In her new book, Brain Food: The Surprising Science of Eating for Cognitive Power (Avery/ Penguin Random House), Dr. Lisa Mosconi, PhD, INHC, Associate Director of the Alzheimer’s Prevention Clinic at Weill Cornell Medical College, highlights the connection between diet and brain function and shares approachable, actionable tips to put that research into practice.
However, normally when you hear the term nootropic kicked around, people really mean a “cognitive enhancer” — something that does benefit thinking in some way (improved memory, faster speed-of-processing, increased concentration, or a combination of these, etc.), but might not meet the more rigorous definition above. “Smart drugs” is another largely-interchangeable term.
Eliminating foggy-headedness seems to be the goal of many users of neuroenhancers. But can today's drugs actually accomplish this? I recently posed this question to Chatterjee's colleague Martha Farah, who is a psychologist at Penn and the director of its Center for Cognitive Neuroscience. She is deeply fascinated by, and mildly critical of, neuroenhancers, but basically in favour - with the important caveat that we need to know much more about how these drugs work. While Farah does not take neuroenhancers, she had just finished a paper in which she reviewed the evidence on prescription stimulants as neuroenhancers from 40 laboratory studies involving healthy subjects. Most of the studies looked at one of three types of cognition: learning, working memory, and cognitive control. A typical learning test asks subjects to memorise a list of paired words; an hour, a few days, or a week later, they are presented with the first words in the pairs and asked to come up with the second. Neuroenhancers did improve retention, especially where subjects had been asked to remember information for several days or longer.
She reveals where she went astray. In a lecture she gave, she lamented the failure of science to offer a cure for Alzheimer’s or even an effective treatment. Someone in the audience asked, “How about olive oil?” She realized she didn’t know anything about the effects of nutrition on Alzheimer’s. She seems to have assumed that diet must be crucially important, and for some reason instead of studying conventional nutrition science, she got a degree in Holistic Nutrition. She bills herself as a certified Integrative Nutritionist and holistic healthcare practitioner. I couldn’t find where she studied, but Stephen Barrett has criticized the Institute for Integrative Nutrition on Quackwatch. Its training is not based on scientific nutrition. It seems most programs in Integrative Nutrition are 6- to 8-month correspondence courses with no prerequisites. I wonder what she was taught.
Methylphenidate was accepted into medical practice in 1960 as a way to treat narcolepsy and ADHD. It works by inhibiting the reuptake of dopamine and norepinephrine into the nervous system, causing a flooding of dopamine and norepinephrine in the synapse between the nerves, which in turn leads to amplified signaling between neurons. It’s been said that these effects are basically the same as those of amphetamines (see more details below), which are synthetic, addictive, mood-altering drugs, used illegally in sports as a stimulant and also legally as a prescription drug – like Ritalin – to treat children with ADD and adults with narcolepsy.
Looking at the prices, the overwhelming expense is for modafinil. It’s a powerful stimulant - possibly the single most effective ingredient in the list - but dang expensive. Worse, there’s anecdotal evidence that one can develop tolerance to modafinil, so we might be wasting a great deal of money on it. (And for me, modafinil isn’t even very useful in the daytime: I can’t even notice it.) If we drop it, the cost drops by a full $800 from $1761 to $961 (almost halving) and to $0.96 per day. A remarkable difference, and if one were genetically insensitive to modafinil, one would definitely want to remove it.
Amphetamine – systematic reviews and meta-analyses report that low-dose amphetamine improved cognitive functions (e.g., inhibitory control, episodic memory, working memory, and aspects of attention) in healthy people, and in individuals with ADHD. A 2014 systematic review noted that low doses of amphetamine also improved memory consolidation, in turn leading to improved recall of information in non-ADHD youth. It also improved task saliency (motivation to perform a task) and performance on tedious tasks that required a high degree of effort.