Monday, 24 September 2012

Micronutrients for stress and anxiety after earthquake

Lycosthènes @ Wikipedia
The junction between stress, anxiety and environment is of particular interest to this blog. I don't pretend to be an expert on the various mechanisms at work in such a relationship but, based on quite a thorough reading of some of the autism research literature in this area, I am beginning to understand how anxiety, chronic anxiety in particular, is a debilitating condition and plays a primary role in the reduction in quality of life for many, many people.

Moving slightly away from the autism link, I've talked before about some interesting research by Julia Rucklidge and colleagues at the University of Canterbury, New Zealand and their studies following the 2011 earthquake described at the time as " New Zealand's darkest day".

The main premise of that research was that supplementation with various micronutrients - vitamins, minerals and other compounds - may increase 'resiliance' to stress and anxiety associated with highly stressful events like earthquake in individuals diagnosed with ADHD and asymptomatic groups. Quite a bold claim I'm sure you would agree.

Today I'm following up that earlier post as a result of the fairly recent publication of this paper by Dr Rucklidge and colleagues* looking at different micronutrient formulations and their impact on stress and emotions linked to the 2011 earthquake (see trial database entry here). I apologise that I cannot post a link to the full-text paper but hope a short summary from me will suffice:

  • Two formulations were evaluated which, to save any commercial advertising issues, I will refer to as B and C, dispensed to 91 participants exhibiting heightened anxiety or stress a few months after the earthquake (B: n =30; C low dose: n=31; C high dose: n=30) based on a random allocation. A separate group of 25 people who either initially declined to participate or did not meet inclusion criteria acted as a non-randomised control group.
  • Various measures of anxiety and stress were delivered and completed at baseline and 4-weeks (study end). Measures included: the Depression Anxiety & Stress Scale (DASS), the Traumatic Exposure Severity Scale (TESS) and the Impact of Event Scale (IES) alongside other measures.
  • Results: all three treatment groups showed a significant decrease in measures of anxiety and stress following supplementation (based on change in scores between baseline and 4-weeks active treatment). Comparisons with the non-supplemented control group also revealed significant improvements in "stress, anxiety, avoidance, and arousal after 4 weeks of consumption of micronutrients".
  • Across the two preparations and different dosages, there were a few differences related to mood, anxiety and energy which have been put down the slightly broader spectrum of nutrients included in formulation C over formulation B. 

Appreciating that there are a number of potential forms of bias to be had in this type of research including a lack of blinding and no placebo as a control, I have to say that I am quite impressed with the reported findings. The authors have gone to some lengths to control for as many factors as possible (being free of psychotropic medication, exclusion of various conditions/states including neurological disorders) and looked at various angles including SES, alcohol/caffeine/smoking/drug use, mental health history, etc as potential influencing variables. Also importantly reporting potential adverse effects from supplementation.

I kinda like the suggestion that the stress and anxiety of being involved in such a horrific natural act might to some degree be abated by simple supplementation with an off-the-shelf micronutrient supplement. Even if it is purely a placebo action - 'take this pill it will help with your anxiety and stress' - giving a daily vitamin-mineral supplement after a disaster like that knocking out infrastructure and interfering with access to food for example, is probably not such a bad idea also in light of the increased risk for disease following such natural disasters (see the Haiti earthquake for a good example). It has to be slightly less expensive and more easy to administer than a few sessions of behavioural therapy or a course of more traditional pharmacotherapy even just as an emergency measure?

The authors do discuss some of the research on how certain components of the micronutrient preparations used might potentially be able to affect symptoms like stress. I'm taken back to the work of David Kennedy and colleagues at Northumbria University and their reports on high-dose vitamin B and vitamin C supplementation on perceived stress in healthy volunteers** (under placebo-controlled, double-blind conditions). There are several hundred more references on this topic also.

Finally, one has to wonder how deep the rabbit hole goes with regards to micronutrient supplementation and stress and anxiety. Outside of the natural disaster bit, could this work imply that nutritional supplementation might be an alternative route to treating anxiety and stress in the general population? (or at least some cases of anxiety and stress). Physiologically what are the mechanisms of effect, acknowledging snippets of research of interest to me on things like gut hyperpermeability and stress (see here)? What about those trillion or so bacteria which reside in our deepest, darkest bowels; how do they respond to stress and what action can they exert? (I note that this same team are going to be looking at a probiotic formulation in a subsequent trial). Even the possibility of trauma being transmitted across generations as per this interesting post on pregnant 9/11 survivors and the emerging field of epigenetics? Lots and lots of questions to answer.

To finish, how about a little piano genius from Ben Folds Five (and Fraggle Rock?).

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* Rucklidge JJ. et al. Shaken but unstirred? Effects of micronutrients on stress and trauma after an earthquake: RCT evidence comparing formulas and doses. Human Psychopharmacology. July 2012.

** Kennedy DO. et al. Effects of high-dose B vitamin complex with vitamin C and minerals on subjective mood and performance in healthy males. Psychopharmacology. 2010; 211: 55-68.

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ResearchBlogging.org Rucklidge JJ, Andridge R, Gorman B, Blampied N, Gordon H, & Boggis A (2012). Shaken but unstirred? Effects of micronutrients on stress and trauma after an earthquake: RCT evidence comparing formulas and doses. Human psychopharmacology PMID: 22782571