As we age, many of us become concerned about our cognitive health and the potential for cognitive decline. It's no wonder that brain health supplements have become increasingly popular, with claims that they can improve memory, focus, and overall brain function. However, before you rush out to buy the latest brain-boosting pill, it's essential to understand the truth about these products and why you should think twice before spending your money.

First, let's look at the numbers. In Canada, the market for brain health supplements has been steadily growing, reaching $136 million in 2018. This includes products like Ginkgo Biloba, omega-3 fatty acids, and various vitamins and minerals marketed as beneficial for brain health.

However, research on the efficacy of brain health supplements is mixed at best. While some studies have shown promising results, others have yet to find much benefit from these products.

What can we take away from this? There's no solid proof these “brain supplements” work.

The main issue with all over-the-counter supplants is the need for more regulation. Health Canada has amended the Natural Health Products Regulations to ensure products have an NHP (Natural Health Product) number and effect labels that are easier to read and understand. There will be additional changes and controls rolling out for July 2025.

Often, with brain health supplements, labelling can make vague or misleading claims. For example, a product might claim to "boost brain function" without specifying what that means or providing any evidence to support the claim. This can create false expectations among consumers and lead them to believe that these products are more effective than they are. Currently, a supplement manufacturer can claim a product helps with mental alertness or memory loss — but not that it protects against or improves dementia or Alzheimer's disease.

Many brain supplements focus on omega-3 fatty acids (such as those found in fish oil), vitamin E, various B vitamins, or various combinations. Why these? There is strong evidence that specific diets — like the Mediterranean, DASH, and MIND diets — can help improve cognitive function.

These diets contain foods with large amounts of these vitamins and minerals. But what is unclear is whether it's the combination of nutrients in these diets that's beneficial, or whether it's specific ones or even certain amounts, or some other factors. Researchers have tried to answer these questions by testing how these nutrients affect cognitive health. So far, the limited studies have found no evidence they help, with a few rare exceptions.

Still, this doesn't mean that the brain supplements may not work; it’s just that there is not much if any, good evidence because most supplements are not tested rigorously in clinical trials.

What we do know with some level of confidence:

Omega-3 fatty acids (Fish oil) 

There are three types of omega-3s: eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) — which are found primarily in fatty fish like salmon and mackerel — and alpha-linolenic acid (ALA), which is located in leafy green vegetables (Brussels sprouts, spinach), vegetable oils (canola, soybean), and nuts and seeds (walnuts, $axseeds). The body converts ALA into EPA or DHA, but only in small amounts, so the best way to get high amounts of EPA and DHA is by eating more fish.

Omega-3s help build cell membranes in the brain and may have anti-inflammatories and antioxidant effects that could protect brain cells.

Fish is a staple in the Mediterranean and MIND diets, among others, and studies have found an association between a higher intake of fish and a lower risk of cognitive decline. However, omega-3 supplements are not the same as taking more Omega-3s from a greater fish intake and not from fish oil supplements.

Vitamin E 

Vitamin E is an antioxidant believed to help with brain health by reducing oxidative stress. It is the only supplement found to have any possible benefit. A 2014 study in the journal Nutrients reviewed the existing research on vitamin E and various health issues, such as heart disease, stroke, and Alzheimer's disease.

The researchers found that high-dose vitamin E may help people with mild to moderate Alzheimer's dementia continue to perform daily life functions for a short period. However, vitamin E does not prevent the disease or reduce other symptoms; high doses increase the risk of hemorrhagic stroke.

B Vitamins 

Three B vitamins are often linked with brain health: B6, B9 (folate), and B12. They can help break down homocysteine, high levels associated with a greater risk of dementia and Alzheimer's disease. B vitamins also help produce the energy needed to develop new brain cells. However, most people get enough B vitamins through their diet. "You may need extra B vitamins via supplements if you have a deficiency or have trouble getting enough through your diet, but otherwise, they do not have any clear benefit for brain health," says Dr. Marshall.

What about Ginko Biloba?

The pretty fan-shaped leaves of the ginkgo tree are used in traditional Chinese medicine to treat all kinds of ailments, including memory enhancers. The Ginkgo Evaluation of Memory (GEM) study was one of the most extensive clinical trials exploring the possible link. Researchers recruited more than 3,000 older adults, with an average age of 79, 54% of whom were men, with normal cognitive function or mild cognitive impairment. Everyone was given 120 milligrams of ginkgo or a placebo twice daily for almost six years. The results found that ginkgo biloba did not lower the overall rate of developing dementia.

So, how can you protect your brain health without relying on supplements? The answer is simple: focus on a healthy lifestyle. Regular exercise, a balanced diet, and adequate sleep are critical to maintaining cognitive health. Additionally, engaging in mentally stimulating activities, like puzzles or reading, can help to keep your brain sharp.

Of course, there may be cases where a healthcare professional recommends a brain health supplement based on their clinical experience and expertise. In these instances, choosing a reputable brand and following the instructions carefully is essential. However, for most people, the best way to protect and improve cognitive health is to focus on overall wellness and avoid getting caught up in the hype of brain health supplements.

One of our pharmacists will be happy to help with any questions you may have!