Best 9 Nootropics (Smart Drugs) To Unlock Your Full Potential

Nootropics; sometimes referred to as smart drugs – are compounds that enhance brain function. They’re becoming a common way to give an extra boost to your mind. According to one Telegraph survey, up to 25 percent of students at leading UK universities have taken the prescription smart drug modafinil [1], and California tech start-up workers are trying everything from Adderall to LSD to drive their brains to a higher gear[2].

I have been actively benefiting from nootropics since 1997 when I was struggling with cognitive performance and ordered nearly $1000 worth of smart drugs from Europe (the only place where you could get them at that time). I remember opening the unmarked brown package and wondering if the pharmaceuticals and natural substances would really make my brain better.

They did, and I’ve been a big fan of some cognitive enhancers ever since.

But I’m suspicious of the others. The trouble with using a general term like “nootropics” is that you lump all kinds of substances together. Technically, you could argue that both caffeine and cocaine are nootropics, but they’re hardly the same. With so many ways to enhance your brain function, many of which have significant risks, it is most important to look at nootropics on a case-by-case basis. Here’s a list of 9 nootropics, along with my thoughts on each of them.

Modafinil (Provigil), Armodafinil (Nuvigil), Adrafinil

Focus, motivation, clarity, and memory.

I started taking modafinil while I was receiving my MBA at Wharton. At the same time, I was also working at a start-up that was later sold for $600 million in cash, so you can imagine how busy I was. I was looking for a way to keep my brain running.

When I started taking modafinil for the first time, I felt more like myself than I had in years. I took it at different doses every day for 8 years (with a doctor’s prescription). It gave me energy, and it changed my life. I wouldn’t be a biohacker without modafinil today.

When I was working on the Bulletproof Diet book, I wanted to check that the results I was getting from Bulletproof Coffee didn’t come from modafinil, so I quit using it and tested my cognitive performance when I was out of it. What I noticed was that my emotional performance on Bulletproof Coffee and Bulletproof Diet was almost the same as my performance on modafinil. I’m still traveling with modafinil, and I’m going to take it occasionally, but I rarely feel the need while living a Bulletproof lifestyle.

There is a slight risk (about 5 in a million people) of having a life-threatening immune response to modafinil. It’s the same reaction that occurs with ibuprofen and other NSAIDs (non-steroidal anti-inflammatory drugs), so if you know that you don’t respond well to NSAIDs, talk to your doctor before taking modafinil.

One reason I like modafinil is that it stimulates the release of dopamine, but it binds to your dopamine receptors differently than addictive substances like cocaine and amphetamines do, which may be part of the reason that modafinil provides many of the advantages of other stimulants but does not trigger addiction or withdrawal symptoms. [3][4] It does increase concentration, problem-solving, and alertness, but it is not in the same class of drugs as Adderall, and it is not a traditional stimulant. Modafinil is patent-free, so you can get it generically, or order it from India. It’s a prescription drug, so you need to talk to a doctor about it.

You can also seek armodafinil, a more refined form of modafinil, with only biologically similar molecules in it. It has almost the same and sometimes stronger effects. Without insurance, it’s very expensive.

If you don’t want to get a prescription, there’s adrafinil, which has similarities, but I wouldn’t recommend taking it regularly, because it’s a lot of stress on your liver.

Normally prescribed modafinil dose: 50-200 mg, taken in the morning (unless you want to be awake all night) Normally prescribed armodafinil dose: 100-200 mg, taken in the morning Adrafinil dose: 300 mg, taken in the morning.


Focus, mood, motivation

Nicotine is a smart drug: picture of sunrise tobacco plants Nicotine can be a potent nootropic if you take it carefully and sp. Here is a complete guide to the use of nicotine as a nootropic, complete with pros and cons, risks, dose recommendations, and advice on what kind of nicotine to use.

I don’t recommend smoking cigarettes or using tobacco to get nicotine. I’m thinking about very small doses that are much smaller than you would get from smoking. Nicotine has a direct effect on your mitochondrial energy, and just about anything that increases mitochondrial function will make your brain work better.

Amphetamine (Adderall)

Focus… but with high risk and several drawbacks

Big Pharma has been recommending amphetamine (Adderall) for ADHD sufferers for years to come. It’s also popular at college campuses around the time of the exam. Too bad, because there are a lot of better choices.

Amphetamine is at considerable risk. In healthy adults, it improves attention, focus, motivation to work, and short-term memory, all by increasing the release of dopamine and norepinephrine in your prefrontal cortex. [5][6] Amphetamine also reduces fatigue, but it makes you jittery and can increase anxiety.

What concerns me about amphetamine is its addictive potential and the fact that it can cause stress and anxiety. Research says that it is only slightly likely to cause addiction in people with ADHD [7], but we don’t know much about its addictive potential in healthy adults. We all know about the addictive potential of methamphetamine, and amphetamine is closely related enough to make me nervous about so many people giving it to their children. Amphetamines induce withdrawal symptoms, so there is a risk for addiction.

If you want to have a stimulant, drink some coffee.

Forskolin & artichoke extract

Memory, focus, learning

Because smart drugs like modafinil, nicotine, and Adderall come with drawbacks, I have developed my own line of nootropics, including Forbose and SmartMode, which is safe, widely available, and does not require a prescription.

Forskolin, found in Forbose, has been part of Indian Ayurvedic medicine for thousands of years. In addition to being fun to say, forskolin increases cyclic adenosine monophosphate (cAMP), a molecule essential for learning and memory formation. [8] I have been using forskolin for more than a decade.

Forskolin is particularly effective if you combine it with an artichoke extract. Artichoke extract inhibits PDE4, an enzyme that breaks down the cAMP. PDE4 inhibitors make cAMP more available, and when you add cAMP-enhancing effects to your artichoke extract, you get a significant boost to learning, memory, and motivation.

Or you get a headache and an energy crash when you “come down.” That might be because cAMP upping uses more dopamine than your brain would normally do. It affects different people in a different way. All you know is if you try it.

As part of our Bulletproof Brain Mix, Smart Mode includes artichoke extract and other cognitive-enhancing ingredients. Taking Forbose to get your dose of forskolin. Forbose is a special product that helps the body create more energy to power through vigorous physical and mental exercise.


A calm alertness, reaction time, mental endurance

L-theanine is a major component of black and green tea. Theanine, on its own, promotes relaxation,[9] alertness and excitement. [10]

Theanine also works with caffeine synergistically. Together, they increase response time, memory, and mental endurance. [11]

You can get your theanine from a capsule-like Zen Mode, or you can have a cup of green tea or two. If you decide to make green tea, look for tea that’s grown in the shade, because shade-grown green tea tends to have much higher levels of theanine.

A dose of L-theanine: 200 mg. Take 3 Zen Mode soft gels with your morning coffee or take it at night like me.

Bacopa Monnieri

Attention, mood, stress, memory

This is a small water plant native to India. Bacopa is an adaptive agent–it helps your body to adapt to stress. It also improves memory in healthy adults[12] and enhances attention and mood in people over 65 years of age. 13] Scientists still don’t fully understand how Bacopa works, but they do know it takes time to work; study participants didn’t feel its memory-enhancing effects until they had been supplementing it every day for 4 weeks, so if you try Bacopa, stick with it for a month before you give it up.

Bacopa suppresses sperm production in male mice, so if you’re trying to conceive, you might want to skip it. 14] However, it did not affect the testosterone or sex drive of the mice.

Many nootropic companies include Bacopa in their stacks, but they often do not use enough to give you real benefits. You want at least 750 mg a day. Take Bacopa with a fat source to increase absorption.

Bacopa monnieri dose: at least 750 mg daily, taken with a fat source

CoEnzyme Q10

Energy, clarity

Unfair Advantage supports your mitochondria, the power plants of your cells, with two different ingredients: CoQ10 enhances cellular energy production in your mitochondria, giving you both a mental and physical boost. 15] (The dose of CoQ10 is low, but it is in a colloidal form that enhances the delivery of PQQ) ActivePQQTM is a novel form of PQQ that is not inactivated by stomach acid. PQQ promotes the growth of new mitochondria and also helps your body clear up and replace old mitochondria. 16] You have the highest density of mitochondria in your brain’s prefrontal cortex, which helps explain why I first feel the Unfair Advantage in my head. You have the second-highest density in your heart, which is likely why I feel it next in the center of my chest. Mitochondrial energizers may have profound nootropic effects! At higher doses, mitochondrial energizers also make excellent pre-workout supplements.

Unfair Advantage Dose: 1-4 ampules, taken at any time


energy, stress

KetoPrime is another powerful nootropic. It contains oxaloacetate, a compound that can protect your brain from environmental toxins.

Common environmental toxins–pesticides, for instance–cause your brain to release glutamate (a neurotransmitter). Your brain needs glutamate to function, but when you make too much of it, it becomes toxic and begins to kill neurons.

Oxaloacetate protects rodents from brain damage caused by glutamate.[17] Of course, more research is needed to determine whether or not oxaloacetate has the same effect on humans.

KetoPrime is a great way to give a little extra boost to your brain. In animal studies, the Krebs Cycle is also modified, shifting the ratio of NADH to NAD+, making mitochondrial energy production more efficient.

KetoPrime Dose: 1 lozenge, taken in the morning


Memory and Focus

NeuroMaster is a supplement that I helped to formulate when I learned about the power of coffee fruit extract. This significantly increases the level of the brain-derived neurotrophic factor (BDNF)–even more than exercise. BDNF is a key neuroprotein that helps increase neuroplasticity and create new neurons, resulting in better memory and focus.

This is important for the short term and is essential for the long term because you naturally lose BDNF as you age. Lower BDNF levels are associated with age-related hippocampal shrinkage and memory decline.[18] In several studies, 100 mg of coffee fruit extract (red fruit surrounding coffee beans) increased BDNF by approximately 140 percent.[19][21] The boost lasted a few hours.

Dose NeuroMaster: 1 cap, taken in the morning with or without food. You should know about nootropics. When you start taking nootropics for the first time, sometimes you feel like nothing is going on. That’s exactly what I’ve experienced. Then, a week later, I stopped taking them and immediately noticed their absence. This is because when your brain works better, it feels so natural that it’s hard to see unless you have a high degree of self-awareness.

On the other hand, sometimes, you feel a significant cognitive boost as soon as you take a pill. It could be a good thing or a bad thing. For example, I find that modafinil makes you more of what you already are. That means, if you’re already kind of a dick and you’re taking modafinil, you might act like a big dick and regret it. It definitely happened to me! I like to think that I’ve done enough to hack my brain to get through that programming… and that when I use nootropics, they help me help people.

You can also get deeply depressed. One of the nootropics I haven’t written about here, Lucidril, has excellent anti-aging and cognitive benefits for some. Still, others get deeply sad after taking it. After three days on Lucidril, I felt hopeless about my life. Luckily, I did my research, and I stopped taking it right away.

There is an inherent risk of experimenting with pharmaceuticals or illegal drugs such as LSD. The risk is higher than that of most natural substances. You may have a psychotic experience if you take too much LSD; you are more likely to have a severe headache if you take too much of a choline-stimulating herbal substance.

It’s also worth checking the purity of your nootropics. I’ve seen some companies promoting pre-made nootropic stacks that contain ingredients such as blue agave (fructose!), food coloring–even metal pieces. Read the labels!

I have high hopes that the medicine will wake up to the fantastic benefits of nootropics and begin to be incorporated into society. Not only do many of them increase your quality of life, but they also make your brain more resilient to the environment around you. We could all use a little more of that.

Before you try nootropics, I suggest you start with the basics: get rid of things in your diet and life that first reduces cognitive performance. That’s the easiest. Then add energizers such as Brain Octane and clean up your diet. Then go to herbals and natural nootropics. Use drugs selectively only after you’ve figured out your basics.

The truth is, almost 20 years ago, when my brain failed, and I was fat and tired, I didn’t know how to follow this advice. I bought $1000 worth of smart drugs from Europe, took them all out of desperation at once, and had enough cognitive function to save my career and solve my metabolic problems.

You don’t need to do that with the information we have now. Please learn from my mistakes, please!

Medications That Changes Who We Are

“Patient Five” was in his late 50s when a trip to the doctors changed his life.

He had diabetes, and he had signed up for a study to see if taking a “statin” – a kind of cholesterol-lowering drug – might help.

So far, so normal.

But soon after he began the treatment, his wife began to notice a sinister transformation.

A previously reasonable man, he became explosively angry and – out of nowhere – developed a tendency for road rage.

During one memorable episode, he warned his family to keep away, lest he put them in hospital.

Out of fear of what might happen, Patient Five stopped driving. Even as a passenger, his outbursts often forced his wife to abandon their journeys and turn back. Afterward, she’d leave him alone to watch TV and calm down. She became increasingly fearful for her own safety.

Then one day, Patient Five had an epiphany. “He was like, ‘Wow, it really seems that these problems started when I enrolled in this study,'” says Beatrice Golomb, who leads a research group at the University of California, San Diego.

Alarmed, the couple turned to the study’s organizers. “They were very hostile. They said that the two couldn’t possibly be related, that he needed to keep taking the medication, and that he should stay in the study,” says Golomb.

Ironically, by this point, the patient was so cantankerous that he flatly ignored the doctors’ advice. “He swore roundly, stormed out of the office, and stopped taking the drug immediately,” she says. Two weeks later, he had his personality back.

Others have not been so lucky. Over the years, Golomb has collected reports from patients across the United States – tales of broken marriages, destroyed careers, and a surprising number of men who have come unnervingly close to murdering their wives.

In almost every case, the symptoms began when they started taking statins, then promptly returned to normal when they stopped; one man repeated this cycle five times before he realized what was going on.

Antidepressants may not just lighten moods, they may also reduce expressions of neuroticism, research suggests.

According to Golomb, this is typical – in her experience, most patients struggle to recognize their own behavioral changes, let alone connect them to their medication. In some instances, the realization comes too late: the researcher was contacted by the families of a number of people, including an internationally renowned scientist and a former editor of a legal publication, who took their own lives.

We’re all familiar with the mind-bending properties of psychedelic drugs – but it turns out ordinary medications can be just as potent. From paracetamol (known as acetaminophen in the US) to antihistamines, statins, asthma medications, and antidepressants, there’s emerging evidence that they can make us impulsive, angry, or restless, diminish our empathy for strangers, and even manipulate fundamental aspects of our personalities, such as how neurotic we are.

In most people, these changes are extremely subtle. But in some, they can also be dramatic.

The list of potential culprits includes some of the most widely consumed drugs on the planet

Back in 2011, a French father-of-two sued the pharmaceutical company GlaxoSmithKline, claiming that the drug he was taking for Parkinson’s disease had turned him into a gambler and gay sex addict, and was responsible for risky behaviors that had led to him being raped.

Then in 2015, a man who targeted young girls on the internet used the argument that the anti-obesity drug Duromine made him do it – he said that it reduced his ability to control his impulses. Every now and again, murderers try to blame sedatives or antidepressants for their offenses.

If these claims are true, the implications are profound. The list of potential culprits includes some of the most widely consumed drugs on the planet, meaning that even if the effects are small at an individual level, they could be shaping the personalities of millions of people. 

Research into these effects couldn’t come at a better time. The world is in the midst of a crisis of over-medication, with the US alone buying up 49,000 tonnes of paracetamol every year – equivalent to about 298 paracetamol tablets per person – and the average American consuming $1,200 worth of prescription medications over the same period. And as the global population ages, our drug-lust is set to spiral even further out of control; in the UK, one in 10 people over the age of 65 already takes eight medications every week.

In the US, more than 49,000 tons of paracetamol is consumed every year – the equivalent of 298 pills per person.

How are all these medications affecting our brains? And should there be warnings on packets?

Golomb first suspected a connection between statins and personality changes nearly two decades ago, after a series of mysterious discoveries, such as that people with lower cholesterol levels are more likely to die violent deaths. Then one day, she was chatting to a cholesterol expert about the potential link in the hallway at her work when he brushed it off as obvious nonsense. “And I said ‘how do we know that?’,” she says.

Filled with fresh determination, Golomb scoured the scientific and medical literature for clues. “There was shockingly more evidence than I had imagined,” she says. For one thing, she uncovered findings that if you put primates on a low-cholesterol diet, they become more aggressive.

Golomb remains convinced that lower cholesterol can cause behavioral changes in both men and women

There was even a potential mechanism: lowering the animals’ cholesterol seemed to affect their levels of serotonin, an important brain chemical thought to be involved in regulating mood and social behavior in animals. Even fruit flies start fighting if you mess up their serotonin levels, but it also has some unpleasant effects in people – studies have linked it to violence, impulsivity, suicide, and murder.

If statins were affecting people’s brains, this was likely to be a direct consequence of their ability to lower cholesterol. 

Since then, more direct evidence has emerged. Several studies have supported a potential link between irritability and statins, including a randomized controlled trial – the gold-standard of scientific research – that Golomb led, involving more than 1,000 people. It found that the drug increased aggression in post-menopausal women, though, oddly, not in men.

In 2018, a study uncovered the same effect in fish. Giving statins to Nile tilapia made them more confrontational and – crucially – altered the levels of serotonin in their brains. This suggests that the mechanism that links cholesterol and violence may have been around for millions of years.

Golomb remains convinced that lower cholesterol and, by extension, statins can cause behavioral changes in both men and women, though the strength of the effect varies drastically from person to person. “There are lines of evidence converging,” she says, citing a study she conducted in Sweden, which involved comparing a database of the cholesterol levels of 250,000 people with local criminal records. “Even adjusting for confounding factors, it was still the case that people with lower cholesterol at baseline were significantly more likely to be arrested for violent crimes.”.

Fruit flies become more aggressive when their serotonin levels become mixed up; research has shown.

But Golomb’s most unsettling discovery isn’t so much the impact that ordinary drugs can have on who we are – it’s the lack of interest in uncovering it. “There’s much more of an emphasis on things that doctors can easily measure,” she says, explaining that, for a long time, research into the side-effects of statins was all focused on the muscles and liver, because any problems in these organs can be detected using standard blood tests.

This is something that Dominik Mischkowski, a pain researcher from Ohio University, has also noticed. “There is a remarkable gap in the research actually when it comes to the effects of medication on personality and behavior,” he says. “We know a lot about the physiological effects of these drugs – whether they have physical side effects or not, you know. But we don’t understand how they influence human behavior.”

Mischkowski’s own research has uncovered a sinister side-effect of paracetamol. For a long time, scientists have known that the drug blunts physical pain by reducing activity in certain brain areas, such as the insular cortex, which plays an important role in our emotions. These areas are involved in our experience of social pain, too – and intriguingly, paracetamol can make us feel better after a rejection.

Mischkowski wondered whether painkillers might be making it harder to experience empathy

And recent research has revealed that this patch of cerebral real-estate is more crowded than anyone previously thought because it turns out the brain’s pain centers also share their home with empathy.

For example, fMRI (functional magnetic resonance imaging) scans have shown that the same areas of our brain become active when we’re experiencing “positive empathy” –pleasure on other people’s behalf – as when we’re experiencing pain.

Given these facts, Mischkowski wondered whether painkillers might be making it harder to experience empathy. Earlier this year, together with colleagues from Ohio University and the Ohio State University, he recruited some students and spilled them into two groups. One received a standard 1,000mg dose of paracetamol, while the other was given a placebo. Then he asked them to read scenarios about uplifting experiences that had happened to other people, such as the good fortune of “Alex,” who finally plucked up the courage to ask a girl on a date (she said yes).

L-dopa is the most successful treatment for Parkinson’s, but it can have side effects, making people act more impulsively. 

The results revealed that paracetamol significantly reduces our ability to feel positive empathy – a result with implications for how the drug is shaping the social relationships of millions of people every day. Though the experiment didn’t look at negative empathy – where we experience and relate to other people’s pain – Mischkowski suspects that this would also be more difficult to summon after taking the drug.

“I’m not entirely junior anymore as a researcher, and to be honest, this line of research is really the most worrisome that I’ve ever conducted,” he says. “Especially because I’m well aware of the numbers [of people] involved. When you give somebody a drug, you don’t just give it to a person – you give it to a social system. And we really don’t understand the effects of these medications in the broader context.”

Empathy doesn’t just determine if you’re a “nice” person, or if you cry while you’re watching sad movies. The emotion comes with many practical benefits, including more stable romantic relationships, better-adjusted children, and more successful careers – some scientists have even suggested that it’s responsible for the triumph of our species. In fact, a quick glance at its many benefits reveals that casually lowering a person’s ability to empathize is no trivial matter. 

Scientists have known for a while that the medications used to treat asthma are sometimes associated with behavioral changes, such as an increase in hyperactivity

Technically, paracetamol isn’t changing our personalities because the effects only last a few hours, and few of us take it continuously. But Mischkowski stresses that we do need to be informed about the ways it affects us so that we can use our common sense. “Just like we should be aware that you shouldn’t get in front of the wheel if you’re under the influence of alcohol, you don’t want to take paracetamol and then put yourself into a situation that requires you to be emotionally responsive – like having a serious conversation with a partner or co-worker.”

One reason medications can have such psychological clout is that the body isn’t just a bag of separate organs, awash with chemicals with well-defined roles – instead, it’s a network, in which many different processes are linked.

For example, scientists have known for a while that the medications used to treat asthma are sometimes associated with behavioral changes, such as an increase in hyperactivity and the development of ADHD symptoms. Then, more recently, the research uncovered a mysterious connection between the two disorders themselves; having one increases the risk of having the other by 45-53%. No one knows why, but one idea is that asthma medications bring on ADHD symptoms by altering levels of serotonin or inflammatory chemicals, which are thought to be involved in the development of both conditions.

There have been many reports of severe psychological change from the use of statins.

Sometimes these links are more obvious. Back in 2009, a team of psychologists from Northwestern University, Illinois, decided to check if antidepressants might be affecting our personalities. In particular, the team was interested in neuroticism. This “Big Five” personality trait is epitomized by anxious feelings, such as fear, jealousy, envy, and guilt.

For the study, the team recruited adults who had moderate to severe depression. They gave one-third of the study’s participants the antidepressant paroxetine (a kind of selective serotonin reuptake inhibitor (SSRI)), one third a placebo, and one third talking therapy. They then checked to see how their mood and personalities changed from the beginning to the end of a 16-week treatment.

“We found that massive changes in neuroticism were brought about by the medicine and not very much at all by the placebo [or therapy],” says Robert DeRubeis, who was involved in the study. “It was quite striking.”

The idea that antidepressants are affecting neuroticism directly is intriguing

The big surprise was that, though the antidepressants did make the participants feel less depressed, the reduction in neuroticism was much more powerful – and their influence on neuroticism was independent of their impact on depression. The patients on antidepressants also started to score more highly for extroversion.

It’s important to note that it was a relatively small study, and no one has tried to repeat the results yet, so they may not be totally reliable. But the idea that antidepressants are affecting neuroticism directly is intriguing. One idea is that the trait is linked to the level of serotonin in the brain, which is altered by the SSRIs. 

While becoming less neurotic might sound like an appealing side-effect, it’s not necessarily all good news. That’s because this aspect of our personalities is something of a double-edged sword; yes, it’s been associated with all kinds of unpleasant outcomes, such as an earlier death, but it’s also thought that anxious over-thinking might be helpful. For example, neurotic individuals tend to be more risk-averse, and in certain situations, worrying can improve a person’s performance.

Cholesterol-lowering drugs save tens of thousands of lives every year, so people should seek medical advice before stopping taking them.

“What [the American psychiatrist] Peter Kramer warned us about was that when some people are on antidepressants, what can happen is that they begin not to care about things that people care about,” says DeRubeis. If the results do hold up, should patients be warned about how their treatment might change them?

“If I were advising a friend, I would certainly want them to be on the lookout for those kinds of undesirable effects, just like they would naturally be looking out for other side-effects, like whether they’re gaining weight, and so on,” says DeRubeis.

At this point, it’s worth pointing out that no one is arguing that people should stop taking their medication. Despite their subtle effects on the brain, antidepressants have been shown to help prevent suicides, cholesterol-lowering drugs save tens of thousands of lives every year, and paracetamol is on the World Health Organisation’s list of essential drugs because of its ability to relieve pain. But it is important that people are informed about any potential psychological side-effects.

The association with impulsive behaviors makes sense because L-dopa is essentially providing the brain with a dose of extra dopamine

The matter takes on a whole new urgency when you consider that some personality changes can be dramatic. There’s solid evidence that the drug L-dopa, which is used to treat Parkinson’s disease, increases the risk of Impulse Control Disorders (ICDs) – a group of problems that make it more difficult to resist temptations and urges.

Consequently, the drug can have life-ruining consequences, as some patients suddenly start taking more risks, becoming pathological gamblers, excessive shoppers, and sex pests. In 2009, a drug with similar properties hit the headlines after a man with Parkinson’s committed a £45,000 ($60,000) ticket scam. He blamed it on his medication, claiming that it had completely changed his personality.

The association with impulsive behaviors makes sense because L-dopa is essentially providing the brain with a dose of extra dopamine – in Parkinson’s disease, the part of the brain that produces it is progressively destroyed – and the hormone is involved in providing us with feelings of pleasure and reward.

Experts agree that L-dopa is the most effective treatment for many of the symptoms of Parkinson’s disease, and it’s prescribed to thousands of people in the US every year. This is despite a long list of possible side effects that accompany the medication, which explicitly mentions the risk of unusually strong urges, such as for gambling or sex.

In fact, DeRubeis, Golomb, and Mischkowski are all of the opinion that the drugs they’re studying will continue to be used, regardless of their potential psychological side-effects. “We are human beings, you know,” says Mischkowski. “We take a lot of stuff that is not necessarily always good in every circumstance. I always use the example of alcohol, because it’s also a painkiller like paracetamol. We take it because we feel that it has a benefit for us, and it’s OK as long as you take it in the right circumstances, and you don’t consume too much.”.

But in order to minimize any undesirable effects and get the most out of the staggering quantities of medications that we all take each day, Mischkowski reiterates that we need to know more. Because at the moment, he says, how they are affecting the behavior of individuals – and even entire societies – is largely a mystery. 

By Zaria Gorvett, BBC

Nutritional psychiatry: Your brain on food

Nutritional psychiatry: Your brain on food. A very insightful read from Harvard Health Publishing by Eva Selhub:

Think about it. Your brain is always “on.” It takes care of your thoughts and movements, your breathing and heartbeat, your senses — it works hard 24/7, even while you’re asleep. This means your brain requires a constant supply of fuel. That “fuel” comes from the foods you eat — and what’s in that fuel makes all the difference. Put simply, what you eat directly affects the structure and function of your brain and, ultimately, your mood.

Like an expensive car, your brain functions best when it gets only premium fuel. Eating high-quality foods that contain lots of vitamins, minerals, and antioxidants nourishes the brain and protects it from oxidative stress — the “waste” (free radicals) produced when the body uses oxygen, which can damage cells.

Unfortunately, just like an expensive car, your brain can be damaged if you ingest anything other than premium fuel. If substances from “low-premium” fuel (such as what you get from processed or refined foods) get to the brain, it has little ability to get rid of them. Diets high in refined sugars, for example, are harmful to the brain. In addition to worsening your body’s regulation of insulin, they also promote inflammation and oxidative stress. Multiple studies have found a correlation between a diet high in refined sugars and impaired brain function — and even a worsening of symptoms of mood disorders, such as depression.

It makes sense. If your brain is deprived of good-quality nutrition, or if free radicals or damaging inflammatory cells are circulating within the brain’s enclosed space, further contributing to brain tissue injury, consequences are to be expected. What’s interesting is that for many years, the medical field did not fully acknowledge the connection between mood and food.

Today, fortunately, the burgeoning field of nutritional psychiatry is finding there are many consequences and correlations between not only what you eat, how you feel, and how you ultimately behave, but also the kinds of bacteria that live in your gut.

How the foods you eat affect how you feel

Serotonin is a neurotransmitter that helps regulate sleep and appetite, mediate moods, and inhibit pain. Since about 95% of your serotonin is produced in your gastrointestinal tract, and your gastrointestinal tract is lined with a hundred million nerve cells, or neurons, it makes sense that the inner workings of your digestive system don’t just help you digest food, but also guide your emotions. What’s more, the function of these neurons — and the production of neurotransmitters like serotonin — is highly influenced by the billions of “good” bacteria that make up your intestinal microbiome. These bacteria play an essential role in your health. They protect the lining of your intestines and ensure they provide a strong barrier against toxins and “bad” bacteria; they limit inflammation; they improve how well you absorb nutrients from your food; and they activate neural pathways that travel directly between the gut and the brain.

Studies have shown that when people take probiotics (supplements containing the good bacteria), their anxiety levels, perception of stress, and mental outlook improve, compared with people who did not take probiotics. Other studies have compared “traditional” diets, like the Mediterranean diet and the traditional Japanese diet, to a typical “Western” diet and have shown that the risk of depression is 25% to 35% lower in those who eat a traditional diet. Scientists account for this difference because these traditional diets tend to be high in vegetables, fruits, unprocessed grains, and fish and seafood, and to contain only modest amounts of lean meats and dairy. They are also void of processed and refined foods and sugars, which are staples of the “Western” dietary pattern. In addition, many of these unprocessed foods are fermented, and therefore act as natural probiotics. Fermentation uses bacteria and yeast to convert sugar in food to carbon dioxide, alcohol, and lactic acid. It is used to protect food from spoiling and can add a pleasant taste and texture.

This may sound implausible to you, but the notion that good bacteria not only influence what your gut digests and absorbs, but that they also affect the degree of inflammation throughout your body, as well as your mood and energy level, is gaining traction among researchers. The results so far have been quite amazing.

What this mean for you

Start paying attention to how eating different foods makes you feel — not just in the moment, but the next day. Try eating a “clean” diet for two to three weeks — that means cutting out all processed foods and sugar. Add fermented foods like kimchi, miso, sauerkraut, pickles, or kombucha. You also might want to try going dairy-free — and some people even feel that they feel better when their diets are grain-free. See how you feel. Then slowly introduce foods back into your diet, one by one, and see how you feel.

When my patients “go clean,” they cannot believe how much better they feel both physically and emotionally, and how much worse they then feel when they reintroduce the foods that are known to enhance inflammation. Give it a try!

For more information on this topic, please see: Nutritional medicine as mainstream in psychiatry, Sarris J, et al. Lancet Psychiatry. 2015

The field of Nutritional Psychiatry is relatively new, however there are observational data regarding the association between diet quality and mental health across countries, cultures and age groups – depression in particular. Here are links to some systematic reviews and meta-analyses:

There are also now two interventions suggesting that dietary improvement can prevent depression:

Diet during early life is also linked to mental health outcomes in children (very important from public health perspective):

Extensive animal data show that dietary manipulation affects brain plasticity and there are now data from humans to suggest the same:

Finally, while there are yet to be published RCTs testing dietary improvement as a treatment strategy for depression, the first of these is underway and results will be published within six months:

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Best Adderall Alternatives

Pending review. Contribute to this article.

In a world of distractions and competition, it’s only natural to want to strive for more. When it comes to cognitive and physical improvement, Adderall meets much of the user’s “needs” and is often thought of as a nootropic. Some people use Adderall for medical purposes, while others do not necessarily need Adderall to work but take Adderall to gain an edge in work or school.

As you will come to learn, there are safer and non-addictive ways to achieve the desired effects. But let’s first focus on what Adderall is, so you know what to replace with.

What is Adderall? #

Adderall is a drug combination containing four salts of the two amphetamines. Its incredibly effective for ADHD, as well as in boosting focus, enhancing concentration, and enhancing performance.

“Adderall is a combination medication containing four salts of amphetamine. Adderall is used in the treatment of attention deficit hyperactivity disorder (ADHD) and narcolepsy. It is also used as an athletic performance enhancer and cognitive enhancer, and recreationally as an aphrodisiac and euphoriant. It is a central nervous system (CNS) stimulant of the phenethylamine class. Adderall is generally well-tolerated and effective in treating the symptoms of ADHD and narcolepsy.

At therapeutic doses, Adderall causes emotional and cognitive effects such as euphoria, change in desire for sex, increased wakefulness, and improved cognitive control. At these doses, it induces physical effects such as a faster reaction time, fatigue resistance, and increased muscle strength.

In contrast, much larger doses of Adderall can impair cognitive control, cause rapid muscle breakdown, or induce a psychosis (e.g., delusions and paranoia).” [1]

Still, Adderall is one of the world’s most prescribed stimulants, with many doctors seeing it as the optimal solution to manage narcolepsy, shift work sleep disorder, and other sleep-related disorders. However, many consider its side effects to be too much, causing Adderall to solve a problem while creating another one.

Adderall is also highly addictive, and there are many unfortunate cases of children checking for Adderall addiction in rehabilitation. Especially in the US, this is a real problem.

Fortunately, other substances act similarly and are significantly safer than Adderall. Although most of them are not as powerful, some are surprisingly effective and come very close to achieving the same effects.

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What Are the Uses of Adderall? #

Adderall has been prescribed for some people, many people use it off-label. It may vary from those who use it for purposes off-label. Some people may enjoy its socially enhancing effects, while others may use it as a tool in life to achieve more.

You may use it, or you may intend to use it. The main question you should ask yourself is, “What do I want to get out of the experience?”. Some solutions might work better for you than others, and potency isn’t all.

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What Are the Adderall Alternatives? #

Adderall is not a sustainable solution, whether it is used to treat mental problems or to gain an edge in work or school as a cognitive enhancer. Also, ordering Adderall online is illegal, which is why it is best to look for legal alternatives to Adderall that meets your needs. With some of the best Adderall alternatives that are both safer and more effective for your purposes, you can easily get the same benefits.

Natural Adderall Alternatives #

L-Theanine & Caffeine #

L-theanine is an amino acid widely consumed through green tea.

As a nootropic, L-Theanine is not precisely known for its stimulating effects, although the usual way it is consumed would make you believe it is responsible for stimulation. Green tea also contains caffeine, which is part of the experience’s stimulation.

Through its action on alpha brain waves, L-Theanine produces a state of mindful relaxation, the same that is affected during meditation.

However, the amount of L-theanine found in green tea is too low, and you’d have to drink about four cups of tea to eat a moderate dose of L-theanine. This would make it difficult for you to identify the effects of L-theanine, as you would also consume abundant quantities of caffeine.

Supplementing L-theanine with caffeine, or alternatively, with your usual cup of coffee, is effective in increasing focus and energy levels, minus the “stimulating jitters” that results from caffeine sometimes. L-theanine cancels the jitters or the over stimulation some people tend to get as a reaction to caffeine.

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Noopept #

Noopept is a racetam-like nootropic that improves memory, focus, and boosts brain function, in addition having neuroprotective properties. It has soothing effects on anxiety, and while it differs significantly from Adderall, it can help to serve similar purposes.

It’s beneficial in the areas of social anxiety, information processing, and learning.

Instead of being toxic to the brain, as is the case with Adderall, Noopept encourages the growth, maintenance, and longevity of brain cells (NGF & BDNF). It’s also very inexpensive.

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Phenylpiracetam #

Racetams are popular among the nootropic community, especially Phenylpiracetam, said to be the one closest to Adderall in both its effects and structure.

It is a derivative of piracetam with an added phenyl group.

It was developed by the Russian Academy of Sciences and said to be up to thousands of times higher in potency than Piracetam, also producing noticeable stimulating effects.

Phenylpiracetam is widely and easily available to purchase online. It is one of, if not the most, potent compounds from the racetam family of nootropics and one of the more powerful, potent smart drugs available.

The chemical resemblance of Phenylpiracetam to Adderall is responsible for creating effects that, although somewhat different, can be compared with stimulants.

It is also known that Phenylpiracetam decreases anxiety and helps in the treatment of depression.

During his 200-day space travel, Aleksandr Serebrov took Phenylpiracetam and thought of its effect to be an “equalizer of the entire organism” and praised his ability to “exclude impulsiveness and irritability.”

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Aniracetam #

Originally intended to treat memory disorders, Aniracetam is currently one of the racetams that many people use for improving concentration and focus.

It has the function of stimulating specific (AMPA and Glutamate) receptors in the brain. The slight structural difference from other racetams makes aniracetam a fat-soluble compound that has different properties in the human body.

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Modafinil and Adrafinil

Modafinil is a prescription wakefulness enhancer.

It’s a smart drug that increases productivity and cognitive function – with much lesser potential side effects. It’s considered to be the short-term effects closest to Adderall.

Interestingly, Modafinil does not belong to the drug stimulant class, as its effects may lead you to believe. Modafinil is a wakefulness-enhancing agent and is different from Adderall mechanism of action.

Adderall increases dopamine and norepinephrine activity and causes histamine, serotonin, and epinephrine to be released. This leads to a similar feeling to the response to fight or flight, creating intense stimulation and excitement.

Modafinil inhibits GABA production and increases dopamine, norepinephrine, histamine, and orexin, though much more gentle than traditional stimulants like Adderall.

As a result, the effects are mild, with the peak effects lasting about 6 hours, while the entire experience is up to 12 hours, followed by an afterglow period.

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What’s Adrafinil?

Adrafinil is a Modafinil prodrug, meaning the body is metabolizing it through the liver into Modafinil.

This means that in terms of effects, they are almost the same.

Modafinil peaks around the 60-90 minute mark somewhere, whereas Adrafinil may take about 2 hours to take effect as it needs to be processed first by the liver.

It is reported that Adrafinil is about three times less potent than Modafinil in terms of dosage comparison.

A typical dose of Modafinil ranges from 100 mg to 200 mg, although for many people, lower or higher doses are just as effective.

Adrafinil dosage ranges anywhere from 300 mg to 600mg, with some community members saying they take doses of up to 1,200mg.

I personally have never taken more than 600mg neither would I recommend that.

Adderall has a real therapeutic value, but its long-term and short-term side effects cost too much. The diversity of natural and synthetic cognitive enhancers makes experimentation a wiser choice, whether you’re currently using or plan to use Adderall in the future.

In selecting the best alternative for Adderall, you have to understand that there is no one-size-fits-all choice that can work well for everyone.

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Adderall vs Modafinil #

Concerning the “battle” between Modafinil and Adderall, the winner is definitely Modafinil, for two reasons: first, Modafinil is as effective as Adderall. Some might even call Modafinil better for productivity and learning because of its non-euphoric nature, laser-like focus on one experience, and prolonged effects.

Another reason why Modafinil is the best Adderall alternative is that Modafinil has low addictive potential, fewer side effects, and a nearly non-existent crash. After prolonged use, Adderall causes changes in the brain, leading to addiction and damage that can take a long time to mend.

In fact, when it comes to Adderall, if you go past a certain threshold, you will experience difficulty in completing tasks. Adderall will also make you feel drained after the effects have been worn off, after a few hours after the last dose.

Usually follow cognitive dysphoria and mental fatigue, which is not exactly the best idea when it comes to productivity or long-term study.

Modafinil half-life (the time it takes half the substance to leave the body) is 15 hours and should be taken early in the day to avoid night-sleeping difficulty. Even after prolonged use, one or two days of tiredness would be experienced if one were to stop. It is back to normal after that. Nothing like Adderall’s symptoms of depression and withdrawal.

Modafinil, however, is also a prescription drug.

Related: 6 Best Natural Nootropic Supplements

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Power Foods for the Brain


A brilliant talk by Dr. Neal Barnard that is very important and useful for everyone and anyone. In his TEDx talk, Dr. Barnard talks about power foods for the brain, saying:

On February 8, 2012, my father passed away.

The truth is that was the day his heart stopped beating.

For all intents and purposes, my father had died years earlier. It started with memory lapses, and as time went on, his memory failed more and more, and it got to the point where he didn’t know his own kids who came in to see him.

His personality changed, and his ability to take care of himself was completely gone. And… If you could make a list of all the things that could ever happen to you, the very last thing on your list, at the very bottom of the list, the thing you want the least is Alzheimer’s disease, because when you lose your memory, you lose everything. You lose everyone who ever mattered to you.

If you could look into the brain of a person who has this disease, what you see is, between the brain cells are these unusual looking structures. Beta-amyloid protein comes out of the cells, and it accumulates in these little meatball-like structures that are in front of you, on a microscopic slide. They shouldn’t be there, and they are a hallmark of Alzheimer’s disease. This disease affects about half of Americans by their mid-80s.

You could say to your doctor, “OK, I don’t want that. What can I do to stop that?” Your doctor will say, “Well, its old age and it’s genetics.” There’s a gene – it’s called the APOE-[epsilon]4 allele. If you have this gene from one parent, your risk is tripled;

if you got it from both parents, your risk is 10 to 15 times higher than it was before.

What’s the answer? Get new parents? No, I don’t think so. That’s not it. So, I’m sorry: it’s old age, it’s genes, period, that’s it; there’s not a darn thing you can do just wait for it to happen. Or maybe not. In Chicago, researchers started something called the Chicago Health and Ageing Project.

What they did was they looked at what people in Chicago were eating. They did very careful dietary records in hundreds and hundreds of people, and then they started to see who, as the years go by, stayed mentally clear, and who developed dementia.

The first thing they keyed in on was something that I knew about as a kid growing up in Fargo, North Dakota – My mom had five kids, we would run down to the kitchen to the smell of bacon.

My mom would take a fork, and she’d stick it into the frying pan and pull the hot bacon strips out and put them on a paper towel to cool down, and when all the bacon was out of the pan, she would carefully lift up that hot pan and pour the grease into a jar to save it – that’s good bacon grease, you don’t want to lose that!

My mother would take that jar, and she would put it not in the refrigerator but she’d put it on the shelf, because my mother knew that as bacon grease cools down, what happens to it? It solidifies. And the fact that it’s solid at room temperature is a sign that bacon grease is loaded with saturated fat, bad fat.

We’ve known for a long time that that raises cholesterol, and there’s a lot of in bacon grease. And by the way, the next day, she’d spoon it back into the frying pan and fry eggs in it; it’s amazing any of her children lived to adulthood. That’s the way we lived.

The number one source of saturated fat is actually not bacon, it’s dairy products, cheese, and milk, and so forth; and meat is number two. In Chicago, some people ate relatively little saturated fat, around 13 grams a day, and others ate about twice that much, and the researchers just looked at who developed Alzheimer’s disease. And can I show you the figures? Here’s the low group, and there is the high group. In other words, if you are avoiding the bad fat, your risk was pretty low, but if you were tucking into the cheese and the bacon strips, your risk was two, three, or more-fold higher.

Then they looked not just at saturated fat, they looked at the fat that’s in doughnuts and pastries; you know what that is, that’s trans fats you’ll see on the labels. They found the very same pattern in there, too.

So, the people who tended to avoid the saturated fat and the trans fats, wanted to avoid them for cholesterol and heart disease reasons, but they also seem to affect the brain. Then researchers in Finland said, “Wait a minute, let’s go further.”

There is a condition we call mild cognitive impairment. You’re still yourself – you’re managing your checkbook, you’re driving, your friends know it’s you – but you’re having mental lapses, especially for names and for words.

They brought in over 1,000 adults, they were 50 years old, and they looked at their diets. Then, as time went on, they looked to see who developed mild cognitive impairment.

Some of these people ate relatively little fat, some people ate a fair amount, and then they looked at whose memory started to fail.

They found exactly the same pattern. In other words, it’s not just, “Will I get Alzheimer’s disease?” but, “Will I just have old age memory problems?”

Well, what about that gene, that APOE-[epsilon]4 allele the one that condemns you to Alzheimer’s disease?

Well, they then redid the study, and they focused only on those people, and some of these people ate relatively little fat, some people ate more, and– …Exactly the same.

In other words, if you are avoiding the bad fats, even if you have the gene, your risk of developing memory problems was cut by 80%. And this is my most important point: genes are not destiny. Let’s take another look in those plaques.

We know there’s beta-amyloid protein, but there’s also iron and copper. Metals in my brain? That’s right, there are metals in foods, and they get into the brain. Now think about this: I have a cast-iron pan, and we had a backyard barbecue, and a week later, I remember, “Oh… I left my frying pan on the picnic table, and it rained last week.” What happened to my pan? It rusted, and that rust is oxidation.

Or you take a shiny new penny, and does it stay shiny forever? No, it oxidizes too. Well, iron and copper oxidize in your body, and as they do that, they cause the production of what are called free radicals.

You’ve heard of free radicals: free radicals are molecules that are swimming around in your bloodstream, and they get into the brain, and they act like sparks that seam through the connections between one cell and the next.

So, how is this happening? Where am I getting all this iron? Where am I getting all this copper?

How can that be? How many people have a cast iron pan? Let me see hands. If that’s your once a month pan, I’m going to say, “Who cares?” But if it’s every single day, you’re getting the iron into your food, and it’s more iron than your body needs. Or copper pipes. Who has copper pipes?

That water sits in the copper pipes all night long, and in the morning it goes into the coffee maker, and you’re drinking that copper, you get more than you need, and it starts producing these free radicals that go to the brain. If you’re a meat eater, of especially liver, there’s iron and copper in those foods too.

And we used to think, “Isn’t that great?” until we realized iron is a double-edged sword. You need a little bit, but if you have too much, it becomes toxic. Vitamins. Vitamin manufacturers put in vitamin A, and the B vitamins, and vitamin C, and vitamin D.

And then they throw in iron and copper, thinking, “Well, you need these,” not recognizing you’re already getting enough in foods, and if they add it to your supplement, you are getting too much. OK, so what am I saying?

What I’m saying is aside from the fact that the saturated fat and the trans fats will increase our risk, these metals will, too, and they are causing sparks to form in the brain, free radicals to form that seam through the connections. And if that’s the case, then I need a fire extinguisher. And we have one, and it’s called vitamin E. Vitamin E is in spinach, and it’s in mangoes, and it’s especially in nuts and seeds.

And in Chicago, some people eat a little bit of it, and some people eat a lot of it, and the beauty of this is vitamin E is an antioxidant: it knocks out free radicals. So, if what I’m saying is true, then the people in Chicago who ate only a little bit of vitamin E would be at much higher risk than people who ate a lot, and that’s exactly what the research showed.

People getting eight milligrams a day of vitamin E cut their risk of Alzheimer’s by about half compared to people getting less than that.

Hmm, OK, how do I get that?

It’s very, very easy: run to the store and just buy a bottle of vitamin E pills.

No, I don’t think so, and here’s why not.

Nature has eight forms of vitamin E. It’s built into nuts and into seeds, but if I put it into my supplement pill, I can legally call it vitamin E if it has only one form. And if you’re eating too much of one form of vitamin E, it reduces your absorption of all the others. So, you want to get it from food; that’s the form that nature has designed for us, and that’s the form that we’ve evolved with.

We can go a step further. Oh, by the way, I forgot to tell you. How much should I have? If I put some nuts or seeds into the palm of my hand, by the time it hits your fingers, that’s just one ounce, and that’s about five milligrams of vitamin E, right there. The trick is: don’t eat it; because if you do, you know what happens. If you have those diced salty almonds, and you’ve eaten them: you fill your hand again, and then you eat it again.

There’s something about salty cashews and almonds, is it just me? There’s something about them, they’re a little bit addicting in some way. So, don’t do that, that’s going to be way more than you need. The answer is pour them into your hand, and then crumble them up, and put them on your salad, or put them on your oatmeal, or on your pancakes, or something. Use them as a flavoring not as a snack food, then you’re going to be OK. All right, researchers at the University of Cincinnati went one step further.

Not just saturated fat, not just trans fats, not just vitamin E, but they said, “What about color?” Look at blueberries and grapes: that color that they have is dramatic. And the colors of blueberries aren’t just there to make them pretty, those are called anthocyanins. They brought in a group of individuals into a research study: average age: 78, and everyone was already having memory problems. And what they asked them to do was to have grape juice, a pint a day.

A cup in the morning, a cup at night. Three months later, they tested everyone, and their memory was better, and their recall was better. Three months? That sounds too easy. How can that be? Well, think about it: a grape has a rough life.

A grape has to sit on the vine, all day long under the sun, and exposed to the elements, and it has no protection. Or does it? That purple color, those anthocyanins happen to be powerful antioxidants, just like vitamin E, but they’re the grape form, and if you consume them, they go into your bloodstream.

And if that’s true, it doesn’t have to be grapes, it could be anything that has that color. Like blueberries. So, back into the laboratory: a new group of patients, they came in, they all had memory problems. And three months on blueberry juice,

Their memory was better, their recall was better. Now, the moral of the story is not to have grapes and blueberries, and blueberry juice, and grape juice.

No, the answer is color.

If you look at the colorful foods, there’s an important lesson there for us. You walk into the grocery store, and from a hundred feet away, looking at the produce department, you can recognize beta-carotene, lycopene, anthocyanins.

Your retina can detect them because that’s the orange color of a carrot, or the red color of a tomato, or the purple color of a grape. And the brain also tells you they’re pretty, they’re attractive, you can recognize antioxidants, you’re drawn to them. So, back in 2009, my organization, the Physicians Committee for Responsible Medicine, went to the Department of Agriculture. We said, “This is important. Let’s throw out the pyramid.”

The pyramid was a nice shape, but it had a meat group, and it had a dairy group, despite the fact that people who don’t eat meat or dairy products happened to be healthier than people who eat them.

And also, who eats off a pyramid anyway? We eat off a plate. So, we devised a plate that said fruits, and grains, and legumes – that’s the bean group – and vegetables, those should be the staples. Well, we gave this to the USDA in 2009, and we didn’t hear back from them. So, in 2011, we sued the federal government, the Physicians Committee filed a lawsuit against the USDA, simply to compel response.

And did you see what the US government came out with in 2011? I’m not taking any credit for this, but this is now US government policy, it’s called MyPlate, and it does look in some way similar to what we’d sent them a couple of years earlier.

Fruits, and grains, and vegetables, and they have this thing called ‘the protein group.’ The protein group could be meat, but it could be beans, or tofu, or nuts, or anything that’s high in protein, it doesn’t have to be meat. In fact, there is no meat group anymore in federal guidelines.

There’s a dairy group there, but to their credit, soy milk counts. So, things are improving. So far, what we’ve talked about is getting away from the saturated fats, that’s in cheese, and bacon, and meats; getting away from the trans fats and snack foods; you’re having the vitamin E and the colorful foods; and there’s one more step. It’s not all food, there’s something to say about exercise.

At the University of Illinois, researchers brought in a large group of adults, 120 of them, and they said, a brisk walk, three times a week. After a year, everyone went into the laboratory for a brain scan. They measured the hippocampus which is at the center of the brain, and it’s the seat of memory: it decides what should be let through into memory, and what should not be let through. It turned out that this organ, which is gradually shrinking in older adults, suddenly, stopped shrinking.

The exercisers found that their hippocampus was a little bit bigger, and a little bit bigger, and a little bit bigger, it was as if time was going backwards: It reversed brain shrinkage, and on memory tests, they did substantially better.

So, I’ve devised my own exercise plan. I’d like to present it to you, I do this three times a week. Arrive at the airport as late as possible, carry massively heavy luggage, and just run for the plane.  At the University of Illinois they had their own ideas, and their idea was a little simpler. Do a ten-minute walk, and do it three times a week. And then, next week, let’s do a 15-minute walk, and the week after that, 20.

All they did was add five minutes a week until they got to 40 minutes.

And a 40-minute brisk walk – this is not a trudge, but it’s a good brisk walk – 40 minutes, three times a week is all you need to improve memory and reverse brain shrinkage. Very simple. What I would like to do is to go back in time, and I want to sit down with my dad, and I want to say, “Dad, I found out something really important. We can change our diet, we don’t really need that cheese and that bacon. There’s plenty of healthy things that we can eat. Let’s bring in the colorful vegetables and fruits, let’s make them part of our everyday fair.

Let’s lace up our sneakers, let’s exercise together.” It’s too late for him.

But it’s not too late for you. It’s not too late for me either, and if we take advantage of what we have now learned about how we can protect our brain, then perhaps, families will be able to stay together a little bit longer.

Thank you very much.

Dr. Barnard TEDx Talk

Dr. Barnard has led numerous research studies investigating the effects of diet on diabetes, body weight, and chronic pain, including a groundbreaking study of dietary interventions in type 2 diabetes, funded by the National Institutes of Health. Dr. Barnard has authored over 70 scientific publications as well as 17 books. As president of the Physicians Committee, Dr. Barnard leads programs advocating for preventive medicine, good nutrition, and higher ethical standards in research. He has hosted three PBS television programs on nutrition and health and is frequently called on by news programs to discuss issues related to nutrition and research. Originally from Fargo, North Dakota, Dr. Barnard received his M.D. degree at the George Washington University School of Medicine and completed his residency at the same institution. He practiced at St. Vincent’s Hospital in New York before returning to Washington to found the Physicians Committee.

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6 Best Natural Nootropic Supplements


Whether you’ve just come across the term ‘Nootropics‘ and wondering what the hell it means, or you’ve been supplementing with them for a long time already, the following guide is insightful for both cases.

William Cole, a “functional medicine practitioner” (a term I haven’t heard until today but very intrigued by for sounding very promising) wrote as an introduction to compilation:

Brain and neurological problems have reached the highest numbers in human history. Anxiety, brain fog, fatigue, depression, ADD, autism, Alzheimer’s, Parkinson’s, and multiple sclerosis are just some of the brain conditions affecting nearly everyone on planet Earth in some way. Why is this happening? What are we doing as a society that could have triggered such a massive epidemic—one that threatens the quality and quantity of countless lives? My job as a functional medicine practitioner is to get to the root cause of health problems, especially brain and neurological issues like the ones mentioned above. And although multifaceted and complex, one exciting tool we use to improve and support optimal brain function is nootropics.

And in that introduction is another exciting fact, is that in their practice of improving and supporting optimal brain function, in such an important field, is the use of nootropics.

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What Are Nootropics?

Although we already have a progressive Nootropics 101 page to answer that What Are Nootropics question, this is more focused on the list in hand.

So what are nootropics? I’m glad you asked! They’re fancy-sounding, but “nootropic” is just a term for a broad range of supplements, drugs, or other substances that may have the ability to enhance cognitive function.

Also referred to as smart drugs, the goal of nootropics is to improve memory and cognitive performance in otherwise healthy individuals—hence the nickname. They have also been praised for their neuroprotective benefits. In other words, they not only claim to boost brain power, but they also may protect your brain from deterioration over time.

Natural Nootropics versus Pharmaceutical Nootropics

Nootropics can be natural, synthetic, or prescription. In fact, the commonly prescribed Ritalin and Adderall are considered nootropics. There are also many synthetic options hitting the market now, but research surrounding their long-term effects is still developing. So while synthetic options like Modafinil, Adrafinil, and Piracetam can seem tempting for those struggling with severe brain fog or fatigue, in functional medicine we strive to uncover and treat the underlying cause and try natural solutions before synthetic ones.

Luckily, there is also a wide range of natural nootropics—many of which you might already be familiar with—that have been used in alternative medicine for years.

So while medications and synthetic drugs offer a quicker reaction time, they also have more intense side effects and require a prescription.

Nootropic Supplements, Drinks, Ingredients

If you’re just looking to dip your toes into the world of nootropics and boost brain performance, including natural nootropics in your wellness routine is the way to go.

These can be easily accessed, and you’d be surprised by how many you are probably already familiar with.

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Best Natural Nootropics List

1. Caffeine

Everyone’s favorite, caffeine is the superstar nootropic. Found in coffee, green tea, and chocolate, chances are you’ve been using this for your morning boost for years. You can also find caffeine supplements if you aren’t a fan of any of the usual vehicles. Caffeine helps you feel more alert and wakes you up by blocking your brain’s adenosine receptors.

2. L-Theanine

If caffeine alone just isn’t cutting it, add in this amino acid to boost the benefits of both of these nootropics. L-theanine and caffeine are both naturally occurring in tea, especially green tea, making this beverage the better choice over coffee if you are wanting the boost of both, sazwq\q

L-theanine is a natural amino acid, often called the “natural xanax”. It almost only exists in green tea leaves. It works brilliantly in unwinding and relaxing the body and brain without causing drowsiness, while reducing stress and increasing cognitive function. Due to not causing drowsiness, it is the perfect choice to combine with stimulants of any sort to take the edge off.

3. Creatine

This amino acid is used by your body to make protein and promote muscle growth, making it a popular supplement among athletes. It is also considered great fuel for your brain because it binds with phosphate in your brain to give energy to your brain’s cells for increased short-term memory.

4. Ginkgo biloba

You can’t expect me to get through a list of herbs without mentioning at least one adaptogen. The leaves of the ginkgo biloba tree have been shown to be a powerful brain booster. Not only has this been shown to improve memory, but it can also alleviate stress by decreasing your stress hormone, cortisol.

5. Panax ginseng

This other superstar adaptogen works to improve memory by reducing oxidative stress to promote brain-protecting nitric oxide. Research has further shown this adaptogens brain-boosting power with its ability to prevent age-related memory loss and improve long-term memory.

6. Curcumin

You may have 99 problems, but curcumin has probably already solved 98 of them—and you can add improved cognitive performance to that list. This compound in turmeric has been shown to improve working memory with consistent long-term supplementation. Curcumin can also increase BDNF, reduce oxidative stress, and inhibit inflammatory cytokines.

How To Use Nootropics?

The amazing thing about natural nootropics is that you can easily add them to your daily wellness routine. Most of these herbs and compounds can be found in supplement form from any natural food or vitamin store and even online. You can also find adaptogens and turmeric in powder form, which you can add to various smoothies, elixirs, or recipes.

While these natural smart drugs are considered generally safe, it’s still important to remember that the research surrounding them as nootropics is limited and still developing. Since everyone is different, depending on your health case, you may be more sensitive to certain nootropics, such as L-theanine or caffeine. Some people, for example, have specific gene mutations that make metabolizing caffeine more difficult. My advice is to start slow, listen to your body, adjust accordingly, and always tell your doctor about your supplement use.

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About the author:

Dr. Will Cole, leading functional-medicine expert, consults people around the world via webcam at and locally in Pittsburgh. He specializes in clinically investigating underlying factors of chronic disease and customizing health programs for thyroid issues, autoimmune conditions, hormonal dysfunctions, digestive disorders, and brain problems.Dr. Cole was named one of the top 50 functional-medicine and integrative doctors in the nation and is the author of Ketotarian in which he melds the powerful benefits of the ketogenic and plant-based diets.

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New Drug Hopes to Reverse Memory Loss

An experimental drug that bolsters ailing brain cells has raised hopes of a treatment for memory loss, poor decision making and other mental impairments that often strike in old age.

The drug could be taken as a daily pill by over-55s if clinical trials, which are expected to start within two years, show that the medicine is safe and effective at preventing memory lapses.

Tests in the lab showed that old animals had far better memory skills half an hour after receiving the drug. After two months on the treatment, brain cells which had shrunk in the animals had grown back, scientists found.

Etienne Sibille, at the Centre for Addiction and Mental Health in Toronto, said the treatment was aimed not only at the “normal” cognitive decline that leads to senior moments, but at memory loss and mental impairments that commonly afflict people with depression, schizophrenia and Alzheimer’s disease.

If the drug did well in human trials, Sibille said it was possible that “anybody over the age of 55-60 who may be at risk of cognitive problems later on could benefit from this treatment”.

“Our findings have direct implications for poor cognition in normal ageing,” he said, with the drug potentially improving learning, memory, decision making and essential life planning. “But we see this deficiency across disorders from depression to schizophrenia and Alzheimer’s.”

There are no medicines on the market that improve the sort of memory loss seen in old age and psychiatric disorders such as depression and schizophrenia. But the Toronto researchers believe their drug can reverse failing memories by targeting specific cells involved in learning and memory, and rejuvenating them. The changes the drug brings about in the brain suggest it could prevent memory loss at the beginning of Alzheimer’s and potentially delay its onset.

Research on memory loss has shown that it is partly linked to levels of a neurotransmitter known as GABA. Its normal job is to slow down the rate at which neurons fire, effectively dampening down electrical “noise” in the brain. Lower this background noise and important signals in the brain can be processed more easily, or so the theory goes.

The new drug is a derivative of benzodiazepine, a family of medicines that includes the anti-anxiety pills Valium and Xanax. While Valium and Xanax have broad effects in the brain, the new drug is designed to target specific GABA “receptors” found on neurons in key parts of the brain, such as the hippocampus, which are heavily involved in cognition.

Scientists tested the drug on mice in a maze and found that half an hour after receiving a single dose, old animals performed nearly as well as young mice. The drug also restored the performance of young mice whose memories had been temporarily impaired by the stress of being kept in a confined space.

“An old mouse will naturally perform at about 50-60% on this test. Its working memory is basically not working. But within 30 minutes of administration of the drug, their performance is back up to 80-90%, so almost at the level of a young mouse. We have a rapid reversal of age-related working memory deficit and that is exciting,” Sibille told the Guardian.

In the latest work, the Toronto team showed that brain cells which had shrunk in older mice grew back after two months of having the drug put in their drinking water. “We can actually grow the brain cells,” Sibille said.

“They tend to shrink with age and they shrink in neurodegenerative diseases. What we see is that the cells grow to a level that’s pretty close to that in young animals.”

The lab tests showed no benefit when the drug was given to healthy young animals, suggesting that it would not work like a cognitive enhancer and give healthy people superhuman memory skills. “It’s not a drug a student would take if they wanted to be smarter when they study for their exams,” Sibille said. The researchers submitted a patent on the drug on Wednesday before a talk at the American Association for the Advancement of Science annual meeting in Washington DC.

Scientists now hope to test the drug in humans, with the first trials expected to be in people with depression. When people are in remission from depression, those with poor memory and other mental impairments are often most likely to relapse, Sibille said.

“If we could somehow treat those deficits we could potentially have a major impact on the lifelong trajectory of the illness in those people. It would be a gamechanger in how we treat depression.”

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Inside The Fragmented Minds of People With Dissociative Identity Disorder

The condition was formerly known as “multiple personality disorder,” and the medical field is still in disagreement on whether it is real. But does ‘real’ matter when a diagnosis can help?

by Shayla Love, I heard it on the Vice podcast and went to find the original article. Very insightful.

he lights dimmed at a movie theater about 100 miles northeast of London, in a city of more than 100,000 people. I had traveled nearly 3,500 miles from New York to watch The Three Faces of Eve, a black-and-white movie from 1957. The film, about a woman with multiple personality disorder, is based on a real case study and subsequent book authored by her psychiatrists. In the seat next to me was Lizzie Green*, a woman diagnosed with the same condition, though it’s now called dissociative identity disorder, or DID.

Movies aren’t kind to DID. Fight Club, Sybil, Primal Fear, Hide and Seek, Black Swan, Secret Window, Dr. Jekyll and Mr. Hyde—in films like these, when someone has a hidden personality, it’s usually a violent one that commits unspeakable acts, while the character has no memory of their actions.

“They’re all horror films, aren’t they?” Green, a thin woman in her mid 60s, said to me. “They use a mental disorder to make a very good horror movie.” She paused, and smiled begrudgingly. “I watched Split, and I think it’s a very good film. But I don’t like them doing it.”

Dissociation—a feeling of being disconnected from your thoughts and feelings, often described as seeing yourself from an outside perspective—isn’t rare. According to the US national nonprofit Mental Health America, about a third of all people say they’ve once felt they were watching themselves from afar, as if in a movie.

But when dissociation becomes more extreme, it crosses into surreal territory, becoming Hollywood fodder. Severe dissociation can include psychogenic amnesia, when a person can’t remember personal information with no seeming physical cause, or dissociative fugue state, when a person loses his or her identity altogether—as if they’ve just stepped out of their body and walked away. With DID, it’s more like a person’s body is a boardinghouse filled with many guests, and you’re not quite sure who will come to the door when you knock.

DID affects an estimated .01 to 1 percent of the general population, but it’s a condition that many researchers still disagree on. Its history is fraught with tales of false memories and Satanic cults; only three paragraphs into WebMD’s page on DID, a subheading asks: “Is Dissociative Identity Disorder Real?” To this day, only some believe it is, while others believe it’s a disorder brought on by the power of suggestion and scary stories. Clinicians don’t doubt the suffering of people who get a DID diagnosis, but they can’t agree on where the suffering originates, and that conflict has had major implications for how people with DID are treated.

How does one prove that a mental disorder is “real”? Scientists can look to the brain, case studies, symptoms, and treatments, all to find evidence of a distinct disease. But the disagreements around DID highlight the subjective nature of our categorizations of illness, especially mental ones. Historical context and culture have clearly influenced our understanding of illnesses and their prevalence. In the case of DID, the legacy of multiple personality disorder continues to seep into the work of those treating the disorder as well as those who have it.

In my discussions with people who study DID and treat patients who have it, some said that the diagnosis wasn’t a real thing—that it was just another way to talk about the symptoms of other disorders, like PTSD or bipolar disorder (an illness characterized by mood swings and confusing behavior). Yet others vehemently insisted that DID was a disorder unto itself, perverted by what we’ve seen in the movies but very real, caused by the worst kinds of childhood trauma—such as what Green eventually uncovered in her own mind.

Throughout the movie, I peeked at Green’s face, trying to gauge if she was upset at the way DID was being portrayed onscreen. Joanne Woodward played Eve White, an exceedingly timid woman who gets headaches and seeks out a psychiatrist after she starts blacking out and losing track of time.

While Eve is talking to her doctor, an alternate personality, who goes by Eve Black, emerges. Black is the opposite of White in every way: She’s reckless, outgoing, and cares little about family or the rules of society. The two personalities wrestle for control over Eve’s body. Toward the end of the movie, Jane, a third, mild-mannered “alter,” enters the mix. Eve’s therapist uses hypnosis to reveal a trauma in Eve’s past: She was forced to kiss her grandmother’s dead body during an open-casket funeral. After reckoning with this experience, Eve White and Black disappear. Jane, now a single “integrated” person, cinematically lives happily ever after.

I thought the movie was a bit overwrought. But Green surprised me by saying that the moments when Eve switched from White to Black weren’t far off from her own experience with DID. Green too discovered a previously unknown traumatic past when she was 39, and said there were many different alters coexisting in her head.

A few hours earlier, I had climbed into the front seat of Green’s midsize SUV, and we drove a short distance to her home, making polite conversation about my train ride and how I was enjoying my stay in London. A spray of plants framed her one-story house, and bees were audibly buzzing from one blooming flower to the next. Inside, the decor was clean and bright, and the sun poured in through the windows.

Green led me to a sitting room, where she sat curled up, catlike, in a chair across from me. Her husband brought out lunch on a tray: cheese melted on bread for her, hummus on bread for me (she had been thoughtful enough ask about my dietary restrictions in advance). It was a strangely cheery environment in which to begin talking about dark subjects, but in a way, it mirrored the unsettling contrasts of her childhood. She was born in the early 1950s in England on a farm that was incredibly isolated, she said, five fields off from any sort of road. “If the abuse hadn’t been going on, it would have been a blissful situation,” she told me. “Absolutely blissful.”

Green said she was sexually abused starting at a young age, until she was 16. She thinks it was by her father, as well as others. She doesn’t have any direct memories of the abuse; instead, her alters, which she called her “parts,” do. They all inhabit the same body, so they are her memories. But before, they were compartmentalized, she said, locked behind closed doors in her head.

“I would not have use of my brain, and there were parts that did,” she said. “We always finished with the part that would get us back into bed, and there was a part who came and lay on her tummy, and her job was to empty the brain of everything that happened, so that when I woke up in the morning, I would have absolutely no memory. No single part could have held the whole abuse situation, because we wouldn’t have been able to. The whole thing had to be this fragmented for us to be able to stay sane.”

As she talked, Green switched pronouns, going between “I” and “we” to refer to herself. (If she had her way, she said, she’d always use “we”—it feels more accurate. But she uses “I” to make others comfortable.)

Green told me she didn’t realize she had no complete memories of her childhood until she was 39, when the emotional trauma of a death in her family started to break down the dissociative walls she had put up. She started to get tiny snippets of memories back but didn’t know what to think of them. She thought perhaps she was going crazy.

She would find herself walking like she did when she was a toddler, with her feet turned inward. Or she’d find herself wanting to eat only baby food. Other times, she could only sleep on the floor in the corner of her room. Until that point, Green had been a busy, productive adult. She had four children. She’d consistently held a job.

One day at the library she picked up the book The Flock by Joan Frances Casey and read it cover to cover. It was about a woman who had DID, and the symptoms sounded just like the puzzling experiences she had been having. “I just couldn’t put it down,” she told me.

The book suggested writing to your inner child, and so Green began to write letters to herself. Ten to 12 parts wrote back, each with different handwriting styles. “Memories were coming up, and the more and more dysfunctional we became,” she said. “It was awful, absolutely awful, because it was just chaos.”

After some internet research, she went to a psychiatric conference where she said she first heard the description of structural dissociation: when a person is divided into parts that do the everyday living, separate from parts who were abused.

“I was living in this mad world,” she said. “Parts were writing down these terrible things that apparently happened to us. It was hell, and my head the whole time was like World War III. When I heard this description of structural dissociation and understood these other parts were children stopped back in time, like trauma has literally just happened to them, it began to make sense.”

n 1973, the book Sybil was published, which told the story of a woman’s tormented childhood, repressed memories, and multiple personalities. The book sold millions of copies, and when it was turned into a popular television movie in 1976, 40 million Americans watched. Movies like The Three Faces of Eve and Sybil brought multiple personality disorder to the masses. Whereas tales like Dr. Jekyll and Mr. Hyde were fiction, these films claimed to be based on “true stories.” The idea that memories of trauma could be hidden and excavated through repressed memory therapy or regression hypnosis swept through the country, opening the possibility that anyone could have a history of terrible abuse and just not remember it. Before the 1970s, there were very few known cases of multiple personality disorder; by 1990 there were at least 20,000 confirmed diagnoses, “with estimates of as many as two million more,” according to a 1998 New York Times article.

But doubts from psychiatrists, and then patients themselves, quickly crept in. If traumatic memories could be so easily shut away, how could you explain the symptoms of people with PTSD, who couldn’t turn off the deluge of traumatic memories? Was it really possible that so many people had suffered through horrific events as children, and were just now, collectively, remembering them? Researchers simultaneously began to study false memories—the idea that with suggestion, a person could sincerely believe something had happened to them in their past.

Elizabeth Loftus, a cognitive psychologist now at the University of California, Irvine, was a leading figure in this work, and published many studies on how a suggestion could lodge itself in someone’s mind and become a memory. The False Memory Syndrome Foundation was formed in 1992 as a space for Loftus and others to probe the fallible nature of memory, and her book The Myth of Repressed Memory was published in 1994. One of her studies from 1995 showed that 29 percent of people to whom she provided a false childhood memory would later say that they “remembered” it and provide additional details.

Examples of “implanted” memories and personalities started to make the news. “The courts don’t know what to do with it,” said George B. Greaves, a clinical and forensic psychologist, about multiple personality disorder in the New York Times in 1994. “The field right now is just in chaos.”

In 1997, a woman named Sheri Storm filed a malpractice suit against her therapist Kenneth Olson, claiming that her diagnosis of multiple personality disorder, and her more than 200 alternate personalities, were induced by his suggestion. She had initially sought therapy for insomnia and anxiety.

“She had ‘remembered’ being sexually abused by her father at the age of three and forced to engage in bestiality and satanic ritual abuse that included the slaughtering and consumption of human babies,” wrote the Emory University psychologist Scott Lilienfeld in an article about Storm’s case in 2007. “According to her psychiatrist, these traumatic experiences had generated alternative personalities, or alters, within Storm’s mind.”

In transcripts of Storm’s therapy sessions, Lilienfeld wrote, Olson dominates the conversation. Storm doesn’t provide any information of other personalities, but Olson identifies them and talks with them.

In 1997, another one of Olson’s patients, Nadean Cool, received a $2.4 million settlement after she sued him for malpractice. She said that using hypnosis and suggestion, he led her to believe she had been abused in a Satanic cult and was witness to all kinds of violent activities. He had diagnosed her with multiple personalities, which included “a duck, Satan, and angels who talked to God,” the LA Times reported.

At a 1998 American Psychological Association meeting, the psychologist Robert Rieber said that he had reviewed the 25-year-old tapes of therapy sessions with Shirley Mason—the real Sybil—and that he thought her many personalities were also “implanted by her own psychiatrist, eager to break ground in the research of multiple personality disorder,” the Times reported. Rieber’s announcement called into question one of the most famous examples of “real” multiple personalities.

Four years prior, in 1994, the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) had already discontinued including the diagnosis of multiple personality disorder and replaced it with DID. The American Psychiatric Association (APA), which writes the DSM, continues to distance DID from multiple personality disorder.

On its website, in a Q&A, the APA says that people with DID have a lack of connection to their memories, emotions, and senses, and to regard those people as having multiple personalities isn’t quite right. In its rebranded form, DID was not caused by false memories or an influx of new personalities, but a disruption of a personality that was already there, a kind of fracturing of the self. They “do not have more than one personality,” the APA wrote, “but rather less than one personality.”

uch of the current skepticism around DID comes from the scandals of multiple personality disorder and its messy genesis in the DSM. The contemporary debate boils down to two sides that argue for differing explanations of DID: One is called the “trauma model,” and the other the “sociocognitive model,” also referred to as the “fantasy model.”

The trauma model describes a relationship between a history of trauma and dissociation, and explains the fragmenting of the self as a response to this trauma. The sociocognitive model argues that DID is influenced by other factors, such as therapists, the media, preexisting ideas about multiple personality disorder, and misinterpretation of other mental and physical health considerations. In essence, the sociocognitive model is an updated version of the idea that DID is brought on through suggestion, while the trauma model posits that an experience of trauma is mostly what leads to DID.

Studies that try to determine if DID is explained by the trauma model or the sociocognitive model can have mixed results. Some have found that there is a consistent relationship between trauma and dissociation, and that dissociation isn’t associated with suggestibility, or being prone to believe what others say.

Simone Reinders, a neuroscientist at King’s College London, has been looking for, and finding, differences in the brains of people diagnosed with DID. She’s seen variation in the brain’s blood flow for different areas and changes in brain physiology compared with controls. She has also seen differing brain activity when people with DID were in one identity state or another.

But Lilienfeld, who wrote about Storm’s case after meeting her, told me that the majority of people with DID sincerely believe they have multiple, indwelling personalities, and in these studies, they are compared with people who are trying to simulate DID, but don’t really believe it to be true. This, according to him, would reflect in their brain scans, and account for the differences. What the brain imaging revealed, he told me, isn’t DID, it’s their belief in DID. “My take on DID is that it is a disorder of belief,” he said. Lilienfeld said that when psychologists have tried to see if people with DID have memories that only one alter has access to—which would prove they were truly distinct from each other—they haven’t been successful.

“The fact that people believe they possess different ‘personalities’ is not the same as their actually possessing different personalities that are separated by amnesic barriers so that one personality is unaware of what another personality has learned or experienced,” Steven Jay Lynn, the director of clinical training at the Psychological Clinic at Binghamton University, and another sociocognitive-model proponent, told me.

Lynn doesn’t think DID is necessarily the fault of a therapist, and he said people with DID don’t need to be highly suggestible. He’s begun to suspect that other long-ignored physical factors, like sleep issues, may play a role: Consistently bad sleep may produce dreamlike experiences and feelings of unreality. And other psychiatric conditions may be interpreted as DID. He told me we shouldn’t ignore the influence of genetics, which might make a person more prone to feelings of dissociation.

“What I am saying is that many influences can interact and conspire to form a compelling narrative of multiple selves,” he went on. “In short, neither trauma alone, nor media alone, nor suggestibility alone, can fully explain many cases of dissociative identity disorder. What is clear is that we need to better understand the role of multiple determinants in the case of this disorder, as is typically the case with any complex psychological disorder.” As can happen in academic disagreements, I found passionate responses published by Lilienfeld to Reinders’s work, and then responses from Reinders to Lilienfeld’s responses. The bickering and callouts can be found both in papers that favor the trauma model and in ones that argue for the sociocognitive model.

For a disorder in which patients have trouble figuring out the truth about their experience of a dissociated self, the research can feel equally fragmented in its conclusions about what people are feeling and why. People may have already had one diagnosis— multiple personality disorder—taken from them and thrown in the scrap pile, and yet the battles rage on in the fight to define DID. “I don’t understand what the controversy is about DID,” Reinders told me over the phone. “It has been included in the DSM for decades now. There is a huge amount of research available [on it], empirical research, and case studies. My data, among other people’s data, has shown that neuroanatomical changes in DID are similar to those in PTSD.”

Reinders had another theory about the resistance: She thinks that DID, and the kinds of trauma that she thinks cause it, reveal an underbelly of our world that few want to acknowledge, like childhood sexual abuse.

“For me, that might be an explanation for why critics don’t want to believe that DID exists, because it shows them the darkness of our society,” she said.

I asked Green what she would say to people who believe DID comes about by suggestion of a therapist. Was she understanding her childhood trauma this way because a therapist was providing her the idea? “I would talk about something, but never, ever, ever did he suggest this might have happened,” she told me. “It had to come from me.”

Sarah Palmer

The day after I met with Green, I sat with Ruby King* in a hotel cafe in the Bloomsbury neighborhood of London. She was soft-spoken and seemed a little nervous. After a splash of milk and a thoughtful stir of her tea, she said her first psychiatrist told her she had severe depression and anxiety, but possibly also symptoms of a complex dissociative disorder. King is a doctor, but she had to go home and look up what a dissociative disorder was. That was 15 years ago.

King is in her late 50s and, like Green, grew up in a small village in England. She said her father was abusive to her, her mother, and her brothers, though until she was an adult, she didn’t remember any of the abuse against herself. “I genuinely would have told you that I’d got off lightly and that most of the harm was done to my mother and my brothers, and I’d somehow escaped,” she told me.

She considered herself her mother’s protector. She tried to stop arguments from progressing to physical violence, and it consumed her childhood. “I watched from the stairs a lot to see how bad the situation was,” she said. “Once, he had his hands around her throat and was throttling her, so I ran down screaming and broke the whole thing up. When you had that kind of responsibility, you sleep like crap, with your eyes still watching, still listening, still on alert, even when you’re asleep.”

King didn’t notice symptoms until her 40s, when her mother died; before that, she had gone to medical school, gotten married, and become a doctor. She tried going to therapy, but still felt unsettled and depressed, trying to hold it together.

“Just press on and keep going and try to be a good wife, a good doctor, a good mother,” she explained of her attitude. “Keep all the plates in the air. But it was getting harder and harder. I was more and more weary, lacking in energy, struggling to concentrate.” About seven years after her mother died, her father died. A couple of weeks later, King said the “wheels came off completely.” “I had what you’d call a breakdown,” she told me. “I was in a heap on the floor. Could barely speak. Didn’t know how to put a load of washing on. Couldn’t voluntarily drink or eat unless somebody’d put it in front of me.”

She was taken to the hospital and she began to have flashbacks that popped up in rapid succession. “I picture it like I was holding all these balloons underwater, and they just started coming up,” she said.

In the hospital, she was living in flashbacks most of the time. This meant reliving previously unknown memories of sexual abuse, physical abuse, and the accompanying terror, pain, and other emotions. Sometimes she didn’t know her name, sometimes she referred to herself with her maiden name. She felt younger and shorter, as if she were the same age and height she was when an incident took place.

“I honestly thought I was going mad,” she said. “Completely and utterly mad.”

Sarah Palmer

Richard Loewenstein saw his first DID patient when he was a research associate at the National Institute of Mental Health (NIMH) in the early 1980s. He had been referred to a patient in the refractory affective disorders unit, where patients with mood disorders who didn’t respond to any medications were sent for experimental treatments.

The patient had been in a lithium study that hadn’t helped her much, and Loewenstein was conducting an exit interview with her. One of the nurses told him the patient had said she had multiple personalities, and Loewenstein responded, “She doesn’t have that. She’s bipolar. When she shifts high, she must feel like one person. When she shifts low, she must feel like another.”

But as their interview was coming to an end, just to rule it out, he said, “If there’s anybody else in that body who wants to talk to me, I’d be happy to talk to them.”

“And she began to shift states,” he told me. “It was completely different from TV, and it was completely different from what was in the old textbooks. Rather than seeing somebody who was kind of like a revolving door, actually what I saw were states that overlapped each other and one state would emerge through another state.”

Loewenstein is now the medical director and founder of the trauma disorders program at Sheppard Pratt Health System in Baltimore and a professor of psychiatry at the University of Maryland School of Medicine. He told me that movies and repressed-memory lawsuits associated with multiple personality disorder have damaged the public and clinicians’ understanding of DID. “They’re not separate people,” he told me. “All the stuff that people get excited about, the names and the accents, and one’s a seven foot, winged monkey that only speaks Vietnamese—those are all completely secondary [symptoms]. It is a disorder of being betrayed by the people who you would hope would have cared for you in a loving way in your childhood.”

At his center, there are around 300 admissions a year, and about 80 percent have DID, he said. “Far from being an anomaly and far from being rare, it’s actually a common and severe psychiatric disorder, but it is not recognized.” He told me most clinicians just don’t know what to look for.

Only a minority of patients come to see him with elaborate stories of different personalities, and for Loewenstein, it’s not a very good prognostic sign. True DID, he said, is hidden. It’s subtle. It’s not dramatic. A lot of people don’t show symptoms until adulthood, which show up as upsetting thoughts, lapses in memory, anxiety, depression, and feelings of dissociation.

Loewenstein believes that DID should be understood as a childhood-onset post-traumatic developmental disorder. It happens when children have early, extreme traumatic experiences and don’t develop a sense of self that is unified across different situations, emotions, or contexts. And while many of his patients also have PTSD, depression, substance abuse problems, or suicidal ideation at the same time, he said that DID is a condition on its own.

He agreed that society could influence the interpretation of DID— but culture and historical context always make their way into the expression of mental disorders. Schizophrenics living today may have delusions about surveillance on the internet, whereas in the 19th century that delusion may have focused on the telegraph. The AIDS crisis fueled delusions and obsessions in the 1990s, whereas before it might have been tuberculosis that was doing the same. Loewenstein told me that he’s done longitudinal studies in which he’s looked at patients over time being treated elsewhere compared with people receiving his treatment model. He says that people get better his way, albeit slowly. “Their PTSD symptoms get better,” he said. “They get less dissociative. They get less separated between their different states. They’re less self-destructive.”

“Rather than trying to suppress the states, we try to get them to communicate more, to be more related to each other, to be more empathic with each other, to be more coordinated and cooperating,” he explained. 

King said her therapy was a bit like family therapy, but the family was all the parts inside her, and it was similar to the technique Loewenstein describes. She now knows that her parts are her, just at different ages. Each part became separated to deal with a specific memory or experience. She said that what she’s gone through does feel like a form of PTSD, but that it’s more complicated because it took place during her developmental ages.

When Green eventually found a therapist who specialized in DID, she would give each part a little bit of time in the driver’s seat of her consciousness, which also meant doing things that a young version of herself would want to do, like watching Teletubbies or coloring. On trips, she used to have to pack three big bags, filled with dolls, teddy bears, coloring books, and different clothes for each part. To me, talking to Green felt like talking to one person; no other parts came out. She said that once she had given each part its own time, their needs weren’t as dominant. Now when she goes away, she can just bring adult clothes (though occasionally she’ll still bring one stuffed animal).

I asked Green if she thought she was the leading character of the cast that’s in her head. She used to, she told me, because she was the one who held monopoly on her body for most years. But now, she thinks she’s just one part of many.

“In some ways, I am the most superficial part, because I have the least connection to the original child, who holds all the ingredients of being a real person,” she said. “I do see me as a part, just a part.”

Sarah Palmer

Denial and doubt in itself can cause just as much harm as the symptoms of an illness. When you’re suffering and you don’t feel like what you’re going through is valid, understood, or exists at all, it can take a powerful psychological toll.

Loewenstein said that he leaves deciding what’s real to the philosophers; his job is to make people feel better. “The mind has its own reality and, by the way, medical disorders are social constructions also,” he told me. “All of our disorders, psychiatric and medical, are at some level social constructions.”

That a diagnosis can come and go from the DSM shows that our understanding of mental illnesses is always changing and evolving. The DSM has been referred to as the “bible” for the field of psychology; it’s a book rooted in faith and human constructs, rather than objective facts. In 2013, the former director of NIMH, Thomas Insel, wrote that the DSM was “at best, a dictionary, creating a set of labels and defining each.” It gave patients and clinicians a set of words to use, and made sure people were using the same words, but it didn’t mean those words were valid. Unlike cancer, heart disease, or diabetes, mental disorders exist via a patient’s description; we don’t yet have blood or brain tests that can give definitive results for anxiety, depression, bipolar, or really any psychological condition.

Insel announced that the NIMH would be leaving the DSM behind and launching the Research Domain Criteria (RDoC)— an attempt to classify mental illness through more objective means like genetics or brain imaging. “It is critical to realize that we cannot succeed if we use DSM categories as the ‘gold standard,’” Insel wrote. And yet, until the RDoC matures and becomes a tool we can use—it’s currently still being researched— the DSM is the best we have when it comes to defining and diagnosing mental health.

However imperfect, it’s important to know when our categories are helping or hurting. Sometimes when you accept a diagnosis, your world shrinks in on itself. Everything becomes pathologized and restricted; people can get caught up in what will make them sicker. They only interact with others who are suffering in similar ways. Their world gets smaller. But that’s not what I saw in Green. At the end of The Three Faces of Eve, Green made her way to the front of the theater. She had agreed ahead of time to answer questions from the audience about DID. I observed her speaking from my seat in the back row. She looked confident and her voice didn’t waver.

During the Q&A, she said that getting her diagnosis, and finding a voice in advocacy for DID, had expanded her life. It’s full of family, travel, grandchildren, events, and collaboration. A DID diagnosis had improved things for her, whether or not she can prove she has it, or that her memories really took place. King told me the same: “My psychiatrist always made it quite clear, and I agreed with him, that nothing that I’d come up with could ever be presented in court… But if [a] person either believes those things happened or they actually did happen, then they clearly need help of some kind, don’t they? So I think that’s the part to start from, and not go into the forensic side.”

Loewenstein and Reinders may say that DID stems from trauma, while Lynn and Lilienfeld think there is a more complex origin story, but they all feel that the way multiple personalities is depicted in movies isn’t true to what’s it’s really like. They believe that, as with all health issues, its causes are probably multifactorial, and often comorbid with other disorders. Most important, and this goes for all mental disorders, they believe in the subjective experience of the sufferer, no matter what the diagnosis is.

“Diagnosis, in and of itself, is only helpful if it assists the people with that label, isn’t it?” King said. “It’s only helpful if it serves a purpose for that person’s journey. For me it has, because it’s helped me to understand. It’s helped me to not feel mad.”

The researchers will continue to look for and debate a biomarker in the brain, or definitive criteria of symptom presentation. In the meantime, we—the suffering, and the witnesses to suffering—may have to come to terms with how big a role belief plays, and will continue to play, in the labeling and the experience of disease. As well as with the knowledge that for each person, getting a diagnosis will mean different things. Some will find a cage, and many others, their freedom.

*This name has been changed to protect the person’s identity because of the sensitive nature of the information she shared. (source)

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Israel Approves MDMA Compassionate Use to Treat PTSD

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Israel Approves MDMA ‘Compassionate Use’ to Treat PTSD

MDMA, the principal ingredient in the party drug ecstasy, is about to give a lifeline to some of the worst sufferers of post-traumatic stress disorder (PTSD) in Israel—and the U.S. could be just years behind in launching similar clinical treatments using the substance.

Israel’s Ministry of Health has approved the use of MDMA, a psychoactive drug, for use on dozens of patients, Israeli newspaper Haaretz reported. While the drug is still on the country’s law books as dangerous for recreational use, it is now being administered as treatment for compassionate use.

In compassionate cases the drug will be made available to patients outside of clinical trials if they have not responded sufficiently to other medications or treatments.

Callum Paton

Some 50 patients are due to take the medication at one of four hospitals around Israel. The patients, who have all been diagnosed with PTSD during a course of psychiatric treatment, will be given the drug three times over the course of a number of sessions under close supervision.

2.1 million tablets of the drug seized by U.S. Customs July 26, 2000 in Los Angeles, CA.

MDMA makes people feel euphoric, a sensation that made its use synonymous with rave culture and EDM, because it floods the body with serotonin.

Serotonin is produced by nerve cells. When levels are low it can lead to depression and disrupt other physiological processes.

The launching of the new Israeli initiative is a direct result of groundbreaking research in the U.S. The Middle Eastern nation approved the program after sending a representative to the California-based Multidisciplinary Association for Psychedelic Studies (MAPS) for training.

MDMA has been illegal in the U.S. since 1985 but the findings of clinical trials, ongoing with Food and Drug Administration (FDA) approval since 2001, have shown that the drug enhances the treatment of PTSD in a clinical setting.

PTSD affects 8 million Americans, CNN reported. Symptoms include flashbacks and troubling thoughts that can lead to erratic behavior, substance abuse, problems at home and even suicide.

Individuals who have served in the armed forces or as firefighters or police officers disproportionately suffer from PTSD, which is predominantly treated with psychotherapy and prescription drugs, most often antidepressants.

Israel could now be two years ahead of the U.S. In 2017 the FDA characterized the new therapy as a “breakthrough.” The designation puts it on course to be final approval as a treatment in 2017.      

The Israeli study, which will take place at Sheba Medical Center at Tel Hashomer and the psychiatric hospital in Be’er Yaakov, will involve 14 patients. However, there is a waiting list of 600 people suffering from PTSD – from a range of traumas including military combat, abuse, sexual assault, and traffic accidents – who are eager to take part in this medical trial, which is the second of its kind in Israel.

The previous trial, which was conducted at the Be’er Yaakov hospital, involved ten patients in Israel as part of a global trial involving 107 people. The results were promising and were the basis for declaring MDMA a “breakthrough treatment.” A year after the trials, 68 percent of patients experience a dramatic decrease in symptoms, and some were completely asymptomatic.

The new trial is being led by Dr. Revital Amiaz, a psychiatrist who directs the ambulatory services at the psychiatric department at the Sheba Medical Center. Amiaz previously conducted a study on the use of ketamine for treatment-resistant depression. She believes that MDMA has treatment potential for PTSD sufferers. What convinced her in part was her personal experience, having been administered MDMA in the United States as part of a study of caregivers.

Original source by Ido Efrati

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