Helping patients/clients sustain cognitive abilities.
It’s funny in a way—when middle-aged adults say, “I keep forgetting where I put my phone, am I getting Alzheimer’s?” They are mostly kidding, but there is an underlying rivulet of anxiety about potentially going into mental decline.
Unlike clients of only about five years ago, the current crop of adults you see and will be seeing are more in tune with supporting cognitive health, and more interested in being proactive in this area. And spiraling into dementia is no longer the chief focus or concern about brain function.
For example, Brian Keenan, education manager for Ayush Herbs in Washington, pointed out that within the past several years, there has been a growing social awareness of the importance of mental health and the slow but steady erosion of the stigma surrounding mental illness.
“As a result, the goals of cognitive health are often much more holistic, with people desiring support for both mood as well as mental support such as focus, energy and balance,” he observed. The shift from living for months online (pandemic quarantine) to normal back-in-person routines, has created more anxiety and thus has also led to people seeking support for focus, mood support, relaxation and overall mental balance, he added.
Jing Struve, executive director, Farlong Nutraceutical, California, agreed, noting, “I think people are more aware and in-tune with their cognitive health, especially since the pandemic.”
According to Tracy Breuning, BSc, technical advisor and education liaison (Human Health Care), ADM Protexin (Miami, FL), the World Health Organization (WHO) states that in 2030, one in six people will be 60 and older and this will create a higher need for cognitive support. Cognitive function usually peaks in the mid-20s, and then functions, such as speed of recall and working memory decline gradually until our 60s, after which more rapid decline takes place. “We all want to age as healthily as we can, continuing to take part in daily activities that give us pleasure and many of us will still be working past retirement age,” she commented. “However, with a progressive aging of the world population, it is likely we will see an increasing number of people suffer from cognitive impairment and dementias such as Alzheimer’s disease.”
As research and knowledge grow in this area, she noted, it is known that cognitive function can be influenced by modifiable lifestyle factors, such as sleep, stress, diet, exercise, alcohol consumption and cognitive training. “It is also now widely recognized that imbalances in the body related to cognitive decline likely begin years prior to the onset of symptoms,” she commented.
The surging desire to enjoy full health during older years will impact the cognitive health supplement market by helping it to grow by 7.11 percent by 2024. Another analysis for the brain health supplement market predicted an approximate 10 percent increase in market size between 2021 to 2030. Market research suggests that the increase in sales largely stems from the younger population’s concerns relating to cognitive decline. Further, pointed out Breuning, “the aging population of the U.S. and globally is likely to increase the demand for supplements targeting cognitive health.”
Hank Cheatham, vice president, Daiwa Health Development, California, cited data from Grand View Research showing that the global brain health supplements market size was valued at $7.21 billion in 2020 and is expected to expand at a compound annual growth rate (CAGR) of 8.0 percent from 2021 to 2028. Additionally, Amazon.com reported that products for brain health account for $5.9 million per month on its platform.
He observed, “Over the past year the trends in the brain health category have all been upward. Many brain-health supplements are targeted at the increasingly aging population across the globe. According to the 2019 AARP Brain Health and Dietary Supplements Survey, more than one-fourth of Americans aged 50 and above regularly take brain health supplements. The increasing brain health conditions such as dementia among aged people are fueling the application of these products.”
According to WHO data, the number of new dementia cases globally is approximately 10 million per year, or about one case diagnosed every three seconds. “This growth of brain health problems will accelerate the adoption of these supplements among the older and aging population group,” Cheatham stated.
Stacey Smith, DC, marketing and communications manager, NORAM with Gnosis by Lesaffre, Lille, France, has seen adults prioritizing their brain health more so now than in the previous few years. The 2022 IPSOS Global Health Survey showed that for the first time, mental health is now the No. 2 global health concern, replacing COVID-19. “There is a variety of individuals who are looking to support and enhance cognition, such as high-level executives, graduate program students (especially medical students), high-performance athletes and an upcoming group of serious gamers,” she described.
The link between cognitive function and stress is driving more clients to ask about protecting cognitive and memory function before any issues arise. “Cognitive health has been gaining more attention in light of increasing interest in mental health and stress management in the past several years for both older and younger adults,” observed Vanessa Pavey, ND, education scientist, Florida-based Life Extension. “A new 2022 study has caught the attention of some older adults revealing that regular use of a multivitamin can contribute to cognitive health. And for younger adults, according to a 2022 Mintel report, mental focus and concentration tend to be ongoing concerns.”
Cheryl Myers, chief of scientific affairs and education, EuroMedica, Inc., Wisconsin, believes that one of the major drivers in the interest in cognitive health is concerns about brain aging. “Whether you’re seeing clients from the Baby Boom generation wanting to keep their cognitive powers sharp, or those in Generation X who have noticed their parent’s cognitive challenges, there is a lot of curiosity about how to keep memory, focus, concentration and recall operating smoothly,” she said.
Myers added, “And the demographics may be shifting to a younger range for two basic reasons. One, people are more aware of brain issues, including problems with concentration and stress at much younger ages, and two, people want to be proactive in preserving their cognitive health and well-being for healthier aging. There’s a real interest in stretching our mental abilities, whatever the ultimate goal; promotion at work, more creativity or being more mentally ‘on’ to stay out and be more social.”
The product category of nootropics aligns well with the desire for healthy brain aging; and the number of nootropic products—supplements, beverages and foods—is growing rapidly. But, observed Celine Torres-Moon, science writer, Protocol For Life Balance, Illinois, more recently, nootropics have become more of a “catch-all” category with divergent products having very different mechanisms of action. It is sometimes difficult for patients to sift through products that are more marketing hype and products that have a real effect on the preservation of cognitive function. “I think this is where practitioners can make a difference and guide their clients toward products with real effects on cognitive function,” she commented.
Shifts in Thinking
Supporting healthy cognitive activity, brain structure and mental balance is an endeavor that may be based on several more recent advancements in understanding of neurological and neurochemical pathways.
Although no longer a new area, the gut-brain-axis is gaining more researchers who are exploring and identifying how it works. Keenan commented, “The evolution of understanding the importance of the gut-brain microbiome connection continues to excite as the evidence grows and compounds.” There is more evidence linking impact of specific strains on the gut-brain-axis.
“Recent studies have demonstrated a clear association between changes in the gut microbiota and cognitive behavior, with gut inflammation identified as a possible factor in cognitive deterioration and dementia,” Breuning elaborated. Using live bacteria as a potential way to modulate cognitive health including learning and memory, is therefore a hot topic of research. For example, she pointed out, in a clinical trial, 12 weeks of supplementation with a multi-strain probiotic supplement was shown to positively affect cognitive function and metabolic status in patients with Alzheimer’s disease. Promising research in other neurodegenerative conditions that can affect cognitive function, such as Parkinson’s disease, is also emerging.
Myers has seen a clear shift in balance from a “chemistry-only model of cognitive health, that is, a ‘chemical imbalance’ being primarily responsible for behavioral or cognitive conditions to an awareness of inflammation and oxidative stress and how that affects health across body and mind systems—that our diets are intricately tied to our mental states and that even our gut bacteria can partially determine states of mind and cognitive performance. “We’re much closer to a holistic model in terms of what makes the mind work the way it does, and I see that as a real advancement.”
The Brain Gauge, a brain health assessment tool that utilizes the documented relationship between the sensory nerves in the fingers and the projection of those nerves to corresponding regions in the brain, is technology that Cheatham believes is a significant advancement in the area of brain health and cognitive activity. The Brain Gauge is similar to a computer mouse and uses fingertip vibration patterns to assess cortical function to gain more sensitive and specific detection of compromised neural function.
He explained that the tool is controlled by a software application that guides the study participant through a series of questions that increase in difficulty with each correct answer. During testing, the study participant is asked numerous questions about the vibrations they feel: “Which was stronger?” “Which was longer?” “Which came first?”
After the participant has completed testing, results are displayed in six different categories: Speed (how quickly the brain reacts to stimuli), Focus (the brain’s ability to concentrate on the task at hand), Fatigue (how quickly does the brain tire under stress), Accuracy (the brain’s ability to make small distinctions), Plasticity (the brain’s ability to adapt to change), Sequencing (the brain’s ability to identify the order of events) and Connectivity (the brain’s ability to communicate and to coordinate); and an overall metric. Green bars indicate normal performance and red, orange and yellow bars indicate different levels of cognitive impairment.
A small pilot project has recently begun to evaluate cognitive function improvement among participants taking Daiwa Brain Health powered by HSOP using the Brain Gauge device. The purpose of this project was to determine if Hokkaido Scallop Oil Plasmalogen, (HSOP) under the brand name of Daiwa Brain Health could improve Brain Gauge scores. Participants underwent the test at the start and then 12 weeks after taking one capsule twice daily of Daiwa Brain Health powered by HSOP. So far, Cheatham reported, three patients have completed the test and the results have shown significant improvement in memory and cognitive function after taking Daiwa Brain Health powered by HSOP.
Epigenetics, in Dr. Smith’s viewpoint, is an emerging field. “Evidence shows that epigenetic changes can affect cognitive functions. Some recent studies have highlighted how epigenetic age is a relatively stable biomarker with strong long-term predictive performance for cognitive function,” he said.
Another interesting space Dr. Smith said is relevant for natural practitioners working with clients in the brain/cognitive area is Cognitive Psychology Research Topics. “This deals with how culture is changing societal norms and how that is affecting brain health, mood and cognition,” he described. “From our perspective, this is important because we can tie in lifestyle and nutritional supplement recommendations in attempts to support neurotransmitter balance as a root cause approach.”
Products to Think About
The great news here is that younger adults are seriously considering supporting their cognitive functions and overall brain health—and it isn’t just fear of aging into dementia. It’s about optimal daily performance—making this category of products relevant for just about all your consultations and guidance. Farlong Nutraceutical’s Lifeflower Breviscapine is an active flavonoid extracted from Erigeron breviscapus, containing more than 90 percent of scutellarin. According to Struve, scutellarin has been shown to enhance memory, cognitive function and brain health; increase brain circulation—and support healthy development of new blood vessels.
A recent 90-day double blind, randomized, placebo-controlled, parallel study sought to determine the efficacy Lifeflower Breviscapine on improving long and short-term memory, concentration, and clarity of thinking in 160 healthy individuals who consumed either placebo, 100 mg, 200 mg or 400 mg of the supplement. According to Struve, the researchers found that the most significant positive impacts were seen in the MEM Trax cognitive thinking tests—a psychological test that measures a person’s cognitive abilities and intellectual potential. Participants also experienced positive changes in their Mini-Mental Status Exam (MMSE), a cognitive screening tool that provides an objective measure of cognitive function; and during their Montreal Cognitive Assessment (MoCA), a questionnaire that helps health care professionals detect cognitive impairments early on.
EuroMedica has several supplements targeted toward brain health and cognitive support. Its HRG80 red ginseng, available as Red Ginseng Energy (capsules and chewables) is suited “for staying on task during long afternoons at work,” Myers commented.
A clinical study of individuals who were regularly overloaded with cognitive tasks and heavy demands found that those taking HRG80 increased scores in a standardized, timed d2 Test of Attention, which assessed their ability to focus and concentrate. The score of the HRG80 red ginseng group jumped to five points above baseline, with positive results starting on the first day, Myers reported. “This red ginseng continued to support attention and focus into the afternoon hours, as well. By contrast, the d2 accuracy rate fell 11 points below the original baseline level in the placebo group.”
In another clinical study, HRG80 red ginseng helped restore mental focus and physical vitality to individuals reporting anxiety, exhaustion, brain fog and an inability to concentrate due to already-existing fibromyalgia, chronic fatigue syndrome and post-viral fatigue. Among the 60 percent of participants who noted improvements, four major categories stand out: a 67 percent average boost in energy, a 48 percent average increase in mental clarity, 46 percent average improvement in restful sleep, and a 72 percent increase in stamina.
EuroMedica’s CuraPro featuring BCM-95 curcumin is available in two strengths: CuraPro 375 mg that contains 250 mg of curcuminoids per soft gel, and CuraPro 750 mg, generally a preferred choice of practitioners because it contains 500 mg of curcuminoids per soft gel, according to the company. In experimental models of Alzheimer’s disease, BCM-95 curcumin reduced beta amyloid levels and shrank the size of accumulated plaques by more than 3 percent. “Other studies have shown that curcumin plays a role in regenerating neurons, creating new brain cells, and refreshing cells that may have once been considered irretrievable,” Myers said.
Ayush’ Ayu-Dep is a saffron supplement that Keenan said supports healthy mood and focus. Ayu-Phos phosphatidyl serine has been shown to support the brain, healthy focus and attention. Bacopa Plus features Bacopa monnieri, which supports mental clarity, metabolism and energy. “Paired with more balancing and energizing herbs, this formula is great for the overworked individual seeking the ability to focus and get the job done,” Keenan commented.
Protocol For Life Balance also has several brain-support products in its catalog, such as GABA 750 mg, B complex Neuro Factors, Magtein magnesium L-threonate, Phosphotidylserine 300 mg, Cogumin SLCP 400 mg, PQQ 40 mg Pyrroloquinoline quinone, Mucuna Extract 400 mg, Ginkgo Biloba 120 mg, and Brain Regain featuring Ginkgo biloba, RoseOx and huperzine.
Life Extension’s Brain Fog Relief, Dr. Pavey described, “is a nootropic formula that combines a polyphenol-rich mango leaf extract with standardized peppermint oil for a fast-acting, caffeine-free way to tackle mental fatigue.” Brain Fog Relief provides 300 mg of mango leaf extract standardized to 60 percent mangiferin and 90 mg of peppermint essential oil standardized to 60 percent monoterpenes. Mangiferin works by inhibiting inflammation to promote brain health and supports healthy levels of dopamine and norepinephrine. A study showed that monoterpene-rich peppermint essential oil supported mental stamina and improved attention and working memory in healthy adults. Monoterpenes support neurotransmitters such as GABA and acetylcholine.
Life Extension’s Neuro-Mag L-threonate magnesium is a form of magnesium that has been shown to be better absorbed into the brain, according to Dr. Pavey. In a randomized placebo-controlled trial in 44 adults aged 50-70, the group consuming 1.5 to 2 grams of magnesium L-threonate showed markedly improved cognitive and executive function in just 12 weeks, she reported.
Cognitex Elite Pregnenolone is “our most comprehensive brain health formula,” she noted. Pregnenolone helps modulate brain plasticity to support healthy cognitive function, attention, memory performance and mood. Cognitex Elite also includes phosphatidylserine, an essential part of healthy cell membranes and a whole-food wild blueberry complex rich in antioxidants to help inhibit age-related decline in cognitive and motor function. Also included is the periwinkle alkaloid, vinpocetine, which has been shown in several clinical trials to support healthy brain blood flow, memory and overall cognitive function; ashwagandha for promoting stress resilience and mental performance; and a novel type of sage extract that has been clinically studied to encourage cognitive function by promoting healthy levels of the neurotransmitter acetylcholine.
Daiwa Brain Health powered by HSOP supports brain health by enhancing memory and cognitive function. Hokkaido Scallop Oil Plasmalogen (HSOP) is the active ingredient in Daiwa Brain Health. “Plasmalogens are a type of phospholipid present in almost all human tissues and are most abundant in the brain and the heart,” explained Cheatham. “They are essential for their critical role in memory, focus and other cognitive functions. Hokkaido Scallop Oil Plasmalogen (HSOP) is an innovative, unique, science-based antioxidant that has efficacy in enhancing memory, improving cognitive function, and promoting anti-aging properties.”
Daiwa Brain Health powered by HSOP can be recommended to enhance brain health, sharpen cognitive function and improve memory. In a multicenter, randomized, double-blind, placebo-controlled trial, those who consumed 1 mg day of HSOP showed statistically significantly improved memory using the Wechsler Memory Scale.
Gnosis by Lesaffre’s Adonat premium s-adenoysl methionine (SAMe) plays a critical role in the synthesis of DNA, neurotransmitters, phospholipids, and myelin, explained Dr. Smith. “Lifestyle and aging can deplete the body’s production of SAMe, contributing to various imbalances in brain functionality, so supplementation may be beneficial.”
Because of its methyl donation activity, Dr. Smith noted, SAMe can sustain cognitive functions on three different levels: maintaining adequate levels of phosphatidylcholine,* impacting memory, learning, attention, neutralizing free radicals and working as an epigenetic modulator, supporting DNA methylation, which plays a key gene regulatory role in brain development, protection and functions.
“Brain dysfunctions and cognitive impairments are also connected with the rise of homocysteine, a sulfur-containing amino acid generated by the metabolism of methionine, the precursor of SAMe,” she explained. “Increased levels of homocysteine are recognized as cardiovascular risk factor, damaging vascular structures also in the brain. Indeed, hyperhomocysteinemia has been identified as a risk factor for a multitude of conditions, including cognitive decline and Alzheimer dementia.”
High levels of homocysteine are often present with low levels of SAMe, Dr. Smith continued. High homocysteine levels are often the result of poor conversion of homocysteine to methionine, which is a precursor of SAMe. Consequently, SAMe is usually depleted as homocysteine accumulates.
Another critical ingredient for cognitive health and function is folate, in the form of the biologically active 5-MTHF (Quatrefolic from Gnosis by Lesaffre). In 2016, researchers investigated the efficacy of Quatrefolic (400 mcg of Quatrefolic pulus B6 and B12) in lowering homocysteine serum levels (HCys) versus conventional vitamin supplementation with highly dosed folic acid (5 mg/day), in hypertensive subjects at low cardiovascular risk (104 patients with HCys ≥ 15 µmol/l). The result shows significant HCys reduction in comparison with baseline from 21.5 µmol/l to 10.0 µmol/l with the product containing Quatrefolic. The treatment was significantly effective and the ideal HCys level was reached in 55.8 percent of cases in the Quatrefolic group, and it was significantly higher than in controls.
ADM Protexin’s Bio-Kult Mind contains the live bacteria strain Bacillus subtilis PXN 21, bioavailable flavonoids from grape and wild blueberry extracts, and zinc, which contributes to normal cognitive function and the protection of cells from oxidative stress.
In a study of younger adults and students, researchers found an improvement in working memory and attention during a sustained cognitive exercise after taking an extract of polyphenol-rich grape and blueberry, which is the rationale to be included within Bio-Kult Mind, according to Breuning.
There is no shortage of supplements to recommend for all aspects of brain and cognitive performance, and no shortage of reasons to recommend them!
Healthy Take Aways
• The World Health Organization (WHO) states that in 2030 one in six people will be 60 and older and this will create a higher need for cognitive support.
• Cognitive function can be influenced by modifiable lifestyle factors, such as sleep, stress, diet, exercise, alcohol consumption and cognitive training.
• The number of new dementia cases globally is approximately 10 million per year, or about one case diagnosed every three seconds.
For More Information:
ADM Protexin, www.protexin.com
Ayush Herbs, www.ayush.com
Daiwa Health Development, www.dhdmed.com
EuroMedica Inc., www.euromedicausa.com
Farlong Nutraceutical, https://farlong.com/
Gnosis by Lesaffre, www.gnosisbylesaffre.com
Life Extension, www.lifeextension.com
Protocol For Life Balance, www.protocolforlifebalance.com