Nootropics for Dummies #3: EVIDENCE, Part 2
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In this multi-part, opinionated, skeptic’s guide to the world of nootropics and supplements at large, I attempt to offer some context and perspective on a broad, controversial topic. This is part 3: EVIDENCE, Part 2. If you didn’t read parts 1 or 2, consider doing that before reading on.
Necessarily, in the interest of expedience, some of this will be a gloss. Hence the ‘dummies’ bit in the title. I don’t think you’re a dummy — it’s a figure of speech. Please do read on, regardless of your self-assessed intelligence.
Other posts in this series:
Pt 1: What is a Nootropic?
Pt 3: Evidence: Pt 2
Pt 4: What’s the Difference Between a Supplement and a Drug?
Pt 5: How to Read a Supplement Label
OK, so the last section got a little primary-sourcy and, well, chewy.
Admittedly, the idea of digging through PubMed for studies to read and making sense of them yourself isn’t exactly ‘dummies’ guide material.
As I mentioned in a previous post — it took me years to dig through the primary evidence as I whittled down the list of candidates for a safe, effective nootropic for my own use, and it was only after I came out on the other side that I realized how long I’d spent poring over the material. I don’t actually think that’s a reasonable thing for most people to do when trying to find what meets their standard — I missed my grand-niece’s birthday, and I didn’t even know I had a grand-niece!
So if we’re not going to read all this stuff ourselves, where can we go to find evidence-based analysis on the ingredients we want to know more about? How do we decide for ourselves what works?
Where to Find Studies, Meta-Analysis and Commentary
If you’re not The Lawnmower Man or a research nut with far too much reading time on your hands and the excellent eyesight necessary to decipher tiny footnotes and photocopied graphs, perhaps you’re looking for something a little more … summarized.
Fortunately, there are a few excellent resources that provide searchable, contextualized access to studies, along with some commentary on the quality of the research and the usefulness of its outcomes.
#1: Examine.com
Top of any list should be Examine.com. Examine is my first stop for a baseline understanding of the research on anything I’m curious about.
Helpfully, if you’re evaluating a supplement for its practical uses, near the top of every Examine article is a table summarizing the conclusions of the available research on an ingredient according to a ‘Human Effect Matrix’.
This table prioritizes the quality and consistency of the evidence first and foremost, and makes it very easy to see at a glance whether the evidence is there for a given effect across as many studies are available.
Further down in an Examine entry, you’ll find similarly useful summaries of sources, composition, pharmacology, neurology, interactions, safety, and more, all helpfully footnoted with the original sources.
Examine’s archives aren’t exhaustive, but they are quite thorough on the entries they do have — if what you’re interested in isn’t in Examine, odds are there isn’t a ton of research available about it.
An issue with Examine that will probably only bother the most diligent researchers: the footnotes are not themselves linked to the original articles, so it’ll be up to you to find them. With that said, trial names are pretty specific, so it’s easy to Google your way to the publication if it’s available.
#2: Drugs.com
Drugs.com, despite the name, covers supplements as well as pharmaceuticals, and while the articles on Drugs.com are less helpfully formatted for a quick survey than those on Examine, there’s much to be said for Drugs’ more conservative readings of studies’ conclusions.
Concordant with that, Drugs.com’s copy is a bit more, well, medical, and might require a little more effort in deciphering for the lay reader. I do like the way Drugs.com separates data into ‘in vitro’, ‘animal’, and ‘clinical’ categories, making it easy to skip directly to the clinical outcomes if you’re interested in the measured effects in your fellow humans.
You may also find that Drugs.com’s entries are more inconsistent than those on Examine — in format and in completeness. YMMV.
#3: PubMed!
I know we said we were going to talk meta-analysis here, but once you’ve found something you’re getting serious about, odds are there are a handful of studies that found significant results in the area you’re concerned with. At that point, it’s a good idea to kick the tires on those findings a bit, and to do that, you’ll likely find yourself at PubMed.
PubMed is a searchable, cross-linked archive of the full text of about 5.4 million medical articles. It should be on a hard drive in every fallout shelter, and a hard copy should be in a fire safe in every third basement across the world. We should engrave its contents on a golden disk and send it into near-Earth orbit in case we screw up badly enough that we need to pick it up on the way to Mars.
Many, if not most, of the footnotes you’re looking at will be available, at least in summary, at PubMed, if not in full. Here you can use your common sense and some of the tools we talked about in the last section to scrutinize the methods and conclusions of the studies you’re basing your decisions on.
Getting Started
Even given these helpful high-level resources, this seems like a blank slate to begin with. Where do we go to even know what to look at?
There are a few high-level lists of ingredients that can give us an idea of what is considered a nootropic and where to begin our survey:
Examine.com has a list of ingredients (good and bad, useful and otherwise, safe, questionable, and unproven, all mixed together), nested amongst some serious sales pitches for their guides on the topics. I’m not endorsing those guides or all of the ingredients in their list, but if you’re looking for survey of the field, it’s a good starting point, and naturally it’s already linked to Examine pages.
The Nootropics Reddit Beginner’s List is well-formatted, relatively conservative, and research-oriented. It offers ‘low-hanging fruit’ like exercise, sleep, and blue light first, and doesn’t de-emphasize caution when experimenting. The Nootropics Reddit at large has some well-informed and experienced mods, but the content of the posts varies wildly from discussions of basic research to some disturbing personal accounts of extreme self-experimentation.
The Takeaway
Even with the availability of high-level tools and lists to point you in the right direction, this might seem like a lot of work to you, and you’d be right. It takes a lot of work to really understand what there is to know about a given supplement.
My perspective on supplements is this — unlike with drugs (and more on that distinction in part 4), you can’t simply say ‘OK this is any old generic of ______, and ______ has been approved to be marketed for _____, let’s get on with it’. You can do that with cetirizine, the active ingredient in Zyrtec, but with supplements, especially herbal supplements, it’s more complicated.
As we’ll discuss in the next part of this series, the ‘structure/function claims’ allowed for a given supplement have a lower evidentiary bar than that required of pharmaceuticals or even OTC drugs, and even if you know you’re getting the right amount of the ingredient you’re looking for, and you know the ingredient offers the benefit you’re after, without unwanted side-effects, you’re still going to need to be sure the actual product you buy is ‘right’ in a number of ways that might not be obvious to you right now.
Naproxen sodium 220mg on the label is naproxen sodium 220mg. ‘Panax ginseng 100mg’ on the label could be of any potency, could carry contaminants, could be mislabeled Panax quinquefolius, could be whole plant rather than just root (not a good thing in this case), or could be a very young root with little of the Ginsenosides we think confer Panax ginseng’s benefit. How do we know what’s actually in the capsule, regardless of what’s on the label?
Read on for how to judge the quality of a product, and the related topic, how to read a label, in a later post.
The Outro
This concludes part 3 of Nootropics for Dummies, because I’m gonna keep these bite-sized. Not because you’re a dummy — I just know you’re busy.
Read on for Part 4: What’s the Difference Between a Supplement and a Drug?, where we’ll take a look at why supplements are different from pharmaceuticals and how the financial viability of ingredients informs what research is done.
Give me an example / Just tell me what to take / The Shortcut
I get it. With the tables and the citations and so on and you were here because you’re overwhelmed already. I felt the same way at one point, and I’m flattered you already want my opinion.
I suppose it won’t be a spoiler to say that I figured out something that works for me, and that, nearly 3 years later, it’s now available for anybody, whether or not they want to read the rest of this article. It’s called Plato, it’s exactly what I’ve been taking for 2.5 years†, and you can hit that link to get it.
† I’m not Rain Man now but more on that soon.††
†† More like The Lawnmower Man, a recurring joke I think you’ll continue to enjoy throughout this series.
