The supplements in the US have zero guarantee of purity or efficacy due to the fucking stupidity of the US Congress passing the Dietary Supplement Health and Education Act of 1994 (DSHEA).
This note from Feb. 24 just proves that stupidity.
Prescription galantamine drugs were labeled accurately, but dietary supplements were not.
Brain-Boosting Supplements: All Hype or Some Hope?
Media consumers are bombarded daily with aggressive, testimonial-driven ads for pricey supplements purported to sharpen memory, focus, and working brain function.
Some even claim to stop or slow the development of dementia.
Patients, especially older adults, may express interest in these supplements during clinic visits.
Most claim to be “clinically tested.” However, since the FDA exercises only limited regulatory control over these products, they are not held to the same purity, safety, and efficacy standards as are FDA-approved drugs.
“Manufacturers have a lot of leeway to market them as they want,” said Pieter Cohen, MD, director of the Supplement Research Program at the Cambridge Health Alliance in Somerville, Massachusetts, and an associate professor of medicine at Harvard Medical School in Boston. “That’s not to say they haven’t been studied — there might be small studies posted online done in, say, 100 people in another country, for example.”
Cohen, therefore, does not generally recommend that his patients take them to improve brain health, “although I do recommend supplements to patients who need them to treat medical conditions,” he told Medscape Medical News.
Many contain dubious or unlisted ingredients, he noted. In a 2021 study of over-the-counter (OTC) cognitive enhancement supplements, Cohen and colleagues identified unapproved drugs (omberacetam, aniracetam, phenibut, vinpocetine, and picamilon) — as well as compounds not listed on the label and with unknown health effects. For those products with ingredient quantities provided on the labels, 75% of declared quantities were inaccurate.
These OTC brain enhancers may feature, alone or in combination, nonpharmaceutical ingredients such as vitamins (including vitamin E), minerals like magnesium, omega-3 fatty acids, turmeric, and herbal compounds like ginseng, Ginkgo biloba, and coffee fruit extract. Some feature alleged boosters of brain performance that are less familiar, including alpha-GPC (L-alpha-glycerylphosphorylcholine), huperzine A, the Chinese mushroom lion’s mane, L-carnitine, and the Ayurvedic medicine compound Bacopa monnieri.
Some ingredients are more exotic. The memory enhancer Prevagen, for example, contains apoaequorin, a lab-made version of a protein found in the bioluminescent jellyfish Aequorea victoria.
In 2024, the Federal Trade Commission and a federal district court in New York State ordered Prevagen’s makers to stop their claims on the grounds they lacked reliable evidence.
The brain health supplements all have one thing in common, noted Jayne Zhang, MD, an attending neurologist specializing in cerebrovascular disease at Johns Hopkins School of Medicine in Baltimore — uncertain evidence of claimed efficacy.
“There is some modest support for a benefit from these products in people who already have nutritional deficiencies or mental degeneration, but there’s not a lot of strong evidence from rigorous trials,” she told Medscape Medical News.
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