Possible Limiting Factors

Since 1996, we have observed that various factors can significantly limit responses to nutrient therapy, such as medications, lifestyle, and gastrointestinal health. Recognizing these factors and taking appropriate steps can make a significant difference to Daily Essential Nutrients treatment response.

8.1 Psychiatric medication management
Changing psychiatric medications inappropriately during Daily Essential Nutrients therapy can be a significant limiting factor. Improper medication dosages can affect neurotransmitter systems in various ways and lead to fluctuations in brain chemistry that complicate symptom management.

8.1.1 Discontinuation
Gradually tapering off psychiatric medications generally provides the greatest stability for patients during treatment with Daily Essential Nutrients. We do not recommend abrupt discontinuation of any psychiatric medications during Daily Essential Nutrients therapy.

To prevent pronounced discontinuation symptoms as well as rebound (a significant return of the original symptoms), psychiatric medications should be reduced gradually. The rate at which medications are terminated and the duration of the pharmacological treatment are key factors that influence discontinuation symptoms. Discontinuation effects are typically more acute with drugs that have a relatively short half-life.

8.1.2 Increasing dose
Increasing psychiatric medication dosages while using Daily Essential Nutrients may increase the possibility of drug-nutrient interactions (see 4.2.2 Psychoactive drugs).

8.2 Non-psychiatric medications
Worsening of symptoms has been observed when various medications have been used together with Daily Essential Nutrients. These effects have been most pronounced with the following medications:



8.2.1 Anesthetics
Anesthetics have potential interactions with psychiatric medications. Psychiatric medication status is an important consideration in the management of the patient about to undergo anesthesia and surgery.(32-34)  For example, benzodiazepines are commonly administered for many surgical procedures to sedate and relax patients. This may be considered increasing or changing medications (see 8.1 Psychiatric medication management).

Some unmedicated individuals taking previous formulations of Daily Essential Nutrients have reported withdrawal or post-withdrawal symptoms following surgery which have responded to standard post-withdrawal drug symptom alleviation measures (see 8.6.2 Psychiatric drug use).



8.2.2 Antacids
Antacids (such as Zantac, Prilosec, Tagamet, etc.) neutralize or inhibit the production of stomach acid which is necessary for digestion. Acidic denaturation is a major step in the process of extracting nutrients. Inhibiting this step of the digestive process can reduce the bioavailability of critical nutrients during the absorption phase.

8.2.3 Antibiotics
Antibiotics have saved countless lives. However, antibiotic use can cause collateral damage to the intestinal microbiome.(35)  Oral antibiotics may vastly impact both good and pathogenic gut microflora, resulting in reduced nutrient absorption.

Individuals who take antibiotics during Daily Essential Nutrients therapy may experience a worsening of symptoms. This effect has not been observed with intravenous antibiotics, suggesting that the interaction occurs in the gastrointestinal system.

A temporary 50% increase in micronutrient dose for the duration of the antibiotic treatment generally compensates. Adding a probiotic-prebiotic combination (such as Hardy Nutritionals™ Greens & Probiotics) during the course of antibiotic treatment, plus one to two weeks after completion, is also recommended.

A natural antibiotic/anti-fungal agent is also recommended for the duration of the antibiotic treatment, especially if the individual has a history of fungal/microbial infections. Possibilities include olive leaf extract (such as Hardy Nutritionals™ Olive Leaf Extract), ionic silver solution, caprylic acid, garlic capsules, and oil of oregano.

8.2.4 Antihistamines
Antihistamines have been observed to cause clinically significant increases in psychiatric symptoms when used together with DEN. Cautious use is warranted.

8.2.5 Oral contraceptives
Oral contraceptives may worsen depression, alter mood, and/or increase nervousness and irritability when used together with DEN. Cautious use is warranted.

8.2.6 Hormone replacement therapy (HRT)
HRT may worsen depression, alter mood, and/or increase nervousness and irritability . Cautious use is warranted.

8.2.7 Opioid analgesics
Opioid analgesics may cause clinically significant increases in psychiatric symptoms when used together with DEN. Cautious use is warranted.



8.3  Recreational Drugs


8.3.1 Street Drugs
Street drugs can cause a definite psychotropic effect, and the potential interaction with Daily Essential Nutrients may cause mood and mind altering effects (see Appendix A, reference 1). Keep in mind that many individuals who are addicted to street drugs try to conceal their addictive behaviors, and a patient’s lack of progress or unexplained symptoms may be the result of consuming street drugs. Specialized nutrient therapy has been used to successfully treat addictions.(36)

8.3.2 Alcohol
Alcohol abuse can significantly interfere with Daily Essential Nutrients therapy. Ideally, alcohol use should be minimized.

8.4 Supplements



8.4.1 Vitamins
Although taking extra vitamins while taking Daily Essential Nutrients is not usually necessary, adding individual vitamins for specific clinical purposes may be useful. For example, where long-standing specific vitamin deficiencies or genetic conditions predisposing individuals to higher vitamin needs exist, it may be necessary to add therapeutic amounts of specific vitamins in order to optimize therapeutic response to Daily Essential Nutrients.


8.4.2 Minerals
Additional iron may be added to Daily Essential Nutrients therapy without any issue. Generally, we recommend that the minerals copper, zinc, calcium and magnesium should not be added to Daily Essential Nutrients therapy, as they can alter critical mineral balances of the Daily Essential Nutrients formulation and render it less effective. Whole foods containing these minerals are not a problem.

8.4.3 Psychoactive Supplements
Any psychoactive supplement has the potential to interfere with Daily Essential Nutrients effects. These include (but are not limited to) SAM-e, 5-Hydroxytryptophan (5-HTP), St. John’s wort, ginseng, kava kava, skullcap, and valerian root. If patients choose to use psychoactive supplements during Daily Essential Nutrients therapy, advise cautious dosing and monitor their responses carefully.

8.5 Gastrointestinal problems
Diarrhea or constipation can reduce the absorption of essential vitamins and minerals. If either condition becomes an issue, whole foods and probiotics are often useful. Adequate hydration and a healthy diet with plenty of fiber from fruit and vegetables prevent many problems.



8.5.1 Bowel disorders
Irritation and inflammation of the intestinal lining is a common occurrence in chronic bowel disorders. These disorders may improve in time while using Daily Essential Nutrients, but can significantly reduce the absorption of key nutritional elements until they are corrected. Restriction diets, probiotics, digestive enzymes, certain oils, fatty acids, and various other supplements may be beneficial in restoring and maintaining more normal bowel function.

8.5.2 Constipation
Constipation can be a critical limiting factor of Daily Essential Nutrients treatment by severely reducing absorption of essential vitamins and minerals. Root causes of constipation are varied. Depending on the cause of constipation, different measures may be appropriate to rectify the problem according to clinical judgment.

A few simple measures can often help constipation. Adequate hydration is essential. Fiber-rich whole foods like prunes, raw fruits and vegetables often help. In addition, patients with constipation benefit long-term from a probiotic-prebiotic combination (such as Hardy Nutritionals™ Greens & Probiotics), which can help restore intestinal microflora balance.

8.5.3 Diarrhea
Diarrhea can severely limit the effectiveness of Daily Essential Nutrients treatment by preventing absorption of essential vitamins and minerals. Causes of diarrhea are varied. Depending on the cause of diarrhea, different measures may be appropriate to rectify the problem according to clinical judgment.

Certain foods like unripe bananas, peanut butter, cheddar cheese often helped rectify diarrhea related to initiating nutrient therapy. In addition, many patients with chronic diarrhea benefit long-term from a probiotic-prebiotic combination (such as Hardy Nutritionals™ Greens & Probiotics), which can help restore intestinal microflora balance.

8.5.4 Microflora imbalance
Gut microflora may become imbalanced due to factors such as antibiotic use, infections, and diet patterns. Restorative measures should be taken to ensure optimal absorption of micronutrient treatments.

A probiotic-prebiotic combination product (such as Hardy Nutritionals™ Greens & Probiotics) may be beneficial in restoring healthy gut function in individuals with mild microflora imbalance.

If this is not sufficient and symptoms do not improve, then a natural antibiotic/antifungal agent (such as Hardy Nutritionals™ Olive Leaf Extract) may be warranted. In particular, patients with a history of extensive or chronic antibiotic use are often highly susceptible to severe microflora imbalances (see Appendix B for indicative questionnaire).

Note: Antibiotic/antifungal agents like Hardy Nutritionals™ Olive Leaf Extract may cause a die-off response, known as the Herxheimer reaction, which presents as flu-like symptoms and can arise anywhere from the first day to the first couple of weeks after beginning the product. If vomiting occurs, reduce the dosage or introduce an alternate antibiotic/antifungal agent (e.g. caprylic acid, garlic capsules, or oil of oregano). Changing antibiotic/anti-fungal products periodically may prevent organisms from adjusting to a single product. If there is no Herxheimer reaction, complete the course at recommended levels.

8.6 Patient History





8.6.1 Antibiotic use
If an individual has had a lengthy history of oral antibiotic use, particularly as a child, a probiotic (such as Hardy Nutritionals™ Greens & Probiotics) is recommended. Normally, probiotics do not need to be taken on a continual basis. Once the probiotic has had its effect, it may only need to be taken periodically thereafter.

If symptoms do not improve with probiotic use, additional measures may be needed (see 8.5.4 Microflora imbalance).

8.6.2 Psychiatric drug use
Residual medication-related symptoms can appear for months and in some cases even years after psychiatric medications have been discontinued. Post-withdrawal medication symptoms are often triggered by such things as physical exertion, weight loss, stress, prolonged sun exposure, and liver or bowel cleanses. To a lesser extent, post-withdrawal drug symptoms may also be triggered by massage, chiropractic, or acupuncture therapies.

Some symptoms of post-withdrawal include insomnia, anxiety, depression, crying jags, agitation, and irritability. Individuals often report they feel medicated again. Post-withdrawal symptoms can often be mistaken for a return of psychiatric symptoms.

Suggestions for treatment of post-withdrawal drug symptoms include avoiding or moderating ‘trigger’ activities and/or temporarily adding protein isolate or free-form amino acids (such as Hardy Nutritionals™ Free-Form Aminos) to the patient’s treatment regimen.

8.6.3 Sensitivities 
Sensitive individuals may require and/or tolerate lower doses of Daily Essential Nutrients. Sensitive individuals may be identified by their history or by low medication tolerance. They may become restless, agitated, or irritable within hours or several days of starting micronutrient products.

8.6.4 Special nutrient needs
Where long-standing specific vitamin or mineral deficiencies exist, including genetic conditions that predispose individuals to higher vitamin or mineral needs, it may be necessary to add therapeutic amounts of specific vitamins or minerals in order to optimize therapeutic response.

8.7 Lifestyle factors





8.7.1 Inadequate diet
Daily Essential Nutrients is designed to add vitamin and mineral density to an existing diet. Thus, it is still very important for patients to eat regular, well balanced meals each day. There are many important nutritional factors that are best obtained from whole foods. Individuals taking Daily Essential Nutrients should avoid diet extremes and over-consumption of refined foods, especially if they are susceptible to gastrointestinal microflora imbalance (see 8.5.4 Microflora imbalance).

8.7.2 Inadequate sleep
Poor sleep quality and/or sleeplessness significantly exacerbates mania and psychosis issues. Adequate sleep is a significant factor in psychiatric health. Doses of Daily Essential Nutrients late in the day (after 6 pm) may contribute to wakefulness in some people.

8.7.3 Inadequate hydration
It is important to drink an adequate amount of water. Eight cups (approximately 2 quarts or 2 liters) of fluids per day are typically recommended. Water assists in moving nutrients into and flushing wastes out of the body.

8.7.4 Non-compliance
Inconsistent or “as needed” dosing of Daily Essential Nutrients is not recommended. The best results come from regular, steady dosing. It may be helpful to think of Daily Essential Nutrients as food for a starving brain. Non-compliance may indicate that the individual may require additional education and/or assistance.

8.7.5 Weight loss
Weight loss can trigger post-withdrawal drug symptoms, presumably by facilitating the release of sequestered medication residues from poorly perfused tissues. For measures that may alleviate post-withdrawal drug symptoms, see 8.6.2 Psychiatric drug use.

8.8 Physical health and life stage factors





8.8.1 Menstrual cycle
Psychiatric symptoms may increase during the menstrual cycle. This is likely due, in part, to changing hormone levels and increasing nutrient demands. Should symptoms become apparent during this time, Daily Essential Nutrients should be increased by at least one full dose of 5 capsules/day for about one week. In subsequent cycles, additional Daily Essential Nutrients taken a few days prior to menstruation may be preventative.

8.8.2 Physical illness
Additional Daily Essential Nutrients may be beneficial when a person becomes ill with a cold, flu, or other illness. Recurrent illness and infections are a sign of a weakened immune system. Increasing Daily Essential Nutrients by 4 capsules daily to support the immune system through illness may lead to faster recovery.

8.8.3 Pregnancy and breastfeeding
Nutritional requirements are significantly increased during pregnancy and breastfeeding. The daily dose of Daily Essential Nutrients should be increased in relative proportion to daily caloric intake, particularly in individuals with psychiatric symptoms. An additional dose of 4 Daily Essential Nutrients capsules per day may be useful.

8.8.4 Puberty
Puberty is a time when hormones are changing and the body’s nutritional demands may be changing as a result. The onset of many psychiatric symptoms often corresponds with this period of development. For these reasons, additional Daily Essential Nutrients may be beneficial during puberty.