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Good morning everyone! Thank you, Sarah, for sharing your final thoughts as we close the topic. This concludes the special event with brain health experts Howard Fillit, M.D. (@HowardFillit), Paul Coates, Ph.D. (@PaulCoates) and our very own Sarah Lock (@SarahLenzLock). Thank you all for being here for the lively discussion!

We welcome your continued participation in the Brain Health forum here on AARP.org. In addition, please visit our Health channel on AARP.org where you'll find a wide range of information and resources such as healthy living, conditions/treatments, brain health and more. 

Here's a takeaway resource for participants: Check out a handy infographic developed by AARP to summarize the Global Council’s 30-page in-depth report for all consumers considering whether to take supplements for their brain health. Click here to open (PDF).

 

If you'd like to see more events like this one, please let us know by giving this post a Kudos!

 

Best wishes and be well! -AARPLynne

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It is so great that so many AARP Community members engaged in the discussion about brain health supplements.  We know lots of people take at least one dietary supplement for brain health reasons – so putting the evidence out there for people to know what works and what doesn’t, along with what we need to know more about, feels like it resonated with you!  Thanks for participating. 

 

We also know that people of all ages take supplements, but the older you are the more likely you are to take them.  The bottom line is that many more people are taking these dietary supplements than are necessary, so we hope people take a sensible approach.  Only take vitamins if you are deficient in them and you aren’t able to absorb them from food.  Make sure you look for trusted markers of quality assurance if you have to take them.  And for all those products out there claiming they can improve memory or halt dementia be very skeptical.   Make sure there is independent proof it works and actually contains what the label says before you part with your hard earned money.  So far, the independent experts of the GCBH haven’t found sufficiently reliable evidence to recommend any.  Healthy lifestyle habits like keeping physically and socially active, eating a balanced healthy diet and getting enough quality sleep have far more evidence of effectiveness.    

* * *
Did you know? In 2016, Center for Science in the Public Interest (CSPI) lawyers filed suit on behalf of consumers over the labeling and marketing of CVS’s Algal-900 DHA—a dietary supplement which claimed to be “clinically shown” to improve memory.  CPSI said that “the FTC had concluded that the industry-conducted study relied on by CVS cannot, in fact, be used to justify memory-boosting claims." And studies have shown that DHA is no better than a placebo at improving cognitive function. The court has now given preliminary approval to a settlement. To learn more, visit http://www.cvsdhasettlement.com/.

 

Sarah Lenz Lock, AARP Expert Brain Health
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@AARPLynne wrote:

@HowardFillit, what are some common health conditions/causes of vitamin deficiency that our audience should be aware of as they age?


@AARPLynne, thank you for your question about health conditions associated with vitamin deficiency.  There are several vitamins that can become deficient depending on health conditions.

 

Vitamin B12:  Although most people get plenty of vitamin B12 from foods (e.g., meat, fish, dairy products, eggs, and fortified breakfast cereals), older adults may become deficient in this vitamin as our ability to absorb this vitamin decreases with age.  Also, people with celiac disease or other illnesses of the small intestine, and those who have undergone gastrointestinal surgery are also at risk for vitamin B12 deficiency.  To learn more about vitamin B12 deficiency, please visit our blog post on this topic.

 

Vitamin B6:  Although most people get enough vitamin B6 from their diets (e.g., poultry, fish, organ meats, potatoes, and some fruits), people with kidney disease, rheumatoid arthritis, celiac disease, Crohn’s disease, inflammatory bowel disease, and several other autoimmune disorders sometimes have low vitamin B6 levels.  Symptoms of vitamin B6 deficiency can include numbness/tingling in the hands and feet, confusion, and a weakened immune system. 

 

Vitamin D:  Vitamin D can come from food (e.g., salmon, tuna, mackerel, and fortified milk), or produced by our skin when exposed to sunlight.  The skin’s ability to produce vitamin D can decline with age, so vitamin D deficiency can be common in older adults.  People who are obese can also be at an increased risk for vitamin D deficiency.  Your doctor may also advise you to take vitamin D (and calcium) supplements if you are at a high risk for osteoporosis.  For more information on vitamin D, see our vitamin D rating page on CognitiveVitality.

 

If you are concerned about vitamin deficiencies, talk to your doctor—a simple blood test can tell you whether you have enough of these vitamins. 

 

Howard Fillit, MD

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@AARPLynne wrote:

@HowardFillit, what should someone look for when buying any type of supplement to make sure that they are safe and contain quality ingredients? 


@AARPLynne, thank you for your question about what to look for when buying a supplement.  Safety can be a concern as the quality of ingredients in supplements can vary.  Unlike drugs, the ingredients in supplements are not reviewed for their purity and content by government agencies before being sold.  Some supplements may contain harmful ingredients not listed on the label.  Therefore, if you choose to take a supplement, you may wish to look for unbiased verification of its quality.  You can look for products that have been tested by independent third parties such as: ConsumerLab, Labdoor, NSF International, and US Pharmacopeia.  You may also wish to research whether a supplement's benefits are supported by high-quality research by visiting reputable sites including the National Institutes of Health Office of Dietary Supplements, the National Center for Complimentary and Integrative Health, and our CognitiveVitality website.

 

Howard Fillit, MD

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@HowardFillit, what are some common health conditions/causes of vitamin deficiency that our audience should be aware of as they age?

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@HowardFillit, what should someone look for when buying any type of supplement to make sure that they are safe and contain quality ingredients? 

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@HowardFillit, thank you for getting back to me so quickly.

 

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Dear Sarah (@),

Thank you so much for your thoughtful reply. If I may, I'd like to respond with a few suggestions:

 


1. It may be critical to draw a clearer line between prevention of dementia and short-term benefits for cognitive health. The majority of consumers are not expecting dietary supplements to solve complex problems. People take supplements to support their daily life activities and their always not perfect daily nutrition. A reduction in symptoms of some chronic disorders is usually viewed as a positive bonus, and the way people judge supplements is by how they "feel" after starting to take them.

If a proven even partial prevention of dementia is a criterion, it'd automatically axe all dietary supplements as not having enough proof to support their claims.

If some compound has been proven to really work for treatment of dementia / Alzheimer's disease, and has gone through the whole nine yards of clinical trials, it would simply become a prescription drug for treating an existing or emerging disease. If something really works, it usually means it has strong positive effects, yet such effects cannot be isolated and have a complex effect on processes in our body, including negative side effects. Therefore prescription drugs have to be regulated and administered only with a doctor supervision.

But in most cases, people expect from supplements short-term effects on their daily life. And some supplements do deliver well on their promise, and are already what we can say a common knowledge. Therefore your report that pretty much axes all dietary supplements for any brain health support, may be confusing and controversial for so many people, while you are basically axing only those that claim to prevent dementia, yet it may look like you are dismissing pretty much all dietary supplements for any brain related activity.

An artist painting a picture naturally focuses too much on details, so not to lose the bigger picture and to keep the perception of how it will be perceived by the viewers, a common centuries-old technique is to literally step back once in a while for a very brief break to better see the picture you've drawn so far. Or to collect feedback on perception of your report from readers outside of your team.  

Better short-term memory (for the day!), improved concentration and focus, improved alertness, better sleep quality, anxiety reduction, relaxation effect, mood improvement, etc. - all these and others can be achieved with dietary supplements and there is no argument about this. In this regard, dietary supplements simply target biochemical processes in our bodies, just like food does, but with more focus on certain functionality. This is what most people reading your report expect - to see which supplements have what efficacy in what functional areas.

A mere categorization of dietary supplements into, for instance [prevention of dementia], [short-term memory improvement], [improved focus and alertness], [relaxation effect, improved sleep quality] may prove to be very helpful in making it more clear what works or not.

If there is no such information, then everyone will keep taking shortcuts and abuse the intake of stimulants like caffeine, sugar, alcohol, etc. Which definitely work very short-time too, yet with a range of negative side effects on health.

To give one example, I occasionally use a blend of [3g of glycine, 200 mg of L-theanine and 200 mg of Magnesium] for better relaxation and improving sleep quality.

There are not so many dietary supplements with claimed improved cognitive effect, maybe within 50 and many can actually be evaluated (and dismissed) with a few hour research.

 


2. You wrote "The GCBH does not recommend any of these supplements because each of them lack sufficiently reliable evidence to support their use."

You actually don't really have to "judge" each supplement. No need for "pollice verso" (thumb up or down used in the context of gladiatorial combat in Ancient Rome). In the modern world with overwhelming amount of information, and freedom to make your own decisions on dietary supplements, what people may welcome is a tool that simplifies, sieves out false claims and summarizes scientific studies on each dietary supplements, while giving a "ranking" on some key claimed areas. The Cognitive Vitality rating tool is perfect for this, and may just need more evaluated dietary supplements, possibly with a support of contributors. In contrast, there are too many websites that simply summarize and accumulate all possible claims for each supplement, making it sound like each dietary supplement is nothing less than a miracle. For example, listing "10 health benefits" for each dietary supplement.

 


3. A quick note on prevention of dementia through dietary supplements. Alzheimer's disease, and other forms of dementia, cannot be prevented or healed with dietary supplements. Just because of the complexity of processes leading to and in cases of people with Alzheimer's.
Here is a good graphical summary:
https://media.springernature.com/lw785/springer-static/image/art%3A10.1186%2Fs12929-017-0355-7/Media...


From this analytical report:
https://jbiomedsci.biomedcentral.com/articles/10.1186/s12929-017-0355-7

One part of it gives a very clear and short description that simply nails it:

"Low levels of acetylcholine are not the reason for Alzheimer's. But acetylcholine slows down Alzheimer's progression by giving a boost to cognitive skills."

* Acetylcholine is a neurotransmitter responsible for what we know as learning and memory. Its concentration and level of response in our brain determines our daily mental performance, so it's pretty important for us. There are ways to increase acetylcholine activity in our brain directly through improved acetylcholine response or through inhibiting cholinesterase enzyme (AChEI - chemicals whose primary toxic effect is to block the normal breakdown of acetylcholine). There are many ways to possibly influence either of them in some form. Even deep breathing meditation stimulates vagus nerve, leading to a temporary boost in acetylcholine release! There are other mental and physiological tricks to slightly boost levels of dopamine or serotonin.

So basically no supplement can claim really preventing or fixing something as complex as Alzheimer's, BUT an acetylcholine support through supplementation can give a boost to cognitive skills.
 

4. You mentioned: "One of the recommendations the GCBH makes is for supplement manufacturers to conduct rigorous clinical trials..."

Just to make sure we are on the same page, supplement manufacturers are not exactly the same as drug manufacturers and do not do clinical trials like the latter. Supplement manufacturers rely on existing clinical trials. Then there is a level of dietary ingredient manufacturers (who may be the supplement manufacturers, e.g. the final product manufacturer), who manufacture the raw ingredients, and depending on their geographical location, are only required to have some general manufacturing license and, as you know, as not regulated in what they manufacture and even ISO standards, such as ISO 9000 that are only voluntarily. What is possible to do with dietary supplements / dietary ingredient, is to have them tested in an independent lab for the actual content of the active ingredients. For example, acetyl-L-carnitine can be manufactured virtually anywhere, but the quality and its bioavailability may range significantly and in some cases a product may not have any performance whatsoever. In this example, a testing method for acetyl-L-carnitine may be for " for the amount of acetyl-L-carnitine by High Performance Liquid Chromatography (HPLC) using Ultra Violet (UV) detection."

The only way for consumers to know if a product works is to see some independent test report on some particular product / brand, as well as rely on existing scientific studies by evaluating them and making pretty much a personal educated call, on if the evidence of its efficacy is sufficient or not.
 

5. Thank you for your response to some particular examples of supplements I gave. However, as mentioned above, it's not all only about dementia / Alzheimer's when it comes to brain health. Every single supplement and even many approved drugs may be axed and legitimately criticized if judged by this criteria for strong efficacy. Short-term effects are what real, important and enough for many consumers.

As GCBH mentioned in its report, a healthy lifestyle, including balanced healthy nutrition, physical activity (let's also add sleep quality and keeping to learn new things to push the brain to generate more neurons) are the best natural strategy for prevention of dementia. By expanding your report to other brain health areas outside dementia, and including all other supplements, the value of your report may improve even further. Cognitive Vitality rating may be a perfect tool to focus on, expand and promote. 


Paul R.
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@Eeyore60, thank you for your question about Purzanthin Ultra.  Although I cannot comment on the specific brand/product, I can tell you a little bit about its ingredient, astaxanthin.  Astaxanthin is found in marine algae and in animals that eat those algae, such as salmon and lobster.  It is thought to have antioxidant properties.  However, three high-quality clinical trials (double-blind, placebo-controlled) that have been carried out to date have failed to show that astaxanthin supplements improve cognitive functions in people.  Also, because clinical studies testing astaxanthin have all been short-term (up to 12 weeks), we currently lack safety information for long-term use.  As such, the GCBH does not endorse astaxanthin supplements due to the lack of sufficiently reliable evidence to support their use.

 

On a more positive note, you can get astaxanthin from your diet, such as from salmon and lobsters.  Did you know that salmon, lobsters, and flamingos get their pink and red colors from the astaxanthin they ingest (from algae, fish, and other marine animals)?  Salmon has the additional benefit of being rich in omega-3 fatty acids and vitamin D!

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FocusFactor did nothing for me. I tried a lot of vitamins and herbs. Finally broke down and talked to my doctor about a prescription. I was prescribed Adderall and that has had the best results so far. Wish I’ve taken it years ago. 

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