A week later: Golden Sumatran, 3 spoonfuls, a more yellowish powder. (I combined it with some tea dregs to hopefully cut the flavor a bit.) Had a paper to review that night. No (subjectively noticeable) effect on energy or productivity. I tried 4 spoonfuls at noon the next day; nothing except a little mental tension, for lack of a better word. I think that was just the harbinger of what my runny nose that day and the day before was, a head cold that laid me low during the evening.
Apkarian and colleagues imaged the brains of 68 participants and gave them personality tests. The researchers then randomly assigned the participants to groups that either received no treatment, sugar pills or a pain-killing drug. Those given pills were not told if they received a placebo or an active drug. Participants took the treatment for two weeks, stopped for one week and then repeated this cycle.

Alpha Brain's most noticeable impact on hunting was making it easier to wake up early. Since I'm typically not a morning person, this was striking, and helpful. I also felt slightly more organized, and a curious sense of emotional stability. These changes could also be attributed to parenthood, and my determination to do the deed and get home as soon as possible.
The third category was cognitive control - how effectively you can check yourself in circumstances where the most natural response is the wrong one. A classic test is the Stroop Task, in which people are shown the name of a colour (let's say orange) written in a different colour (let's say purple). They're asked to read the word (which is easy, because our habitual response to a word is to read it) or to name the ink colour (which is harder, because our first impulse is to say "orange"). These studies presented a more mixed picture, but overall they showed some benefit "for most normal healthy subjects" - especially for people who had inherently poorer cognitive control.
In that year, Dr. Corneliu Giurgea, a Romanian scientist, synthesized piracetam for the first time. Piracetam is classified as a nootropic, although the term nootropic was not used until 1972.[2] Dr. Giurgea coined the term “nootropic” by combining the Greek words for mind (nous) and bend (trepein).  Nootropic literally translates into the phrase “mind bender.”
First half at 6 AM; second half at noon. Wrote a short essay I’d been putting off and napped for 1:40 from 9 AM to 10:40. This approach seems to work a little better as far as the aboulia goes. (I also bother to smell my urine this time around - there’s a definite off smell to it.) Nights: 10:02; 8:50; 10:40; 7:38 (2 bad nights of nasal infections); 8:28; 8:20; 8:43 (▆▃█▁▂▂▃).
Some suggested that the lithium would turn me into a zombie, recalling the complaints of psychiatric patients. But at 5mg elemental lithium x 200 pills, I’d have to eat 20 to get up to a single clinical dose (a psychiatric dose might be 500mg of lithium carbonate, which translates to ~100mg elemental), so I’m not worried about overdosing. To test this, I took on day 1 & 2 no less than 4 pills/20mg as an attack dose; I didn’t notice any large change in emotional affect or energy levels. And it may’ve helped my motivation (though I am also trying out the tyrosine).
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When it comes to brain power, greens should be on your plate (and cover a lot of that plate) every meal. “Leafy greens are a great base. You swap out a lot of the empty carbohydrates you get from things like pastas or breads, and you can use some leafy greens,” says Psychiatrist Drew Ramsey, MD, author of The Happiness Diet and Eat Complete: The 21 Nutrients That Fuel Brainpower, Boost Weight Loss, and Transform Your Health. “Again, just lots of nutrient density.”

The U. S. nootropics industry was valued at more than $1.3 billion in 2015 and is projected to reach $6 billion by 2024. This growth is due in part to slick marketing from biohacking “experts” such as Dave Asprey (founder of Bulletproof) and Josiah Zayner, Ph.D. (CEO of the Odin), who’ve built big social-media and podcast followings as well as customer bases. At the grassroots level, there are meetups across the country like the one at Idea Coffee, plus a vibrant online community.
Today, extraordinary research is showing that bacopa has the remarkable ability to increase levels of BDNF, a protein responsible for the growth, maintenance and survival of neurons, and the creation of new neural connections in the brain. It also has been shown to help promote the growth of new neurons and neural pathways, which helps to explain why it’s such a powerful memory and concentration booster.
I took 1.5mg of melatonin, and went to bed at ~1:30AM; I woke up around 6:30, took a modafinil pill/200mg, and felt pretty reasonable. By noon my mind started to feel a bit fuzzy, and lunch didn’t make much of it go away. I’ve been looking at studies, and users seem to degrade after 30 hours; I started on mid-Thursday, so call that 10 hours, then 24 (Friday), 24 (Saturday), and 14 (Sunday), totaling 72hrs with <20hrs sleep; this might be equivalent to 52hrs with no sleep, and Wikipedia writes:
(On a side note, I think I understand now why modafinil doesn’t lead to a Beggars in Spain scenario; BiS includes massive IQ and motivation boosts as part of the Sleepless modification. Just adding 8 hours a day doesn’t do the world-changing trick, no more than some researchers living to 90 and others to 60 has lead to the former taking over. If everyone were suddenly granted the ability to never need sleep, many of them would have no idea what to do with the extra 8 or 9 hours and might well be destroyed by the gift; it takes a lot of motivation to make good use of the time, and if one cannot, then it is a curse akin to the stories of immortals who yearn for death - they yearn because life is not a blessing to them, though that is a fact more about them than life.)
The best of the old world combined with the science of the new. Huntington Labs offers a Focus, Memory and Clarity supplement that delivers a targeted and specifically stacked combination of nootropics, or “brain enhancers.” Specially chosen extracts, herbs and substances work together to boost attention, creativity, flexibility, focus, speed, memory and clarity. Green Tea Extract: Traditional supplement for mental performance. Promotes better brain function naturally. Huperzine A: Boosts alertness and enhances memory; extracted from Fir moss. Bacopa Monniera: Contains Bacosides which improve cognitive function and memory. L-Glutamine: An essential amino acid that builds protein and aids memory. Huntington Labs pays special attention to the “stacking” benefits of all of these natural nootropic brain boosters, and hopes that you will experience the max benefits from your daily recommended dose. We guarantee it or your money back!

Difficulty concentrating.  As mentioned previously, this may not be a direct result of age—though it can be a common side-effect of struggling with fatigue and brain fog.  When it takes more mental energy to think, it is harder to stay with it for a long time.  Many of us also are surrounded by distractions clambering for our limited attention.  Modern life is fast-paced, stressful, and overcrowded.

Pyritinol: Pyritinol has anti-oxidant effects for supporting the long-term health of the brain. But its primary benefit is aiding glucose uptake for periods of extended mental strain. If you are studying or working for a long period of time, your brain will start to diminish its glucose (sugar) stores which are the primary way that the brain derives its energy.
The benefit of sequential analysis here is being able to stop early, conserving pills, and letting me test another dosage: if I see another pattern of initial benefits followed by decline, I can then try cutting the dose by taking one pill every 3 days; or, if there is a benefit and no decline, then I can try tweaking the dose up a bit (maybe 3 days out of 5?). Since I don’t have a good idea what dose I want and the optimal dose seems like it could be valuable (and the wrong dose harmful!), I can’t afford to spend a lot of time on a single definitive experiment.
But notice that most of the cost imbalance is coming from the estimate of the benefit of IQ - if it quadrupled to a defensible $8000, that would be close to the experiment cost! So in a way, what this VoI calculation tells us is that what is most valuable right now is not that iodine might possibly increase IQ, but getting a better grip on how much any IQ intervention is worth.

I noticed on SR something I had never seen before, an offer for 150mgx10 of Waklert for ฿13.47 (then, ฿1 = $3.14). I searched and it seemed Sun was somehow manufacturing armodafinil! Interesting. Maybe not cost-effective, but I tried out of curiosity. They look and are packaged the same as the Modalert, but at a higher price-point: 150 rather than 81 rupees. Not entirely sure how to use them: assuming quality is the same, 150mg Waklert is still 100mg less armodafinil than the 250mg Nuvigil pills.

On the plus side: - I noticed the less-fatigue thing to a greater extent, getting out of my classes much less tired than usual. (Caveat: my sleep schedule recently changed for the saner, so it’s possible that’s responsible. I think it’s more the piracetam+choline, though.) - One thing I wasn’t expecting was a decrease in my appetite - nobody had mentioned that in their reports.I don’t like being bothered by my appetite (I know how to eat fine without it reminding me), so I count this as a plus. - Fidgeting was reduced further
This product has very nice labeling - very easy to understand and the directions for taking it are immediately at the top of the label in the back. You only have to take or or two tablets a day (preferably with meals) so I 've been taking one a day with my noon meal. I'm a bit surprised that it seems already (after two weeks) that I'm remembering things better (my husband even remarked on it!). Normally, I rely on him for my memory about most things (that, and post-it notes) but I seem to be doing better since taking this supplement. My husband also noticed that I'm in a better mood (more playful and wanting to do things). It has definitely altered my mood - it is winter now where I live and because you don't get as much sunshine and every spare moment is taken up by shoveling, you can get a bit more down in the dumps, which I normally do every year.. It hasn't been like that this year and I feel this supplement has a lot to do with that. Thanks #Vitacern!!!!

Fortunately for me, the FDA decided Smart Powder’s advertising was too explicit and ordered its piracetam sales stopped; I was equivocal at the previous price point, but then I saw that between the bulk discount and the fire-sale coupon, 3kg was only $99.99 (shipping was amortized over that, the choline, caffeine, and tryptophan). So I ordered in September 2010. As well, I had decided to cap my own pills, eliminating the inconvenience and bad taste. 3kg goes a very long way so I am nowhere close to running out of my pills; there is nothing to report since, as the pills are simply part of my daily routine.

(On a side note, I think I understand now why modafinil doesn’t lead to a Beggars in Spain scenario; BiS includes massive IQ and motivation boosts as part of the Sleepless modification. Just adding 8 hours a day doesn’t do the world-changing trick, no more than some researchers living to 90 and others to 60 has lead to the former taking over. If everyone were suddenly granted the ability to never need sleep, many of them would have no idea what to do with the extra 8 or 9 hours and might well be destroyed by the gift; it takes a lot of motivation to make good use of the time, and if one cannot, then it is a curse akin to the stories of immortals who yearn for death - they yearn because life is not a blessing to them, though that is a fact more about them than life.)

I ultimately mixed it in with the 3kg of piracetam and included it in that batch of pills. I mixed it very thoroughly, one ingredient at a time, so I’m not very worried about hot spots. But if you are, one clever way to get accurate caffeine measurements is to measure out a large quantity & dissolve it since it’s easier to measure water than powder, and dissolving guarantees even distribution. This can be important because caffeine is, like nicotine, an alkaloid poison which - the dose makes the poison - can kill in high doses, and concentrated powder makes it easy to take too much, as one inept Englishman discovered the hard way. (This dissolving trick is applicable to anything else that dissolves nicely.)
Ampakines are structurally derived from a popular nootropic called “aniracetam”. Their basic function is to activate AMPA glutamate receptors (AMPARs). Glutamate (a neurotransmitter) is the primary mediator of excitatory synaptic transmission in mammalian brains, which makes it crucial for synaptic plasticity (the adaptation of synapses, the space between neurons across which information is sent), learning and memory, so when you activate or stimulate glutamate receptors, you can trigger many of these functions. AMPARs are distributed across the central nervous system and are stimulated by incoming glutamate to begin the neuroenhancing benefits they’re often used for. But it is possible to have too much glutamate activity. When excess glutamate is produced, accumulates and binds to AMPARs, the result is excitotoxicity, which is a state of cell death (in the case of the central nervous system and your brain, neuron death) resulting from the toxic levels of excitatory amino acids. Excitotoxicity is believed to play a major role in the development of various degenerative neurological conditions such as schizophrenia, delirium and dementia.

The real culprit at the heart of the problem may be impossible to regulate – the human desire to have a supercharged brain. For now, this wish is still largely relegated to the domain of fiction. Researchers point out that increasing the power of certain parts of the brain, such as areas responsible for learning and focus, would likely deprive other parts of the brain that are needed to live. Despite the appeal of a super-brain, a better goal is still to maintain a balanced brain and lifestyle.

In addition to diet, there are many other things you can also do related to lifestyle, such as stress management through mindfulness (8) or gentle movement such as pre or post natal yoga (9), which have both shown to be incredibly helpful in encouraging mental wellbeing. If you feel you need extra support, personalised nutritional therapy can be very helpful as there can often be other drivers such as nutrient deficiencies and digestive complaints that can play a significant role in mental health and will need to be addressed in a way that is tailored to the individual. 

Surgeries – Here's another unpleasant surprise. You're probably thinking we're referring to a brain surgery, but that's not the only surgery that can influence the blood flow to your brain the bad way. For example, a heart surgery can cause hypoperfusion. How? Fat globules, which are released during these kinds of procedures, can find their way to your brain and disrupt the optimal blood flow.

Manually mixing powders is too annoying, and pre-mixed pills are expensive in bulk. So if I’m not actively experimenting with something, and not yet rich, the best thing is to make my own pills, and if I’m making my own pills, I might as well make a custom formulation using the ones I’ve found personally effective. And since making pills is tedious, I want to not have to do it again for years. 3 years seems like a good interval - 1095 days. Since one is often busy and mayn’t take that day’s pills (there are enough ingredients it has to be multiple pills), it’s safe to round it down to a nice even 1000 days. What sort of hypothetical stack could I make? What do the prices come out to be, and what might we omit in the interests of protecting our pocketbook?
People with failing memory and worried about Alzheimer’s disease are sometimes seduced by advertisements for Huperzine A, extracted from a type of moss. Some studies have shown that it increases levels of acetylcholine in the brain, a chemical that is in short supply in Alzheimer’s. But despite increasing acetylcholine, aside from a few questionable studies in China, there is no evidence that it improves memory. Unfortunately when it comes to memory pills, they are best forgotten. There is, however, hope that a nasal spray containing insulin can increase the absorption of glucose into brain cells and improve cognitive function. But in the meantime, the best bet to maintain good brain function is to monitor blood glucose and blood pressure, eat a diet rich in fruits, vegetables and whole grains, and low in simple carbs and saturated fat. And don’t forget that physical exercise also exercises your brain.
A Romanian psychologist and chemist named Corneliu Giurgea started using the word nootropic in the 1970s to refer to substances that improve brain function, but humans have always gravitated toward foods and chemicals that make us feel sharper, quicker, happier, and more content. Our brains use about 20 percent of our energy when our bodies are at rest (compared with 8 percent for apes), according to National Geographic, so our thinking ability is directly affected by the calories we’re taking in as well as by the nutrients in the foods we eat. Here are the nootropics we don’t even realize we’re using, and an expert take on how they work.
Pop this pill and improve your memory. Swallow that one and reduce your cognitive decline. We see ads for such products all the time and I suspect they will increase as the baby boomers reach senior citizenhood. The most popular brain boosting supplements are fish oil pills and they are also probably the best studied ones. The results are not encouraging. When all the studies are pooled, we are left with the possibility of a barely significant improvement in recalling lists of words soon after they have been learned, but the effect does not last. Extracts of the ginkgo biloba tree are also popular, and here the prospects are even dimmer. There is no impact on memory, despite claims of increased circulation in the brain. And ginkgo can interfere with the action of anticoagulants and has also been shown to be an animal carcinogen.
Brain enhancing drug – the steroids of the mental world, these are compounds that can be both artificial or natural that are not recommended for casual consumption. If taken over a long period of time, they can and will result in permanent and debilitating damage, and if taken wrongly, they can and will result in injury, illness, and death. So far from being the best brain pill that they loop around and punch the actual best brain pill in the face.
One SCFA in particular, called propionic acid, has been identified as a driver for abnormal behaviour that is related to both ADHD and the autism spectrum. This SCFA can alter metabolic and immune pathways, as well as gene expression, which can affect the functionality of the brain cells and their receptivity to neurotransmitters, as well as their ability to regenerate and regulate inflammatory responses. Certain strains of pathogenic bacteria, such as clostridia, have been implicated in producing large amounts of propionic acid. This strain of bacteria is naturally present in the gut, however, an overgrowth can occur when good bacteria levels are compromised and/or there is an acute infection. In addition, processed wheat and dairy products often contain propionic acid as a food preservative in the form of calcium propionate.
Sun: This is a day I devote to spiritual disciplines and deep personal exploration, along with a hefty dose of neurogenesis, and for a day such as this, I’ll use a more potent neuron sprouting and ego-dissolving mix – most notably a blend of psilocybin microdose with Lion’s Mane extract and niacin (if the skin flush and increased blood flow from niacin tends to be too much for you, you can also use “nicotinamide riboside”, a form of vitamin B3 that has similar effects without the flushing).

“Who doesn’t want to maximize their cognitive ability? Who doesn’t want to maximize their muscle mass?” 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.
On the other hand, Phillips said, Provigil's effects "have attenuated over time. The body is an amazing adjusting machine, and there's no upside that I've been able to see to just taking more." A few years ago Phillips tired of poker and started playing competitive Scrabble. He was good, but not that good. He was older than many of his rivals and he needed to undertake a lot of rote memorisation, which didn't come as easily as it once had. "I stopped short of memorising the entire dictionary, and to be really good you have to get up to eight- and nine-letter words," he told me. "But I did learn every word up to five letters, plus maybe 10,000 seven- and eight-letter words." Provigil, he said, helped with the memorisation process but, "it's not going to make you smarter. It's going to make you better able to use the tools you have for a sustained period."
These are the most highly studied ingredients and must be combined together to achieve effective results. If any one ingredient is missing in the formula, you may not get the full cognitive benefits of the pill. It is important to go with a company that has these critical ingredients as well as a complete array of supporting ingredients to improve their absorption and effectiveness. Anything less than the correct mix will not work effectively.
Such competitive anxieties are already being felt in the workplace. Recently an advice column in Wired featured a question from a reader worried about "a rising star at the firm" who was "using unprescribed modafinil to work crazy hours. Our boss has started getting on my case for not being as productive." And on internet forums such as ImmInst (Immortality Institute), whose members share a nerdy passion for tweaking their cognitive function through drugs and supplements, people trade advice about dosages and "stacks" - improvised combinations - of neuroenhancers ("Cut a tablet into fourths and took 25mg every four hours, four times today, and had a great and productive day - with no side-effects"). In one recent post a 52-year-old - who was working full time, studying for an advanced degree at night and "married, etc" - wrote that after experimenting with modafinil he had settled on two daily doses of 100mg each. He believed that he was "performing a little better", adding: "I also feel slightly more animated when in discussion."
Your co-worker in the cubicle next to you could now very likely be achieving his or her hyperfocus via a touch of microdosed LSD, a hit of huperzine or a nicotine-infused arm patch. The fact is, concepts such as microdosing, along with words like “nootropic” and “smart drug” (yes, there’s a difference between the two, as you’re about to discover) are quickly becoming household terms, especially due to all the recent media hype that has disclosed how popular compounds such as smart drugs and psychedelics are among Silicon Valley CEOs and college students, along with the smart drug movies “Limitless” and “Lucy“ and popular TV shows like “Limitless”, “Wormwood” and “Hamilton’s Pharmacopeia”.
As it happens, these are areas I am distinctly lacking in. When I first began reading about testosterone I had no particular reason to think it might be an issue for me, but it increasingly sounded plausible, an aunt independently suggested I might be deficient, a biological uncle turned out to be severely deficient with levels around 90 ng/dl (where the normal range for 20-49yo males is 249-839), and finally my blood test in August 2013 revealed that my actual level was 305 ng/dl; inasmuch as I was 25 and not 49, this is a tad low.
Though their product includes several vitamins including Bacopa, it seems to be missing the remaining four of the essential ingredients: DHA Omega 3, Huperzine A, Phosphatidylserine and N-Acetyl L-Tyrosine. It missed too many of our key criteria and so we could not endorse this product of theirs. Simply, if you don’t mind an insufficient amount of essential ingredients for improved brain and memory function and an inclusion of unwanted ingredients – then this could be a good fit for you.
…Four subjects correctly stated when they received nicotine, five subjects were unsure, and the remaining two stated incorrectly which treatment they received on each occasion of testing. These numbers are sufficiently close to chance expectation that even the four subjects whose statements corresponded to the treatments received may have been guessing.
In fact, when combined into a variety of different supplement “stacks” and taken in the correct dosage, these compounds – usually referred to as either smart drugs or nootropics (but now also including the category of psychedelics) – can completely change how your brain performs, including impacting receptor sites for neurotransmitters, altering levels of enzymes that break down specific neurotransmitters, changing cell membrane structures and thus controlling the movement of molecules inside and outside of the cell, increasing cerebral perfusion, which improves blood flow to the brain, affecting what are called “biogenic processes”, including neuronal cell creation or “neurogenesis”, and neuroendocrine regulation, regulating hormonal processes of the body specifically related to cognition (See additional studies here, here, here and here.).
Now, what is the expected value (EV) of simply taking iodine, without the additional work of the experiment? 4 cans of 0.15mg x 200 is $20 for 2.1 years’ worth or ~$10 a year or a NPV cost of $205 (\frac{10}{\ln 1.05}) versus a 20% chance of $2000 or $400. So the expected value is greater than the NPV cost of taking it, so I should start taking iodine.

One thing I notice looking at the data is that the red magnesium-free days seem to dominate the upper ranks towards the end, and blues appear mostly at the bottom, although this is a little hard to see because good days in general start to become sparse towards the end. Now, why would days start to be worse towards the end, and magnesium-dose days in particular? The grim surmise is: an accumulating overdose - no immediate acute effect, but the magnesium builds up, dragging down all days, but especially magnesium-dose days. The generally recognized symptoms of hypermagnesemia don’t include effect on mood or cognition, aside from muscle weakness, confusion, and decreased reflexes…poor appetite that does not improve, but it seems plausible that below medically-recognizable levels of distress like hypermagnesemia might still cause mental changes, and I wouldn’t expect any psychological research to have been done on this topic.

The magnesium was neither randomized nor blinded and included mostly as a covariate to avoid confounding (the Noopept coefficient & t-value increase somewhat without the Magtein variable), so an OR of 1.9 is likely too high; in any case, this experiment was too small to reliably detect any effect (~26% power, see bootstrap power simulation in the magnesium section) so we can’t say too much.
This is absolutely fantastic work - Dr. Mosconi's clear, concise prose readily breaks down the science of how we can protect our beloved brains from the horrors of dementia and keep our minds humming beautifully for years. Her mastery of the various key subjects - neurobiology, nutrition, biochemistry - is incredible and her ability to decode complex scientific findings into digestible, easy-to-use advice for the layperson is second to none. This is easily one of the best popular science books I've ever come across and by far the best read on nutrition I know of.
A week later: Golden Sumatran, 3 spoonfuls, a more yellowish powder. (I combined it with some tea dregs to hopefully cut the flavor a bit.) Had a paper to review that night. No (subjectively noticeable) effect on energy or productivity. I tried 4 spoonfuls at noon the next day; nothing except a little mental tension, for lack of a better word. I think that was just the harbinger of what my runny nose that day and the day before was, a head cold that laid me low during the evening.
I’m wary of others, though. The trouble with using a blanket term like “nootropics” is that you lump all kinds of substances in together. Technically, you could argue that caffeine and cocaine are both nootropics, but they’re hardly equal. With so many ways to enhance your brain function, many of which have significant risks, it’s most valuable to look at nootropics on a case-by-case basis. Here’s a list of 13 nootropics, along with my thoughts on each.
It looks like the overall picture is that nicotine is absorbed well in the intestines and the colon, but not so well in the stomach; this might be the explanation for the lack of effect, except on the other hand, the specific estimates I see are that 10-20% of the nicotine will be bioavailable in the stomach (as compared to 50%+ for mouth or lungs)… so any of my doses of >5ml should have overcome the poorer bioavailability! But on the gripping hand, these papers are mentioning something about the liver metabolizing nicotine when absorbed through the stomach, so…
Armodafinil is sort of a purified modafinil which Cephalon sells under the brand-name Nuvigil (and Sun under Waklert21). Armodafinil acts much the same way (see the ADS Drug Profile) but the modafinil variant filtered out are the faster-acting molecules22. Hence, it is supposed to last longer. as studies like Pharmacodynamic effects on alertness of single doses of armodafinil in healthy subjects during a nocturnal period of acute sleep loss seem to bear out; anecdotally, it’s also more powerful, with Cephalon offering pills with doses as low as 50mg. (To be technical, modafinil is racemic: it comes in two forms which are rotations, mirror-images of each other. The rotation usually doesn’t matter, but sometimes it matters tremendously - for example, one form of thalidomide stops morning sickness, and the other rotation causes hideous birth defects.)

One of the most common strategies to beat this is cycling. Users who cycle their nootropics take them for a predetermined period, (usually around five days) before taking a two-day break from using them. Once the two days are up, they resume the cycle. By taking a break, nootropic users reduce the tolerance for nootropics and lessen the risk of regression and tolerance symptoms.