No brainer? Report pans cognition supplements, much to industry dismay

By Will Chu and Nikki Cutler

- Last updated on GMT

©iStock/
©iStock/
A Global Council on Brain Health (GCBH) report has come under fierce criticism by the industry after it found no convincing evidence to recommend dietary supplements for brain health in healthy older adults.

The report​, which examines supplements, such as omega-3 fish oil and apoaequorin (jellyfish) that claim to boost cognition, cites a lack of evidence to recommend any supplement for adult brain health.

The authors acknowledge though a small body of evidence that show omega-3 fatty acid supplements may benefit those with mild cognitive impairment, which is often a precursor of Alzheimer's.

“There is evidence that omega-3 supplement use is effective in treating older people with mild to moderate depression. Women with low levels of omega-3 tend to have higher rates of depression,”​ the authors said.

“Some research has found that those who have low levels of docosahexaenoic acid (DHA) may benefit from supplements.

“However, the weight of the existing evidence does not sufficiently demonstrate benefit, and we do not recommend omega-3 supplements for brain health.”

‘A missed opportunity’

omega 3 sources dha epa fish oil iStock.com autumnhoverter
©iStock/autumnhoverter

The conclusions jarred with a number of industry associations and companies with one describing the report as “too black and white”.

“The GCBH was looking for indisputable evidence before recommending any supplement(s),” ​said Harry Rice, VP of regulatory & scientific affairs for the Global Organization for EPA and DHA Omega-3s (GOED).

“A total dismissal of omega-3s for brain health was a missed opportunity to provide valuable information to consumers. GOED believes there is a benefit for cognitive decline at higher dosages.

“In addition, omega-3s, eicosapentaenoic acid (EPA) in particular, have been demonstrated to provide benefits for depression. While the science may not be indisputable, it is strong.”

Dr Milka Sokolović, head of food and health science at the European Food Information Council (EUFIC) said that while there was an indication of omega 3 fatty efficacy in treating mood disorders, broadly speaking, data linking omega 3 supplements and brain health seemed “inconclusive”.

“Our understanding of the current consensus is that most of these essential nutrients would be best acquired through a balanced diet,” ​she said.

“However, it is probably safe to say that an increase in long chain polyunsaturated fatty acids (LC-PUFAs) would benefit most of us.

“Moreover, we should bear in mind that some populations and individuals, due to genetic differences, will respond to supplementation better than others, and that there are people with specific vulnerable health status for whom the supplementation could be of help.”

Brain boost

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Concerns over mental health especially in later years has led to increased interest in supplements that aid cognition, memory and alertness.

As well as omega-3 supplements, other vitamin and minerals are also the focus of the report as are caffeine, curcumin, coenzyme Q10 (CoQ10), ginkgo biloba and apoaequorin amongst others.

In one of the report’s consensus statements the GCBH believed that generally there was insufficient evidence backing multivitamins’ effect on improving brain health arguing that multivitamins were not a substitute for a healthy diet in promoting and maintaining brain health.

The report added that while there may be a case for supplementing people with lower-than-recommended levels of B12 and B9 vitamins, there still remained a lack of convincing evidence to recommend daily dietary B12 supplements for brain health in healthy older adults.

“Vitamin D deficiency can be an issue for older adults,”​ the report continued. “Health care providersmay recommend vitamin D supplementation to correct low levels for general health.”

“However, there is insufficient evidence that vitamin D supplementation benefits brain health.”

Dr Emma Derbyshire from the Health & Food Supplements Information Service said that UK food and dietary surveys showed that over the last decade there had been a large reduction in adult intakes of riboflavin, folate, vitamin A, vitamin D, iron, calcium, magnesium, iodine, selenium and potassium.

“Children and teenagers have lower intakes of vitamin A, iron, iodine and zinc,”​ she said. “Older people are failing to achieve the Lower Reference Nutrient Intake (LRNI; the level below which deficiency may occur) for vitamin A, iron, calcium, magnesium, potassium, iodine, potassium and zinc.

“It is inappropriate to suggest that appropriately labelled supplements do not contribute to brain health.

“Food supplements are important to bridge dietary gaps, including for those nutrients that have an impact on brain health. In particular, omega-3 supplementation which can make an important contribution to brain development and brain function.”

A spokesperson for nutrition giants DSM said "In the AARP report attention is given to the importance of quality clinical trials and responsible use of health claims.

"DSM fully agrees with these values. These are reflected in our own product development as well as in collaborations such as with SLS Nutraceuticals. One of the cornerstones of DSM’s collaboration with SLS Nutraceuticals is to further develop the clinical evidence through new, carefully designed clinical trials.

"The impact of human clinical trials is likely to improve as awareness rises on the factors that need to be considered for nutritional intervention tests."

Caffeine controversy

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©iStock/mearman

While the authors mention caffeine as an ingredient used to improve endurance and power in sports as well as improve memory and concentration, they also cite a lack of evidence to recommend its use for a long-term cognitive supplement for brain health.

“Caffeine in high doses, such as those found in some energy drinks, can have adverse effects including insomnia, nervousness, headache and even seizures,”​ the report said.

Joseph Welstead, CEO of Motion Nutrition, a supplement maker catering to the sports sector responded to the report saying, “Supplements are often taken as part of a greater shift towards a healthier lifestyle.

“Taking a broad sweep approach and stating that all supplements are a waste of money in the way these articles do, is extremely unhelpful if our common goal is to improve the overall health of society.”

A portion of the report scrutinises current supplement regulation, in which the European Food Safety Authority (EFSA) is responsible for supplement ingredient safety in the region.

While EFSA form the scientific opinion about the nutrient. The European Commission reviews and updates the lists of nutrients that may be used in food supplements.

To further complicate matters, member EU countries have separate regulations. Italy, for example has a national list of food supplements while UK products described as food supplements (i.e. vitamins, minerals, or amino acids) are regulated as foods and subject to laws such as the Food Safety Act.

If a company sells food supplements, it must register as a food business operator (FBO) with its local authority.

The variety of dietary supplement regulation was of concern to the authors, who said the EU regulation was included to “give the reader a sense of the variation in regulation as well as the relatively lax standards of review for supplements compared to medications.”

In discussing European regulations, Dr Derbyshire said, “The European Food Safety Authority (EFSA) has evaluated a large body of evidence in relation to several micronutrients, which are used as relevant and appropriate to products on pack.

“These include contributing to mental performance for vitamin B2, niacin, pantothenic acid, folic acid, biotin, vitamin B1, vitamin C, calcium, magnesium, selenium, and zinc, and mental performance. All of these substances have claims authorised for use by the European Commission.

“In particular DHA and EPA have an article 13 claim for maintenance of normal brain function and vitamin B12 also has an article 13 general health claim authorised for contribution to normal neurological and psychological function. DHA has an Article 14 claim for normal brain development in children.”

US regulation

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Referring to US supplement makers, whose products — unlike prescription drugs — are not regulated by the US Food and Drug Administration (FDA), Ronald Petersen, a neurologist and member of the GCBH Governance Committee, said, “The market is so large they get by without rigorous documentation of the efficacy of their products.”

However, GOED expressed frustration at the constant comparison between the pharmaceutical and dietary supplement industries.

“They're both regulated, albeit differently,” ​said Rice. “At the end of the day, they can both stand to be improved.”

“Supplements should not and are not intended to cure or prevent diseases,” ​added Welstead. “Good quality supplements should support overall individual health providing support where needed.”

“Does this mean that supplements should be regarded as drugs? No. Should supplements comply to the same regulations as drugs intended to cure or directly prevent diseases? Of course not.

“This is a ridiculous proposition. Consistently comparing drugs to supplements in the way this report does, is unhelpful and irrelevant.”

In closing, the report highlighted that for most people, lifestyle changes or habits were the best way to acquire brain-friendly nutrients.

“Despite claims to the contrary, brain health supplements have not been established to maintain thinking skills or improve brain function,”​ the report concluded.

“However, 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.”

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