Memory-enhancing pills

Can a pill improve brain function and help prevent dementia?
 
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01 .In brief

  • Studies indicate that the omega-3 fatty acids DHA and EPA may decrease the risk of cognitive impairment and dementia, while the evidence for other ‘smart’ pills is less convincing.
  • Four of 20 fish oil supplements we tested had less than the suggested dietary target for omega-3 in the maximum daily dose, and another three didn’t meet the target for men. Instead of taking supplements, you can meet this target by eating two (oily) fish meals per week.

As you get older, particularly past 50, it can become harder to concentrate and it’s not unusual to feel that your mind isn’t as sharp as it once was. The prospect of getting more and more forgetful and eventually losing your marbles can cause significant worry.

Wouldn’t it be great if you could just take a pill to jumpstart the brain, improve memory, and avoid heading down the slippery slope towards dementia? In fact, there are pills on the market that claim these benefits, and more. They can set you back anything from $10 to $70 a bottle. But do they work?

CHOICE reviewed the evidence for omega-3, ginko and brahmi supplements to find out whether the smart option would simply be to save your money.

Please note: this information was current as of July 2008 but is still a useful guide today.


 
 

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The scientific evidence

  • Epidemiological studies. A growing body of evidence from large, wellconducted epidemiological (population) studies suggests that eating omega-3s — specifically the long-chain fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), but DHA in particular — decreases the risk of cognitive impairment and dementia.
    Cognitive impairment ranges from mild to severe, at which point it may be diagnosed as dementia. With mild cognitive impairment, a person has problems with memory, language or another mental function severe enough to be noticeable to other people, but not serious enough to interfere with daily life.

    Epidemiological studies can show statistical relationships between elements of diet and illness or mortality — salt intake and high blood pressure, for example — and the evidence is often used to advocate public health interventions such as dietary changes. But, unlike clinical trials, they don’t conclusively show cause and effect.

  • Clinical trials. The UK-based Cochrane Collaboration conducted a systematic review of research, looking for randomised, controlled clinical trials of omega-3 supplementation in healthy older adults that might support the evidence from epidemiological studies. It found two trials that met its selection criteria, but they were still being conducted.

    They’ve since been completed, but results won’t be published until late this year. Without good-quality clinical trial data the Cochrane Collaboration concluded that omega-3 supplements can’t be recommended for the explicit purpose of preventing cognitive impairment or dementia, although studies do suggest a protective effect.

  • It is, however, widely accepted that DHA and EPA can reduce the risk of heart disease and that increasing your omega-3 intake provides a wide range of other health benefi ts. Given the encouraging results from epidemiological studies that omega-3 may also protect against dementia, it’s worth making sure that you’re getting enough.

How much is enough?

To lower your risk of chronic disease, the National Health and Medical Research Council (NHMRC) suggests a dietary target of 430 mg of omega-3 fatty acids a day for women and 610 mg a day for men. You need to eat at least two fish meals (preferably oily fish) per week to get this much, and Omega-3 in fish, below, shows which sources are best.

But a recent seafood consumption survey found that more than three quarters of us eat less than this amount. If you’re in this category, fish oil supplements could be an option.

Omega 3 in fish

Fish vary a lot in how much omega 3 they deliver. To give you some guidelines, the diagram below compares the amounts of omega 3 per 150 g serve from the species of fish you're most likely to find in your local supermarket or fish shop.

Brand / product (in order of cost per dose within categories) Bottle size (number of capsules) Maximum recommended daily dose (number of capsules) Maximum recommended daily dose as % of suggested dietary target for men (610 mg / day) Maximum recommended daily dose as % of suggested dietary target for women (430 mg / day) Cost / maximum dose ($)
Max. recommended daily dose provides the suggested dietary target for omega-3
Bioglan Omega 3 Fish Oil 1000 400 3 148 209 0.10
Amcal Natural Fish Oil 200 3 148 209 0.15
Greenridge Wild Salmon Oil 1000 300 3 148 209 0.20 (B)
Cenovis Natural Oils Fish Oil 1000 mg with Omega 3 180 3 148 209 0.25
Nature’s Way Fish Oil 1000 mg 200 3 148 209 0.28
Golden Glow Fish Oil + Ginkgo 120 2 74 (A) 105 0.42
Herron Fish Oil 1000 mg 60 3 148 209 0.45
Nature’s Own Odourless Omega 3 Ultra 60 1 82 (A) 117 0.47
Nature’s Way Extra Strength Fish Oil 1200 mg 160 3 177 251 0.47
Golden Glow Deep Sea Fish Oil 60 3 148 209 0.5
Blackmores Fish Oil 1000 90 3 148 209 0.53
Nature’s Own Omega 3 Fish Oil + Ginkgo 3000 90 2 74 (A) 105 0.55
Nature’s Way Brain & Memory Omega 3 Fish Oil 60 2 98 140 0.57
Blackmores Optimal Health Omega Daily 90 2 197 279 0.67
Nature’s Way One a Day Fish Oil Double Strength 60 2 197 279 0.9
Blackmores Brain Health Omega Brain 60 2 197 279 1
Max. recommended daily dose provides less than the suggested dietary target for omega-3 for men & women
Bioglan One-A-Day Super Fish Oil Concentrated 50 1 45 64 0.50
Eye Q 180 2 39 56 0.77
Efamol Efalex (D) 160 3 50 (D) 71 (D) 0.79
NeuroSpark 90 2 52 74 1.00
 

Table notes


(A) The samples we tested were oxidised with peroxide values significantly greater than the limit set by the TGA.
(B) The maximum recommended daily dose does not provide the suggested dietary target for omega-3 for men.
(C) The price we paid in March 2008.
(D) The manufacturer has since informed us that this product is intended primarily for children. Other Efamol products formulated specifically to meet adult daily requirements are available. 

  • Suggested dietary target (SDT) for omega-3 The Federal Government’s National Health and Medical Research Council (NHMRC) suggests a dietary target for longchain omega-3 fatty acids of 610 mg/day for men and 430 mg/day for women.
  • Maximum recommended daily dose as % of SDT This is the maximum number of capsules recommended per day, as stated on the product label, as a percentage of the SDT.
  • Cost per maximum dose This is based on the maximum recommended daily dose on the label and the recommended retail price, as provided by the manufacturer, unless noted otherwise.

Our findings

  • Four products give you less than the suggested dietary target for omega-3, even if you take the maximum recommended daily dose.    
  • Another three provided the suggested dietary target for women, but not for men if taken at the maximum recommended daily dose.
  • The majority of products contained more DHA and/or EPA than claimed on the label. The Therapeutic Goods Administration (TGA) requires that the content of the active ingredient in each capsule is not less than 92.5% and not more than 107.5% of the stated content. But a proposed change to the standard for fish oil capsules will simply require them to contain a minimum of 90% of the label claim for each — EPA and DHA with no maximum limit.
  • Two products had peroxide values higher than the TGA specifications for fish oil, indicating spoilage — despite having a minimum of 12 months before their expiry date (see the table). The freshness of the oil is important because rancid fish oils have an extremely unpleasant smell and also may not be as effective.
  • Nature's Own Odourless Omega-3 Ultra contained significantly less EPA than claimed on the label, and one sample of Neurospark that we analysed contained significantly less DHA. This sample was heavily oxidised but a second sample (from further down the bottle) was less oxidised (but still well beyond the TGA limit) and contained the amount of DHA claimed on the label. Neurospark sent us test results that showed their product to be less oxidised and meeting the amount of DHA claimed on the label.
  • It can cost you anything from 10 cents to more than $2 per day to get enough omega-3s. The table above shows which products offer the best value for money.

We informed the manufacturers of our findings.

Ginkgo biloba is one of the world’s oldest living tree species. It’s been used medicinally for many centuries, and herbal ginkgo supplements are particularly popular in Europe and the US.

‘Smart’ drug

Ginkgo is promoted as a ‘smart’ drug to enhance the brain power of healthy people. But there's little evidence that it actually works.

  • A systematic review published in 2007 looked at 15 randomised controlled clinical trials of ginkgo for cognitive function, carried out in healthy people aged under 60. The majority of studies used subjective ratings (self-reported improvement in memory, for example) to measure effect. Of these, only one of five single-dose studies and one of six longer-term studies reported any signifi cant positive results, and the review concluded there was no convincing evidence for a strong positive effect of ginkgo on any aspect of cognitive function in healthy young people. Findings from studies in older people with no cognitive impairment have been mixed.
  • A large study involving more than 3000 participants is currently under way in the US. The Ginkgo Evaluation of Memory (GEM) study will evaluate whether long-term ginkgo use (120 mg, twice a day) will help prevent dementia in healthy elderly people, or those with mild cognitive impairment. 

Dementia treatment

As a treatment for people with existing dementia or cognitive impairment, the evidence for ginkgo is mixed.

  • A 2007 Cochrane review of the scientific literature included 35 studies, the majority being 12 weeks long. The daily dose was usually less than 200 mg/day, and all studies except one used a standardised ginkgo preparation known as EGb 761. Many of the trials received funding from the company that manufactures this preparation.
  • Data from some trials at 12 weeks showed ginkgo to have a positive effect on cognition, but the effect was variable and shorter trials showed no benefit. The review concluded that the evidence for ginkgo being beneficial for people with cognitive impairment and dementia is inconsistent and unconvincing.

Commission E (a German government regulatory agency) approves the use of standardised ginkgo extract to treat dementia, but Alzheimer’s Australia thinks further research is needed before a definitive statement can be made about its effectiveness as a dementia treatment.

Going on the current evidence, there’s little to recommend the use of ginkgo for preventing dementia or improving memory or cognition if you’re healthy.

The herb brahmi (Bacopa monniera) has long been used in Ayurvedic medicine as a nerve tonic. Studies on rodents have shown encouraging results for the use of brahmi for improving learning and memory, but results from good-quality clinical studies are mixed.

  • One trial using a dose of 300 mg of brahmi over 12 weeks in 46 healthy volunteers found that it improved the speed of visual information processing, learning rate and memory consolidation.
  • In another three-month trial, involving 76 adults, improvements were observed in a test for new information retention, but no changes in the rate of learning.
  • A trial involving 38 healthy people found no changes in cognitive function, but testing was done just two hours after a single 300 mg dose of brahmi.
  • A further study using Blackmores Ginkgo Brahmi (containing 300 mg brahmi and 120 mg ginkgo) in 85 healthy people failed to show any significant differences in memory, attention, comprehension or learning after four weeks.

The current evidence for brahmi isn't convincing enough to warrant paying for supplements.


Some of the supplements and what they claim  

With omega-3 only

  • Neurospark — “may help sharpen thinking processes, improve concentration, minimise memory loss ... and clear ‘foggy brain’.”
  • Eye Q — “may help maintain eye and brain function.”

With ginkgo

  • Blackmores Ginkgoforte — “aids mental alertness. Improves memory. Improves attention and mental clarity.”
  • Greenridge MemRecall — “combines three herbs with vitamins to enhance memory and concentration.”

With omega-3 and ginkgo

  • Nature's Own Omega-3 Fish Oil + Ginkgo 3000 — improves “memory, mental and cognitive performance in healthy adults, maintaining healthy functioning of the ageing brain.”
  • Nature's Way Brain & Memory — is formulated “to help improve memory & concentration.”

With ginkgo and brahmi

  • Bioglan Focus Triple Action Brain Formula — “aids cognitive brain function such as the ability to think, reason, learn, understand and remember.”
  • Totally Natural Products Mega Memory 3000 — “improve memory function. Improve performance and recall. Improve concentration. Increase learning capacity.”

With all three

  • Bioglan Omega-3 Super Fish Oil — may help “improve and enhance short term memory. Maximise cognitive performance and concentration. Improve problem solving.”
  • Pretorius Maxi Fish Oil Brain Smart — “promotes improved memory, problem solving and cognitive performance.”

Mild cognitive impairement: A new term defining memory loss

We all forget things from time to time. Who hasn’t walked into the kitchen and forgotten what they went in there for, or mislaid the car keys?

Everyone is different and the effect on memory of getting older is different for each person. But memory loss that disrupts everyday life isn’t a normal part of aging — it’s a symptom of dementia (the most common cause of which is Alzheimer’s disease), a gradual and progressive decline in memory, thinking and reasoning skills.

It’s perfectly normal to get distracted at times, and forget to serve part of a meal, for example. But a person with dementia may have trouble with all the steps involved in preparing a meal. And temporarily losing a wallet is one thing. But putting it in an unusual place like the freezer could be a warning sign of dementia.

Losing items and having trouble remembering people’s names could indicate that you have what’s recently been termed mild cognitive impairment (MCI). This is defined as a level of memory loss greater than that usually experienced with aging, but without other signs of dementia. People with MCI can usually accomplish all their daily tasks, but often compensate for their memory problems by relying on memory prompts such as reminder notes or calendars.

The presence of symptoms such as these doesn’t necessarily mean you have, or will develop, dementia, but it’s better to see your doctor to discuss them sooner rather than later. Early and accurate diagnosis of Alzheimer’s disease or other types of dementia can ensure you get the right treatment, care and support.

For a checklist of the early signs of dementia go to Alzheimer's Australia , or call the National Dementia Helpline on 1800 100 500 to discuss memory concerns.

Keep your brain healthy

  • Eat well. Eat a balanced, healthy diet. Numerous studies suggest that fruit, vegetables and fatty fish might help preserve mental agility by protecting blood vessels and promoting regeneration of nerve cells. Avoid harmful substances — excessive drinking and drug abuse damage brain cells.
  • Stay socially connected. Sports, cultural activities, emotional support and close personal relationships appear to have a protective effect against dementia.
  • Exercise regularly. Physical exercise is essential for maintaining good oxygen-rich blood flow to the brain.
  • Sleep and relax. Make sure you get regular and adequate sleep, and try to curb stress — it triggers the release of hormones that can impair memory and even damage brain cells.
  • Challenge yourself. Do crosswords or Sudoku, play a musical instrument or learn a new language. Keeping mentally active strengthens brain connections, and you can train your brain to improve reasoning, memory and speed of processing.
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