NEUROSCIENCE AND

BIOBEHAVIORAL
REVIEWS

PERGAMON Neuroscience and Biobehavioral Reviews 25 (2001) 297±309

www.elsevier.com/locate/neubiorev
Review

Micro-nutrient supplementation and the intelligence of children

D. Benton*
Department of Psychology, University of Wales Swansea, Swansea SA2 8PP, UK
Revised 16 March 2001; accepted 19 March 2001

Abstract
A growing number of double-blind placebo-controlled studies have considered the in¯uence of micro-nutrient supplementation on the
intelligence of children. Earlier studies prevented the drawing of conclusions as they did not systematically approach the topic. However,
over the last 10 years, a series of studies have compared the impact of supplementation on either verbal or non-verbal measures of
intelligence. In 10 out of 13 studies a positive response has been reported, always with non-verbal measures, in at least a sub-section of
the experimental sample. A selective response to non-verbal tests was predicted as they re¯ect basic biologically functioning that could be
expected to be in¯uenced by diet. The evidence is that not all children respond to supplementation, rather there is a minority who bene®t,
whose diet offers low amounts of micro-nutrients. Such observations are consistent with dietary surveys that typically report a sub-set of
children with a low intake. The topic is at a very early stage and needs the clari®cation gained from a series of large-scale studies that consider
children of a wide range of ages, dietary styles and social backgrounds. q 2001 Elsevier Science Ltd. All rights reserved.
Keywords: Intelligence; Iron; Micro-nutrients; Minerals; Non-verbal intelligence; Vitamins

Contents
1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
1.1. Earlier studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
1.2. Iron status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
1.3. Non-verbal intelligence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 300
2. Evaluation of vitamin supplementation and intelligence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301
3. Does nutritional status in¯uence the response to supplementation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 302
4. The composition of the micro-nutrient supplement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303
5. The diet of British school-children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 304
6. Micro-nutrient intake and neural functioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305
7. Changes in intelligence over time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 306
8. Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 308

1. Introduction suggestions that vitamin supplementation may improve

When the suggestion that the intelligence of children may
be susceptible to vitamin/mineral supplementation is
considered, we can distinguish two stages of interest. Initi-
ally isolated reports considered the in¯uence of vitamin
supplements on intelligence. Over the last 10 years, more
speci®cally, the possibility that supplementation selectively
in¯uences non-verbal intelligence has been studied. The
* Tel.: 144-1792-295607; fax: 144-1792-295679.
E-mail address: d.benton@swansea.ac.uk (D. Benton).
0149-7634/01/$ - see front matter q 2001 Elsevier Science Ltd. All rights reserved.
PII: S 0149-763 4(01)00015-X
problems such as hyperactivity [19], autism [60] and
Downs Syndrome [38] have not been reviewed, rather
samples of the general population are considered.
1.1. Earlier studies
Table 1 summarizes some earlier studies and outlines
both the methodology and outcomes. As a group, these
early studies are dif®cult to evaluate. The supplements
used were never the same twice, so the nature of the active
ingredients has not been established. The psychological
 298

Table 1
Early studies of the impact of micro-nutrient supplementation on intelligence

Study Double blind Active supplement Duration Number active/placebo Subjects Outcome

Harrell [37] Yes 2 mg Thiamine 1 year 55/55 Children in orphanage After thiamine taller, better
9±19 years memory, eyesight and
intelligence
Harrell et al. [39] Yes 1. Vitamin C 1 year Norfolk Offspring of mothers given IQ higher at age 3 and 4
2. Thiamine ribo¯avin niacin Age 3: 385/133 supplements during pregnancy
3. Thiamine Age 4: 448/163 and lactation
Kentucky
Age 3: 607/204 IQ non-signi®cant
Kubala and Katz [42] ? Orange juice each day 6 months 46 matched pairs low/high 9±14 years If initial vitamin C status poor IQ
vitamin C status increased signi®cantly

Boggs et al. [14] Yes Multi-vitamin/minerals 1 month 6 cross-over design 4.5 years IQ , 80 Better behaviour
Trend for increased IQ

Mora et al. [51] No Food plus iron 1 year 116/76 no supplement Malnourished Colombians SupplementÐIQ 1 6.5
4±30 months No supplement IQ 1 2.1

Maeseck [50] No Multi-vitamins or candies Half school year 11/11 10 years with reading problems Vitamins increased IQ 6.7 points
Waber et al. [74] No Vitamins/minerals to mother 3 years 174 supplemented for Malnourished Colombians 3 Improved speech and hand-eye
Iron to children various periods/54 not months prior to birth to 3 years co-ordination
Food to both supplemented
D. Benton / Neuroscience and Biobehavioral Reviews 25 (2001) 297±309

Aukett et al. [1] Yes Iron alone or with vitamin C 2 months 97 in total English inner-city children Increased developmental rate
17±19 months
Colgan and Colgan [19] Yes Individually designed 5 months 16/16 5±15 years reading and IQ increased 9.5 points more in
supplement vs standard behaviour problems experimental group
supplement
 D. Benton / Neuroscience and Biobehavioral Reviews 25 (2001) 297±309
tests varied from study to study making comparison dif®-
cult. The methodological quality of these early studies
varied and in some instances failed to achieve the standards
demanded today. As the studies do not re¯ect a coherent
body of research, that has considered the same question
systematically, it is impossible to draw conclusions. Usually
estimates of the subjects' diet were missing and it is unclear
whether their nutritional status was signi®cantly worse than
found typically in industrialized societies today. The most
that can be said of such data is that they are positive,
suggesting that the topic should be further considered.
However, the generally signi®cant ®ndings probably create
too positive an impression. It is impossible to know, over the
years, how many negative ®ndings have simply not been
published.
It is worth drawing attention to the better of these earlier
studies. In a double-blind study, 2 mg of thiamine were
administered each day for a year, to children who lived
together in an orphanage eating the same diet [37]. Analysis
of the diet, based on the recommended daily amount (RDA),
suggested that thiamine supplementation was not needed.
However, supplementation resulted in taller children who
had better eye-sight, memory and intelligence. Another
study matched children for socio-economic background
who differed in terms of the vitamin C levels in the blood
[42]. A glass of orange juice a day for 6 months increased
the IQ of those whose vitamin C status had been initially
low, whereas those with an adequate status did not respond.
The importance of an index of nutritional status is illu-
strated by a consideration of pregnant women who attended
a clinic in a slum area of Norfolk, and were given either
vitamin supplements, or a placebo, during pregnancy and
lactation [39]. At 3- and 4-years-of-age the children of the
mothers who received the vitamins scored signi®cantly
better on an intelligence test. The response was greater in
those who received a mixture of thiamine, ribo¯avin, niaci-
namide and iron, rather than thiamine or ascorbic acid alone.
However, a group of Kentucky mountain-people did not
respond similarly. The authors wondered if the difference
in response re¯ected dietary factors. The Kentucky sample
raised their own meat and produced their own fruit and
vegetables, whereas those in Norfolk relied on shops for
their food. Such inconsistencies illustrate the dif®culty in
drawing conclusions, and making generalizations, without
assessing diet.
As the in¯uence of nutritional supplementation on the
malnourished in developing countries has been reviewed
previously [2,56], only representative studies [51,74] that
have included micro-nutrients are included in Table 1. A
review of the topic concluded that the major studies had ªall
demonstrated signi®cant effects of proteinÐenergy supple-
mentation on behavioural developmentº [2]. In those suffer-
ing from protein-calorie malnutrition, it is probable that
macro-nutrients play a substantial role in enhancing
behavioural development. However, a role for micro-nutri-
ents cannot be excluded, although with the exception of
299
iron, they have not been independently examined in these
subject groups.
1.2. Iron status
A study of malnourished Colombians found that an
improved diet and iron supplement increased intelligence
scores [51]. It is possible that iron played a role in these
®ndings as iron de®ciency anaemia is the world's most
common single nutrient de®ciency. A representative study
[1] of the impact of iron supplementation is included in
Table 1. However, as the in¯uence of iron status has been
reviewed frequently [13,45,47,56,57,59] only general
observations will be made. In developing countries an asso-
ciation has been reported repeatedly between poor iron
status, poor performance on tests of intellectual ability and
school performance. ªIron de®ciency affects selective learn-
ing aptitudes required in the classroom, such as concentra-
tion and the appropriate selection of informationº [56].
Iron de®ciency is also a common nutritional problem in
industrialized countries. In the USA, among poor African-
American and Hispanic babies, the rate of anaemia is as
high as 20±24% [58]. A North American sample of adoles-
cents, from poor backgrounds, had a poorer cognitive
performance if they were anaemic [75]. As it is easy to
suggest an association between poverty, iron status and a
range of other developmental risk factors, the causal
mechanism in such correlational studies is dif®cult to estab-
lish. However, the possibility that low iron status has devel-
opmental signi®cance was illustrated by a double-blind
intervention in Birmingham, UK, where the iron supple-
mentation of anaemic infants resulted in a greater weight
gain and rate of development [1]. However, in older British
children there was no evidence of a general association
between iron-status and performance on intelligence tests
[53,69]. Such ®ndings are not surprising as you would only
expect a problem in a sub-group who are iron de®cient. In
fact, in a British study, the intelligence scores of only those
with low iron reserves increased following iron supplemen-
tation [49].
The long-term implications of iron-de®ciency have been
little considered, although there is a suggestion that iron-
de®ciency anaemia has a long-lasting adverse effect. When
a group of Costa Rican children with a good haematological
status were considered at age 5, those who in infancy had
been anaemic, performed more poorly on tests of mental and
motor functioning [46]. Although the children who were
anaemic in infancy tended to come from poorer homes,
when such factors were controlled, the association between
early anaemia and depressed intellectual performance at a
later stage remained.
The impact of iron de®ciency may differ with age.
Although there is evidence of adverse in¯uences of iron
de®ciency in infancy [1], other stages, such as the growth
spurt of puberty, should be examined. Those with particular
dietary styles, for example dieting or consuming a
300 D. Benton / Neuroscience and Biobehavioral Reviews 25 (2001) 297±309
vegetarian diet, should be speci®cally considered as they are
known to be associated with poorer iron status [32,61].
Females beginning to menstruate may require more iron
in the diet.
Interpretation of the ®ndings in this area is limited by
methodological considerations, ideally we need two groups
that are similar in all respects other than iron status, an
outcome that is dif®cult to achieve as one risk factor is
often correlated with another. The generalization of data
from the developing world [44,56±58] to industrialized
countries should be made with caution. Poor iron status in
developing countries is typically associated with poorer
nutrition in general; it can also be associated with a less
stimulating environment that lacks the potential to amelio-
rate the impact of dietary problems.
Given the good evidence that iron de®ciency is common
in industrialized societies [32,56,58] it is surprising that the
in¯uence of iron status on intellectual functioning has been
little considered. If there is a single nutrient whose de®-
ciency in¯uences cognition, then iron is a powerful candi-
date. It is likely that the effect of iron de®ciency will prove
to be more subtle in industrialized countries, given that it is
more likely to occur in individuals who are generally better
nourished and will often have the bene®ts of a more stimu-
lating environment.
1.3. Non-verbal intelligence
More recently, a series of studies have considered supple-
mentation in a more systematic manner. Renewed interest in
the topic was stimulated by the report that the non-verbal
intelligence of 12-year-old Welsh children was increased by
multi-vitamin/mineral supplementation [12]. Several
attempts to replicate the ®ndings have been reported.
Although some of the resulting data are negative, it can be
argued that a consistent picture is emerging.
The Benton and Roberts paper [12] stimulated an acrimo-
nious response [42]. The vast majority of the responses
concerned not the clinical trial, but a 3-day dietary diary
that was used to estimate the dietary status of the subjects.
There are many problems in measuring dietary intake [43]
that were accepted by the authors [4]. However, Southon
[67] contrasted the estimates of micro-nutrient intake in the
original study with a 7-day weighted intake of the diet of
children of a similar age [26]. She commented that the
patterns of data in the two studies were not too dissimilar.
Essentially there was a small-scale trial, that used the
accepted double-blind procedure [12], that produced an
unexpected ®nding. As the ®nding questioned the received
wisdom of many nutritionists, that children receive an
adequate intake of micro-nutrients, it was greeted with skep-
ticism. Benton and Roberts [12] were cautious and
concluded, ªClearly the study must now be replicated ¼º
Although not published until a later date, at the same time
a similar study was being carried out in California. The
supplementation of delinquent juveniles again increased
non-verbal, but not verbal measures of intelligence [62].
Thus two studies, without knowledge of each others ®nding,
had produced the same result.
Although the required replication was available immedi-
ately, two out of the next three studies reported negative
®ndings (Table 2). In a study in London no effect on intelli-
gence was found [53], although the methodology has been
extensively criticised as it differed from the original in many
ways [17,30,36,55]. One reviewer commented that this
study only added to the confusion [55]. Carroll [17] ques-
tioned whether the intelligence tests used had the necessary
validity, whether they measured intelligence, and whether
they were sensitive to small changes.
In contrast, a study in Dundee [22,70] went to some trou-
ble to replicate the original design [12] and produced a
small, but non-signi®cant, advantage on the non-verbal
test following supplementation. Although broadly similar
to the original study, problems with the Dundee study
included a failure to independently consider boys and
girls. Eysenck and Schoenthaler [29] pointed out that the
Dundee study assigned subjects to treatment groups on the
basis of verbal rather than non-verbal scores and commen-
ted on various statistical short-comings.
At the same time a Belgian study gave school-children
either a supplement or placebo for 5 months [7]. Although
not all children responded, boys who ate diets supplying
fewer vitamins and minerals scored signi®cantly better on
a non-verbal intelligence test following supplementation.
The implication that only children who consume a poor
diet respond to supplementation is further considered below.
By far the largest study on this topic administered 23
micro-nutrients at 50, 100 or 200% of the RDA [63].
Again, it was the non-verbal rather than verbal intelligence
scores of those taking the active supplement that signi®-
cantly improved, but only when the 100% RDA tablets
were taken. The ®nding that only those receiving 100%
RDA bene®ted from supplementation detracted greatly
from the credibility of the ®ndings. If children did not
respond to 50% RDA then one might assume that the dose
was insuf®cient. However, if 100% was suf®cient then
200% RDA must also offer a suf®cient supply. Why then
didn't the children respond to 200% RDA? The 200% dose
was not suf®cient to expect a toxic reaction so the data
appeared inconsistent. In the event, as discussed below, it
transpired that those taking 100% RDA were less well nour-
ished. Todman [70] commented that in this study multiple
tests may have produced Type 1 errors, and that data
concerning some intelligence tests had been ignored,
while relying on results with the Wechsler Intelligence
Scale for Children (WISC). In answer the authors claimed
that the WISC had been, a priori, the test of choice, as it was
the most reliable available measure.
Of the 13 studies that have examined the in¯uence of
supplementation on non-verbal of intelligence, 10 reported
a positive in¯uence in at least a sub-set of children. To save
space the more recent studies are not discussed in detail but
 D. Benton / Neuroscience and Biobehavioral Reviews 25 (2001) 297±309 301

Table 2
The effect of vitamin/mineral supplementation of children on non-verbal and verbal measures of intelligence. Only study [41] is not a double-blind placebo
controlled trial. The composition of the supplements is given in Table 3. The studies used multi-vitamins/minerals with the exception of Lynn and Harland [49]
who provided only iron and ascorbic acid. Various individually or group presented standard intelligence tests were used. The exception was the use of visual
and auditory reaction times in study [41]. Reaction times are known to correlate with non-verbal measures of intelligence

Study Age Sample placebo/active Superiority of active treatment over placebo

Non-verbal scores Verbal scores

Benton and Roberts [12] 12±13 30/30 17.2 P , 0.001 11.5 n.s.
Nelson et al. [53] 7±12 105/105 13.3 n.s 21.2 n.s.
Crombie et al. [21] 11±13 44/42 12.4 n.s. 10.5 n.s
21.5 n.s
Benton and Buts [7] 13 87/80 Better diet 11.6 n.s. 20.2 n.s.
Poorer diet 13.0 P , 0.02
Schoenthaler et al. [62] 13±16 11/15 17.4 P , 0.05 Data not reported but n.s.
Benton and Cook [8] 6 22/22 19.6 P , 0.001 17.9 n.s.
Schoenthaler et al. [63] 12±16 /105 RDA
100/105 11.0 (50%) n.s 21.1 n.s
/105 13.6 (100%) P , 0.01 20.2 n.s.
11.4 (200%) n.s 22.6 n.s.
Nidich et al. [54] 8±9 16/18 14.9 P , 0.04 N.A.
Lynn and Harland [49] 12±16 28/42 Ferritin .12 ng/ml 10.70, N.A.
n.s.
177/166 Ferritin .12 ng/ml n.s

Southon et al. [69] 13±14 29/22 10.3 n.s. 11.2 n.s

Snowden [66] 12 7/11 19.2 P , 0.02 14.5 n.s.
Kerimova and Aleskerova [41] 6 20/20 Signi®cantly faster reaction N.A.
times after supplementation
Schoenthaler et al. [64] 6±12 120/125 12.5 P , 0.04 N.A.

are summarized in Table 2. Others [29] have commented in
detail about the design of some of these additional studies.
Although most are similar in nature to the earlier studies of
non-verbal intelligence, one used a herbal source of vita-
mins [54] and did not report the doses administered. One
study was carried out in Azerbaijan using children whose
diet offered 25±60% of the recommended levels of micro-
nutrients [41]. As such, the diet was poorer than that
consumed by the vast majority of children in Western socie-
ties and the data should be generalized with caution.
2. Evaluation of vitamin supplementation and
intelligence
A worry was expressed that the nature of the supplements
may have allowed some subjects to guess whether they were
taking the active or placebo tablets. This is a potential
problem as thiamine has a yeast-like ¯avour and ribo¯avin
will turn urine more yellow than normal. Thus, it is possible
that the active treatment had become obvious and a placebo
response generated. The question arises as to why a placebo
response would selectively in¯uence non-verbal but not
verbal measures. A possible answer could be that measures
of the speed of information processing, rather than acquired
knowledge, is susceptible to increased motivation/effort.
Although only a minority of the studies on this topic
reported such data, some asked subjects whether they
believed they were taking the placebo or active supplement.
The study in Dundee [22] found that, of those actually
taking the active supplement, 13 believed that it was active
and 23 thought that it was the placebo. Of those actually
taking the placebo 12 believed that they were taking the
active tablet and 24 the placebo. Clearly this study was
blind. Although the original study [12] failed to collect
similar data, as they gave exactly the same supplements as
in the Scottish study [22], it is reasonable to suggest that the
children were similarly unable to distinguish the tablets. In
studies of related topics older and better informed subjects
have failed to distinguish multi-vitamins from a placebo
[10].
Twelve out of the 13 studies in Table 2 were double-
blind, placebo-controlled, and allocated subjects randomly
to treatment conditions. In 10 of the 13 studies listed in
Table 2, in at least a sub-set of children, supplementation
resulted in improved non-verbal scores. In all studies the
302 D. Benton / Neuroscience and Biobehavioral Reviews 25 (2001) 297±309
active supplement produced a greater response than the
placebo, although it did not always reach statistical signi®-
cance. If there was no bene®t from supplementation, by
chance you would expect the placebo to have produced a
greater response on 50% of the occasions. The pattern of
response does not appear to be random.
In contrast, on no occasion were verbal measures signi®-
cantly increased. Whereas on ®ve occasions the supplement
produced a greater response, on six occasions the placebo
resulted in higher scores. There is a very strong impression
that verbal and non-verbal responses differed. This selective
impact on non-verbal scores is of theoretical importance
[12,18,63] and makes these data dif®cult to dismiss.
Cattell [18] argued that there are two types of intelligence
that he labelled `¯uid' and `crystallized'. Fluid intelligence
re¯ects basic problem solving and reasoning power. It
allows deduction and an understanding about the relation-
ships between ideas. `Fluid' intelligence was viewed as
being closely associated with innate, biological potential:
it can be estimated using non-verbal tests. Crystallized intel-
ligence, in contrast, relies on speci®c information and voca-
bulary. It is a re¯ection of experience and environment and
can be measured using verbally based intelligence tests.
Within this framework you would predict that any supple-
ment induced improvement in brain biochemistry would
stimulate non-verbal rather than verbal measures. The
predicted pattern has been observed (Table 2).
3. Does nutritional status in¯uence the response to
supplementation?
Although Table 2 presents a body of positive data, there
are inconsistencies that need to be considered. It is clear that
no generalization about the impact of supplementation
would apply to all children. An obvious suggestion is that
where inconsistencies exist they re¯ect a sub-group of chil-
dren, whose diet offers insuf®cient vitamins and minerals,
that bene®t from supplementation. Did those who responded
have a poor diet? Did those who did not respond have a
better diet?
A Belgian study recorded what children ate for 15 days.
About a third of the sample was selected, who consumed
less than 50% of the RDA of ®ve vitamins or minerals. The
non-verbal intelligence of this group of poorly nourished
boys increased after taking a supplement [7]. The majority
of those who responded to supplementation came from
schools for the less academically able, in less economically
privileged areas. The majority who responded to supple-
mentation came from two out of the seven schools that
were studied. Clearly the choice of subjects was critical.
The boys who responded in the Belgian Study had a signif-
icantly lower intake of calcium, iron, zinc, copper, and vita-
mins A, B1, B2, B6 and C than the boys who failed to respond in
the London study [53]. Similarly the diets of only 6% of the
children in the Scottish study [21] were as poor as those who
responded to supplementation in the Belgian study [7]. The
authors of the Scottish study commented that the poor nutri-
tional status of the children who responded in the Belgian
study means the ®ndings have little important for general
public health [20]. It is a matter of judgement whether 6% of
the population is unimportant; it should be considered whether
dietary problems that occur rarely may be concentrated in
speci®c sections of the population.
Although some popular books have implied that if too
many of your calories come in the form of re®ned sugar
then your diet might be de®cient in micro-nutrients, the
levels of minerals and vitamins in the body are more closely
related to total energy intake than sugar intake. However, a
problem can occur if you consume a low-calorie diet with a
high proportion of calories in the form of sugar, a conclu-
sion based on the diet of adults [28].
A child with a poor appetite, who favoured sweet tasting
foods, might have a particular problem, although the topic
has been largely ignored. In a Welsh study a crude measure
of sugar intake was obtained by asking the parents of 6-year-
olds to report the frequency that particular foods were eaten
[8]. The more a child's diet contained sugar, the greater was
the response to vitamin/mineral supplements. It was the
children with high amounts of sugar in their diet who
responded to supplementation with improved non-verbal
intelligence scores. Did those children with a high sugar
intake have a low vitamin intake? It is not known but it is
a suggestion that should be considered in future studies.
The recording of a dietary diary is a procedure known to
be associated with many methodological problems and the
measurement of blood samples is known to offer more valid
indices of vitamin status. Children were distinguished
whose levels of blood micro-nutrients had, or had not,
increased after micro-nutrient supplementation [62]. It was
assumed that if the levels in the blood had not increased this
indicated good vitamin status. If levels increased following
supplementation then the initial vitamin status must have
been poor. The non-verbal intelligence of those whose
blood micro-nutrients improved increased markedly [62],
although the lack of detail of the biochemical assessments
makes the contribution of this paper dif®cult to establish.
Much of the controversy associated with the largest study
[63] re¯ected the ®nding that an improvement in non-verbal
intelligence was associated with the taking of the 100%
RDA tablets but not those offering either 50 or 200%. The
answer became apparent after several years. When frozen
blood samples were analyzed [29], the children who had
responded to supplementation with changes in non-verbal
intelligence were found to have had signi®cantly greater
increases in micro-nutrient status. The levels of blood
micro-nutrients can only rise if the bodies stores are not
already full, that is you are poorly nourished. Importantly
the proportion of children who initially had low levels of
vitamins in their body differed between the groups who had
received 50, 100 and 200% of the RDA [63]. The reason that
the children responded to 100% of the RDA was that, by
 D. Benton / Neuroscience and Biobehavioral Reviews 25 (2001) 297±309 303

Table 3
The composition of supplements used in studies of intelligence

Studies

a,c,i a b d e fb g h j

Retinol equivalents (mg) 375 1000 5000 IU 5000 IU 5000 IU 300 0 750
Thiamine (mg) 3.9 2.2 1.5 4.5 1.5 0.7 1 0.75
Ribo¯avin (mg) 5 2.8 1.7 5.1 1.7 0.9 1.4 0.85
Nicotinic acid (mg) 50 24 20 60 20 10 16 10
Pyrodoxine (mg) 12 2 2 6 2 1.3 1.8 1
Vitamin B12 (mg) 10 5 6 18 6 2.5 3 3
Folate (mg) 100 450 400 400 400 200 400 200
Biotin (mg) 100 100 0 300 300 10 100 0
Pantothenic acid (mg) 50 50 0 30 10 25 4 5
Ascorbic acid (mg) 500 50 60 120 60 70 25 40
Vitamin D (mg) 3 15 400 IU 200 IU 400 IU 10 10 5
Vitamin E (mg) 70 IU 10 15 IU 30 IU 30 IU 6 0 20
Vitamin K (mg) 100 100 0 0 50 100 0 0

Calcium (mg) 100 100 1.6 122 200 30 0 0

Chromium (mg) 200 200 0 100 100 100 50 50
Copper (mg) 0 2 2 2 2 0.03 2 1
Iron (mg) 1.3 15 18 18 18 2.4 12 9
Iodine (ug) 50 100 0 0 150 50 150 0
Magnesium (mg) 7.6 25 25 59 80 8 0 0
Manganese (mg) 1.5 1.5 1 5 2.5 1 2.5 1.25
Molybdenum (mg) 100 0 0 50 250 100 0 0.12
Phosphorus (mg) 0 0 0 122 0 0 0 0
Selenium (mg) 0 150 0 100 100 0 50 50
Zinc (mg) 10 15 10 15 15 4 15 7.5

Bio¯avanoids (mg) 50 0 0 0 0 20 0 0
Choline (mg) 70 0 0 40 0 35 0 0
Inositol (mg) 30 0 0 40 0 15 0 0
Para-aminobenzoic acid (mg) 10 0 0 50 0 5 0 0
a
Study (a) Benton and Roberts [12]; (b) Nelson et al. [53]; (c) Crombie et al. [21]; (d) Benton and Buts [7]; (e) Schoenthaler et al. [62]; (f) Schoenthaler et al.
[63]; (g) Benton and Cook [8]; (h) Southam [68]; (i) Snowdon [66]; (j) Schoenthaler et al. [64]).
b
Study used 50, 100 and 200% of RDA. Data for 100% RDA presented.

chance, they were more poorly nourished. The vitamin
status of those children responding to the 100% RDA
were used to distinguish children in the 50 and 200%
RDA groups who were poorly nourished. When this was
done, it was found that those with a poor vitamin status in
the 50 and 200% RDA groups responded to supplementa-
tion with increased non-verbal scores. Those who were
well-nourished did not respond.
The data relating nutrient status to the response to supple-
mentation are limited, however, they suggest an approach with
the potential to account for the inconsistencies in this area.
4. The composition of the micro-nutrient supplement
From a scienti®c perspective there was much to be gained
by keeping the composition of the original supplement
constant, as this prevents any negative data being explained
in terms of differences in the nature and dose of the micro-
nutrients offered. Table 3 lists the supplements used in the
studies of non-verbal intelligence. The supplements varied
both in the substances they offer and in the doses. Some
supplements included substances other than vitamins or
minerals. The fact that only three of the studies have used
the same preparation has attracted adverse comment [55].
There are, however, also advantages to using varied supple-
ments, as a comparison of the compositions offer some
preliminary indications as to which nutrients are essential
(Table 3).
A positive response has been reported with supplements
that did not contain calcium, chromium, copper, iodine,
magnesium, molybdenum, phosphorus or selenium. In
contrast iron, manganese and zinc are common to the
studies that report a positive response. The presence of the
bio¯avinoids, choline, inositol and para-aminobenzoic acid
in a minority of the supplements was not critical. In contrast
a wide range of vitamins were present in all the supplements
that stimulated non-verbal intelligence, including the B vita-
mins and vitamins A, D and E. In contrast Biotin, Pantothe-
nic Acid and Vitamin K were not essential.
Benton and Roberts [12] argued that the level of iron in
their supplement was so low (1.3 mg) that it was unlikely to
304 D. Benton / Neuroscience and Biobehavioral Reviews 25 (2001) 297±309
be the active ingredient. However, Lynn and Harland [49]
later found that a much higher dose of iron (17 mg) stimu-
lated non-verbal intelligence, but only in those with poor
iron status as judged by ferritin status (17% of the sample).
Although this study adds to the growing evidence that a poor
iron status disrupts cognition, the low level of iron in many
of the supplements (Table 3) makes it is unlikely that iron
accounts for the stimulation of non-verbal intelligence.
Previously it has been reported that iron status correlates
with performance on the Block Design Test of the Wechsler
Adult Intelligence Scale and spatial tests, but not Ravens
Progressive Matrices [31]. These ®ndings suggested that
iron status in¯uenced aspects of spatial ability rather than
`¯uid' intelligence.
These comments about the role of particular nutrients are
extremely preliminary. It may well be that given the wide-
spread physiological functions that rely on an adequate
supply of micro-nutrients, many vitamins and minerals
play a role, perhaps to differing degrees in different indivi-
duals. To date there is evidence that thiamine [37], iron [49]
and vitamin C [42] stimulate scores on intelligence tests,
although the possibility that other nutrients may prove
important should not be excluded. Following supplementa-
tion the stimulation of intelligence scores by over nine
points has been reported in a group of adults with low
serum folic acid levels [16].
5. The diet of British school-children
The Benton and Roberts [12] report attracted a great deal
of criticism from British nutritionists, who tended to believe
that the diet of children typically supplied adequate levels of
micro-nutrients. They responded as if it was not reasonable
to even suggest that the diet of some children was so poor
that micro-nutrient status could in¯uence cognitive func-
tioning. Yudkin [72] claimed that ªThis is the most scanda-
lous paper I've seen printed in The Lancet. The study is
ludicrous meaningless nonsenseº. Several years later he
added, following a study with which he had been associated,
ªOur studies show, we believe conclusively, that adding
vitamins and minerals to the diets of children who have
no obvious physical signs of nutrient de®ciency can never-
theless produce an increase in their IQ scoresº [73]. White-
head, one of the most in¯uential nutritionists in the United
Kingdom, commented that ªNo physiological explanation
exists of how vitamin and mineral supplementation could
affect brain function in a well nourished subjectº [76]. The
quote re¯ects the received wisdom of many nutritionists.
Even if you ignore the tautology, it is a strange observation,
given the well-described metabolic roles of vitamins [3,20].
For example they play important roles in the functioning of
co-enzymes and hundreds of mechanisms will be disrupted
if vitamins are present in sub-optimal levels. What seems to
be implied is that because it is so certain that children are
well fed such responses are inconceivable. In a similar vein,
quoting dietary surveys, Naismith [52] stated ªI would be
surprised if mental ability could be affected by diet ¼ in my
opinion the majority of school children now-a-days are well
nourishedº.
It is apparent from these quotes that there was a wide-
spread belief amongst professional nutritionists that chil-
dren consume adequate levels of micro-nutrients. Can it
really be stated with total con®dence that all children are
well fed?
The demonstration, in a double-blind trial, that the giving of
vitamin/mineral supplements improved functioning, caused
problems for many nutritionists as they believed that it
con¯icted with received wisdom. However, the problem was
more apparent than real. There was no reason to believe that
judgements based on the recording of food-intake and the
calculation of the RDA (or Dietary Reference Values) would
tell us anything about intellectual performance.
In Britain, following the publication of the Benton and
Roberts paper [12], many nutritionists quoted a survey of
the diets of schoolchildren [26] as evidence that there was
little or no reason to worry about their nutrition. In this type
of survey the RDA is used as the bench-mark. The rule of
thumb is that if the average intake of a population is more
than the RDA then the diet can be said to be adequate. A
RDA is a population statistic that aims to satisfy the require-
ments of two standard deviations of the population. What
this approach ignored was that a satisfactory average intake
may hide a sub-set of the population with very low intakes
or very high needs.
If you consume 100% of the RDA, then statistically it
is likely that you are well-nourished, as the intake
declines the probability that it is de®cient increases.
There is a second rule of thumb, sometimes used by
nutritionists. If the intake is less than 70% of the
RDA then this gives grounds for concern; if it is even
less, then the concern is greater. On average the intake
of various vitamins by British schoolchildren reached
the RDA, and the conclusion was drawn that they
were well-nourished [26]. However, when these data
were reanalyzed groups of children were found who
ate less than 70%, or even 50%, of the RDA [5]. The
satisfactory average hid groups of children with a low
micro-nutrient intake. It should be remembered that
although such data are suggestive of a problem, the
RDA is a statistic that says nothing about an individual.
The acid test, needed to show nutritional de®ciency, is
the demonstration in a double-blind trial that supple-
mentation improved functioning. As such, if the data
summarized in Table 2 can be shown to apply reliably
to sub-groups of children there will be hard evidence of
an inadequate diet.
In fact it is questionable whether the RDA should be used
when commenting about intelligence. The RDA is set at a
level that satis®es the `needs' of practically all healthy indi-
viduals. The relevant question is what is meant by `needs'.
The United Kingdom committee charged with establishing
 D. Benton / Neuroscience and Biobehavioral Reviews 25 (2001) 297±309
Dietary Reference Values (similar to RDA) commented
that:
Classically, the requirement of an individual for a
nutrient has been the amount required to prevent clin-
ical signs of de®ciency. Claims have also been made
that at very high levels of intake some nutrient have
especially bene®cial or therapeutic effects but the
panel decided that these effects did not fall within
their de®nition of requirement [27].
`Need' can mean many things; the avoidance of a de®-
ciency disease; the establishing of adequate reserves; the
achieving of optimal functioning. The stated objective of
a RDA is to avoid de®ciency rather than achieve optimal
functioning. There is no logical reason to look to a RDA to
assess the likelihood that a child will, or will not, respond to
micro-nutrient supplementation with improved non-verbal
intelligence scores. The type of evidence used to establish a
RDA, and the objectives of RDAs, tell us nothing about the
optimal functioning of the brain or intelligence. Dietary
surveys and RDAs were never intended to consider such
questions. As such there is no reason for nutritionists to be
concerned that some children respond to supplementation
by performing better on an intelligence test. If they do
happen to be concerned then the RDA offers little guidance.
Even if for some reason it was believed that the RDA
approach to dietary surveys tells us something about the
relationship between nutritional status and intelligence,
the problem that concerned many nutritionists arguably
did not exist. There was no necessary inconsistency between
the improvement in non-verbal intelligence in some chil-
dren (Table 2) and surveys of diet [26,35]. Both suggested
that some, but not all children, have a poor diet. There was
no suggestion that all children responded to supplementa-
tion with improved non-verbal scores, there was no sugges-
tion that all children were poorly nourished. In fact the
limited evidence available suggested the opposite, only a
minority bene®ted from supplementation, those with diets
that supplied low levels of vitamins and minerals.
There are many problems associated with the use of diet-
ary diaries, for example, often they only poorly predict
biochemical indices, better indicators of nutritional status.
There are few biochemically based data from children,
however, a British survey found that the micro-nutrient
intake of the majority of children reached accepted levels
[35]. With many vitamins there was, however, a few chil-
dren who had very low blood levels. An erythrocyte
glutathione reductase activation coef®cient of greater than
1.30 is generally considered to indicate ribo¯avin de®-
ciency. By this index, 59% of boys aged 4±6, and 78%
aged 7±10 years, were de®cient. In girls aged 4±6 years,
75% were ribo¯avin de®cient, something true for 95% of
those aged 15±18 years [35]. The use of the erythrocyte
aspartate aminotransferase coef®cient as a measure of vita-
min B6 status indicated that about 10% of both boys and
305
girls were de®cient. Although no child younger than 14
years was de®cient, 1% of boys and 8% of girls aged 15±
18 years had serum values of vitamin B12 below the accep-
table level. The erythrocyte transketolase activation coef®-
cient indicated that less than 0.5% of boys and 2% of girls
were thiamine de®cient. Although 76% of girls and 72% of
boys had eaten no citrus fruit during a 7-day dietary diary,
no more than 5% of any age groups had plasma levels of
vitamin C below the acceptable range [35]. The level of
serum ferritin, the storage protein for iron, was lower than
the acceptable range for 13% of boys overall, and in girls the
numbers who were de®cient ranged from 9 to 27% depend-
ing on age [35].
These data were similar to the report that 20% of young
adult males and 29% of females were ribo¯avin de®cient
and a further 17% of males and 28% of females were of
marginal status [11]. Such observations are potentially
important as there is only a 35% difference in ribo¯avin
concentration between de®ciency and saturation [3].
However, it is important to note that a similar study [34]
reported that only 1% of young adult males and 3% of
females had a ribo¯avin status in the de®cient range. Clearly
different sections of the population eat markedly different
diets. This is not surprising as vitamin intake has been
reported to vary with age, the area of the country where
you live, social class and family structure [34]. Such obser-
vations imply that data concerning nutritional status should
be generalized with great caution.
In summary, although when judged by estimations of
dietary intake or biochemical markers the diet of the major-
ity of British children is adequate, a minority fail to meet the
relevant criteria.
6. Micro-nutrient intake and neural functioning
Benton [6] marshalled evidence that very often the ®rst
symptoms associated with micro-nutrient de®ciency are
psychological. In addition to the studies presently reviewed
there is a series of well designed studies that report, in at
least some of the population, that micro-nutrient supplemen-
tation is associated with better mood [9,10,40,65,66], better
memory [25,44], attention [8] and eye-hand co-ordination
[15]. Thus there is increasing evidence that particular vita-
mins may modulate psychological functioning. The brain is
the most complex and metabolically active organ in the
body and cognition is the summated outcome of countless
millions of metabolic processes, thus even minor metabolic
inef®ciencies could create a cumulative adverse effect.
As one example, the status of several B vitamins are
assessed by measuring the activity of various red-blood
cell enzymes. A small decline in the activity of a single
enzyme may be ignored as physiologically unimportant,
measurement error, or part of the normal range. However,
when you are examining the output of billions of neurones it
is possible that the accumulated impact of billions of small
306 D. Benton / Neuroscience and Biobehavioral Reviews 25 (2001) 297±309
decreases in enzymatic activity may produce a cumulative
physiologically signi®cant disruption of functioning. If this
argument has validity then the functioning of the brain,
given its complexity, would be expected to be the ®rst
organ to demonstrate disrupted functioning.
Although you can speculate that the brain may be suscep-
tible to a marginal micro-nutrient intake, there is no evidence
to suggest a speci®c mechanism that underlies the improved
performance of tests of non-verbal intelligence. In the absence
of any evidence a few comments will be made to demonstrate
the plausibility of the suggestion that micro-nutrient
de®ciency may in¯uence neural functioning. The widespread
role of vitamins as part of co-enzymes ensures that micro-
nutrient de®ciencies have the potential to in¯uence any meta-
bolic pathway. Given its critical role in neuronal functioning
the in¯uence on neurotransmission will be considered for
illustrative purposes.
One effect of thiamine de®ciency is a reduction of the
brain content of acetyl CoA with a consequent decreased
turnover of acetylcholine. Thiamine de®ciency is also asso-
ciated with reduced levels of brain GABA, glutamate and
aspartate [3]. Ascorbic acid in¯uences the activity of several
hydoxylases involved in the metabolism of neurotransmit-
ters, for example the action of dopamine-B-monoxygenase
that forms noradrenaline from dopamine [20]. Pyridoxal
phosphate is involved in practically all reactions involved
in amino acid metabolism. Pyridoxal-dependent enzymes
are involved in the biosynthesis of serotonin (tryptophan
decarboxylase), dopamine, noradrenaline (DOPA decarbox-
ylase) and GABA (glutamate decarboxylase) [3,20].
In making these comments we should be careful in draw-
ing an analogy between the gross de®ciency of a micro-
nutrient and the marginal de®ciency presently reviewed. It
needs to be demonstrated that a marginal dietary intake
adversely in¯uences enzymic activity, perhaps in a particu-
lar sub-cellular compartment. There is some evidence that
within the normal range vitamin status in¯uences the level
of neurotransmitters. It has been reported that in synapto-
somes dopamine release was in¯uenced by concentrations
of ascorbic acid within the endogenous range [33]. Ascorbic
acid may have a neuromodulatory role that involves changes
at the level of carrier-membrane translocation and orienta-
tion [24]. The treatment of rats with pyridoxine has been
found to increase the serotonin content of various areas of
the brain. It was suggested that the level of pyridoxal phos-
phate regulates the decarboxylation of 5-hydroxytrypto-
phan, the precursor of serotonin. A continuum existed
from pyridoxine de®ciency, to a moderate excess, that
was re¯ected in the synthesis and release of serotonin [23].
Although these data are consistent with the suggestion
that micro-nutrient status has the potential to in¯uence
neural functioning, we have no idea of the mechanism by
which supplementation improves the performance of non-
verbal tests. Given the ubiquitous metabolic roles of vita-
mins, potentially, they can be expected to in¯uence any
aspect of the brain's structure and functioning.
7. Changes in intelligence over time
Our knowledge of the changes in intelligence in the popula-
tion, over time, owes a great deal to the work of Flynn [30].
The parallels with the changes in non-verbal intelligence, that
result from micro-nutrient supplementation, are striking. He
reported very consistent and substantial changes in intelli-
gence over many years. For example in the Netherlands, for
generations, every man when he started his national service
completed the same intelligence test. Thus, with few excep-
tions, we have test results from the entire male population.
Over a period of 30 years, intelligence increased 21 points,
an enormous change. Flynn was able to ®nd similar evidence
from no less than 14 countries. Clearly such massive improve-
ments in intelligence test performance must re¯ect powerful
factors, but what are they? Obvious candidates are better
schooling; more verbal stimulation from watching television;
greater access to books made possible by increased af¯uence.
If any of these mechanisms were responsible for the increases
then you would expect that performance on verbally based
tests would be stimulated. The results are very clear; it was
non-verbal rather than verbal intelligence that had increased
over the decades.
Lynn [48] argued that it was likely that the increases in
non-verbal intelligence re¯ected improved diet. One clue
that nutrition may be important is that as intelligence
increased, there have been parallel increases in height. In
fact the increases in height have been large, about 1.2 cm
every decade. The most widely accepted explanations for
the increase in height is that it re¯ected improved nutrition,
although at earlier stages a reduction in infectious diseases
may have played a role. Lynn [48] considered the hypoth-
esis that the increase in intelligence re¯ected increased
environmental stimulation. When adopted children were
examined after moving from biological parents, to more
stimulating adoptive parents, it was the performance of
verbal tests that tended to improve. Thus, the evidence is
that environmental stimulation improves verbal rather than
non-verbal scores. Given the evidence that it is non-verbal
performance that has dramatically improved over recent
decades, this suggests that the underlying mechanism is
biological, rather than social in origin.
The massive increases in intelligence are not experimen-
tal observations and it is impossible to establish their
origins. At the best all that can be argued is that nutrition
is likely to play a role and the possible alternative explana-
tions do not stand examination [48]. There are interesting
parallels between the improvement in performance on non-
verbal tests and the response of some children to the provi-
sion of vitamin and mineral supplements. There is no way to
disassociate the possible contribution of micro-nutrients
from that resulting from other aspects of diet. However,
the size of the increase in measures of ¯uid intelligence
have led others to suggest that they are in part, at least,
artefacts. It is unclear to what extent the changes re¯ect
test sophistication and experience of educational toys that
 D. Benton / Neuroscience and Biobehavioral Reviews 25 (2001) 297±309
encourage the types of thinking tapped by non-verbal
reasoning tests.
8. Discussion
An independent observer of this area might comment that,
on occasions, the debate has been between individuals with
closed minds. Accepting that with any study there are matters
of methodological concern, is there reason to further consider
the possibility that for some individuals the intake of micro-
nutrients limits intellectual functioning? The number of
studies is such that it is unreasonable to consider each in isola-
tion rather we should examine the overall pattern.
Attention may be drawn to various global observations.
1. Of the 13 studies in Table 2, 10 reported a positive
response in at least a subsection of the subjects.
2. Where a positive response has been reported it has
always been with non-verbal measures, it has never
been reported for verbal measures of intelligence.
3. For theoretical reasons a response to non-verbal, and not
verbal tests, was predicted a priori. Non-verbal tests tap
the biologically based functioning that could be expected
to re¯ect the adequacy of diet. Verbal tests re¯ect knowl-
edge and vocabulary that would not be expected to
improve, at least in the short-term, following micro-nutri-
ent supplementation.
4. The evidence is that not all children respond to supple-
mentation, rather it occurs in a minority whose diet offers
low amounts of micro-nutrients [7,29]. Such an observa-
tion is consistent with dietary surveys that typically
report a sub-set of children with a low intake of micro-
nutrients [26,35].
Those wishing to dismiss the data in Table 2 must explain
the above pattern of results. As the results have been reported
by different investigators, using different methodologies, it is
dif®cult to point to common aspects of methodology that
would produce the distinctive pattern. The time has passed
when a single study, that does not correspond to your precon-
ceptions, can be subject to destructive criticism. Those
wishing to totally dismiss the positive ®ndings need, when
making a methodological evaluation, to point to common
faults not shared by those reporting negative data. Any such
fault must be shown to produce a highly distinctive pattern of
results. The nature of such idiosyncrasies are not obvious.
If the conclusion is accepted that there is a phenomenon
worthy of further study, such a conclusion should be drawn
with caution. We have a series of small-scale studies that
have inconsistencies that await satisfactory explanation.
There is an urgent need for large-scale studies that use reli-
able biochemical measures of dietary status. Ideally the
sample should be large enough to consider the response of
groups who differ in the nature of their nutritional de®cien-
cies and social background. The reaction of males and
307
females of different ages should be contrasted. The associa-
tion between socio-economic background, dietary style and
micro-nutrient status should be considered. Given the many
factors that in¯uence what we eat, and the wide spread
individual need for nutrients, it is perhaps less surprising
that the data are inconsistent than that there is a considerable
amount of consistency.
Finally, it is important that if future studies support these
small-scale studies, the phenomenon is kept in context.
Many parents will readily believe that diet can both cause
and solve complex and worrying problems. In most cases
this is an unreasonable expectation. There is no reason to
expect a supplement to produce dramatic change in a child's
functioning, even if they have a low intake of micro-nutri-
ents. We function intellectually using `crystallized' intelli-
gence, yet it was the `¯uid' scores (non-verbal) that were
stimulated by supplementation. Assuming that your child
would in fact bene®t from supplementation all that you
can expect to improve is intellectual potential. Unless that
potential interacts with a stimulating environment, it
remains as nothing more than potential, something that
has not been exploited. Improved nutritional status of itself
will bring no intellectual gain unless it takes place in a
stimulating, emotionally secure environment. Even then
the changes will take place gradually over a long period.
Eysenck and Schoenthaler [29] concluded, ªwith a certain
degree of con®denceº, that ªinadequate levels of vitamins
and minerals in the blood reduce a child's IQº and ªsupple-
mentation by vitamin and mineral pills can raise the child's
non-verbal IQ signi®cantlyº, although it ªhas no effect on
children with an adequate level of vitamins and mineralº.
The only non-controversial aspect of this summary is the
®nal part. Nobody has suggested that those with an adequate
vitamin status will respond to supplementation, it is not a
way of achieving a level of supra-normal functioning.
You may accept the rest of this conclusion so long as the
operative phrase is ªa certain degree of con®denceº. Is this
certain degree large or small? The tone of the Eysenck and
Schoenthaler chapter [29] is that they have a large degree of
con®dence. Many skeptical scientists, after a sober evalua-
tion, will have a smaller degree of con®dence. Arguably we
are not, however, at a stage where that degree of con®dence
is so limited that the idea that micro-nutrient status can limit
intellectual potential can be safely dismissed as ªludicrous
and meaningless nonsenseº [71]. There are too many posi-
tive results to dismiss the ®ndings out of handÐthere is a
need for further study.
A tentative conclusion re¯ects the many questions that need
to be systematically addressed. The topic is at a very early
stage and needs the clari®cation gained from a series of
large-scale studies. Children of a wide range of ages, dietary
styles and social backgrounds need to be considered. The
nutrients and dosage required should be established. What is
it that is missing from the diet, a little bit of everything or are
particular nutrients important? Are other aspects of psycholo-
gical functioning disrupted as well as non-verbal intelligence?
308 D. Benton / Neuroscience and Biobehavioral Reviews 25 (2001) 297±309
Is the phenomenon more likely to occur at some stages of
development rather than others? What proportion of children
have an inadequate diet? These are questions that we have not
begun to consider, never mind answer.
References
[1] Aukett MA, Parks YA, Scott PH, Wharton BA. Treatment with iron
increases weight gain and psychomotor development. Arch Dis Child
1986;61:849±57.
[2] Barrett DE, Frank DA. The effects of undernutrition on childrents
behavior. New York: Gordon and Breach, 1987.
[3] Bender DA. Nutritional biochemistry of the vitamins. Cambridge:
Cambridge University Press, 1992.
[4] Benton D. Letter. Lancet 1988;i:408.
[5] Benton D. Food for thought. London: Penguin, 1996.
[6] Benton D. Vitamin-mineral supplements and intelligence. Proc Nutr
Soc 1992;51:295±302.
[7] Benton D, Buts J-P. Vitamin/mineral supplementation and intelli-
gence. Lancet 1990;335:1158±60.
[8] Benton D, Cook R. Vitamin and mineral supplements improve the
intelligence scores and concentration of six year children. Personal
Indi Diff 1991;12:1151±8.
[9] Benton D, Grif®ths R, Haller J. Thiamine supplementation mood and
cognitive functioning. Psychopharmacol 1997;129:66±71.
[10] Benton D, Haller J, Fordy J. Vitamin supplementation for one year
improves mood. Neuropsychobiol 1995;32:98±105.
[11] Benton D, Haller J, Fordy J. The vitamin status of young British
adults. Int J Vit Nutr Res 1997;67:34±40.
[12] Benton D, Roberts G. Effect of vitamin and mineral supplementation
on the intelligence of a sample of schoolchildren. Lancet 1988;i:140±
3.
[13] Booth IW, Aukett MA. Iron de®ciency in infancy and early child-
hood. Arch Dis Child 1997;76:549±53.
[14] Boggs UR, Scheaf A, Santoro D, Ritzman R. The effects of nutrient
supplements on the biological and psychological characteristics of
low IQ preschool children. J Orthomol Psychiat 1965;14:97±127.
[15] Bonke D, Nickel B. Improvement of ®ne motoric movement control
by elevated dosages of Vitamin B1 B6, and B12 in target shooting. In:
Walter P, Stahelin H, Brubacher G, editors. Elevated dosages of vita-
mins, Toronto: Hans Huber, 1989. p. 198±204.
[16] Botez MI, Fontaine F, Botez T, Bachevalier J. Folate-responsive
neurological and mental disorders: report of 16 cases. Eur Neurol
1977;16:230±46.
[17] Carroll HCM, et al. A psychometric critique of Nelson's 1990 paper:
nutrient intakes vitamin-mineral supplementation and intelligence in
British schoolchildren. Personal Indi Diff 1995;18:669±75.
[18] Cattell RB. The heritability of ¯uid gf and crystallized gc intelligence:
a critical experiment. J Educ Psychol 1963;54:1±22.
[19] Colgan M, Colgan L. Do nutrient supplements and dietary changes
affect learning and emotional reactions of children with learning dif®-
culties? A controlled series of 16 cases. Nutr Health 1984;3:69±77.
[20] Combs GF. The vitamins. 2nd ed. San Diego: Academic Press, 1998.
[21] Crombie IK, Todman J, McNeill O, Florey C du V. Vitamin-mineral
supplementation and intelligence. Lancet 1990;336:175.
[22] Crombie IK, Todman J, McNeill G, Florey C du V, Menzies I,
Kennedy RA. Effect of vitamin and mineral supplementation on
verbal and non-verbal reasoning of schoolchildren. Lancet
1990;335:744±7.
[23] Dakshinamurti K, Sharma SK, Bonke D. In¯uence of B vitamin on
binding properties of serotonin receptors in the CNS of rats. Klin
Wochenschr 1990;68:142±5.
[24] Debler EA, Sershen H, Hashim A, Lajtha A, Reith ME. Carrier-
mediated ef¯ux of [3H] dopamine and [3H] 1-methyl-4-phenylpyri-
dine: effect of ascorbic acid. Synapse 1991;7:99±105.
[25] Deijen JB, van der Beek EJ, Orlebeke IF, van den Berg H. Vitamin B6
supplementation in elderly men: effects on mood memory perfor-
mance and mental effort. Psychopharmacol 1992;109:489±96.
[26] Diets of British Schoolchildren. Department of Health Report 36.
London: HMSO, 1989.
[27] Dietary Reference Values for food energy and nutrients for the United
Kingdom. Department of Health Report on Health and Social
Subjects, vol. 41. London: HMSO, 1991.
[28] Dietary sugars and human disease. Department of Health Report on
Health and Social Subjects, vol. 37. London: HMSO, 1989.
[29] Eysenck HJ, Schoenthaler SJ. Raising IQ level by vitamin and
mineral supplementation. In: Sternberg RJ, Grigorenko EL, editors.
Intelligence heredity and environment, Cambridge: Cambridge
University Press, 1997. p. 363±92.
[30] Flynn JR, Massive IQ. gains in 14 nations: what IQ tests really
measure. Psychol Bull 1984;101:171±91.
[31] Foley D, Hay DA, Mitchell RJ. Speci®c cognitive effects of mild iron
de®ciency and associations with blood polymorphisms in young
adults. Ann Hum Biol 1986;13:417±25.
[32] Fordy J, Benton D. Does low iron status in¯uence psychological
functioning? J Hum Nutr Dietet 1994;7:127±33.
[33] Girbe F, Ramassamy C, Piton C, Costentin J. Ascorbic acid increases
synaptosomal potassium-induced dopamine release. Neuroreport
1994;9:1027±9.
[34] Gregory J, Foster K, Tyler H, Wiseman M. The dietary and nutritional
survey of British adults. London: Of®ce of Population Censuses and
Surveys, HMSO, 1990.
[35] Gregory J, Lowe S. National diet and nutrition survey: young people
aged 4 to 18 years. London: The Stationery Of®ce, 2000.
[36] Haller J. The action of vitamins and other nutrients on psychological
parameters. In: Hindmarch I, Stonier PD, editors. Human psychophar-
macology, vol. 5. Winchester: John Wiley, 1995. p. 229±61.
[37] Harrell RF. Mental responses to added thiamine. J Nutr 1946;31:283±
98.
[38] Harrell RF, Capp RH, Davis DR, Peerless J, Ravitz LR. Can nutri-
tional supplements help mentally retarded children? Proc Nat Acad
Sci USA 1981;78:574±8.
[39] Harrell RF, Woodyard ER, Gates AI. The in¯uence of vitamin supple-
mentation of the diets of pregnant and lactating women on the intelli-
gence of their offspring. Metabolism 1956;V:555±62.
[40] Heseker H, Kubler W, Westenhofer J, Pudel V. Psychische Verander-
ungen als Fruhzeichen emer suboptimalen Vitaminversorgung.
Ernahrungs-Umschau 1990;37:87±94.
[41] Kerimova MG, Aleskerova IG. In¯uence of ration correction and
varying doses of glutamevitum on the vitamin status and working
capacity of children attending school form the age of six. Voprosy
Pitaniia 1990:Nov±Dec;30±34 [In Russian].
[42] Kubula AL, Katz MM. Nutritional factors in psychological test beha-
vior. J Genet Psychol 1960;96:343±52.
[43] Letters to Editor. Lancet 1988;I:407±8.
[44] Loriaux SM, Deijen JB, Orlebeke JF, de Swart JR. The effects of
nicotinic acid and xanthinol nicotinate on human memory in different
categories of age. Psychopharmacol 1985;87:390±5.
[45] Lozoff B. Behavioral alterations in iron de®ciency. Adv Pediatr
1988;35:331±59.
[46] Lozoff B, Jimenez E, Woll AW. Long-term developmental outcomes
of infants with iron de®ciency. New Eng J Med 1991;325:687±94.
[47] Lozoff B, Klein NK, Nelson EC, McClish DK, Manuel M, Chacon
ME. Behavior of infants with iron-de®ciency anemia. Child Dev
1998;69:24±36.
[48] Lynn R. The role of nutrition in secular increases in intelligence.
Personal Indi Diff 1990;11:272±85.
[49] Lynn R, Harland EP. A positive effect of iron supplementation on the
IQs of iron de®cient children. Personal Indi Diff 1998;24:883±5.
[50] Maseck D. Vitamins: the get-smart pills? J Orthomol Psychiat
1980;9:58±65.
[51] Mora JO, Amezquita A, Castro L. Nutrition health and social factors
 D. Benton / Neuroscience and Biobehavioral Reviews 25 (2001) 297±309
related to intellectual performance. World Rev Nutr Diet
1974;19:205±36.
[52] Naismith DJ. Daily Telegraph, London, 22 February, 1988.
[53] Nelson M, Naismith DJ, Burley V, Gatenby S, Geddes N. Nutrient
intake vitamin/mineral supplementation and intelligence in British
Schoolchildren. Brit J Nutr 1990;64:13±22.
[54] Nidich SI, Morehead P, Nidich RJ, Sands D, Sharma H. The effect of
the Mahaarishi Student Rasayana food supplement on non-verbal
intelligence. Personal Indi Diff 1993;15:599±602.
[55] Po LW. Vitamins IQ and the law. Pharmaceut J 1992:506±8.
[56] Pollitt B. Malnutrition and infection in the classroom. Paris:
UNESCO, 1990.
[57] Pollitt B. Iron de®ciency and cognitive function. Ann Rev Nutr
1993;13:521±37.
[58] Pollitt B. Poverty and child development: relevance of research in
developing countries to the United States. Child Dev 1994;65:283±
95.
[59] Pollitt B. Iron de®ciency and educational de®ciency. Nutr Rev
1997;55:133±41.
[60] Rimland B, Callaway B, Drey¯is P. The effect of high doses of
vitamin B6 on autistic children: a double-blind crossover study.
Amer J Psychiat 1978;135:472±5.
[61] Sanders TA. Vegetarian diets and children. Ped Clin North Amer
1995;42:955±65.
[62] Schoenthaler SJ, Amos SP, Doraz WE, Kelly MA, Wake®eld J.
Controlled trial of vitamin-mineral supplementation on intelligence
and brain function. Personal Indi Diff 1991;12:343±50.
[63] Schoenthaler SJ, Amos SP, Eysenck HJ, Peritz B, Yudkin J.
Controlled trial of vitamin-mineral supplementation: effects on intel-
ligence and performance. Personal Indi Diff 1991;12:351±62.
[64] Schoenthaler SJ, Bier I, Young K, Nichols D, Jansenns S. The effect
of vitamin-mineral supplementation on the intelligence of American
schoolchildren: a randomized double-blind placebo-controlled trial. J
Alternat Compl Med 2000;6:19±29.
309
[65] Smidt LJ, Cremin FM, Grivetti LE, Clifford AJ. In¯uence of thiamin
supplementation on the health and general well-being of an elderly
Irish population with marginal thiamin de®ciency. J Gerontol
1991;46:M16±22.
[66] Snowden W. Evidence from an analysis of 2000 errors and omission
made in IQ tests by a sample of schoolchildren undergoing vitamin
and mineral supplementation that speed of processing is an important
factor in IQ performance. Personal Indi Diff 1997;22:131±4.
[67] Southam S. Micronutrients and IQ. J Micronut Anal 1990;7:179±91.
[68] Southon S, Wright A, Finglas P, Bailey A, Beisten J. Micro nutrient
intake and psychological performance of school-children: considera-
tion of the value of calculated intake for the measurement of micro-
nutrient status in children. Proc Nutr Soc 1992;51:315±24.
[69] Southon S, Wright A, Finglas P, Bailey AL, Louchridge JM, Walker
AD. Dietary intake and micronutrient status of adolescents: effect of
vitamin and trace element supplementation on indices of status and
performance in tests of verbal and non-verbal intelligence. Brit J Nutr
1994;71:897±918.
[70] Todman J. Vitamins and IQ. The Psychologist, August 1993. p. 357±9.
[71] Todman J, Crombie I, Elder L. An individual difference test of the
effect of vitamin supplementation on non-verbal IQ. Personal Indi
Diff 1991;12:1333±7.
[72] Yudkin J. Daily Telegraph, 22 February, 1988.
[73] Yudkin J. Intelligence of children and vitamin-mineral supplements:
the DRF study. Discussion conclusions and consequences. Personal
Indi Diff 1991;12:363±5.
[74] Waber DP, Vuori-Christiansen LV, Ortiz N, Clement JR, Christiansen
NE, Mora JO, Reed RB, Herrera MG. Nutritional supplementation
maternal education and cognitive development of infants at risk of
malnutrition. Amer J Clin Nutr 1981;34:807±13.
[75] Webb TE, Oski FA. Iron de®ciency anemia and scholastic achieve-
ment in young adolescents. J Pediatr 1973;82:827±30.
[76] Whitehead RG. Vitamins minerals schoolchildren and IQ. Brit Med J
1991;302:548.