A randomised trial of nutrient supplements to minimise psychological stress after a natural disaster
Introduction
When natural disasters strike, one of the first daily functions to be impaired is the ability to obtain and prepare nutritious food. Hence, at a time when stress and anxiety are elevated, the nutrition needed to maximise mental health may be in short supply.
It is logical to consider that enhancing people's intake of minerals and vitamins (micronutrients) might be helpful for coping with natural disasters, as it has been known for centuries that a good diet can help optimise health. For example, micronutrients act as cofactors in neurotransmitter synthesis and metabolism, where they can be rate-limiting factors (Ames et al., 2002). There are at least seven randomised controlled trials (RCTs) of B-Complex and combined mineral/vitamin formulations in which improvements in depression, anxiety and stress have been demonstrated (Carroll et al., 2000, Harris et al., 2011, Kennedy et al., 2010, Lewis et al., 2013, Long and Benton, 2013a, Rucklidge et al., 2012, Schlebusch et al., 2000) although not all trials using broad-spectrum micronutrients have shown benefit for changing mood and anxiety (Cockle et al., 2000, Haskell et al., 2010, Haskell et al., 2008). However, all the negative trials were conducted on people who had no presenting psychological/psychiatric challenge. Further, a recent meta-analysis showed a small but meaningful effect of micronutrients on stress and anxiety but not mood (Long and Benton, 2013b).
The information most directly relevant to the context of natural disasters is the series of studies conducted in Christchurch, New Zealand after the earthquakes of 2010–11. When the 7.1 magnitude earthquake hit on September 4, 2010, the Mental Health and Nutrition Research Group at the University of Canterbury was in the midst of conducting a clinical trial of a broad-spectrum mineral/vitamin formula in adults with ADHD, but some individuals had completed the trial or not started the trial and therefore were not taking it on the day of the earthquake and the following weeks. Two weeks after the earthquake, those who were taking the formula at the time of the earthquake were significantly less anxious and stressed than those not taking it (Rucklidge and Blampied, 2011, Rucklidge et al., 2011). Subsequently, when the February 22, 2011 earthquake of 6.3 magnitude struck, this research group immediately implemented a randomised trial in the general population, comparing two doses of the same formula to a B Complex formula (Rucklidge et al., 2012) previously shown to be efficacious for the treatment of stress and anxiety (Carroll et al., 2000, Kennedy et al., 2010, Schlebusch et al., 2000). A nonrandomised group of adults from the community who did not take any micronutrients served as the control group. Those taking the nutrients showed significantly lower levels of Post-traumatic Stress Disorder (PTSD) symptoms after one month as compared with the controls, and those taking the higher dose of the broad-spectrum micronutrient formula reported greater improvement in mood and anxiety than those taking the B-Complex.
In June 2013 a combination of Rocky Mountain snowmelt plus heavy rain caused a devastating flood in southern Alberta, Canada. River flow rates more than tripled in a few hours and over 100,000 people were evacuated from their homes. As in New Zealand, a group at the local university had been studying the potential benefit of multinutrient treatment of stress and anxiety, so the flood provided an opportunity to try to replicate the New Zealand earthquake studies to determine the generalizability of those findings to natural disasters. The research design allowed us in addition to investigate whether a single nutrient (vitamin D) or broader spectrum of nutrients were comparable at reducing psychological symptoms. Three micronutrient formulas were evaluated for their impact on depression, anxiety and stress associated with the Alberta floods.
Section snippets
Methods
At study entry (baseline) questionnaires assessed (a) exposure to the flood, (b) overall impact of the flood on physical and emotional health, (c) diet quality, and (d) depression, anxiety and stress. Those who qualified for the study were randomly allocated to one of three treatment groups (single nutrient, B-Complex, and broad-spectrum mineral/vitamin (BSMV)). Vitamin D was selected as the single nutrient comparator because of some prior evidence based on a meta-analysis of its benefit
Results
The sample consisted of 56 participants, 17 assigned to vitamin D, 21 to B-Complex and 18 to BSMV (see Fig. 1 for the CONSORT diagram and Table 2 for demographic information). Baseline comparisons between groups showed no significant differences for any demographic characteristics.
There were no differences in treatment-emergent adverse events across groups (data not shown). Five people from the vitamin D group, 2 from the B-Complex group, and 4 from the BSMV group dropped out at some point
Discussion
This trial found that people consuming the B-Complex or the BSMV formulas showed significantly greater reduction in stress and anxiety compared with those consuming only vitamin D. Based on the primary and secondary outcome measures, the groups consuming the B-Complex or the BSMV formulas showed significant changes on all variables from beginning to end of treatment. The vitamin D group showed significant changes on all variables except the Anxiety subscale of the DASS and the Arousal subscale
Author contributions
BJK directed the study, interpreted results, and wrote the first draft of the manuscript; JJR directed the analysis and interpretation of the results; AR established all data collection procedures to be parallel to the study being replicated, and interpreted the results; MD coordinated the study, supervised the interviewers, and managed the data entry and analyses. All authors edited the final version of the manuscript.
Conflict of interest
No author has any conflict of interest or financial relationship to report.
Acknowledgments
This research was funded by a University of Calgary private donor fund. We thank the two companies who donated the nutrients: Douglas Laboratories (who provided the vitamin D and B-Complex) and Truehope Nutritional Support (who supplied the Truehope EMP™). We thank our study interviewers Marsha Carnat, Amanda Loven, Marcus Kupila, Wendy Salvisberg, and Lida van den Hadelkamp, We also express our gratitude to the participants, who joined this study during a very stressful time in their lives.
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