I speak with many people who are family caregivers of those with dementia about a wide range of topics.
I have been a family caregiver to someone with Alzheimer’s myself as well as cared for countless other family members and patients over my long healthcare career.
Because I am also a dietitian, I talk with people about nutrition and dementia (as well as all other disease processes) regularly. One of the questions I have been asked a lot about lately is what supplements will prevent dementia from developing especially if there is a family history of cognitive impairment.
Many people want to prevent the debilitating loss of cognition that they see happening in their loved ones.
As a dietitian, science is key and I fall back on the science of nutrition to be able to provide a thoughtful answer that gives us all guidance and hope for the present and future based on research.
Medicine should, at worst, do no harm.
Supplements – What Are They?
We hear frequently in the media and from our doctors, as well as our friends who are offering us advice, about whether to take the next new, “miracle” supplement. One that is sure to cure this or that or change your life!
But will it be safe, not to mention effective?
What exactly is a ‘supplement’?
The Food and Drug Administration (FDA), the government agency responsible for the safety of the nation through the regulation of our food supply, medical devices and drugs, defines a supplement as “a product intended for ingestion that contains a ‘dietary ingredient’ intended to add further nutritional value to (supplement) the diet.”
Supplements are regulated separately than foods under the Dietary Supplement Health and Education Act of 1994 (DSHEA).
FDA and Supplements
The FDA encourages companies not to sell adulterated or misbranded products calling them supplements and indicating they are meeting standards as part of the DSHEA. They will take action if they find a supplement does not comply.
No approval from the FDA is required before supplements are marketed and a manufacturer does not have to provide the FDA with evidence to substantiate the supplement’s safety or effectiveness. The label is required to state that it is a supplement, the name of the product, name/location of manufacturer, list of ingredients and contents of product. It must also contain a Supplement Facts panel similar to our food products.
There is no set value on the amount of the nutrient contained in the product or what constitutes a serving size. FDA does not routinely test supplements for safety and instead focuses their resources on products reported to have caused an illness or injury. Manufacturers are allowed to make health claims but they are responsible for their accuracy with oversight by the FDA and Federal Trade Commission for their advertising practices.
The FDA encourages us to be good consumers when it comes to supplements, including knowing the manufacturer and understanding if claims are true. Buyer beware, in other words.
Supplements can interact with medications so be sure to inform your doctor if you or your senior loved one begin taking any supplements or herbal products.
Disease Fighting Supplement Claims
These are some of the more common supplements and their claims.
- Phosphatidylserine – a fat that forms the membranes around nerve cells. The theory is that this compound will protect nerve cells in the brain from degenerating. Research into this compound was stopped in the 1990s as it is derived from the brain cells of cows and mad cow disease was a safety concern. It is currently being manufactured from soy but plant sources are reported to not be as beneficial as bovine sources and it is not recommended for use until more research can be done on cow sources and people.
- Vitamins – B6, B12, Folic acid may reduce homocysteine levels but only folic acid showed slight effectiveness in the studies. Vitamin E is an antioxidant but has shown no effectiveness to reduce dementia.
- CoEnzyme Q10 – antioxidant occurring naturally in our bodies used in the cells. At this time there have been no research studies to show any effectiveness in Alzheimer’s disease. A synthetic version of this supplement was tested and showed no benefit to dementia. There is no known safe amount for CoEnzyme Q10 so caution should be taken if ingesting it.
- Gingko Biloba – antioxidant and anti-amyloid properties; the claim that it improved cognitive functioning was not substantiated in both a large NIH 2008 study (Ginkgo Evaluation of Memory GEM) and a 2009 follow-up study. It was found that it was ineffective in reducing the development of dementia.
- Curcumin (Turmeric) – antioxidant and anti-inflammatory properties; ongoing research into the possibility that it will reduce the buildup of beta-amyloid plaques.
- Omega 3 Fatty Acids (DHA) in fish oil or fatty fish – anti-inflammatory properties, a controlled trial in 2008 found no effect on cognitive skills compared with a placebo. Some reference a study that reportedly says DHA will reduce the incidence but cited one study from 1996 on how fatty acids might improve the quality of life of those with dementia. Be careful what you believe and learn where the “research” comes from, when it was done and what was actually studied before you trust the claims. The FDA recommends taking no more than a combined total of 3 grams of DHA a day, with no more than 2 grams from supplements but the Alzheimer’s Association does not recommend use of supplements as there is insufficient evidence at this time.
- Resveratrol (grape seed extract) – antioxidant properties, may reduce beta-amyloid but none has yet to be tested in humans.
- Huperzine A from Chinese club moss may be a natural cholinesterase inhibitor and antioxidant. Currently being studied with no results. The Alzheimer’s disease Cooperative Study trial showed no greater benefit received in dementia than the placebo.
- Axona (caprylic acid/MCT or fat) – it is touted to provide energy in another form to the brain when it can no longer process glucose. The manufacturer did not complete Phase III drug trials but instead markets it as a medical food not a supplement. It currently has no research evidence to prove its effectiveness.
- Coconut oil – less expensive form of Axona but there has been at this time no clinical studies to show a connection with Alzheimer’s disease and coconut oil.
Supplement Safety Recommendations
Because there is currently no magic pill that will stop dementia from occurring or reverse it in someone who is already diagnosed with Alzheimer’s or another dementia, we need to make the necessary lifestyle changes that will help to provide us with a strong health foundation.
At this point, there is no evidence that any supplement will prevent or reduce dementia symptoms. There are many studies underway investigating dietary treatments for cognitive impairment that may yield hope for many in the future.
Some may make claims that one of the items above or something else will cure dementia or keep you from developing it, but there is no research to support that claim. You can choose to buy the product or not but beware that it could be harmful. Fully investigate the manufacturing process and dosage of what you choose to try so you are aware of what you might be ingesting. Without government regulation, this may be difficult.
According to the Journal of Clinical Nutrition, the evidence indicates that oxidation and inflammation contributes to dementia. They also point out that supplementing with sources of antioxidants has yet to be proven helpful and may be harmful.
What Can We Do Today
There are actions we can take to have a positive influence on our health.
- Get more physically active and participate in some activity every day.
- Eat fresh foods especially fruits and vegetables that are good sources of antioxidants. Eating a rainbow of colorful foods will help you achieve this goal.
- Stop smoking.
- Lower your fat intake and plan heart healthy meals. What’s good for the heart is good for the brain.
- Choose foods containing omega 3 fatty acids such as fatty fish (salmon, mackerel and tuna) and eat fish three times a week.
- Eat foods which are naturally good sources of folic acid to reduce homocysteine levels including dark green leafy vegetables, fruits, nuts, beans, grains, fortified grains. Good sources are found in these foods: avocado, liver, asparagus, spinach and brussel sprouts.
- Prevent and control other medical conditions such as high blood pressure, heart disease and stroke.
Until more research with valid scientific outcomes are available, experts agree that you get your nutrients in the foods you eat instead of synthetic sources such as supplements, which may give you more trouble than solutions.