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07. Practical Tips for Using BSMs in the Clinical Practice

Published on August 1, 2023 Certification expiration date: August 1, 2026

Amelia Villagomez, M.D.

Assistant Professor of Psychiatry - University of Arizona

Key Points

No consistent predictors of response have been identified for BSMs.
To minimize side effects, BSMs should be taken with a meal.
Try to maintain a 2-hour separation between doses.
There are available recipes for patients who are unable to swallow pills.

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Slides and Transcript

Slide 1 of 14

For those wishing to use broad-spectrum micronutrients, we'll now turn our attention to some considerations for their use in clinical practice.

Practical Tips for Using BSMs in the Clinical Practice Slide 1 of 14

Slide 2 of 14

In the ADHD RCTs, researchers searched for predictors of response. They found that in the majority of individuals, baseline nutrient levels like B12, zinc, folate, iron, potassium from blood were within normal range and nutrient levels did not predict who would respond to treatment. In other words, someone with a normal level of nutrients was just as likely to respond clinically as someone with a low or abnormal level. It's hypothesized that this is the case as an individual's nutrient needs may be higher than the population average. So, blood levels of nutrients will not define who is deficient relative to their own metabolic requirement.

References:

Rucklidge, J. J., Eggleston, M. J., Darling, K. A., Stevens, A. J., Kennedy, M. A., & Frampton, C. M. (2019). Can we predict treatment response in children with ADHD to a vitamin-mineral supplement? An investigation into pre-treatment nutrient serum levels, MTHFR status, clinical correlates and demographic variables. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 89, 181-192.

Practical Tips for Using BSMs in the Clinical Practice Slide 2 of 14

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Slide 3 of 14

Now, let's discuss how to address potential side effects. It's helpful to instruct patients that if they're having difficulty getting to sleep, it's best to take the final dose before 5 or 6 p.m. as the B vitamins in the formulas can be energizing for some individuals. Although GI symptoms occurred equally between the placebo group and broad-spectrum micronutrient group in the studies, about 25% of participants did report GI symptoms of which 5% reported nausea. Clinically, patients have reported nausea and symptoms improved by taking broad-spectrum micronutrients with food, preferably sandwiched in the middle of a meal.

References:

Truehope Nutritional Support Ltd. (2023). EMPowerplus. Truehope. https://www.truehope.com/
NutraTek Health Innovations Inc. (2023). Daily Essential Nutrients. https://www.hardynutritionals.com/products/daily-essential-nutrients-360

Practical Tips for Using BSMs in the Clinical Practice Slide 3 of 14

Slide 4 of 14

It's important to drink six to eight glasses of water daily for adequate hydration in adults. For a child, the amount of fluid ounces needed per day is approximately weight in pounds divided by two.

References:

Truehope Nutritional Support Ltd. (2023). EMPowerplus. Truehope. https://www.truehope.com/
NutraTek Health Innovations Inc. (2023). Daily Essential Nutrients. https://www.hardynutritionals.com/products/daily-essential-nutrients-360

Practical Tips for Using BSMs in the Clinical Practice Slide 4 of 14

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Slide 5 of 14

All capsules cannot be taken at the same time as there's a limit to the amount of nutrients that can be absorbed at a given time by the body. It is recommended to maintain a minimum two-hour separation between doses. In other words, the doses do not have to be equally divided throughout the day.

References:

Truehope Nutritional Support Ltd. (2023). EMPowerplus. Truehope. https://www.truehope.com/
NutraTek Health Innovations Inc. (2023). Daily Essential Nutrients. https://www.hardynutritionals.com/products/daily-essential-nutrients-360

Practical Tips for Using BSMs in the Clinical Practice Slide 5 of 14

Slide 6 of 14

The EMPower Plus Advanced formula is recommended to be given in two separate doses and the Daily Essential Nutrients formula is recommended as a three times daily dosage.

References:

Truehope Nutritional Support Ltd. (2023). EMPowerplus. Truehope. https://www.truehope.com/
NutraTek Health Innovations Inc. (2023). Daily Essential Nutrients. https://www.hardynutritionals.com/products/daily-essential-nutrients-360

Practical Tips for Using BSMs in the Clinical Practice Slide 6 of 14

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Slide 7 of 14

A common hurdle for children to take micronutrients is difficulty swallowing especially since the capsules are not small. To give you a context for size they are not as large as a typical omega-3 capsule but larger than the typical small prescription tablet. And many children do find them large. In my experience, most children over age 7 can be taught how to swallow pills. If they're struggling with swallowing, it's often helpful to first identify that anxiety is likely the driving force as the child may fear that they'll choke.

References:

Kaplan, B. J., Steiger, R. A., Pope, J., Marsh, A., Sharp, M., & Crawford, S. G. (2010). Successful treatment of pill-swallowing difficulties with head posture practice. Paediatrics & Child health, 15(5), e1–e5.

Practical Tips for Using BSMs in the Clinical Practice Slide 7 of 14

Slide 8 of 14

This slide contains a link for a video which teaches children how to swallow pills with a small candy. It is https//bonniejkaplan.com/how-to-swallow-pills.

References:

Kaplan, B. J. (2023). Bonnie J Kaplan, PhD. Bonnie J Kaplan, PhD. https://bonniejkaplan.com/how-to-swallow-pills
Kaplan, B. J., Steiger, R. A., Pope, J., Marsh, A., Sharp, M., & Crawford, S. G. (2010). Successful treatment of pill-swallowing difficulties with head posture practice. Paediatrics & Child health, 15(5), e1–e5.

Practical Tips for Using BSMs in the Clinical Practice Slide 8 of 14

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Slide 9 of 14

This protocol was tested in 348 people across several studies and then validated in a clinical sample. Children are taught five head positions for swallowing. This is followed by two weeks of practice.

References:

Kaplan, B. J. (2023). Bonnie J Kaplan, PhD. Bonnie J Kaplan, PhD. https://bonniejkaplan.com/how-to-swallow-pills
Kaplan, B. J., Steiger, R. A., Pope, J., Marsh, A., Sharp, M., & Crawford, S. G. (2010). Successful treatment of pill-swallowing difficulties with head posture practice. Paediatrics & Child health, 15(5), e1–e5.

Practical Tips for Using BSMs in the Clinical Practice Slide 9 of 14

Slide 10 of 14

DEN and EMPower Plus are also available in powder form and can be mixed into smoothies and various types of cookies. Capsules can be opened and used for recipes but may have more of a bitter taste compared to the powder.

References:

Recipes Hardy Nutritionals. (2023, March 20). Hardy Nutritionals. https://try.hardynutritionals.com/recipes/
EMPowerplus Powder Recipes. (2023). Truehope – Proven Products to Restore and Maintain Mental Health. https://www.truehope.com/recipes

Practical Tips for Using BSMs in the Clinical Practice Slide 10 of 14

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Slide 11 of 14

Vitamins are destroyed by heat, hence, why the recipes are no-bake. If opening the capsules and putting them in applesauce or yogurt, they may have more of a bitter taste compared to the powder.

References:

Kaplan, B. J., Steiger, R. A., Pope, J., Marsh, A., Sharp, M., & Crawford, S. G. (2010). Successful treatment of pill-swallowing difficulties with head posture practice. Paediatrics & Child health, 15(5), e1–e5.

Practical Tips for Using BSMs in the Clinical Practice Slide 11 of 14

Slide 12 of 14

Key points: No key consistent predictors of response have been identified for broad-spectrum micronutrients in clinical trials. To minimize side effects, broad-spectrum micronutrients should be taken with a meal.

Practical Tips for Using BSMs in the Clinical Practice Slide 12 of 14

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Slide 13 of 14

Ideally spaced two hours between doses. Recipes are available for patients who are unable to swallow.

Practical Tips for Using BSMs in the Clinical Practice Slide 13 of 14

Slide 14 of 14

Practical Tips for Using BSMs in the Clinical Practice Slide 14 of 14

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Next Section

08. Dosing EMPowerplus Advanced and Daily Essential Nutrients

Learning Objectives:

After completing this activity, the learner will be able to:

Describe and proficiently utilize the procedure for the clinical implementation of BSMs.
Discuss with patients about the risks and benefits of BSM utilization.
Identify and comprehend the patient profiles that may benefit substantially from BSM supplementation.

Original Release Date: August 1, 2023

Review and Re-release Date: March 1, 2024

Expiration Date: August 1, 2026

Expert: Amelia Villagomez, M.D.

Medical Editor: Paz Badía, M.D.

Relevant Financial Disclosures:

None of the faculty, planners, and reviewers for this educational activity have relevant financial relationships to disclose during the last 24 months with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

Contact Information: For questions regarding the content or access to this activity, contact us at support@psychopharmacologyinstitute.com

Instructions for Participation and Credit:

Participants must complete the activity online during the valid credit period that is noted above.

Follow these steps to earn CME credit:

View the required educational content provided on this course page.
Complete the Post Activity Evaluation for providing the necessary feedback for continuing accreditation purposes and for the development of future activities. NOTE: Completing the Post Activity Evaluation after the quiz is required to receive the earned credit.
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Accreditation Statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Medical Academy LLC and the Psychopharmacology Institute. Medical Academy is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation Statement

Medical Academy designates this enduring activity for a maximum of 0.75 AMA PRA Category 1 credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.