Introduction To Smart Drugs
and Cognition Facilitators

While speaking with a colleague the other day, we engaged in what I consider to be a very interesting and philosophical conversation. The topic of that dialogue focused on her experience with the use of an over-the-counter hormonal supplement called DHEA. DHEA, of course, has been the subject of a considerable amount of media attention and scrutiny. It is often thought to be a memory-enhancing medicine in addition to an anti-aging compound.

In clinical trials, it certainly has been shown to possibly be effective as an anti-tumor agent, an immune modulator, possibly lowering the risk of certain types of heart disease, improving bone density in women at risk for osteoporosis, as a treatment for some types of hypoadrenal dysfunction and many other types of chronic conditions associated with aging. In general, DHEA levels decline with age. Theoretically, bringing those levels up to an amount consistent with what would have been expressed in an individual at a younger age may actually act as an anti-aging medicine. Certainly, this has been borne out in animal trials.

My colleague herself, when taking this medicine, noticed that she felt younger overall and much brighter, and her mental quickness was certainly improved. However, her concern was that, perhaps, on a philosophical level, normal human aging should not be something that we should focus on improving. Her contention was that it might be the order of things that we, as human beings, should gradually become somewhat more senescent, complaisant, less focused, more cluttered, less physically strong, and less mentally alert. This suggestion intrigued me. Her rationale is that, when focused on the goal of self-growth, perhaps these changes associated with aging made it easier for us, as individuals, to focus on the things that are more important or meaningful in the latter part of our life's journey.

My own philosophical bias and perspective was quite the opposite. I really find it a challenge to accept that we, as beings in our own life experience, are necessarily designed, or pre-programmed, to become limited at a certain time frame in our lifespan. Such things, such as good nutrition, sunshine, proper rest and meditation, that can enhance our capacity for self-growth and focus should not be excluded. This would also include chemically mediated cognitive enhancement.

In general, it makes more sense to me that, if substances that are natural and safe could improve our memory, alertness, and intelligence and, possibly, acts as life extension medicine, it might actually facilitate our capacity for our own self-growth and more truly create a reality of "sageing", rather than aging. In addition, when one looks at the potential improvement in many other aspects of human experience, such an observation adds more credence to the possibility that certain nutritional substances could play a significant role in human development.

Piracetam

For example, the smart drug piracetam, although capable of increasing memory and intelligence, has also been shown to improve physical endurance. If our capacity to engage in exercise improves, then all of the benefits derived from exercise itself are factors we can incorporate into our life experience. Also, when one looks at human potential, at least on a vocational scale, the use of cognitive-enhancing substances that can make us more competitive in the market place can, conceivably, allow us to have a greater statistical likelihood of achieving not only our life's ambitions, but maximizing our true potential. This is not to suggest, of course, that such a feat could be realized without persistent dedication and effort. However, a little help along the way is certainly a plus.

The Endocrine System And Intelligence
Thyroid

The thyroid gland secretes hormones that regulate metabolism. They include both T3 and T4. T4 is mostly an inactive hormone that is secreted in the body and converted to the active form, T3, by the body's tissues as the metabolic need arises. The thyroid glad is ultimately controlled by the pituitary gland and the hypothalamus. Research has clearly shown that there are many individuals with low functioning or a hypothyroid state that are undiagnosed. Symptoms of low thyroid function include profound fatigue, easy weight gain, and difficulty in losing weight and a tendency to feel cold the majority of the time, especially in the extremities. Other usual observations are dry skin, brittle nails, dry hair, low sex drive, depression, mental confusion, slow cognitive processing, water retention, poor exercise tolerance and, in women, PMS symptoms and heavy painful periods. Advanced cases can lead to congestive heart failure.

Unfortunately, individuals often have normal laboratory values when tested for low functioning thyroid. This can occur despite the patient having all of the above-named classic, textbook symptoms of low thyroid function. In my clinical practice, I have noted that most patients with these symptoms will improve significantly when started on a low dose of a natural thyroid hormone. This occurs despite the fact that they have normal laboratory test values. There are many reasons laboratory testing for thyroid function might appear to be normal, but the individual has a low-functioning thyroid gland. There has been speculation that the high prevalence of certain chlorinated compounds and chlorine ions in the water supply could potentially displace the active iodine component of thyroid hormones, rendering them somewhat inactive. Fluoride, which is also in the same family of compounds on the periodic table of elements as both iodine and chloride, could, theoretically, displace some of the active iodine molecule from the thyroid hormone. In some cases, certain individuals have a higher than usual metabolic need for iodine which, obviously, is required for the production of normal thyroid hormone. In addition, many types of food additives, coloring agents and chemicals of various sorts have been shown to antagonize the effect of thyroid hormone. Certain disease states, such as diabetes, are also typically associated with low thyroid function.

Relative endocrine, or hormonal balance, is also important. For example, testosterone and adrenal hormones in general (including DHEA) are very closely linked to thyroid function. When a patient is evaluated in terms of a general endocrine check, they need to have all of the hormone levels measured, so that the balance can be properly assessed. If certain levels are too high or too low, then normal physiologic function will, inevitably, be challenged.

There are also many situations in which a person can have adequate hormone levels, as measured by a laboratory test, but, yet, their cells are largely unresponsive to the hormone levels. This would create a deficiency state, in spite of the presence of normal hormone amounts. Such a situation occurs in Type II diabetes. In that state, the levels of insulin are actually within normal levels. However, the cells often are less responsive than normal to the stimulus from insulin. Despite the normal environment of adequate insulin hormone, a deficiency state is created. The same situation occurs with many other types of hormones in the endocrine system. Thyroid seems to be one of those hormones.

Considering the fact that the primary symptoms of low thyroid function include a decrease in cognitive function, impairment of memory and easy mental fatigability, the thyroid hormone could be clinically useful as a cognition-enhancing, or smart, drug. It is important that patients work closely with their physicians in this regard. They may need to find physicians in their local area that are more familiar with the use of thyroid hormone in this unique type of sub clinical situation. Such referrals can be found through the American College for the Advancement of Medicine and the American Holistic Medical Association.

In my practice, I have noticed clinically superior results using natural thyroid extracts, such as prescription Armour Thyroid, compared to semi-synthetics, such as Levothroid and Synthroid. Such observation might not be well supported in the opinions of doctors with a more conventional orientation. However, I feel that, when one focuses on what allows a patient to feel better that, alone, should be a guiding criteria in appropriate decision-making.

Estrogen

Other types of hormonal contributions, aside from thyroid, would, of course, focus on the adequacy of estrogen for women. As a woman ages, her levels of estrogen do tend to decline. Common symptoms around the peri-menopausal time from (from 45 through 55) include a decrease in memory, hot flashes, vaginal atrophy and dryness and insomnia. Estrogen replacement therapy can effectively ameliorate these symptoms in most women. In my own practice, I have had much better luck using natural micronized hormone replacement therapies that are described in the Addendum.

IgF-1

As noted previously, the effort to balance the entire endocrine system is a consideration of relative importance that needs to be addressed with each individual. In that light, I will generally measure levels of IgF-1 in addition to evaluating the status of other hormones. IgF-1 (Insulin-like growth factor, Type 1) is an assessment of the adequacy of growth hormone. Growth hormone injections have gained considerable popularity over the last several years as a strategy in anti-aging medicine. This is generally a modality utilized, as advancing age tends to also co-exist with declining levels of growth hormone. Growth hormone in the body functions in many types of physiologic processes. But, in general, one can simplify that observation by defining growth hormone as that hormone that facilitates and creates all of the physiologic conditions we associate with being more useful. In years gone by, the price of growth hormone has been prohibitive and relegated to the "lifestyles of the rich and famous." However, the prices continue to decline as many other pharmaceutical companies begin to manufacture their own versions. While the cost remains high, at just over $300 a month, it will continue to decrease in price. Other options, such as growth hormone-releasing analogues will also become available. In addition, the Food & Drug Administration has approved growth hormone therapy for treatment of deficiency states in adults, which would open the door for insurance coverage. In many of my patients who use growth hormone therapy there have been (in addition to subjective reports of feeling much younger) improvement in muscle strength, bone strength and health, heart function, metabolic rate, decrease in body fat, increase in lean muscle tissue, and, even, a darkening of hair. One of the primary reports from patients is that their memories have improved significantly. From these observations and from clinical data, it is clear that growth hormone has a potentiating effect on the nervous system, including the central nervous system.

Measuring blood levels of IgF-1 usually does growth hormone assessment. Your doctor may not be familiar with the use of growth hormone, but referrals to physicians who are familiar with these therapies can often be found by contacting one or more of the organizations listed in the Addendum of this text.

Melatonin

Melatonin has garnered a considerable amount of media attention and scrutiny. It has certainly been the subject of several hundred-research trials. It may have a role in medicine as an anti-aging medicine, a treatment as an immune modulator and, specifically, as an anti-cancer treatment for those types of cancers which are responsive to it. Melatonin adequacy can be accurately measured with a salivary melatonin test. During this test, an individual expectorates into a laboratory-provided analysis cuvette which will be mailed to the laboratory and the amount of melatonin measured. From this information, an objective, clinical determination can be made as to the patient's melatonin level. If a deficiency is established, this is a good indication for melatonin replacement therapy as a specific anti-aging approach and cognition enhancer. Melatonin helps regulate sleep and is a potent anti-oxidant. Many types of medical conditions, including chronic fatigue states, are thought to have poor sleep or sleep deprivation as a contributing factor. While it would not necessarily explain the overall picture, many patients feel significantly better as their sleep patterns are improved. This makes intuitive sense and has been well corroborated by clinical studies. In this group of individuals, I have found that they often function and perform at a much higher capacity when they get adequate sleep, and melatonin can certainly facilitate that experience in many individuals. In that capacity, it can act as a "smart drug" or cognition enhancer, allowing the cerebral function to operate at its maximum efficiency.

Pregnenolone is yet another hormone, primarily of adrenal origin, that may have anti-aging and cognition-enhancing capacities. In at least one study, pregnenolone was shown to dramatically enhance memory and learning tasks in rodents. As a matter of fact, it was found to be significantly more effective than any of the other, more commonly studied, hormonal derivatives were noted to be.

Pregnenolone

Although pregnenolone has been the subject of clinical evaluation since the 1940's, its use had not become widely known secondary to the wider availability of newer, high-tech medicines, such as potent cortisol-derived anti-inflammatory hormonal treatments for various types of arthritis. Despite the lack of a large volume of human clinical trials, pregnenolone may actually represent an effective approach to modulating human aging, as it, also, is a hormone that tends to decline with age. It also seems to have a specific trophic effect on the central nervous system, as evidenced in animal model trials. In addition, pregnenolone serves as a precursor for the synthesis of other body hormones, including DHEA, estrogens, progesterone, cortisol, and testosterone. In this capacity, pregnenolone can often serve as an effective treatment to bring other hormonal levels into balance, as the body is able to effectively shuttle pregnenolone synthesis into the production, or pathways, of other hormone systems that might be deficient.

Pregnenolone is available through both compounding pharmacies and over-the-counter. In my practice, I generally use 25-50 mg, once or twice daily, although higher doses have been used as treatment for various types of arthritis and possible utility as a weight-loss aid. In general, before and after blood tests, which measure the levels of pregnenolone as well as down-stream, metabolites, such as DHEA, estrogen, and testosterone, would be recommended.