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Osteopathic medical student Scarlett Saitta discusses her article “Integrating vitamin education in mental health care,” highlighting the growing evidence that nutritional deficiencies can profoundly impact psychiatric outcomes. Scarlett explains how deficiencies in vitamin D, B12, and folate are common in patients with depression, and how targeted supplementation can dramatically improve treatment response and reduce hospitalizations. She emphasizes that nutritional psychiatry is evidence-based, not alternative medicine, and advocates for its integration into medical education and clinical practice. Listeners will gain actionable insights on screening for deficiencies, reframing nutrition as science-based care, and adopting low-cost, high-yield strategies to support better mental health outcomes.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Scarlett Saitta. She is an osteopathic medical student. Today’s KevinMD article is “Integrating vitamin education in mental health care.” Scarlett, welcome back to the show.

Scarlett Saitta: Thank you, Dr. Pho, for having me on again. It is truly an honor.

Kevin Pho: All right. Tell us what your latest article is about.

Scarlett Saitta: In summary, the article was about integrating vitamin education into medical education. I feel like a lot of times it seems to be very left out and seen as just alternative medicine or even as far as quackery. But then I read a lot of the studies, some of which were published in journals such as JAMA, and I saw how for some patients it could really be quite helpful, especially for treatment-resistant depression. This is important, especially with one in five American adults living with a diagnosed mental illness and many, many more living in complete silence without that diagnosis, but their lives and the people around them are still greatly affected.

For example, there are many psychiatric patients that are deficient in key vitamins. I believe it was forty-two percent of people experiencing depression are deficient in vitamin D, and up to forty percent of inpatient psychiatric patients have a deficiency in vitamin B12. Moreover, seventy percent of patients with depression have low folate, and all of these also stunt the effectiveness of traditional pharmaceutical drugs and traditional cognitive behavioral therapy.

Kevin Pho: So I know that in medical school, there is not much time spent on nutrition in general, let alone vitamins. Has that been your experience from what you have heard and from talking to your peers about the lack of nutritional education?

Scarlett Saitta: Yes. I guess it would depend on the medical school. I do have friends that are at other medical schools, and I will say that I am definitely more proud of the progress that medical schools have made with integrating nutrition. This is especially important considering that only about ten to twenty percent of someone’s health is determined by what happens in the doctor’s office or at the hospital. A lot of the rest is influenced by policies, but also our access and our willingness to integrate lifestyle changes.

Kevin Pho: Tell us more about the study you mentioned, that connection between various psychiatric diagnoses and a deficiency in vitamin D, B12, and folate. Is it only associated with depression? Are there any other psychiatric conditions that also may be affected by nutritional or vitamin deficiencies?

Scarlett Saitta: I mostly looked at it for anxiety and depression. For example, there was one study done in 2014 that demonstrated that patients who were deficient in vitamin D and were supplemented with vitamin D had their depressive symptoms reduced by ninety-two percent. There was also a subgroup of other studies published in 2024 that said vitamin B12 enhances pharmaceutical antidepressant effectiveness. It can also delay the onset of depression. Methylfolate, which is a bioavailable form of folate that is a little bit easier for the body to take in and absorb, led to significant symptom improvement for eighty-one percent of patients with treatment-resistant depression, as opposed to just thirty-nine percent of study participants that were taking a placebo. That study was published in 2012.

Kevin Pho: I am hearing from these studies that repleting, for example, vitamin D leads to a significant decrease in depressive symptoms. I think you had mentioned ninety-plus percent improvement. So why is this not done more often? Why are we not hearing as often that these vitamin deficiencies are so closely linked with these psychiatric conditions?

Scarlett Saitta: That is a very good question. To be honest, I am not completely sure. Maybe sometimes it is because the vast majority of studies are only done on pharmaceuticals. It could also be because although vitamin supplements can be very helpful, they are also not as regulated, which is why when you turn the vitamin over on the back, it gives you that disclaimer.

It could also be because of product inconsistency. For example, there was a study published where they grabbed ten different bottles of melatonin off of random grocery store shelves, and zero of them matched the actual amount listed. So it could definitely vary how much of a vitamin D or folate is actually in there. That being said, there are brands that are more reliable than others, and I think there should be more studies and education on that.

It could be because when a lot of people hear it, their mental biases just tell them that this is quackery because they were not trained on it. So whenever we say, “That makes sense to me,” all we are really saying is that it fits our preconceived mental biases that were shaped through what we have been taught, what we have experienced, and what we have had our friends experience, etc. So that is why I believe it is not happening as much.

Kevin Pho: So I think you bring up a good point in that a lot of studies sometimes are funded by pharmaceutical companies, and if there is not a positive result for their specific drug, then sometimes these studies are not funded. When we are talking specifically about vitamins, it does not really fit into that profit paradigm of pharmaceutical companies that funds a lot of these studies. Now, for patients who may be looking to supplement some of these vitamins you are talking about—folate, B12, and D—you mentioned that sometimes these vitamins do not always contain the right amount, and there is a lot of that “wild West” when it comes to these supplements. Tell us from a patient’s perspective what they should be looking for whenever they look for vitamins on the store shelves.

Scarlett Saitta: What I know about vitamins in particular, I might backtrack on the question a little bit because there is not a lot of information out there about which vitamins are very true to their labels. This is why I think medical education from providers would be important, so they could say, “I recommend this brand because studies have shown that it is very accurate to the dosage.”

I sadly do not have a really good answer for that. But I would also say to be sure that you have a test to show you are actually deficient in that vitamin. Even though the tests are not used as often, they still exist, because not every patient with treatment-resistant depression has a vitamin D or a folate deficiency. Also, if you take too many vitamins together, especially vitamins that are not completely accurate to their label and are fat-soluble, then that could end in very severe results.

Kevin Pho: So tell us more about this field of nutritional psychiatry. If you were in charge of the medical curriculum, tell us the type of changes that you would make to better educate future clinicians. Because like you said, sometimes if it does not fit into the paradigm in which they trained, they could be less accepting of that information. So what kind of changes would you make in a medical curriculum?

Scarlett Saitta: The kind of changes I would make in a medical curriculum, and some medical schools already have this, but I would definitely incorporate a very healthy diet as the basis of the medical education for this class. However, a healthy diet now, even when you teach it very well and very specifically of what constitutes a healthy diet, there was actually a landmark study that I found from the University of Texas, and it compared USDA data from 1950 to 1999, I think it was, for over forty different fruits and vegetables. They found very reliable declines in protein, calcium, iron, vitamin C, riboflavin, and various other nutrients. So over time, we have basically bred crops to be larger and to have them ripen faster, and our fertilization methods are not exactly keeping up with that or allowing the plants to absorb the most nutrients from the soil.

That also needs to be taught. Just to put it into perspective, a fun fact that I found out is that one analysis concluded that you would need to eat about eight oranges today to get the same amount of vitamin A that your grandparents once got in 1950. So incorporate that and especially show that even though a healthy diet is very good, there are a lot of nutrients that it is very short on.

Also, train students to know what kind of tests to order, like what kind of deficiencies tend to be common in people with depression, anxiety, or various mental health issues. Also, teach them how to respectfully and non-judgmentally figure out what their patients are eating and their lifestyle, as well as their access to food, because there are many Americans that live in an extreme food desert, especially out here in Arkansas where the only grocery store is a Dollar General. And assess from there which brands and which dosage of a vitamin would be most helpful to that patient, but also be sure the vitamin is in a form where the body can very easily absorb it since there are some supplements out there where the body does not completely absorb it. So in short, that is how I would train medical students to handle this issue.

Kevin Pho: As far as you know, are there any studies on the horizon regarding vitamins in general and associations with diseases that traditionally may not have had that association? What do we have potentially to look forward to?

Scarlett Saitta: That I am not completely sure of. But in recent years, we have been hearing more about vitamin supplementation, and I remember hearing stories, even though I know these are just anecdotal evidence, of friends or people that maybe they were being treated for depression ten years ago, and now maybe other people are being treated for, let us just say, depression now. And the doctor is ordering tests for their vitamin D especially, and their folate levels, as well as various other vitamins.

For example, I did have a friend who had treatment-resistant depression, and she finally found a physician that ordered a test for her vitamin D levels as well as various other levels. She was supplemented with vitamin D, and after that, even though I know it is just one case, she did not even need antidepressants. She basically recovered from depression as well with cognitive behavioral therapy.

Kevin Pho: We are talking to Scarlett Saitta. She is an osteopathic medical student. Today’s KevinMD article is “Integrating vitamin education in mental health care.” Scarlett, let us end with some take-home messages that you want to leave with the KevinMD audience.

Scarlett Saitta: Probably my biggest take-home message would be that mental health deserves the whole picture. So even if a therapy sounds too alternative or like quackery, we must be conscious of our mental biases and really assess the studies and the research that is out there. We also cannot afford to treat the body and the brain separately. Addressing something like a vitamin D deficiency can definitely change lives, and our medical training and practice should do everything it can to catch up to that emerging evidence.

Kevin Pho: Scarlett, thank you so much for sharing your perspective and insight, and thanks again for coming back on the show.

Scarlett Saitta: Thank you so much, Dr. Pho.