Focus, Please! Part Three of a Four-Part Series on Brain Health

These brain-support nutrients are sure to grab the attention of you and your customers.

Hey! Over here! You were about to read this article on natural supplements that support attention and focus, remember? Like every other aspect of cognitive performance, the ability to maintain concentration and perform complex mental tasks is based upon certain structures and chemicals in the brain.Each of these components depends, in turn, on specific nutrients. The following information will help you get a handle on how this works by giving you the lowdown on these brain support substances and the research that backs them. Let’s get started, before I lose you again…

The Science of Paying Attention
Higher cognitive functions are only possible once we decide to focus on something, and are then successful in achieving that focus. Whether it’s hitting a tennis ball, solving a math problem or keeping up with a conversation, if the brain doesn’t have the foundation it needs to hone in on something, the other mental processes that follow can’t get down to work. As the most complex and important organ in the body, the brain needs a vast array of nutrients to lay this foundation and perform its functions.

The neurological and structural underpinnings of our ability to focus are but little understood. Yet, the results of thousands of studies attest to a causal relationship between improved cognition and certain nutrients that are available in supplement form.

We’ll touch here on several of the most important nutrients for keeping alert and focused. Some of these are basic nutrients that we need for different purposes throughout our physiology, such as amino acids. Others are various less-essential substances and extracts that have been found to support brain health. Then, there is a select group of chemical compounds that could be collectively called the star players of the brain support arena. These are nutrients with proven capacities to benefit cognitive performance, and more evidence mounting in their favor each year.

Before discussing these nutrients in depth, it is helpful to note the two recurring demographics in most studies on attention and focus: the elderly experiencing cognitive decline, and children diagnosed with the attention disorders ADD (attention deficit disorder) and ADHD (attention deficit hyperactivity disorder).

Now, leading off for this class of compounds with special brain-support qualities is phosphatidylserine (PS). In one study, a combination of PS with the omega-3 fatty acid EPA improved ADHD symptoms in children eight through 13, according to Sigalit Zchut, Ph.D., director of R&D for the division of bio-active ingredients, Enzymotec, Ltd., Morristown, NJ. PS, a phospholipid necessary for the makeup of cell membranes, was used as a carrier of EPA into the brain and created significant improvements in the test subjects over placebo and other carriers. We will touch more on the significance of omega-3s for brain health later.

The 80 children in this study were supplemented with 300 mg of the combination in a double-blind, random manner. Like many other similar trials, benefits were demonstrated through improved scores on a relevant test of cognitive ability. In this case, the children scored higher on the Test of Variables of Attention (TOVA) after three months (1). Zchut describes this test as an objective, computerized measure, employing a “game-like” scenario to test responses to auditory and visual signals.

In addition to PS, Chase Hagerman, business development and marketing manager for Chemi Nutra, White Bear Lake, MN, says that the compound alpha-glycerylphosphorylcholine (A-GPC) can help individuals to focus better. A-GPC is a choline compound found naturally in the brain, and is a precursor to the important neurotransmitter acetylcholine. “There is evidence supporting A-GPC’s ability to support individuals with head trauma,” says Hagerman. A study performed by the department of psychiatry at the University of Trieste, Italy showed A-GPC to be well tolerated, and to improve various cognitive measurements in these individuals (2).

In a study of elderly men and women with memory complaints, A-GPC was the lead ingredient in a branded capsule blend (Cognitex from Life Extension, USA) that proved to benefit cognitive function (3). “The results suggest a significant improvement in parameters of both sustained attention and focused attention following six weeks of supplementation, as well as other parameters of memory,” Zchut says.

Jonny Bowden, Ph.D., CNS, scientific advisory board member for Barlean’s, Ferndale, WA, points out that numerous studies show consistent cognitive benefits from supplementation with acetyl-l-carnitine (a neuroprotective antioxidant), PS and A-GPC in various combinations.

The protection that all antioxidants afford is an important consideration for clients trying to support brain health. “Research indicates that antioxidants can provide benefits for neurological health and cellular production,” says Dave Barton, director of education for Enzymedica, Port Charlotte, FL. According to Barton, one proprietary blend of antioxidants, active botanicals and enzymes (MemoryCell) has also been shown to support memory, as well as overall brain function.

The general decline in focus and memory that can coincide with aging may seem inevitable. But, it can be abated with the use of substances with high antioxidant activity like astaxanthin, according to Bob Capelli, vice president of sales and marketing for Nutrex-Hawaii, Kailua-Kona, HI. He explains how research has demonstrated these benefits, stating, “For example, there have been several studies indicating that supplements such as astaxanthin and spirulina can help prevent neuro-degeneration and dementia commonly caused by aging.”

According to a recent seminar conducted by Parris Kidd, Ph.D., two additional nutrients that are primed to push to the forefront as brain support supplements are 5,10-Methylenetetrahydrofolate (MTHF) and S-Adenosylmethionine (SAMe) (4). MTHF levels have been linked to the efficiency with which neurotransmitters are transmitted, and it therefore holds promise for individuals with dementia, and for supporting focus.

Perhaps more well known is SAMe, a compound that is chemically active in the process of methyl transfer. Methyl, according to Kidd, is an important component in the functioning and growth of neurological structures. Among these isolated nutrients with potential benefits for attention, Kidd also cited astaxanthin, describing it as an antioxidant carotenoid that is naturally present in many life forms.

In a double-blind, placebo-controlled study using an extract of French maritime pine bark (Pycnogenol), 101 Australian seniors showed signs of significantly improved memory (5). Further research is underway to help pin down the physiological basis for these cognitive benefits, according to Frank Schönlau, Ph.D., director of scientific communications for Horphag Research, global distributor of the ingredient and Natural Health Science, Hoboken, NJ, North American distributor.

In an article by Joseph Maroon, M.D., and Jeff Bost, PAC, on the subject of preventing dementia through supplementation, research is cited that links resveratrol intake to improved cerebral blood flow (CBF) (6). Resveratrol is a polyphenol compound found in chocolate and the skins of red grapes, among other natural sources.

A recent study conducted in England studied CBF after supplementation with 250 or 500 mg of resveratrol. While subjects completed assigned cognitive tasks, changes in oxygen levels in their brains, an indicator of CBF, were closely monitored. A dose-dependent increase in CBF was found during the cognitive tests (7). The article points out that reduced cranial blood flow has been associated with difficulty processing information, as well as risk of stroke and poor memory.

Omega-3 fatty acids have a well-established role to play in a healthy brain. They are also essential nutrients that we need for overall bodily health. They, therefore, straddle the line between baseline nutrients and the brain health superstars just described. High levels of omega-3s are associated with more efficient neurotransmitter activity. On the flip side of the coin, “Low levels of omega-3s are linked to lower levels of IQ, attention and focus problems, behavioral acting out, and even visual acuity,” Bowden says.

Omega-3 deficiency can lead to stiffness in cell membranes, restricting the flow of information much like what happens with a sluggish computer, according to Bowden. “You can think of the 100 billion or so neurons wired up in your brain like a very fast desktop; but when it gets ‘clogged up’ with spyware and viruses or tons of open programs, it runs slow like molasses,” he says.

Of the various types of omega-3s, DHA has by far the largest and most important presence in the brain. “The brain is 60% fat, with a good portion of it being DHA. Without this essential fatty acid, the brain simply does not have proper nutrition to stay focused,” says Keri Marshall, M.S., N.D., chief medical officer for Nordic Naturals, Watsonville, CA. In fact, the benefits of supplementing with DHA have been found to begin before the brain is even fully developed.

In a recent study published in the Journal of Pediatrics, breastfeeding mothers received capsules of high-DHA algal oil (200 mg) or a placebo of vegetable oil from delivery until the children were four months old (8). “At five years of age, the children whose mothers received algal DHA supplementation performed significantly better on the Sustained Attention Subscale of the Leiter International Performance Scale,” says Andrea Martin, manager of brand public relations at Martek, Columbia, MD, a division of DSM Nutritional Products, Parsippany, NJ.

Kathy Birkner, CRNA, Ph.D., CNC, general manager of Pain and Stress Center, San Antonio, TX, emphasizes an important aspect of omega-3 intake, and that is balance. Individuals need to remain cognizant, she says, of the ratio of omega-6 fatty acids to omega-3s in their body. Western diets are typically far out of proportion in this regard, and this discrepancy is believed to be a cause of inflammation in the brain, one culprit behind cognitive decline.

Receiving a full complement of essential and non-essential amino acids is a key contributor to brain health. Tryptophan is a biochemical precursor to the neurotransmitter serotonin, for instance, while tyrosine is a precursor of the neurotransmitter dopamine. “Consuming sufficient amino acids on a daily basis enhances sustenance of attention and focus,” Birkner states.

Deficiency in this area is a problem many people often face without knowing it, and it can especially be a problem for children, whose bodies have not yet developed an ability to synthesize enough amino acids on their own. “Many people, if not most, do not obtain enough amino acids on a daily basis through typical diets. In fact, one disorder associated with amino acid imbalances is ADD/ADHD,” says Birkner.

Most people would agree that eating chocolate makes one feel good, and now it appears that one of the components of the cocoa bean may have concrete benefits for the brain. “New research on cocoa flavanols indicates that these potent polyphenol compounds help increase nitric oxide and improve circulation and blood flow to the brain,” says Rob Maru, vice president of innovation and brand development for Reserveage Organics, LLC, Gainesville, FL. A study published in October 2010 found that cocoa flavanols can improve one’s ability to sustain mental effort (9).

Extra help paying attention need not only be sought from nutrients in isolation. Individuals may find that the components of many natural herbs and fungi aid their ability to focus, as well. Lion’s Mane mushroom has undergone recent research into its potential benefits for dementia and Alzheimer’s sufferers, and for attention and focus specifically, according to Mark Kaylor, vice president of education and research for Mushroom Wisdom Inc., East Windsor, NJ (10). “A class of constituents found in the Lion’s Mane mushroom called hericenones and a fatty acid complex containing DLPE have demonstrated in animal, lab and small clinical trials the ability to not only improve attention and focus, but also memory, quality of life, balance, mood and perception in dementia,” Kaylor says.

Research trials of this type are conducted on both animals and humans. Animal tests in the context of Lion’s Mane, according to Kaylor, were performed using the Morris Water Maze test, where the ability of rats to pay attention and remember how to swim to a platform quickly is measured. Human trials, appropriately, were conducted with the use of questionnaires after supplementation. Another researched quality of this mushroom is its capacity for neuronal repair (11). Kaylor states, “One of the actions of Lion’s Mane is to stimulate Nerve Growth Factor (NGF); it would be likely that the use of it for peripheral nerve damage may be a positive use.”

Maru refers to research into the rhodiola plant that links it to qualities of fatigue-resistance and increased mental performance, particularly concentration (12). Whereas sleep deprivation is a major contributor to lack of focus on both a long-term and short-term basis, it is obviously the first order of business to start getting some rest if one wants to concentrate. “Herbs such as ashwagandha and L-theanine, an amino acid derived from green tea, have both been shown to help reduce stress and allow the body to relax,” says Maru.

There is research that supports Maru’s claim about L-theanine. In addition to published evidence that L-theanine can help one relax, additional studies indicate that it can enhance cognition and mood when taken in combination with caffeine. A recent trial examined the effects of L-theanine on brain waves in humans, and saw researchers conclude that the amino acid may help facilitate attention during difficult, long-lasting tasks (13).

There are many other herbs that have potential to improve cognition. Bowden points out that, while the actual human clinical trials may be missing for a plant like Ginkgo biloba, it nonetheless is a documented antioxidant and neuroprotectant that could confer cognitive benefits to those of any age.

The cognitive decline that is often the cause of lack of focus can be the result of many factors, and is often due to more than one. “Things that accelerate the decline include emotional trauma, alcoholism, depression, seizures, stroke, and obesity,” says Hagerman. Individuals with issues that fall into these categories are apt to benefit from cognitive-support supplements, though they should of course be addressing the root problem first and foremost, with the help of their doctor.

One group that may see non-age-related declines in mental acuity are those on statin drugs, according to Hagerman. These cholesterol-lowering pharmaceuticals are currently in use by millions of Americans, and might see even more widespread use if cholesterol standards are adjusted lower. Studies have linked their use to declines in brain function, Hagerman says, adding, “One such study, conducted recently at the University of Pittsburgh by Muldoon and colleagues, showed the after six months of statin use, patients performed poorly in tests involving complex mazes and on psychomotor and memory tests.”

Think Young
The goal in the brain health market is fixed firmly on turning back the cognitive clock; but, does the hour have to be getting late for consumers to really see a major change? “Improvement will certainly be more noticeable in older adults, since, for the most part, cognitive decline begins when individuals reach their 30s,” says Hagerman. Positive results often turn out to be more evident in older individuals, because they are recouping the cognitive skills they have already lost, Kaylor believes. “Conversely, in some cases the deterioration may be so pronounced and structural that it becomes very difficult to significantly impact,” he says.

Tempered expectations will help a client’s outlook when dealing with cognitive health supplements. “I often tell people in this situation that if we can prevent further decline, rather than a reversal, then this should be measured as success,” says Marshall. In this category, it is important to understand also that supplements are not designed only for those experiencing age-related decline or those with attention disorders. People looking to gain a mental edge in their professional setting; students looking for a safe, legal edge in their studies (contra to the epidemic of prescription drug abuse); and cognitively normal people who just want to shake away that light fog or sharpen their wits a bit are all likely candidates.

As stated previously, the majority of studies on supplements for cognitive function use the aging population as their subjects. Yet, trials catering to the above demographics do exist and many are ongoing. One recent study described by Schönlau investigated Pycnogenol’s effect on university students after eight weeks. As judged by computer-based testing systems, the mental performance of the students was significantly improved. Self-reported alertness scores were higher than in the placebo group, as well. “This pilot trial does indeed support the hopes for improving cognitive function in the young healthy population,” Schönlau says.

Cognitive decline, meanwhile, doesn’t only afflict trauma victims, those with brain diseases and the elderly. The ever-present toxicity of our environment may be a contributing factor to brain health issues at all ages. In an animal trial, young rodents were given ischemia (blocked arteries that can lead to dementia) or were given chemicals that cause brain damage, according to Capelli. Astaxanthin was found to mitigate the symptoms. “The mechanism of action was shown to be astaxanthin’s intense antioxidant activity and/or its anti-inflammatory properties. This may equate to benefits in human brains subjected to the high levels of oxidation which exist in the modern world,” he says, adding that this means clearer thinking, even for young or middle-aged people.

Zchut echoes the notion that many younger people stand to gain a lot from brain health supplements. “I believe it could particularly be beneficial for children and students that are still in school or people whose line of work requires concentration and focus,” he says.

A terrible thing to waste. We are only afforded one brain per lifetime, so young people should be looking at long-term brain health from a preventative perspective, as well. “Younger people who are at risk for cognitive decline based on family history should absolutely take between one and two grams a day of EPA and DHA in the form of fish oil, because this is the time when they can have the most impact on brain health and development,” says Marshall.

A couple of previously mentioned nutrients come recommended by Maru for preventing or slowing cognitive decline. Both PS and acetyl-l-carnitine are precursors of the neurotransmitter acetylcholine, which is often found to be lacking in the brains of those with failing cognition. Keeping levels of acetylcholine high may therefore be a way to short-circuit potential deterioration.

As with any other costly epidemic, society as a whole would do well to stem the tide of cognitive diseases occurring late in life. Call it a civic duty. “The ageing society will translate to an increasing number of people suffering from cognitive decline, with a further increasing number of people with dementia. This, in turn, will go along with medical and financial strains,” says Schönlau.

Of course, nutritional intake is not the only concern when it comes to strengthening the brain. As most everyone understands, the brain is a muscle, and can be trained to support better focus. “Many physicians and experts advise the ‘use it or lose it’ approach. Read. Learn. Get involved as a volunteer. Do puzzles. Join special interest groups,” says Birkner.

There’s more to learn. The brain presents us with a last frontier, physiologically speaking. The more science can learn about its inner workings, the more evident it will become how we can help it work from a nutritional standpoint. For instance, “More research on how to prevent amyloid plaque formation as well as what nutritional supplements may help breakdown the deposits is needed,” Maru says. In general, Kaylor compares the brain to the rest of the body’s systems. It requires balance to work properly, and is perhaps even more delicate in that regard. “Finding that right amount of stimulation and rest is key to long term functioning and memory,” he says.

Marshall only laments the limitations on how science-supported supplementation can be portrayed in marketing literature. Companies are restricted from talking about the exact mechanisms of action due to the confines of the Dietary Supplements Health and Education Act (DSHEA), she explains. Still, further knowledge of these matters that may arrive in the future is all going to benefit the consumer. States Marshall, “If we had a better understanding of how the brain works, and how specific natural products support or assist some of these biochemical pathways, supplement users could likely take fewer, but more specific natural products, and have higher therapeutic efficacy.” WF

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2. E Aguglia, et al., “Choline Alphoscerate in the Treatment of Mental Pathology Following Acute Cerebrovascular Accident,” Funct. Neurol. 8 (Suppl), 5 (1993).
3. Y. Richter, et al., ”Cognitex Supplementation in Elderly Adults with Memory Complaints: An Uncontrolled Open Label Trial,” J. Diet. Suppl. 8 (2), 158–168 (2011).
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6. Joseph C. Maroon, MD; Jeff Bost, PAC, “Dementia Prevention, The Role of Supplements.” Article Provided By Reserveage Organics.
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9. A.B. Scholey, et al., “Consumption of Cocoa Flavanols Results in Acute Improvements in Mood and Cognitive Performance During Sustained Mental Effort,” J. Psychopharmacol. 24(10), 1505-14 (2010).
10. K. Mori, et al., “Improving Effects of the Mushroom Yamabushitake (Hericium Erinaceus) on Mild Cognitive Impairment: A Double-Blind Placebo-Controlled Clinical Trial,” Phytother. Res. 23 (3), 367–372 (2009).
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13. Gomez-Ramirez, M., et al. “The effects of L-theanine on alpha-band oscillatory brain activity during a visuo-spatial attention task,” Brain Topogr. 22, 44–51 (2009).

Published in WholeFoods Magazine, August 2011