels may particularly impact levels of iron, zinc and protein in our diet. Countries that are most at risk are also discussed.


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Can mineral-vitamin treatment change the microbiome? Yes it can! – The UC Science Blog

write about supplements

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Professor Julia Rucklidge explores the potential of manipulating the microbiome to drive good mental health.

Source: Can mineral-vitamin treatment change the microbiome? Yes it can! – The UC Science Blog

Gut Gardening to improve mental health

Long-term benefit of Microbiota Transfer Therapy on autism symptoms and gut microbiota“. 


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Feeding mitochondria: Potential role of nutritional components to improve critical illness convalescence

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Persistent physical impairment is frequently encountered after critical illness. Recent data point towards mitochondrial dysfunction as an important d…

Source: Feeding mitochondria: Potential role of nutritional components to improve critical illness convalescence


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Keys Experiment Revisited

write about nutrition for the brain

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https://www.madinamerica.com/2013/05/starvation-what-does-it-do-to-the-brain/?fbclid=IwAR3kmR1VlvLKfh0M84Pud12dM8sglOaG3EYDBwU0Ezn7Ykjw5ixh85NruS4


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How Dietitians Can Help In Kidney Disease-Looking at the Research

write about kidney disease and bone health

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Review this Study and Write an article that shows our value!

Dietary Interventions with Dietitians for Adults with Kidney Disease


Your writing adds immense value to The NutriScape Project’s educational mission and places our writers as experts in the field. It can deliver you attention from your perfect clients so that they can connect—that’s what it’s all about. But first, let’s make sure this article is going to get the attention it deserves.

When Google Likes Your Article, Clients Find You

We want to make it easy to write great articles that get awesome levels of traffic.  That requires SEO.  SEO is the art and science of getting found on Google. It is a highly technical topic that most dietitians prefer not to tackle. And SEO is best done before any writing even takes place. 

Our specialist dietitian has already done much of the SEO work for you–researching and testing out the best keywords and heading structure to include to make your article show up in internet searches.

Keywords:

Coming up with the best keywords is tricky. Many of the keywords we would normally think of having either too much competition or too little search traffic. You will want to use the keyword/keyphrase in the first paragraph of your article and several more times.

According to our research, these are the best keyword(s) or keyphrase(s) to include in your article:

  • importance of a ietitian for nutritional management of a renal patient
  • interventions of a dietitian for renal patients
  • dietitian’s role in renal patients

Suggested Headings

Readers love easy reading! Google looks for readability and scanability, so headings are important. Headings make your article easy to scan and can also break up long blocks of text that tend to overwhelm your readers.

During the keyword research process, these heading ideas came up in the top-rated articles and searches. If these headings fit the topic you are writing about and the article you want to write, they would probably help the article rank well in Google searches. They are only suggestions, so if they don’t fit what you are writing, you will want to create something better. Here are the headings our SEO dietitian suggested for this article:

  • Chronic Kidney Disease & Nutrition for Dietetic Educators
  • Dietitians at the Dialysis Center
  • How an RDN Can Help with Kidney Disease
  • What do renal dietitians do?

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Diet Explainer Articles Needed

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The main NutriScape.NET site will have a category for discussing the pros and cons of each of these diets.  Yes, we preach against “diets” the verb, but we need to offer a non-judgemental look at each “diet” [noun] strategy and help readers understand the basics.

People need support for implementation, so each article might look for ways incorporate the value of working with a dietitian where appropriate.  As always, you can link to your own website.  The sidebar on the published article will link to NutriScape’s Telenutrition site to get services.

Vegetarian Diet
Pescetarian Diet
DASH Diet
Mediterranian Diet
Vegan Diet
Lacto-Ovo Vegetarian Diet
Flexitarian Diet
Meatless Mondays
Ketogenic Diet
Atkins Diet
Pritikin Diet, Ornish Diet
ADHD diet
Autism Diet
Low-Fat Diet
Anti-Inflammatory Diet
Gluten Free Diet
Wheat Free Diet
Dairy Free Diet
Soy Free Diet
Wheat Free Diet
PCOS Diet
Insulin Resistence Diet
Glycemic Index Diet
Pre-Conception Diet
Thyroid Diet
MIND
Weight Watchers Diet
GAPS Diet (Gut and Psychology)
Whole 30 Diet
AIP Diet (Autoimmune Paleo)
Raw Food Diet
Paleo Diet
5:2 Fast Diet
Acid-Alkaline Diet
Optavia/Medifast, HMR Diet
Slimfast Diet
Macrobiotic Diet
South Beach Diet
Zone Diet
Engine 2 Diet
Nutritarian Diet
Fertility Diet
Jenny Craig, NutriSystem Diet,
Noom Diet
Nordic Diet
Mayo Clinic Diet
TLC (Therapeutic Lifestyle Changes) Diet
Volumetrics Diet

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What Does the Research Say About Caffeine and Migraine


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Caffeine is sometimes a helpful treatment for migraine, but is more often a risk factor. Learn the connection between the two and how it affects you.

Source: Caffeine and Migraine | American Migraine Foundation

Need a Consumer Article

Need an Article for RD/RDNs


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Allergen advisory statements for wheat do NOT appear to be useful predictors of the potential for quantifiable gluten in database reviews

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For Immediate Release April 4, 2018 Allergen advisory statements for wheat do NOT appear to be useful predictors of the potential for quantifiable gluten in database reviews 1,2 A pdf of this relea…

Source: Allergen advisory statements for wheat do NOT appear to be useful predictors of the potential for quantifiable gluten in database reviews


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Study: Connection between “disadvantaged” neighborhoods, obesity

Peer Review

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A new study suggests that children growing up in “disadvantaged” neighborhoods are nearly one-third more likely to face obesity as adults.

Article from: NCPR.com, Study: Connection between “disadvantaged” neighborhoods, obesity


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A systematic review and meta-analysis of randomized controlled trials: Effect of psyllium (Plantago ovata) fiber

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Effect of psyllium (Plantago ovata) fiber on LDL cholesterol and alternative lipid targets, non-HDL cholesterol and apolipoprotein B: a systematic review and meta-analysis of randomized controlled trials.
The aims of this study were to update evidence on the effect of psyllium on LDL cholesterol and to provide an assessment of its impact on alternate markers: non-HDL cholesterol and apolipoprotein B (apoB).”

Original Article



A pilot feasibility study exploring the effects of a moderate time-restricted feeding intervention on energy intake, adiposity and metabolic physiology in free-living human subjects

write about a study

Source: A pilot feasibility study exploring the effects of a moderate time-restricted feeding intervention on energy intake, adiposity and metabolic physiology in free-living human subjects | Journal of Nutritional Science | Cambridge Core


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A Review of HAES: What Does the Research Say

Abstract
Current guidelines recommend that “overweight” and “obese” individuals lose weight through engaging in lifestyle
modification involving diet, exercise and other behavior change. This approach reliably induces short term weight
loss, but the majority of individuals are unable to maintain weight loss over the long term and do not achieve the
putative benefits of improved morbidity and mortality. Concern has arisen that this weight focus is not only
ineffective at producing thinner, healthier bodies, but may also have unintended consequences, contributing to
food and body preoccupation, repeated cycles of weight loss and regain, distraction from other personal health
goals and wider health determinants, reduced self-esteem, eating disorders, other health decrement, and weight
stigmatization and discrimination. This concern has drawn increased attention to the ethical implications of
recommending treatment that may be ineffective or damaging. A growing trans-disciplinary movement called
Health at Every Size (HAES) challenges the value of promoting weight loss and dieting behavior and argues for a
shift in focus to weight-neutral outcomes. Randomized controlled clinical trials indicate that a HAES approach is
associated with statistically and clinically relevant improvements in physiological measures (e.g., blood pressure,
blood lipids), health behaviors (e.g., eating and activity habits, dietary quality), and psychosocial outcomes (such as
self-esteem and body image), and that HAES achieves these health outcomes more successfully than weight loss
treatment and without the contraindications associated with a weight focus. This paper evaluates the evidence
and rationale that justifies shifting the health care paradigm from a conventional weight focus to HAES.

Link to the Article: Weight Science: Evaluating the Evidence for a Paradigm Shift



Age-Related Eye Disease Study 2 (AREDS2)

A scene as it might be viewed by a person with AMD. View more AMD Photos and Images

Source: Age-Related Eye Disease Study 2 (AREDS2)

NIH study provides clarity on supplements for protection against blinding eye disease
05/05/13
Normal vision
Normal vision

Adding omega-3 fatty acids did not improve a combination of nutritional supplements commonly recommended for treating age-related macular degeneration (AMD), a major cause of vision loss among older Americans, according to a study from the National Institutes of Health (NIH). The plant-derived antioxidants lutein and zeaxanthin also had no overall effect on AMD when added to the combination; however, they were safer than the related antioxidant beta-carotene, according to the study published online today in the Journal of the American Medical Association.

“Millions of older Americans take nutritional supplements to protect their sight without clear guidance regarding benefit and risk,” said NEI director Paul A. Sieving, M.D., Ph.D. “This study clarifies the role of supplements in helping prevent advanced AMD, an incurable, common, and devastating disease that robs older people of their sight and independence.”

The Age-Related Eye Disease Study (AREDS), which was led by NIH’s National Eye Institute and concluded in 2001, established that daily high doses of vitamins C and E, beta-carotene, and the minerals zinc and copper—called the AREDS formulation—can help slow the progression to advanced AMD. The American Academy of Ophthalmology now recommends use of the AREDS formulation to reduce the risk of advanced AMD. However, beta-carotene use has been linked to a heightened risk of lung cancer in smokers. And there have been concerns that the high zinc dose in AREDS could cause minor side effects, such as stomach upset, in some people.

In 2006 the NEI launched AREDS2, a five-year study designed to test whether the original AREDS formulation could be improved by adding omega-3 fatty acids; adding lutein and zeaxanthin; removing beta-carotene; or reducing zinc. The study also examined how different combinations of the supplements performed. Omega-3 fatty acids are produced by plants, including algae, and are present in oily fish such as salmon. Lutein and zeaxanthin are carotenoids, a class of plant-derived vitamins that includes beta-carotene; both are present in leafy green vegetables and, when consumed, they accumulate in the retina. Prior studies had suggested that diets high in lutein, zeaxanthin, and omega-3 fatty acids protect vision. Before the AREDS2 study finished, manufacturers began marketing supplements based on the study design.

In AREDS2, participants took one of four AREDS formulations daily for five years. The original AREDS included 500 milligrams vitamin C, 400 international units of vitamin E, 15 milligrams beta-carotene, 80 milligrams zinc, and two milligrams copper. Other groups took AREDS with no beta-carotene, AREDS with low zinc (25 milligrams), or AREDS with no beta-carotene and low zinc. Participants in each AREDS group also took one of four additional supplements or combinations: these included lutein/zeaxanthin (10 milligrams/2 milligrams), omega-3 fatty acids (1,000 milligrams), lutein/zeaxanthin and omega-3 fatty acids, or placebo. Progression to advanced AMD was established by examination of retina photographs or treatment for advanced AMD.

AMD breaks down cells in the layer of tissue called the retina in the back of the eye that provide sharp central vision, which is necessary for tasks such as reading, driving, and recognizing faces. Advanced AMD can lead to significant vision loss and, in the United States, is the leading cause of blindness. About 2 million Americans have advanced AMD; another 8 million are at risk.

In the first AREDS trial, participants with AMD who took the AREDS formulation were 25 percent less likely to progress to advanced AMD over the five-year study period, compared with participants who took a placebo. In AREDS2, there was no overall additional benefit from adding omega-3 fatty acids or a 5-to-1 mixture of lutein and zeaxanthin to the formulation. However, the investigators did find some benefits when they analyzed two subgroups of participants: those not given beta-carotene, and those who had very little lutein and zeaxanthin in their diets.

“When we looked at just those participants in the study who took an AREDS formulation with lutein and zeaxanthin but no beta-carotene, their risk of developing advanced AMD over the five years of the study was reduced by about 18 percent, compared with participants who took an AREDS formulation with beta-carotene but no lutein or zeaxanthin,” said Emily Chew, M.D., deputy director of the NEI Division of Epidemiology and Clinical Applications and the NEI deputy clinical director. “Further analysis showed that participants with low dietary intake of lutein and zeaxanthin at the start of the study, but who took an AREDS formulation with lutein and zeaxanthin during the study, were about 25 percent less likely to develop advanced AMD compared with participants with similar dietary intake who did not take lutein and zeaxanthin.”

Because carotenoids can compete with each other for absorption in the body, beta-carotene may have masked the effect of the lutein and zeaxanthin in the overall analysis, Chew said. Indeed, participants who took all three nutrients had lower levels of lutein and zeaxanthin in their blood compared to participants who took lutein and zeaxanthin without beta-carotene.

Removing beta-carotene from the AREDS formulation did not curb the formulation’s protective effect against developing advanced AMD, an important finding because several studies have linked taking high doses of beta-carotene with a higher risk of lung cancer in smokers. Although smokers were not given a formulation with beta-carotene in AREDS2, the study showed an association between beta-carotene and risk of lung cancer among former smokers. About half of AREDS2 participants were former smokers. “Removing beta-carotene simplifies things,” said Wai T. Wong, M.D., Ph.D., chief of the NEI Neuron-Glia Interactions in Retinal Disease Unit and a co-author of the report. “We have identified a formulation that should be good for everyone regardless of smoking status,” he said. Adding omega-3 fatty acids or lowering zinc to the AREDS formulation also had no effect on AMD progression.

More than 4,000 people, ages 50 to 85 years, who were at risk for advanced AMD participated in AREDS2 at 82 clinical sites across the country. Eye care professionals assess risk of developing advanced AMD in part by looking for yellow deposits called drusen in the retina. The appearance of small drusen is a normal part of aging, but the presence of larger drusen indicates AMD and a risk of associated vision loss. Over time, the retina begins to break down in areas where large drusen are present during a process called geographic atrophy. AMD can also spur the growth of new blood vessels beneath the retina, which can leak blood and fluid, resulting in sudden vision loss. These two forms of AMD are often referred to as dry AMD and wet AMD respectively.

In a separate study, published online today in JAMA Ophthalmology, the AREDS2 Research Group evaluated the effect of the various AREDS formulas on cataract, a common condition caused by clouding of the eye’s lens. Globally, cataract is the most common cause of blindness and is a major health problem in areas where cataract surgery is unavailable or unaffordable. About 24.4 million Americans are directly affected by cataract.

As reported in 2001, the original AREDS formulation does not protect against cataract. In AREDS2, none of the modified formulations helped reduce the risk of progression to cataract surgery, although a subgroup of participants with low dietary lutein and zeaxanthin gained some protection. “While a healthy diet promotes good eye health and general well-being, based on overall AREDS2 data, regular high doses of antioxidant supplements do not prevent cataract,” Chew said.

Many factors contribute to the development of AMD and cataract, including genetics, diet, and smoking. Scientists are unsure how supplements in the AREDS formulation exert their protective effects. However, an April 2013 report in the journal Ophthalmology by the AREDS Research Group shows the beneficial effects of taking the AREDS vitamins are long-lasting. The report describes a follow-up study of AREDS participants. Those who took the AREDS formulation during the initial five-year trial were 25 to 30 percent less likely to develop advanced AMD—mostly due to a reduction in the number of neovascular, or wet, AMD cases—over the next five years, compared with participants who took placebo during AREDS. Seventy percent of all participants were taking the original AREDS formula by the end of the follow-up period.

“Long-term use of AREDS supplements appears safe and protective against advanced AMD,” said Chew. “While zinc is an important component of the AREDS formulation, based on evidence from AREDS2 it is unclear how much zinc is necessary. Omega-3 fatty acids and beta-carotene clearly do not reduce the risk of progression to advanced AMD; however, adding lutein and zeaxanthin in place of beta-carotene may further improve the formulation.”

The AREDS2 study results provide physicians and patients with new information about preventing vision loss from AMD. People over 60 years old should get a dilated eye exam at least once a year and should discuss with their eye care professional whether taking AREDS supplements is appropriate.

For more information about AREDS2, visit www.nei.nih.gov/areds2.

The research described in this news release was supported by the NEI Intramural Research Program and contracts N01-EY-5-0007, N01-EY-0-2127, HHS-N-260-2005-00007-C. Additional research funds were provided by the National Institute of Neurological Disorders and Stroke; the National Institute on Aging; the National Heart, Lung, and Blood Institute; the National Center for Complementary and Alternative Medicine; and the NIH Office of Dietary Supplements.

The AREDS follow-up is registered in www.ClinicalTrials.gov (link is external) as NCT00594672. AREDS2 is registered as NCT00345176.

References:
AREDS2 Research Group. “Lutein/Zeaxanthin and Omega-3 Fatty Acids for Age-Related Macular Degeneration. The Age-Related Eye Disease Study 2 (AREDS2) Controlled Randomized Clinical Trial.” JAMA, published online May 5, 2013.
AREDS2 Research Group. “Lutein/Zeaxanthin for the Treatment of Age-Related Cataract.” JAMA Ophthalmology, published online May 5, 2013.
Chew et al. “Long-Term Effects of Vitamins C, E, Beta-Carotene and Zinc on Age-Related Macular Degeneration.” Ophthalmology, published online April 11, 2013.

Contact:
National Eye Institute
(301) 496-5248
neinews@nei.nih.gov

Source Article from NIH




Is Dieting Passe? Study Finds Fewer Overweight People Try To Lose Weight

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Source: Is Dieting Passe? Study Finds Fewer Overweight People Try To Lose Weight


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Effect of green tea on plasma leptin and ghrelin levels: A systematic review and meta-analysis of randomized controlled clinical trials – Nutrition

The purpose of this study was to conduct a meta-analysis of randomized controlledtrials (RCTs) to assess the effect of green tea on serum leptin and ghrelin concentrations.

Source: Effect of green tea on plasma leptin and ghrelin levels: A systematic review and meta-analysis of randomized controlled clinical trials – Nutrition