Hello,
Thanks for asking this question. I will go ahead and answer it using
objective, physician-written and peer reviewed data. If you are
looking for more information, please do so via the answer
clarification option and I will be happy to explain any of my
research.
You asked for:
“(Are there any) supplements for energy, memory, and alertness?”
Well, there is a lot of conflicting data. There are some small trials
outlined below which show some benefit. However, this is no medical
consensus guideline. I will focus solely on dietary supplements (as
you stated in your question). If you want information on prescribed
medical therapy, I will be happy to answer that in a separate
question.
1) Memory
a) Vitamin E
There have been several studies discussing supplements for memory.
Most of the studies have been in the setting of dementia (i.e. which
is manifested most frequently by memory loss). Alpha-tocopherol
(vitamin E) and selegiline (a monoamine oxidase inhibitor) have been
studied in AD because of their antioxidant properties. The most
influential but controversial trial examining disease progression in
AD is a study comparing selegiline, alpha-tocopherol, or both with
placebo (1). The primary outcome in the study was time to a combined
endpoint of death, institutionalization, loss of the ability to
perform activities of daily living, or progression to severe dementia
on a Clinical Dementia Rating scale. There was a delayed progression
to outcome in the treatment groups. Since alpha-tocopherol (vitamin E)
and selegiline did not differ in terms of efficacy and their
combination was no better than either agent alone (and in fact was
non-significantly worse), it is suggested that taking vitamine E at a
dose of 1000 IU twice daily may help symptoms of dementia (i.e.
possibly improving memory function.)
b) Ginkgo Biloba
A single placebo-controlled trial with an extract of ginkgo biloba
showed a very modest improvement on cognitive testing; 29 percent of
the patients treated for at least 26 weeks improved by four or more
points on the ADAS-Cog compared with 13 percent in the placebo group.
However, there are conflicting studies. One of the best performed
double-blind trials that investigated the use of ginkgo biloba extract
for memory enhancement did not show a beneficial effect (3). This
study randomly assigned 230 community dwelling men and women over the
age of 60 with mini-mental state examination scores greater than 26 to
receive ginkgo biloba, 40 mg three times daily (the dose recommended
by the manufacturer) or matching placebo for six weeks. There was no
improvement in memory with ginkgo treatment as measured by standard
neuropsychological tests, self-reported memory function, or global
rating by spouses, friends, and relatives. One potential criticism of
this study is that the investigators did not chemically verify the
ginkgo content of the preparation used.
c) Folate, B12 and B6
A study was performed to evaluate these supplements on memory
enhancement.
“Based on research demonstrating associations between folate, B-12 and
B-6 vitamins and cognition and mood, we investigated the effects of
short-term supplementation in 211 healthy younger, middle-aged and
older women who took either 750 microg of folate, 15 microg of vitamin
B-12, 75 mg of vitamin B-6 or a placebo daily for 35 d. In addition,
we examined associations between dietary intake of these vitamins and
cognition and mood. Usual dietary intake status was estimated using a
retrospective, self-report, quantified food frequency questionnaire.
Participants completed alternate forms of standardized tests of
cognitive processing resources, memory, executive function, verbal
ability and self-report mood measures before and after
supplementation. Supplementation had a significant positive effect on
some measures of memory performance only, and no effect on mood.
Dietary intake status was associated with speed of processing, recall
and recognition and verbal ability.” (4)
2) Fatigue (i.e. supplements to increase energy)
I looked at several supplements and interventions to combat fatigue
(in other words, increase energy).
a) Essential fatty acids
There have been some studies that suggest that essential fatty acids
have a role in increasing energy.
Two good-quality randomized controlled trials (RCTs) of essential
fatty acids reported some beneficial effects of the intervention (5,6)
and 1 also found an overall beneficial effect:
"The preparation given contained linoleic, gamma-linolenic,
eicosapentaenoic and docosahexaenoic acids and either it, or the
placebo, was given as 8 x 500 mg capsules per day over a 3-month
period. The trial was parallel in design and patients were evaluated
at entry, one month and three months. In consultation with the patient
the doctors assessed overall condition, fatigue, myalgia, dizziness,
poor concentration and depression on a 3-point scale. The essential
fatty acid composition of their red cell membrane phospholipids was
analysed at the first and last visits. At 1 month, 74% of patients on
active treatment and 23% of those on placebo assessed themselves as
improved over the baseline, with the improvement being much greater in
the former." (6)
b) Magnesium
Magnesium supplements were found to have an overall beneficial effect
in 1 good-quality RCT:
“The hypotheses that patients with chronic fatigue syndrome (CFS) have
low red blood cell magnesium and that magnesium treatment would
improve the wellbeing of such patients were tested in a case-control
study and a randomised, double-blind, placebo-controlled trial,
respectively . . . Patients treated with magnesium claimed to have
improved energy levels, better emotional state, and less pain, as
judged by changes in the Nottingham health profile.” (8)
There are many prescription medications that have been studied in
fatigue, including antidepressants, corticosteroids, and acyclovir,
however your question asks specifically for dietary supplements. I
can give you data on the medical therapies for fatigue in a separate
question if you wish.
3) Mood
a) St. John’s Wort
From UptoDate:
“The ACP-ASIM (American College of Physicians – American Society of
Internal Medicine) guidelines state that St. John's wort can be
considered for short-term treatment of mild acute depression, but
patients should be advised that treatment is not approved by the
United States Food and Drug Administration, and that preparations can
vary significantly from those used in clinical trials (9). In
addition, there are still no data regarding long-term efficacy and
safety and the optimal dose has not been determined. Based upon the
studies cited above, St. John's wort should probably not be used in
patients with significant major depression.” (10)
b) Kava Kava
“Kava kava is used to treat anxiety. Clinical trials demonstrate it to
be superior to placebo, and roughly equivalent to oxazepam 15 mg/day
or bromazepam 9 mg/day.” (11)
Again, if you are interested in prescribed medications for these
disorders, I will be happy to explain the options to you. I have
focused solely on dietary supplements.
Please use any answer clarification before rating this answer. I will
be happy to explain or expand on any issue you may have.
Thanks,
Kevin, M.D.
Internet search strategy:
No internet search engine was used in this research. All sources were
from objective physician-written and peer reviewed sources.
Bibliography:
1) Sano, M, Ernesto, C, Thomas, RG, et al. A controlled trial of
selegiline, alpha-tocopherol, or both as treatment for Alzheimer's
disease. The Alzheimer's Disease Cooperative Study [see comments]. N
Engl J Med 1997; 336:1216.
2) Le Bars, PL, Katz, MM, Berman, N, et al. A placebo-controlled,
double-blind, randomized trial of an extract of Ginkgo biloba for
dementia. North American EGb Study Group. JAMA 1997; 278:1327.
3) Solomon, PR, Adams, F, Silver, A, et al. Ginkgo for memory
enhancement: a randomized controlled trial. JAMA 2002; 288:835.
4) Bryan, et al. Short-term folate, vitamin B-12 or vitamin B-6
supplementation slightly affects memory performance but not mood in
women of various ages. Journal of Nutrition. 132(6):1345-56, 2002 Jun.
5) Behan PO, Behan WM, Horrobin D. Effect of high doses of essential
fatty acids on the postviral fatigue syndrome. Acta Neurol Scand.
1990;82:209-216.
6) Warren G, McKendrick M, Peet M. The role of essential fatty acids
in chronic fatigue syndrome: a case-controlled study of red-cell
membrane essential fatty acids (EFA) and a placebo-controlled
treatment study with high dose of EFA. Acta Neurol Scand.
1999;99:112-116. [
7) Cox IM, Campbell MJ, Dowson D. Red blood cell magnesium and chronic
fatigue syndrome. Lancet. 1991;337:757-760.
8) Stewart W, Rowse C. Supplements help ME says Kiwi study. J Altern
Complement Med. 1987;5:19-20, 22.
9) Snow, V, Lascher, S, Mottur-Pilson, C. Pharmacologic treatment of
acute major depression and dysthymia. Ann Intern Med 2000; 132:738.
10) Paulsen et al. Treatment of depression. UptoDate, 2002.
11) Cauffield, et al. Dietary supplements used in the treatment of
depression, anxiety, and sleep disorders. Lippincott's Primary Care
Practice. 3(3):290-304, 1999 May-Jun. |
