1. What is the decision or change (e.g. clinical topic, practice guideline, system design, delivery of care) you are facing or struggling with where a summary of the evidence would be helpful?
A summary of evidence on the potential benefits, drawbacks and uses of dietary supplements in prevention and treatment of mental health and substance use disorders could be useful to health professionals, behavioral health patients, family members and others.
With the HHS/USDA dietary guidelines recently updated, some have noted the importance of acknowledging the differing diets of various subpopulations (1). In general, nutritional research has been underemphasized (2). A slight majority of all adult Americans and substantial numbers of racial and ethnic minorities consume dietary supplements (3). Similarly, about half of children are given dietary supplements by their parents or caregivers (4). The recent and ongoing COVID-19 public health emergency has heightened interest in the impact of dietary supplements on health, though benefits of any particular supplement for prevention or treatment of COVID appear at this time to be fairly modest (5).
Dietary supplements can enhance micronutrient access and intake, though they probably cannot replace a healthy diet based on consumption of healthy foods (6). With respect to behavioral health, additional research in this area could have broad benefits, including for racial and ethnic minority populations (7). For instance, are some subpopulations more at risk of behavioral health conditions (or less so) due to dietary factors and can any risks be mitigated and potential benefits more broadly applied? To what extent can dietary supplements, alone or in conjunction with approved medications, enhance the treatment of behavioral health conditions? (8). What are the potential risks of dietary supplement use, if any, for those with behavioral health conditions? (9). What impact can changes in diet have on mental health and functioning in institutional settings (10).
While there has been growing interest in the impact of dietary supplements in the mental health area, as reflected in references cited below, also of interest is the impact of diet on substance use disorders (11). In contrast to the mental health area where there appear to be a fair number of reviews and studies, though not well-synthesized or comprehensively reviewed, studies appear to be fairly limited in scope and less common with respect to diet and treatment and recovery of substance use disorders. An AHRQ evidence review could consider dietary supplements and substance use disorders as a separate topic or in the same review as mental health conditions, perhaps appropriate given the frequency of co-occurring mental health conditions and substance use disorders (12).
- https://civileats.com/2020/07/28/should-the-dietary-guidelines-help-fight-systemic-racism/; https://www.dietaryguidelines.gov/resources/2020-2025-dietary-guidelines-online-materials; National Academies of Sciences, Engineering, and Medicine 2022. Challenges and Opportunities for Precision and Personalized Nutrition: Proceedings of a Workshop. Washington, DC: The National Academies Press.
- C. Boudreau and HB Evich, How Washington keeps America sick and fat, Politico, https://www.politico.com/news/agenda/2019/11/04/whywe-dont-know-what-to-eat-060299; https://theconversation.com/why-nutritional-psychiatry-is-the-future-of-mental-health-treatment-92545.
- ED Kantor et. al., Trends in Dietary Supplement Use Among US Adults From 1999-2012. JAMA. 2016;316(14):1464–1474.
- Healthy Eating and Use of Dietary Supplements in Children, Mott Poll, April 2022, https://mottpoll.org/reports/healthy-eating-and-use-dietary-supplements-children.
- Speakman LL, Michienzi SM, Badowski ME. Vitamins, supplements and COVID-19: a review of currently available evidence. Drugs Context. 2021;10:2021-6-2. https://ods.od.nih.gov/factsheets/COVID19-HealthProfessional/.
- JB Blumberg et. al., Contribution of Dietary Supplements to Nutritional Adequacy in Race/Ethnic Population Subgroups in the United States. Nutrients. 2017;9(12):1295. Published 2017 Nov 28. doi:10.3390/nu9121295; 2015-2020 Dietary Guidelines for Americans, https://www.dietaryguidelines.gov/current-dietary-guidelines/2015-2020-dietary-guidelines.
- J. Firth et. al., Food and mood: how do diet and nutrition affect mental wellbeing? BMJ, BMJ 2020;369:m2440; RAH Adan, Nutritional psychiatry: Towards improving mental health by what you eat, European Neuropsychopharmacology (2019) 29, 1321–1332; JE Banta et. al., Mental health status and dietary intake among California adults: a population-based survey, International Journal of Food Sciences and Nutrition, 2019; DOI: 10.1080/09637486.2019.1570085; J. Sarris et al. Nutritional medicine as mainstream in psychiatry. Lancet Psychiatry. 2015;2(3):271-274; FN Jacka, Nutritional Psychiatry: Where to Next?. EBioMedicine. 2017;17:24-29.
- S. Demelash, The Role of Micronutrient for Depressed Patients. J Neuropsychopharmacol Mental Health 2017; 2:116; D. Ramsey Vitamin deficiencies and mental health: How are they linked?, Current Psychiatry, 2013, 2(1):37-44, https://www.mdedge.com/psychiatry/article/64985/depression/vitamin-deficiencies-and-mental-health-how-are-they-linked S. Gillihan, Micronutrients in Psychiatry: Sound Science or Just Hype?, Psychology Today, Feb. 2019, https://www.psychologytoday.com/us/blog/think-act-be/201902/micronutrients-in-psychiatry-sound-science-or-just-hype; J. Rucklidge and BJ Kaplan, Nutrition and Mental Health, Clinical Psychological Science 2016, Vol. 4(6) 1082–1084; RA Clay, The link between food and mental health, APA Monitor, Sept. 2017, 48(8); https://www.cochrane.org/CD004692/DEPRESSN_omega-3-fatty-acids-depression-adults; https://nutritionguide.pcrm.org/nutritionguide/view/Nutrition_Guide_for_Clinicians/1342091/all/Schizophrenia#4
- F. Or et al. Taking Stock of Dietary Supplements’ Harmful Effects on Children, Adolescents, and Young Adults, J. of Adolescent Health, June 5, 2019; 65(4): 455-461.
- https://www.sciencefocus.com/the-human-body/prison-food-nutrition-violence-mental-health/; https://frac.org/blog/school-meal-participation-contributes-positive-mental-health-outcomes; J. Johnstone et. al. Micronutrients for Attention-Deficit/Hyperactivity Disorder in Youths: A Placebo-Controlled Randomized Clinical Trial, J Am Acad Child Adolesc Psychiatry 2022;61(5):647–661.
- S. Simpson et. al. Drugs and Bugs: The Gut Brain Axis and Substance Use Disorders, Journal of Neuroimmune Pharmacology https://doi.org/10.1007/s11481-021-10022-7/; Mahboub N, Rizk R, Karavetian M, de Vries N. Nutritional status and eating habits of people who use drugs and/or are undergoing treatment for recovery: a narrative review. Nutr Rev. 2021;79(6):627-635. doi:10.1093/nutrit/nuaa095; Chavez, M. N., & Rigg, K. K. (2020). Nutritional implications of opioid use disorder: A guide for drug treatment providers. Psychology of Addictive Behaviors, 34(6), 699–707. KD Jeynes, EL Gibson, The importance of nutrition in aiding recovery from substance use disorders: A review,Drug and Alcohol Dependence, 2017, 179: 229-239; https://nutr.uw.edu/project/nutritional-concerns-in-substance-use-disorders/; https://casatondemand.org/2021/05/19/the-importance-of-nutrition-in-recovery-what-the-research-shows/?utm_source=Facebook&utm_medium=CASATFacebo ok&utm_campaign=nutritionblog
- Substance Abuse and Mental Health Services Administration. Substance Use Disorder Treatment for People With Co-Occurring Disorders. Treatment Improvement Protocol (TIP) Series, No. 42. SAMHSA Publication No. PEP20-02-01-004. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2020.
2. Why are you struggling with this issue?
There appears to be significant interest in how dietary supplements may impact mental health and wellbeing. Though studies of the impact of nutritional deficiencies and potential benefits of dietary supplements in mental health conditions has garnered significant interest, guidelines appear to be lacking and these studies do not appear to have been recently reviewed in a comprehensive and systematic manner. As well, it is important to consider the potential harms that may occur from overuse or misuse of dietary supplements such as medication-supplement interactions or use of supplements that are unsafe or ineffective (11). With respect to the role of dietary supplements in prevention of and treatment and recovery from substance use disorders, reviews appear to be uncommon but also could prove useful to health professionals, patients and family members/caregivers.
- https://www.clinicaladvisor.com/home/topics/psychiatry-information-center/fda-warns-illegal-selling-dietary-supplements-mental-illnesses/; https://www.fda.gov/news-events/press-announcements/fda-warns-potential-contamination-multiple-brands-drugs-dietary-supplements
3. What do you want to see changed? How will you know that your issue is improving or has been addressed?
Clarity about the role of dietary supplements and their potential adjunct role in treatment of behavioral health conditions could be helpful to health professionals, patients and family members.
4. What will you do with the evidence report?
An AHRQ evidence review could support mental health and substance use disorders being addressed in future versions of the USDA/HHS dietary guidelines. As well, an evidence review could support recommendations or professional guidelines by health care provider associations and health professionals in their treatment of behavio ral health conditions and provide additional options for patients and family members complementary to medical treatment. The information from an AHRQ report also could be used as the basis for additional studies or programs within the public and private health sectors and by government agencies such as NIH. the US Preventive Services Task Force, Community Preventive Services Task Force (CPSTF) and others in guiding future research and developing guidelines and recommendations.
Optional Information About You
What is your role or perspective? public health professional
If you are you making a suggestion on behalf of an organization, please state the name of the organization? NA, personal suggestion
May we contact you if we have questions about your nomination? Yes