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.

Citoline

Credit:http://www.chemicalbook.com/ChemicalProductProperty_EN_CB1343597.html

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

References

[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

Neuroethics journal club: jobbing on the sleep

Feeling tired? You’re not the only one. According to a 2009 poll conducted by the National Sleep Foundation, 20% of Americans sleep less than six hours a night. How can people even do their jobs with less than six hours of sleep?

Oh.

Before you get too impressed by my ability to cite statistics, I should tell you I’m quoting directly from the article we read for the most recent meeting of the Neuroethics program’s journal club: “Examining the Effects of Sleep Deprivation on Workplace Deviance: a self-regulatory perspective” by Michael Christian and Aleksander Ellis.



Dr. Gillian Hue presented the article. Not only did Gillian study sleep and circadian rhythms as a graduate student, she also has extensive experience with sleep deprivation thanks to her young son, Lucas (hey, she made that joke, not me). One of the first things Gillian asked was how many of us had gotten seven hours or more of sleep the night before. Only two people raised their hands: Kristina Gupta and Cyd Cipolla, both Ph.D. candidates in Women’s, Gender, and Sexuality Studies at Emory (They are also teaching the class “Feminism, Sexuality, and Neuroethics” this semester that they developed as part of their winning Neuroethics Scholar applications). Two people out of roughly twenty had slept the bare minimum seven hours. I would make a joke here about how I should’ve gone into Women’s Studies, but I’m too tired to think of way to phrase it that doesn’t sound vaguely smarmy. Gillian asked us whether we’d gotten seven hours of sleep because that’s the criterion that Christian and Ellis use in their paper to decide whether subjects in their studies were sleep deprived. Why do they care if people are sleep deprived? Here’s the main hypothesis, taken from the abstract:
“Utilizing self-regulatory resource theories, we argue that sleep deprivation decreases individuals’ self-control while increasing hostility, resulting in increased workplace deviance.”

Christian and Ellis then proceed to test their hypothesis on two groups: nurses and undergraduates. Surprisingly, “results from both samples largely converge in supporting [their] hypotheses.” I say “surprisingly” because I would have predicted that sleep deprivation would increase self-control and lower hostility. Like all great science, their results run against our intuitions, yet allow us to explain the world more simply. If you think you detect a note of sarcasm, let me confirm that. If you also think you detect some jealousy on my part because I wasn’t smart enough to come up with a “no duh” hypothesis that would let me sail through grad school and land a cushy job as an Industrial/Occupational psychologist, let me also confirm that.

I mainly want to comment on the theory behind the experiments in this paper. If Christian and Ellis have chosen a “no duh” hypothesis, then it’s no surprise that I can’t find much to argue with in their approach. They’re working within the framework of self-control as a limited resource—as if self-control were a muscle that can tire. They cite multiple articles from the psychologist who has done the most work around the idea that people have a limited reserve of self-control, Baumeister (and I have to point out that most of the articles they cite from Baumeister’s group are reviews, not studies). Christian and Ellis argue that self-control can also be depleted by sleep deprivation. To support that idea, they cite a couple of papers that talk about lack of sleep and poor glucose metabolism in the pre-frontal cortex, of which one is a review (aargh! why don't they cite some primary literature?!) of healthy adolescent sleep (there’s no adolescents in Christian and Ellis’ paper! double-aargh!) and the other is a meta-analysis (see first “aargh!”). Not coincidentally, Baumeister’s group is now pushing the idea that self-control depends on glucose. I can hardly find fault, again, with a hypothesis like “if you use up all your glucose, then your brain will go out of control”. However, just because Christian and Ellis can point to that hypothesis doesn’t mean that they have “[integrated] research from the social psychological, sleep, and neurocognitive literatures” as they claim in their introduction. Similarly, citing a random review and a meta-analysis of sleep deprivation studies barely qualifies as “integrating evidence from neuroscience with organizational behavioral research” as they state in their discussion.

Lest you should think I’m just taking potshots at this paper, I’ll admit that it does make an important contribution. While I might think their results are a bit, well, obvious, it’s also true that their results might not be obvious to everyone. Recall that Christian and Ellis carried out the first part of their study on nurses. I don’t know how sleep-deprived nurses are, in general, but I do know that doctors in residency are definitely asked to work long hours all the time. Why hasn’t this practice changed if neuroscience shows how dangerous sleep deprivation is? Because, as our in-house medical ethics expert Dr. John Banja pointed out at journal club meeting, “the old guard” in charge of organized medicine and the professional medical societies are “very opposed to change”.

In this sense, Christian and Ellis provide some cold hard evidence that might open at least one pair of eyes. Maybe. During journal club Cyd Cipolla asked, “If we all know sleep deprivation is bad, why are Kristina and I the only ones getting enough sleep?” Kristina then wondered if, “in economic terms, the gains would outweigh the losses if people worked less and slept more”. Banja replied that, as far as hospitals are concerned, if residents work less, then attending physicians have to work more, which is more expensive.

So the cost of residents per hour might matter more to people running hospitals than the amount of deviance in whatever hospital they’re running. Christian and Ellis have asked with their study what the neuroscience of sleep can tell us about our ethics. They might not have done much for the ethics of neuroscience, though. I mean, our society still seems pretty bent on running a giant sleep deprivation experiment. That reminds me—I’d better post this and get to bed.

Be sure to RSVP for next month's meeting, on March 28th form 1230-130pm. We'll talk about Deboleena Roy's article, "Neuroethics, Gender, and the Response to Difference". The discussion will be facilitated by Neuroscience graduate student Laura Mariani (chief whistler of the Caspary lab and sitting duck exec prez of the Graduate Student Council).





Want to cite this post?


Nicholson, D. (2012). Neuroethics journal club: jobbing on the sleep. The Neuroethics Blog. Retrieved on
, from
http://www.theneuroethicsblog.com/2012/03/neuroethics-journal-club-jobbing-on.html