The Doctor Is In! : What are nootropics?

Hello Steemians,

About once a week I will be running a feature where I will give an indepth and non-biased answer to a medical topic chosen by my students or by other steemians. None of this should be considered specific medical advice, but it is my professional opinion on the matter.

Last week Hive account@cryptogee asked me to talk about nootropics, so today I would like to talk to you about NOOTROPICS.

image courtesy of purenootropic.com this is not an endorsement, just a nice image

The word means “towards the mind” in Greek, it is used in reference to compounds that are both neurologically active and which directly or indirectly enhance the cognitive potential of a person via increased capabilities, learning potential or state of well being.

Our brain uses chemicals called neurotransmitters to send and receive information, how well these work depends on how much we produce, how well we deliver them to their target organs and long they act.
To give you an example, caffeine will inhibit enzymatic breakdown of acetylcholine this in turn enables our brain to have more available in the inter-synaptic cleft, continuing to excite the neuron.

So why is caffeine a nootropic?
Because it permits the action of a neurotransmitter for a longer period of time.

We have 3 neurotransmitters which most stimulants target in some way. These are acetylcholine, dopamine and serotonin. To enhance memory we increase the amount of acetylcholine and boom, better memory, now this sounds great, except that for the acetylcholine receptor as soon as it senses there is a lot of acetylcholine it will up regulate its function, so that if it needed one molecule, now it will need two and so on. That is the reason why most drugs will need to be continuously increased in dosage if you use them constantly. This happens with people that use illegal drugs, the dosing is off and they are used to using x amount and suddenly it’s not enough so they tweak the dose and suddenly it's too much.

Cholinergic enzymes and transporters. image courtesy of wormbook.org

Most of the problems we have in medicine stem from the fact that our receptors for everything are made in such a way that if there is too much of any substance, they will up regulate the amount they need in order to stimulate it. So for example if we give a diabetic more insulin, the insulin receptors will always need more because they keep increasing the dose they need to work, this is why diabetics have a tough time regulating their glucose.
In Alzheimer’s the acetylcholine receptors don’t work properly, this is because there is something interfering with it. When a molecule of acetylcholine tries to activate the receptor something gets in the way and it can't stimulate the action.

To treat this, we give the patient more acetylcholine which in turn makes the receptor up regulate and this starts the never ending circle, ultimately resulting in a pathology due to non functioning receptors.
The correct solution we are finding is to clean the receptor, down regulate it, and normalize the amount of stimulant.

So these are not all bad, but they need careful and supervised control in order to maximize benefits while limiting risks.

With nootropics the idea is to provide the brain with more stimulants either by directly increasing the amount of stimulant available, slowing its metabolism, or improving its distribution. To ensure they keep working, we must control the duration of usage to limit the possibility of up regulation. Used in moderation and with proper supervision, they will produce the desired effect without problems.

The two most widely (ab)used nootropics are

MODAFINIL (Provigil) increases HA, NE, 5-HT, and DA levels in the brain

AMPHETAMINE (Adderall) Comprised of mixed amphetamine salts.

drug images courtesy drugs-forum.com

Modafinil and Adderall are used for different purposes and are not within the same class as one another. The modafinil vs amphetamines comparison is like comparing apples to oranges. Provigil (modafinil) is an anti-fatigue agent, whereas amphetamines act directly on the dopaminergic reward centers to increase executive function.

Adderall enhances concentration, executive function and goal-oriented behavior. Modafinil promotes wakefulness and arousal, and acutely prevents some of the negative effects of sleep deprivation on cognitive function.

Adderall is approved for the treatment of ADHD. Modafinil treats shift work sleep disorder, chronic fatigue syndrome and excessive daytime sleepiness associated with sleep apnea.

Adderall mimics the fight or flight response by promoting catecholamine release. Modafinil has a novel mechanism of action that involves glutamate/GABA, catecholamine’s, orexin/histamine and gap junctions between neurons

Adderall use is more likely to result in dependence or abuse. Modafinil has negligible abuse potential
Adderall is associated with more adverse effects than Modafinil, but is more effective at managing the core symptoms of ADHD

Studies have been mixed, but amphetamines and Modafinil taken together may improve cognition in healthy subjects. If these results are confirmed, these drugs would only improve cognition for certain type of tasks.

Moreover, Adderall and Modafinil...
Do not benefit high-performing individuals!
Why?

Because these people already produce high levels of stimulants naturally, giving them more will force the receptor to up regulate and so adding these drugs means the body retards the effectiveness.

This is a stupidly dangerous message!

Students abuse these drugs to "gain an edge", in extremely competitive environments. The truth is that their ability to enter these competitive programs demonstrates that they are already running "on overdrive".

They are already highly performant...
These drug won't really help them!

Any "enhancement" that an already healthy and peak performing mind feels from running on these substances is mostly placebo effect, but it's a dangerous placebo because the brain will attempt to stabilize it's own chemistry. This could easily lead to long term ill health effects from a short term "enhancement" that could just as easily been obtained by eating an apple or an orange before studying.

In fact consider looking at adding bananas, carrots, apples, oranges and trail mix with walnuts (assuming no allergies) as well as plenty of peanut butter or almond butter to your late night studying sessions and watch your test scores soar. There is real scientific evidence for these "snacks" since they work by increasing your sense of well being, attention and awareness. They also provide the nutrients most depleted by long sessions of focusing. These all help with long term retention, the conversion of short term memory to longterm memory. Getting plenty of sleep is also essential here since it cleans up the toxins built up from a long day of strenuous activity. Water of course helps the body flush these toxins out as well.

Here is some information on other, nootropics.

RACETAMS:
Piracetam / Aniracetam - https://examine.com/supplements/phenylpiracetam only member of the racetam family that has a stress-lowering effect and also increases memory IO (getting memories into and out of your mind but keep in mind the only evidence for this claim is a single study performed on rats. More research is required)

image courtesy of ieet.org
NICOTINE (powerful nootropic) - Also a well known insecticide with addictive effects on par with heroin.

There are also natural nootropics and while I don't recommend anyone mess around with their neural chemistry, you should be aware that these exist and are believed to be less harmful than others while showing effectiveness on par with the others.

L—THEANINE is a major component of black and green tea. On its own, theanine promotes relaxation, alertness and arousal. Works synergistically with caffeine. Together, the two decrease reaction time, while increasing memory, and mental endurance. Because of it's presence in tea it is considered GRAS (generally regarded as safe), just don't over do it.

BACOPA MONNIERI is a small water plant native to India. Bacopa is an adaptogen- it helps your body adapt to stress. There is strong evidence that it improves memory in healthy adults and enhances attention and mood in people over 65.

This subject was a lot of fun. I enjoyed catching up on the most recent research on the topic. As always this is not intended to be specific medical advice. Make sure to talk with your own doctor before adding, removing or otherwise altering anything in your current regime, because everyone is unique and only someone who's known you for awhile can help you find what is best for you.

What did you think of this topic? What medical topics would you like me to go into depth on next?