From The May 2001 Natural Foods Merchandiser
Wendy L. Bonifazi, R.N., A.P.R.
Whether your customers want to think faster, learn quicker or remember longer, supplements manufacturers say the solution may be in a bottle. And the potential market is huge because age-related cognitive decline, which can range from mild memory lapses to more serious dysfunction such as Alzheimer's, affects most people after age 40.
Also, the burgeoning 65-plus populationalive before physicians relied on pharmaceuticalswillingly augments or replaces medical treatment, particularly for memory impairment. A University of Florida study published in the January 2001 Journal of Advanced Nursing found almost half of female subjects over 65 used an average of 2.5 herbal products the previous year; 85 percent were used for almost three years. Most common: Ginkgo biloba, to improve and preserve memory.
But brain-boosting products aren't just for elders. Boomers concerned about memory loss, students anxious about class performance and workers worried about on-the-job mental acuity also want them. And manufacturers have responded to this increasing demand with herbal memory formulas based on traditional Chinese, Ayurvedic and African medicines; chemical products; and prepackaged blends of antioxidants and supplements.
But some scientists say there's little hard research and brain-booster producers are making mountains out of mouse hills of data. "There are lots of rat and mouse studies showing some products' effects, but that's no way to make recommendations for people," says research scientist David M. Klurfeld, Ph.D., chairman of nutrition and food science at Wayne State University in Detroit, after recently reviewing hundreds of "brain booster" studies. For example, "Out of 837 relevant choline papers, virtually all are on rats," he says.
It's easier, less expensive and more acceptable to put rats through a maze of clinical trials than to do so with humans. Studies of brain-boosting supplements can suffer from investigator bias, difficulty judging and interpreting behaviors, placebo effect and limited funding.
Scientists still have yet to determine exactly what causes memory problems. A July 1999 study in Developmental Psychology attributed age-related working memory differences to lack of storage capacity, rather than processing efficiency.
Circulation impairment theories are yielding to other possibilities. Alzheimer's disease, which affects nearly 50 percent of people over age 85, appears to involve widespread degeneration of brain cells, beginning with memory impairment and progressing to death. However, little effective medical treatment exists.
Meanwhile, consumers buy products, hoping to avoid or alleviate memory problems, and researchers seek answers. Here's what they're buying and finding, respectively.
Ginkgo, Vitamins E, C and Mixed Formulations
"Seven or eight studies now demonstrate ginkgo works for normal age-related memory loss, although it probably doesn't increase oxygen to the brain," says Steven Bratman, M.D., director of The Natural Pharmacist.com in Fort Collins, Colo. Ginkgo leaf extract, Germany's most widely prescribed drug, is a dementia treatment.
American results have been mixed, but large government-funded ginkgo and vitamin E studies are under way.
"A small body of clinical evidence suggests ginkgo is useful for Alzheimer's prevention," says Bill Thies, Ph.D., vice president of medical and scientific affairs for the Chicago-based Alzheimer's Association. "It's worth the probable $20 million cost for the University of Pittsburgh clinical trial. Every year, Americans spend more than $200 million on ginkgo," he adds.
"Preventive medications now available are weak to nonexistent. Prevention would be a great step forward."
For more than a year, the Mayo Clinic in Rochester, Minn., has studied vitamin E to find if it prevents progression from mild cognitive impairment to Alzheimer's. "Vitamin E is relatively innocuous and inexpensive, so the risk/benefit ratio is positive, even if benefits are modest," Thies notes. "But megadoses are unproven."
In February, University of Hawaii researchers reported in Neurology that in long-term use, vitamins E and C appear to interact strongly, promoting cognitive performance, slowing vascular dementia and improving late-life brain function. However, no protective effect for Alzheimer's was found.
Ginkgo, the industry heavyweight, overshadows consumer awareness of other products. For example, Rainbow Light, based in Santa Cruz, Calif., recently renamed its Mind and Memory product to highlight the popular ingredient. According to Marci Clow, M.S., R.D., the company's director of research and quality, ginkgo Mind and Memory also includes vitamins A, E and C for antioxidant and circulatory benefits; B vitamins for memory and brain function; magnesium, zinc, copper and potassium; St. John's wort and lavender to lift spirits; gotu kola as a central nervous system stimulant; L-tyrosine for short-term increase of brain stimulants; and nutrients. "These are supportive multivitamin levels, not replacements," Clow says.
Rainbow Light's Ginkgo Total Recall herbal formula, designed to support circulation and mental clarity, includes huperzia extract; Rhodiola rosea from Russia and Tibet, a newly popular herb considered a brain-function adaptogen; rosemary essential oil for increased blood flow and product stability; and digestive blends for absorption. "A lot of people don't want additional nutrients because they take multivitamins," Clow says. Both products may take effect in hours, she says, although that's affected by differences in metabolisms.
Some health providers express concerns about taking multiple substances, particularly high dosesand instead recommend several individual ingredients.
"Few consumers have time and money to research and take 10 products," says Rainbow Light Brand Manager Sara Lovelady. "Some are too confused and take nothing. If they can take one formulation, they comply with recommendations."
Vinpocetine and Huperzine
"Both are chemically produced, synthetic drugs sold as dietary supplements," Bratman says, "and both seem effective for Alzheimer's and age-related memory loss." Vinpocetine is processed from common periwinkle leaves and African voa canga seeds. More than 20 years ago, a Hungarian physician developed it as Cavinton, an Alzheimer's and memory-impairment drug. "There's significant evidence that it aids memory and mental function, particularly with Alzheimer's and related conditions," Bratman says.
Vinpocetine won't fly off shelves without retailers' help, says Don Stanek, director of sales for Easton, Pa.-based raw materials manufacturer Linnea Inc. "It's very expensive to make, doses are small, consumers take few capsules and tablets, and consumer awareness and marketing are lacking."
Although Bratman doubts the accuracy of Chinese huperzine studies, Thies is optimistic. "Huperzine has mildly anticholinergic effects that mimic Alzheimer's medications and may get some improvement with early Alzheimer's," Thies says.
Although carnitine is involved in the synthesis of essential brain molecules, Thies says there's no evidence acetyl-L-carnitine gets into the brain if consumed, and it appears overblown as a medical treatment. Bratman concurs, citing recent research that contradicts weaker early studies.
Phosphatidylserine and Lecithin
Phosphatidylserine, or PS, a popular European treatment for dementia and normal memory loss, appears effective, but studies were based on cow-based products. "We don't know if soy products will work as effectively," Bratman says.
Several interrelated substancescholine, phosphatidylcholine and lecithinhave been studied extensively for Alzheimer's treatments without evidence of effectiveness, Bratman says.
"Although there's lots of lecithin in nerve cell membranes, soy and eggs are a rich supply, and it's made in our bodies so the medical community doesn't take the need for it more seriously," Thies says.
Since ginkgo, vinpocetine, phosphatidylserine, high-dose vitamin E and other supplements including fish oils and garlic are blood thinners, their use may be contraindicated for anyone taking other blood thinners such as aspirin and prescription medications such as heparin, Coumadin or warfarin.
On formulations, "Reasonable doses are fine, but megadoses are especially worrisome for older people, who may have weaker hearts; more prescriptions; and problems with kidney, liver and stomach function that affect digestion, assimilation and excretion," warns board-certified family practitioner Ray Sahelian, M.D., Marina Del Ray, Calif., author of Mind Boosters (St. Martin's Press, 2000).
He advises taking supplements with breakfast and lunch, adding them gradually and watching for counterproductive overstimulation. "They can result in irritability, restlessness and insomnia," he cautions.
Wendy L. Bonifazi, R.N., A.P.R. , has won numerous national awards for health and science writing.