Blog #38 Looking for Piracetam

Recently, my oldest daughter graduated from college (wahoo) and we decided to take a trip to celebrate. I have always wanted to go to Spain and she was willing to go anywhere that had Wi-Fi service so off we went to Barcelona. Barcelona turns out to be a wonderful place to visit and I highly recommend it if this was a travel log. Nor is this a culinary treatise so I will not go on about the intricacies of rabbit stew (not a fan) or chickpeas with black sausage (absolutely delicious). Instead, it is about how even though I left the country, the nutrition detective tagged along.

At first I did not notice her as I experienced the wonders of drinking chocolate and becoming entranced by any architecture designed by Gaudi. Eusebi Gaudi is Barcelona's most famous architect and his presence in the city is impossible to miss. He designed the Sagrada Familia Cathedral using nature as his inspiration. The inside of the cathedral has a forest motif and the outside spires are shaped like stacks of fruit. So, there is something vaguely nutritious about it. There are honeycombs, spirals, plant and animal designs all piled together in an over the top mishmash. You either love or hate the result.

Detectives have curious natures (that is, they experience curiosity, they are not necessarily odd) and as I wondered around, I could not help but notice that in busy areas there are pharmacies on practically every block. You cannot fail to notice them because they have either flashing green or red crosses. And unlike our super pharmacies that carry everything from mops to narcotics, these pharmacies are very small. They have the equivalent of one CVS aisle's worth of items on display and over the counter medicines, like ibuprofen, are all behind the counter. One pharmacy might carry feminine hygiene products and the next not. Maybe that is why they need so many. They must have some type of community pharmacy group where they all agree on who can carry what. Hector's pharmacy gets the face cream but one on 10th and Cambria gets the deodorant.

I could not figure the system out so if we needed something, we just went from one to the next until we ran into it, which never took long. Then I started wondering about locating piracetam. Piracetam is a substance developed in Belgium in the 70's that is the best cognitive enhancer I know. It improves the motor planning and speed of thinking. Nobody knows exactly how it works but taking it with choline enhances its effect. There have been many variants developed since the 70’s but piracetam has a long history of use and so I think it is the most predictable. Piracetam can be found in the US, but the source tends to be China, so I tell people Nootropil (a Spanish brand) from Europe is a more reliable product. And here I was in Spain!

So one morning I walked into a tiny pharmacy three streets behind our apartment and requested in my best high school Spanish a box of Nootropil. They speak a Catalan version of Spanish in Barcelona so nobody ever seemed to understand anything I said. Either that or my Spanish is dreadful which was my daughter's explanation. The clerk looked at me blankly. After repeating several versions of my request she handed me a slip of paper and instructed me to write down the name. "Ahhhhh," she responded with understanding after reading the name. That was easy, I thought until she started shaking her head and waving her hands. I needed to try the pharmacy next door or three doors down that carried piracetam and hair spray.

Armed with my paper I made faster progress until finally at the third pharmacy, I hit pay dirt. There for a measly 3.5 Euros (less than $6), I was able to purchase a box of Nootropil in my choice of potencies (800 or 1,200 mg). When I asked in my cringe inducing Spanish if a prescription was needed, the pharmacist appeared puzzled that I asked. I had asked because piracetam inexplicably sometimes seems to require a prescription and other times does not. I have a client in Ireland who needed a prescription while one from Italy, did not. You can order it from England without a prescription but I think you need one if you are actually in England.

To further thicken the plot, getting piracetam in Spain was no harder than tracking down a nail clipper and about the same cost while getting piracetam in the US can take weeks and costs many times more. It made me realize again how little medicine is about what works and how much it is about health care politics and just how things are done in a particular place at a particular time.

Last year, I saw a child who had severe, global developmental delays. Dmitri had been getting occupational, speech and physical therapies but was making very slow progress. After creating a good nutritional base for learning, I asked his mom if she had ever thought about trying piracetam. In these complicated cases, piracetam can speed up progress by building neuroconnections across the corpus callosum to help with processing. I pointed her to some resources and information about it so she could consult with her doctor.

Several weeks later she reported her doctor advised her against using piracetam. It cannot be that good, the specialist had said, or he would know about it. He could not assure her it was safe and there was no evidence (according to the expert), that it worked. What was his alternate suggestion? There wasn’t one. She would have to learn to live with his disabilities. Dmitri’s mom was discouraged but listened to her doctor. Dmitri progressed very slowly until the summer. His mom decided to take Dmitri home to Poland and spend time with her family.

While there she made an appointment with a neurologist her family liked and asked him about piracetam. He told her Dmitri should have been put on piracetam a long time ago. Of course, it was safe and if she were there, he would have been put on it a long time ago. She started it right away and Dmitri’s speed of progress increased.

So either piracetam only works in Europe or if someone tells you they have never heard of something, you should not trust their opinion on it. The US doctor did not realize how much of what he thought he knew was colored by limited medical cultural experiences. Maybe he should travel more.