While proper nutrition has intuitively been accepted by clinicians and patients as essential to a healthy life, there is now a moderate body of research that has shown an association between a nutrient-dense diet and better mental health. Some studies have shown a correlation between a nutrient poor, ultra-processed food diet and the onset of poor mental health. In addition, randomised controlled trials (RCTs) have demonstrated that increasing the consumption of real, whole foods while decreasing ultra-processed foods improves mental health outcomes. Reference Bizzozero-Peroni, Martínez-Vizcaíno, Fernández-Rodríguez, Jiménez-López, Núñez de Arenas-Arroyo and Saz-Lara1
However, there is increasing evidence that at least a subset of individuals may not be obtaining the necessary vitamins and minerals from diet alone. The most obvious cause for this is the increasing manufacture and promotion of ultra-processed food, so that in many Western countries it makes up around 50% of the calorie intake proportion of dietary intake. But other contributors include changes in farming practices which prioritise yield over nutrient density, over-tilling while fertilising the soil with limited essential nutrients and the use of herbicides which impair mineral absorption. There is also concern that higher levels of CO2 leads to decreased nutrient density in crops. Reference Rucklidge, Bruton, Welsh, Ast and Johnstone2
Plausible mechanisms linking minerals and vitamins to mental health include their role in supporting the brain metabolic functioning and microbial diversity, acting as anti-inflammatory agents, involvement in neurodevelopment and the production of neurotransmitters as well as modulating genetic expression and cell signalling. Reference Rucklidge, Bruton, Welsh, Ast and Johnstone2
As Western diets have shifted to more ultra-processed foods, a widespread view has emerged that we have – to use a cliché – a ‘mental health crisis’, particularly in young people. There is evidence that mental health among students and other groups has been steadily declining over the past two decades. Alongside this has been an increasing recognition that around 15–25% of the population are neurodiverse. Whether this is related to increasing prevalence or increasing recognition is a subject of debate. To link these changes to diet is too simplistic; there are multiple factors involved in mental health distress. But eating food deficient in minerals and vitamins is one factor that might be contributing. More importantly, unlike many other proposed contributors – social media, climate change, artificial intelligence, genetics – it is something that can be corrected relatively easily.
In addition, the high rates of mental distress are not well managed by traditional individual psychotherapies or drugs (even if countries had the resources to do so), so alternative treatments need to be considered.
Broad-spectrum micronutrient formulations
Initial attempts to improve mental health using mono-supplementation, even when single deficiencies are corrected, showed small to no effects on mental health. Therefore, recent studies have focused on broad-spectrum micronutrients (BSM). This has been somewhat arbitrarily defined by Popper as a formulation that includes at least 10 different vitamins and minerals. Reference Popper3
Independent researchers have studied the effectiveness of three commercially available BSM formulas: EMPower Plus, Daily Essential Nutrients and the Autistic Nutrition Research Centre essentials. Over time, the manufacturers have made slight modifications to BSM formulations. Each formula has approximately 30 minerals and vitamins.
What has research found?
Across several randomised, double-blind, placebo-controlled trials, researchers from New Zealand and North America have examined the effects of broad-spectrum micronutrient formulations, primarily in paediatric populations but also in adults with mood and stress-related difficulties. In children and adults with attention-deficit hyperactivity disorder (ADHD) and associated emotional dysregulation, multiple RCTs have demonstrated modest but inconsistent effects on core ADHD symptoms. However, more robust improvements in emotional regulation, irritability, aggression, overall functioning and clinician-rated global improvement, with small-to-medium effect sizes and favourable tolerability profiles have been reported. Reference Rucklidge, Johnstone, Villagomez, Ranjbar, Kaplan and Dinan4
The US-based MADDY trial further showed that children randomised to micronutrients exhibited greater linear growth over the trial period compared with placebo, addressing concerns regarding growth suppression commonly associated with stimulant medications. Reference Johnstone, Hatsu, Tost, Srikanth, Eiterman and Bruton5 Extension and duration studies suggest that clinical gains are maintained or increase with continued exposure. A 12-week RCT conducted with adults experiencing anxiety and/or depression using BSM (NoMAD) reported significantly faster improvements in both mood and anxiety symptoms compared with placebo, but both groups self-reporting similar rates of response (49% on micronutrients, 44% on placebo) with sustained effects observed in naturalistic follow-ups. Reference Blampied, Tylianakis, Bell, Gilbert and Rucklidge6
The NUTRIMUM RCT Reference Bradley, Moltchanova, Mulder, Dixon, Henderson and Rucklidge7 investigated BSM for antenatal depression, demonstrating symptom improvements during pregnancy. Again, effects were stronger in the clinician-rated assessment of improvement than in specific ratings of depression. Reduced incidence of postnatal depression at six-month follow-up, indicated potential downstream benefits extending beyond the acute treatment phase. Reference Rucklidge, Bradley, Campbell, Heaton, Moltchanova and Dixon8 Complementary findings emerge from randomised trials conducted by Adams and colleagues in children with autism spectrum disorder (ASD), where micronutrient treatment produced greater improvements in overall health, adaptive functioning and related behaviours than in core ASD symptoms per se, reinforcing a pattern of broader functional gains rather than disorder-specific symptom resolution. Reference Adams, Audhya, McDonough-Means, Rubin, Quig and Geis9
What are the implications of this research?
There are now sufficient RCTs to allow some general, albeit tentative, points to be made. The first is that overall health and adaptive functioning appear to improve more consistently than core symptoms of the disorder being treated. Clinician-rated and patient-rated improvement in psychological functioning, as well as emotional regulation, irritability and aggression robustly show significant positive effects across different diagnostic groups. Core ADHD and depressive symptoms less consistently so.
The second is people, including children and adolescents, are able to take 10–12 tablets per day. In most trials, adherence has been high. The third is that adverse events are minimal and well tolerated. The most common are some nausea and/or gastrointestinal issues in the first few weeks of taking nutrients.
Overall, across trials, adherence has been high, blinding adequately maintained and adverse events minimal. Collectively, this body of RCT evidence supports broad-spectrum micronutrients as a low-risk, adjunctive intervention with particular relevance for emotional dysregulation and functional outcomes.
Why might one intervention have a broad impact?
There is understandable scepticism that a single intervention may have broad impact across psychiatric disorders and psychological distress. However, different psychiatric disorders have been linked to a wide variety of alterations in brain activity, including fronto-limbic circuitry, neurotransmitter signalling, inflammatory activity, mitochondrial and oxidative stress regulation and stress response systems, including hypothalamic–pituitary–adrenal axis function. BSM engage these interconnected processes through non-redundant mechanisms, including support for neurotransmitter synthesis, mitochondrial energy metabolism, immune regulation and microbial diversity. Together, these convergent effects provide a rationale for why individuals with different problems collectively respond to an intervention that targets multiple neurobiological processes simultaneously rather than a single pathway. Reference Rucklidge, Bruton, Welsh, Ast and Johnstone2
Drug-nutrient interactions
Consistent clinical observations report that there is potentiation of psychiatric medications when combined with BSM. While there are no specific clinical trials, it is advised that psychiatric medications are tapered when using BSM. This may be done after starting BSM and tapering as side effects appear or, depending on patient preference, tapering and stopping the psychiatric medication before beginning BSM. There are no reports of serious interactions between psychiatric medications and BSM.
Future directions
Like all fields in psychiatry, replication using larger samples with more variation in symptom severity would help clarify mechanisms, prediction of response and comparative effectiveness relative to standard treatments. In addition, studies in more diverse populations are necessary. The most obvious are children and adolescents with neurodiversity. Post-hoc analyses of those identified as neurodiverse in the teen study showed benefit for associated symptoms such as dysphoria, prosocial behaviours, conduct symptoms, suicidal ideation and quality of life. Given these symptoms would not necessarily improve with current treatments, the findings are notable.
We believe that the evidence base for BSM has reached the level where it should be presented as part of an informed choice when considering treatment for ADHD, antenatal depression, emotional dysregulation, aggression, as well as overall psychological functioning. This is very unlikely to happen at present since most clinicians have minimal knowledge of BSM and its effects. While effect sizes are modest, they are similar to alternatives such as cognitive–behavioural therapy (CBT) and antidepressants. BSM is also cheaper and easier to access than CBT and has significantly fewer side effects than antidepressants. It is time for psychiatry to update its reductionist aetiological models of psychopathology and include holistic approaches to improving mental health. By doing so, we might both improve mental health outcomes alongside reducing the burden on overstretched healthcare systems.
Acknowledgement
No artificial intelligence tools have been used in the research or writing process for this manuscript.
Author contributions
R.T.M. and J.J.R. conceptualised the manuscript. R.T.M. drafted and J.J.R. revised the manuscript.
Funding
The study received no specific grant from any funding agencies, commercial or not-for-profit sectors.
Declaration of interest
R.T.M. is a member of the B JPsych editorial board but did not take part in the decision-making process for this paper. J.J.R. has no conflict of interest to declare.
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