Like most adults over the age of 65, my wife and I have noticed some difficulty recalling names as we get older. We all worry that our minds will fail us and wonder if there is any validity to those claims about dietary supplements to improve our brain function. Who hasn’t wondered if those ubiquitous ads about Prevagen, the jelly-fish supplement, have any truth to them? After all, they claim to be “clinically proven” to improve brain function.

To answer these questions, I decided to do some research. The first thing I learned is that there is big money to be made out there selling brain supplements. By some estimates, the dietary supplement market is expected to reach $350 Billion by 2026. With that amount of money up for grabs, you can be sure there is a lot of competition – and a lot of back-stabbing by competitors.

The first whole page of my Google search came up with competing claims for one brain supplement against another. One site listed their top five supplements while the next listed their top five – and all the reasons why the other site’s top five were bogus. There was an alarming lack of agreement – and a shocking lack of scientific credentials from those making their recommendations. It was obvious I would need to dig deeper to find the truth.

Deeper research was rewarding – at least to dispel the false claims of the brain supplement manufacturers and their fans. First of all, I learned that the makers of Prevagen, the most widely advertised brain supplement, has been warned by the Federal Trade Commission and the New York State’s attorney general about making deceptive claims in 2017. “The marketers of Prevagen preyed on the fears of older consumers experiencing age-related memory loss,” said Jessica Rich, director of the FTC’s Bureau of Consumer Protection. “But one critical thing these marketers forgot is that their claims need to be backed up by real scientific evidence.”

A 2019 article from the Journal of the American Medical Association (JAMA), written by neurologists and dementia researchers at The University of California San Francisco, says there is no known dietary supplement that prevents cognitive decline for dementia. I found support for this viewpoint in other scientific literature as well as the Harvard Medical School Health Blog. An excellent review of the literature can be found from the Department of Geriatrics and Palliative Medicine, Mt. Sinai School of Medicine in New York.

The key statement from this review can be found in the Abstract: “Currently, there are no effective preventive strategies for cognitive decline.”  However, there is reason for concern with the use of dietary supplements because of their potential interaction with other medications. The Abstract goes on to warn: “Considering the insufficient evidence for their efficacy, potential for interaction with other therapies and costs to patients, physicians should be aware of the use of dietary supplements among their patients so that they can advise their patients on the potential benefits and harms.”

The Most Commonly Used Supplements

The reviewers commented on the most commonly used supplements, their efficacy, and potential side effects:

• Ginkgo biloba– Studies have found that there was no difference in dementia incidence in all participants or in the rate of progression to dementia in participants when compared to the placebo group. Ginkgo biloba may interact with antiplatelet or anticoagulation medications which may lead to bleeding. The incidence of hemorrhagic strokes in the ginkgo biloba group was twice as high as placebo.
• Vitamins B6, B9, B12 – Supplementation with B vitamins did not demonstrate any improvement in cognitive performance compared with placebo. However, there was an increased incidence of depression in the high-dose supplement group.
• Vitamin E– There was no difference in cognitive performance between the Vitamin E treated group and placebo. There was some evidence to suggest that higher intake diets of Vitamin E may provide some protection against development of dementia when compared to low dietary intake of Vitamin E but this was not found in the studies uses Vitamin E supplementsto diet. Further study of this is needed.
• W-3 Fatty Acids – Studies of these unsaturated fatty acids (PUFA) have been inconsistent but to date there is no study that has found any association between fish or w-3 fatty acids demonstrating better cognitive function or less cognitive decline in over 6 years follow-up.
• Vitamins A and C – Evidence for the protective effects of Vitamins A and C against cognitive decline, impairment, or dementia is inconsistent and insufficient to recommend Vitamin A or C supplementation for cognitive health.
• Vitamin D –To our knowledge, there are no available randomized control trials of Vitamin D supplementation for the enhancement of cognition or prevention of cognitive decline and dementia.
• Phospholipids:phosphatidylserine and phosphatidylcholine –
  These phospholipids are the second most frequently endorsed substance for older adults with memory complaints by proprietorsof dietary supplements. In a recent small study of 157 participants, there was some suggestion of better cognitive performance in 15 weeks’ follow-up when compared with placebo in a group using phosphatidylserine, a w-3 long-chain (PUFA) and longer-chain decosahexaenoic acid (DHA) plus eicosapentaenoic acid (PS-DHA). Larger trials are needed confirm these findings before recommending the use of phospholipid supplementation.
• Ginseng –For adults with cognitive impairment or dementia, there were no randomized, placebo-controlled trials assessing the effect of ginseng. Further large randomized controlled trials are needed.

Conclusions

I conclude with this quote from the Mt. Sinai School of Medicine review: “There is little evidence today to suggest any benefit to the use of dietary supplements to improve cognitive function or delay the progression of dementia. The exception may be in Vitamin E supplementation among older adults with moderate dementia, but its harmful effects must be considered. Until further studies are available to better demonstrate the benefits of supplements on cognition, encouraging a balanced diet that contains essential vitamins and nutrients may reap more health benefits.”

The panic over the Covid-19 virus is diminishing and America is beginning to reopen again for business and social interaction. But the risk remains that you may still get infected if you’re exposed to someone contaminated with the virus and you fail to take the necessary precautions.

Most people who do contract the virus will have minimal symptoms and recover uneventfully. But a small but significant few will get seriously ill and some will die, mostly those with significant co-morbidities such as heart disease, diabetes, and respiratory illnesses.

Only two developments can change that scenario: an effective drug to treat the virus, or even better, an effective vaccine to prevent viral infection in the first place. Absent these two developments, the virus will continue to run its course, wreaking havoc on our lives and our economy.

Multiple pharmaceutical companies are working hard now to develop an effective vaccine and there are hopeful signs of one by early next year. But the big news this past week is the FDA approval of remdesivir as an effective treatment for those with serious Covid-19 infection. This is great news and should be a huge encouragement to all Americans, as well as people around the world.

Remdesivir was developed by Gilead Sciences and the company has already donated 1.5 million doses, free of charge, for treatment of the seriously ill. But it should be understood that this is no overnight achievement. Remdesivir has actually been in development for over ten years.

John F. Cogan and George P. Schultz, senior fellows at the Stanford Hoover Institution, tell us in The Wall Street Journal this drug treatment breakthrough is a product of the American market and legal system. In this system, privately owned biotech and pharmaceutical companies, financed by investor capital, seek to invent, develop and distribute new medications. Patent protection provides drug companies with additional incentives over and above those normally provided by the market to undertake the necessary risks. The incentives come from governmental protection of intellectual property and the associated ability temporarily to charge prices above the marginal cost of production. Even so, drug companies and their investors reap rewards from their successes, and suffer losses when their efforts fail.

Developing new drugs is a risky and expensive business. About 70% of drugs never make it to market because they prove ineffective or too toxic. Drugs typically gain approval only after many years of development. Charging more than the cost of production, at a price customers are willing to pay, allows developers to recoup these costs.

Over ten years ago, remdesivir was determined to be effective as an antiviral drug. Research of the drug as a treatment for childhood respiratory diseases has been done since 2010. Ultimately, it failed in that purpose, but it was tested in other viral illnesses including Ebola virus and two other corona viruses, SARS and MERS. However, with the passage of those illnesses, there were insufficient patient numbers for human trials of the drug.

Now, remdesivir is back in the news and the most exciting new treatment of Covid-19 yet. But its approval for this new application comes after over ten years of research and development. That’s ten years of expensive R & D, only possible in the American system that permits companies like Gilead to temporarily set prices above the cost of production in normal times, thus enabling the development and donation of this potent treatment now.

Politicians from both political parties have railed against the pharmaceutical companies for over-pricing their drugs. Progressives, like Senator Bernie Sanders, have called for drug price-controls as part of a government-controlled healthcare system. President Trump has also made proposals that would tag the price of drugs in this country to the prices paid in European countries. While these proposals are politically popular, such changes in the current system would seriously hamper our ability to develop new drug treatments at times of national and world-wide crisis such as this Covid-19 pandemic.

It’s a good thing we don’t have government-controlled healthcare, yet.