In the crowded world of supplements with the promise of preventing age-related memory loss and Alzheimer’s disease, a few are taking the lead. These candidates meet the necessary requirements of an ideal dietary supplement. They are safe, have been investigated in reputable epidemiological and basic research studies with convincing positive results, have minimal to no side-effects at reasonable doses, and are cheap. The ultimate test, a placebo-controlled randomized clinical trial, is now underway for many of them.

In Alzheimer’s disease, levels of a natural brain protein, amyloid, gradually increase over time and form clumps. These are toxic and attract a vicious inflammatory reaction worsening the mess. Those with obesity, diabetes, heart disease, a couch-potato lifestyle, or boring jobs buy themselves more risk factors and show signs of dementia well before they hit 80. A biochemical solution would be to interrupt these cascades of events. In conjunction with eating a heart-healthy diet and improving mind and body fitness, such supplements could delay the onset of Alzheimer’s symptoms by 5-10 years.

One of the exciting new discoveries in the field of Alzheimer’s prevention has been the realization that the omega-3 fatty acid, DHA, can reduce the amount of amyloid in the brain. Alzheimer’s patients, and in fact even those with depression or learning disability, have low levels of DHA. Taking DHA by eating fish 2-3 times a week, or taking supplements, increases memory and attention in normal healthy subjects. According to two large population studies in Framingham and Chicago, DHA significantly lowers the risk of Alzheimer’s in the elderly. DHA is so safe and effective the American Heart Association recommends it for patients with coronary heart disease. Even infant formula preparations contain DHA, to help with brain development. Small clinical trials in Japan and Sweden have shown positive results and large scale placebo-controlled trials are now underway in the United States.

In one of the largest epidemiological investigations of brain health and aging, Dr. Peter Zandi at Johns Hopkins School of Public Health along with his colleagues of the multi-center Cache County Study discovered that taking vitamin E plus vitamin C leads to a lower chance of developing Alzheimer’s. Vitamin C appears to recycle vitamin E so it can have a longer-lasting anti-oxidant property in the brain. Vitamin E at doses less than 300 international unit is also safe. In a more recent analysis of the Cache County data, we found that normal elderly at high genetic risk for Alzheimer’s maintained their cognitive abilities if they were taking a super combination of vitamin E, vitamin C, and NSAIDs such as ibuprofen. This raises the idea that a cocktail pill may be more effective than using any one single supplement.

The brain protective properties of Curcumin, the active ingredient in the curry spice, have been surprising. Indians, who have 25% less risk of developing Alzheimer’s than Americans, consume curry on a regular basis. They also rub it on the skin and joints to heal wounds and reduce pain. In fact, in a recent study in the University of Kansas, Dr. Barbara Timmermann and her colleagues discovered that Curcumin can reduce inflammation in an animal model of rheumatoid arthritis. Curcumin is a “natural” NSAID without all the GI side effects and has been shown to be fairly safe up doses of 8000 mg/day. It would be a great substitute for Motrin.

Ginkgo biloba is an old favorite herbal remedy for healing a dozen different ailments that also includes erectile dysfunction. It failed to show specific memory enhancing effect in at least two clinical trials. However, like Huperzine A, it still has a strong chance to be used for treatment of Alzheimer’s and larger scale clinical trials are underway. Either green or black tea, just like small amounts of wine, may have anti-inflammatory and neuroprotective benefits too and don’t seem to be harmful.

Having reviewed the literature in the field of supplements and brain health, I would vote for a cocktail that contains vitamin E, vitamin C, DHA, and Curcumin. At the same time, I strongly recommend improving physical and mental fitness and eating generous amounts of fruits and vegetables daily, as there will never be a chemical substitute for benefits of a healthy lifestyle.

As long as I have been in the field of Alzheimer’s disease, there has been one claim after another that some natural product is an effective treatment, if not a cure. As many family members of patients know from expensive experience, none of these do much to help. Currently, there are a number of claims being made for Ginkgo biloba, Huperzine A, Coenzyme Q10 and Phosphatidyl serine. More detailed information about the Alzheimer’s Association analysis of these claims can be found on their Web site: (www.alz.org/professionals_and_researchers_ alternative_treatments_.asp) and only a few general points will be discussed here.

As a researcher, I have no bias against natural products as potential treatments for Alzheimer’s disease. For several years, I have collaborated with groups trying to find treatments by screening large collections of natural product extracts. The difference between me and the people promoting natural products as treatments is that I demand hard scientific evidence on BOTH the safety and the effectiveness of these extracts. This is simply not available for the compounds currently being heavily advertised.

My major concern is that these products are not rigorously tested for safety, nor is there adequate regulation in terms of the quality of the products available for sale.We simply don’t know if it safe to take these compounds, especially in cases where large amounts are consumed over long periods. It is quite possible that there will be negative side effects, especially if high doses are used for long periods. There is no reliable information on the possible toxicity of these compounds, and there is no requirement that manufacturers report negative effects, the way that the pharmaceutical industry is required to report side effects of drugs they test. There is also no requirement that the manufacturers present hard scientific evidence that the compounds are effective treatments, before offering them for sale.

It is hard for me to understand how a reputable company can claim that their product is an effective treatment for Alzheimer’s disease without having good evidence that this is so. For Ginkgo biloba, Huperzine A, Coenzyme Q10 and Phosphatidyl serine, this evidence does not currently exist. Responsible scientists are testing some of these compounds, and the results of these tests should be available in the next few years. It is even harder to understand how a company can market a product that may not be safe for the people who take it. It seems cynical to believe that people who promote these products are just trying to make money from desperate patients and families, but this seems to be what is going on. Patients and their families would do well to avoid these unscrupulous advertisements.