TriStar Summit - June 08, 2020

By the year 2060, an estimated 14 million older adults in the United States will be living with dementia, which affects not only memory, but also decision-making and one’s overall ability to perform daily activities, according to the Centers for Disease Control and Prevention. Alzheimer’s disease—the most common and often feared type of dementia—currently affects 5.8 million Americans of all ages. Despite its rising prevalence, dementia isn’t a normal or inevitable part of aging. But this fate is a common concern among adults, particular those approaching older age, according to a poll published in 2019 by the University of Michigan Institute for Healthcare Policy and Innovation.

Researchers surveyed 1,028 people between 50 and 64 years of age about brain health and found that nearly half were worried about facing memory loss or dementia. They also found that most folks did not discuss these concerns with their healthcare provider (HCP)—but 73% of the participants did try unproven strategies to protect their mind, including doing mentally stimulating games, like crossword puzzles or taking brain health supplements. In fact, 48% admitted to taking some type of vitamin or supplement to boost their memory, and 32% used fish oil or omega-3 supplements, the research showed.

This isn’t the only poll suggesting that brain supplement use is widespread among adults. The 2019 AARP Brain Health and Dietary Supplements Survey found that 26% of U.S. adults age 50 and older take at least one of these products. Not only are brain supplements widespread, but its big business, too: the AARP projects that sales of these products will reach $5.8 billion by 2023. But do over-the-counter brain health supplements really help sharpen fuzzy thinking or boost mental alertness? Could they really help stave off mental decline, or even Alzheimer’s?

The short answer: it’s unclear. There is little scientific evidence about the effectiveness of brain supplements. The only things we know with certainty are that they’re not cheap and they’re not risk-free.

Another important truth: you should not take supplements of any kind, including those labeled as “all-natural,” without talking to your HCP about it first.

Supplements aren’t regulated

The U.S. Food and Drug Administration (FDA) doesn’t regulate dietary supplements in the same way that it controls prescription and over-the-counter medications. That means health officials do not test supplements for safety or effectiveness, and they could contain harmful hidden ingredients. Brain supplements also can’t be advertised as treatments for diseases, such as Alzheimer’s, but many are marketed as being beneficial for mental focus and memory—claims that aren’t backed by iron-clad research.

Understanding the claims

What is a brain supplement anyway? Most of these products focus on a few key nutrients that are usually included as part of overall, heart-healthy eating plans—such as the Mediterranean and DASH diets—which have been associated with greater longevity. Among these nutrients:

  • Omega 3 fatty acids. Some studies suggest that eating fish—particularly fatty fish like salmon and sardines—and other seafood is associated with reduced risk for cognitive decline. But omega-3 fatty acid supplements, also known as fish oil, don’t appear to do the same thing.

    A large 2015 study sponsored by the National Institutes of Health failed to show that taking the omega 3 fatty acid supplements DHA and EPA could help slow mental decline. Other smaller studies have hinted at the possibility that DHA supplements may be beneficial for those with mild cognitive impairments, but more research is needed before a recommendation could be made.

  • B vitamins. Healthy levels of certain B vitamins, such as B12 and B9 (folate or folic acid), are essential for brain health. B12 deficiency can cause reversible cognitive impairment. A deficiency in these vitamins has also been linked to mental decline and dementia later in life. A 2019 analysis of 31 trials involving people with and without cognitive impairment published in Drugs & Aging found no conclusive evidence, however, that B-vitamin supplementation was associated with a brain benefit.

    Meanwhile, most people get adequate amounts of these vitamins through their diet alone. Folate is found in a wide range of foods, particularly dark leafy greens, fruits, nuts, beans, peas, meat, poultry, seafood, grains and dairy products. Vitamin B12 is found mainly in animal products, such as fish, meat, poultry, eggs and other dairy products, but it’s often added to breakfast cereals and other fortified foods. Keep in mind, B12 deficiency is fairly common among older people and those in this age group should ask their doctor if they would benefit from a supplement.

  • Vitamin E. This antioxidant helps keep your immune system working properly and protects against cellular damage. Some research suggests that getting a lot of vitamin E through your diet is linked to a lower risk for dementia, but there is little evidence that supplements offer the same protective benefit. And while there is no known risk from consuming vitamin E-rich foods, high-dose supplements can increase the risk for stroke and bleeding. It may be particularly risky for people taking blood thinners, such as warfarin (Coumadin).

  • Curcumin. This is the ingredient that gives the spice turmeric its bright orange color. The nutrient has been touted as a “superfood” with a range of anti-inflammatory and antioxidant properties. It’s also been linked to improved mood and working memory.

    A 2018 review of existing studies published in GeroScience concluded that while short-term curcumin use is generally considered safe, there is not enough evidence to suggest it could help prevent or manage dementia. It’s also important to note that turmeric or curcumin supplements may not be absorbed correctly unless eaten with fatty or oily foods. Combining curcumin with piperine (a major component of black pepper) could also boost its bioavailability, or its ability to be absorbed and used by the body.

    Other supplements touted for brain health include ginkgo biloba and coenzyme Q10 (CoQ10), but there is scant evidence that these products offer any actual cognitive benefit.

The bottom line on brain supplements

It’s wise to keep your cash in your wallet, advises the AARP-founded Global Council on Brain Health (GCBH), a group of leading neurologists and other brain experts. A 2019 GCBH report, which reviewed recent research on some well-known brain health supplements, concluded that there’s simply not enough evidence that they actually work.

A doctor can give you the best advice on whether a product is right for you based on your health history and any medications you may be taking.

What you should do instead

Rather than spend money on unproven and possibly risky brain supplements, you could focus on what has been shown to improve cognitive function, including the following:

  • Focus on foods. Certain diets, which emphasize fruits, vegetables, healthy unsaturated fats, nuts and whole grains, are associated with better brain function. These eating plans are rich in many of the nutrients used to make so-called brain supplements, but the body may not absorb nutrients from supplements in the same way that it does from food. When consumed as part of an overall healthy diet, nutrients may also work together and have synergistic effects, which isn’t the case when they’re consumed as individual supplements.
  • Limit alcohol. Anyone who has had a few drinks, or been around someone who’s been drinking, can attest to alcohol’s effects on the brain. In the short term, drinkers may have trouble walking, have slowed reaction times and memory lapses. While these effects may wear off, heavy alcohol consumption is also linked to short- and long-term cognitive impairment and an increased risk for dementia.

    While the effects of moderate drinking are less clear, if you don’t drink, it’s best not to start. And if you do decide to imbibe, limit your intake to reduce your risk for a slew of health issues. For women, that means no more than one drink per day. Men should have no more than two daily drinks.

  • Don’t smoke or vape. It’s important to avoid all forms of tobacco, including e-cigarettes. Smoking can speed up cognitive problems and even contribute to brain aging.
  • Get moving. Exercise can benefit your brain and overall health by improving blood flow, protecting heart health and keeping stress hormone levels and inflammation in check. Physical activities such as swimming, walking and biking may preserve your brain cells and encourage the growth of new ones. Long term exercise may also bolster the area of the brain that helps form memories.
  • Prioritize sleep. Poor sleep can lead to “brain fog” or reduced mental alertness. It could also lead to more accumulation of beta-amyloid, a protein in the brain associated with impaired brain function and Alzheimer’s disease.
  • Protect your heart health. Good heart health is linked to better brain health. Keeping health issues such as high blood pressure, diabetes and high cholesterol under control will help protect your brain function over time as well.
  • Prevent accidents. A brain injury can increase your chances of developing cognitive problems. Wear a helmet when biking or playing any contact sport. Always use your seat belt in the car, and clear obstacles in your home or workspace that could increase your risk of falling.
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