Brain Supportive Nootropics: Could They be the Key to Better Focus, Attention, and Memory in Your Patients?

by Krista Russ

Many if not all of your patients are concerned about their day-to-day brain function. Whether it be improving their memory, focusing better, or thinking faster, it seems that just about everyone–young and old–wants to give their brains a boost. Yet, most of these patients go unseen because they don’t have a specific ailment like Alzheimer’s Disease (AD) or Parkinson’s Disease (PD), but these smaller manifestations like brain fog and poor focus are problems on their own that can profoundly affect quality of life and job performance. And worse, sometimes they may even precede the more debilitating ailments. 

In this blog, we will explore the current way we are handling these patients who simply desire better memory and focus, as well as introduce some of the larger implications on long-term brain health. But before we dive into the current standard of care for treating focus and memory-related issues and detail some innovative solutions, we have to establish a foundation: that is, an understanding of the factors that contribute to declining brain performance in the first place. While there are dozens of factors, we will focus on five of the largest ones here. 

Take Course for Part 1: Brain-Boosting Supplements for Better Memory, Faster Cognition, and Sharper Focus in Your Patients

The Root Causes of Brain Decline

Neuroinflammation

How?

According to a 2017 paper [1], “Neuroinflammation is defined as an inflammatory response within the brain or spinal cord. This inflammation is mediated by the production of cytokines, chemokines, reactive oxygen species, and secondary messengers.”

Neuroinflammation disrupts brain chemistry and leads to long-term brain damage. It is linked to many neurodegenerative disorders including Multiple Sclerosis, ALS, Schizophrenia, AD, and recently Chronic Fatigue Syndrome (CFS) and fibromyalgia (per Very Well Health [2]). 

Oxidative Damage and Free Radicals

How? 

Destroys DNA and brain cells, including neurons and synapses, causing disruption in their normal functioning. 

Poor Cerebral Blood Flow

How?

Starves the brain of essential nutrients like oxygen and glucose. It is associated with long-term degenerative brain changes like AD and can affect memory, cognition, and decision-making skills.

Insulin Resistance

How? 

When brain cells fail to respond to insulin (often comorbid with T2D), it can lead to several disruptions in normal brain functioning such as impaired neuroplasticity, neurotransmitter disturbances, and ultimately impaired cognition and mood. Insulin resistance is now being linked to Alzheimer’s Disease, which is often called Type Three Diabetes [3] as a result.

Aging

How?

Aging and its associated biochemical changes underpin all of these risk factors, leading to brain decline over time, including normal age-related memory loss and more severe degenerative brain disorders like AD and PD. For deeper insight into how these phenomena contribute to long-term brain changes, be sure to read our blog Alzheimer’s Disease: Potential Causes & Treatments [4].  

The Current Treatment Approach

Because our standard of care in Western culture is largely disease-centered and reactive rather than proactive, patients who desire improved cognitive performance in absence of disease are left with few therapeutic options. There aren’t many drugs designed for normal, age-related cognitive decline or memory loss until it is severe. 

Because of this unmet need, a whole category of products solely dedicated to enhancing cognition is on the rise. They are called nootropics or sometimes “smart drugs” (per Web MD [5]). 

And while nootropics won’t give your patients superhuman abilities like what you may have seen in the movie Limitless starring Bradley Cooper, there is plenty of evidence to suggest they can enhance cognitive function, especially in someone who already has a brain-supportive lifestyle.

Some aspects of cognitive function nootropics can facilitate include:

• Memory
• Attention
• Cognitive speed
• Focus
• Long term brain health (risk for degenerative, age-related brain conditions like Alzheimer’s and Parkinson’s Disease)

Many nootropics aren’t drugs at all and can be easily obtained by patients at their local health food store or over the counter at the pharmacy. This is because any naturally occurring or synthetic compound that positively impacts mental capacity is considered a nootropic, including synthetic compounds, prescription drugs, and dietary supplements. 

As mentioned, prescription brain-enhancers are far and few. They are limited to stimulant medications like Adderall and Ritalin used to treat ADHD. Although these drugs help many people with ADHD, their use is not recommended by the general public. Still, these drugs are popular and often illegally traded on the college scene as popular “study drugs” albeit not without risk such as insomnia, pounding heart, high blood pressure, and addiction. 

Outside of amphetamine-based stimulants, the other prescription nootropic is  modafinil (Provigil). Currently, it is only FDA-approved to treat narcolepsy, shift work disorder, and sometimes sleep apnea-related fatigue. The good news is that studies show Provigil is potentially safer than amphetamines and may even help learning and memory in healthy individuals, but research is ongoing.

A Cup of Java

One common, everyday nootropic you are familiar with is the stimulant caffeine. In fact, by and large, caffeine is the most commonly used drug worldwide. And while too much can cause problems like a racing heart and jitteriness, some caffeine is often beneficial because of its natural stimulant effects on the brain. 

The reason caffeine makes us feel more alert is because it affects several neurotransmitters involved in not only alertness but focus, attention, and learning, such as acetylcholine, epinephrine, and dopamine, either by increasing their production or slowing their rate of breakdown. Caffeine also increases adrenaline released by the adrenal glands, and all of these effects combine to make us feel more alert. Many other nootropics we’ll soon discuss work similarly, by modulating the release of neurotransmitters. 

A Comprehensive Solution

Although drugs do have their place, there are few drugs on the market designed to enhance cognitive function–with most of them being targeted towards more serious diseases like Alzheimer’s, but there are many plant and herb-based nootropics backed by research that can help your healthy patients who simply want to enhance their memory, cognition, and focus. 

Just keep in mind that most of these options work best when combined with a comprehensive approach to brain health that includes an emphasis on nutrient dense foods, physical activity, stress management, and sound sleep–all factors that have been shown to support the brain–both in the short term and long term.

Ginkgo Biloba

Ginkgo biloba is perhaps one of the most widely known cognitive enhancers. Ginkgo is one of the oldest species of trees and is one the top selling supplements in the U.S and Europe (per Mount Sinai [6]). It has been used for thousands of years for treating memory issues, and is best known for keeping one’s memory sharp and boosting cognitive speed. Its mechanism of action includes improving circulation to the brain and opening blood vessels that feed the brain. New research suggests it may protect nerves that have been damaged by Alzheimer’s Disease, which likely explains why it is widely used to treat dementia in Europe. 

It even plays a role in long-term brain health, with several studies demonstrating positive effects on memory and cognition in people living with vascular dementia and Alzheimer’s Disease (per Mount Sinai [6]). Several studies have found that Ginkgo may work just as well as some prescription medications used for treating symptoms of AD. Some of its beneficial effects on Alzeheimer’s Disease include:

1. Improvements in social behavior
2. Fewer feelings of depression
3. Improved thinking, learning, and cognitive function

While most of the research on Ginkgo is focused on people with dementia, it is less clear whether or not Ginkgo improves memory in healthy people with normal, age-induced memory loss. Some studies show benefits while others do not. Preliminary research does suggest it can help treat Attention Deficit Hyperactivity Disorder (ADHD), however. 

Regarding Alzheimer’s research, systematic reviews [7] have looked at the use of Ginkgo in dementia patients given 60-600 mg of Ginkgo per day or placebo. Results showed overall that a higher dosage (240 mg of Ginkgo per day) improved memory and ability to tend to self-care like household chores, bathing, and other daily life activities in these patients. 

With regards to ADHD, in a 2014 study [8], 20 children assigned to 240 mg of Ginkgo biloba extract each day for a period of 3-5 weeks experienced a significant reduction in ADHD symptoms and with few negative side effects, according to Healthline [9].

Phosphatidylserine (PS)

Phosphatidylserine (PS) is an important phospholipid that coats and protects brain cells (per Web MD [10]). Important for keeping the memory and brain sharp, this substance declines naturally with age. 

PS has been shown to help many brain-related conditions that affect memory and attention, including ADHD, Alzheimer’s disease, Multiple sclerosis, and even depression and anxiety (per Verywell Mind [11]). It can even improve sleep and exercise performance which indirectly benefit brain health. 

With regards to memory loss, studies are optimistic. For example, in a 2010 study [12] out of the Journal of Clinical Biochemistry and Nutrition, 78 older participants with mild cognitive impairment were given PS or a placebo for six months. After six months, the participants who took the PS supplements experienced substantial improvements in their memory. 

Another 2012 study [13] looked at the effects of PS supplementation combined with omega three fatty acids in children with ADHD. 200 children diagnosed with ADHD were assigned to the PS and omega three supplement or a placebo for 15 weeks. The results showed that children treated with the PS and omega three combination experienced a much greater reduction in both hyperactivity and impulsivity compared to children assigned to the placebo. 

Other studies show that PS can reduce cortisol levels, which we know can wreak havoc on health over time, including in the brain. 

Bacopa Monnieri (aka Brahmi)

Bacopa is considered to be a traditional Indian herb that grows in wet environments such as the tropics and even underwater (per Healthline [14]). Like many medicinal herbs, it has been used for thousands of years and has been shown to help the brain process information more quickly (per Web MD [5]). It works in part by making the branches of nerve cells (dendrites) grow longer, with results observed in as little as 4-6 weeks time. 

In ayurvedic medicine, it is used to boost memory, treat epilepsy, and reduce anxiety (per Healthline [14]). It contains powerful antioxidant compounds known as bacosides responsible for most of its beneficial effects on the brain such as reducing inflammation, boosting cognitive function, calming anxiety, and even reducing ADHD symptoms. 

Bacopa’s abundance of antioxidants is relevant to many long-term brain conditions like Alzheimer’s and Parkinson’s, which are due at least in part to oxidative damage. The antioxidants in Bacopa specifically target fat oxidation which is important because the brain is 60 percent fat, the fattiest organ in the body (per Healthline [14] and Northwestern Medicine [15]). 

With regards to memory in healthy people, a clinical trial [16] showed that adults who took 300 mg of Bacopa per day experienced significant improvements in their learning rates, memory, and speed of processing visual information after 12 weeks of treatment over a placebo (per Healthline [14]).

Regarding ADHD, a 2014 clinical trial [17] that included 31, 6-to-12 year old children diagnosed with ADHD, found that a dose of 225 mg of bacopa per day for six months greatly reduced ADHD symptoms like restlessness, inattention, and impulsivity in approximately 85 percent of the treated children (per Healthline [9]). 

Huperzine A

Huperzine A is a compound extracted from the Chinese club moss plant, according to VeryWell Health [18]. It can be purchased as a dietary supplement and is best known as a treatment for Alzheimer’s disease. It is used in alternative medicine as a cholinesterase inhibitor, meaning it inhibits the enzyme that breaks down acetylcholine. You might recall that acetylcholine is important for memory and learning and is often disrupted or in low supply in people with Alzheimer’s diseases and other disorders that affect memory. Huperzine A is also used to protect against general memory loss and cognitive decline that occurs naturally with age. 

In a 2013 review [19] published in PloS One, researchers reviewed all the available randomized controlled trials on huperzine A with regards to treating Alzheimer’s disease and concluded that huperzine A proved more effective than placebo when it came to improvements in several features of the disease, including behavioral disturbance, cognitive function, and overall brain performance (per VeryWell Health [18]). A 2008 review [20] out of the Cochrane Database of Systematic Reviews concluded the same thing: huperzine A was superior to placebo. 

In another double blind, placebo controlled trial [21], 50 Alzheimer’s patients were given 0.2 mg (four tablets) Huperzine A and 53 patients were given po 4 tablets of placebo, bid for 8 weeks. At the end of the study, all patients were evaluated using Wechsler memory scale, Hasegawa dementia scale, mini-mental state examination scale, activity of daily living scale, treatment emergent symptom scale, and urinalysis. 58 percent of patients treated with Huperzine A demonstrated beneficial improvements in memory, behavioral, and cognitive function over the placebo with no serious side effects. The study even concluded that huperzine should be viewed as a promising drug in the symptomatic management of Alzheimer’s Dementia. 

While there are very few studies on huperzine A regarding general memory enhancement, an older 1999 clinical trial [22] on 68 junior high school students assigned to huperzine A supplements experienced greater improvements in learning and memory compared to the students assigned a placebo after just four weeks of treatment. 

Vinpocetine

Similar to Huperzine A, Vinocetine is also isolated from a plant. In fact, it was first extracted from the periwinkle plant by a chemist in 1975, according to the site Nootropics Expert [23]. Soon thereafter, a Hungarian pharmaceutical company called Gedeon Richter began to manufacture it. 

To this day, Vinpocetine is a best selling drug worldwide and is available by prescription in many countries including Japan, Mexico, and parts of Europe for treating various cognitive disorders. In the U.S and Canada, it can be purchased over the counter as a dietary supplement. 

Vinoceptine works to improve memory and cognitive function primarily by increasing blood flow to the cerebral cortex, protecting neurons from oxidative damage, and enhancing neuroplasticity, which has been recently implicated in many brain related disorders, such as depression and memory loss. 

Vinpocetine also protects neurons by preventing excessive buildup of sodium, neutralizing brain cell-damaging free radicals, inhibiting the enzyme PDE1, and protecting neurons against the excitotoxin effects of glutamate and NMDA which can kill brain cells in excess. Overtime, free radicals and inflammation can ultimately result in neurodegenerative diseases like Parkinson’s and Alzheimer’s. 

By inhibiting the enzyme PDE1, Vinpocetine causes a series of enzymatic reactions that ultimately results in increased neuroplasticity–which you might recall refers to the brain’s ability to adapt by forming new synaptic connections or reorganizing existing ones in response to either injury (like a stroke) or learning. Neuroplasticity increases both memory and cognition. It can even reduce the symptoms of epilepsy and has been recently implicated as a cause of major depression. 

According to the site Nootropics Expert [23], “Vinpocetine also reduces the TNFα-induced expression of the mRNA of pro-inflammatory molecules such as interleukin-1β, monocyte chemoattractant protein-1 (MCP-1), and vascular cell adhesion molecule-1 (VCAM-1). Researchers have found that Vinpocetine prevents this inflammatory response at the cellular nucleus level. And this mechanism of action is independent of Vinpocetine’s action on PDE1.”

This is noteworthy because TNFa is known to cause neuronal cell death in Parkinson’s Disease. There is even emerging evidence that the buildup of amyloid beta protein seen in Alzheimer’s Disease causes an upregulation of interleukins and TNFa which both contribute to the neurodegeneration seen in the disease. 

Several studies verify these alterations in brain chemistry have positive real life implications. For example, a study [24] of 12 healthy female subjects treated with 40 mg of vinpocetine TID or a placebo for two days who then took a series of psychological tests on the third day of the study, concluded that the treatment group saw significant improvements in their recall and memory skills over the placebo. 

In another randomized, double-bind, placebo-controlled trial [25] where 203 dementia patients were treated with 10 mg of vinpocetine TID, 20 mg vinpocetine TID, or placebo TID for 4 months, the patients were later assessed for cognitive performance. Both treated groups experienced a significantly higher cognitive performance score over the placebo, and it was concluded that vinpocetine is beneficial for the management of dementia symptoms.

Synergistic Support

B-Complex Vitamins

B-vitamins serve a critical role in brain health and function because they boost several important neurotransmitters. For example, Vitamin B6 is vital for the conversion of the amino acid tryptophan into the neurotransmitter serotonin which serves an important role in mood, wellbeing, and even pain perception. 

In fact, a 2009 study [26] out of Wayne State University School of Medicine found a strong link between B-vitamin deficiencies and depression, dementia, and mental impairment (per CNBC [27]). All eight B-vitamins serve a role in brain function. 

For example:

• Vitamin B1 (Thiamin) deficiency actually causes dementia and nerve damage and is often a problem in alcoholics. 
• Vitamin B3 (Niacin) works in tandem with over 400 enzymes, many of which are used to produce cholesterol and fats that makeup the brain. 
• Vitamin B7(Biotin) is needed for neurotransmitter signaling. 
• Vitamin B5 (Pantothenic acid) is needed to make coenzyme A which helps build and breakdown fats for energy. This is particularly important for a fat-dominant organ like the brain. 
• Several B-vitamins such as Folate, Vitamin B6, and Vitamin B12 are important for a process known as DNA methylation [28], which refers to the activation of genes critical for proper brain development, memory, and learning. Disrupted DNA methylation has been implicated in many brain diseases. 

Choline

Choline has only recently been recognized as a required nutrient since 1988, according to Healthline [29]. Still, very few people have heard of choline or know of its importance. The body can make some choline, but not enough to meet all our needs. You may recognize the word choline from the neurotransmitter acetylcholine, which is no coincidence, as choline is essential to the creation of acetylcholine in the brain. 

Choline is neither a vitamin or a mineral; instead, it is an organic, water-soluble compound that works similarly to B-vitamins, so it’s often called a “B-vitamin-like” compound. Some of the many processes choline facilitates related to brain health include brain cell membrane structure, cellular messaging, fat metabolism, DNA synthesis (along with other B-vitamins like B12 and B6), and the creation of acetylcholine which is vital to memory, cognition, muscle movement, and many other functions. 

Magnesium

The mineral Magnesium plays a critical role in brain health, in part due to its role as a cofactor for more than 300 enzymes in the human body, including those that affect nerves and brain cells. For example, magnesium helps convert the amino acid tryptophan into serotonin, which is suspected to be deficient in patients with brain-related mood and pain disorders like depression, migraines, and fibromyalgia. 

According to a 2018 paper [30] out of the journal Nutrients, “From a neurological standpoint, magnesium plays an essential role in nerve transmission and neuromuscular conduction. It also functions in a protective role against excessive excitation that can lead to neuronal cell death (excitotoxicity), and has been implicated in multiple neurological disorders. Due to these important functions within the nervous system, magnesium is a mineral of intense interest for the potential prevention and treatment of neurological disorders. Current literature is reviewed for migraine, chronic pain, epilepsy, Alzheimer’s, Parkinson’s, and stroke, as well as the commonly comorbid conditions of anxiety and depression.”

Furthermore, 2010 research [31] out of Massachusetts Institute of Technology (MIT) shows that magnesium can improve both short and long term memory and reduce age-related memory loss, further evidencing the mineral’s critical role in brain function.

Vitamins C and E

Vitamins C and E are both antioxidants that protect against free radical damage, including in the brain, where such damage can lead to memory issues or culminate in long-term brain disorders like Alzheimer’s or Parkinson’s. Vitamin E is a fat-soluble antioxidant that works in fatty tissue, which makes it supremely beneficial for reducing oxidative damage in a fatty organ such as the brain. In fact, some research shows that high doses of Vitamin E may even slow the progression of Alzheimer’s in patients diagnosed with mild to moderate Alzheimer’s disease (per Mayo Clinic [32]). 

Vitamin C works similarly in non-fatty parts of the brain and plays a direct role in neuron differentiation and maturation as well as myelin creation, according to a 2017 paper [33] out of the journal nutrients. 

What’s Next?

We have two upcoming webinars on brain support that you won’t want to miss. Because brain support is such an important topic, we have decided to create a two-part webinar series. Part one will dive deeper into nootropics for brain support, discussing areas such as:  

• The problem with our current standard of care
• Brain support supplement dosages
• Supplement forms for superior absorption 
• Side effects, concerns, and special considerations 
• A high-level overview of other short and long term brain support influences like nutrition, physical activity, and sleep hygiene as part of a comprehensive approach to brain health. 

Part two will highlight the influence of nutrition and diet on brain support and neuro protection, which we feel is a large and important enough topic to stand on its own, with strong research backing both immediate and long term benefits to brain function that will greatly benefit your patients. Be sure to sign up for both parts so you don’t miss anything. 

Take Course for Part 1: Brain-Boosting Supplements for Better Memory, Faster Cognition, and Sharper Focus in Your Patients

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