Micronutrients absorbed in the mouth reduce irritability and anger but not stress in university students

Long-term stress can increase the risk of all kinds of adverse physical and mental health conditions, such as strokes, cardiovascular disease, emotional distress, anxiety, and depression. In addition, stress can lead to poorer lifestyle choices, including smoking, drinking, and overeating(1-6). There are high rates of stress among university students(7); however, only a small number of students receive support(8). Many barriers to accessing help have been identified, for example lack of time, wanting to handle issues themselves, and thinking that their struggles are not severe enough to require treatment(9). These challenges highlight that for students, interventions need to be feasible and easily accessible.

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Written by: Nurina Katta

Long-term stress can increase the risk of all kinds of adverse physical and mental health conditions, such as strokes, cardiovascular disease, emotional distress, anxiety, and depression. In addition, stress can lead to poorer lifestyle choices, including smoking, drinking, and overeating1-6.

There are high rates of stress among university students7; however, only a small number of students receive support8. Many barriers to accessing help have been identified, for example lack of time, wanting to handle issues themselves, and thinking that their struggles are not severe enough to require treatment9. These challenges highlight that for students, interventions need to be feasible and easily accessible.

Stress and micronutrient interventions

Previous studies have shown that taking vitamins and minerals (micronutrients) during or after having experienced a stressful event has positive effects on psychological functioning10-12. Research has noted nutritional supplements in particular have become more and more important in maintaining appropriate vitamin and mineral levels that support successful coping with stress. Although taking vitamin and mineral capsules is considered safe13, some people find swallowing multiple capsules difficult14. Recently, an alternative option has been developed whereby the vitamins and minerals are absorbed by the membranes lining the inside of the mouth (the oral mucosa). This bypasses the challenge for those who cannot swallow capsules or are seeking a different option.

This alternative option provides 36 vitamins and minerals in a pouch that contains a flavoured powder which is poured on or under the tongue and left there until it is dissolved. The formula contains very similar ingredients to a capsule formula that has been widely tested for the treatment of psychological symptoms; however, the doses in the powdered pouches are much lower than in the capsules – most ingredients are well below the Recommended Dietary Allowance (RDA). Absorbing the vitamins and minerals through the mouth potentially allows for this lower dose as they enter into the blood stream more directly compared to capsules (which are absorbed via the gut).

The STress Anxiety (STAR) Trial

During the lockdowns of 2020, we monitored 72 stressed students over a period of four weeks. Thirty-five students were allocated to the micronutrient group and 37 to the placebo group, and they were asked to take one powdered pouch (either vitamins and minerals or placebo) for four weeks. The participants completed various online questionnaires assessing stress, mood, emotion regulation, wellbeing, diet, and sleep. This study was the first independent randomised controlled study that looked at the effectiveness of this new way of taking vitamins and minerals as an intervention for stressed students.

What did we find?

The clinical findings were published in an APA Journal, International Journal of Stress Management.15 The results showed that this powdered vitamin and mineral option did not improve symptoms of stress better than the placebo. In both groups, the average stress scores reduced from the moderate to the mild range, with a similar number of students from both groups reducing to the normal nonclinical range (43% in the micronutrient group, 46% in the placebo group). With regards to self-rated overall improvement, at four weeks, 16.2% of the placebo group and 17.1% of the micronutrient group rated themselves as ‘much’ to ‘very much’ improved.

However, the micronutrient group showed a greater reduction in symptoms of irritability and anger compared to the placebo group. These findings align with previous research, showing that vitamins and minerals can improve emotion regulation in children and adults.16 17  

Take away

Nutritional interventions have received growing attention in treating psychological symptoms, and it is important to continue to research new modes of delivery in this field. Absorbing vitamins and minerals through the mouth does not seem to be as effective in reducing stress compared to vitamin and mineral capsules at higher doses; however, if future research confirms that this method of taking vitamins and minerals can improve emotion regulation, this might represent an alternative and more convenient option for those who struggle with taking capsules. It might also be possible that because of the time of conducting the study, that is during lockdown and while students had high demands on their time, the stress was different from that experienced in the other studied events.

Note that this research was funded by the University of Canterbury and supported by a PhD scholarship from the UC Child and Well-being Research Institute. The manufacturers of the product, Truehope, did not provide any funding; however, they donated the product (EMP Lightning Sticks) and matching placebo for free for the duration of the trial.

Want to learn more?

sign up for our free edx Mental Health and Nutrition course via UC Online and learn what foods and nutrients should and should not be consumed to improve mental wellbeing and explore the fundamental role that nutrition plays in our mental health.

References

1. Chandola T, Britton A, Brunner E, et al. Work stress and coronary heart disease: What are the mechanisms? Eur Heart J 2008;29(5):640-48.

2. Huang C-J, Webb HE, Zourdos MC, et al. Cardiovascular reactivity, stress, and physical activity. Front Physiol 2013;4:314.

3. Kivimäki M, Nyberg ST, Batty GD, et al. Long working hours as a risk factor for atrial fibrillation: A multi-cohort study. Eur Heart J 2017;38(34):2621-28.

4. Heikkilä K, Nyberg ST, Fransson EI, et al. Job strain and alcohol intake: A collaborative meta-analysis of individual-participant data from 140 000 men and women. PLoS One 2012;7(7):e40101.

5. Leka S, Hassard J, Yanagida A. Investigating the impact of psychosocial risks and occupational stress on psychiatric hospital nurses’ mental well‐being in Japan. J Psychiatr Ment Health Nurs 2012;19(2):123-31.

6. McEwen BS. Protective and damaging effects of stress mediators: Central role of the brain. Dialogues Clin Neurosci 2022;8(4):367-81.

7. Zeng Y, Wang G, Xie C, et al. Prevalence and correlates of depression, anxiety and symptoms of stress in vocational college nursing students from Sichuan, China: A cross-sectional study. Psychol Health Med 2019;24(7):798-811.

8. Garlow SJ, Rosenberg J, Moore JD, et al. Depression, desperation, and suicidal ideation in college students: Results from the American Foundation for Suicide Prevention College Screening Project at Emory University. Depress Anxiety 2008;25(6):482-88.

9. Czyz EK, Horwitz AG, Eisenberg D, et al. Self-reported barriers to professional help seeking among college students at elevated risk for suicide. J Am Coll Health 2013;61(7):398-406.

10. Rucklidge JJ, Andridge R, Gorman B, et al. Shaken but unstirred? Effects of micronutrients on stress and trauma after an earthquake: RCT evidence comparing formulas and doses. Human Psychopharmacology: Clinical and Experimental 2012;27(5):440-54.

11. Kaplan BJ, Rucklidge JJ, Romijn AR, et al. A randomised trial of nutrient supplements to minimise psychological stress after a natural disaster. Psychiatry Res 2015;228(3):373-79.

12. Rucklidge JJ, Afzali MU, Kaplan BJ, et al. Massacre, earthquake, flood: Translational science evidence that the use of micronutrients postdisaster reduces the risk of post-traumatic stress in survivors of disasters. International Perspectives in Psychology 2021;10(1):39-54.

13. Rucklidge JJ, Eggleston MJ, Ealam B, et al. An observational preliminary study on the safety of long-term consumption of micronutrients for the treatment of psychiatric symptoms. The Journal of Alternative and Complementary Medicine 2019;25(6):613-22.

14. Polaha J, Dalton 3rd WT, Lancaster BM. Parental report of medication acceptance among youth: Implications for everyday practice. South Med J 2008;101(11):1106-12.

15. Katta NM, Blampied NM, Mulder RT, et al. Micronutrients absorbed via the oral mucosa reduce irritability and anger but not stress in university students during COVID-19: A randomized placebo-controlled trial. International Journal of Stress Management 2023:No Pagination Specified-No Pagination Specified.

16. Rucklidge JJ, Eggleston MJ, Johnstone JM, et al. Vitamin‐mineral treatment improves aggression and emotional regulation in children with ADHD: a fully blinded, randomized, placebo‐controlled trial. Journal of Child Psychology and Psychiatry 2018;59(3):232-46.

17. Gordon HA, Rucklidge JJ, Blampied NM, et al. Clinically significant symptom reduction in children with attention-deficit/hyperactivity disorder treated with micronutrients: An open-label reversal design study. J Child Adolesc Psychopharmacol 2015;25(10):783-98.

Written by: Nurina Katta

Photo Credit:  Nathan Dumlao on Unsplash