Do brain supplements do anything?

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Illustration by Slug Signorino

Dear Cecil: Is Prevagen cognitive supplement as effective as its TV ad states? Rob Sutterfield

Cecil replies:

Probably not, but you don’t have to take my word for it. Just ask the Federal Trade Commission, which together with the New York Attorney General filed a lawsuit last year over those claims you’re wondering about, Rob, calling them “false and unsubstantiated.”

A little catch-up for those TV-shunning readers who consequently have never heard of this stuff: Prevagen is a dietary supplement whose key ingredient is a protein extracted from jellyfish, called apoaequorin. Wisconsin-based Quincy Bioscience, the manufacturer, claims apoaequorin aids cognitive function and memory by supplementing proteins lost in the brain during aging. The bone of contention here is their commercials’ reference to a “double-blind, placebo-controlled study” — sounds legit, no? — in which folks who took the pills daily were said to have demonstrated rapid improvement in recall ability: 20 percent better in 90 days.

Just one problem: the clinical trial cited apparently didn’t show anything of the sort. In this study, 218 subjects with “self-reported memory concerns” were given either apoaequorin or a placebo, then took a test gauging verbal recall. The results? Zip — no difference between the treatment group and the control group. The FTC suit alleges that Quincy’s researchers (on the company payroll, let’s note) basically sliced and diced these unpromising numbers via what’s called post-hoc analysis: going back into the data and poking around in search of correlations you didn’t predict beforehand. Post-hoc findings can be useful as a basis for further study, but seemingly Quincy just took three such analyses that tentatively pointed to some cognitive improvement (ignoring 27 others that didn’t) and touted those results on TV.

On top of that, the complaint alleges, Quincy hasn’t proven satisfactorily that apoaequorin ingested orally can cross the blood-brain barrier: even if it were an effective brain supplement, in other words, it would presumably need to get to your brain to work its magic, whereas all evidence points to it breaking down in the digestive process. So the answer to your question, Rob, is: Who knows if Prevagen works, but you’re still welcome to shell out $24 to $68 a bottle and see what happens.

Then again, there are currently scores of other brain supplements on the market you could sample instead, though these don’t come with a lot of scientific backup, either. Welcome to the burgeoning field referred to as nootropics (from Greek words for “mind” and “bending”), awash with various arcane-sounding products all claiming to improve mental function.

Why so much interest now? Well, one reason is that baby boomers are getting to that age where at best they keep misplacing their keys; at worst, they’re developing conditions like Alzheimer’s. (The FTC claimed the Prevagen ads “preyed on the fears of older consumers experiencing age-related memory loss.”) Another major driver here is Silicon Valley, which is on fire with the idea that the brain can be “hacked” into greater productivity, ideally using drugs that’re easier to get (and tolerate) than prescription-only pills like Adderall. A 2017 Washington Post article profiled one Bay Area entrepreneur who was taking 25 pills a day to give him “the cognitive edge he needs” to do business. I’ll confess I find this all a bit dispiriting. Remember when we used to take unlicensed mind-altering drugs for fun?

It’d be tough to make any broad claims for the effectiveness of this stuff, simply because there’s so much of it out there: from Huperzine A, a moss-derived supplement thought to improve short-term memory, to the amino acid L-carnitine, which hasn’t yet been demonstrated to provide meaningful cognitive benefit, though on the plus side it may impart a fishy smell to your bodily secretions.

But beyond the merits of any one product lurks a bigger issue: because these are marketed as supplements, they’re unregulated by the Food and Drug Administration. The Dietary Supplement Health and Education Act of 1994, or DSHEA, places such products outside the FDA’s ambit — essentially they’re considered food, not medicine. With the uptick in allegedly brain-boosting supplements on the market have come concerns, as with Prevagen, of unscrupulous marketers selling useless or even harmful products to credulous consumers and facing few consequences. Speaking to Wired, a supplements expert from Harvard med school said, “If I were looking for opportunities to make a lot of money while deceiving people, I think going into the brain supplement business would be real high on my list.”

Will they continue to get away with it? No reason to think not. Quincy Bioscience’s strategy on the FTC suit, filed in January 2017, seemed to be to wait it out; the company characterized the plaintiff as an overreaching lame-duck regulatory body that’d be reined in by the Trump administration. The suit was thrown out last September and is now in the appeals process, but the company’s sanguinity reflected that of the supplements industry at large, which was described by one trade website as feeling “bullish” about its prospects under the current anti-regulatory regime. In some quarters at least, it’s evidently reassuring to know there’s a snake-oil salesman in the White House.

Cecil Adams

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