Ask the Experts: Citicoline on the Brain; Agave’s Sweetening Fix

Q: Does citicoline have any cognitive health benefits?

A: With over 5 million Americans suffering from Alzheimer’s disease and the risk of developing some form of dementia doubling every five years after age 65, there is much interest in preventing and treating memory loss. Citicoline is a brain chemical that occurs naturally in the body but also may be taken as a supplement.
Preliminary evidence suggests that, as a supplement, citicoline may be useful in treating some forms of memory loss in people 50-85 years of age, especially memory loss due to stroke or other cerebrovascular diseases. Citicoline has also been suggested as a treatment for traumatic brain injuries and Parkinson’s disease. So far there is no strong evidence that citicoline supplementation is useful in preventing or treating Alzheimer’s disease, but research suggests supplementation may be beneficial for older people with mild cognitive impairment—especially as it relates to stroke. The supplement is probably safe when taken for 90 days or less, although some people have reported diarrhea, insomnia, high blood pressure, blurred vision, and chest pains. There is no evidence for its safety during pregnancy and lactation.

—Sharon Salomon, MS, RD

Q: Should I switch my sweetener to agave?

A: Agave nectar or syrup is a sweetener produced by cactus-like agave plants, including Agave tequilana, from which tequila is derived. Agave has been billed as a healthier alternative to other sweeteners because of its low glycemic index. It is popular in health food circles and is commonly found in baked goods that are produced “without sugar.” Agave syrup is slightly sweeter than honey and about 1.5 times sweeter than sugar.

While agave is relatively new to a lot of consumers, it has a long history of use in Mexico. Agave rose to prominence in the U.S. alongside the backlash on refined sugar and high fructose corn syrup. However, agave syrup has a very high fructose concentration, which may not spike blood glucose levels immediately, but could have a deleterious impact on insulin sensitivity in the long term. However, it’s important not to lose sight of the big picture: No sweetener—even agave—should ever be considered health-promoting, as overall diet pattern is most important. Added sweeteners, no matter their origin, should be limited in healthy diets.

—Matt Ruscigno, MPH, RD

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