Despite bold promises, most brain supplements lack scientific proof — and some may even pose health risks.

From drugstore shelves to glossy online ads, brain supplements are marketed as quick fixes for memory loss, focus, and cognitive decline. Branded as “nootropics” or “memory boosters,” these pills are pitched as science-backed solutions for an aging brain. But experts reveal a very different picture, one of limited evidence, misleading marketing, and sometimes real safety risks.

Neurologist Joanna Hellmuth, who studies Alzheimer’s and dementia at UCSF, underscores a fundamental problem: The supplement industry operates under looser regulations than prescription drugs. This allows companies to make bold claims without the burden of proving them, she told Being Patient.

“Supplement manufacturers are legally allowed to make misleading claims that may not have the greatest degree of scientific integrity,” she said.

This legal gap means products can be sold with impressive-sounding promises like “supports brain health” or “clinically shown to improve memory,” even when the evidence is slim or nonexistent.

Are supplements doing what they say on the label?

Galantamine, a drug prescribed by neurologists for mild to moderate Alzheimer’s disease, has also gained traction in the world of nootropics, where it’s sold over the counter as a “brain-boosting” supplement. But research findings highlight the potential dangers of these over the counter supplements. 

One study compared 11 different FDA-approved generic galantamine prescriptions with 10 over-the-counter brands of galantamine supplement. While the prescription drugs passed all quality checks, nearly all the supplements failed. 

“Ninety percent, or nine out of the 10 brands, had an inaccurate amount of galantamine on the label,” said Dr. Pieter Cohen, neurologist at Cambridge Health Alliance and the study’s lead author. Even more alarming: “Disturbingly, 30 percent — three out of 10 brands — were also contaminated with bacteria that could, if consumed at higher levels, cause diarrheal illnesses,” he added.

The findings underscore a troubling gap in regulation between prescription drugs and dietary supplements. 

“Our study raises a troubling question: Are the laws regulating dietary supplements in the U.S. adequate to ensure the quality of the many active drugs sold directly to U.S. consumers as supplements? We think not,” Cohen said. For those considering galantamine, the safest option remains the prescribed route through a doctor, until supplement laws change.

Why supplements carry risks

Sometimes the issue isn’t just that supplements don’t work. Worse, they can be unsafe. One study on brain health supplements found some products contained illicit pharmaceutical compounds, according to internist Pieter Cohen, an author on that study and an associate professor at Harvard Medical school.

“Consumers need to avoid this whole category of brain-boosting supplements for two reasons,” Dr. Cohen told Being Patient. “Number one, I’m not aware of any supplement ingredients that’s legal [and] can improve memory and cognitive functions. The second thing is that they may contain potent pharmaceutical drugs that are not approved for use in the United States.” 

These unlisted ingredients can interact with prescription drugs or pose serious health risks, particularly for older adults.

One supplement that has drawn specific scrutiny is serine, an amino acid naturally produced in the body and once celebrated for its promise in animal studies. A 2022 study found that people with Alzheimer’s had higher levels of the enzyme that produces serine, PHGDH, a finding that flips the original theory on its head.

“Anyone looking to recommend or take serine to mitigate Alzheimer’s symptoms should exercise caution,” Riccardo Calandrelli, another author of that study said in a news release.

What about vitamin supplements?

Scrutiny of the so-called “natural” supplements like ginkgo biloba, ginseng, saffron, and vitamins B, D, and E has found a similar pattern. 

Early research often shows intriguing results, but larger, better-quality studies typically fail to replicate those findings. Fish oil is a good example: while diets rich in fatty fish are linked to better cognitive health, isolated fish oil supplements have not been shown to provide the same benefit. 

Ginseng has only been tested in a handful of small Alzheimer’s trials with no clear preventive or treatment effect. Saffron, too, has produced modest improvements in small studies but is far from clinically proven. And while certain vitamins are essential for overall health, research hasn’t shown that supplementing them improves memory or prevents dementia unless a person is deficient.

The marketing of specific brands illustrates the industry’s gray areas. Prevagen, a supplement containing apoaequorin (a protein originally derived from jellyfish), claims to improve memory and support brain health. The company behind Prevagen has been sued by the Federal Trade Commission and state attorneys general over allegedly deceptive advertising, though it continues to sell the product widely. 

Similarly, Neuriva, a popular supplement from Reckitt Benckiser, markets itself as “clinically proven” to support brain performance, based on two ingredients: coffee fruit extract and phosphatidylserine. But those studies were small, often involved unrelated health conditions, and did not directly test Neuriva as a product. The company settled a false advertising class-action lawsuit in 2021, agreeing to change its labeling and marketing to avoid overstating the science. 

For consumers, the financial stakes are not trivial. Many older adults spend $20 to $60 a month on brain supplements. Neurologist Steven DeKosky put it bluntly: “A recent study found that a quarter of adults over 50 take a supplement for brain-related health. But that same study, done by experts convened by the AARP, suggests that seniors should spend their money elsewhere. The supplements don’t work.” 

If supplements fall short, what does the evidence actually support? Across its coverage, Being Patient’s interviews with neurologists, nutritionists, and researchers point to the same conclusion: the best investment for brain health is in lifestyle, not pills.  As vascular neurologist and neuroscientist Dr. Jason Hinman told Being Patient, “About 40 percent of all cases of dementia are due to modifiable risk factors.” 

Regular physical activity, a balanced diet rich in fruits, vegetables, and healthy fats, good sleep, mental stimulation, social connection, and managing chronic conditions like high blood pressure and diabetes are the habits that appear to be associated with lower dementia risk.

Research has yet to prove that when it comes to brain health, there is no magic bullet in a bottle. While the marketing of products like Prevagen and Neuriva can be misleading, the science simply doesn’t live up to the hype. And in some cases, like serine or contaminated supplements, the risks may outweigh any potential benefit.