When it comes to mental health, can supplements play a therapeutic role, or are they just "expensive urine?" Well thanks to researcher Professor Julia Rucklidge from Massey University, we have some answers.
Dr Rucklidge has been able to show that supplemental nutrients, even just a decent multi-vitamin mineral supplement, can have beneficial effects on both mood and cognition, even helping to lessen the need for anti-depressants in children with behavioural disorders. Prof Rucklidge joins us today to share her insights into how, with a few simple interventions we could alleviate a considerable amount of mental illness burden plaguing our communities.
Covered in this episode
[00:45] Introducing Julia Rucklidge
[02:28] From psychology to nutrition
[05:09] Opening up to nutritional interventions
[09:30] Diving into research: overcoming challenges
[14:01] Power analysis definition in research
[17:02] Pharmacological dose vs. correcting deficiency?
[19:02] Nutrigenomics: personalising therapy
[24:48] Evidence: diet /food vs. supplementation
[29:23] Overcoming compliance issues
[32:08] The intricacies of Julia's research
[37:44] Nutrients vs. stimulants for behavioural disorders
[42:36] Nutrients: impact to performance and creativity?
[46:57] Navigating the regulatory minefields
[54:08] Thanks to Prof Rucklidge for joining us
Andrew: This is FX Medicine, I'm Andrew Whitfield-Cook. Joining me on the line today all the way from Christchurch, New Zealand is Julia Rucklidge. Julia is a professor of clinical psychology in the Department of Psychology at the University of Canterbury, Christchurch in New Zealand.
Originally from Toronto, Canada, she did her undergraduate training in neurobiology at McGill University in Montreal. She then completed a master's and PhD at the University of Calgary, boy, you've moved around a bit, in clinical psychology, followed by a two-year post-doctoral fellowship at the Hospital for Sick Children in Toronto.
In 2000, she joined the Department of Psychology, where she teaches child psychology in the child psychology program and introduced the topic of mental health and nutrition into the wider psychology program. Her interests in nutrition and mental illness grew out of her own research showing poor outcomes for children with significant psychiatric illness despite receiving conventional treatments for their conditions. And we'll be delving into this with Julia Rucklidge today on FX Medicine. Welcome, Julia. How are you?
Julia: I'm great. Thanks for having me on your show.
Andrew: Now, I've got to say you were actually a danger to me while I was driving because I could not put down your TEDx Talk, and I kept on having to pull over, off into side streets hoping for a red light and everything like that. I dare say there was a time or two when I glanced down. So I apologize to any drivers around me at the time. I found it riveting.
Julia: Well, I certainly don't recommend that you watch a video while you're driving. I've never heard this before.
Andrew: It was glances.
Julia: But anyway, maybe your life is too busy that that's the only opportunity you get?
Andrew: I was in my zen moment. But take us through your background, what sparked your interest to look at nutrition?
Julia: Yep, sure. Well, I'm a clinical psychologist as you mentioned in my bio. And, you know, I always tell everyone that I was told that nutrition was irrelevant in mental illness when I went through graduate school. And that it really played a, you know, insignificant role in the development of mental illness and in the treatment of mental illness, and that only drugs or psychotherapy could treat, you know, these serious conditions.
But as you also said in my bio, I was very aware of research that was showing poor long-term outcomes for people with mental illness despite receiving the best care. And if we look at the data, you know, for the last decade, it's certainly true that across the board we know, whether people are taking stimulants or whether people are taking antidepressants or they're taking antipsychotics, in the long-term, we are simply not resolving these problems for enough people. And so I think it's really important that as scientists, we explore new avenues no matter how controversial they might be and no matter how much they might contravene the current way of thinking.
So in...actually, towards the end of doing my PhD at the University of Calgary, my supervisor, Professor Bonnie Kaplan was approached by some families who were treating themselves with nutrients, and they were reporting getting well and staying well on these nutrients. And they had...you know, these members of these families had bipolar disorder and depression, some even had psychosis and yet these nutrients seemed to be helping them. And so my supervisor was certainly skeptical at the time and, you know, at first told them to go away, take their snake oil somewhere else, but she then was convinced by some data that they shared with her and showed her, you know, people getting well. And so she decided to study the nutrients in the earlier part of the century.
And so she and others actually published some very preliminary data in 2001-2002 that certainly convinced me that it was worthwhile looking at it. And, you know, taking that in the context of what I've just described, that in the long-term we're not doing very well in terms of addressing mental health issues, the number of people with psychiatric illness is going up, it's not going down despite receiving the best conventional care, that I decided to study the nutrients. And so that's what I decided to do back in well, over a decade ago, 2005-2006, and I haven't stopped.
Andrew: Okay, some of the smacks of my stance I guess when I was a registered nurse. I was totally blind, totally ignorant, totally arrogant, would not accept. You could have put any study in front of me and I wouldn't have accepted it. I merely would have said what I had been taught, ad verbatim, vitamins and herbs are of no use.
Julia: Yeah, absolutely.
Andrew: So how did you open up? What was it that changed or tweaked you to think, "Oh, maybe?"
Julia: Yeah. As it is for many people, it's seeing a case get better. And so my first study, my first case study that I published was on a young boy, a young man with OCD, and so obsessive-compulsive disorder. And he had actually been seeing me as a psychologist for over a year and I had, you know, given him the best cognitive behavioral therapy, as you know, the best treatments that are, you know, recommended for the treatment of OCD. And he had really marginally improved over that time. You know, we had a very good relationship, he didn't mind coming to see me, but if we looked at his symptoms, they had really only had a modest change over that period of time.
And so then I was in the situation where I was thinking about using the nutrients. I was skeptical. I was not sure what...you know, where I was going to go with that. And I had some of the...I had some free nutrients that had been given to me, a trial that we wanted to get going, we were struggling with it. There were some problems in getting it going and off the ground, you know many reasons for that that I don't need to go into. But I had these nutrients. And so I said to the family, "Look, I have no idea if these are going to work for you. There's a case study out there of a boy who had OCD symptoms, it seemed to have helped him. I have no idea this is going to help you, but, you know, we've offered you the, you know, psychotherapy." The family at the time were unwilling to try medications. And so I said, "What do you have to lose?" And so this young man took the nutrients, and he came in two weeks later and he and his mother said the OCD is gone. And you don't have that experience...
Julia: ...very often in my world.
Julia: That kind of thing happening to you. And so I paid attention. Because I'd heard about this from my supervisor, I have great respect for Bonnie Kaplan. She had told me about families getting well. You know, I trusted her. It's still hard to believe, even when someone tells you it. But when you see it, you see someone get well with nutrients, someone who you've worked with. You know it's not a placebo effect because you've worked with them for so long. There's no way it had anything to do with...I mean, it could, I suppose you could still claim it was a placebo effect. But it just was so dramatic, and we'd worked so hard to try to change this young man's OCD with really such little success that I was impressed. And so we monitored him over time. After eight weeks he was doing really well, the family decided to stop the nutrients, the OCD symptoms returned.
Andrew: There's your challenge.
Julia: And then we put him back on them and then his OCD symptoms got better. He went off. So we did what's called a classic A-B-A-B design with this young person and really saw that there was on/off, on/off control of the symptoms with or without the nutrients. So that was enough to get me really curious about what was going on.
And then, you know, up until then I was always like, "Vitamins and minerals, why..." You know, as you say, "Why would they work? That doesn't make any sense." But as soon as you delve into it you realize it couldn't make more sense. That every single biochemical process that happens in our bodies require cofactors. Cofactors are vitamins and minerals, and they're required for all of these chemical reactions to be occurring. So for us to be so arrogant, as you used that word, to suggest that it's meaningless, really is not doing...it's really doing a disservice to just understanding basic physiology.
Andrew: Absolutely. So how then do you talk, particularly now, given your understanding of over a decade of use, responsible use, of micronutrients, macronutrients in mental health disorders. How do you talk to colleagues who are still skeptical? Do you grab them round the throat and shake them around?
Julia: No, I've learned that doesn't work. I've learned that when someone's mind is closed, someone's mind is closed. And that's it's like with any debate, that they've formed an opinion and that they...it's very hard to shift them from there.
So I've just taken the approach of, "We use data." And so fine, if you're not going to listen to our early work. Our open-label trials were pretty much dismissed as, you know, that they were...you know, the reason why we observe people getting better on the nutrients was because, of course, was the strong placebo effect, and that that's why these patients were reporting themselves getting better. I mean, again, when we did an open-label trial of 14 adults with ADHD and just hearing these patients come in and just telling me they just hadn't felt so calm or so regulated, you know, just didn't have the ups and downs like they used to have. They just felt really...you know, just they felt normal, is often what people will tell me.
And so, you know, after a while, I've gotten used to those stories. But certainly in the early days I was still...I mean, I was still just as stunned that just vitamins and minerals could have such a powerful effect for some people. Certainly not everyone. I mean, not everyone responds, but, you know, a good proportion of people do. So I just...we've just collected...we just sit here in my lab and we run clinical trials. It's not my favorite pastime to do randomized controlled trials. In that they're challenging, they're difficult, it's hard to get people enrolled, you know, they take a long time, they're expensive. But that's what we have to do. Because that's what people will listen to, is that if you've done a properly designed randomized control trial, fully blinded, using a placebo, then it's hard at that point for people to ignore you. Especially if you...as we've been able to successfully do is to publish it in good journals.
Julia: I mean, that's been the other challenge is to actually publish this work. You know, just sometimes I go into this so naively. I think, "Okay, we've finished." Our first RCT with the adults with ADHD was our first blinded RCT. We've done a few RCTs after the earthquake but those weren't blinded. But our first blinded RCT, you know, it was done exactly like a drug trial. Where, you know, we’d, you know, followed the protocol of how you would have done it if, you know, you were using a stimulant instead of nutrients. And the statistician was independent of our program and analyzed the data independent of us. And, you know, done, you know, perfectly in those...you know, from those perspectives, as how you run an RCT. I was surprised at how hard it was to publish it and that the work was getting rejected by journals without even being reviewed.
Andrew: Oh, really?
Julia: Yeah. Yeah, it was. Again, it was like, "You know, I was told that your sample is too small." But, you know, when it comes to sample size, you do a power analysis and you determine what sample you need based on, you know, pilot data. And so we adequately powered it. You know, I had some ridiculous things like, "This is better for a child journal," which suggests that they didn't even read the title, which showed that it was with adults. I mean, it was really an interesting journey to find out and what types of excuses were used to prevent it from even being published.
But fortunately, we did get into the British Journal of Psychiatry, which is a really good journal. You know, well regarded. And it was at that point that, you know, people really then started to struggle that they couldn't ignore it anymore. That there was...maybe there was something to this. And so, yeah, that's what we've had to do. You know, a long answer to your question around, "How do you try to convince people and get them to change?" I think you have to do the hard work, hard labor of doing the types of trials that they will pay attention to.
Andrew: I'm so glad you covered the point though of power analysis. It's not often talked about. And this is something...in fact, perhaps you can give us a definition of what that really means when you're looking at...
Andrew: ...you know, psychiatric versus cardiovascular versus what sort of intervention you're trying to look at.
Julia: Yeah, okay. So a power calculation is where you decide how many people you need to put through your study in order to detect a significant effect. And so what's really important for your listeners to understand is that if you have a really, really big study with lots and lots of people in it, then it has the...that has the opportunity of being able to detect group differences. And oftentimes you'll detect group differences with really, really large studies.
But the group difference, it will actually tend to be quite small. So we've been a little bit...you know, ‘the wool pulled over our eyes’ in a way from really big RCTs that have been published by the drug companies. Because they often will have very large samples and they'll detect a group difference. And so they'll say that the...for example, the antidepressant was superior to placebo.
But what the lay person or the public won't realize is that the group difference is very small, because with those large studies you can detect very small effects. And that's...you know, in a way that's interesting, that's important. It's good to see that the, you know, the treatment group was better than the placebo group. But then we also have to think about magnitude of that effect. And so it's a very, very small group difference, but it's significantly different. At that point, you do have to weigh that small group difference. The benefit that you get by taking the antidepressant versus the potential risk based on the side effects. And so you really need to weigh those carefully.
But if you have a small sample and you detect an effect, that means that the group difference is much larger, and so that means that the effect is much larger. Because with a small sample you can only detect a large effect. So with our study, having a...what's usually viewed as a fairly small sample, there was 80 adults, you know, approximately 40 in each group. Then in that kind of situation if you find a significant group difference then your effect is going to be at least a medium to large effect. And so then that makes it more clinically relevant. And that's when if you have a large effect and then your side effect profile is really minimal, which it is with vitamins and minerals, at least based on the data that we've collected to date. Then you have a bit more confidence that it's worth trying this treatment because the chances of it working are much greater and the risks associated with it are much smaller. You know, relative anyway to the medication. So I don't know if that answered your question about effect sizes.
Andrew: No, that's perfect. Absolutely, perfect. But flowing on from that, we see for instance like, you know, antidepressants. You've really got to ‘flip the coin chance’ of it working or not working on a first choice of antidepressant. And I guess you hone that over time with regards to what might work or what doesn't for your patient.
Just including the micronutrient of zinc might help it to work better regardless of first choice. I guess where my flow on question from there is when you're looking at biochemistry and you're looking at adequate intakes of foods and micronutrients. Are we looking at a pharmacological effect here of the nutrient or are we only looking at correcting it efficiency? i.e., can we force our way through broken machinery, like the concept of methylation?
Julia: Yeah, you know, good question. Hard to answer. Not quite sure, but we think it's having a pharmacological effect. And so I think it's more than just correcting a deficiency, because correcting a deficiency would require much lower dose than what we're using. If you're just looking to prevent yourself from say getting scurvy or rickets. Then you don't need as high a dose of say vitamin C in that situation than if you are vitamin D… than if you're trying to determine what is optimal level for brain functioning.
But on top of that, you're talking about, "Is the system broken?" And we do wonder whether people who have mental illness do have something going on. Is it, you know, driven by genetics? Is it because of environmental insults? It's hard to know, but it may very well be that their biochemistry is not working as optimally as other people and that in turn, they, therefore, need more nutrients than what someone with a normally function biochemistry would need.
And so we might be, you know, dosing, having to give...provide more in order for that biochemistry to work...you know, to work optimally. So for the biochemical reaction to work, you might need to provide more enzymes and coenzymes, than you would if the biochemistry was working properly. And that might be because of SNPs in specific genes.
Andrew: Ahh, so here we get into something. So I'm going to tie this in, and it might seem distant, but the work of Professor Lyn Griffiths with regards to my migrainers on Norfolk Island. I asked her if she found an issue with methylation with regards to the SNPs and she didn't. She didn't see that she had to use the "active folate," she just used folic acid. She didn't seem to see this. Have you found this, though? Because it just seems to me to be not just an area of great interest. But what I'm getting from the feedback from clinicians is, you know, you can use one form and it will work not at all, or too much, might aggravate symptoms. So it really does seem to be quite personal.
Julia: Yeah. So I can't answer your question because we haven't been able to address that appropriately through research. So in our research, we are always giving people the same combination. And you can't really do anything other than that in a double-blinded trial. Because you can't individualize the approach, you can't give some people, you know, what you think would match that biochemistry versus giving somebody a different, you know, nutrient because of their biochemistry.
Andrew: Twelve-arm trial.
Julia: Yeah. So I've put a lot of thought into, "How can we do this and try to address things like the MTHFR, and, you know, are there people who would do better with methylated folate or others who would do better without it or just, you know, without any folate?" Because I've certainly heard about those issues that have been raised clinically.
So as far as I know at this point, you know, we've got a lot of the clinical data of people saying, "I think that some patients do better on this specific nutrient versus not using that specific nutrient," as you're describing, but whether...you know, as far as I know, the research isn't there yet. To say that there are...you know, if you've got a specific biochemistry then we need to match it, that just hasn't happened. We are doing our best to start to try to answer this, but it's actually not a simple thing to study.
Julia: To look at whether or not you can correct biochemistry through giving nutrients. Because you then have to look at, you know, whether or not you're changing the genetic expression, and that's not a simple thing to do nor is it a cheap thing to do.
So we are trying to explore this but, you know, whether or not we succeed in determining whether or not you can predict who should...you know, what nutrients you should give, given someone's biochemistry, I just don't think we're there yet. I know some people would argue with me, but I would say, "Just show me the data. Show me the data that someone does better, you know, on this particular nutrient versus another one," particularly when it comes to either methylated or unmethylated. I've heard a lot about it.
Andrew: Yeah, yeah, it's very contentious, and it just seems that, as you say, we're just not there yet. There are those people that make...that specialize in it. But the data isn't there to back that sort of choice of therapy up, at least now.
Julia: Yeah, you'd have to...you'd essentially have to do...you know, you could do it quite easily. Well, not that easily. But you could test somebody for MTHFR, for example, and you could then randomize people. You know, even if they've all got this genetic mutation you then randomize them to either, you know, one to another, one or another, and see what impact that has on their symptoms. I suppose you could do it that way. As far as I know, it hasn't been done. I'm just trying to think that's a single nutrient. There might be some stuff on that, but I'm far more familiar with the combination approach of what we've been doing, which is to give a whole bunch of nutrients at the same time and see what happens.
I mean, I've certainly reviewed the literature generally on using single nutrients and, you know, overall it's modest. Some people will benefit from that, others won't. And the overall effects are pretty small, with some exceptions. There's a few exceptions where you get larger effects. But, you know, the approach that we're taking is more of a shotgun approach. Give everyone the nutrients that are needed to make sure that the mitochondria are well fed, that the, you know, that you are addressing all of the nutrients that are required for the methylation cycle, that you're ensuring that the gut, you know, the gut bacteria are well fed with nutrients, and then see what happens.
Rather than taking the approach of, "Let's just try to fix this little bit of biochemistry that's wrong," because I just don't think we're at the point where we know what's wrong. And so to take that approach of, "Let's just give that one nutrient," it's actually not appreciating that they work synergistically together. You know, all the nutrients are working together. You look at the...you know, the biochemical processes to make neurotransmitters like serotonin, and you see that it requires a whole host of different nutrients.
Andrew: That's right.
Julia: And the same goes with the mitochondria and the Krebs cycle and making ATP. That a whole host of different nutrients are required. So why we would think that we could fix it with just one nutrient actually doesn't totally make physiological sense.
Andrew: No, it's a whole paradigm shift that people, if they want to embrace natural medicine, they really have to get out of pill-drug-type mentality.
Julia: One nutrient, yeah.
Andrew: It doesn't work that way.
Julia: Yes, I think you’re…exactly.
Andrew: That’s why we eat breakfast.
Julia: Exactly. That's why we eat a variety of food because that's what we need.
Andrew: So let's move on from there. Felice Jacka has done great work with diet and mood...
Julia: Yeah, I agree.
Andrew: ...mood disorders. Do you then employ or do you find effect of using micronutrients even given a poor diet or do you really need that foundation there first. That they have the diet and then micronutrients can work?
Julia: Yeah, yeah, great question. Okay, so we don't manipulate diet in any of our studies. So they come in and we have a great variety of diets that are being, you know, consumed by our participants. Some do have great diets and some of them come in with having just eaten at Kentucky Fried Chicken and bring in their, you know, Coca-Cola. So we accept anyone, and we don't make any comment about diet. Not that I don't think it's important. But because we can't have them manipulating their diets while we're giving them nutrients.
So we've looked at whether or not people change their diet and whether or not that might better explain the changes in symptoms over RCT, and that doesn't, that doesn't. People typically don't change their diet. There are a few who come in and go, "Oh, this is the study about nutrition, maybe I should change my diet?" And we've certainly had that happen.
Andrew: Right, the enlightened.
Julia: But it doesn't actually happen that often. That people kind of make...you know, they put two and two together and go, "Yeah, I should actually change my diet." But what we don't...I mean, what Felice's work has shown is that if you've come in with a really bad diet and you shift someone towards a healthier diet, like the Mediterranean diet, which is the smallest trial. Then you can have a positive impact on mood symptoms.
But the question is is that are there people out there who even when that happens and they get switched to a better diet, do they...do some people actually need more nutrients than what they would get out of a good diet? And that's something that we don't really know the answer to yet. So we'd have to do a comparison of the nutrients versus a dietary change perhaps? In order to know whether or not some people actually need more nutrients. I think some people do.
You know, having seen enough people go through our clinical trials and hearing about some people who've come in with fantastic diets. Eating really well, lots of fruits and vegetables, lots of fish, you know, healthy fat, nuts, etc., and they're still struggling with a lot of mental health symptoms then you know that that's not going to be enough for them. And they may have that type of biochemistry that just needs more nutrients, and that they may...that's in order for their biochemistry to get corrected.
So that's what I think, but we haven't been able to...we haven't studied that empirically. It's a really hard study to do. I mean, if we're going to get into that randomizing people to nutrients or dietary change, it's not a...that's a tricky study to run. Well, you can hear it already, there are no blind… So you'd have to...yeah, you'd have to try to solve that. I'd probably have to do a three or four-arm trial and then you're looking at 200 people. So I haven't gone there yet.
So for me, I see that as important, but I also think that my role at the moment is getting nutrition on the map. With our research and that we're showing that just giving vitamins and minerals can have a positive impact on mental health symptoms. And across the board we've looked at it with sleep, we've looked at it with ADHD, we've looked at it with stress, of PTSD following the earthquakes. So we've looked at it with a whole host of different symptoms. And yes, we see that these symptoms get better. And so we are putting on the map that this is relevant. You know, if you then take our research and you say, "Okay, let's eat better," fantastic. You know, that's great if we have that impact on getting people to really be considerate of what they're putting in their mouths. I'm delighted, even though I haven't done those types of studies. We can't supplement the whole world.
Julia: We'd much prefer that we invested in good food, ensuring that our soils are properly replenished with all the minerals that that are required. At the moment we don't do that enough, and so our soils are depleted in nutrients. There are challenges with, you know, just overall, the nutrient quality of our food. That does mean that for some people they have no choice but to supplement in those circumstances.
Andrew: I want to ask a question a little bit later about ligands of the micronutrients that you use, but in the meantime, with regards to...
Julia: I don't know if I can answer that question.
Andrew: What about things like compliance issues with regards to not being...you're not taking one little tablet to, you know, block...effectively block a biochemical process. You have to nourish things. And this is the issue that a lot of orthodox medical professionals have with nutrition is that, you know, you're getting a plate full of tablets sort of thing. How do you find the issue therefore of compliance with any sample size, but let's also include kids?
Julia: Right, getting them to swallow the pills, is that what you mean?
Julia: Yeah, yeah. So we have some really great data on compliance from our studies...
Julia: ...and so we collect pills after...you know, after a couple of every two weeks we collect back everything that we've given to them. We have them report back to us on how many pills or how many, you know, doses were missed so that we have a pretty good idea of whether or not we can get people onto this schedule.
So we work hard to get people in our clinical trials to take the pills 3 times a day because they needed to take up to 12 pills a day. So that's 4 3 times a day to get the full breadth of the nutrients that we're giving. So our experience has been yes, we can do it. And these are people with ADHD for the...you know, the ones that have been our blinded trials. So they are people who inherently struggle with, you know, remembering things, paying attention, all of those things. So we've been able to get people like that to follow the regime of taking the pills three times a day.
Julia: And so I guess the answer is you can do it. I mean, I think for some people they might require, you know, maybe some text reminders or other, you know, useful electronic reminders to help them get on track. But as soon as you get into the routine of taking it with every meal then we find that we can actually get people to remember.
There will be people out there who just can't do it, but I've been actually pleasantly surprised at the number of doses that actually do get consumed. And we can also confirm that, because we send them for blood work and we can see that nutrient levels are going up. So we do know that it's not just about them telling us what we want to hear, but that it's actually being...
Andrew: That was my next question.
Julia: Yeah, it's actually being confirmed by the nutrient levels in blood. Some nutrients don't change just because of homeostasis. So you'll never see a change in some of them. But there are nutrients that are good markers of compliance. Like B12 will go up if you're giving people a large amount of B12.
Andrew: Yeah. That's a salient point actually, the elegant machinery to bring the body back to homeostasis. You know, if you don't know what you're measuring or know why you're measuring it then you can say it's having no effect. This has been raised years ago with, for instance, oral glutathione. Do you employ more than just B vitamins and minerals though? Do you employ these, you know, nutrients called, you know, N-acetyl cysteine for tics and things like that? Do you find that they’re of any import? Or do you tend to look at the basic micronutrients minerals?
Julia: Yeah. Well, I haven’t. I'm a clinical psychologist, not a pharmacist and not a compounder, so I do not put the micronutrients together.
Julia: So remember the story that I told you, which was that there were these Alberta families who were treating themselves with nutrients. They're the ones who developed the formula that we've been studying. It has changed over time because that was over 25 years. Wow, is that about right? It probably was about 25 years ago. So the formula has changed over time. But that's the one that we decided...I decided to study.
For the most part, is that there's just no other company that's actually decided to provide or to produce a nutrient formula that targets mental illness. Most people, you know, many supplement companies will do things that target the ‘well population’. But not really mental illness. If you think about it, because there's more money in wellness. There's more people then that you can get to consume your products so why would you, you know, restrict yourself to a smaller percentage of the population, right? I mean, it makes kind of...you know, it does.
Andrew: It does make sense. I wonder, though, whether part of that might be claims. You know you can't claim, so...
Julia: Oh, goodness. Yeah, where do we go with that one? That's just a...you've just opened up...
Andrew: That's a nightmare.
Julia: ...a can of worms on claims. I mean, I could talk about that. I mean, so just to finish that story is that the company in Alberta made the product and specifically targeted for mental health symptoms. You know, they've gotten into a lot of trouble with Health Canada about claims. They don't put claims on their labels. That doesn't exist there. But people know that that's what the product is for.
But, I mean, I've...the nice thing about this particular formula and working with this company is that there are no strings attached. So I do not receive any money from the company, and they don't pay me to do this research. They give me the micronutrients and matching placebo for free, with absolutely no expectation of me...of what I do with that, the data that we collect. So that means that they don't...they can't influence me on what I publish, how I publish it, where I publish it, what study I run. They just give it to us for free. And they'll give it to any researcher anywhere in the world for free if they're going to research it.
So there's not a lot of companies out there that will give you their nutrients with no strings attached. I've certainly been approached by other companies over the years and, you know, I just say to them, "I'm happy..." People will say, you know, I'll get an email, "Why don't you study my product?" "Okay, I'll happily study your product, but these are the conditions. You give it to me for free, you give me a matching placebo, and you don't have any control over the data."
Andrew: It's got to be that way.
Julia: Who's going to agree to that?
Andrew: Yeah, there's no point. There's no point in doing that data if it's tainted from the outset.
Julia: Yeah, so that's why we've had to run it this...it's been so important to not be tainted in order for us again, to be taken seriously. Because if I had accepted any money from, you know, this company or any other company that we've studied their products. Because it's not just this one company, there are other ones that we study. Then I will get immediately tarred with a big brush stroke of huge conflict of interest.
And so I have been able to keep completely clean of any industry money. There's not a lot of researchers out there who can keep that claim. And that's been 10 years. So all our funding comes from independent sources, either, you know, people who are interested in our work, who decide to donate money to our research. Or that I've gotten small grants from, you know, different places that have managed to help me fund these studies. We run it very much on a shoestring budget. You know, there's not a lot of bells and whistles, and I do what I can do with the money that I've got. But we've been able to do an awful lot with a very little amount of money.
Andrew: Brilliantly done, brilliantly done to maintain your ethics.
Julia: Absolutely, otherwise...I mean, again, the number of people who have accused me of getting money, that's huge. You know, even, you know, in the British Journal of Psychiatry someone wrote a letter saying that they must have ties, you know, to the industry.
Andrew: They must have.
Julia: Even though we declared no conflicts of interest in our paper. I had to go back to them and say, "Well, actually, no, we don't. I mean, this is how it is. This is how we've chosen to run our research, is to have no...to receive no money from the industry." I think the pharmaceutical industry has become so corrupt that it's really, really hard to believe that there are some people out there that are actually...you know, will do it this way. We just had to. There was no way we could be taken seriously if we didn't do it this way. Yeah.
Andrew: What about looking at micro therapy...micronutrient therapy versus antidepressant therapy or, you know, stimulant therapy in mood disorders, behaviour disorders?
Julia: I mean, I've thought about it, and, you know, at this point I haven't done it, for lots of reasons. We really need to, again as I said before, we've got to put this on the map. And the only way we can put this on the map is just running, you know, head-to-head trials of placebo versus nutrients.
If you were to compare to stimulants. There's...in the short-term stimulants have such a huge impact on ADHD symptoms. Like in terms of these kids are suddenly, you know, within a few hours calmed down. That we would never be able to have that same level of effect in the short-term. And it would be very hard to run a very long-term study. So in the short-term, I think stimulants would win. And I always tell people that if you want to have a very quick change in your child's behaviour then micronutrients is not the way forward. Because the changes are going to occur very gradually over time, and so you're not going to have immediate hit within the next three or four hours that you take the micronutrients.
So they're apples and oranges. They have such a different effect. The stimulants are very...you know, so effective in that short-term that we can't...we simply can't compare. And that's not necessarily a bad thing, they just work very differently, and you just, at the end of the day have to weigh up, you know, the long-term effect and the risks and benefits. And that's where I think micronutrients will come ahead. It's like the hare. You know, is that the right...is it the hare that goes slow? Is that the one?
Andrew: The tortoise and hare.
Andrew: Tortoise and the hare, yeah.
Julia: Yes, the tortoise and the hare. Sorry, it's a tortoise, isn't it?
Andrew: Yeah, yeah, tortoise goes slower, but he wins.
Julia: Okay, sorry. Yeah, so your Ritalin is the hare, would that be right?
Andrew: That's right.
Julia: And your micronutrients are your tortoise. So I've just come up with that analogy. I hope it works. So the micronutrients are long-term. Like when we observe people over a long period of time. Not only do we see changes in the symptoms that we were targeting, but we also see wonderful changes in other areas as well. So we will hear of improved sleep, we will hear about stabilization of mood. They're a lot better regulated. Parents will tell us that their kids can be reasoned with now. And we don't take the...you know, the child can still be active. So we don't remove their activity. But, you know, my perspective as a parent, I would say do you really want to completely sedate your child?
Andrew: No, that's right.
Julia: Probably not. But, you know, it'd be nice if there was greater control over it. That's what the micronutrients seem to do. So they don't...you know, they don't sedate them, you know, they're still...they can still be lively kids. But they're less anxious or as I said, you know, their mood is more stable.
And I guess a parent has to weigh those things in the long-term, of, "Do I want to achieve an immediate change in their ADHD symptoms at the risk of having long-term potential challenges?" And we do know in the long long-term for stimulants is that the child will very likely be shorter than what they should have grown, and that in the long-term kids who are taking Ritalin are no better off than kids who haven't taken Ritalin. So their symptoms are exactly the same when you follow them over the long term. So you kind of say, "Okay, well is that worth it?" You know, that they're going to be shorter and their symptoms are going to be no better than someone who never took this drug. So, you know, that's I think what people have to consider.
And in the end, what we've noticed with micronutrients is if you stay on them then we continue to see good stability of their symptoms, maintained, that they're well...you know, that their symptoms are well controlled over a long period of time, and that seems to stay. That they continue...we continue to see that over time. We haven't...I mean, in terms of growth, we haven't looked at that in the long-term because we just haven't had that opportunity.
Julia: But we are intending to do that. But we do find that the kids eat, that the parents report that they actually have good appetites when they're taking the micronutrients as opposed to what you'd expect to see with the stimulant.
That was a long answer to your question of, you know, do we want to compare the micronutrients to drugs? And I just...you can see some of the challenges of, what would it achieve? Because we would actually just show that with respect to ADHD symptoms, you would probably get a bigger effect with the stimulants. But that may not necessarily be what you want. You know, what is actually in the best interest of that kid in the long term.
Andrew: When you're talking about the evolution of this product that you've been using, do you personalise it "to the Australian/New Zealand landscape?" I see actually quite a big difference there. But I guess, what I'm referring to here is in Australia, every pregnant woman since 2010 is now recommended to take not just their iodine-enriched food, but a supplement as well. Because the iodine-enriched food is not enough to support the needs of iodine in the pregnant woman.
Julia: Yeah, that's right.
Andrew: And the addition of this supplement has helped IQ levels and things like that in kids.
Julia: By just giving iodine.
Andrew: Just giving iodine. Now, just is it the same for the soils, the geological makeup of New Zealand?
Julia: Yeah, so iodine and selenium are very deficient in New Zealand...
Andrew: Got you.
Julia: ...and so those are, of course, two nutrients that we need to make sure that we do get in New Zealand. So we're currently running a pregnancy study, so I'm up-to-date on all of that.
Andrew: So that was my next question because we're talking about preconception to prevent this sort of thing from...or hopefully, to prevent these sort of disorders from happening in the first place.
But there's a couple of things I need to delve into, and that is, do you find...I know that your academic, looking after these studies and that, you know, your role is really the controller of these studies. But in practice, do you find that the long-term use of the stimulants to control behaviour or indeed the sedatives to control behaviour in some instances is actually doping down a gift that some of these kids might have?
Julia: I mean, I think some people would argue that that's exactly what they do. And I think that that would still be up for debate about whether or not that's actually what happens.
But what we do know with the stimulants is that there's no benefit to academic achievement, which is something that people should really stop and think, you know, you've got something that seems to be improving your concentration so that you can do your homework. And parents will tell us that their child is finally able to focus. And so you'd think that that should translate into better academic outcomes. But all the studies that have been done looking at long-term academic outcomes, there's no advantage to having taken the Ritalin.
Andrew: That's only on the Ritalin.
Julia: But you have to stop and wonder...that's on Ritalin.
Andrew: That's only on the Ritalin, yeah. What about with using micronutrients as well, is there any difference?
Andrew: With their academic performance.
Julia: Oh, academic performance. I think most of the studies, I haven't looked at this recent...really, really, recently, but my understanding of the studies that have been done using micronutrients for normal children is that there is some intellectual advantage...
Julia: ...that is conferred by using the nutrients. But it depends on the study. Because I don't think all the studies have necessarily shown the benefit. They haven't shown a decline. But some studies have shown that the kids who take micronutrients are at a greater advantage.
Andrew: I guess where my mind goes with this is I wonder if ever, you know, Einstein was known for his social ineptitude, and I wonder if he were born today would he be over-medicated, and would we be seeing the things that we term as genius?
Julia: Brilliant, yeah.
Andrew: So I've got to ask this question, are we really dumbing down some geniuses out there?
Julia: Oh, I don't know, I don't know. I hate to comment on that one. Yeah, that's happened.
Andrew: Another study.
Julia: So, I mean, there's certainly some research that's been done on creativity and ADHD. One of my PhD students many years ago looked at that. So, you know, there is a debate around whether or not kids who have ADHD whether or not they're creative. And we found that it was, you know, overall mixed findings on that one. So some kids are creative, some aren't. Some have ADHD and are creative, some are creative, don't have ADHD and etc., etc. So I guess I'm not going to...I don't want to be held on that one if Einstein was born today...
Andrew: No, that's fine.
Julia: ...would he have been medicated. Yeah, maybe, and would it have produced the brilliance? I don't know. Yeah.
Andrew: Now, you've got Medsafe as the regulatory body in New Zealand, we've got the TGA, which...
Julia: Yes, you do.
Andrew: ...despite its failings, really is the envy of the world with regards to quality testing and things like that, the manufacture. Would this supplement be approved for TGA, or would it …
Andrew: … because New Zealand is rather liberal in its inclusions of things?
Julia: Yeah, I mean, you raised...I mean you touched on this a little bit before about health claims, and that's sort of part and parcel of the legislation. So the problem is...I mean, it's very much a grey zone at the moment. We've had the National Health Products bill has been in front of Parliament at it’s third reading. I've been involved very much in petitioning it and preventing it from going through, and so far we've been really successful at preventing it from going through.
What it would essentially do, I mean, what they're claiming it would do is give greater confidence to Kiwis about claims that can be made on supplements, but it would also limit the doses that would be allowed so...basically take in the TGA limits that are there and apply them in New Zealand. And make it even worse because they would take some of the limits that are applied in Canada and take those, and basically take the lower limit. So we would really lose out in terms of opportunity to be able to use things at a therapeutic level.
Andrew: That's the whole point.
Julia: Oh, it's such an interesting...I mean, it's a really interesting area to delve into. Essentially, though, if you have...like, allowing health claims to be made on natural health products they say is a good thing. But if you actually start to delve into it, and, you know, there's a lot of health claims that have been proposed and put forward for New Zealand, you know, that will support, you know, mood, or will support cognitive functioning. But when you look at the research, and, you know, a really good example here is the VITACOG trial, which is a trial that came out of the UK that showed that if you use three B vitamins at a certain dose, and I can't, you know, I can't remember all the doses specifically, that they could assist in preventing cognitive decline. So that health benefit is allowed in New Zealand according to this new bill. But the doses that are required in order to match that health claim aren't allowed because they were putting limits on B12, like really low limits. Low limits on folate, etc. So they're saying that we're going to allow these health claims to be made but they're not allowing the manufacturer to use the nutrients at the level that is required in order to be able to make that health claim. Does that follow?
Andrew: Oh, yes. Call me a conspiracy theorist but I do stick to the adage that just because you're paranoid doesn't mean you're not being followed.
Julia: Exactly, exactly.
Andrew: And I wonder if this is a way, a backdoor way of allowing Codex Alimentarius to prevail.
Julia: Yes! You've got it, exactly. And so we all need to be really, really suspicious of that kind of legislation...
Julia: ...that wants to limit the levels. Because they also claim that it's about safety. And I've done a lot of submissions again to our government around safety of nutrients. And produced all the documents that are required in order to show that. For example, I mean, B12 is a great example. B12 is limited to a very small dose for...you know, based on the...for TGA. I mean, I know the TGA...I can't remember what it is, you know, it's just a few micrograms. You know, B12 is a good example. It's where they put a really low limit on it. And yet B12 is water-soluble and there's no toxicity related to B12 whatsoever, so there really shouldn't be a limit on it. There's no need for a limit on it, so why have they limited it? Why is that being put forward? So you have to then wonder what is the ulterior motive to put a limit on B12? Because we know that B12 is so important for a good mental health functioning. And we need it at those really high levels in order for it to have the impact.
So that's one of those really curious ones where they're claiming safety and keeping New Zealanders safe. But actually, the data don't support that. So when I started to...you know, started going through all of the five and a half thousand ingredients that are being put forward with all of their dose restrictions on them. And started to go through all the vitamins and minerals and see these dose restrictions, they were not logical, they were not based in science. And so that was my huge objection to the whole thing. Which is that they're saying it's about keeping Kiwis safe and it's not. And you guys have the TGA and you've got limits on your nutrients, and it's not about safety. It's about preventing nutrients from being used at a medicinal level. Because that's where...I mean, you can get these nutrients at those therapeutic doses, but it has to be registered as a medicine.
Andrew: Yeah, that's right.
Julia: And so do we really want nutrients to be limited? To have the access to limit...to nutrients be limited in that way? I would say we should resist that as much as we possibly can because that's essentially saying, "We're going to control and tell you how much nutrients that you're allowed to have." Selenium is a great example. Selenium has been limited, and I'm sure it's Australia and New Zealand as well at 150 micrograms. So you can get that amount of selenium out of five Brazil nuts, as long as they're from Brazil. So essentially they're saying, "Well, it's okay..." I mean, I could have 10 Brazil nuts. I'm assuming that there's no limit on the number of Brazil nuts that I'm allowed to consume. But if I want to take that in a pill form, I'm going to have to go to the doctor and get a prescription for it.
Andrew: Yeah, that's right. Yeah.
Julia: Just looking at mental illness, the statistics are showing that the number of people with mental illness is on the rise. We don't have...we haven't trained enough psychiatrists and psychologists in order to be able to meet the growing demand, nor will we ever be able to. You know, we don't have enough personnel on the ground to be able to meet all the needs of our community...
Julia: ...you know, with health professionals. And yet that's what we're, you know, expecting. Essentially how to solve this problem is that they'll just train more, train more, train more. Get more drugs, get more drugs, which is exactly what we're doing. You know, 1 in 10 New Zealanders is on an antidepressant. I'm sure it's similar in...
Julia: ...Australia and other countries. So that's how we're responding to this problem. How about we respond and say, "Okay, how about we look at their nutritional needs?" Because we know that they're probably deficient and that it's a pretty cheap option to see if we could just raise everyone's nutrient levels to a higher level. We probably eliminate a good chunk, not everyone, but a good chunk of people and be able to just resolve mental health problems in that group.
Then you leave the ones who are much more, you know, serious. If you just don't respond to that approach then, you know, we've got professionals available for that. But wouldn't it be nice if we could just take a little bit more charge of our...you know, educate our public and take more charge of things that they can do in order to improve their health?
Andrew: Professor Julia Rucklidge, I can't thank you enough for that. Particularly that last wrap-up paragraph. Because I can hear the emotion in your voice about...you know, it's almost...you're almost pleading for the government to take heed of the need for this sort of intervention to take place. So I thank you for joining us on FX Medicine. I wish you so much good fortune with your research that you're undertaking at the moment. And I'd love...
Julia: Thank you.
Andrew: ...to have you on FX Medicine at a future time. That'd be great.
Julia: Sure. Always happy to talk. Because these messages need to get out.
Julia: And we haven't successfully got the message out yet. So as long as that message doesn't...you know, hasn't broken through and people are telling me how everyone is on nutrients and we're kind bored of hearing about it, I need to keep talking.
Andrew: Well done. This is FX Medicine, I'm Andrew Whitfield-Cook.
|Prof Julia Rucklidge|
|TEDx Christchurch: Julia Rucklidge: The surprisingly dramatic role of nutrition in mental health|
|Prof Bonnie Kaplan|
Rucklidge J, Frampton C, Gorman B et al. Vitamin-mineral treatment of attention-deficit hyperactivity disorder in adults: double-blind randomised placebo-controlled trial. Br J Psychiatry 2014 Apr; 204(4):306-315
Rucklidge J, Taylor M, Whitehead K. Effect of micronutrients on behavior and mood in adults With ADHD: evidence from an 8-week open label trial with natural extension. J Atten Disord. 2011 Jan;15(1):79-91
Smith AD, Smith SM, de Jager CA et al. Homocysteine-Lowering by B Vitamins Slows the Rate of Accelerated Brain Atrophy in Mild Cognitive Impairment: A Randomized Controlled Trial. PLoS One. 2010 Sep 8;5(9):e12244