As a healthcare provider who is ethically bound to offer evidence-supported therapies, I am sceptical about new treatment ideas until I've seen some evidence that they work. While treatments for ADHD have centred on cognitive behavioural therapies and medication, a growing body of research suggests that high-dose multinutrient supplements offer some benefits. One such supplement is Daily Essential Nutrients (DEN), which contains a range of vitamins and minerals in dosages significantly higher than those found in typical over-the-counter supplements. In this article, I'll explore what the research says about DEN, and its potential role in treating some aspects of ADHD and autism symptom presentations.
Disclaimer
Before I get started, I'm going to disclose that my son, my husband, and myself have been regularly using DEN for at least two years. What we have all found is that it helps improve emotional regulation. Personally, it appears to lift my frustration tolerance, meaning I get upset and shout much less often than I used to. My mother was recently talking about this at a family dinner, saying I used to be snippy and irritable with her before I started taking DEN. Thanks mum!
One more link between myself and high-dose multinutrients is that I was employed as a research assistant in one of Professor Julia Rucklidge's first adult ADHD and multinutrient trials in the early 2010s. This was a double-blind randomised control trial comparing high-dose multinutrients to placebo for the treatment of ADHD symptoms. I never took high-dose multinutrients myself at the time. It has been a somewhat roundabout trip to having them back in my life.
Although DEN is used in my household, I have decided not to undergo the training offered to health professionals by the makers of DEN, even though it would get me a significant discount on the purchase price. I want to stay as impartial as I can about the product. I also do not speak about DEN with most of my clients, do not routinely include it as a recommendation in ADHD assessment reports, and really only discuss it if a client raises questions about supplements themselves, or if multiple medications for ADHD and/or mood and anxiety issues have failed.
No one is paying me to write this post, and no one has read it for approval prior to posting. All errors are my own (and will be fixed if pointed out).
What Are High-Dose Multinutrient Supplements?
High-dose multinutrient supplements are formulations containing a large number of vitamins and minerals, often in dosages that exceed the Recommended Dietary Allowances (RDAs). The rationale behind these high doses is to correct possible deficiencies and imbalances that could be influencing neurological function, and to do this using a "broad-spectrum" approach; targeting multiple pathways that might contribute to these conditions rather than supplementing with individual nutrients. Also, perhaps higher than recommended doses of some of these nutrients are actually helpful and not harmful. This is very different from the approach of supplementing single nutrients as a result of a blood test that shows a deficiency. Blood tests are not deemed necessary prior to using a high-dose multinutrient.
While I am talking about DEN in this blog post, two other multinutrient formulations that come to mind (due to their assertive advertising presence) are AG1 and Nutrient Rescue. I have no experience with either of these formulations and they do not have the same level of clinical research that DEN does. You can find plenty of anecdotal positive reviews of these multinutrient formulations if you care to go searching. Just remember that anecdote is not the same as data and evidence, and the plural of anecdote is not data (it's anecdata).
Because DEN is high-dose, this means a lot needs to be ingested. DEN comes in powder or capsule forms. It tastes and smells quite terrible, so capsules are generally the easiest way to take it. But they are big capsules, and the recommended dose for people trying to treat a mental health disorder is 12 capsules a day divided into three doses. And then there's the cost, at around $200 a month if taking 12 capsules a day. It took some training for my son to begin swallowing these capsules at the age of 6-7. But he did it when I thought it would never happen. We started training with Tic Tacs. He can now swallow two at a time.
For anyone on the pathway of thinking about high-dose nutrient supplementation, I highly recommend reading the book The Better Brain: Overcome Anxiety, Combat Depression and Reduce ADHD and Stress with Nutrition by professors Bonnie Kaplan and Julia Rucklidge which specifically discusses DEN and other evidence-based formulations, as well as more general information about nutrition and mental health.
Current Research
Studies on the effects of high-dose multinutrient supplements in treating symptoms of ADHD, autism, and other mental health conditions are still in their infancy, but some findings are promising.
The Hardy Nutritionals website keeps a list of research articles about DEN which can be sorted by mental health condition and sample (adult/child). Broadly speaking, when used in children and adults with ADHD, DEN has been associated with reductions in ADHD symptoms and improvements in other mental health measures significantly greater than placebo. Children with autism have experienced significant reductions in disruptive and aggressive behaviour. Importantly, research has also found DEN to pose no risks to health when taken as directed as part of these trials.
Pharmac and DEN
In 2022 the New Zealand drug-buying agency Pharmac reviewed an application for DEN to be endorsed as a treatment for ADHD in adults and children for whom trials of stimulant medication and atomoxetine have not been successful. Following a review of the ADHD research, Pharmac issued a statement that DEN be recommended as a low priority and following a special authority process (i.e. approval by a psychiatrist with review every two years - which is the same system used for stimulant medication).
Getting Access to DEN
The makers of DEN suggest that lower doses or complete cessation of psychotropic medications are usually required when multinutrients are taken, due to a possible increase in medication effects and side effects. To purchase DEN in a private capacity in New Zealand when medication is already being taken, a letter from a person's doctor stating that they are supportive of their patient taking DEN and that they will monitor health is required.
For my son, we provided a letter of support from both his GP and his pediatrician before we could purchase DEN. We also reduced his stimulant meds, which in hindsight wasn't a great idea as his behaviour deteriorated markedly over those months. We boosted the DEN dose, and then boosted his stimulant dose back up to where it had been previously, with no apparent adverse effects. I know of other people taking DEN and stimulant medication together without incident.
Conclusions and Recommendations
High-dose multinutrient supplements like DEN offer a fascinating avenue for further research in the treatment of ADHD, autism, and mental health and wellbeing in general.
If you're considering trying high-dose multinutrient supplements I strongly suggest that it should be as part of a broader, evidence-based approach. Personally, I wouldn't recommend taking DEN as a standalone treatment for ADHD until stimulant and other evidence-based medications have been trialled adequately. Consult a healthcare professional to ensure that it's appropriate for your circumstances. There are some medical conditions, e.g. hemochromatosis (too much iron in the blood), where DEN will not be suitable to take.
Any changes or reductions to psychotropic medication for the purpose of trialing DEN should be done under the guidance of a person's GP, with a risk analysis of what could possibly go wrong, how to notice this, and how to respond.
This ADDitude article discusses 10 Supplements and Vitamins for ADHD Symptom Control, including a brief section on DEN
Here's the Hardy Nutritionals website, and here's their list of research studies using their products
This New Zealand based website sells DEN, and requires GP approval if other medications are taken
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