PLEASE NOTE- the NoMAD trial is closed for recruitment. No further referrals will be accepted.
Micronutrients: What is the evidence?
Research has investigated the role of nutrition in the development of mental health issues (Davidson & Kaplan, 2012a; O’Neil et al, 2014 ).
Individuals with poor mental health (hauora hinengaro) report nutrient-poor diets when compared to healthy controls (Robson & Gray, 2007; Davidson and Kaplan, 2012b).
More recent trials have demonstrated efficacy of multi-nutrients (taiora) in improving emotional regulation, reduce stress and improving attention/concentration and hyperactivity symptoms and improving insomnia with no adverse effects (Gariballa & Forster, 2007; Schlebusch et al, 2000; Rucklidge et al, 2014a; Popper, 2014; Lothian et al, 2016).
The safety profile of multi-nutrient treatment in adults (pakeke) and children (tamariki) is reassuring (Simpson et al, 2011, Rucklidge et al, 2014b; Rucklidge et al, 2019).
What is the trial?
To test the effectiveness of multi-nutrients on symptoms of anxiety (āwangawanga) and depression (mate pāpōuri) in adults NOT currently taking anti-depressant or anti-anxiety medications.
200 participants will be randomised to a placebo or treatment condition.
Participation is limited to people living in the Canterbury (Otautahi/Waitaha) region.
The treatment condition will involve taking 12 multi-nutrient tablets per day (4 pills, 3 times a day) for 10 weeks.
The trial will also include a 2 week initial baseline phase, where no treatment or placebo will be offered.
Participants will complete initial assessment questionnaires and weekly monitoring of their symptoms.
At the conclusion of the trial, all participants will be offered multi-nutrients for a further 10 weeks in an open trial phase.
The trial has been prospectively registered under the Australian and New Zealand Clinical Trials Registry. Trial Identification = ACTRN12617001647325. Universal Trial Number = U111111994026. Ethics approval was granted through the New Zealand Heath and Disability Ethics Committee 17/STH/131 on 14 November 2017 and the University of Canterbury Human Ethics Committee: HEC2017/108/LR, on 27 November 2017.
What is the intervention?
The multi-nutrient formula that will be used in the trial is Daily Essential Nutrients. The ingredients are as follows:
| Ingredients: | 1 capsule | 12 capsules |
| Vitamin A (as retinyl palmitate) | 480 IU | 5,760 IU |
| Vitamin C (as ascorbic acid) | 50 mg | 600 mg |
| Vitamin D (as cholecalciferol) | 250 IU | 3,000 IU |
| Vitamin E (as d-alpha tocopheryl succinate) | 30 IU | 360 IU |
| Vitamin K (75% as phylloquinone; 25% as menaquinone-7) | 10 mcg | 120 mcg |
| Thiamin (as thiamin mononitrate) | 4 mg | 60 mg |
| Riboflavin | 1.5 mg | 18 mg |
| Niacin (as niacinamide) | 7.5 mg | 90 mg |
| Vitamin B6 (as pyridoxine hydrochloride) | 5.8 mg | 69.9 mg |
| Folate (as L-methylfolate calcium) | 66.8 mcg | 801 mcg |
| Vitamin B12 (as methylcobalamin) | 75 mcg | 900 mcg |
| Biotin | 90 mcg | 1080 mcg |
| Pantothenic acid (as d-calcium pantothenate) | 2.5 mg | 30 mg |
| Calcium (as chelate) | 110 mg | 1,320 mg |
| Iron (as chelate) | 1.15 mg | 13.8 mg |
| Phosphorus (as chelate) | 70 mg | 840 mg |
| Iodine (as chelate) | 17 mcg | 204 mcg |
| Magnesium (as chelate) | 50 mg | 600 mg |
| Zinc (as chelate) | 4 mg | 48 mg |
| Selenium (as chelate) | 17 mcg | 204 mcg |
| Copper (as chelate) | 0.6 mg | 7.2 mg |
| Manganese (as chelate) | 0.8 mg | 9.6 mg |
| Chromium (as chelate) | 52 mcg | 624 mcg |
| Molybdenum (as chelate) | 12 mcg | 144 mcg |
| Potassium (as chelate) | 20 mg | 240 mg |
| Proprietary blend ingredients: | ||
| Choline bitartrate | ||
| Alpha-lipoic acid | ||
| Shilajit | ||
| Inositol | ||
| Acetylcarnitine (as acetyl-L-carnitine hydrochloride) | ||
| Grape seed extract | ||
| Ginkgo biloba leaf extract | ||
| Methionine (as L-methionine hydrochloride) | ||
| Cysteine (as N-acetyl-L-cysteine) | ||
| Germanium sesquioxide (as chelate) | ||
| Boron (as chelate) | ||
| Vanadium (as chelate) | ||
| Lithium orotate (as chelate) | ||
| Nickel (as chelate) | ||
| Other ingredients: | ||
| Cellulose | ||
| Glycine | ||
| Citric acid | ||
| Magnesium stearate | ||
| Silicon dioxide | ||
The placebo formula ingredients are as follows:
| Ingredients: | 1 capsule | 12 capsules |
| Fiber Acacia Gum | 300 mg | 3,600 mg |
| Maltodextrin | 395.90 mg | 4,750.8 mg |
| Cocoa Powder | 4 mg | 48 mg |
| Riboflavin Powder | 0.10 mg | 1.2mg |
Inclusion and Exclusion criteria
INCLUSION:
1) between 18 and 65 years,
2) regular access to the internet,
3) considered reliable and compliant with the protocol (including the ingestion of as many as 12 capsules/day with food/kai),
4) be experiencing functionally impairing anxiety or depressive symptoms which cannot be better accounted for by a medical condition,
5) and be living in the Canterbury (Otautahi/Waitaha) area.
EXCLUSION:
1) The main strict contraindications are metabolic conditions such as Wilson’s disease (copper), haemochromatosis (iron), phenylketonuira (phenylalanine) and trimethylaminuria (choline).
2) Neurological disorders involving brain or other central function (e.g., intellectual disability, autism spectrum disorder, epilepsy, MS, narcolepsy) or other major psychiatric condition requiring hospitalization (e.g. significant mood disorder with associated suicidality, substance dependence or psychosis),
3) Any serious medical condition,
4) Any patient known to be allergic to the ingredients of the intervention (see above).
5) Any other medication with primarily central nervous system activity, including psychotropic medication (e.g. SSRIs, tricyclics, benzodiazepines). Participants must have been off of these medications for a minimum of four weeks prior to the trial. Participants are not encouraged to come off of a medication in order to participate in the trial. All exclusions will be reviewed by study physician.
6) There are some other medications that can have interactions with multi-nutrients (e.g. medication for thyroid conditions). Investigators will review potential participants’ medications for interactions and may decline participation in the trial if interactions exist. Please contact us for more information if you are concerned about potential interactions (contact details below).
7) Women who are pregnant or breastfeeding.
For more information on a current trial exploring multi-nutrients, depression and anxiety in pregnancy: www.bit.ly/pregnancy-study
To refer suitable patients to the trial, please provide their details in the form below:
Please note: information in referral boxes is a guide to completion, not client information.
For more information, please contact Meredith Blampied (Principal Investigator):
References:
Davison, K. M., & Kaplan, B. J. (2012a). Nutrient intakes are correlated with overall psychiatric functioning in adults with mood disorders. Canadian Journal of Psychiatry, 57(2), 85-92.
Davison, K. M., & Kaplan, B. J. (2012b). Food intake and blood cholesterol levels of community-based adults with mood disorders. BMC Psychiatry, 12. doi:10.1186/1471-244X-12-10
Gariballa, S., & Forster, S. (2007). Effects of dietary supplements on depressive symptoms in older patients: A randomised double-blind placebo-controlled trial. Clinical Nutrition, 26(5), 545-551. doi:http://ddoi.org/10.1016/j.clnu.2007.06.007
Lothian, J., Blampied, N.M., & Rucklidge, J.J. (2016). Effect of Micronutrients on Insomnia in Adults: A Multiple-Baseline Study. Clinical Psychological Science, 4(6), 1112-1124.
O’Neil, A., Quirk, S. E., Housden, S., Brennan, S. L., Williams, L. J., Pasco, J. A., . . . Jacka, F. N. (2014). Relationship between diet and mental health in children and adolescents: a systematic review. American journal of public health, 104(10), e31-e42.
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
Robson, D., & Gray, R. (2007). Serious mental illness and physical health problems: a discussion paper. International journal of nursing studies, 44(3), 457-466.
Rucklidge, J. J., Blampied, N., Gorman, B., Gordon, H. A., & Sole, E. (2014). Psychological functioning 1 year after a brief intervention using micronutrients to treat stress and anxiety related to the 2011 Christchurch earthquakes: A naturalistic follow-up. Human Psychopharmacology, 29(3), 230-243. doi:10.1002/hup.2392
Ruckildge, 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. The Journal of Alternative and Complimentary Medicine, oo(00), 1-10. doi: 10.1089/acm.2018.0352
Rucklidge, J. J., Frampton, C. M., Gorman, B., & Boggis, A. (2014a). Vitamin-mineral treatment of attention-deficit hyperactivity disorder in adults: double-blind randomised placebo- controlled trial. The British Journal of Psychiatry, 204(4), 306
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. S Afr Med J, 90(12), 1216-1223.
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. doi:10.1186/1471-244X-11-62