© Whole Foods Magazine
Restoring Mental Function
An Interview with Shari Lieberman, Ph.D., CNS, FACN
By Richard A. Passwater, Ph.D.
During the past year, I have had the opportunity to lecture on the health benefits of phosphatidylserine (PS) a number of times in the United States and Asia. What has been disappointing is that there are so many people who still don’t know about these benefits and that there is little up-to-date material to refer people to for additional information. I have found that many people do not know about studies showing that PS can restore brains, enabling them to function as they did a dozen years earlier. Now, to my delight, there is a new book written by two of my friends that will help many people improve their mental functions lost to age.
Dr. Shari Lieberman and James Gormley have written Health Benefits of Phosphatidylserine. Their new book discusses numerous topics, including the following: slowing down brain aging; reducing the risk of dementia; improving brain power; fending off cognitive decline; and treating Alzheimer’s disease. Both authors should be familiar to most of you, as they have brought much health information to the public over the years. When I learned of the new book from publisher Norm Goldfind, I immediately called my longtime friend, Dr. Lieberman. It has been a while since I last lectured with her in Rio, but I see her so often on television that it seems more recent. In this month’s column, Dr. Lieberman will discuss some of the clinical research involving PS and mental function. In upcoming months, I will discuss the biochemical functions of PS.
Shari Lieberman, Ph. D., CNS, FACN earned her Ph.D. in clinical nutrition and exercise physiology from The Union Institute, Cincinnati, OH and her M.S. degree in nutrition, food science and dietetics from New York University. She is a certified nutrition specialist (C.N.S.); a fellow of the American College of Nutrition (FACN); a member of the New York Academy of Science; a member of the American Academy of Anti-Aging Medicine (A4M); a former officer and present board member of the Certification Board for Nutrition Specialists; and president of the American Association for Health Freedom.
Dr. Lieberman is the recipient of the National Nutritional Foods Association (NNFA) 2003 Clinician of the Year Award and a member of the nutrition team for the New York City Marathon. Her best-selling book The Real Vitamin & Mineral Book is now in its third edition (Avery/Penguin Putnam 2003). She is also the author of several other books including User’s Guide To Brain-Boosting Supplements (Basic Health Publications, Inc. 2004) and All About Vitamin C (Avery Publishing Group1999).
Dr. Lieberman is a faculty member of the University of Bridgeport, School of Human Nutrition graduate program; an industry consultant; a contributing editor to the American Medical Associations’ 5th Edition of Drug Evaluations; a peer reviewer for scientific publications; a published scientific researcher and a presenter at numerous scientific conferences. She also is a frequent guest on television and radio and is often quoted in magazines as an authority on nutrition. She has been in private practice as a clinical nutritionist for more than 20 years. She encourages readers to visit her at her website at www.drshari.net
James Gormley is an award-winning health and nutrition journalist who was editor-in-chief of Better Nutrition magazine from 1995 through 2002 and is author of DHA, A Good Fat (1999). He has also lectured and chaired discussion panels at nutrition industry meetings.
Passwater: Dr. Lieberman, I am so pleased that James Gormley and you wrote this book. There is so little information available for the general public on phosphatidylserine. You had written an earlier book on brain nutrients, so why did you decide to write Health Benefits of Phosphatidylserine?
Lieberman: Because PS can have such profound effects on brain function, yet is often therapeutically overlooked. I just presented at the Alzheimer’s Association, and practically no one in the audience had ever heard of PS. The possibility of PS improving dementia, age-related memory loss, Alzheimer’s disease and overall brain function is tremendous. And there are no negative side effects.
Passwater: What happens to the mental functions of most people as they age?
Lieberman: Studies suggest that memory peaks between ages 20 and 30. After this age most people may experience a very subtle decline. After age 60, the memory capacity, itself, declines; at age 70 or age 80 and beyond, memory loss—if already present—typically becomes pronounced.
Researchers divide the degrees of memory loss into two major categories:
* Normal aging—no loss of memory capacity but it takes a little longer to remember things.
* Age-associated memory loss (AAML)—Dr. Ronald Petersen, director of the Mayo Clinic Alzheimer’s Disease Research Center, in Jacksonville, FL, says that people with this condition typically experience small lapses of memory—such as misplacing something, forgetting to pick up a much-needed item at the store or briefly forgetting someone’s name.
Passwater: Does that have to be? Some of us seem to stay mentally sharp?
Lieberman: My personal opinion is this doesn’t have to be, and we can stay mentally sharp. I have patients who are over 70 years old and work five days a week because they really want to! They are as sharp as a tack. But they take a number of dietary supplements, eat really well and exercise regularly. It is no miracle that they are so mentally fit. Dietary and lifestyle changes can prevent deposits of a waxy plaque, called beta-amyloid protein, in the brain’s blood vessels and neurofibrillary tangles (bunched up neural cells). A brain-friendly diet would include a nutritional program rich in antioxidants, such as vitamin E, and good fats such as PS.
Passwater: You mentioned PS. What’s so special about PS?
Lieberman: PS enhances the activity of receptors on the brain cells’ membrane surface and boosts the synthesis and release of certain neurotransmitters essential for brain function including epinephrine, norepinephrine, serotonin and dopamine. PS may restore acetylcholine levels in the brain. This is an important neurotransmitter for optimal memory and brain function.
PS is essential for supporting neurotransmitters that pass messages from one brain cell to another and promote good memory function. By restoring the activity of PS in aging cell membranes with a PS supplement, we can keep the chemical interaction and transfer of electrical impulses between neurons more open at both the sending and receiving ends so that new information can be more easily transmitted and more easily stored and remembered.
PS may also produce its beneficial effects by preventing the degeneration of dendrites in the brain’s hippocampus and perhaps by helping to restore them as well. PS may also restore acetylcholine levels in the brain—another important neurotransmitter for optimal memory and brain function.
Also important is that, as we age, modern diets lead to an alteration of the ratio of the various phospholipids in cell membranes, as well as to an alteration in the phospholipids-to-cholesterol ratio in neuronal membranes. This entails loss of functionality, fluidity and enhanced rigidity of brain cell membranes.
Passwater: The chemical structure of the phosphatidyl family of phospholipids is unique, which gives PS a chemical advantage not present in other nutrients. PS is essential to some functions and can’t be replaced by other nutrients or drugs. It is not important to understand the biochemistry of PS, but it is important to realize that only PS has the capability to make brain cells—and other cells—work.
As I noted above, I will be discussing the biochemistry of PS in detail in a later article, but perhaps a brief overview here will help readers who are unfamiliar with this nutrient understand why it is unique. PS is a fairly long molecule that can be thought of as containing a head, body and tail. The unique structural property of PS that gives PS its unique biochemical function is that the "head" of the PS molecule has a negative charge at body pH, whereas its "tail," separated by a long "body" has no charge and exists as a neutral dipolar zwitterion.
Translated into plain English, this means that the chemical structure of PS allows the "head" region of PS to interface with water and the "tail" region to interface with lipids (fats). This property of PS provides a compatible environment for fats to exist in aqueous regions of the body such as in the cytoplasm of cells and is essential for the formation of bi-layers such as cell membranes.
Now, returning to what you were saying a moment ago, what causes us to lose PS as we age? Is the problem triggered by decreased production of PS in our bodies, or are we eating less in modern diets—or both?
Lieberman: Although phosphatidylserine appears almost everywhere in the human diet, it is virtually impossible to take in enough PS from foods alone (200 mg is needed as a daily minimum, and 300 mg would be better, in order to reduce the risk of age-related dementia or of mental (cognitive) dysfunction). According to Dr. Kyle Smith in his 2002 PS health claim application that was submitted to the Food and Drug Administration (FDA), "only a supplemental source of phosphatidylserine can ensure that efficacious quantities are ingested daily." Also, as we age, production of PS, hormones, enzymes—just about everything—starts to decline!
Passwater: The problem is that many modern diets are just plain low in PS. PS is found in respectable amounts in meats and fish, but not in dairy products, vegetables or junk foods. Whole grains and white beans are also respectable PS sources. The richest sources, of course, are brains and innards, but most fast food outlets don’t include these organ meats in their menus.
In the 1980s, Western diets typically supplied 250 mg of PS daily. At the turn of the millennium, vegetarian diets typically contained less than 50 mg of PS per day, reduced-fat diets about 100 mg, and diets rich in meats, still only about 180 mg. This indicates an undersupply of at least 70 to 150 mg of PS per day, and for vegetarians, the shortage could be 200 mg or more.
You mentioned that Dr. Smith has made it possible to label PS products with accurate information describing its health benefits. I’ll be chatting with Dr. Smith about his success in getting the FDA to finally allow these truthful claims in an upcoming column.
Would you mind briefly reviewing the basic research that proves that PS supplements do indeed counteract declining mental function due to age?
Lieberman: There is excellent research demonstrating that PS can be therapeutic for treating cognitive impairment, including Alzheimer’s disease, age-associated memory impairment, dementia, and mental deterioration.
Passwater: Is the evidence strong enough for an approved health claim? In your book, you go into the details of three studies. If you had to rely on only one study, which would you choose to make your case on?
Lieberman: All of them! I would never rely on just one study. In fact, there is a large body of scientific evidence that supports the health claims. It is the FDA that I disagree with. These are the actual claims approved by the FDA with the agency’s "appropriate" disclaimers:
"(1) Consumption of phosphatidylserine may reduce the risk of dementia in the elderly. Very limited and preliminary scientific research suggests that phosphatidylserine may reduce the risk of dementia in the elderly. FDA concludes that there is little scientific evidence supporting this claim." or,
"(2) Consumption of phosphatidylserine may reduce the risk of cognitive dysfunction in the elderly. Very limited and preliminary scientific research suggests that phosphatidylserine may reduce the risk of cognitive dysfunction in the elderly. FDA concludes that there is little scientific evidence supporting this claim."
Very limited and preliminary? Very little scientific evidence? Oh really? The studies on PS have looked at mild (age-associated memory loss) as well as more severe cognitive decline such as seen in Alzheimer’s disease and dementia. Stellar results have been reported. How many more studies does the FDA need to convince it? Especially when conventional drug treatment has yielded less than impressive results. And PS can be taken with conventional treatments for Alzheimer’s disease and dementia, since it is completely safe and non-toxic. Something a drug for either of these illnesses has yet to achieve.
Passwater: Please describe some of the studies that support this.
Lieberman: A double-blind, placebo-controlled trial was carried out using PS in 39 elderly patients with chronic brain-circulation-caused (cerebrovascular) dementia. The 20 treated patients received 300 mg/day of the supplement for two months versus the 19 people who did not. After analyzing the data, the authors found a significant improvement in the treatment group in one of the cognitive tests compared to the placebo group.
German researchers looked at administration of PS in people with Parkinson’s disease who also had "senile dementia of the Alzheimer’s type." These authors used electroencephalographic (EEG) brain mapping to actually prove "the therapeutic effects of phosphatidylserine." They found improvements in brain-wave activity, brain metabolism, and even reduced anxiety in this group of patients. The study concluded: "preliminary therapeutic results" of PS supplementation indicate that [PS] may prevent or slow down brain aging. Both of these studies confirmed numerous other well designed studies conducted in the 1980s.
At the Max-Planck Neurological Institute in Cologne, Germany, researchers studied 40 patients with "probable Alzheimer’s disease." The patients were assigned to one of several treatment groups, including cognitive training alone, PS and cognitive training, or an Alzheimer’s drug and cognitive training for a six-month period. The patients who scored best on memory and neuropsychological tests were those who had been assigned to the group that received PS plus cognitive enhancement.
The same year, in a study in Japan, gerbils were given soybean lecithin PS for five days. Looking at the effects of an experimentally caused brain damage due to lack of blood flow, giving PS beforehand reduced brain cell damage compared to those animals that did not receive the pre-treatment; this suggests that PS has a protective effect on brain cells (neurons, specifically). These studies support numerous animal and human studies conducted in the 1990s.
In an open-label study out of Israel (meaning everybody received treatment and knew what they were getting), 15 healthy older patients who had age associated memory impairment (AAMI) received 300 mg a day of soybean PS. In tracking changes over a 12-week period, the authors noted significant improvements in brain performance.
In an unpublished 2000 study report, also from Israel, researchers looked at long-term results of soy lecithin PS supplementation in outpatients at a geriatric clinic. The findings suggest that PS treatment can produce "statistically significant, positive" cognition-boosting results in patients with cognitive impairments.
In other unpublished studies from Israel, researchers used PS in two different groups: in 96 patients with Alzheimer’s disease and in 72 functioning elderly patients. The first study (in Alzheimer’s patients) used a proprietary formulation of 300 mg of soybean PS and 240 mg of phosphatic acid, which was given daily. The second study (in functioning elderly) used 300 mg daily of soybean PS. The authors found significant improvements in indicators of quality of life, general health, mental function, mood and other factors. Both of these studies support several studies conducted since the year 2000.
Passwater: Is the rest of the body of scientific evidence extensive?
Lieberman: Yes it is. And there are virtually no negative studies using PS in animals and humans. Study after study has confirmed that PS can have a dramatic impact on memory—whether it is mildly or severely impaired. Studies have also shown that PS supplementation has no adverse effects.
Passwater: Is PS new? Why doesn’t everyone know about the positive effects of this nutrient?
Lieberman: As a supplement, PS is relatively new; most of the research did not begin until the 1980s. Many alternatively minded practitioners do know about PS and use it in their practice. As the health claim starts to become visible on supplement labels, more people will at least have an idea about why they should consider taking it.
Passwater: How much PS do you recommend?
Lieberman: I recommend 100-300 mg per day. The therapeutic intervention studies generally used 300 mg per day. Perhaps 100 mg per day may be a good preventive dose to preserve brain function with the higher 300 mg dose being used to actually improve brain function that has deteriorated.
Passwater: As with any nutrient, it is important to be sure that the supplement one is taking contains the desired amount of PS. Some products are labeled as PS and others as PS complex. In addition to PS, the complex contains other phospholipids and, possibly, such other ingredients as choline and inositol. These, too, are beneficial, but the main consideration is the amount of PS itself. There is no substitute for PS.
Lieberman: In our User’s Guide to Brain Boosting Supplements, I discuss numerous supplements that also help improve such areas of brain performance as memory, concentration and cognition. These include dietary supplements like Gingko biloba, Huperzine-A, vinpocetine, alpha-lipoic acid, acetyl-L-carnitine and more. Some companies may combine several of these in a brain-boosting formula. A knowledgeable buyer will make sure that the manufacturers of these products are not just "spritzing" these things in and that they are really getting a therapeutic level of at least several of the major components. In the User’s Guide to Brain Boosting Supplements there are specific recommendations for safe and effective therapeutic ranges of supplements.
Passwater: Some of these compounds work by preserving the PS content of cell membranes, some work by energizing the mitochondria in the cell, and others work by improving neurotransmitter activity. Nevertheless, it is my understanding that PS is a critical factor needed by essentially all cells.
Now, before we conclude our discussion, does PS confer any noteworthy health benefits on parts of the body other than the brain?
Lieberman: The vast majority of the research has focused on PS and brain function because PS is so important for maintaining and improving neurotransmitter levels as well as preserving and improving neuronal communication. One could consider PS as an essential brain nutrient, however, since PS helps keep all cells healthy by contributing to the restoration of their proper membrane function.
There are studies showing health benefits of PS to include sports performance, ADHD (hyperactivity) and protection against the stress hormone cortisol. A new study that I find interesting (J Immunol. 2004 Sep 1;173(5):2985-94) discusses the role of PS in immune function. PS is exposed on the surface of apoptotic cells and thus is implicated in immune regulation. This new study examines the effects of PS on the maturation and function of dendritic cells, which play a central role in both immune activation and regulation.
Passwater: Is PS just for the elderly, or can children also benefit (think of their encounters with ADH and, stress)?
Lieberman: While elaborate formal clinical studies have not been specifically conducted in children with ADD or ADHD, open label studies (Kidd and Ryser) have shown PS to be clinically useful in children with this disorder. It may also prove useful to students who have problems with concentration and memory. Once again, there is no down side to trying it—and the results can be quite dramatic.
Passwater: What else do you recommend in your book to keep mentally sharp?
Lieberman: Exercising your brain! Learn something new such as another language, a musical instrument or a new game that you haven’t mastered yet. Consider going back to school to learn something new as well—tests and homework will definitely keep you sharp. Also, I truly believe after more than 20 years of seeing patients that exercise is definitely the fountain of youth. All of my patients with excellent brain function not only exercise their minds but their bodies as well. And clean up your diet. Diets high in antioxidants and low in sugar are optimal for brain function. The typical American diet is anything but brain healthy. WF
© 2004 Whole Foods Magazine and Richard A. Passwater, Ph.D.
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