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Melanie Cole (Host): Today’s topic is Nootropics, also known as smart drugs and cognitive enhancers. Are they performance-enhancing drugs for the brain or are they snake oil? My guest today, Dr. Jesse Corry, fan favorite, here on the Well Cast. He’s Board-Certified in Critical Care and Neurology and serves as a Neurologist at Allina Health United Hospital, Saint Paul. Welcome to the show, Dr. Corry. What is a neurotropic?

Dr. Jesse Corry (Guest): These are drugs – like you said, they’re cognitive enhancers. These are a class of drugs that actually date back to 7,000 years. There are texts in Ancient Indian and even Mesopotamian literature about different drugs that are meant to basically improve your memory, help with attention, help with creativity. What these drugs are meant to do is to do that very thing. It takes those components of how we think, how we perform mentally – memory, attention, creativity, and whatnot – and improves those inherent traits within us.

Melanie: Well, so where are these drugs? Are they a prescription medication? Do doctors use them for certain conditions? Where would they be found?

Dr. Corry: Great question. We kind of see them both in the form of supplements as well as medications that we prescribe. When we think of some pretty common ones – Nootropics – you would consider stimulants, a case of that. Children who are on medications for ADHD -- Methylphenidate – these medications would be considered in the class of Nootropics. They’re meant to improve attention. Memory – I’m sorry, medications like Namenda or Aricept we use for Alzheimer’s would be considered in that class of medication, as well. But more and more what we’re seeing is people who are otherwise healthy who don’t have problems with attention, problems with memory, trying to use these medications. Often times they’re taking them more in the form of supplements. There’s an increasing – about a $1 billion a year industry now in these supplements meant to improve how the people’s attention, memory, creativity, and intelligence.

Melanie: Is Adderall considered a Nootropic?

Dr. Corry: Many people who do not have ADHD do take Adderall for its Nootropic effects – for its ability to improve focus and attention. It’s not uncommon to find people who take this medication without a prescription.

Melanie: Now, you said that they’re in some supplements? Is this a particular active ingredient that’s legal over the counter so it can be used in supplements, but yet, it’s also used in drugs like Adderall and prescription medications?

Dr. Corry: Great question. Now, as far as stimulant medications like Adderall, those you do need a prescription for. Probably the most commonly studied medications that are Nootropic that is over the counter that doesn't require a prescription would be things like Ginkgo Biloba, which does have some weak evidence – but there is some evidence out there that Ginko Biloba does help with improving memory.

Probably the best-studied one is – this is a hard name to say – but it actually has about a 7,000-year track record is Bacopa Monnieri. This is a medication – this is a chemical that comes from a flower found in India, and this has a pretty long history with some smaller, but well-done trials that have shown that people who take this medication – or, I should say supplement, pardon me – if you take this supplement, do show, in fact, improvements in both attention as well as their ability to switch attention and remain focused. There has actually been a number of studies that have looked at this. Probably the best one to date was one where they looked at medical students who took this medication and found that the medical students who took the medication for six weeks did better than their counterparts who did not have this medication on board.

Melanie: So aside from the attentional, and the focus – like Bacopa Monnieri – what about a mood-enhancer. Do these things also help your mood and maybe your energy level, as well?

Dr. Corry: Yeah, some of them very much would help with things of that nature. When we look at the neurotransmitters that are helping with memory and attention -- the memory is stimulated through more of these acetylcholine network, but a lot of times, when you indirectly affect that acetylcholine, you will affect the neurotransmitters that help more with mood, like serotonin, as well as help maybe make you a little more prone towards being happy – things like dopamine. We do know there is some evidence that – again, mainly with Ginkgo, but also another medication called Panax Ginseng, which is also known as Asian Ginseng, which has been shown to help improve mood in many, many a person. It seems as though the overall push of this supplement-Nootropics market is more for the memory, attention, and creativity type focus. The mood-enhancers probably still typically are more in the realm of SSRIs and more in the prescription medications you would receive from a psychiatrist.

Melanie: Well, there’s one very popular Nootropic, Dr. Corry, and that’d be caffeine --

Dr. Corry: Yes.

Melanie: And people also hear about creatine, and that’s an energy supplement that plenty of athletes, and/or weightlifters, that sort of thing – they look to creatine to see if it’s going to enhance their energy formation for working out.

Dr. Corry: Right.

Melanie: Tell us what you want us to be careful of because we’ve heard of some of the dangers of overdoing caffeine – people get the jitters or of creatine as well – tell us some of the dangers, things people should really be on the lookout for.

Dr. Corry: Okay, with caffeine – caffeine is like you said, it’s a great medication. It helps with attention, helps improve memory. The thing with caffeine obviously, is the jitters. There are some folks that if they have a little too much, they can get a little jittery with it. The biggest thing to worry about with caffeine would be changes in blood pressure, particularly people who have high blood pressure, to begin with. They may be more prone towards developing hypertension as a result of the caffeine. However, a lot of times folks who take caffeine for a long time, their body gets used to that, and it mitigates that hypertension.

Another problem with caffeine would be intermittent changes in heart rhythm. If you’re a person who has a history of atrial fibrillation, caffeine may not be the thing that you want to be using. Now, you also bring up another great issue – is the creatine. Creatine, obviously, it’s in a lot of supplements. It’s being used by MMA athletes, et cetera, to help improve those energy stores within muscles. The biggest thing that folks need to be aware of when they’re taking something like creatinine is you need to drink enough water. If you take too little fluid intake with this particular supplement, it puts you at a huge risk of developing renal failure. The kidneys are similar to the brain in that once you start losing kidney tissue, you don’t have a – you often times do not recover that kidney tissue. It’s important then, people who are taking these supplements for improving their strength and explosiveness, that they take in plenty of water on top of that supplement.

Melanie: Well, and another point about supplements -- if people are looking to buy Nootropics, and they’re going to an all-natural store – supplement store – it’s not regulated, whereas Adderall is going to be regulated, caffeine you can get anywhere, but some of these others aren’t regulated, so you don’t know what you’re getting?

Dr. Corry: Exactly, and that’s a big point, and thank you for bringing that up. When folks take in those Nootropics, these are supplements – they’re at a very – at a completely different FDA set of standards by which that they have to comply with as opposed to medications that have to go through Phase I, Phase II, Phase II Trials, et cetera. When you’re taking supplements, you’re often times not knowing if you’re having maybe too much Mercury in them. You’re not sure if the dose is the same from dose to dose.

Why is this important? Particularly with medications that people are taking for those Nootropic effects – for those cognitive effects – is that when you start playing with neurotransmitters, you can develop a whole cascade of unintended side effects. If the person is on, let’s say an antidepressant, and they’re taking a Nootropic that may affect serotonin more or norepinephrine more, they can put themselves at risk for what’s called a serotonin syndrome. Basically, the body goes into mass muscle breakdown, becomes very febrile, very hyperthermic, and the person can develop all sorts of problems just from being encephalopathic and delirious to having muscle breakdown, to having irregular heart rhythms. It’s really important that if a person is going to invest the time into taking a Nootropic that they go and they do some research on it to make sure that the vendor of this particular drug is, in fact, held to standards.

Melanie: That’s really a very good point. Tell us, before we wrap up here, Dr. Corry, does it increase intelligence in the long-run, do you think? Or do you know, as a Neurologist, are you seeing any studies done on it?

Dr. Corry: When we look at right now at does it improve the person’s overall intelligence? The short answer is: probably not. It takes your attention, it takes your memory, and these things especially you can see, it improves what’s inherently within that individual, so it’s more of a performance enhancer. Over time, though, there is increasing evidence – it’s not huge, but just increasing – that these Nootropics, particularly the Bacopa Monnieri and some other medications, may, in fact, stave off some of the oxidative effects – some of those damaging effects that happen to our brain as we age, as we drink too much alcohol, et cetera, and over time, it may hopefully stave off things like Alzheimer’s. The final answer isn’t there yet, but in the long run, these medications may, in fact, let you be yourself longer than you otherwise would have been.

Melanie: So what do you want people to know? What do you want to tell people if they’re considering some of these – if they’re looking into them or if they’re a college student that’s saying they’re going to borrow their friend’s Adderall, what do you want them to know as a Neurologist, Dr. Corry –

Dr. Corry: I would say that –

Melanie: Because this is important to hear from an expert, like you.

Dr. Corry: Yeah, first and foremost, talk to somebody. Talk to a medical professional – a therapist, a neurologist, what have you. Identify are your problems more with mood? Are you having problems with anxiety and depression? That often times will affect things like memory, will affect things like creativity, behavior, and would be treated much differently than a person who just wants to go and improve what they already have – improve their memory, improve their attention. If you’re a person, who’s looking and saying, “My mood is fine. I feel great, but I want to retain more. I want to be able to focus better,” talk to a medical professional. Ensure that you don’t have the criteria for a true ADHD type phenomenon because the medications that they have for that are very good, but they need to be prescribed, so you can be followed under a doctor’s supervision. Many stimulants will affect things like blood pressure blood vessel health, and you want to be under the care of a medical professional if you’re taking these particular drugs so that you don’t develop side effects.

If you are a person who doesn’t have ADHD, but you’re interested in taking one of these supplements, then it’s important that you go on the web, research these places. When they cite different papers, review those papers, make sure that these medications do sound as good as they, hopefully, are portraying themselves to be. Start small, take breaks from the medication, and to be very objective in what you’re looking at. If you’re looking to say, “Okay, is my memory improving?” Find some way to – if your test scores aren’t improving, if you’re noticing you’re still needing to reread books, obviously it’s not working as well as it should have – or you would like it to do, then stop taking the medication.

Melanie: That’s good advice. I think that people also definitely need to do their research on them, and listen to the good advice that Dr. Corry is giving you about Nootropics – if you’re somebody who’s looking to, or if your teenager comes to you and asks you about things like caffeine and creatinine, make sure that they do research and that the listen to this podcast. Thank you, so much, Dr. Corry, for being with us today.

Dr. Corry: No problem.

Melanie: You’re listening to the Well Cast with Allina Health, and for more information, please visit AllinaHealth.org, that’s AllinaHealth.org. This is Melanie Cole. Thanks so much for listening.