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Improvement in Cognition and Mood With Multivitamin/Mineral

Improvement in Cognition and Mood With Multivitamin/Mineral in Healthy Males
Commentary by: Tina Kaczor, ND, FABNO

Reference: Kennedy D, Veasey R, Watson A, 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.
Design: Randomized, placebo-controlled, double-blind trial

Participants: 215 healthy male volunteers ages 30-55 were recruited. 210 completed the study (placebo group = 107, multivitamin/mineral group = 103).
Intervention: 1 tablet daily of a multivitamin/mineral (Berocca®). Each tablet contained: B1 (15 mg), B2 (15 mg), B6 (10 mg), B12 (10 mcg), vitamin C (500 mg), biotin (150 mcg), folic acid (400 mcg), nicotinamide (50 mg) pantothenic acid (23 mg), calcium (100 mg), magnesium (100 mg), and zinc (10 mg).

Primary Outcome Measures: Cognitive assessment was done 1 day prior and 1 day following 33 days of intervention or placebo. A Profile of Mood States (POMS), Perceived Stress Scale (PSS), and the General Health Questionaire-12 (GHQ-12) were used. A 60-minute cognitive demand battery was also performed at baseline and study conclusion.
Key Findings: The intervention group had significant improvements in the PSS, the GHQ-12 and the "vigour" subscale of the POMS questionnaire. In addition, the intervention group performed better on the serial 3 subtraction test and reported they were less "mentally tired" both before and after the cognitive testing at the study's conclusion.

Clinical Implications: The use of vitamin/mineral supplementation in healthy adults is growing in popularity. Whether this is beneficial in populations assumed to be nutrient-replete and without any pathology is not known. This study, while small, suggests that cognitive and mood improvements may be seen as soon as 1 month after beginning a B complex with vitamin C and calcium/magnesium/zinc.

As with any nutrient intervention study, the question of nutrient deficiency in participants prior to the intervention must be asked. This Swiss study is notable for its recruitment of healthy, fully employed males, a population presumed to be adequately nourished. While adequate nutrient status was assumed, no serum measurements were performed. Intake of fruits and vegetables was 3.71 servings on average in the intervention group. In a 2005 U.S. survey of fruit and vegetable consumption, only 27.2% of adults ate 3 or more servings of vegetables per day.1The significant improvement in cognitive ability and mood from the supplemental intervention in this trial implies that participants had suboptimal levels of one or more of the nutrients contained in the supplement. Since these participants' intake is higher than that of the majority of Americans, one can presume that suboptimal levels may also exist in our patients who are otherwise "healthy."

This is not the first study that demonstrates mood improvement with B complex/vitamin C/mineral formula. Schlebusch et al showed that after 28 days of supplementation there was significantly decreased anxiety and improved sense of well-being.2 In another trial of 28 days, Carroll et al found that supplementation led to improved GHQ scores and a decreased perception of stress as assessed by the PSS scale.3 In a study assessing 12 months of supplementation, Benton et al showed that there was a significant improvement in mood in females.4
For the practitioner of natural medicines, these results are not surprising. B complex is a foundational supplement in most protocols for our patients feeling "highly stressed." Indeed, B vitamins' reputation in helping to cope with stress is well established in the public domain as well, as evidenced by product names such as "Stress B Complex." But to what extent is supplementing with B vitamins, vitamin C, and minerals such as calcium, magnesium, and zinc a good idea for otherwise healthy adults?

The answer to this question is unclear. What is clear is that the risk of supplementing these nutrients is negligible, but comes with significant potential benefit. While it is often espoused that a nutrient-rich diet should be able to provide all the vitamins and minerals one needs to function optimally, this study suggests otherwise. There is little debate that it is prudent for everyone to increase their intake of fruit and vegetables in an effort to consume adequate nutrients through diet. This study, along with the others that corroborate it, may be impetus for us to hedge this assumption of adequate intake with a little supplementation as well.

1. Centers for Disease Control and Prevention. Fruit and vegetable consumption among adults--United States, 2005. MMWR Weekly Report. 2007;56(10);213-217.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5610a2.htm. Accessed December 1, 2010 2. Schlebusch L, Bosch BA, Polglase G, Kleinschmidt I, Pillay BJ, Cassimjee MH. A double-blind, placebo-controlled, double-centre study of the effects of an oral multi-vitamin/mineral combination on stress. S Afr Med J. 2000;90:1216-1223.
3. Carroll D, Ring C, Suter M, Willemsen G. The effects of an oral multivitamin combination with calcium, magnesium, and zinc on psychological well-being in healthy young male volunteers: a double-blind placebo-controlled trial. Psychopharmacology. 2000;150:220-225.
4. Benton D, Haller J, Fordy J. Vitamin supplementation for 1 year improves mood. Neuropsychobiology. 1995;32:98-105.