BY Samuel Mathis MD, MBA
Recently, there has been a lot of media attention regarding supplements and prescription medications for certain neurological conditions and syndromes. This attention may encourage patients to ask questions about supplements that may help their brain health. While these supplements may help in certain situations, there is no quick fix or supplement that will delay or reverse cognitive decline. Let’s review some of the evidence surrounding supplements for brain health and what may actually help improve patients’ cognitive abilities. Before discussing these supplements, it is important to remember that the greatest health strategy to improve neurological function is to focus on a healthy diet and regular physical activity.
The supplement receiving the most attention recently is folate supplementation or prescription-grade folic acid. Folic acid is critical for brain health both in utero and throughout life. It is so important that in the 1990s, the US and UK began adding folic acid to our flour and commercial grain products to ensure that citizens obtained enough of it during pregnancy and early childhood development. A significant amount of evidence is emerging that links not only folic acid, but many B Vitamins to brain health (1). A study performed over a decade ago found that supplementation with a Vitamin B complex over two years “reduced global and regional brain atrophy, as measured by MRI” (1). Many studies have shown that appropriate supplementation with these essential vitamins can have a profound impact on our cognitive health. My typical recommendation for patients is 1 Vitamin B complex supplement a day if not getting these essential vitamins through foods such as legumes, whole grains, fruit (citrus, bananas, avocados), and nuts (almonds, peanuts, sunflower seeds).
Other supplements and vitamins that may prove helpful in improving memory, attention, executive function, and even neuroprotection are also being evaluated. Studies looking at antioxidants, omega-3 fatty acids (fish oil), Ginkgo biloba, Vitamin D, and mineral supplementation have all found evidence of benefit when used regularly (2). These supplements have a significant impact on cognitive decline associated with the aging process. A combination of supplementation and mental health exercises can provide significant improvement in the cognitive abilities of many patients. Thi should be an individualized approach and not focused on one-size-fits-all supplements. It is important to recognize that, currently, there is no evidence that supplementation by itself will reverse or cure cognitive decline associated with dementia or other neurological disease processes.
For the coffee lovers out there, one supplement that shows some significant potential is whole coffee cherry extract. A randomized, double-blinded, placebo-controlled trial found significant improvement in cognitive function and memory in adults with self-reported memory concerns after 42 days of supplementation (3). This study found that the supplementation of coffee cherry extract was well tolerated and improved memory, accuracy, focus, concentration, and learning without significant side effects. This may be related to caffeine and various compounds found in coffee itself. While coffee has been found to help cognitive function, it is not to the extent that supplementation was able to provide. It is important to note that this study only looked at a total of 138 participants, and larger trials are needed to verify the findings (3).
So, how do we address patients who ask about their personal or family’s neurological health? It is important to note that prescription-grade folic acid is not routinely recommended for cognitive function. These medications should be limited to those individuals with known or suspected autoimmune conditions that limit their folic acid absorption or function within the brain and should not be routinely prescribed. If prescribed, they should be discontinued if no evidence of their effectiveness is seen within 1-2 months to prevent side effects from over-supplementation with folic acid. The best advice we can provide for our patients is to promote low-processed foods, regular physical activity, and supplementation only if they are deficient.
For patients who still desire something for their memory, I start with a good third-party tested multivitamin and then recommend specific supplements like fish oil supplementation, Vitamin D (depending on their age), and a short course of ginkgo biloba (6 months with a 2–3-month break). Many Ginkgo biloba supplements are contaminated with heavy metals and should not be taken for prolonged periods of time. Finally, I will be starting to recommend coffee cherry extract for those wanting something specific for their memory. After my research, I may try it myself. No matter what is recommended, it is important to remind patients that their daily health choices have a more profound impact on their memory and cognitive ability than any supplement may hope to impact.
References:
- McGarel C, Pentieva K, Strain JJ, McNulty H. Emerging roles for folate and related B-vitamins in brain health across the lifecycle. Proc Nutr Soc. 2015;74(1):46-55. doi:10.1017/S0029665114001554
- Fekete M, Lehoczki A, Tarantini S, et al. Improving Cognitive Function with Nutritional Supplements in Aging: A Comprehensive Narrative Review of Clinical Studies Investigating the Effects of Vitamins, Minerals, Antioxidants, and Other Dietary Supplements. Nutrients. 2023;15(24):5116. Published 2023 Dec 15. doi:10.3390/nu15245116
- Doma KM, Lewis ED, Barracato JM, et al. A Randomized, Double-Blind, Placebo-Controlled, Parallel Study Investigating the Efficacy of a Whole Coffee Cherry Extract and Phosphatidylserine Formulation on Cognitive Performance of Healthy Adults with Self-Perceived Memory Problems. Neurol Ther. 2023;12(3):777-794. doi:10.1007/s40120-023-00454-z