Freakonomics Radio, Episode 658: "This Is Your Brain on Supplements"

Date: January 9, 2026
Host: Stephen J. Dubner
Main Guests:

• Dr. Peter Attia (Longevity physician, author, and podcast host)
• Dr. Peter Cohen (Harvard Medical School, supplement researcher)
• Dr. Marty Makary (FDA Commissioner, surgeon, author)
• Danielle Douglas (Emergency medicine physician, listener contributor)

Episode Overview

This episode kicks off Freakonomics Radio’s month-long “Guide to Getting Better” series by tackling the booming—and murky—world of brain supplements. Host Stephen Dubner dives into the industry with three physicians, exploring what supplements actually do, the science behind them, regulatory oversights, potential risks, and the powerful role of placebo and consumer psychology. The conversation blends expert critique, memorable anecdotes, and hard data on who’s taking what, why they’re taking it, and what evidence (if any) supports these practices.

Key Discussion Points & Insights

1. What Are Brain Supplements—And Why Are They So Popular?

• ~60% of American adults take at least one dietary supplement; brain supplements are among the fastest-growing types, predicted to reach $25 billion in sales soon.
• Common supplements listeners report taking: multivitamins, omega-3s, creatine, choline, magnesium, MCT oil, N-acetylcysteine.
• Listener’s Voice (02:44–04:03): Testimonials and motivations for supplement use, sometimes based on podcasts or anecdotal research.

2. Wild West: The Supplement Industry Has Little Oversight

• Under the 1994 DSHEA Act, supplements are regulated as food, not drugs. This means premarket testing, manufacturing controls, and efficacy demonstrations aren’t required.
• The number of supplement products has ballooned from 4,000 to 90,000 since 1994.
• Quote (Peter Attia, 04:51): “You can imagine in an industry that has absolutely zero oversight and regulation, it’s truly the Wild West.”
• Supplements can be contaminated or inaccurately labeled (lead in protein powders, active ingredient variability).

3. Evidence: Do Brain Supplements Actually Work?

• Effectiveness: On a 0–10 scale, Dr. Cohen rates supplement reliability “between 0 and 1” (12:02).
• Quote (Peter Cohen, 11:08): “It’s basically completely unpredictable what you’re getting.”
• Supplements can’t legally claim to prevent or cure disease, but the law allows vague “structure/function” claims (e.g., “supports memory”). These are highly exploitable loopholes.

4. Risk and Harm: Who’s Watching Out?

• Annually, about 23,000 Americans end up in the ER due to adverse effects from supplements (17:52).
• Regulation is spotty: voluntary industry groups do some testing, but it’s optional and limited.
• The CDC’s system to track supplement-related ER visits has been shut down due to funding cuts.

5. When Doctors DO Recommend Supplements

• Both Attia and Cohen use/recommend supplements selectively:
  • Cohen: multivitamin, vitamin D, calcium, iron for those needing replenishment (19:18).
  • Attia: magnesium (different types, e.g., threonate for brain/sleep), creatine, EPA/DHA/fish oil, and occasional melatonin and phosphatidylserine for jet lag (31:48–33:50).
• Quote (Peter Cohen, 18:56): “I couldn’t practice good medicine without them.”

6. Scientific Studies and Specific Supplements

• Creatine: Good data for athletic recovery, little robust evidence for cognitive benefit (20:26–21:12).
• Choline: Theoretically logical (precursor for acetylcholine), but studies haven’t proven memory benefit (21:13–21:43).
• Ginkgo Biloba: Well-studied; no better than placebo for memory. Yet it’s still widely promoted, showing disconnect between research and marketing (22:08–23:11).
• Omega-3s: Dietary omega-3s correlate with lower Alzheimer’s rates, but supplements haven’t shown benefit in trials (23:11–23:53).
• Food vs. Supplements: Consuming nutrients via actual food is generally superior—supplements isolate compounds from a complex matrix of nutrients and fiber (24:10–24:54).

7. Pharmaceuticals vs. Supplements: Regulatory and Scientific Divide

• Drugs undergo rigorous, expensive FDA approval with large clinical trials and verified safety/efficacy (14:05–14:39).
• Supplements bypass this standard through DSHEA, leading to wide variance—even unsafe contamination—between different brands/sources.
• Example: Galantamine (for dementia) is accurately dosed in pharma, wildly inconsistent (2–110% of label) and sometimes contaminated in supplement form (26:10–26:56).

8. Lifestyle Trumps Supplements for Cognitive Health

• Actual pillars for protecting brain health: sleep, exercise, nutrition (real food), social/intellectual engagement.
• Quote (Peter Attia, 39:32): “All the supplement stuff you’re doing is a little bit of rearranging the deck chairs on the Titanic. You earn the right to worry about that stuff once you have the stuff that provides 90% of cognitive function taken care of.”

9. Transparency, Disclosures, and Conflict of Interest

• Attia acknowledges investing in two supplement companies—Element (electrolyte drink) and AG1 (multivitamin blend)—and stresses the importance of patient/client awareness of conflict of interest (44:10–44:22).
• Quote (Attia, 44:10): “Make sure anybody who’s selling you anything has a really clear line of conflict disclosures around [it].”

10. Information Environment: Social Media and Misinformation

• Social media (Instagram, TikTok) floods the public with supplement advice; easy “pill solutions” outcompete “boring” foundational advice like sleep and exercise (46:33–48:01).
• Quote (Attia, 47:25): “Our species is becoming lazier and lazier... Most people just want the pill. They don’t have the time, energy or desire to kick the tires...”

11. The Media, Policy, and Regulatory Future

• The Dr. Oz effect: Mainstream media hypes faddish (sometimes dangerous) advice for viewership, frustrating scientist-physicians (48:26–51:29).
• Peter Cohen proposes an FDA registry for “permitted” supplements with mandatory, transparent testing and valid claims—if the political will exists (51:54–52:57).
• Industry is pushing for looser rules and more ability to make health claims; so far, the government is mostly static (53:03–53:59).

12. FDA Perspective and Next Steps

• Dr. Marty Makary, now FDA Commissioner, discusses plans to challenge the “Generally Recognized as Safe” standard to require actual safety data for new food/supplement additives (55:15–55:39).
• FDA prioritizes enforcement where it can “safeguard the public,” not just for the sake of regulation (55:51–56:34).
• More changes in FDA policy may be forthcoming in future episodes.

Notable Quotes & Memorable Moments

• Peter Cohen, on overall supplement claims (12:02):

  “It’s very distorted, and I’m really struggling between 0 and 1 [out of 10].”

• Peter Attia, on the industry (04:51):

  “It’s truly the Wild West.”

• Stephen Dubner, on regulation (14:39):

  “Why is it...if I want to sell a drug, I need to go through a long-established standard...But if I want to sell a supplement, [making] identical claims...there’s not much inspection, not much guarantee of consistency or even ingredients?...Am I missing something?”

• Attia, on lifestyle (39:32):

  “All the supplement stuff you’re doing is a little bit of rearranging the deck chairs on the Titanic.”

• Attia, on public attitudes (47:25):

  “Most people just want the pill...[even though adjusting sleep, exercise, and nutrition]...will make like a 50% improvement in my cognition. And what this other guy’s talking about is gonna do nothing. But he sounds better and it’s easier.”

• Cohen, on food vs. supplementation (26:56):

  “Many supplements...fall into what you might call gossip-based medicine.”

Timestamps for Major Segments

• Consumer anecdotes and supplement popularity: 02:44–04:03
• Regulation and contamination issues: 04:03–09:33
• Unreliable claims and marketing loopholes: 11:08–14:05
• Pharma vs. supplements: 14:05–15:47
• ER visits and risks: 17:09–18:05
• Doctors’ use of supplements: 18:56–21:43
• Scientific evidence for specific supplements: 20:26–24:54
• Food vs. supplements: 24:10–24:54
• Lifestyle vs. supplements: 39:32–40:13
• Conflicts of interest/Transparency: 44:10–44:22
• Social media and misinformation: 46:33–48:01
• Regulatory proposals and FDA goals: 51:54–55:51

Conclusion

This episode shows that the brain supplement marketplace is booming, yet mired in unreliable information, minimal regulation, and widespread consumer confusion. Most of what’s sold is likely ineffective or potentially risky; even expert physicians limit their recommendations to select, evidence-based scenarios. Overall, the path to true “cognitive enhancement” still lies in time-tested lifestyle fundamentals—sleep, diet, exercise, and engagement—while the pill-shaped shortcut, for now, is mostly hope in a bottle.

Best takeaways: Buyer beware—do your homework, trust real food, and don’t let flashy TikTok claims trump slow, boring, but proven solutions.

Next episode tease: A deeper dive into FDA’s evolving priorities and regulatory battles around supplements.