A 31-page report issued in 2019 by the Global Council on Brain Health (GCBH) concludes there is no convincing evidence to recommend dietary supplements for “brain health” in adults 50 and over who do not have identified nutrient deficiencies. (“The Real Deal on Brain Health Supplements: GCBH Recommendations on Vitamins, Minerals, and Other Dietary Supplements”)
Supplements have not been demonstrated to delay the onset of dementia, nor can they prevent, treat or reverse Alzheimer’s disease or other neurological diseases that cause dementia. For most people, the best way to get your nutrients for brain health is from a healthy diet. Unless your health care provider has identified that you have a specific nutrient deficiency, there is not sufficient data to justify taking any dietary supplement for brain health. . . Despite claims to the contrary, brain health supplements have not been established to maintain thinking skills or improve brain function.
The GCBH describes itself as an independent collaborative of scientists, health professionals, scholars, and policy experts convened and funded by the AARP, with support from the charity Age UK, “to offer the best possible advice about what older adults can do to maintain and improve their brain health.” Experts consulted for this report include the former Director of the NIH’s Office of Dietary Supplements, physicians and scientists from universities in several countries, and research foundations, as well as the president of an independent supplement testing lab.
“Brain health” is defined by the GCBH as
A state of having good underlying neural mechanisms to support high functioning mental processes of cognition that support well-being.
The GCBH notes that supplement marketers are making a plethora of unproven claims, such as:
A dietary supplement that has been clinically shown to help with mild memory problems associated with aging.
Clinically shown to be safe and support memory and brain function.
Clinically proven natural ingredients.
Helps your brain maintain healthy neurons to support learning and recall.
Designed to help improve memory while increasing focus and concentration.
Improve your ability to retain and recall various kinds of information.
The GCBH does not believe that there is sufficient evidence to support these claims and a number of others being made by marketers and listed in the report.
While supplement marketers are permitted to claim that their products “help maintain” or “support” brain health, labels and ads may also mislead or confuse consumers into believing the supplement safe and effective:
“Clinically studied” does not mean the same thing as proven safe and effective for the [intended] purpose by rigorous, well-designed scientific studies in humans. “Natural” does not always mean safe. “Statistically significant” doesn’t establish that it is likely to or actually will positively affect human health.
Countering these unproven claims is an uphill battle given the alarming statistics on widespread misinformation about dietary supplements. According to a 2019 AARP survey of American adults on dietary supplement use:
- 81% of adults over 50 believe that supplements are “at least somewhat important for health”
- 69% are currently taking a dietary supplement at least 3 times a week
- 26% regularly take supplements for their brain health
Among adults specifically taking dietary supplements for brain health, 21% say they take them to maintain, and 20% to improve, brain health; 11% take them to delay the onset of dementia and 8% to “reverse” dementia.
These false beliefs are maintaining and improving the bottom lines of brain health supplement manufacturers, a growing segment of the supplement market. The Government Accountability Office recently found that “memory supplement” sales in the U.S. nearly doubled in value from 2006 to 2015, when sales were $643 million. One industry report found that brain health supplement sales totaled $3 billion worldwide in 2016, projected to reach $5.8 billion by 2023. In 2018, an estimated 85,000 types of dietary supplement products were sold in the U.S., amounting to more than $40 billion in retail sales. Worldwide the sales figure was $121 billion.
The report reviews a number of supplement ingredients often recommended for brain health, including apoaequorin, a protein isolated from the Aequorea victoria jellyfish and the active ingredient in the ubiquitous supplement Prevagen. After noting deficiencies in company-sponsored research, the review says that apoaequorin’s chemical structure is “likely broken down in the gut before reaching the brain, so it’s unlikely for it to have any brain benefits” and that the expert panel does not recommend taking it. Along with the state of New York and the FTC, AARP is one of the advocacy groups challenging Prevagen’s claims that it “improves memory and provides other cognitive benefits” as deceptive in federal court.
Other ingredients promoted for brain health garnering negative reviews include coenzyme Q10 (CoQ10), curcumin/turmeric, ginkgo biloba, coconut oil, and fish oil.
The report specifically warns about traditional Chinese herbal remedies, noting they are not required to undergo clinical trials prior to use. They may not contain the ingredients on the label and may be contaminated with toxins, heavy metals, or drugs. Some herbal remedies used in Chinese medicine can have serious side effects, interact with prescription drugs, or be unsafe for people with certain medical conditions.
The GCBH report includes Consensus Statements, Expert Recommendations, and practical tips for consumers. A brief summary:
- Adopt healthy lifestyle habits and get your nutrients for brain health from a healthy diet, not dietary supplements. Well-designed studies of supplements for brain health found no benefit in people with normal nutrient levels. There is also insufficient evidence for “medical foods” being marketed to older adults for brain health.
- Consult your health care provider before taking any supplement. Medications, surgery and having cancer can all be contraindications for using supplements.
- Health conditions linked with aging, such as poor nutrient absorption and poor dental health, can increase the risk of nutrient deficiencies, and these can affect brain health. Your health care provider can determine whether you are deficient or at risk of becoming so. Even then, diet and other lifestyle recommendations may be better than supplementation. (E.G., eating fatty fish instead of taking fish-oil derived omega-3 supplements, for which there is insufficient evidence of benefit.)
- Beware of vague or exaggerated claims about brain health made by supplement marketers. Dietary supplements, unlike drugs, do not require FDA review of their safety or effectiveness before going to market.
- Ingredient quality in supplements can vary widely and there is generally no government review for purity or content. Some supplements contain harmful ingredients. Look for third-party verification of quality from ConsumerLab.com, NSF International, or U.S. Pharmacopeia.
- More is not better: Some supplements can be toxic at high levels. For example, large doses of vitamins A,D, E and K, as well as excess iron and caffeine.
- Dementia patients should avoid melatonin because of increased risk of falls and other adverse events.
I’ll interpose one caveat to this otherwise excellent advice: All “health care providers” are not created equal. Be very wary of the advice of naturopaths (including naturopathic “doctors” and naturopathic “physicians”), chiropractors, acupuncturists, and “integrative” physicians, especially if they sell dietary supplements to their patients (a huge conflict of interest), which many do. These practitioners may also use bogus tests to justify selling supplements. Just because your state licenses (or otherwise regulates) a particular type of health care provider, it doesn’t mean their practices are evidence-based or safe.
Unfortunately, the AARP does not seem to be aware of this problem: Its policies are based on the false assumptions that licensing “ensure[s] professional competence” and that “continuing education plays a critical role in maintaining a well-qualified workforce”. While this may be true for physicians, nurses, dentists, and other science-based health care professionals, it is dangerously naïve when applied to CAM practitioners, for whom licensing legalizes pseudoscience and continuing education spreads hazardous misinformation and quackery. Indeed, the AARP has, regrettably, supported legislation expanding the scope of practice for naturopaths in the past. The AARP’s policies also call for increasing clinical education in complementary, alternative, and traditional medicine, implying that physicians should actually learn these methods rather than simply being knowledgeable about them.
The report ends on a positive note and so will I. While brain health supplements do not maintain cognitive skills or improve brain function,
there are many other lifestyle habits such as getting enough sleep, exercising regularly, eating a healthy diet, staying mentally active and being socially engaged that are recommended by the council.
For more on these strategies, see the Global Council on Brain Health section of the AARP website.