What supplements are best for brain health? (Better Brain Fitness)


[00:00:00] Welcome to Better Brain Fitness, hosted by doctors Josh Turknett and Tommy Wood. In this podcast, we will explore the frontiers of how to keep our brain fit and healthy so that we can perform at our best and do the things we love for as long as possible. Let’s go.

All right. Welcome to another episode of the Better Brain Fitness Podcast. With me again today is my co-host, Dr. Tommy Wood. How’s it going, Tommy?

Hello. I’m glad to be here. Gonna talk about some of my favorite things this morning, so excited about that. Awesome. I can’t wait.

So as you guys know the main format for this show is us trying our best to answer your questions.

So if you have one for us or if one pops into your mind as you’re listening, send it our way. There is a link in the show description for you to do so, or you can go directly to brainjo.academy/question .

Okay. Tommy is fielding today’s question and Tommy, what is our question for the day?

So, we have a text question from John who asks, “are the advertised vitamins effective in maintaining brain health?”

For those of you who don’t understand my British accent, he means vitamins. Vitamins, and because John hasn’t mentioned any specific vitamins I’m going to take a stab at maybe what’s sort of commonly out there and talk a little bit around why they may be beneficial and some of the evidence for that.

So there’s three main things that I’m gonna talk. Technically, not all of them are vitamins, but I think they’re sort of come together in this important mechanism in terms of supporting brain health and, and growth and function.

So the three main things that I’m gonna talk about initially are omega-3 fatty acids, B vitamins, and Choline. And to sort of prepare for each of those, omega-3 fatty acids are long chain polyunsaturated fatty acids. Probably people know of them from things like seafood. That’s where you’ll typically get them.

And you can obviously get them in fish or in tablets. And the one that’s maybe most important directly because it accumulates in the brain during development and later in life it’s very critical for the membranes, sort of the wrappers around the cells in the brain is DHA, or Docosahexaenoic Acid.

And DHA is specifically concentrated into the synapses of neurons as well as into the membranes of mitochondria, which are the sort of the powerhouse of the cell we like to think of. So critically important.

The other long chain omega three fatty acid EPA, Eicosapentaenoic acid is maybe less directly involved in the cell structure in the brain, but it’s really important for vascular health, and what we talked about previously, one of the critical components of supplying nutrients to the brain is having healthy blood vessels.

And so that’s probably where EPA has its biggest effect.

So that’s kind of the fatty acid part. And then the next part is B vitamins.

So these are probably the vitamins that most people have, have mostly heard of in terms of brain health. And there are a few of them that I think are important, but folate, B12, B6 and probably Riboflavin are gonna be the top four that I think are particularly important and we’ll get to why they’re important in a minute.

Then the last thing that I’m gonna talk about here is, is Choline. And you can buy that as a supplement. It’s also very abundant in eggs, in particular, as well as things like liver. And when you are trying to put your long chain omega-3 fatty acids into the membrane of a cell, they need to be attached to something and one to make something called a phospholipid. And one of those things that performs that function is Choline.

So you can’t just expose the brain to a bunch of DHA. You need to then build the structure. That allows it to be integrated into cells. And so that part of that structure is a phospholipid.

And you need something like Choline to attach, that’s part of what the fats is attached to. And then in order to attach the fats to the Choline to make your phospholipid, you need B vitamins. So all of these things come together in terms of having this really important effect on brain function and brain health.

And all of these have also been studied in one respect or another. And there’s some pretty good evidence from randomized control trials for all of these in terms of improving brain health and at least slowing cognitive decline or brain atrophy, which is the shrinking of the brain with age.

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So starting with B vitamins, and this is where I think some of the best evidence exists is some studies run by David Smith in Oxford. He ran some randomized controlled trials looking at B vitamins as an intervention in older adults, and they looked at brain atrophy. So how fast does the brain shrink with age in older individuals?

And they looked at those who are at highest risk, and the way that they determined risk was looking at something called blood homocysteine levels, it’s a cheap and easy test that anybody can get. And they particularly targeted homocysteine levels over 13, which they thought was high risk. And then they randomized people to give them these B vitamins, which then decrease homocysteine, but then also do all these other functions that I mentioned earlier.

And what they showed was if you took people with high homocysteine, which is actually quite common, and it’s an easy blood test to get, and you gave them B vitamins, the homocysteine came down and you slowed the rate of brain atrophy. And it was actually it wasn’t even a great B vitamin supplement, if I’m honest.

It was some folic acid, some B6 and some Cyanocobalamin, which is a not very good form of B12. The B vitamins you could get at any pharmacy, right? Nothing special. And even that was was beneficial. When they did sort of secondary sub-analysis of this study, what they found was that the greatest benefit was in those who had higher levels of omega-3 circulating. And they tested that again in a blood test. And so I think this kind of comes back to the fact that it’s not a single variable problem, right? You need all of these nutrients in place to interact with one another to have the final effect.

So the greatest improvement in terms of slowing brain atrophy by giving these B vitamins was in people who had adequate omega-3 status. And so that means that if you are supplementing with one, making sure that you have enough of another is probably gonna be beneficial. And again, if you’re eating some seafood, a nutrient-rich diet, you know, maybe some organ meats, things like that, which have lots of B vitamins, you’re gonna be getting all of this. You don’t even necessarily need to supplement.

Separately, other studies have have looked at giving omega 3s in individuals at risk of cognitive decline, and the results have been mixed, not gonna lie. About half of the studies show benefit about half the studies don’t.

And guess is it’s because of other nutrients that are gonna be required for these things to have an effect. But one recent study, for example, showed that in individuals with normal cognitive function, but with heart disease, and then they gave a version of omega-3 fatty acids, it was three and a half grams per day combined of EPA and DHA. They showed that in those individuals there was an improvement in cognitive function with the intervention. So that’s just one of the studies. And there were several others that show benefit, but I think having these other nutrients around is gonna be important.

And so then the final thing that I mentioned was Choline. And you can buy this as a supplement, again, as CDP-choline or citocoline. There are fancier versions of choline like Alpha-gpc. There’s less evidence for those. They’re also more expensive. Don’t worry about those. Standard choline is great.

Also, eggs are great too. You could eat a couple of eggs a day and probably get enough on average. And similarly, there are studies that have given 500 milligrams of citocoline twice a day, so a gram a day, and showed either improvements or less of a decline in cognitive function tests, things like the mini mental state exam, MMSE.

So, to kind of tie these things together, they all interact, they’re all important. They’re all available in adequate amounts from a nutrient dense diet. And you probably need enough of each for the benefit of another to have an effect. So supplementing with one when you don’t have the others is probably not gonna have much of an effect.

And that’s probably why we see a lot of variability in terms of the results of studies. And then of course, you also need to be, you know, stimulating your brain to even make these changes and improve things. Sort of the whole point of the model that we propose. So there is some evidence for the vitamins that you’ll see advertised, particularly the B vitamins, omega-3 fatty acids and choline.

Those are not technically vitamins, but they all sort of come together in terms of the same mechanism. However, you probably need to be adequate in terms of all of them, as well as, you know, do all the other things that we talk about in terms of stimulating the brain, providing adequate sleep and recovery, so that you know these growth and repair mechanisms can happen.

So any, any questions on or thoughts on any of that, Josh?

Josh: Yeah. That’s great. So my first question is, say your patient walks in the door and says I’m interested in my brain health, you know, maybe worried about my cognition a little bit, should I be supplementing with any of these things? How will you kind of think through that answer?

Tommy: Yeah, that’s a great question. And I think, in general, the way that I’ve practiced, it’s usually been sort of a high touch approach. So the easiest way for me to answer that question is to do some basic testing, and related to those supplements that we mentioned, there’s a whole bunch of blood tests that we could talk about that we won’t talk about here. But I would measure a homocysteine level and you could do something called an omega-3 index to measure the various omega-3 fatty acids that are circulating, that are in the walls of your red blood cells.

Those are the ones we measure, but they do seem to give you some idea of availability. You could also take a dietary history, and that’s gonna be important because your lifetime consumption of fish or foods that contain Omega 3s is probably gonna tell you something about how much you have available and your fat stores act as this kind of depot of omega-3 that the brain does access, and it probably accesses it during fasting, during sleep. That’s a bit hypothetical, so I won’t say I have a huge amount of evidence for that, but that’s just sort of thinking about fatty acid flux and that kind of stuff. So if you’ve eaten a lot of fish historically, you probably have a lot stored in your body, it’s unlikely that you need to supplement with with omega-3. But again, you’re gonna get a better answer if you test.

Similarly, we can ask about other foods that you eat that may have a good amount of B vitamins, choline. Are you eating eggs, organ meats? You know, we all talk about fish and meat, leafy greens, which have some of those B vitamins, things like that sort of whole, nutrient dense foods. And if you’re doing that, then again, it’s unlikely that you’ll need to supplement. But I think that as we sort of get to the real sort of pointy end of trying to improve this process as much as possible, I would still just test.

So a couple of simple blood tests will maybe get us most of the answer that we want, and then based on those, we may recommend supplementation. What’s good I think about all of those nutrients that we talked about is that if you’re really sort of like a belt and braces type of person, there are things that you can supplement with, with very low risk, and maybe there’s some benefit. And those are the kinds of things that I like to recommend because taking some fish oil, if you don’t need it, the worst thing that you’ve wasted is money. And like, that’s an important thing. Like, of course you shouldn’t take something if it’s not gonna be beneficial.

But some people would just prefer to cover all their bases. And I think that’s fine. That’s fine too. So it would kind of depend on the individual. Some people I’ve worked with have said to me, if I have to take a supplement, I want maybe like one.

And so then you might use those other things, blood tests, a history to kind of figure out where’s my biggest bank for my buck? And often it may be no supplements at all. That would be the ideal. If you get everything from your diet, that would of course be the thing that I’d prefer.

But sometimes, you know, people with very high levels of homocysteine or whatever reason there are, omega-3 index doesn’t look great, then you may choose to intervene with a supplement.

Yeah. I think broadly that’s probably one of the most important points is this is only after you’re addressing and making sure the lifestyle you don’t wanna do this at and not be doing the core lifestyle factors that are, that are most absolutely critical.

Right. And that’s probably the biggest drawback to all the attention that supplements get is because people get the sense that they’re the thing when they’re a supplement. They may be assisting this process, but if they’re not part of the core of what you’re doing to promote health.

Josh: In your view, as far as the data on these and their benefits, would you say that’s largely or entirely coming from these things correcting for a deficiency, or with any of these, do you think there’s any kind of extra effect along the lines that you might think of a pharmaceutical.

Tommy: In terms of their effect on, on the brain, I think it’s just correcting what is a functional level deficiency. I don’t think more is better here. With the omega-3 studies, some of them, when they’ve been done in individuals with heart disease and then looked at the brain.

I think at that point you may be giving doses and types of omega-3 S that are more pharmaceutical like, but we’re only really using those as examples of where, you know, omega-3 S are showing benefit. So I don’t think that more is better. I don’t think we are, we’re thinking about drug type doses.

If you are trying to overcome a deficit, maybe you start with some supplements to make up some of that gap to begin with, but then hopefully you get to a point where you are sufficient and then you could maintain it with diet. That would be an ideal strategy. .

Josh: Yeah. Great. I think the other key takeaway, which you talked about is to remember that context is everything, right?

These things only exist in the context of everything else that’s around them. Mm-hmm. To the extent that they’re sort of facilitating the whole system working better, they’re useful. But they’re not working in isolation, right? No silver bullets.

So you always have to be thinking of them in the context of everything. Just like we talked about, you can’t just eat a bunch of protein and expect your muscles to grow. You’ve gotta put some demand there. It’s the same thing with all of this stuff. So you can’t just shove in something and expect results. You have to make sure that it’s in the context of everything else that you’re doing.

Tommy: So I imagine a lot of tension has come up, maybe even with some of the listeners. They’ll, they’ll have heard somebody say, well, this study shows that taking these omega-3s or taking these B vitamins or taking this choline doesn’t improve brain functions, therefore it’s not worth your time and money.

And I think if you zoom out and think about the whole bigger picture, of course, if you’re not changing anything else, it’s very unlikely that one supplement is gonna have much of an effect. But if you create an environment that supports growth and repair, and you make sure there are adequate nutrients around which may or may not require some supplements, then the likelihood that you’ll see benefit is, is much, much higher.

So thinking about in this, in the context of everything else is really that critical determining factor.

Yeah. Whether you have stimulation in the equation is probably gonna be a huge factor as we’ve talked about in what type of effect you’re gonna see with any of this stuff.

Great. Well, part of the reason I do this podcast, it gives me an excuse to pick Tommy’s brain on things that I’m really interested in hearing his opinion on, and I don’t think there’s anybody better to talk about those, those sorts of things than him. So, you’re lucky listeners.

All right.

Thank you for that question John in Maine. Once again, if you have any questions for us, please feel free to submit them. There’s a link in our show notes or you can go directly to brainjo.academy/questions.

That is it for today, and we hope to see you all in the next episode. Thanks everybody. Bye-bye.

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