Smart drugs and botanicals are gaining attention from proponents and detractors.
Who wouldn’t want to feel stronger, smarter and more focused every day?
That was the idea behind the movie “Limitless,” starring Bradley Cooper as a struggling writer who takes a smart drug and finds himself able to learn, analyze and recall information with astonishing speed.
It’s not entirely science fiction. Smart drugs, or nootropics, have actually become a billion-dollar global industry, as time-starved people from Silicon Valley to Wall Street look for ways to pack more performance and productivity into each day.
Dave Asprey, a former Silicon Valley executive and author of The New York Times bestseller “The Bulletproof Diet,” told CNN that “smart pills” are already commonplace at the highest levels of business.
“When I meet people through work who run companies that have many zeroes in their bank accounts, it’s uncommon that they don’t have a baggie full of supplements. They say ‘this is what I take for my brain.’”
While today’s real-life cognition enhancers may not give you mental superpowers such as those demonstrated by Cooper’s character, nootropics users say they do give you greater focus and energy to help power through the challenges of the day.
“One of the biggest benefits I’ve seen is better overall mental clarity,” says Geoffrey Woo, founder of Nootrobox, a nootropics subscription service. “My thinking is very crisp and clear … and I have better stamina. I’m able to put in a lot of hours without getting burned out and tired.”
Some compare this new trend of “biohacking” mental performance to the experimentation with supplements by bodybuilders for greater muscular gains.
But all this experimentation has become a big concern for many neurologists, psychologists and physicians. In June, physicians at the annual meeting of the American Medical Association (AMA) adopted a new policy discouraging the nonmedical use of prescription drugs for cognitive enhancement in healthy individuals.
“As temptation grows to use prescription drugs for a competitive advantage at work and school, the nonmedical use of these drugs should be discouraged given potential for substance misuse and other adverse consequences,” said AMA member Dr. Maya A. Babu.
What exactly are nootropics?
The term nootropic (pronounced noh-uh-TROH’-pihk) is used to describe any drugs, supplements or substances thought to boost mental performance in some way.
More than 100 substances fall into this category, from the mundane — such as caffeine, B12 and fish oil — to herbs, peptides, stimulants such as Ritalin and other drugs designed for specific medical conditions.
Globally, nootropics are a relatively new business, with increasing use as a study aid on college campuses and a way to survive the long hours at many tech startups. However, the quest for a better-performing brain goes back more than 50 years, when Romanian psychologist and chemist Corneliu E. Giurgea synthesized the drug piracetam — now used to treat epileptic seizures — for cognition and memory.
Giurgea coined the term nootropics, derived from the Greek words for “mind” and “bend” or “turn,” several years later in 1972.
Outside of caffeine, some of the most heavily researched drugs used for cognition enhancement, experts say, are the drugs piracetam and modafinil.
While piracetam has shown promise in the last decade for treatment of traumatic brain injuries and neurogenerative disease, it does not have U.S. Food and Drug Administration (FDA) approval as a drug or supplement and is mostly used in Europe, Canada, Asia and South America.
Modafinil has been approved in the U.S. to enhance wakefulness in narcoleptics, and new research shows it to also be effective as a mental performance enhancer.
A systematic review of the cognitive effects of modafinil, published online last year in the peer-reviewed journal European Neuropsychopharmacology, shows that the drug does confer some cognitive benefits in the areas of decision-making and planning, with few adverse effects (insomnia, headache or stomachache) that weren’t also reported in a placebo group.
“Modafinil may well deserve the title of the first well-validated pharmaceutical nootropic agent,” said the study’s authors, Dr. Ruairidh Battleday and Dr. Anna-Katharine Brem from the University of Oxford and Harvard Medical School.
How do they work?
Just how these drugs work is not entirely clear. Piracetam is thought to improve cognition by increasing mitochondrial function in damaged brain cells.
Modafinil is believed to increase neurotransmission — or the chemicals released by neurons to other nerve cells — by elevating levels of catecholamines, or hormones such as dopamine, epinephrine (adrenaline) and norepinephrine, which are produced in response to stress.
Many compare them to antidepressants, which balance the brain’s chemical production. However, more research is needed, experts say, to pinpoint the exact mechanism behind the benefits to these and other cognition-enhancing drugs.
Botanical brain boosters
Drugs, however, are just the tip of the iceberg. Other well-documented herbs that are taken to enhance cognition include the following:
- Bacopa monnieri: Long a staple of traditional Indian medicine, bacopa, or water hyssop, is considered to be particularly useful for strengthening the mind and attention, says Dr. Tieraona Low Dog, a former clinical associate professor of medicine at the University of Arizona who was appointed by Bill Clinton to the White House Commission on Complementary and Alternative Medicine Policy, and who served on the scientific advisory council for the National Center for Complementary and Alternative Medicine.
A meta-analysis of the cognitive effects of bacopa conducted of studies through 2013 concluded that the herb had the potential to improve cognition but that more research was needed. Two more studies published subsequently also supported this conclusion, Low Dog says. Her patients who take bacopa often notice a difference in mental acuity within three to four weeks.
- Rhodiola rosea: Also known as golden root, the herb rhodiola has been shown to have anti-depressant and anti-fatigue — both mental and physical — effects in a number of randomized controlled trials, according to Low Dog. “I have found rhodiola to actually be quite useful in a small number of my patients with fibromyalgia and chronic fatigue,” she says. The effect, she explains, is less subtle and more stimulating than bacopa, and the full benefit is often felt within seven to 10 days.
- L-theanine: This naturally occurring amino acid found in green tea leaves is also believed to aid cognition by relaxing the mind without increasing drowsiness. “I often recommend drinking green tea,” Low Dog says. “You get the increased focus and alertness with caffeine, while getting the relaxing anti-anxiety effects of the L-theanine.”
Side effects of these three supplements are generally mild, Low Dog claims, and there are no significant safety concerns at the proper doses.
However, as with other supplements, they should not be taken by pregnant women and a doctor should be consulted to vet potential drug interactions. Low Dog adds that it is critically important to look at lifestyle changes first — including rest, exercise and optimal nutrition — before looking to botanical supplements such as these.
Human guinea pigs
The problem, experts say, is that many people rush into taking supplements, taking several at once or larger doses than recommended to get maximum effect.
Many of these substances are combined in “stacks” to enhance their benefits. And this is where the science gets muddy.
Much of the research on nootropics is limited to single ingredients, rather than these combinations of herbs, nutrients, peptides and other unpronounceable chemicals. Little is known about the efficacy of these substances taken together, says Dr. Tod Cooperman, president of ConsumerLab.com, a third-party supplement-testing company.
And long-term safety data on many of these substances is still lacking, Cooperman and Low Dog agree.
With so many people taking multiple substances — sometimes dozens of pills a day — experts say it’s hard to tell what’s working and what isn’t.
Additionally, there are real risks involved with dosing, contamination and potential toxicity associated with some of these supplements. That’s why physicians say it is important to look for companies that have passed muster with a third-party testing lab.
Moreover, just because supplement makers advertise their supplements as “generally recognized as safe” by the FDA, it doesn’t mean they have to undergo testing or clinical trials before their new product hits the market. The FDA will only stop a company from selling it when it has been demonstrated to cause harm.
“You can easily create a product that’s not safe and wouldn’t be breaking any laws doing it,” says Cooperman.
His firm regularly finds contamination, inaccurate levels of key ingredients, and extra caffeine or other pharmaceutical ingredients not included on the label that are used to “spike” a product.
Indeed, the dearth of testing, regulation and information on nootropics have spurred the growth of large online forums on the topic, such as subreddit /r/nootropics, where tens of thousands of users compare notes on substances and suppliers, and outside testing is conducted and posted, tagging vendors that sell false products.
“People are no longer taking the company’s word for it,” says “MisterYouAreSoDumb,” the moderator of the Reddit forum. “They want to see analytical testing proving the products are what they say they are. They want to see and understand the research behind the efficacy of these compounds.”
To that end, some supplement makers, including Nootrobox, have begun partnering with academia to conduct and publish research validating their products. But scientists and physicians say there is a long way to go before nootropic supplements will be accepted and embraced as an effective tool to boost mental performance in already healthy people.
The AMA’s official position on nootropics, released in May 2016, is that they “do not make people smarter.” And it says that the cognitive effects of many prescription smart drugs are highly variable among individuals, highly dependent on the right dosage, and “limited or modest at best in healthy individuals.”
As Amy Arnsten, a professor at the Kavli Institute for Neuroscience at Yale University, put it to the BBC, “You’re not taking Homer Simpson and making him into Einstein.”
Nootropics, tomorrow’s coffee?
Still, despite this admonition and the caveats, many, including Low Dog, think nootropics are here to stay.
“Sleep-deprived, stressed-out people are going to continue to look for substances that can enhance their mental performance,” she says.
And researchers say, given the swell of college students already popping stimulants and middle-aged workers juggling a huge number of demands, there is real reason to support better research on nootropics and to regulate and develop sound policies around their use.
“We should welcome new methods of improving our brain function,” and doing it with pills is no more morally objectionable than eating right or getting a good night’s sleep, a team of researchers wrote in a hotly debated 2008 piece published by the journal Nature.
It’s certainly true that for hundreds of years, our culture has had no problem accepting caffeine as a daily pick-me-up, one that many find hard to live without.
The French novelist Honoré de Balzac was said to write for about 15 hours a day aided by up to 50 servings of coffee. His musings on the cognition-enhancing effects of coffee, detailed in this Slate article, sound strikingly similar to those of today’s “noonauts.”
“Coffee glides into one’s stomach and sets all of one’s mental processes in motion. One’s ideas advance in column of route like battalions … Memories come up at the double, bearing the standards which will lead the troops into battle … The artillery of logic thunders along … Brilliant notions join in the combat as sharpshooters.”
Those who take nootropics see them as the next evolution of Balzac’s “precious essence” and the next stage in our obsession with Fitbits and other tools of human performance. Soon, Nootrobox’s Woo says, we will be not only popping nootropics daily but also tracking our stress levels and mental acuity with wearables and apps.
Indeed, he compares where nootropics are today to the small computing groups of the 1970s that eventually led to everyone carrying a smartphone in his or her pocket.
“It’s a niche community now, but in five or 10 years, it will be part of everyday normal behavior,” Woo asserts.
Giurgea, the father of nootropics, anticipated this relentless push for better mental performance when he said,
“Man is not going to wait passively for millions of years before evolution offers him a better brain.”