Maintenance of brain health and retention of memory function are key priorities for many aging adults. The first article of this series addressed how to identify patients who may be experiencing age-related memory loss and how to initiate a counseling session on the topic. The article also discussed the best exercise strategies that will maximize memory improvement and retention.

This article will shift focus toward confronting the misconceptions surrounding OTC supplements and information on what changes to the diet may be beneficial in supporting brain health. Let’s talk about some popular OTC treatments for memory loss, why many of them may actually have more risks than benefits, and how to discuss these products, as well as diet changes, candidly with your patients.

Some OTC supplements can pose great risks to the health of our patients. Most patients don’t give much thought to whether their OTCs interact with their prescription medications, but the reality is that many OTC products can cause severe adverse reactions when taken in combination with specific prescription drugs.

Take ginkgo biloba, for example, a popular OTC product that has been believed by consumers to improve memory function, despite large-scale studies not finding this to be true. Ginkgo biloba additionally is known to significantly interact with any drug product that has anticoagulant properties. The leaf extract slows blood clotting and can cause serious bleeding in patients who take medications, such as warfarin, NSAIDs, and other anticoagulants.1

Vitamin E is a product that has actually been shown to have some positive effect on improving memory function. Unfortunately, a very high dose at 2000 IU is what has been shown to provide this benefit, yet there are other studies that claim doses of over 400 IU are related to increased risk for prostate cancer and are additionally risky to use in patients with cardiovascular disease.2

When patients ask about these products as a supplement to improve memory function, be sure to thoroughly evaluate the risk-to-benefit ratio of these drugs for each individual patient. Fish oil and vitamin B12 are 2 supplements that are thought to have beneficial effects on memory function. Although taking them may not pose many serious health risks like what is seen with ginkgo biloba, they also may not provide any benefit depending on the circumstance.

Vitamin B12 is known to be an important vitamin for brain health, but supplementing B12 if levels are already within the normal range does nothing to improve memory. However, if a patient is clinically deficient in vitamin B12, supplementing it either on its own or through the diet could potentially lead to better memory.

Fish oil is also popular due to omega-3s playing a key role in maintaining brain health. However, taking fish oil as a supplement is not as effective as being sure that omega-3s are being consumed adequately through the patient’s diet. Many patients and physicians attribute a Mediterranean diet to being highly beneficial for many aspects of health, including memory.

Mediterranean diets heavily incorporate seafood, legumes, olive oil, and vegetables. These types of diets are packed with omega-3 fatty acids, potentially leading to an improvement in the patient’s brain health.3 Discuss with patients the benefit of including fish and other healthy fats in the diet. Also, discuss with their providers whether they could benefit from vitamin B12 supplementation.

In summary, shared decision-making between patients, pharmacists, and providers will need to be used in order to determine whether a patient could benefit from taking an OTC supplement for their brain health. Some OTCs may cause serious adverse reactions and others may cost more than they’re worth.

Understanding the patient’s goals, knowing what medications they are currently taking, and staying updated on their medical conditions are all crucial when recommending supplements to improve memory. Overall, dietary changes prove to have more benefit than taking OTC products.

Recommending that patients include seafood in their diet at least once a week may be one of the safest, most beneficial, and most cost-effective strategies for patients to achieve their desired level of memory function.

References
  1. Lerner, KC. Madison Memory Study: A Randomized, Double-Blinded, Placebo-Controlled Trial of Apoaequorin in Community-Dwelling, Older Adults. August 2016. https://www.prevagen.com/wp-content/uploads/2017/02/ClinicalTrialSynopsis-cmk816.pdf Accessed July 2020.
  2. Federal Trade Commission. FTC, New York, State Charge the Marketers of Prevagen With Deceptive Memory, Cognitive Improvement Claims. January 9, 2017. https://www.ftc.gov/news-events/press-releases/2017/01/ftc-new-york-state-charge-marketers-prevagen-making-deceptive. Accessed July 2020.
  3. Mayo Clinic Staff. Ginkgo. October 12, 2017. https://www.mayoclinic.org/drugs-supplements-ginkgo/art-20362032. Accessed July 2020.