ACSH Explains: Nootropics

By Katie Suleta — May 10, 2024
It’s final exam time, which means all manner of study hacks are making their semi-annual resurgence amongst students across the country. Among those hacks are nootropics – substances ostensibly increasing cognitive function. What’s behind these brain-boosting products?

What Are Nootropics

Nootropics are substances that improve brain function. This includes memory, concentration, thinking, learning, etc. Nootropics can come in many forms, including prescription medications, foods, and supplements. More specifically,

“Nootropics describe a broad classification of compounds with cognitive enhancing properties, with minimal side-effects, that are appropriate for long-term use. These compounds can include synthetic analogs of naturally occurring chemicals, neurologically active compounds already produced in the human body (such as neurotransmitters), and chemicals found in nature, some of which we already consume in foods such as B vitamins, caffeine, and L-theanine.”

Lila Abassi, MD

Most people are broadly aware of nootropics, even if not by that name. Examples of common nootropics from each of the aforementioned categories include stimulants prescribed to treat Attention Deficit Hyperactivity Disorder, also known as ADHD, caffeine, and ginseng.

While the effects of some of these substances, e.g., caffeine, are well studied and known, others are questionable and lack a convincing evidence base. Let’s dig into these categories a bit.

Prescription Medications

Multiple drugs are approved to treat cognitive disorders and diseases. Two of the most prominent areas that nootropics treat are ADHD and diseases with memory degradation, like Alzheimer’s disease. We understand enough about how the brain works and how these drugs work to know that targeting neurotransmitters is essential for communication within the body. Specifically,

“Neurotransmitters are chemicals that transfer information between neurons and help neurons communicate with one another… Dopamine helps regulate the feelings of pleasure (euphoria and satisfaction) and also plays an important role in controlling movement, cognition, motivation, and reward. Stimulant use also causes the brain to release norepinephrine, which helps regulate mood, attention, learning, memory, and arousal…The prescription stimulants methylphenidate and d-amphetamine increase dopamine signaling—methylphenidate by blocking dopamine transporters and d-amphetamine by enhancing dopamine release from nerve terminals.”

Treatment for Stimulant Use Disorders: Updated 2021

One of the defining symptoms of ADHD is the inability to maintain attention or focus. Drugs used to treat ADHD are categorized as stimulants and non-stimulants. Stimulants are typically drugs like methylphenidate and amphetamines, which increase levels of the neurotransmitters dopamine and norepinephrine in the brain. Non-stimulant drugs increase levels of norepinephrine and include selective norepinephrine reuptake inhibitors and alpha-2 adrenergic agonists.  Non-stimulants take longer to work than stimulants do.

While we don’t know all the nuances of exactly how this works, rigorous clinical trials, meta-analyses, etc., revealed that these drugs help people to focus their attention more than they otherwise would.

Other medications are directed at treating memory issues. The main symptom that people attribute to Alzheimer’s is memory loss, and our understanding of the biological underpinnings of memory is incomplete. This makes finding plausible and science-based treatments and preventives challenging.

There are new monoclonal antibody treatments for Alzheimer’s disease (lecanemab and donanemab) that can be classified as nootropics. These drugs target a type of amyloid protein and train the immune system to target and clear it. The broad idea behind this is that the amyloid can sometimes clump together and produce plaques that may be responsible for the progression of Alzheimer’s disease, the hallmark of which is memory degradation.

As of this writing, Lecanemab has received full FDA approval; Donanemab is still awaiting FDA approval as they continue to review its clinical testing. Post-market data analysis is being collected to understand more and anyone given Lecanemab is closely monitored.

You’ll notice that these monoclonal antibodies are not being hyped as the latest and greatest memory enhancers and targeted at the general public. These drugs are being carefully tested, considered, and used in restricted settings.   

Foods

There are certain foods that may be a part of your everyday routine that could be considered nootropics: coffee, tea, soda, energy drinks, and chocolate. All contain caffeine, a stimulant that increases the release of neurotransmitters, including those linked with attention.

Caffeine can improve athletic performance, attention, and alertness. This is especially true of people who are sleep-deprived. While caffeine is far from a cure-all, it is often touted as the most widely consumed drug in the world. It may be because people have noticed that it helps with focus, especially when they feel sleepy.

It’s easily obtained, tolerated well, and gives you a quick jolt, especially on those mornings when getting out of bed is extra hard.

Supplements

The brain remains mysterious to us: its nuances, how it works, why it works, etc. This type of uncertainty allows all manner of hucksters an opportunity for exploitation. Everyone wants to perform better cognitively. As a result, the supplement market is rife with brain-boosting serums, pills, tonics, and the like. Ginseng, ginkgo, creatine monohydrate, and vitamins, to name just a few, not to mention the countless proprietary blends.

Many of the prominent wellness influencers have proprietary lines of supplements that likely include nootropics. The question to ask is, is there a robust body of independently conducted research to support the claims made about the brain boosters they sell? Most likely not. And they count on you, the time-constrained consumer, not conducting a thorough literature review or thinking critically.

While it’s outside the scope of this article to cover all of the claimed nootropics in the world of supplements, it’s important to remember:

  • They can make structure/function claims that sound really good.
  • The marketing will try to convince you that you need it.  
  • Supplements don’t need clinical trials or any kind of research to be sold or marketed.

While we understand much about the brain and the body, our understanding is incomplete. Some of these substances are well understood. Some we’re just beginning to understand. Others are using unsupported claims to take advantage of the medical and scientific grey area by selling products that are not tested.    

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