Saffron and memory: the Tehran trials, explained by a curious cook

I came to the saffron memory studies sideways. I was trying to find out why good saffron costs so much, and kept running into papers from Tehran with titles about Alzheimer's disease. Eventually I sat down with a pot of tea and read them properly. Here is what they say, as plainly as I can put it.

The first trial: saffron against a placebo

In 2010, a team led by Shahin Akhondzadeh at Tehran University of Medical Sciences gave 46 people with mild-to-moderate Alzheimer's disease either a saffron capsule or a placebo, twice a day, for 16 weeks. The saffron dose was 15 mg twice a day, so 30 mg in total.

At the end, the saffron group scored better on two standard tests of memory and thinking than the placebo group (Akhondzadeh, 2010). Side effects were about the same in both groups.

Thirty milligrams is a small amount, by the way. A pinch of threads for a paella is often in that range. But the capsules used extract, which is concentrated, and the participants took it every day for four months, which is not how anybody cooks.

The second trial: saffron against a real drug

The same group then did something bolder. They compared saffron not with a sugar pill but with donepezil (sold as Aricept), one of the standard prescription drugs for Alzheimer's. Fifty-four people took either 30 mg of saffron a day or donepezil for 22 weeks.

The two groups improved by about the same amount on the memory and thinking tests (Akhondzadeh, 2010). Vomiting was more common with donepezil.

This was the result that got everybody's attention, and I understand why. But it helps to know that donepezil itself has a modest effect. "As good as donepezil" means a modest improvement, not a dramatic recovery.

Putting the trials together

When researchers find several small trials pointing in the same direction, they often pool them in what is called a meta-analysis. A 2020 review did that for saffron, combining four randomized trials in people with mild cognitive impairment or Alzheimer's. Saffron beat placebo on cognitive scores, and it was not significantly different from the conventional drugs it was compared with (Ayati, 2020).

The authors were careful in their conclusion. They said saffron "may have the potential" to help, but that there were not enough high-quality studies to recommend it for clinical use. I appreciated that. It is more careful than most of what I read on supplement labels.

How much weight I put on all this

More than I expected when I started reading. Less than an ad would like.

On the plus side, these were randomized and double-blind, meaning neither the patients nor the doctors knew who got what. They agree with each other. And one of them held up against an actual drug.

On the other side, the trials were small, dozens of people each, and short, a few months. Most came from one research group. And they were done in people who already had Alzheimer's or mild cognitive impairment, not in healthy people worried about forgetting names, who are the ones most supplements are sold to.

What this means if you are looking at a supplement

If a memory supplement lists saffron, the question I would ask first is how much. The trials used 30 mg a day. A product that lists ten ingredients in one tablet may have much less, and if the label does not give milligrams, you cannot tell.

I looked at one product that has been advertised heavily, Phytomem One, which lists saffron first on its label, alongside nine other ingredients. The review site I read was upfront that the sales page does not list the saffron dose, and it also explains how much the other nine ingredients add, which is mostly blood sugar support rather than memory. That is a fair summary of the trade-off with combination products: more ingredients, less certainty about each one.

A few things I noticed in the fine print

Reading the actual papers, rather than the summaries, taught me a few things I had not expected.

The participants were Persian-speaking adults in Iran, mostly recruited through university clinics. That is not a flaw, but results do not always carry over between populations with different diets, genetics and medical care.

The saffron came from Iranian producers, and the capsules were made for the study. That means the researchers knew exactly what was in them, which is more than can be said for many supplements on store shelves.

The main tests used, the ADAS-cog and the CDR-SB, are standard tools in Alzheimer's research. They measure things like recalling word lists, following instructions and handling daily tasks. They are good at picking up changes over months, less good at capturing the small everyday slips most of us worry about.

Several of the trials came from the same research group. When one lab produces most of the evidence, other scientists rightly want to see the results repeated elsewhere before they get too excited.

What I would want to see next

A larger trial, run in several countries, in healthy older adults with ordinary forgetfulness, lasting at least a year. That is the study that would tell people like my parents whether a saffron capsule is worth buying. As far as I can tell from searching the trial registries, nobody has published one yet. Until then, the honest description of saffron for memory is "promising and unproven," which is still a better description than most supplement ingredients get.

Saffron at the dinner table

None of this research changes how I cook, but it has changed how I talk about saffron at dinner. When a friend says "isn't that the spice that's good for your brain?", I can now say exactly what is known and what is not, which makes for a better conversation than either "yes, eat more" or "that's all hype." Both of those answers would be wrong.

My kitchen-table conclusion

I find the saffron research genuinely interesting, and more convincing than the evidence for most memory supplements. I also think it is a long way from "might help people with early Alzheimer's a little" to "will sharpen your memory." If someone in my family had memory changes, I would want them to see a doctor first and to treat saffron as a possible addition, not an answer.

In the meantime, I will keep cooking with it, because the one thing I can promise about saffron is that it makes rice taste wonderful.