Tuesday, September 11, 2012

Brain-Boosting or Pulp Fiction?

It comes as no surprise that pulling all-nighters comes with the territory of being an undergraduate. It is the price that most of my peers and I have paid at one time or another for trying to get more work completed before a fast-approaching deadline. The sleepless nights ramp up during finals week while the use of caffeine and energy drinks fuels our self-induced, sleep- deprived zombie states.

                                                We all do it: study zombies 
                                      (Credit: zombiesandtoys.blogspot.com)                                 

Usually, our energy drinks do not purport to have cognitive-enhancing effects. However the drink Nawgan claims to be “What to Drink when you want to Think.” The label of the can states that it is powered with Cognizin, free of caffeine, taurine, gluten, carbonation and under 40 calories with natural ingredients. Now whom would this cleverly-branded Nawgan drink not appea tol? And how can Nawgan boast such wonderful claims?

Pretty packaging, but...?
Credit: fitblogr.com

According to the Nawgan website, Nawgan was co-founded and created by neuropsychologist Dr. Robert Paul. Dr. Robert Paul’s day job is as an adjunct assistant professor at Brown University. To his credit, he has had several publications from his work on cognitive performance and cognitive decline in subjects who have dementia or in subjects taking anti-retroviral medication for HIV. Dr. Paul’s joined the energy beverage industry because he “decided it was time to stop advising companies what to do and simply do it [him]self and make sure it is done right.” But did he accomplish his goal? Do Nawgan and Cognizin work? Or are the claims more substantiated in the minds of consumers because an Ivy League neuroscientist created and branded the drink?

Nawgan’s key ingredient is Cognizin, which ostensibly increases the cognitive performance of the user. After doing a little research, I found that Cognizin is the brand name for citicoline, a precursor to a neuropeptide known to be a dopamine agonist.


Outside of the U.S., citicoline has been given to stroke patients in countries such as Japan and England. However citicoline has not been administered in the U.S. due to a lack of clinical data supporting its efficacy in providing long-term neuroprotection in phase III clinical trials.

The method of administration of any drug meant to reach the brain is critical, due to the blood-brain barrier’s role in insulating and protecting the brain from pathogens. One major issue with Nawgan’s cognitive enhancing claims  is citicoline’s chemical structure, which would prevent it from appreciably crossing the blood- brain barrier. In 2000, Wurtman et al. found that citicoline orally administered to humans was metabolized rapidly even before fully circulating in the body [1]. Yes, citicoline has approximately 100% bioavailability when taken orally; however, studies also show that only (0.5%) of the original dose is taken into the brain when citicholine is ingested (Secades et al 1995, Adibhatla et al 2002) [2]. Although citicoline has not been found to have any major side effects when taken short-term, the long-term effects of exogenous dosages of this compound are still not understood.

That said, Nawgan appears to have an effective marketing campaign. The target consumer of Nawgan isn’t the ischemic stroke patient or the person with Alzheimer’s. Nawgan is continuously sold and distributed on college campuses as a cognitive enhancer. In fact, on Emory’s campus, free samples of Nawgan were given during finals week. In 2011 Nawgan received a $3 million dollar investment from the Japanese beverage company Kirin Holdings, to expand its distribution in stores such Walgreens. With the rapid onslaught of neuro-enhancing products, we need better measures to protect the consumers. A scientifically unsophisticated public enticed by scientific jargon might be convinced by the scientific evidence provided on the Nawgan website. Additionally, some consumers might see the Vitamin B complexes and Vitamin E listed in the ingredients and not realize the health complications that could come with product overuse and think “the more the merrier.”

For an otherwise healthy person, I’m not convinced that Cognizin works in the manner that Nawgan has reported. As a scientist-in-training, I realize that the dosage and the method in which a drug is administered is often equally as important as the compound itself. In an article in Discover Magazine, Dr. Paul Wolpe, Director of the Emory Center for Ethics and Editor-in-Chief of the American Journal of Bioethics Neuroscience, expresses similar concern for consumers of beverages boasting neuro-enhancing properties - especially people that may have an underlying mental health condition.

The underlying issue at hand, then, is, “Why are we relying on energy drinks in the first place?” Even though a healthier solution might be to get a sound night’s sleep, there seems to be a certain appeal, perhaps especially amongst college students, to consume energy drinks and supplements is to keep us alert and focused. Sleep deprivation, stress, overexertion and poor nutrition are the real culprits to our fatigue and poor concentration.

Who, me?
Credit: http://www.everydaylifeandbalance.com/quick-tips-to-help-you-let-go-of-stress.html

Surveys show that Americans continue to cut back on sleep to prioritize work and other obligations. There is even a growing problem of ADHD medication abuse by women who feel the need to keep pace with the ever increasing demands of work and family, as well as college students who feel the pressure to have an edge over their fiercely competitive peers. In a society that devalues sleep for the sake of productivity, reliance on energy drinks and caffeine, and other substances can only increase. Yet, some individuals might ask, “why not encourage people to enhance their cognitive abilities?,” if doing so enhances their productivity and happiness in their daily lives, and their utility to society. Hypothetically, if a researcher were to develop a novel drug to cure multiple sclerosis, and did so with the aid of cognitive enhancers, is there anything wrong with that?

With such widespread use of enhancers, we have to wonder whether current governing bodies are keeping pace with regulating technological innovation. Obviously new discoveries in science are being made daily, and as neuroscience continues to advance, scientists and entrepreneurs alike will capitalize on and commercialize its information to the public. Although currently Nawgan likely does not provide the cognitive boosting abilities it reports to have, future biotechnological innovations may well provide the possibility of neuroenhancement beyond the effects of a cup of coffee.

Bioconservatives such as Dr. Leon Kass, of President Bush’s Bioethics Commission, hold the belief that enhancements of humans beyond therapeutic purposes can compromise the dignity of an individual and ultimately affect the welfare of humanity. Some might suggest that, in the process of utilizing drinks like Nawgan in order to feel more productive, students are dehumanizing themselves and even others. Other students might look to “enhanced” students as an example for how to balance work and family life, and strive for an ideal unattainable without the aid of the same or a similar cognitive/performance enhancement.  While some might say that an individuals should have the right and freedom to access any enhancer, the students’ use of the drinks like Nawgan might “un-level” the playing field and result in peer pressure for other students to follow suit.

Overall, I think that Nawgan does not deliver on its claims of being an effective neuroenhancer. Additionally, I believe that the messages advocated by this product and products like it are damaging to our views on health, wellness, and achievement. Until safe and effective neuroenhancements are produced and accessible to consumers, we will continue to wrestle with the consequences of maintaining habits that contribute to lack of sleep and alertness, including obesity, heart disease, and other co-morbid conditions. Sure, in the short-term, with the aid of energy drinks you might get through a hard day’s work, but then what? A chronic dependence on caffeine and Vitamin B12 shots? Ultimately changes in lifestyle habits such as sleep and a well-balanced diet offer sustainable and safe measures towards increased concentration and alertness. Yet for many, this advice will fall on deaf ears, if some of the benefits of sleep can be mimicked from contents in a can.

Want to cite this post? 
Shagarabi, S. (2012). Brain- Boosting or Pulp Fiction? The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2012/09/brain-boosting-or-pulp-fiction.html

[1] Wurtman RJ, Regan M, Ulus I, Yu L. 2000. Eftect of oral CDP-choline on plasma choline and uridine levels in humans. Biochem Pharmacol 60: 989–992.

[2] Rao Muralikrishna Adibhatla , Hatcher, J. F. and Dempsey, R. J. (2002), Citicoline: neuroprotective mechanisms in cerebral ischemia. Journal of Neurochemistry, 80: 12–23. doi: 10.1046/j.0022-3042.2001.00697.x

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