LifeStyle Blog

With the start of the new year, we, at Smart Life Medical Center would like to wish you a different year – a year filled with health and well-being, a year that brings glad tidings and more importantly, growth. Something new that you can look forward to; someone better that you’ll become!

And as custom to New Years, we’ve made an initiative for change also, one that aims to benefit and improve your lives. And that is this blog section. We’ve decided that we are going to regularly post health-related articles that are simple to understand, beneficial and practical. In fact, if you’re interested, you could also write to us and request us to cover a particular health-related topic or subject. We’d love to address your curiosity. 

Now, what better way to start this year with a post about mental health and well-being. Mental health problems pertaining to stress, anxiety, attention deficit, chronic fatigue, etc. have become increasingly prevalent and a quick search on the internet brings back a lot of false advertising about products in the dietary supplement marketplace for brain and cognitive health! These supplements have become increasingly popular, promising improved memory, focus, cognitive performance, and energy. But do they? 

To help you answer this question, we’ve decided to start a series on the nootropics or “smart drugs” market. These articles will be distilled versions to help you digest the information quickly and help you become an informed consumer when considering these supplements and whether they actually boost your brain health and cognitive performance. 

First thing to keep mind is this: no evidence exists to show that any dietary supplement product can satisfy all (or any) of the criteria of “cognitive enhancers,” which includes, enhanced memory, helps brain function at a more superior level, protects the brain, and is relatively safe. Yes, sure, caffeine gets you started, makes you focus, etc., and so do some prescription drugs. But what we’re referring to is the idea that manufacturers employ: the “magic supplement that boosts your brain”! These include herbal ingredients such as ashwagandha, Ginkgo biloba, ginseng, omega-3 fatty acids, etc.

So, stay tuned and stay safe.

Source: Operation Supplement Safety

(OPSS) in support of the Consortium for Health and Military Performance Brain Health Guide: https://www.opss.org/sites/default/files/downloadable/OPSS_BHG_022521_508.pdf.

An Introduction to the World of “Smart Supplements”

The United States Food and Drug Administration (FDA) are the entity responsible for overlooking and approving medication intended for medical purposes. So, the over-the-counter prescription and non-prescription drugs must ideally be approved by the FDA to convince the medical boards of their efficacy. Sort of like getting legitimacy for their use.

Prescription nootropic drugs that are FDA-approved for specific conditions do exist, such as modafinil,methylphenidate, and various other drugs to treat attention deficit hyperactivity disorder (ADHD) or Alzheimer’s disease. These drugs have been proven to be safe and are intended only for use under medical supervision.

However, a quick glimpse at the back of nootropic dietary supplements and it becomes clear that seldom, if any, are FDA approved for their intended purposes. This is because the FDA regulates dietary supplements differently than prescription drugs. Dietary supplements do not require FDA approval prior to marketing, so dietary supplement products can be misbranded or adulterated. Nevertheless, a dietary supplement cannot claim to treat or prevent any medical condition by law because if they do make such claims, the ingredients are considered “new drugs,” and according to the FDA, the product cannot be sold without going through their pre-market approval process required for drugs.

So, the pharmaceutical companies brand their products in line with the popular consumer believe that dietary supplement products are “natural”—and therefore safe. But are they?

Stay tuned for the next post in this series to find out about each of the popular dietary supplements…

Withania Somnifera (Ashwagandha)

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Withania Somnifera or Ashwagandha as it is popularly named, is crushed from a small low woody perennial plant having several major stems that is cultivated in the drier regions of India, Yemen, and parts of Africa.

The shrub is used as an ingredient in many different kinds of dietary supplements, and has been a successful part of Ayurvedic (traditional Indian) medicine for conditions related to

both physical and mental health for as far back as more than 3,000 years ago. So, its history is well documented, but what about its science?

Today, it is being marketed mainly as an “adaptogen,” which means it is used to help the body cope with stress; a scavenger of damaging molecules in the body and support for the immune system, but it has had its fair share of associations with improved cognitive functioning. However, most of the studies to date are relatively small, with inconsistent results, so more research is needed to determine its effectiveness and it is ongoing. In fact, it has been studied for various specific uses, including for the treatment and prevention of cancer (thanks to a compound present in it called withaferin A), arthritis, diabetes, infertility, etc.

Adverse health effects have been reported mostly by those taking large doses (more than 3 grams) and appear to be minor—including nausea, diarrhea, and vomiting—with one important exception: Ashwagandha can induce abortion, so pregnant women should not take it!

As an individual, I am fully aware of the persuasive effects a desperate desire to improve combined with the enticing branding of a product can have. And as a physician, my role is to be as involved with the developments in this sphere as possible. So, I decided to experience Ashwagandha as a dietary supplement. I took on two of the most positively reviewed products for two months, and my dose was approximately 600mg per day. The dose can vary but more than 1 gram per day has been shown to be relatively safe for oral use for up to about 12 weeks, so I decided to get it up there without pushing the limits.

Of course, the duration of use appears to depend on the intended effect. However, in my two months of consumption, I was hard-pressed to notice any difference. If you’ve consumed this dietary supplement before, feel free to share with us your experience.

Bacopa Monnieri

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The Waterhyssop or Bacopa for short is a well-known aromatic and creeping plant that lacks a permanent woody stem. These herbs are cultivated in India but are also native to the wetlands of the rest of the world where they last for an indefinitely long time (suggesting self-renewal) and are therefore, perennial herbs.

In India, they are commonly referred to as “Brahmi,” and used in Ayurvedic medicine as a brain tonic to improve cognitive function, including memory and learning. They are also used to treat health conditions such as anxiety and epilepsy. You see where this is going?

Although the US Food and Drug Administration (FDA) have warned manufacturers of Bacopa-containing supplements against making unproven (and therefore illegal) claims about this herb, some of the latest research has shown improvements for brain health, attention, and memory-related performance tasks after the use of approximately 300 mg per day. The onset is seen as soon as one hour after taking the dietary supplement and for as long as 12 weeks (the duration of the study).

But then again, other research has shown no improvements, especially when participants took higher amounts. So, the bottom line is that there isn’t enough scientific evidence to confirm whether it can improve brain performance, and more importantly, the safety of both short-term and long-term use. In addition, Bacopa-containing supplements are commonly pat of multiple-ingredient products, so it is nearly impossible to know which substance might cause any benefit or adverse event! Side-effects include dry mouth, nausea, diarrhea, and fatigue.

Ginkgo Biloba

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One of the oldest living species of trees native to China, Ginkgo leaf extract is commonly used as a dietary supplement for treating problems such as cognitive decline, memory loss, difficulties with focus and concentration, depression, and anxiety. By definition, dietary supplements are not intended to treat “problems.” Regardless, ginkgo is one of the most popular dietary supplement ingredients on the market today because of such claims.

But to ‘cut-to-the-chase’, there is no scientific evidence strong enough to substantiate those claims; the latest research has shown that taking 120mg ginkgo per day for 12 weeks does not seem to result in better cognitive performance than a placebo. Although there were previous studies that revealed enhanced performance on some tasks related to attention, memory, and problem solving, up to 6 hours after taking one capsule of 120–360 mg ginkgo. But then there was other research that showed a decline in the performance of certain tasks immediately after taking 120 mg ginkgo.

So, the evidence is inconsistent in terms of the specific tasks tested as well as the serving sizes used in research and it’s hard to say if and how much you might gain.

Although the Ginkgo leaf should never be taken by mouth in the raw form (it’s poisonous), Ginkgo extract appears to be safe for most people (except pregnant women and patients prone to bleeding) when taken as a dietary supplement in amounts of 120–360 mg per day for up to 12 weeks and possibly longer. Possible minor side effects include headache and nausea, but it could also cause unexplained bleeding, moodiness, and irregular heartbeat.

My first experience with the product had been when I had been suffering from bouts of brain fog and mental fatigue. I went to the pharmacy and enquired about products that could help me get out of my rut. The advice I received was plentiful, one of which was a multivitamin product that contained Ginkgo Biloba extract. Did I notice any difference? As a physician, I tend to stick with some basic principles for health and wellbeing which I will elaborate on in future posts, and after including this dietary supplement, there was no obvious noticeable difference for me personally.

Ginseng

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Ginseng is the root of the plants in the genus Panax, that is grown and cultivated in Korea, China, and North America. It is widely popular as a dietary supplement, marketed to promote brain health and enhance cognitive performance. Ginseng extracts are also included in products such as tea and energy drinks.

The active constituent of ginseng is ginsenosides and some of the latest research has shown that they actually do improve performance on attention and memory-related tasks up to 6 hours after a single use of 200-400 mg Panax ginseng extract. No such effects have been reported with amounts greater than 400mg. Finally, something that actually works!

However, since no studies have been conducted for longer than 12 weeks, long-term effects on healthy adults are still unknown. Also, some dietary supplements that contain ginseng are also combined with other ingredients, in which case you also can’t tell whether the effects are from the ginseng or the other constituents.

Panax ginseng extracts are likely safe for adults when used short-term and in small amounts (less than 400mg per day), but common minor side effects include insomnia, headache, and stomach upset. Long-term use (continuous use past 6 months) could be unsafe. Severe effects reported seeming to be more common with combination products where it is challenging to know which of the ingredients could be responsible for the effects. Nevertheless, it might be unsafe for pregnant or breastfeeding women, as well as for infants and children so take precautions.

Omega - 3 Fatty Acids (Fish Oil)

Omega-3 fatty acids are a staple supplement of mine. The reason being that there has not been a fatty acid that has been as thoroughly studied and proven to be beneficial to the brain as the Omega-3s (α-linolenic acid or ALA, eicosatetraenoic acid or EPA, and docosahexaenoic acid or DHA).

First of all, they are considered essential nutrients because your body can’t make them on its own AND they have studied and proven benefits for brain health; they help build brain cells and maintain brain function (as one of the main constituents of the protective sheath around neuronal cell structures). Second, they’re also marketed for cardiovascular health because they tend to reduce triglycerides (one type of fat that can build up in blood vessels), and slow the buildup of cholesterol plaques, which harden and block arteries, as well as reduce the risk of developing an irregular heartbeat.

Third, it has been shown that they have a profound effect on depression and mood. In a double-blind placebo-controlled study, first published in 2008 and many others followed, where 1g of EPA daily compared with 20mg of Prozac (anti-depression medication) was done, and they both were equally effective in reducing depressive symptoms over the course of eight weeks. Some of this research shows enhanced performance on tasks related to attention and memory after taking 2 to 2.5 grams per day of fish-oil dietary supplements (at various ratios of EPA and DHA) over the course of 3 to 6 months.

In fact, the American Heart Association and the American Psychiatric Association recommend at least 2 servings of fish per week (an average daily intake of 450–500 mg EPA and DHA combined for overall heart and mental health. However, most people don’t consume enough of the foods they need to get the recommended amount of omega 3, which also includes flax, chia, or hemp, seeds. Which is why fish oils are a popular supplement today.

Minor side-effects may be experienced such as fishy aftertaste, upset stomach, headache, or flu-like symptoms. According to some reports, extremely high amounts (more than 20g/day), might reduce immune function and lead to an increased risk of bleeding and potential stroke (when used in combination with certain medications) over the long run.

Huperzia Serrata (Huperzine A)

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Huperzine A is a chemical compound that is isolated from the plant Huperzia

Serrata, the Chinese club moss, and is popular in China as an Alzheimer’s disease remedy. It is regularly used in traditional Chinese medicine as a remedy for strains, swelling, bruises, and even mental disorders like schizophrenia. In fact, it is available in most hospitals in China and is regularly prescribed in conjunction with Alzheimer’s medications.

Huperzine A is commonly listed as “Huperzia serrata extract,” or “HupA,” on dietary supplement product labels, and is often marketed for brain health and cognitive performance, with claims of enhanced brainpower, memory, alertness, attention, concentration, and focus. Although preliminary evidence suggests it might have beneficial effects on cognitive function among Alzheimer’s disease patients, more research is needed to establish this conclusively so be wary of the marketing ploy that it can “cure” Alzheimer’s.

Moreover, the Alzheimer’s Association does not recommend taking huperzine A, especially with prescription drugs, because the combination could increase the risk of serious side effects, like decreased heart rate, nausea, vomiting, diarrhea, dizziness, sweating, blurred vision, and insomnia.

Overall, safety data are lacking, and long-term use is not well understood, so given the limited evidence of its safety, we advise caution with this supplement.

 

Rhodiola Rosea

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Rhodiola Rosea is a plant that grows at high altitudes in the arctic areas of Europe and Asia. And just like Ashwagandha, it is mainly marketed as an “adaptogen,” to help the body cope with stress and support the immune system. In fact, it has been used for centuries to enhance physical and mental performance and fight stress.

In addition, Rhodiola is also marketed as a dietary supplement with claims to boost brain health, increase energy, reduce fatigue and anxiety, and improve athletic performance and mental clarity. Although research with animals has shown improved learning and memory function, there are only a few studies on healthy adults – not enough to reach solid conclusions. However, those studies have shown improvements in general fatigue under stressful conditions and improvements in performances related to attention and short-term memory tasks. The studied Rhodiola dose was up to 600mg per day for as short as one day and up to 4 weeks.

But again, overall, the studies suffer from poor methods and small sample sizes, so the strength of the evidence is very low. Side effects appear to be minimal but could include dizziness, headache, dry mouth, or (the opposite) excess saliva. Nevertheless, avoid it if you are pregnant or nursing, or if you’re considering its use for a child until further research on its safety is available.

Vinpocetine

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Vinpocetine is made from the alkaloid compound vincamine found in the leaves of the Vinca minor (lesser periwinkle) plant and in voacanga seeds. It’s often advertised as being able to improve memory or focus due to reported effects of increased blood flow to the brain. But because it is synthesized (man-made), the FDA announced that it does not meet the definition of a dietary ingredient and is excluded from the definition of a dietary supplement. In fact, in China, Germany, and Russia, vinpocetine is considered a pharmaceutical drug.

Nevertheless, some studies have shown that stroke patients suffering mild or moderate symptoms of dementia do perform better in memory, concentration, and cognitive related tasks. However, more research is needed to determine its effects on healthy and younger populations. Also, because it can affect blood flow, anyone taking blood thinners should consult their physician first. The potential adverse side of increased blood flow is facial flushing, which may leave you looking embarrassed, and there have been reports of headache, nausea, and dizziness. And according to FDA, vinpocetine has been associated with harmful reproductive effects and might cause a miscarriage or damage fetal development.

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