UCSF and other aging experts challenge supplements’ ability to improve cognitive function.
Maybe it starts with forgetting your aunt’s birthday. Misplacing your (reading) glasses — again.
You’re at that age, hardly youthful, yet not quite old (or are you?). And with each fuzzy memory or fleeting forgetfulness, you wonder: Is this a sign of dementia? Alzheimer’s?
And you wonder: What should I do? What can I do?
Or maybe you’re still on the young side of middle age but have a family history of Alzheimer’s, leaving you wondering the same.
It’s no wonder the claims jump out at you from your computer or the drug store aisle: “Brain Lift.” “Alpha Brain.” “Brain Dust.” “Brain Octane Oil.” And the smaller print: Improves cognitive functioning. Enhances memory. Roll back your mental clock.
This leaves a group of dementia experts at UC San Francisco Medical School deeply concerned.
The burgeoning market of brain health dietary supplements — pills, capsules, tonics — is filled with bogus claims that aren’t backed up by science, say the researchers, who published their opinion in the Journal of the American Medical Association in January.
There is no magical dietary ingredient yet proven to prevent or cure dementia, they say, though the topic is hotly researched.
They call on consumers to be skeptical and urge fellow physicians to educate their patients about the difference between treatments tested by rigorous research and the lesser-regulated world of non-medicines, including pills that melt fat, creams that erase wrinkles, and capsules that restore lost memory.
“These are claims that are peddling hope and making money off of you,” said neurologist Joanna Hellmuth, an assistant professor at UCSF’s Memory and Aging Center and one of the authors of the JAMA article. “I see patients with all sorts of cognitive disorders. It’s a frightening diagnosis. More people are more frightened of Alzheimer’s than cancer. Fear creates an environment where people will cling to hope.”
She added: “I want to promote whatever is known to be safe and effective.”
According to the Centers for Disease Control and Prevention, about five million people in the United States have Alzheimer’s disease and related dementias. This number is expected to grow to almost 14 million people by 2060, as the wave of baby boomers reach old age.
Alzheimer’s is a progressive brain disease causing memory loss, confusion, disorientation, and mood changes. As brain cells degenerate or die, symptoms worsen, eventually affecting nearly all functioning. It’s not clear what causes the disease. It usually starts after age 60.
There is no cure for Alzheimer’s or dementia. The U.S. Food and Drug Administration has approved a couple of types of prescription medications to treat Alzheimer’s symptoms. The medicines don’t halt progression of the illness but can lessen symptoms, at least for some patients for some period of time.
These medicines are cholinesterase inhibitors (their brand names are Aricept, Exelon, and Razadyne) and memantine (brand name Namedna). Cholinesterase inhibitors are used most often during earlier stages of the disease, with memantine a later-stage drug.
They have variable results and don’t help everyone.
The bleak prognosis for Alzheimer’s understandably leaves many people scared as well as vulnerable and eager for anything that might help. With the lofty promises of many products, brain health supplements are understandably tempting.
It’s a booming market, estimated at $3.2 million globally in 2016, and projected to grow to $11.6 billion by 2024, according to Research and Markets, a private market research firm.
“The landscape of limited treatments for dementia and wide access to information has culminated in a troubling increase in pseudo-medicine,” said Bruce Miller, M.D., a senior author of the opinion piece and director of the UCSF Memory and Aging Center and the Global Brain Health Institute. “While unethical forces promote pseudo-medicine, an educated community of doctors and patients can combat these practices.”
Supplements aren’t subject to the same rigorous testing as medicinal drugs by the FDA. With supplements, the onus is on the manufacturer to evaluate safety and to accurately advertise its products based on evidence.
Manufacturers aren’t allowed to say their products treat, cure, or prevent diseases or illnesses. But makers are allowed to link their products to structures or processes of the body such as smoothing skin, enhancing memory, or sharpening focus.
This creates a false illusion for consumers, Hellmuth said. “Who will read it improves memory and not think it will help mom with her Alzheimer’s disease? It’s really an obstacle. It’s a big burden for consumers and creates a sense of hope.”
This also opens the door to a hungry consumer market, she pointed out. “This has created a landscape where people can make a lot of money off of these claims. It’s not like these are being sold for pennies each day. Someone is making money off of this desire for hope.”
Andrew Shao, interim senior vice president of the Council of Responsible Nutrition, a leading trade group representing supplement manufacturers, said in an email that many companies are ethical and don’t make false claims about their products.
“Dementia and Alzheimer’s disease are serious diseases, and consumers should not rely on supplements to treat these conditions,” he said. “Claims of ‘boosting’ memory or preventing dementia are not well substantiated, and consumers should avoid such products. If claims are too good to be true, they should be avoided.”
Shao pointed to some studies showing a correlation between diet (specifically Omega-3 fatty acids and Vitamin D) and less cognitive decline over time as a foundation for some supplements. “While use of certain supplements may delay the rate of cognitive decline with age, their ability to ‘boost’ function is questionable at best,” Shao said.
His organization actively works to weed out bad actors in the supplement world, he said. The council works closely with the Better Business Bureau to report and research complaints against false advertising by supplement companies. If companies refuse to make changes, they may be reported to the Federal Trade Commission for action.
The UCSF team, and many of the team’s colleagues, said while some research on dietary ingredients, such as Omega-3s, indicates possible benefit to brain function, this is a far cry from proof, which isn’t there yet. Rigorous scientific testing hasn’t yet identified a dietary ingredient to treat cognitive decline, they said. Genes also play a role, though this isn’t clearly understood.
“So much is put out there of variable quality it’s very challenging for even very qualified individuals to discern what’s supported by the scientific literature and what’s not,” Hellmuth said.
The Alzheimer’s Association put it this way: “Research in the area of the relationship between diet and cognitive functioning is somewhat limited, but it does point to the benefits of two diets in particular: the DASH (Dietary Approaches to Stop Hypertension) diet and the Mediterranean diet. These diets can help reduce heart disease and may also be able to reduce risk of dementia.”
The research will continue. Meanwhile, Hellmuth said she wishes the money spent on marketing questionable supplements would instead go to educating patients about what is known to improve brain health. “Let’s instead divert those resources to higher-level interventions,” she said.
Several lifestyle habits are tied by research to brain health. For starters, Hellmuth said, “What’s good for the heart is good for the brain.” This includes:
• Getting regular cardiovascular exercise. “We know this is very important in neurodegenerative disorders like Alzheimer’s,” she said.
• A diet that is low in red meats, high in fishes, vegetables, and fruits, with “good” oils such as olive oil, such as the Mediterranean diet.
• Also beneficial: keeping your mind/brain engaged and staying socially connected.
“We know that staying cognitively active in something you enjoy really promotes brain heath; something that keeps your brain engaged,” Hellmuth said. “Isolation and loneliness are negative for brain health. People need to have social networks, they need to stay out there with friends.”
She pointed out that these kinds of things don’t cost a lot of money.
“Nothing is perfect at this point, but we’re trying to divert resources to things that have data behind them,” Hellmuth said. “Most of these are free. People aren’t profiteering off of your brain health. It’s not necessarily something in a bottle. These are things you can do right now.”