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REPLAY: Stress Resilience & Practical Prescribing with Dr. Adrian Lopresti and Professor Julia Rucklidge

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REPLAY: Stress Resilience & Practical Prescribing with Dr. Adrian Lopresti and Prof. Julia Rucklidge

Professor Julia Rucklidge discusses the essential role of nutrition to support resilience in the face of acute stress or trauma in our podcast replay.  

With our ambassador, Dr. Adrian Lopresti, Julia delves into her research and the use of micronutrients to support survivors of natural disasters and acute trauma experiences. Julia also discusses the diets and nutritional status of individuals following a traumatic experience, and how practitioners might best support these people. 

Julia is generous with both academic and personal anecdotes on the benefits optimal nutrition (supported by nutritional supplementation) has on the individual in a high stress or trauma period and to promote recovery, sharing insights from her experience during the Christchurch earthquakes.  

We learn about the essential role the B group vitamins play in supporting the production of adrenalin and cortisol required to respond to an acute situation and how nutritional inadequacy may lead to poor mood and sleep regulation.  

Covered in this episode

[00:31] Welcoming Dr Julia Rucklidge
[01:36] Discussing Julia’s background and the importance of including diet and nutrients into the curriculum of psychologists in training
[06:16] Physical and psychological effects of acute stress and trauma 
[09:58] How chronic stress impacts our biochemistry
[15:04] Do our diets change while stressed?
[19:10] Emphasising self-care during periods of chronic stress
[21:22] The effects of giving nutrients prior to stressor
[28:41] Julia’s research on nutrients after major natural disasters and the Christchurch terrorist attacks
[38:57] Julia’s advice on product selection 
[46:14] Do different forms of nutrients work better than others?
[46:28] What Julia’s research is revealing about our food supply
[49:51] Julia’s book The Better Brain
[50:44] Thanking Julia and final remarks

Key takeaways 

  • The physiological and psychological response to acute trauma involves a racing heart, feeling sick to the stomach, changes to respiration, focus and concentration and an increase in irritability and anxiety. These are signs of the fight or flight response. 
  • Trying to prevent an anxiety-inducing trigger through avoidance can perpetuate the problem. The process of avoidance relieves the anxiety in the first instance but reinforces the message that the trigger is something to be fearful of. Considered exposure to anxiety-inducing triggers is important to reduce the anxiety. 
  • People who live with uncertainty, in the face of trauma may need support to maintain their resilience. Supporting a population in a time of stress and trauma, such as a natural disaster or the pandemic, may be required to reach the most amount of people.  
  • Nutritional support to support the stress response are designed to support methylation and DNA expression. The B group vitamins are essential for the methylation cycle and in turn, the production of adrenaline and cortisol required for the acute fight or flight phase. The physiological redirection of nutrients to support the fight or flight response can lead to reduced cofactors for neurotransmitter production, impacting mood and sleep. 
  • Dietary sufficiency is essential to support the fight or flight response, however, the diets of most people in the Western world are inadequate to support the nutritional needs of an acute survival situation. 
  • Dietary records of people both pre and post trauma demonstrate an increased consumption of comfort, or high carbohydrate and energy-dense foods with a reduction in complex carbohydrates. Environmental challenges including access to healthy food and food preparation facilities can influence these changes. 
  • An increase in resilience in the face of trauma can support recovery. Reduced resilience may increase the risk of PTSD. 

Resources discussed by Julia

Dr Julia Rucklidge
The Better Brain: How Nutrition Will Help You Overcome Anxiety, Depression, ADHD and Stress’ by Julia Rucklidge and Bonnie Kaplan
Julia's Free EdX Course: Mental Health and Nutrition
Mental Health and Nutrition Research Group at the University of Canterbury 
Research: Micronutrients reduce stress and anxiety in adults with Attention-Deficit/Hyperactivity Disorder following a 7.1 earthquake (Rucklidge, et al., 2011)
Research: 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 (Rucklidge, et al., 2011)
Research: Shaken but unstirred? Effects of micronutrients on stress and trauma after an earthquake: RCT evidence comparing formulas and doses (Rucklidge, et al., 2011)
Research: Clinically Significant Symptom Reduction in Children with Attention-Deficit/Hyperactivity Disorder Treated with Micronutrients: An Open-Label Reversal Design Study (Gordon, Rucklidge, Blampied & Johnstone, 2015)
Research: A randomised trial of nutrient supplements to minimise psychological stress after a natural disaster (Kaplan, Rucklidge, Romjin, & Dolph, 2015)
Research: Massacre, earthquake, flood: Translational science evidence that the use of micronutrients postdisaster reduces the risk of post-traumatic stress in survivors of disasters. (Rucklidge, et al., 2021)

Additional resources and further reading

Upcoming event with Julia Rucklidge 

‘The Connection Between Nutrients, Nutrition and Mental Health’ Mental Health Education and Resource Centre event

 Julia Rucklidge’s writing

Article ‘While we wait for a coronavirus vaccine, eating well, exercising and managing stress can boost your immune system’, The Conversation, 2020
Article: ‘Junk food and the brain: How modern diets lacking in micronutrients may contribute to angry rhetoric’ The Conversation, 2021

More of Julia Rucklidge’s research 

Research: ‘Clinician guidelines for the treatment of psychiatric disorders with nutraceuticals and phytoceuticals: The World Federation of Societies of Biological Psychiatry (WFSBP) and Canadian Network for Mood and Anxiety Treatments (CANMAT) Taskforce’. The World Journal of Biological Psychiatry, 2021
Research: ‘Massacre, Earthquake, Flood’ International Perspectives in Psychology, 2021
Research: ‘Nutrition Provides the Essential Foundation for Optimizing Mental Health’ Evidence-Based Practice in Child and Adolescent Health, 2021
Research: ‘Broad spectrum micronutrient formulas for the treatment of symptoms of depression, stress, and/or anxiety: a systematic review’, Expert Review of Neurotherapeutics, 2019
Research: ‘Study Protocol for a Randomized Double Blind, Placebo Controlled Trial Exploring the Effectiveness of a Micronutrient Formula in Improving Symptoms of Anxiety and Depression’, Medicines, 2018
Research: ‘Database Analysis of Depression and Anxiety in a Community Sample—Response to a Micronutrient Intervention’, Nutrients, 2018
Research: ‘Anxiety and Stress in Children Following an Earthquake: Clinically Beneficial Effects of Treatment with Micronutrients’ Journal of Child and Family Studies, 2017

Julia Rucklidge TedX

Video: ‘The surprisingly dramatic role of nutrition in mental health’  

Nutritional Psychiatry Education 

Online Course: Introduction to Nutritional Psychiatry: Nutri-Psyche, Future Learn and Deakin Food and Mood Centre
Julia's free online course: ‘Mental Health and Nutrition’ Food and Nutrition Courses, EdX

Dietary Assessment 

Food and Mood Centre Dietary Assessment


Adrian: Hi, and welcome to FX Medicine, where we bring you the latest in evidence-based integrative, functional, and complementary medicine. I'm Dr. Adrian Lopresti and joining us on the line today from New Zealand is Professor Julia Rucklidge

Julia is a clinical psychologist, the director of the Mental Health and Nutrition Research Group at the University of Canterbury in New Zealand, and the author of over 140 peer-reviewed publications. Julia is passionate about advocating for a good nutritional foundation being central to helping people prevent and recover from mental health challenges. And that's what we're going to discuss today, the relationship between stress, trauma, and nutrition. 

So welcome to FX Medicine, Julia. How are you today?

Julia: Oh, I'm doing great. And it's a delight to be here.

Adrian: That's great. It's great to have you on today. I know that you've trained as a clinical psychologist so I suppose I'm really interested in how you became interested in nutrients and its relationship to mental health.

Julia: Sure. And I'd be interested in your journey as well, Adrian, given you're also a clinical psychologist. But my journey was that I was trained in a very traditional model back in the 1990s, a very conventional program at the University of Calgary in Canada. And I was trained that nutrition was pretty irrelevant to the brain. I don't know if that's exactly explicitly what they said, but it was never covered and anytime there was a suggestion that you could change your diet, it was always viewed with great scepticism. And patients who said they changed their diet and that their mental health symptoms got better were typically dismissed, that that probably couldn't possibly be causal.

So I was very sceptical of the idea that nutrition could be relevant to helping people's mental health problems. But when I was doing my PhD, which was done alongside the clinical psychology training in Canada, my PhD supervisor, Bonnie Kaplan, was approached by some families from Southern Alberta, Canada, who were using nutrients, particularly micronutrients, minerals, and vitamins in a pill form to help people who were suffering from really serious psychiatric problems like bipolar disorder, and psychosis, and depression. 

So initially she ignored their data and ignored what they viewed as a revolutionary idea. But over time, she accepted as to at least look at some of the changes and hear stories about people using these nutrients. And so got a little intrigued and decided to do some very small preliminary open-label studies around the time when I was finishing up.

So that led me to hear about these stories, and then it doesn't take long before you realise that not enough people are getting well with our current conventional treatments, like psychotherapy and medications. I mean, they certainly play a role. And so I decided to follow this lead and start studying them when I moved to New Zealand back in 2000. I mean, I didn't start doing the research until quite a few years later ,but it got me intrigued and I started to do some trials and saw a lot of people, not everyone, get better. But it was certainly intriguing.

Adrian: Right, yeah. I certainly had the similar experience to you in my training. We didn't talk about nutrition at all. And even practising as a clinical psychologist, I went straight out into private practice so, yeah, I really didn't consider diet or nutrition at all until I became interested in it through just my personal interest and then just reading some of the research.

Julia: Yes, oftentimes, that's what happens is that people experience benefits themselves. I've certainly heard a lot of psychologists tell that to me, that they went on their own personal journey and then realised, "Gosh, this is actually quite important. This can really make a substantial difference to my life." I'm sure you have hundreds and hundreds of stories of people getting well with change in diet or adding additional nutrients in a supplement form. 

So the data though now are so compelling and incredibly, I'd say, robust. I mean, there's problems, as there is with any field. But I feel pretty confident that we're starting to really get a clearer picture about what specific things can help and in what combinations they can help people.

Adrian: I imagine a lot of your students now are coming out of their psychology training understanding and appreciating the importance of nutrition for mental health, which is going to be great.

Julia: Yeah, I hope so. I have to convince my colleagues that it's something that's foundational to the training of a clinical psychologist, and you know how much they cram into these programs. So I haven't convinced them that it needs to be the forefront, even though I think that a good foundation of nutrition should be the first thing that you look at. If they're not feeding their brains appropriately, then, of course, they're going to be unwell. And of course, that's going to contribute to their psychological presentation. And so we need to be asking those questions. 

Maybe I've gotten them asking those questions about gut health and asking about diet, but it can be slow to change. And then of course, you need to change it at the national level around what is viewed as essential parts of core curriculum as a clinical psychology program. But I assume Australia has the same problems.

Adrian: Yeah, absolutely. Certainly just trying to work out which components to include in training or not. So we'll see how we go.

Julia: Yeah. But I think more people are getting interested in it and definitely asking for workshops and things like that. So it's encouraging.

Adrian: Yeah, absolutely. So in this podcast, I suppose what I really wanted to specifically concentrate on is the relationship between stress, and trauma, and nutrition. And so firstly, can you tell us a bit about what effect stress and trauma has on us physically and psychologically?

Julia: Sure. Well, I think we're all familiar with that fight-flight-freeze response that we can get when we're faced with particularly an immediate acute stressor. For me, I've felt that enormously over the last...well, not necessarily recently, but certainly 10 years ago when we had ongoing earthquakes, I experienced that physiological response quite acutely, and over, and over, and over again. 

So that's the heart racing, and feeling sick in the stomach, and the change in breathing, and then the change in focus, and concentration, so all of those physical changes that we have. But we also know that it impacts on our sleep, on our levels of irritability, on our anxiety levels in general. So it has a wide range of effects on us, both physically and psychologically.

Adrian: Yeah, absolutely. You've got all those...there's certainly that fight or flight response that occurs. I mean, I suppose over time, it also changes how you see the world which can then potentially consistently put you in that fight or flight response. Any small stressor may kind of trigger that response in someone.

Julia: Well, absolutely. I mean, we know very well about the avoidance that can happen around trying to prevent yourself from getting that trigger of that anxiety reaction. And then that just perpetuates the problem because as we know, you avoid and then that relieves the anxiety. And so you think that there must have been something fearful to avoid and then you just keep that going. And so we know how important it is to expose ourselves to the fearful situation. 

But when you are dealing with things that are threatening, it can be hard to figure your way through that and feel that fear and do it anyway. And so, from my perspective, I think it's something we really need to think about is how do we make people more resilient around that journey and helping them to be able to live with uncertainty and live with...things are going to be bad. Bad things happen to us, but how do we have that resilience to overcome them?

Adrian: Yeah. And that's where that combination of certainly...well, obviously, we'll talk today about the nutritional side and the dietary side, but that's where that combination of psychological therapy, and diet, and nutrition play a really integral part in healing someone, isn't it?

Julia: Absolutely. Yeah, no, I mean, I think if we could figure out ways of integrating the different treatments to have a really wonderful package that we can offer people when they are experiencing those levels of stress.

The challenge though is that when you have these stressors that affect an entire population. I'm happy to talk about the research that I've done in the post-earthquake and other stressors. But then I think about the pandemic and you think that's a population level stressor, and all the things that are happening there. And it's very hard then to reach people on a one-to-one. 

So we need to be thinking more broadly, how do we make sure that people have the resources and the knowledge so that they can empower themselves to better cope with those types of situations because, I mean, at the end of the day, we just don't have enough personnel to help a community that large.

Adrian: Yeah, absolutely. And that's where certainly nutrients can play a part there. 

So I suppose what I wanted to do first for listeners is really just go into briefly just some of the physiological changes that occur when somebody experiences ongoing stress or trauma, because that might help people to understand then how then nutrients potentially play to help heal somebody. 

So from a biological perspective, you've mentioned the fight or flight response that occurs, and the adrenaline, and the cortisol that often occurs during that fight or flight response. But what else happens physically when people are experiencing trauma?

Julia: What else happens physically? I'm just wondering where you're trying to go with this, Adrian.

Adrian: Okay. Well, I suppose...

Julia: Are you thinking about like the gut changes and...

Adrian: Yeah, yeah, absolutely.

Julia: ...inflammatory response and...

Adrian: Yeah.

Julia: ...changes in neurotransmitters? I mean, we do know that there's a wide range of different physiological changes. And feel free to jump in on the ones that you feel...I'm sure that you have more knowledge than I do. 

What I've really focused in on is directed by the research that I've been doing. And so the research that I've been doing has been on using vitamins and minerals in that stress response, acknowledging the role that they play in, say, the methylation cycle. 

So we know that the B vitamins are really important for supporting the methylation cycle. And so the methylation cycle being an important cycle in ourselves, that produces your methyl group. I don't know how much you want me to go into that for your listeners. But we know how important methyl groups are for changing expression of DNA. 

So we know that the B vitamins or minerals are essential for all of those steps, all of those chemical transformations that are happening at that biological level. So to make sure that we provide the body with those nutrients that are cofactors along those cycles is going to be really important for anything. But they're also going to be important at a time when you're needing to make more cortisol or make more adrenaline because it doesn't just come out of a vacuum, you need ingredients in order to make them. 

And so we know that the making of, say, adrenaline requires, again, those cofactors along the different pathways. So making sure that you have an ample supply of those nutrients is going to always be really important so that your fuel tank is full, so that when you have that fight-flight response you've got everything that's going to be required.

One way that I've found it really helpful to think about it is from a hypothesis or a theory that's called the Triage Theory. And the Triage Theory postulates that when your body is under an immediate threat that threatens your survival, then it's going to always shunt all of the resources towards ensuring that your survival occurs at the expense of other long-term function. 

So I liked this idea because it made me realise, "Okay, if you've got a limited supply of nutrients to support the making of these neurotransmitters that are important for the fight-flight response, for example, then they're going to go towards that and then there's less available for the regulation of your mood, or regulation of your sleep, or just other bodily functions. That it's okay for you to be irritable, as long as you're alive. It's okay for your sleep to not be great, as long as you're alive."

So I've found that a really useful way of thinking about what happens when we're under a lot of stress. And so then you have to have that thought of, "Okay, but where do we get these nutrients from and why is it that when we look at the research on, say, even just regular stress?” And there's been research on B vitamins, for example, and stress for, I think it's close to over two decades, and you look at that research, you go, "Well, why is it that these people do better when they're receiving more B vitamins? Why aren't they getting that out of their food?” I mean, they should be getting it out of their food if they have what we would call a normal healthy diet. And so then that leads you down the rabbit hole of going, "Oh my gosh, our diet is just really not sufficient to help us maintain those adequate nutrient levels for all kinds of reasons." I mean, the number one obvious reason is that our diets, the diets of so many people, are really not adequate. I mean, they're not adequately giving the brain the nutrients it needs. And so I don't know if that's what you're getting at...

Adrian: Yeah, absolutely.

Julia: ...because I know there's other things. And I'm happy for you to throw other things in. But sort of concentrating on those aspects of the stress response are really due to the research that I've been conducting on the nutrients. But I really would like to hear your thoughts on that too.

Adrian: Well, I mean, certainly I agree. Really, during times of stress and trauma, the body demands are greater so therefore, the need for nutrients is going to be more imperative, particularly in producing the different hormones that are necessary for survival. So I definitely agree with that. 

And I mean, it's curious, as you're talking, I was thinking, "Okay, there's lots of research showing that people who are depressed, or stressed, or maybe suffering from anxiety, maybe their diet isn't so great." But have you seen any research about what actually happens when people are experiencing stress? Does their diets change for the worse or for the better? Have you seen any of that research?

Julia: Yeah, we have researchers here at the University of Canterbury who have been monitoring people's diets longitudinally. And so they had diet records of their eating patterns before the earthquake, for example. And then they looked at what their dietary patterns were after the earthquake. And it was very clear that there was a dietary change for the worse, for the most part. More are reaching for those comfort foods that we're very familiar with and high sugary foods and those high carb foods, but not as many of those complex carbs. 

So we know that there's definitely research that supports that idea, and it makes intuitive sense, and having been through these earthquakes and understanding it firsthand what happens, you're displaced from your home. So our house was incredibly badly damaged in the February 2011 earthquake, and so we couldn't live at home. We were in temporary housing, so you don't have access to even your cookbooks or the pots and pans that you'd normally use. Everything is just different. Even your staples are gone, right, your flour, your spices. All of those are just not as easily accessible.

So your diet pattern does change. And then you look at what happens to people who end up in the relief centres, people who've been completely dislocated and are in those really large centres. You look at the food, I saw the food, and I remember just seeing white bread and really highly ultra-processed foods that they're giving people during that time. That makes sense. It's easier to package it that way. But it's certainly not going to be providing the nutrients that those people need to help them with those stressors. 

So we've got the research, and I can give you the anecdotal experience that there are changes that are happening in people's diets at a time when I would now go, "Oh, it's so essential that you eat well." I'm so much more familiar with this and how important it is that when there are ongoing stressors that I will...you're going to know that I have a good diet. And so it's going to be obvious, you practice what you preach, right?

Adrian: Absolutely.

Julia: So there's not necessarily huge changes that can be made. But I have experienced some stressors that I can think of where I would add in additional nutrients, like as a supplement. I'm thinking of when I was overseas this year, I had to go overseas because my father passed away and I went over to the UK. And so I went from New Zealand where there was just no COVID to a high-COVID environment where you're completely vigilant and hyper-vigilant of your environment. Not because I was scared of getting COVID, I was just scared of getting a positive test, which meant that I wouldn't be able to leave and get home again. 
So it's just there's these really big stressors on you. And I found that just adding in some additional nutrients at that point really helped with just easing that stress and helping me return to a more resilient state. So, those are, I know, personal stories, but we also have a lot of clinical data from our lab and from labs overseas that also show that sometimes you do need additional nutrients when the stress levels really do increase substantially.

Adrian: Yeah. You make a good point that certainly after a trauma or a major event that's happened to somebody, what should be happening is that their self-care should be better. But unfortunately, because of lifestyle circumstances and changes in their environment, often that can't happen. So unfortunately, then the diet becomes worse or the nutrient kind of intake becomes worse...

Julia: Yeah, exactly.

Adrian: ...and that's where potentially vitamins and minerals could play a really important part.

Julia: Yeah, exactly. But I do wish, and I don't know if I'm just being naive here, but I think about the ongoing stress that we've all experienced over the last two years. And I think, why is that there isn't more messaging about lifestyle? Why hasn't that happened? Why aren't we getting that at that public level? Is it that they just think it's too hard, or we had to focus on one message, and that if you start to introduce some other things that you could also do that it might dilute the primary message that's out there? I don't know. 

But I just think that we would all benefit if we were constantly focusing on our well-being and reducing our stress levels during this sort of really chronic period of stress. But they must have a good reason for not including looking after your diet or making sure that you exercise every day. There was some at the beginning I remember, but I certainly haven't heard it more recently, or even, "Get outside, get some vitamin D," these types of things. Maybe it's happened in Australia?

Adrian: I think they've talked a little bit about getting out there and so forth. But, yeah, I suppose a lot of what you say, getting outside, and taking a supplement, or sleeping better and spending time with other people, they're not difficult things to implement and really, we need to be advocating more for that. And yeah, unfortunately, it's not the case unfortunately.

Julia: Exactly, yeah.

Adrian: So a question I had, when somebody experiences... Is there any research around like when somebody experiences a trauma or a major stress, is there research saying that people with better nutrient status or better diets are more resilient, they'd kind of respond better to the stress or the trauma?

Julia: Right. Well, that's not an easy thing to answer, as you can probably imagine, Adrian, because it requires you to sort of predict a stressor. But I guess the thing that I think of when you ask that question is my own research, which was where we had a naturalistic opportunity to look at whether or not people who happen to be better nourished, and by that I mean, they were taking additional nutrients in quite high doses, not toxic levels, but high doses of vitamins and minerals prior to a major stressor, and then the stressor happened, and then we were able to see whether those who had that intake of nutrients prior to the stressor were more resilient in terms of reductions of their anxiety, and their stress, and mood, whether or not those improved following that stressor. 

So you might be thinking, "How in the world did she do this?" It's the earthquakes that we had opportunities as a consequence of having people in clinical trials. And so some of them had started the clinical trial and some of them hadn't. And so as a naturalistic experiment, I don't know how you would do...I mean, as I say this, I think, "Can you actually do this? You could maybe manipulate this. You could probably do this in a lab." I'm just like, going and my mind is going elsewhere.

But that earthquake that happened in September 2010 allowed us to answer that question, which was that if people happen to be taking the nutrients before that really major stressor...it was a 7.1 earthquake. Have you been in an earthquake, Adrian?

Adrian: No, I haven’t. No.

Julia: So it's a life-threatening event and absolutely downright terrifying. So your house is just shaking violently for two to three minutes. Things are falling off the wall. Things are crashing. The noise is incredible. And then after that, you have these ongoing aftershocks. So that just goes on, and on, and on, and on. 

So that study, this naturalistic observation allowed us to answer this question, and that is that people who happened to be taking the nutrients before the earthquake were more resilient. And their stress levels, of course, went up soon after the earthquake. But they decreased much more rapidly and to a much lower level, and huge effect sizes between the two groups. They were large, like I think it was 0.8 or something between those two groups of people who happened to be taking nutrients and happened to not be taking nutrients. 

So I guess, for me, that was a really good naturalistic experiment that really answers your question. But I'm not aware of anything else. Are you aware of any other kind of study? I mean, people have stress and then they see whether or not they can help reduce stress. But to answer that question around prior to a stressor, I can only think of that study that I did after the September earthquake. But I'd love to know if there are other studies like that out there.

Adrian: No, I haven't seen a lot as you know, when it's used as suppose as a preventative, which is really how I think we need to be looking at it.

Julia: Exactly.

Adrian: The last few days, I've actually been writing a paper looking at an herbal ingredient, curcumin actually, and looking at some of the research around depression and so forth. And I was looking a lot at the animal studies. And what I noticed was that in more than 95% of these animal studies, what they actually did was they gave curcumin prior to the stressor, so not actually after the stressor. 

So all these animal studies, they're giving the ingredient before the stressor, then potentially preparing these animals for the stressor, and then obviously, then they go okay, then the curcumin had these antidepressant or anti-stress effects. And there was one study actually where what they did was in one group of animals, they gave the curcumin before the stressor and it had positive effects, positive anti-depressant effects. But then in another group of animals, what they did is they actually gave curcumin after the stressor, and it didn't actually work. So it's really interesting...

Julia: Oh.

Adrian: Yeah, and that makes me think, "Okay, well when you talk about the micronutrients, certainly could we get a bigger bang for buck in terms of its mental health effects if we actually deliver it prior to the stress?” Obviously, you're not going to know when a trauma is going to happen, but it just...

Julia: Exactly.

Adrian: It's just something to think about obviously, that stress, or give it as soon as possible, which is after the stressor. Maybe what we need to be looking at, rather than one to two, or three years after the stressor - which still might be helpful - but maybe we're going to get greater efficacy if we can use it immediately after people have been exposed.

Julia: Yeah, you know what, I didn't know about those studies. I'm like, "Of course animal studies can answer that question." You can do things like that with animals. You just can't do that as easily with humans.

Adrian: No.

Julia: But that's really intriguing, isn't it? But it makes sense. We know that from trauma in general, that a lot of people are resilient and they do recover and we know what some of those risk factors are for those people who are less likely to recover and to have ongoing PTSD symptoms. They're going to be the ones who had PTSD before, and they were the ones who were more vulnerable before. 

Adrian: Yeah.

Julia: And so we know that those who have less resources, and maybe they have less resources because they have lower economic status, or they have less psychological resources, we know they're going to be struggling more. So we kind of know who they are. 

And just, again, it makes so much sense that we use that information that we have from some of these psychological studies or from these nutritional studies that you described, and we try to really up the resilience of the entire population rather than just using this as a one-to-one kind of information that when somebody comes to your office and they're stressed, or they're struggling with depression, you go, "Well, hey, did you know about all of these things that you could be doing?" 

That just always, to me, seems like the ambulance at the bottom of the cliff approach. It can work. But we would just do so much better if we could just...I guess I'm being far too hopeful of what we can achieve at a population level, but that's really seems to be where we could have way greater impact, if we could disseminate these ideas at that big, broader level.

Adrian: Yeah, most certainly. Us as practitioners, we can certainly inform our clients that we see and even get them to inform their family members about the importance of nutrients. And maybe if we can do it on a one-to-one basis and then just really get that message out there, that'd be really important. 

Now, I was hoping for you to just really just summarise some of your research, what the research says around micronutrients as a treatment for stress and trauma. Have most of the studies been with adults that you've done? Or you've done with children, or was it mostly adults?

Julia: We've done both. We've done studies with, yeah, children and adults after...so I described that one study which is the only study that we've done where we gave the nutrients before the stressor, but that was only because of the naturalistic environment and how it happened. 

In Christchurch, we had two really big earthquakes. One was in September, and one was in February. We had lots of other aftershocks. But those were identified as the really big ones. So we had that September one where we discovered this resilience. And then after the Christchurch earthquake, what my team did was that we randomised people to different doses of micronutrients and also had a comparator with only mostly B complex, but a couple of minerals, to see whether or not...was there a better dose? Was it advantageous to have the additional minerals? So yeah, so we could look at those kinds of questions. 

And what we found was that, in fact, it didn't matter what condition you were in, we saw great changes in people's stress and anxiety that had happened as a consequence of that February earthquake. So that's really good news is that even a B complex is really useful at reducing stress when you've had that kind of really major stressor.

All three groups were better than the...we had a non-randomised treatment as usual group. And they were people who actually looked quite similar at baseline because we couldn't randomise people to not receive treatment, but we did have people who signed up for the study and then they decided they didn't want to do nutrients. They wanted to go for medication or not do anything. They decided this was just going to be too hard for them. But they allowed us to monitor them. 

So we had this naturalistic kind of treatment as usual group. And they just showed very, very little change over the one-month monitoring period, as opposed to the other three groups who showed really substantial difference. I mean, the rate of what I call probable PTSD — and I say that because we didn't do clinical interviews. We used a questionnaire and we used a cut off. And so we used the impact of events scale, the IES rating scale. So there's a cut off that you can use and identify people. If they went for a clinical interview, they probably have PTSD. So it's not perfect, but it's all we could do in that kind of environment. The rate of probable PTSD in collectively of those people who were taking the nutrients went from 65% down to 19% in that one-month period using that cut off that I described. Whereas there was no change, it stayed about 48% in the treatment as usual group.

So you can't argue that it was just the natural passage of time, or regression to the mean, or other things that happen that explain why people get better. And also during that monitoring period or that randomised period, there were a lot of aftershocks. So it's not like the stressor had gone away. There was ongoing stress, ongoing things going on in the community. All kinds of things were happening. Their land was being declared as being what we called red zones, which meant they couldn't go home. They weren't allowed to go home and rebuild. The government bought their houses and so they had to relocate. Whole communities had to relocate. 

Adrian: Wow.

Julia: So there's a lot that was going on during that time. So that, for me, was pretty robust. But what we did find was that those people who were getting additional minerals, if you look at the sort of overall trajectory of the data, it does seem like there's this incremental dose effect, but probably fairly small. But where, as you add more nutrients, then you do tend to get an even bigger effect, especially for their self-report of how much better they thought they were doing. So that's sort of the earthquake study. 

We then did a study with children, but not in this RCT kind of way. We did an on-off, on-off experimental design, and we saw great changes though in these groups of children who were using nutrients and then went on and off. And so we saw some really robust improvement in their anxiety levels that then went backwards when they went off the nutrients, and then back on, the anxiety improved again. But I haven't done an RCT with kid with stress and anxiety. We did it with children with ADHD but not with stress.

And then after a flood in Alberta, Canada, we replicated, sort of did a similar design but used a vitamin D comparator. And the vitamin D comparator did not show much change in the stress, whereas there were huge changes in the B complex and the broad-spectrum nutrient approach. So it's sort of replicated what we've seen after the earthquake. 

And then a third replication was after the mosque shooting, I don't know if you heard of it. 

Adrian: Yes.

Julia: On March 15, 2019,  horrible event in Christchurch, where a gunman went into two mosques and shot and killed 49 and injured a similar number, so 49 people killed. And what we did as research-to-practice intervention, so not research, but really the translation was that we couldn't sit by and do nothing. 

We did everything that we could to try to elicit the community to use the resources, to purchase nutrients or to just use nutrients as one of the arms of intervention. And none of my efforts worked. And so we ended up just fundraising ourselves and then giving them away and then monitoring people clinically. And again, we saw the exact replication, the effect that we'd seen after the earthquake and after the flood. So it really was a simple intervention that you can actually apply broadly because you don't need a lot of resources to give people nutrients. There's a lot of people out there who think that they're dangerous, or they're somehow going to harm people.

There are a few cautions that you need to be aware of. If people are already taking antidepressants, then we just need to be a bit careful of that. But outside of that, if you have allergies, that'd be something to think about. But most people don't have allergies to nutrients for the most part. I mean, we've got some rare ones, where if you took too much iron, for those people who have haemochromatosis then that could be a problem, or Wilson's disease, or too much copper. But those are fairly rare events. So for the most part, a fairly easy to implement strategy when you do have a big stressor in a community.

Adrian: So with that mosque tragedy, was that people who were directly involved or was it also people who just obviously witnessed it through media and so forth?

Julia: We certainly didn't choose people to...if they wanted nutrients. If they approached us, and the context was that I'm a white woman who didn't have any connections with the Muslim community. But there was a graduate student in my department who did. He's a Muslim student doing a PhD. So he knew already about the research that I'd been doing. And so he really facilitated sharing that information with people in his community. 

So we had people who had been in the mosque for sure, that had suffered greatly, either had been injured or they'd witnessed this terrorist attack. But also the widows, the widows of the men who have been killed in the mosque, we were open to giving it to them. I guess, if you look at the definition of PTSD, it can be a trauma either to you or someone else and we certainly didn't want to exclude giving the nutrients. If somebody was feeling stressed and traumatised by that event, then we gave it to them. We certainly didn't want to exclude people from getting help. We had a lot of refugees who we were helping because a lot of refugees were involved in the event, in the massacre.

And again, that speaks to the difficulty of intervening with refugees sometimes because of the language barriers. And we saw a lot of that, the difficulties of even providing psychotherapy even though it was being offered, it was very difficult to do because of having to do that via translation. And so that certainly put up a lot of barriers, whereas they were very open to the idea of taking nutrients. In fact, they would far prefer to get the nutrients than get psychotherapy if they were offered psychotherapy. If they already heard about this underground thing that was going, the nutrients, and they said, "Well, I want those nutrients," so.

Adrian: That's far simpler, isn’t it?

Julia: Yeah. So we did this until pretty much lockdown of last year. And then at that point, we could no longer keep going because it just became too challenging. But we did it for about over a year, we were giving out nutrients.

Adrian: So what is it that you gave them? Was it a B complex or was a combination? What was it that you gave them?

Julia: Oh, broad-spectrum, again, very similar to what we'd used in the earthquake and in the flood. It was the full array of your B vitamins, absolutely, but full array of your minerals.

Adrian: So for practitioners, if they wanted to include micronutrient formulas or micronutrients with their clients, how do they choose one that they feel might work better than another?

Julia: I know, and that's a really hard question to answer as you can well imagine. Well, first of all, just so that your listeners know, I don't sell nutrients and supplements. I just research them. And I've researched a number of different products over the years. And so for me, I'd say, there's so much out there, and there are probably some really, really good products. And so I would be definitely looking for that breadth. And I'd also be looking for the dose. 

And this is where it becomes a bit difficult around the legislation and the legislative differences between Australia and New Zealand, although they're probably more similar than different, is that some doses are restricted in terms of what you can purchase from the supermarket. And so if you start to look at the doses, you'll know it's too low when it says something like 10% of your RDA or your DV, your recommended dietary allowance or your daily value. 

So when those numbers are really quite low, I'd say it probably will help you maybe with scurvy, prevention of scurvy, that'd be a good thing, or prevention of rickets maybe, but probably not adequate for your overall brain health because those RDAs were developed with the physical body in mind...and not that the brain is part of the physical body, but it was more about your heart, or your bones, or your muscles. But remarkably, the brain needs have not been really taken into consideration in the development of RDAs, which is kind of really surprising. And I wish they'd update them and take that into consideration.

Adrian: Yeah.

Julia: So I'd be looking at that breadth. And for me, I think that there's no single nutrient that's special. There's a lot of push for different single nutrients like zinc, or iodine, or magnesium. And there are some people who they just take that single nutrient and they can do really well. Maybe it improves their sleep or improves their anxiety. We haven't talked about herbs, and it's not my area of expertise, but I know that you're involved in a lot of that type of research and practice. But herbs aren't, from what I know, a single ingredient, are they?

Adrian: Yeah.

Julia: They are complex. Would that be a fair statement to say about a herb?

Adrian: Absolutely. It's a full range of phytochemicals.

Julia: Yeah, so it's a full range. And so maybe that is part of the...not the magic, but part of why they can be so useful clinically, whereas when it comes to vitamins and minerals, we always seem to think about them in their singular form. And when we look at the singular data, there are some studies that show some benefit for some single nutrients. But for the most part, we don't see that. 

So again, that's why I really push for the breadth. And then the dose, I think the therapeutic level is between your RDA and your UL. That's definitely where our research is showing that the therapeutic benefit seems to occur there. And so that's where you then, as a consumer, or as a health practitioner, would want to look at the formulas that have been studied within that window of likely above the RDA but not at a toxic level. And there's a huge opportunity between the RDA and the UL to give the nutrients in that zone, and then collectively together because if you give a single nutrient at a high-level, then it can cause a lot of imbalances. And so you'd want to give it as the full breadth of the nutrients the way we would consume them normally in nature.

Adrian: Yeah, okay. All right, so it's really that…

Julia: But I think you'll notice that I haven't named any products because I can't but I can go to the research or can I promote my book and say it's all written in our book, in The Better Brain?

Adrian: Oh, I was going to certainly, yeah, find it in your book.

Julia: Yeah. I've done an EdX. I don't know if you're familiar with EdX. It's an online educational platform through Harvard. And I developed an online course on mental health and nutrition just over a year ago now. And that's free. So you can go online there and take that course. It takes eight weeks to do it if you're really committed, but you can dip in and out and choose to watch what you want to watch. And all of the information about the supplements is provided on the online platform.

Adrian: Perfect. I must admit I did subscribe to it and watched a few of the...

Julia: Oh did you? Okay.

Adrian: It was brilliant. Well done. So it was absolutely great. So if anybody's interested in learning more about nutrients and its relationships to mental health, I would certainly recommend that. And we'll include a link to it in the show notes for sure.

Julia: Oh, thanks, Adrian.

Adrian: So just a question then with regards...so you've got the breadth, you've got obviously your dosage is important. Any difference between, let's say, different forms of the nutrients, activated, non-activated? Any comments on that.

Julia: Yeah. I get confused about some of this because some people say they can't possibly tolerate some of the active versions of, say, methylated folate. And they'll talk a lot about being an under-methylator, or over methylator, or whichever one will apply to them. And that influences which kind of supplements that they take. 

I've looked at it in the formulas that we've studied and for the most part they are methylated. There might be some people who react to that. I haven't been able to really quantify it or observe it clinically. And we did look at a little bit about whether or not some people had the variants of the MTHFR gene and looked at the different variants there and couldn't find that as being a predictor of response. But then our sample size was pretty small and so maybe that's the problem. But then I'd say, if your sample size is unable to detect it, then how useful is it at an individual level?

Adrian: Yeah.

Julia: So I guess I don't know the answer to your question. I can't give you a really good answer because we've typically used active versions and forms. But there may be people out there who react to it.

Adrian: Okay.

Julia: I don't know if you know better about that than I do.

Adrian: I mean, I don't think I’ve... Yeah, personally, I haven't had enough exposure to seeing the activated versus non-activated with my clients and seeing whether one works better than the other. And obviously, the problem for me is I'm not just giving micronutrients with my clients. There's a whole range of treatments. So who knows which bit works and so forth, which is always very difficult. 

So just then to summarise, from what you're saying today, it really sounds like obviously, micronutrients could really be delivered on a population-based level and potentially make people far more resilient to stressors that they may be experiencing in life, or there's an upcoming trauma, that could potentially make them more resilient and maybe prevent them from developing full blown PTSD. That's what seems to be some of what your research is saying. Is that right?

Julia: I certainly would like to think that. We haven't explored it to big, big population studies, so I can't confirm that that would happen. But it makes sense. The biology makes sense. The research that's been done to date would suggest that that's what should happen, that we should be able to really avert the development of some fairly significant psychological problems as a consequence of being well-nourished. 
I mean, if you start to think what kind of research needs to be done to really prove that? I think it's hard. It would be hard to do because once you get into those really large population studies, then it's harder to do the controlled trials. But we have a lot of data that shows at that population level that the more you eat nutrient-dense foods, like consistent with the Mediterranean diet, then that does seem to confer a level of resilience and reduces your likelihood of developing anxiety disorders or mood disorders down the road.

And then conversely, the more you're eating a really nutrient-depleted diet, like the Western diet...and we know it's depleted in micronutrients, and so you just can look up any of those foods and look at their nutrient contents. I always think that if we could just have them list the nutrient, the micronutrients on the back of the packages, UPS packages, then we'd hopefully convince more people to see, "Oh my gosh, there's zero phosphorus in there. There's zero selenium in there, zero copper or manganese in these products." And then when you know that you need those minerals on a daily basis, hopefully, people would start to make that connection of, "Maybe I should be changing what I eat."

And I always say that as much as my research has been about supplementation, I think what it tells us is that our food supply is inadequate for far too many people. And be that because of food choices, be that because of food deserts, food opportunities, the types of foods that you can purchase, it's a complex web of what's happening there. But we've allowed that to happen. And we've allowed the food industry to really just dictate what we're eating. And so, I do think we need to be far more active around changing our food environment for the betterment of our physical health and mental health. 

And all my research does is really brings that home because it shows when you give people additional nutrients, then we seem to be able to improve their mental health. So kind of, sorry, a long-winded answer thinking about your question.

Adrian: No, I think...yeah, I mean, I'm mindful of time, but I mean, certainly, if people want to learn more, I mean, I'd certainly recommend your book, The Better Brain.

Julia: Yeah.

Adrian: And I'd certainly recommend it for listeners. It's got obviously, lots of information about the relationship between diets and nutrients and mental health. And it even got some Better Brain recipes that people can kind of refer to.

Julia: Absolutely, yes, I'm happy about where it ended up and delighted that Bonnie...because Bonnie really, in her retirement, thought that writing a book would be a really good idea and dragged me along. But it was really a fun project and I'm really, really glad that I did it. Once I get my mind onto something, then I do it and I put everything into it. But it's just that decision of, "Is this really what I want to do with my life? Write a book?"

Adrian: Well done. You've done a great job. 

All right, so, Julia, thank you so much for coming on the show to discuss this important issue. I know that most natural health practitioners are acutely aware of the links between nutrition and mental health, particularly when dealing with trauma and stress. But having solid scientific evidence and the extra insights you've provided from your research really drives that point home for us. And it's a reminder to us all the power that nutrients have, not only in extreme situations like treating PTSD, but also for everyday stressors. So thank you very much for being with us today. It's been a pleasure to talk with you.

Julia: Oh, my pleasure, Adrian.

Adrian: So thanks, everyone, for listening today. Don't forget that you can find all the show notes, transcripts, and other resources from today's episode on the FX Medicine website. I'm Dr Adrian Lopresti, and thanks for joining us. We'll see you next time.

About Professor Julia Rucklidge



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