How to decide whether to take any kind of dietary product
In an opinion piece in a recent edition of the Journal of American Medical Association (JAMA), three neurologists at the University of California San Francisco’s (UCSF) Memory and Aging Center wrote that older Americans are being ripped off and served false hope by the multi-billion-dollar “brain health” supplements industry.
“This $3.2-billion industry … benefits from high-penetration consumer advertising through print media, radio, television and the internet,” the neurologists wrote. “No known dietary supplement prevents cognitive decline or dementia, yet supplements advertised as such are widely available and appear to gain legitimacy when sold by major U.S. retailers.”
The neurologists also warned about a “similarly concerning category of pseudomedicine” involving interventions promoted by licensed medical professionals that are said to counteract unsubstantiated causes of dementia, such as metal toxicity, mold exposure and infectious diseases.
“Some of these practitioners may stand to gain financially by promoting interventions that are not covered by insurance, such as intravenous nutrition, personalized detoxification, chelation therapy, antibiotics or stem cell therapy. These interventions lack a known mechanism for treating dementia and are costly, unregulated and potentially harmful,” the article states.
Earlier this month, the Food and Drug Administration (FDA) issued a statement saying it posted 17 warning and advisory letters to domestic and foreign companies that illegally sell 58 products — many of them dietary supplements — that claim to prevent, treat or cure Alzheimer’s disease and other serious health conditions. The FDA said the products are often sold on websites and social media and contain unapproved new drugs and/or misbranded drugs. “These products may be ineffective, unsafe and could prevent a person from seeking an appropriate diagnosis and treatment,” the FDA said.
The recent actions by the UCSF neurologists and the FDA might lead many to wonder what to think about these supplements and how to know whether any kind of supplement is really effective and safe.
Dr. Joanna Hellmuth, one of the authors of the JAMA article, recently browsed the supplements aisle at a natural foods store in San Francisco, finding an entire shelf full of dietary supplements claiming to improve cognitive health and prevent dementia. The dosage instructions on the bottles amounted to a price range of between $20 to $60 per month, she says. She looked up the active ingredients on one of the bottles. “There was certainly data on its efficacy, but it was very poor-quality data in a very low-quality journal,” Hellmuth says.
Motivated by Fear
All of the patients Hellmuth and her colleagues see at the UCSF Memory and Aging Center have cognitive issues. The neurologists wrote the JAMA opinion piece, in part, because their patients frequently ask about brain health supplements, Hellmuth says. They are searching for answers as they face the fact that today, there is no known drug or other intervention that actually stops, slows or prevents Alzheimer’s and other dementias.
In addition, older adults who don’t suffer from cognitive decline but worry about getting it in the future might be intrigued by products that promise to stave off dementia.
“If people really reflect, a lot of this is motivated by fear, which is understandable because these diseases are horrible, they’re frightening,” Hellmuth says. “They are diseases that alter your personality, who you are as an individual. So, understandably, people are driven by fear or compelled to want to do something.”
That fear is what the brain health supplements industry feeds on, she says.
“It’s not that vitamins or supplements in themselves are bad; it’s just that we don’t know of any supplements for brain health that are supported by quality data to suggest that they are effective,” she says.
Brain Health Supplements: Possibility of Harm
There’s also the concern that these products could do harm to people. The FDA doesn’t review dietary supplements — including vitamins, minerals and herbs — for efficacy or safety, although that could soon change, according to a recent announcement by FDA Commissioner Scott Gottlieb.
In the meantime, not being able to verify exactly what’s in the bottles worries Hellmuth and her fellow neurologists because even natural ingredients can cause health problems and interact with prescription drugs in harmful ways. “And there’s the added fact that a lot of these supplement (manufacturers) are saying ‘we can improve brain health,’ and that’s just ethically incorrect,” she says.
A Naturopathic Doctor’s Perspective
Marianne Calvanese, a naturopathic doctor at Austin Naturopathic in Austin, Texas, agrees with Hellmuth regarding the problems with dietary supplements that are not backed by quality research.
“It’s very challenging for medical people as well as lay people to assess the safety and the effectiveness of supplements, especially these newer ones that are always coming out. There’s so many; it’s a jungle out there,” Calvanese says.
Her practice involves the use of homeopathic medicines — a very different approach from dietary supplements. But she worries that people tend to lump all “natural” medicines and products together, including the brain health supplements.
“Because the claims they make are pretty good, and then people try it and it doesn’t work. So, then people want to just say well, ‘it’s just a natural supplement and it won’t work.’ And that’s not accurate,” Calvanese says.
When a patient asks her about a new dietary supplement, she researches it, including checking for the ingredients within the databases of two independent evaluators she trusts: Consumer Lab and Environmental Working Group. “They haven’t tested every single supplement or every single company, but they have tested a lot,” Calvanese says.
The FDA recommends people talk to a doctor, pharmacist or other health care professional before using a dietary supplement. “If claims sound too good to be true, they probably are. Consumers need to be mindful of product claims such as ‘works better than (a prescription drug),’ ‘totally safe’ or has ‘no side effects,’” the FDA responded in an email.
If you or a loved one tried a dietary supplement that you think caused a negative reaction or illness, the FDA recommends you stop taking the product and submit a complaint using this Safety Reporting Portal.
Both Hellmuth and Calvanese say it’s important for people to realize that no one prescription drug or natural medicine is the answer for everybody. There are prescription drugs that can help some people temporarily with some symptoms of particular types of dementias, but they have side effects. “So, it’s always a risk-benefit (consideration) whether being on a certain medication is helpful for a patient,” Hellmuth says.
A More Effective Prevention Approach
Rather than buying supplements, Hellmuth suggests people would be better off spending their money on exercise classes “or doing more social activities that get you cognitively and socially active — things that we know are associated with positive brain aging.”
“The things we recommend are being socially active, cognitively active and physically active,” she continues. “And for physically active, we follow the American Heart Association recommendations of two and half hours a week of vigorous cardiovascular exercise.”
She also recommends a heart-healthy diet. Basically, Hellmuth says, what’s good for the heart is good for the brain. “So, diet, exercise, getting that cholesterol under control, making sure your blood pressure is well controlled, these are all very important,” she says.
Calvanese also recommended focusing on nutrition and exercise, adding that good-quality sleep helps prevent cognitive decline as we get older, too.
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