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What are "broad-spectrum micronutrient" supplements, and do they have greater health benefits than multivitamin/multimineral supplements?
The term broad-spectrum micronutrients is relatively new in the medical literature. It has come to refer generally to a wide range of nutrients compared to a narrow range or single nutrients. This concept is detailed in chapter six of the American Psychiatric Association textbook entitled Complementary and Integrative Treatments in Psychiatric Practice.[1]
Recently, paid reviewers for Consumerlabs.com compared Kirkland Signature (Costco) Daily Multi and Hardy Nutritionals® Daily Essential Nutrients (DEN). [2] [Note: The full review is behind a member login]
On the surface, reason would suggest that there should be no substantial difference between the compared products. This seems to be the approach the reviewers take.
On the other hand, after analyzing the reviewers’ assessment and taking into account information from the Dietary Reference Intakes, the DEN product label, and corresponding independent research studies, reason would also suggest that there is a greater difference than at first appears.
Two assumptions
There are two unstated assumptions that underlie the comparison from the ConsumerLabs reviewers.
The assumptions become evident as the reviewers attempt to answer the question posed by the members “do they [Daily Essential Nutrients] have greater health benefits than multivitamin/multimineral supplements?”
The first assumption is that everyone’s vitamin and mineral needs are the same. The second assumption is if the first assumption is true, then cost is the only factor that determines value.
These two assumptions together produce a common error in reasoning known as a ‘straw man’ argument. The question about greater health benefit is reduced to cost, so the reviewers are no longer comparing apples with apples.
Assumption One: Nutrient needs are the same
One oversight in the reviewers' argument in favor of Kirkland Signature Daily Multi is the possibility that different individuals might have different nutritional needs. To compare the nutritional value of DEN to Kirkland Signature Daily Multi, the reviewers refer to the term "Recommended Daily Allowance (RDA)", specifically for iron and iodine. The definition of the RDA from the Dietary Reference Intakes by the Institute of Medicine strongly implies something significant about vitamin and mineral needs. (Note: The reviewers use two terms, “Daily Value” and “Recommended Daily Allowance (RDA),” which are not equal and merit a separate conversation).
“The Recommended Dietary Allowance is the average daily intake level that is sufficient to meet the nutrient requirement of nearly all (97 to 98 percent) individuals in a life stage and gender group.”
“… intake at the level of the RDA or AI would not necessarily be expected to replete individuals previously undernourished, nor would it be adequate for disease states marked by increased requirements.”
Directly from these statements, we can see that there are three groups for which the RDA is not adequate (2-3% of apparently healthy individuals, the previously undernourished, and those with conditions of higher need). At a minimum, these three groups will need higher average nutrient intakes compared to most other individuals and not because they have a deficient diet.
Additionally, we see a frequent error when reading the DEN product label. The reviewers conflate serving size with daily dose. This is far more common than you might think, even among well-informed individuals.
The Kirkland signature product recommends a single serving per day – so that is the daily dose. By contrast, the daily dose of DEN is three servings per day. This is three times the amount on the supplement facts panel. This fact will change several of the assertions made by the reviewers.
The suggested DEN dose is accompanied by the following statements.
“Suggested Use: Studies show 12 or more capsules per day is often required for optimal results. Start with one capsule three times daily and increase to four capsules three times daily.”
When comparing the Daily Essential Nutrients supplement facts to any other multivitamin-mineral product, it is important to multiply the daily values on the DEN label by three to accommodate the serving size of four capsules three times per day.
The reviewers mention only two double-blind studies on the DEN formula but missed the third and more recent double-blind study published ahead of print in 2021 and over 30 other independent medical journal publications backing the safety and efficacy of the formula and its predecessor versions.[3],[4],[5]
In fact, over 40 independent studies have been published on DEN and its predecessor versions for a wide range of mood and mental health disorders, making it the most research-backed supplement in the world for mental health.
The Kirkland Signature product has zero published comparable studies.
Assumption Two: Cost is the only consideration
Cost is mentioned three times by the reviewers. While reducing the question of health benefit to cost makes the reviewers' position a ‘straw man’ argument, this does not mean that discussion of cost is not important.
An alternative to evaluating only by cost is to evaluate a cost-to-benefit ratio. Here we see another assumption by the reviewers. Their answers imply a universal need, a universal response, and this ignores the individual nature of response, which underlies the evaluation of the cost-to-benefit ratio. For those who do not respond to DEN, the Kirkland product will be a far more cost-effective supplement. For those who do respond to DEN, in or out of the clinical trials, what is the cost/benefit they see?
In general, the benefits that people report fall into four categories of response: improved cognition, improved sense of well-being, improved mood, and reduced anxiety and stress (improved mood being the most robust response observed). If those benefits improve quality of life, relationships, work, school, etc., it may be obvious that the cost is more than worth it.
The reviewers mention their top pick product costing about 3¢ per day. A couple of paragraphs later, they compare the cost of a single ingredient, high-quality magnesium, that can easily be acquired for about 8¢ per day. This illustrates two things. First, the single ingredient costs 260% more per day than the complete comparator product. If you were to buy each ingredient separately, it would be far more expensive compared to buying a broad-spectrum or multivitamin product. More value can demonstrably be delivered with this supplement format.
Second, the reviewers identified a high-quality form of magnesium that is clearly not used in the comparator product. Is the comparator product using a lower quality and cheaper form of magnesium? DEN has a more expensive form in a "chelation complex," and provides more of it per day; and this distinction applies not only to magnesium but to all the minerals in DEN. Could this possibly be a factor in differentiating a product that provides a greater health benefit?
Greater Health Benefits?
Let us attempt to answer the members’ question about greater health benefits.
Many Kirkland products are existing products, some slightly modified, which have been private-labeled.
The Kirkland Signature Adult 50+ Mature Multi Vitamins & Minerals formula is very similar to the Centrum Silver Adults formula, which has just had a three-year double-blind placebo-controlled trial (DBRCT) published.[6] This study showed an improvement in global cognition (which includes things like story recall, verbal fluency, and digit ordering etc.) in Centrum Silver consumers.
This clinical trial took three years. Compare that to the DEN studies. The two DBRCTs in ADHD using DEN took 10 weeks and eight weeks, respectively, but let’s say 12 weeks – three months. If we assume that the treatment outcomes, or benefits, between the two products are equal, then DEN produces the same or better effect or benefit as Centrum Silver (analogous to the Kirkland product) but in 1/12th of the time.
While the Centrum Silver study indicates improved cognition in consumers, readers may recall from our earlier discussion of cost-benefit that improved cognition was one of four categories of response seen with DEN. Assuming that each category of response is equal, then DEN has a four-fold greater benefit in 1/12th the time.
In a 2022 review[7], the World Federation of Societies of Biological Psychiatry and Canadian Network for Mood and Anxiety Treatments (CANMAT) Taskforce rated and gave the 'Micronutrient Formula' known as Daily Essential Nutrients an 'Evidence Grade' of 'A', due to a statistically significant meta-analysis with statistically significant RCTs. They gave the following supporting statements for Daily Essential Nutrients:
● Meta-analytic level results have shown supportive evidence for efficacy in ADHD as a monotherapy.
● This particular micronutrient formula’s efficacy cannot necessarily be extended to other multi-nutrient formulas.
● Dosing may need to be supervised (and titrated) via a health professional.
● Acceptable safety data.
In summary, four essential product differences account for the measurable benefits of DEN over its comparative product: first, it is a very complete — or broad spectrum— formula; second, the balance achieved among the formula’s nutrients – not just a blanket 100% of a potentially arbitrary Daily Value; third, a sufficient dose – certainly higher than the minimum RDA and fourth, the employment of a chelation complex, which renders the nutrients, especially the minerals, more bioavailable.
Based on these considerations, the question now posed to the reader is, can this be construed as a greater health benefit? While Hardy Nutritionals would argue yes, each individual, depending on need, must do the experiment for themselves because that is where the definitive answer lies.
[1] Popper, C. Kaplan, B. Rucklidge, J. (2017). Chapter 6. Single and Broad-Spectrum Micronutrient Treatments in Psychiatric Practice. In Gerbarg P. Muskin P. Brown R. (Eds.), Complementary and integrative treatments in psychiatric practice. American Psychiatric Association, Arlington, VA.
[2] https://www.consumerlab.com/answers/what-are-broad-spectrum-micronutrients/broad-spectrum-micronutrients-vs-multivitamin/
[3] Rucklidge JJ, Eggleston MJF, Johnstone JM, Darling K, Frampton CM. Vitamin-mineral treatment improves aggression and emotional regulation in children with ADHD: a fully blinded, randomized, placebo-controlled trial. J Child Psychol Psychiatry. 2018 Mar;59(3):232-246.
[4] Reihana PK, Blampied NM, Rucklidge JJ. Novel Mineral-Vitamin Treatment for Reduction in Cigarette Smoking: A Fully Blinded Randomized Placebo-Controlled Trial. Nicotine Tob Res. 2019 Oct 26;21(11):1496-1505.
[5] Johnstone JM, Hatsu I, Tost G, Srikanth P, Eiterman LP, Bruton AM, Ast HK, Robinette LM, Stern MM, Millington EG, Gracious BL, Hughes AJ, Leung BMY, Arnold LE. Micronutrients for Attention-Deficit/Hyperactivity Disorder in Youths: A Placebo-Controlled Randomized Clinical Trial. J Am Acad Child Adolesc Psychiatry. 2022 May;61(5):647-661. Epub 2021 Jul 22.
[6]https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/alz.12767
https://www.prnewswire.com/news-releases/centrum-silver-is-now-clinically-shown-to-support-cognitive-health-in-older-adults-301624185.html
[7] Sarris J, Ravindran A, Yatham LN, Marx W, Rucklidge JJ, McIntyre RS, Akhondzadeh S, Benedetti F, Caneo C, Cramer H, Cribb L, de Manincor M, Dean O, Deslandes AC, Freeman MP, Gangadhar B, Harvey BH, Kasper S, Lake J, Lopresti A, Lu L, Metri NJ, Mischoulon D, Ng CH, Nishi D, Rahimi R, Seedat S, Sinclair J, Su KP, Zhang ZJ, Berk M. Clinician guidelines for the treatment of psychiatric disorders with nutraceuticals and phytoceuticals: The World Federation of Societies of Biological Psychiatry (WFSBP) and Canadian Network for Mood and Anxiety Treatments (CANMAT) Taskforce. World J Biol Psychiatry. 2022 Jul;23(6):424-455.
