Thursday, 13 February 2014

Vitamin-mineral mix for ADHD?

The BBC quite recently ran with the headline: "Vitamins ‘effective in treating ADHD symptoms’" discussing an interesting paper by Julia Rucklidge and colleagues* reporting results from a controlled trial of a vitamin-mineral mix on 80 adults diagnosed with Attention-Deficit Hyperactivity Disorder (ADHD). The trial entry can be seen here and NHS Choices have also given the trial the research once-over.
Food n' medicine? @ Wikipedia 

The paper, by someone who is not an unfamiliar name to this blog based on some previous work looking at micronutrients for stress after earthquake (see here and see here), utilised the gold-standard of experimental design (double-blind randomised placebo-controlled trial). The authorship team looked at an all-in-one supplement containing things like "vitamin D, vitamin B12, folate, magnesium, ferritin, iron, calcium, zinc and copper" and compared use of it for 8 weeks against a placebo or dummy pill (see here). Their results, based on a protocol of intention-to-treat, "showed significant between-group differences favouring active treatment on self- and observer- but not clinician-ADHD rating scales". The authors conclude that their study "provides preliminary evidence of efficacy for micronutrients in the treatment of ADHD symptoms in adults, with a reassuring safety profile". I think we might have already seen a taster of these results in a publication** from late last year (2013) too.

Given my interest in Prof. Rucklidge's previous research and the potential effectiveness and ease of use of a simple vitamin-mineral supplement on anxiety and stress after a major natural disaster such as an earthquake, I was always going to be drawn to this paper. Indeed, with the current weather that we are enduring here in Blighty, I dare say that there may be some further applications from the previous Rucklidge results. That also similar findings, based on an equally rigorous methodological design, have been reported in cases of autism (see here) and the growing realisation of an overlap between autism and ADHD (see here) just adds to the interest. Dare I even mention the suggested link of food and nutrition between the two conditions too (see here)?

That's not to say that there isn't more to do in this area, particularly in light of the important issue of scientific replication. As Prof. Rucklidge talked about in another review paper*** preliminary support is all well and good****, but further well-controlled investigations are still required.  There is also the question of 'why'... why did supplementation with vitamins and minerals seem to 'work' on the presentation of ADHD? I can't offer a definitive answer on this, but as per some of the additional commentary on the BBC website about this work, the suggestion "that vitamins and minerals improved brain metabolism" is a front-runner explanation. Indeed, based on the study talking about treatment response** one finds a few potential starting points based on statements like: "higher baseline ferritin and lower baseline copper and vitamin D levels were associated with a better response to treatment for some but not all outcomes". Regular readers might already know about my interest in all things vitamin D, but one does wonder whether correcting this deficiency might have some interesting physiological effects not just directly related to the brain (see here) indeed harking back to that solar intensity - ADHD link posited not so long ago (see here). Indeed, other research has also turned up vitamin D deficiency as potentially being more frequent in [pediatric] ADHD***** too. I might add that I'm under no delusion that any effect is probably going to be synergistic across the various micronutrients and a lot more complicated that just a single effect on one physiological process.

Still the Rucklidge results offer some really interesting insights into both ADHD, or at least some types of ADHD (the ADHDs!) and how one might go about potentially improving quality of life for those diagnosed with the condition. That cases of adult ADHD seem to be increasing****** and as the authors noted about the issue of comorbidity - "[for] those with moderate/severe depression at baseline, there was a greater change in mood favouring active treatment over placebo" - one wonders whether a cheap and cost-effective nutritional supplement may indeed have an important role to play for at least some diagnosed with ADHD, bearing in mind my blogging caveat: no medical or clinical advice given or intended. Oh and such results might indeed be timely if the recent Nature news piece on the over-selling of medication strategies for ADHD is to be believed.

And to finish, treat your vitamin supplements as pharmaceutics...

Now something short and loud for your listening pleasure (and for all you lovers, er, rock lovers, out there).

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* Rucklidge JJ. et al. Vitamin-mineral treatment of attention-deficit hyperactivity disorder in adults: double-blind randomised placebo-controlled trial. Br J Psychiatr. 2014: 30 Jan.

** Rucklidge JJ. et al. Moderators of treatment response in adults with ADHD treated with a vitamin-mineral supplement. Prog Neuropsychopharmacol Biol Psychiatry. 2013 Dec 26;50C:163-171.

*** Rucklidge JJ. & Kaplan BJ. Broad-spectrum micronutrient formulas for the treatment of psychiatric symptoms: a systematic review. Expert Rev Neurother. 2013 Jan;13(1):49-73.

**** Rucklidge JJ. et al. Can micronutrients improve neurocognitive functioning in adults with ADHD and severe mood dysregulation? A pilot study. J Altern Complement Med. 2011 Dec;17(12):1125-31.

***** Goksugur SB. et al. Vitamin D Status in Children with Attention Deficit Hyperactivity Disorder. Pediatr Int. 2014 Jan 13. doi: 10.1111/ped.12286.

****** Montejano L. et al. Adult ADHD: prevalence of diagnosis in a US population with employer health insurance. Curr Med Res Opin. 2011;27 Suppl 2:5-11.

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ResearchBlogging.org Julia J. Rucklidge, Chris M. Frampton, Brigette Gorman, & Anna Boggis (2014). Vitamin-mineral treatment of attention-deficit hyperactivity disorder in adults: double-blind randomised placebo-controlled trial British Journal of Psychiatry Other: 10.1192/bjp.bp.113.132126