THE ART OF VOICE

Dietary supplements or, more commonly, "supplements," are products taken by mouth that contain a "dietary ingredient." 

Dietary ingredients include vitamins, minerals, amino acids, botanicals (including herbs) and enzymes, as well as other substances alone or in the combination that can be used to supplement one's diet. Supplements come in many formulations, including pills, capsules, tablets, powders, food bars and liquids. In 2018 an estimated 85 000 types of dietary-supplement products were sold in the United States alone, according to the Nutrition Business Journal, with more than $40 billion in retail sales in the United States and $121 billion worldwide. In conjunction with this report, AARP surveyed a representative sample of adults 18 and older on their use of dietary supplements.' Among adults age 50 and older, 81 percent believe that supplements are at least somewhat important for overall health. Sixty-nine percent are currently taking a dietary supplement at least three times a week. The United States Government Accountability Office (GAO) recently examined available data and found that memory supplements were a small but growing portion of the overall market for dietary supplements. In the United States, their sales nearly doubled in value from 2006 to 2015, increasing to $643 million in 2015. According to an industry forecast report, the brain-health supplements generated $3 billion in sales globally in 2016, and that figure is projected to reach $5.8 billion by 2023. Given the huge interest, folks have in maintaining and up their brain health as they age, the GCBH has little question that the employment of brain-health supplements targeted at an increasingly aging population worldwide is growing and large numbers of people are already taking them. The 2019 AARP Brain Health and Dietary Supplements Survey show that more than a quarter of Americans age 50 and older are regularly taking supplements for their brain health. Twenty-six percent of adults take at least one supplement for brain-health reasons. Among adults specifically taking dietary supplements for brain health, 21 percent report taking dietary supplements to maintain — and 20 percent report taking them to improve — their brain health. Interestingly, 11 percent report currently taking a supplement to delay the onset of dementia, and 8 percent say they take a supplement to reverse dementia. In this document, we summarize the state of the scientific evidence on whether dietary supplements currently on the market can benefit the brain health of adults, focusing primarily on those age 50 and older. We discuss a broad range of issues about supplements and cognitive health. We examined the evidence relating to vitamin and mineral supplements, focusing primarily on the eight B vitamins, and vitamins D and E. We also discussed other well-known supplement ingredients commonly marketed for brain health including: the omega-3 fatty acids docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), and alpha-linolenic acid (ALA); fish oil; medium-chain triglycerides (coconut oil); Huperzine-A; caffeine; nicotinamide riboside; phosphatidylserine; curcumin; flavonols; coenzyme Q (CoQ10); ginkgo Biloba; and apoaequorin (derived from jellyfish). These consensus statements and recommendations are based on the GCBH experts' knowledge of the field and their evaluation of the best available evidence from peer-reviewed published observational studies and randomized controlled trials in humans, as well as studies conducted in animals designed to help determine the effects of dietary supplements on brain health. The context in which dietary supplements are manufactured and sold also played an important role in the consensus and the resulting recommendations. Around the world, manufacturers are generally prohibited from selling unsafe ingredients, but we are aware of no country that regulates or evaluates dietary supplements for effectiveness before they are permitted to be sold. There is also no global consensus on how these types of products should be defined or regulated. For example, regulators consider melatonin to be a dietary supplement in the United States, a natural health product in Canada, but a prescription medicine in Australia. Regulations and government oversight of dietary 1. 2019 AARP Brain Health and Dietary Supplements Survey, fielded Jan. 30, 2019, to Feb. 7, 2019, from a nationally representative sample that included 1,747 adults age 18 and older (809 adults age 50 and older). Oversampling augmented the number of African American/Black, Hispanic/Latino and Asian adults to achieve a total sample for each group of 350, 350, and 200 adults age 18 and older, respectively. The margin Of error is  2.4 percentage points. The Real Deal on Brain Health Supplements: GCBH Recommendations on Vitamins, Minerals, and alternative Dietary Supplements two