What to ask your doctor before you try a memory supplement

My sister-in-law Marge called me last spring, excited about a memory supplement she had seen advertised. She had already ordered it. When I asked whether she had mentioned it to her doctor, she said, "Walt, it's natural, it's just plants." I knew exactly how she felt, because I would have said the same thing a few years ago.

Natural does not mean it cannot interact with your pills. Some of the strongest drugs in the pharmacy came from plants. So here is the list of questions I now bring to the doctor or pharmacist before I start anything, along with why each one matters.

Bring this to the appointment

• Every pill bottle in the house that you take, including vitamins, fish oil, sleep aids and allergy pills.
• The supplement itself, or a clear photo of the full ingredient list.
• A short note on what you want it to do. "Help me remember names" is a fine answer.

The government's health library has a sensible page on herbal medicine that is worth reading the night before.

The nine questions

1. "Could any of these ingredients interact with what I already take?"

This is the big one. Many memory supplements now include ingredients that lower blood sugar, like berberine, cinnamon or banaba leaf. If you are on metformin or insulin, that can add up. Others include things that thin the blood a little, which matters if you take warfarin or a daily aspirin.

2. "Is there anything in my bloodwork that could explain my memory?"

Low vitamin B12, thyroid trouble and blood sugar problems can all affect memory, and all three show up on a blood test. It makes sense to rule them out before paying for a supplement.

3. "Are any of my current medications known to affect memory?"

Some common drugs, especially certain sleep aids, allergy pills and bladder medications, can fog thinking in older people. My doctor took me off one. Ask.

4. "Is this dose anywhere near what was studied?"

Supplement research is done at specific doses. If a product does not list the amount of each ingredient, you cannot compare it to the studies. Your pharmacist can help you read the panel on the bottle.

5. "How long should I try it before deciding?"

For most memory supplements, a month is not long enough to tell. The saffron studies, for example, ran for several months. Agree on a trial period and a way to judge it.

6. "What should make me stop right away?"

Stomach trouble, feeling shaky or sweaty (a sign of low blood sugar), unusual bruising. Know the stop signs before you start.

7. "Should I stop it before surgery or a procedure?"

Usually yes, for anything that affects blood sugar or bleeding. Two weeks is a common rule, but ask.

8. "Is there something with better evidence I should do first?"

Your doctor might say walking, a hearing test, better blood pressure control or a sleep study. Those have stronger evidence than any supplement. The National Institute on Aging's page on cognitive health covers the list well.

9. "Would you take it, in my shoes?"

Doctors are people. Sometimes their answer to this one tells you more than the other eight.

How to read the label yourself

Three things I look for now:

• The amounts. A real supplement facts panel lists milligrams next to each ingredient. If you only see names, that is a gap.
• The claims. Supplements are allowed to say they "support" memory. They are not allowed to say they treat or cure a disease. If a label promises to reverse Alzheimer's, put it down. The FDA's dietary supplement page explains what the rules are.
• The return policy. For products sold online, read it before you buy, not after.

The NCCIH guide to using dietary supplements wisely has a few more good questions if you want them.

Questions to ask yourself first

Before you even get to the doctor, three questions worth answering honestly at the kitchen table.

What exactly do I want this to fix? "My memory" is too vague. "Remembering names at church" or "not losing my train of thought mid-sentence" gives you something to watch.

What will I do if it does not work? Decide in advance. If the answer is "keep buying it anyway in case it starts working," that is how people end up with a cabinet full of half-empty bottles.

Is anything else going on? A new medication, poor sleep, a hard stretch since a loss, more drinking than usual. Any of those can affect memory, and none of them is fixed by a supplement.

Keep a simple trial log

If you do start something, keep a log. Mine was a single page in my pocket notebook with three lines a day: how I slept, any memory slips I noticed, and anything unusual like an upset stomach. At the end of the trial I could look back at sixty days of notes instead of trying to remember how I felt, which, given the subject, is not the most reliable method.

When to stop

Agree on this before you start, the same way you agree on a trial period. Stop and call your doctor if you notice stomach trouble that does not settle after a few days, any sign of low blood sugar like shakiness or sweating, unusual bruising or bleeding, a rash, or new confusion. Also stop before any surgery or dental procedure, unless your doctor tells you otherwise. And stop at the end of the trial if your notes do not show a difference. There is no prize for finishing the bottle.

What happened with Marge

She took the bottle to her pharmacist, as I nagged her to. It was one of the newer ten-ingredient formulas, and the pharmacist flagged the blood sugar ingredients against her metformin. Her doctor said she could try it if she did some extra home glucose checks for the first couple of weeks. If you are looking at the same kind of product, there is a ten-ingredient formula broken down by the research that shows what each component is for. Marge also wanted to know whether the company was on the level before she paid; is Phytomem One legit answered that for her better than the sales page did.

Whether she takes it is her business. What mattered was that a five-minute conversation turned a guess into a plan, and that is all I am asking anybody to do.

I would rather ask a dumb question than take a dumb risk. My doctor has never once made me feel silly for bringing a bag of bottles.