Monthly Archives: June 2017

Q: What are nootropic drugs, and do they really boost brainpower?

A: Cognition-enhancing drugs known as nootropics some prescription, some over-the-counter, others available on a worldwide gray market of private sellers are said to improve memory, attention, creativity and motivation.

The word "nootropic" was coined in 1972 by a Romanian scientist, Corneliu Giurgea, who combined the Greek words for "mind" and "bending." Caffeine and nicotine can be considered mild nootropics, while prescription Ritalin, Adderall and Provigil (modafinil, a drug for treating narcolepsy) lie at the far end of the spectrum when prescribed off-label as cognitive enhancers. Even microdosing of LSD is increasingly viewed as a means to greater productivity.

But when aficionados talk about nootropics, they usually refer to substances that have supposedly few side effects and low toxicity. Most often they mean piracetam, which Giurgea first synthesized in 1964 and which is approved for therapeutic use in dozens of countries for use in adults and the elderly. Not so in the United States, however, where officially it can be sold only for research purposes.

Piracetam is well studied and is credited by its users with boosting their memory, sharpening their focus, heightening their immune system, even bettering their personalities. But it's only one of many formulations in the racetam drug family. Newer ones include aniracetam, phenylpiracetam and oxiracetam. All are available online, where their efficacy and safety are debated and reviewed on message boards and in podcasts.

A number of companies now market nootropic "stacks," or formulas, some of which include piracetam, herbal remedies, amino acids and citicoline, a naturally occurring brain chemical that can be taken orally as a supplement, intravenously or as a shot.

Because they are sold as nutritional supplements and natural products that refrain from making health claims, they avoid close government scrutiny.

"Who doesn't want to maximize their cognitive ability?" asks Murali Doraiswamy, who has led several trials of cognitive enhancers at Duke University Health System and has been an adviser to pharmaceutical and supplement manufacturers as well as the Food and Drug Administration. He attributes the demand to an increasingly knowledge-based society that values mental quickness and agility above all else.

But while some studies have found short-term benefits, Doraiswamy says there is no evidence that what are commonly known as smart drugs of any type improve thinking or productivity over the long run.

"There's a sizable demand, but the hype around efficacy far exceeds available evidence," notes Doraiswamy, adding that, for healthy young people such as Silicon Valley go-getters, "it's a zero-sum game. That's because when you up one circuit in the brain, you're probably impairing another system."

Although piracetam has a history of "relatively few side effects," it has fallen far short of its initial promise for treating any of the illnesses associated with cognitive decline, according to Lon Schneider, a professor of psychiatry and behavioral sciences at the Keck School of Medicine at the University of Southern California. "We don't use it at all and never have."

As for newer nootropic drugs, there are unknown risks.

"Piracetam has been studied for decades," says cognitive neuroscientist Andrew Hill, the founder of a neurofeedback company in Los Angeles called Peak Brain Institute. But some of the newer compounds "are things that some random editor found in a scientific article, copied the formula down and sent it to China and had a bulk powder developed three months later that they're selling. Please don't take it, people!"

Sara Solovitch, The Washington Post

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Medical Q&A: So-called smart drugs can turn out to be a dumb idea - Sarasota Herald-Tribune

A lot of people made the same bad joke on Twitter when Senator John McCain seemed confused during former FBI Director James Comeys senate testimony last week. Get John McCain some Prevagen! The joke makes no sense unless you know what Prevagen iswhich you probably don't, unless you frequently watch one of the major news networks. It's a nootropic dietary supplement, aka a smart drug, mostly marketed to baby boomers on TV as a memory enhancer . "Prevagen is a dietary supplement that has been clinically shown to help with mild memory problems associated with aging," its marketing materials say.

The thing is, though, theres no evidence the drug works.

In January of this year, the New York State Attorney General sued the makers of Prevagen for false advertising claims, since theres no evidence its jellyfish-based formula can help improve memory as it claims. We sent letters to at least five major networks who were airing these ads," says Bonnie Patton, director of the consumer watchdog group Truth in Advertising. "And guess what? Prevagen ads are still airing.

Prevagen is hardly alone. Though it's targeting the 59-and-older set who watch cable news, Prevagen is just one of many nootropics on the market, each aimed at a different kind of audience. There's Brain Dust, made by spiritual hippie foodie guru Amanda Chantal Bacon , which targets the Gwyneth Paltrow-admiring Goop set. There's Qualia, made by a group called Neurohacker Collective, that appears targeted at professionals and emphasizes its scientific approach, and Nootrobox, which offers a whole cocktail of different brain enhancers and a complete guide to biohackingto name just three. As baby boomers hit the age that memory normally starts to fade, and as Silicon Valley pours money into the biohacking fad, the market for chemical cognitive enhancers like these is booming.

And while demand for such miracle pills is high, the laws about supplement advertising are incredibly lax. If I were looking for opportunities to make a lot of money while deceiving people, I think going into the brain supplement business would be real high on my list, says Pieter Cohen of Harvard Medical School, a leading expert in the efficacy and risks of dietary supplements. You can make a lot of money, do something entirely legal, and youre good to go.

Like sports or dietary supplements, these brain supplements are not regulated by the FDA. Almost no research has been done into their exact formulations. And theres no real oversight of how much of any given ingredient they contain. The potential for deception plagues the supplement industry as a whole, thanks to a 1994 law that classified supplements as food rather than medication. According to a study from 2015, dietary supplements lead to at least 23,000 emergency room visits a year in the US.

The regulatory framework is all set up for this. You can advertise pills as if they support or improve brain function even if you dont have one bit of research in humans to demonstrate thats true, Cohen says. The law is pretty much clear: You can say pretty much anything short of saying this is a cure for Alzheimer's .

None of this is to say that users don't think these drugs help them out. The chemicals in these formulations may not have proven cognitive effects, but their presentation clearly is doing something to customers' brains.

As demand for cognitive enhancers increases, VC money is flooding the market. The supplement industry as a whole brings in $30 million a year, according to Cohen, and Silicon Valley appears to want to get in on itVC firm Andreesen Horrowitz, for instance, invested $2 million in Nootrobox. All that money could fund researchbut more immediately, it buys a slick website, which can do a lot to sell the promise of a brain boost.

Go to Qualias website, and youll see a neatly organized list of its ingredients, which range from neuro-vitamins to adaptogenic compounds to amino acids. This medicalese lends the pills an air of credibility, as do the links to scientific studies about each ingredient. Really, though, its an over-the-counter supplement that theyve thrown everything in the kitchen sink at, says Kimberly Urban, a scientist at the Childrens Hospital of Philadelphia, who has studied brain-enhancing medicines.

Also on the list of ingredients in most of these? Caffeine. Part of the reason caffeine is so often found in dietary supplementsweight loss, cognitive, or otherwiseis because you feel it. And when you feel it, you think its working. The same reason that caffeine in weight loss drugs makes you feel that its doing something: It wires you up, says Urban. Many supplements dont contain enough of any of their given molecules to actually produce an effect, so they rely entirely on the placebo effect to work.

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The overlap with diet pills is what most worries Cohen about the trend of memory supplements. He and his research team have long studied the illegal inclusion of amphetamines or methamphetamines in diet pills. (You thought caffeine made you feel sped up?) Though he hasn't tested nootropics, he sees no reason to believe companies wont try to sneak the same tweaked amphetamines into them, compounds which are both incredibly addictive and very hard to test and find.

But even without illegal drugs snuck into the formulations, supplements can be dangerous on their own. Though they are ostensibly made with only natural ingredients, lots of natural things are deadlyand without oversight, you'll never know exactly how much of each compound you're getting. You should be especially careful if you are sensitive to caffeine or take other medications, since many of the natural ingredients found in supplements can interact with prescription medications. (Did you know that St. Johns Wort can render oral contraceptives less effective? Me neither! But if you are taking the pill, thats something youd want to bear in mind before taking Qualia.)

Most of these nootropics also contain amino acids and plant extracts. Some of these things may be beneficial to the brain, say Cohen and Urban. Urban points to one nootropic listed in Qualia, phosphatidylserine, as something preliminary research has shown interesting results on. On Qualias website, under a section of the FAQ headlined Is Qualia a scam or snake oil? the company writes this:

Qualia is not a scam. We have a non-proprietary formulationwe publish exactly whats in our product, with the exact amounts. We publish links to the research that support their safety and efficacy, which includes Phase II & III university and clinical trials, strong quantified self research data, and over 40+ years international research on nootropic stack formulation.

But most of those studies are basic research into individual compounds done in animals or with animal cells in petri dishes. The leap from there to this specific formulation is helpful to the human brain is huge. (WIRED reached out to Neurohacker Collective for comment but didn't hear back before publication.) Neuroscientists are only beginning to understand how memory even functions in the human brain, let alone how a specific compound might affect it. This is not about science," says NYU professor of nutrition Marion Nestle. "Its about wishful thinking."

Wishing to be smarter, better, more productive is natural. Unfortunately, even as most things in 2017 are available at the click of a button, maintaining brain health is still complicated. Doctors recommend you get a good night's sleep, limit your caffeine and alcohol consumption, exercise regularly, and keep your brain stimulated. None of that's as easy as popping a pill, but hey, at least it works.

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Don't Fall for the 'Memory' Pills Targeting Baby Boomers - WIRED