USA supplements ‘tourism’ – the latest melatonin headlines – and a possible new pathway for Alzheimer’s

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1:55Hi, I'm Sophie and this is Age Well with Dr. Sophie Schotter, a space devoted to all things health, wellness and longevity. Because for me, ageing well is about looking and feeling like the best possible version of ourselves inside as well as out. So together with my producer Fee, I'll be deep diving into the latest research, sifting fact from fiction. I'll also be talking to all kinds of trusted experts, tapping into their knowledge, along with bringing you conversations from a range of interesting women and men, finding out how they age well. So this is my show. Welcome along. And as always, thank you so much for listening.

2:40All right.

2:41Dr Sophie Shotter:So in this age of increased focus and interest in health and longevity, there is apparently this growing trend towards supplement tourism. In particular, Aspera is picking up all kinds of nutritional and, I guess, biohacky type of supplements while over in America. So my first question is, why are so many things not available here in the UK or in the case of melatonin, for example, only available by prescription? So there are several reasons. One is that we have different regulations over here. So in the UK, we have the Medicines and Healthcare Products Regulatory Agency, which is also known as the MHRA, while in the US they have the FDA, the Food and Drug Administration.

3:23And the FDA and MHRA tend to classify things differently. So in the US, for example, many substances are classified as food supplements, meaning they have less stringent regulation, while the same substances might be classified as prescription-only medications here. Likewise, while most vitamins and minerals are available in both countries, you'll often find significantly higher dose tablets more easily in US stores simply because the UK's MHRA might cap certain levels. But on the flip side, it'll also ensure minimum levels so you can be sure you're getting what you've paid for. Generally, we're also stricter over here on health claims and the MHRA strictly regulates what claims can or can't be made about a supplement, linking them only to specific authorised ingredients, whereas the US market generally allows for broader claims.

4:11Another thing to note is that certain herbs are banned or restricted here in the UK. But while it feels as though the US market is slightly like the Wild West in terms of being less strict, there are certainly several very good quality supplements available over the counter and it's worth looking out for them if you're in the US or ordering online if you're able to.

4:29Dr Sophie Shotter:Okay, well let's talk about some of these. Shall we start with GABA? Yes, so GABA has become something of a buzzword in health and longevity. and it's something we already have in our bodies. It's short for gamma-aminobutyric acid and it's a naturally occurring amino acid that works as a calming neurotransmitter in the brain. GABA is basically our off switch so it's usually associated with sleep and relaxation but research is also finding that it has a role to play in things like epilepsy, Parkinson's, blood pressure and memory among other things. Again our bodies can make it and it can be found in certain foods such as broccoli, kale, sweet potatoes and some herbs and fermented foods.

5:11And it can also be synthesised into a supplement by again fermenting food. But this is currently banned in the UK due to concerns over the potential for misuse. It's perfectly legal, however, in the US, where you can buy supplements with various dosages ranging from 10 milligrams to 750 milligrams. Plus there are things like GABA-infused gummies and chocolate and drinks. If I was in the US, I'd probably go for something like Thorn's 100 milligram because I like Thorn's approach to third-party testing and high quality ingredients and they actually offer a few different dosages so you can customise what's right for you.

5:45Thorn uses a natural form of GABA called Pharma GABA which does have a little bit of data behind it. I also like the look of Pure Encapsulation's Liquid GABA which is made with glycine and L-C-N in and this is another brand that's really well regarded and a brand that I rate, largely because of their transparency and clean formulations without unnecessary additives. Pure Encapsulations also makes a capsule version at a higher dose of 700 milligrams, which is ideal for anyone who needs more intense support. Another brand you might recognise is Nail Supplements and over in the US they offer a 500 milligram dose.

6:21It does contain some filler ingredients like rice flour, but nothing that's harmful so it's not a bad choice for anyone on more of a budget.

6:29Dr Sophie Shotter:Okay thank you for all of that. What about DHEA supplements? This is quite buzzy too isn't it? Yeah and listeners may know that DHEA or dehydroepiandosterone is a hormone that naturally declines as we age. It's mainly produced by our adrenal glands which are located just above the kidneys. Small amounts of DHEA are also made by the ovaries, the testes and in the brain. And while it doesn't seem to have much of a function on its own, it's a vital precursor for other hormones and in particular sex hormones like oestrogen and testosterone. DHEA is also known for its thermogenic properties, which means it increases the production of heat in the body by promoting metabolism.

7:12So again, our levels of DHEA peak in our 20s, then gradually tend to decline as we age. And this decrease in DHEA has been associated with a reduction in cognition, mood and even lifespan. So over in the US, DHEA supplements are often marketed as a way to boost energy, improve mood and enhance both physical and sexual health. They have synthetic DHEA available in various forms, including tablets, capsules, powders, creams, gels. And in limited small studies, DHEA supplements have been shown to enhance skin hydration and potentially also collagen production. But when it comes to its other reputed anti-aging effects, we don't have a huge amount of evidence.

7:54Some studies do show promising results but the jury is still out on whether supplementing is a good idea. DHEA supplements are maybe safe for short term use so up to two years at doses of up to 50 milligrams daily under medical supervision but from what I've read they're not recommended for long-term use due to potential side effects. Ultimately this is a hormone and it's long-term safety as a supplement isn't well established and to be clear it's definitely not recommended for anyone who's pregnant or breastfeeding or someone with PCOS or liver problems. One interesting development though is 7-keto DHEA often just called 7-ketone and this is a molecule that's created when DHEA is broken down and unlike DHEA 7-keto is not converted into sex hormones.

8:43It can't be turned back into DHEA either but it does maintain DHEA's thermogenic properties and preliminary studies suggest that when 7-keto is taken as a supplement it can safely promote thermogenesis and might therefore support metabolism. It also has a low risk of adverse effects when taken as a tablet or capsule. Note however that if applied topically 7-keto might affect hormones in the body so for example in men we know that it can affect thyroid function cholesterol and sex hormone levels and I know she gets a lot of flack but Gwyneth Paltrow's Goop brand has created something interesting called the metabolism boosting super powder supplement with a clinically studied dose of 7-keto DHEA.

9:29It's the kind of thing you'd mix into a smoothie so this might be the kind of thing I'd personally shop for in the US if for example I felt my metabolism was running under par but otherwise I'd likely give the DHEA supplements a wide berth.

9:44Dr Sophie Shotter:Okay, let's do a couple of, I guess, more random ones. How about allulose? Yeah, so this is another interesting one. Allulose is a sugar. It's also known as D-psychose and it's quite a rare sugar because it's only naturally present in a few foods. For example, wheat, figs and molasses. It's about 70 % as sweet as table sugar and some people describe allulose as having a similar taste and texture to regular sugar. But unlike sugar, it's absorbed in the small intestine and then excreted so it doesn't cause a significant spike in your blood sugar, which is why it's become so popular with biohackers.

10:24Preliminary studies also show that consuming allulose with a meal, even one containing regular sugar, can lower your post-meal blood glucose. We think it might even improve insulin sensitivity and early research suggests that allulose has anti-inflammatory properties and could even reduce the risk of chronic disease. Although again, as always, there's not enough data. So it's less well known over here compared to the US, but it's becoming more and more popular. I'd also add that I have seen it for sale over here in the UK. Do you bear in mind, however, that it does have the potential for side effects such as bloating or gas if you eat a lot of it.

11:02Dr Sophie Shotter:Okay I will look out for that one and what about this US buzz about raw milk? Yeah so as you said this is a trend that started in the US and if the latest stats are to be believed it's still going. To give some background the vast majority of milk we drink is pasteurized so it's heat treated to kill off harmful pathogens. Raw milk on the other hand, goes straight from udder to bottle. Its fans say that this is milk as nature intended, so nutrient-rich and full of probiotics, with claims that it boosts the immune system and can even treat asthma, eczema and allergies. There are also fans of raw goat's milk as a so-called anti-parasite cleanse.

11:42But in all of this, there's no evidence to suggest that raw milk has any of these benefits. Saying that, the US government estimates that 3.2 % of people over there now drink raw milk, which is not an insignificant number in a country as big as the US. My own feeling is that pasteurisation is the norm for good reason. It's highly effective at killing things like E. coli, salmonella, campylobacter and listeria. And all of these nasties can hang around in the gut and faeces of even healthy cows. Raw milk, on the other hand, relies heavily on the skill of the farmer and the cleanliness of the operation to avoid contamination.

12:19So I do agree with one US food safety official who compared drinking raw milk to playing Russian roulette and certainly one study published said that raw milk illnesses have spiked as more people drink it. In fact some people might recall that back in 2017 two people died after eating raw milk cheese from an artisan producer and that was listeria related. So these things do happen and they're not to be underestimated which is probably why raw milk is banned in some states in America and I will also add that if you're pregnant this is definitely a trend you need to avoid so in the US unless it's banned you can buy it right off the shelf usually in a health food type grocery store but over here it's slightly different you can actually buy raw milk in England Wales and Northern Ireland but it is banned in Scotland and for the rest of the UK it's restricted to being sold from registered producers only again all in all not a trend I'm going to be looking at

13:15Dr Sophie Shotter:No, me neither. Should we talk about melatonin, including these new headlines looking at heart failure? Yes. So melatonin is a synthetic version of the exact same hormone that's naturally produced in the brain. There's hormonal darkness because it regulates our sleep-wake cycle. And unlike in the States and in many other parts of the world, it's only available in the UK on prescription. but it's been prescribed in the UK for nearly two decades and is generally seen as having a high safety record for treating short-term sleep problems in adults and under specialist supervision again for children with learning disabilities or ADHD.

13:55The news story you mentioned is a reasonably recent one so a study presented at the American Heart Association scientific meeting has now raised concerns with the suggestion that long-term users face a higher risk of heart failure but please let me stress that this is only preliminary data. It's a 300 word summary of the study that we have so far. So it does mean crucial information is unreported at the moment. So we don't know about the melatonin dosage, the insomnia severity, lifestyle factors, and the list goes on. Essentially the study only found an association, not causation, and this distinction matters.

14:34For example, maybe those prescribed the drugs suffered more severe or disruptive sleep problems. And these are symptoms that might reflect other underlying health issues, including heart problems. Remember, poor sleep is actually linked to problems with the heart, along with problems with metabolism, mental health and the immune system, among other things. So melatonin might simply be a marker of existing risk rather than the cause of it. In fact, previous studies in heart failure patients has suggested melatonin may actually protect heart health. Other researchers indicated it could ease symptoms in people with heart failure.

15:09Bear in mind as well that the study hasn't undergone peer review and information on the study's methods and results does remain limited. So while the findings are certainly newsworthy, at present they're far from conclusive.

15:23Dr Sophie Shotter:Okay, makes sense. And what do you think about melatonin more generally? I think there could be a reliance and I say that because in the US sales have doubled in recent years and NHS data indicates that prescriptions for melatonin have also seen a tenfold increase yes many studies appear to show that melatonin supplements can be helpful for restoring healthy sleep patterns and minimizing the effect of jet lag and the way that it works means that in theory you're very cleverly hacking your body clock but it's also worth saying that we're still unsure of its effects if taken long term. And the other thing is that in the States, they're classified as nutritional supplements.

16:01So they're not subject to checks and regulations. So if you end up buying either in the States or an American product online, as some people might do, you can't be certain of the exact ingredients or what else is in the ingredients list. None of this is to put people off. I'm just saying be mindful.

16:20Dr Sophie Shotter:Yeah. Okay. Good idea. Okay. Another one. Kava. What about kava? Okay, another slightly controversial one. Kava is made from the piper methisticum plant and in the South Pacific it's a popular drink that's traditionally used for indigenous ceremonies to promote relaxation. It affects the brain and other parts of the central nervous system and in supplement terms is often used for anxiety or stress. Although I should add that we don't have solid evidence to support any of this. It's also been linked to liver damage so it was in the UK in the early noughties, but was never taken off the market in the US.

16:57It's now back in the UK. And to add some balance, many academics and herbalists swear by it. I was reading a quote from Edzard Ernst, who's a professor at the University of Exeter. He said Carver is one of the better researched herbal medicines for anxiety. However, he also says that it's been implicated in causing liver damage, some of it, quote, severe. From what I can tell, Carver was implicated in 21 cases of liver damage reported in Europe, four of which resulted in transplantation and one of which resulted in death. However, in all of these cases, kava was used along with alcohol or other potentially liver damaging drugs.

17:35So it's not entirely clear how risky kava on its own actually is, which is why in 2003, the government banned the sale of it entirely. It's readily available in the US and people over here can also buy it online from US retailers. I think the official line is that kava is possibly safe when taken for up to six months. But my feeling is that there could be other better ways of dealing with stress and anxiety.

17:58Dr Sophie Shotter:Yeah, interesting. And possibly linked, then of course, there's recreational as well as medicinal cannabis over in the US. Yes, but many states have made their own separate legislation for cannabis use. Some states allow cannabis for medical use, some allow it for both medical and recreational use, and others still consider it fully illegal. I'd say that if anyone's interested in learning more about medical cannabis, then listen to our episode with Professor David Nutt, who talks about the therapeutic qualities of cannabis and how people in the UK can get a perfectly legal prescription, albeit for certain indications such as anxiety or epilepsy.

18:36Dr Sophie Shotter:Yeah, that was a great episode. And possibly a slight detour, but speaking of the latest melatonin news, I think you also wanted to cover this story on lithium or lithium and its possible links with protecting against Alzheimer's. Yeah, so this is really interesting. Lithium is a metal that most of us might know better for its use in batteries, but it's also used as a drug for mood disorders such as bipolar. And new research shows that it might play a key role in protecting against Alzheimer's disease. For nearly a decade now, scientists from Harvard have been studying how it works in the brain.

19:14And lithium is actually naturally present in small amounts in our brains and this comes from our diet where it's transported through the bloodstream to the brain cells. But these very clever Harvard researchers have found that as people move beyond mild cognitive impairment, which is often seen as a warning sign for Alzheimer's, their lithium levels drop. They found that lithium supports brain growth, shields nerve cells and calms inflammation, all of which are super important for healthy aging. so keeping lithium levels stable could have wider benefits in preventing dementia and supporting brain resilience just to say that lithium is currently available in prescription strength lithium carbonate for mood disorders and also low-dose over-the-counter lithium orotate supplements which are marketed for mood and cognitive support but again as always consult a healthcare professional before taking any form of lithium because of its potential side effects with other medications.

20:09Ultimately, any supplements are not tested in the same way as prescription medications and too high a dose could be toxic. I did think it was worth giving it a little mention though.

20:18Dr Sophie Shotter:Yeah, absolutely. And all of this has been super interesting. And I'm now wondering what's available in the UK that maybe the Americans would like from us, apart from pine spake beans and a cabbage chocolate. I don't know what we have that they don't, but this is super, super interesting. Thank you so much, Sophie. Thank you, Fee. And that ends this week's podcast. If you want to find out more about me and my work, or maybe book a consultation, head to drsophyshotter.com. And you can find me on socials at drsophyshotter. And again, thank you so much for listening.