Channel 4’s Countdown is one of the longest running TV gameshows in the world and by any measure the raw ‘statistics’ are pretty impressive. In the UK it’s been running for almost thirty years and has racked up – to date – sixty-five series and more than five thousand episodes. In France, where the show originated under the name ‘Des chiffres et des lettres’ (‘Numbers and Letters’) it’s been running continuously since 1965.

I’m not by any means an avid viewer of the programme, its the kind of show that I might occasionally have on in the background if I’ve got the day off and if there’s absolutely nothing else on TV, so its only very recently that its come to my attention that for the last couple of years the show has been sponsored by a company called Vitabiotics, which is seemingly the largest producer and supplier of branded vitamin and mineral supplements in the UK.

The company’s products aren’t exactly cheap. The going rate for a standard pack of own brand multivitamins at Boots is around £2-3 for 30 tablets while the cheapest of Vitabiotics’ branded product retails at just under £5 and most of its products sell at £8 and upwards for 28-30 tablets. The other thing that Vitabiotics is heavily into is targeting its products at specific market segments and life stages. It has specific brands for men, women and children with sub-branding for different age groups, i.e. teens, 50+, 70+ and its own ‘sports’ sub-brands. It also has several brands that target specific lifestages or common health concerns, e.g. ‘Pregnacare’, ‘Cardioace’ and ‘Jointace’.

The brand that’s piqued ny own interest is called ‘Neurozan’ which comes in two varieties; a standard version that’s marketed as being for ‘Brain Performance and Memory’ and a ‘Plus’ version for which the sales pitch is ‘Brain Function and Performance’. The standard version retails for around £9-10 for 30 tablets while the plus version – and the plus element is the inclusion of Omega 3 ‘fish oil’ capsules – weighs in at around £17-18 for 28 dual packs of tablets and capsules. Neurozan is one of several brands that Vitabiotics has promoted via its sponsorship deal with Channel 4 and Countdown and is of particular interest here because the programme is well known as being popular with both students and pensioners, groups with a limited income but who, nevertheless, may be swayed in purchasing a product which claims to be capable of improving their cognitive performance.

Students, in particular, are likely to be easy marks for a product which claims to ‘feed your mind’ and its therefore no surprise to find comments like this one turning up on Twitter:

firstly I will consume a neurozan brain tablet, plus a concuction of tea & coffee. then coursework & revision shall commence

I won’t embarrass the individual responsible for this tweet by naming them, not least because there are more worrying examples of the lengths that some people are prepared to go to ‘boost’ their brain power, such as:

Anyone taking Neurozan out there? I wonder what happens if you combine it with modafanil… 🙂

Modafinil is a prescription analeptic that used to treat narcolepsy and it’s marketed in the US under the brand name ‘Provigil’ (for anyone who watched this week’s Law & Order SVU on Channel 5) so the answer to this guy’s question is ‘you’ll fuck yourself up!’*.

* A good rule of thumb here is that if you think drug will make you more intelligent then you’re just not intelligent enough to be taking drugs. A guy on my degree course (psychology of all things) decided that a wrap of speed was just the thing he needed to help him turn in an essay on a short deadline, which he did… a 3,000 + word essay (the limit was only 1,500 words) which began with a capital letter and ended with a full stop but which contained no other punctuation whatsoever. I’ll leave you to take a guess at the grade he was given for his amphetamine-enhanced efforts.

Update – since I posted this article, another comment has popped up on Twitter from a student who’s looking to Neurozan to improve their prospects in upcoming examinations…

They’re only £10.20 so worth a try right? Why not! Lol… I’m desperate so I’ll try anything. :S #JoinTheFun #Neurozan

So the question is can Neurozan actually do what its packaging suggests and support, or even improve, people’s memory, brain function and performance, particular is light of the claim that Vitabiotic’s including in its press release announcing its original sponsorship deal with Countdown.

All of Vitabiotics formulations are based on solid scientific research, supported by thousands of peer-reviewed research papers, proven in clinical trials and manufactured under pharmaceutical quality control.

First port of call is the Neurozan product page on the company’s own website and in the product FAQ we find the following statement.

Will Neurozan® definitely help with poor memory or learning?

Neurozan® includes nutrients used by the brain including L-Arginine which is important for the natural production of a bio-messenger used in information retrieval such as learning and memory. However, no one can make the guarantee that your memory or learning will definitely improve and as with all supplements, the experience of individuals may vary.

That looks very much like a Quack Miranda warning to me, so that’s our first red flag of the day.

While we’re on the subject of disingenuous marketing, Vitabiotics seems to be fond of assuring its customers that none of its products have been tested on animals. This is true in the sense that the company doesn’t conduct its own animal testing but trivially so as, if you look up many of the active ingredients contained in its products on PubMed, then you’ll quickly find that a sizeable number of ‘thousands of peer reviewed research papers’ from which the company claims support for its products were in fact conducted on animals, especially mice and rats.

So that’s red flag number two, and number three turns up very quickly afterwards on the company’s ‘Charity Partners’ page where we find not only the University Westminster’s School of Integrated Health – for which David Colquhoun is the go-to-guy – but also this little gem…

Food For The Brain

Food For The Brain (FFB) is a leading education charity promoting the link between nutrition and brain health and performance, especially in children. Vitabiotics WellKid®, Neurozan® and Pregnacare® Plus are proud to support FFB and have been certified and approved by FFB.

Where we do we start with this one?

Food for the Brain’s registered charity correspondent is Patrick Holford, so where do we start, especially as the original and best ‘Holfordwatch’ is currently offline? You could just google ‘Patrick Holford Quack’ but to get you started a little more easily, both Ben Goldacre and The Quackometer have an extensive range of Holford-related material for you to peruse with this article on ‘Holfordism’ being as good a primer as any I can think of for the time being. I’d also recommend Gimpy’s article on Holford’s brand of ‘pill pushing proselytising‘ and Margaret McCartney’s article in the BMJ on the activities of ‘Food for the Brain’ and its use of an unvalidated online cognitive function test as a marketing tool as further reading

To be certified and approved by Patrick Holford isn’t a so much red flag as a parade of the Chinese Communist Party.

That’s what on the Vitabiotics website but what isn’t on their website is equally notable; i.e. nothing whatsoever by way of a reference to any clinical trials relating to Neurozan, so it would appear that there is no direct evidence for any of the claims made for this product.

Next port of call? Advertising Standards Authority, of course, and a quick search of their adjudications database turns up six adjudications relating to Vitabiotics, five of which were upheld in full while the other was partially upheld – there’s also an adjudication again a company called Neocell which stemmed from a complaint made by Vitabiotics which all seems a bit pots and kettles. Of the six product for which Vitabiotics have been censured for making dodgy claims and using dubious testimonials, five relate to products that the company has promoted via is sponsorship of Countdown, including one which relates specifically to Neurozan and statements made on its packaging, as it appeared on an advertising poster.

This particular complaint focussed on specific claims made in relation to B vitamins contained in the product and not on the product as a whole but the adjudication also helpfully identifies the other active ingredient that Vitabiotics claims are beneficial to ‘brain performance’.

The second ad had the headline “ADVANCED MICRONUTRIENTS FOR THE BRAIN” next to a picture of two boxes of supplements. Text on the first box stated “neurozan plus To help maintain Brain Function & Performance NUTRIENTS FOR THE BRAIN”. Text on the second box stated “neurozan feed your mind Bio-active nutrients to help maintain Brain Performance & Memory NUTRIENTS FOR THE BRAIN”. Text below the boxes stated “B-VITAMINS & THE BRAIN Also includes the specific B vitamins reported in ground-breaking research”. Text below the headline stated “Designed to help keep you at your razor sharp best, Neurozan Plus contains NEURO-SPECIFIC MICRO-NUTRIENTS including phosphatidylserine, 5 HTP, Co-Q10, vit D3, B complex and zinc to help maintain cognitive function and mental performance.” Text at the bottom of the ad stated “VITABIOTICS WHERE NATURE MEETS SCIENCE”.

Now that is useful because, if you look at the product formulation you’ll see that it contains a veritable grab-bag of assorted vitamins and minerals, including vitamins C, D, E, several B vitamins, iron, zinc, magnesium, selenium, chromium, etc. all of which serve a variety of useful purposes within the human body. The general point to be made about vitamin and mineral supplementation is that its only really beneficial if you’re deficient in a particular vitamin or mineral due to a poor diet or because you have underlying medical condition which causes the deficiency or undergoing a treatment, such as chemotherapy, which causes you to become deficient in certain vitamins/minerals. Folic acid for women who’re intending to try for a baby is perhaps the only major exception to this general rule and even here it’s worth noting that you can pick up generic folic acid tablets for less than £2 for 9o tablets on the internet, compared to the £9-10 you’ll pay for 30 tablets of Vitabiotics’ Pregnacare Conception range.

Most people simply don’t need to take vitamin and mineral supplements as they get all the vitamins and minerals they need from eating a normal healthy diet and if, for any reason, you do need supplements then your doctor will happily tell you which one’s you do and don’t need and, more important, why you need them.

This being the case we can focus specifically on just the ‘neuro-specific micro nutrients’ in Neurozan, including a couple of the B vitamins for which specific heralth claims have been made, to see if any of Vitabiotics’ claims stand up to scrutiny. To help us with this task we can look to the European Food Standards Agency which is busily engaged in a process of evaluating the scientific validity of health claims made in relation to various foodstuffs, vitamins and minerals, not least because many of the ingredients in Neurozan have already been assessed by the EFSA.

We’ll start almost at the top, as I’ll set the Ginkgo Bilobo extract to one side for the moment as its a herbal product and not directly covered by the EFSA panel for Diatetics, Nutrition and Allergies, so we’ll kick things off with 5-HTP – and for each ingredient I’ll give the name, EFSA assessment and link to the full recommendation.

5-HTP (5-hydroxytryptophan) – link

The Panel considers that the evidence provided does not establish that clinically ill patients with anxiety, panic and sleep disorders are representative of the general population with regard to normal attention, or that results obtained in studies on subjects with anxiety, panic and sleep disorders can be extrapolated to normal attention in the general population.

On the basis of the data available, the Panel concludes that a cause and effect relationship has not been established between the dietary intake of 5-HTP and normal attention.

L-Arginine – link

No neuro-specific health claims have been evaluated by the EFSA, however it appears that Vitabiotics may be making an indirect claim for L-Arginine on the basis of a claimed role in endothelium dependent vasodilation, which the EFSA have assessed as follows:

The claimed effects are “vascular system (blood pressure, circulation, vessels)”, “vascular health; blood circulation”, and “normal blood circulation as a nitric oxide precursor”. The target population is assumed to be the general population. In the context of the proposed wordings and the clarifications provided by Member States, the Panel assumes that the claimed effects refer to the improvement of endothelium-dependent vasodilation. The Panel considers that an improvement of endothelium dependent vasodilation may be a beneficial physiological effect.

In weighing the evidence, the Panel took into account that one study did not show an effect of L arginine consumption on endothelium-dependent vasodilation, and that in a second study the observed changes in endothelium-dependent vasodilation could have been due to an acute effect of arginine rather than to a sustained effect.

On the basis of the data presented, the Panel concludes that a cause and effect relationship has not been established between the consumption of L-arginine and improvement of endothelium-dependent vasodilation.

The review goes on to add that that:

The Panel considers that no conditions of use can be defined for L-arginine.

Glutamine (L-Glutamine) – link

Claims were submitted for ‘maintenance of normal neurological function’, increased attention and improvement of working memory for which the EFSA’s panel found that no cause and effect relationship could be established for any of the claims as no supporting references were provided for any of them.

Glutathione – link

No claims have been submitted to the EFSA for glutathione.

Claims were submitted for L-cysteine and L-methionine in relation to their role in Glutathione formation with the panel concluding that “a cause and effect relationship has not been established between the consumption of L-cysteine and L-methionine alone or in combination and contribution to normal glutathione formation.”

Co-enzyme Q10 – link

The claimed effect is “protection of healthy neurological system”. The target population is assumed to be the general population. In the context of the clarifications provided by Member States, the Panel assumes that the claimed effect refers to normal cognitive function. The Panel considers that contribution to normal cognitive function is a beneficial physiological effect.

No references were provided from which conclusions could be drawn for the scientific substantiation of the claimed effect.

On the basis of the data presented, the Panel concludes that a cause and effect relationship has not been established between the consumption of coenzyme Q₁₀ (ubiquinone) and contribution to normal cognitive function.

Phosphatidylserine

There are currently no references to Phosphatidylserine in the EFSA journal.

A US Food and Drug Administration review in 2003 found that “the totality of the publicly available scientific evidence, the agency concludes that there is not significant scientific agreement among qualified experts that a relationship exists between phosphatidylserine and reduced risk of dementia or cognitive dysfunction.” The review also noted all 10 intervention studies it looked at ‘were seriously flawed or limited in their reliability in one or more ways.” and concluded that “most of the evidence does not support a relationship between phosphatidylserine and reduced risk of dementia or cognitive dysfunction, and that the evidence that does support such a relationship is very limited and preliminary.”

Looking at recent research on PubMed, things haven’t moved on much since 2003 in terms of improving the evidence base, which may explain why there’s nothing in the EFSA journal. The research that has been undertaken since 2003 has focussed primarily on Alzheimer’s and on cognitive impairments in the elderly is not likely to generalisable to the wider population.

Phosphatidylcholine – link

The claimed effect is “cognitive, memory functioning; neurological functioning”. The target population is assumed to be the general population. The Panel considers that maintenance of normal neurological function is a beneficial physiological effect.

No references were provided from which conclusions could be drawn for the scientific substantiation of the claimed effect.

On the basis of the data presented, the Panel concludes that a cause and effect relationship has not been established between the consumption of choline and the maintenance of neurological function.

And…

The claimed effect is “cognitive, memory functioning; neurological functioning”. The target population is assumed to be the general population. The Panel considers that contribution to normal cognitive function is a beneficial physiological effect.

No references were provided from which conclusions could be drawn for the scientific substantiation of the claimed effect.

On the basis of the data presented, the Panel concludes that a cause and effect relationship has not been established between the consumption of choline and contribution to normal cognitive function.

Before going on to add that…

The Panel notes that no dietary reference values for choline have been established in the EU. There are no reliable intake data and there are no indications of inadequate choline intakes available in the EU. The Panel also notes that dietary references values (adequate intakes) have been established outside the EU for different population subgroups. A nutrient content claim has been authorised in the United States based on the adequate intake for adult males (550 mg of choline per day).

Neurozan contains 10 mg of Phosphatidylcholine.

Vitamin B1 (thiamine) – link

General claims have been submitted to the EFSA for vitamin B1 in relation to ‘function of the nervous system’ for which the panel has given this assessment:

The Panel concludes that a cause and effect relationship has been established between the dietary intake of thiamine and normal energy-yielding metabolism, normal cardiac function, and normal function of the nervous system. The evidence provided does not establish that inadequate intake of thiamine leading to impaired function of the above-mentioned health relationships occurs in the general EU population.

So, no evidence that B1 deficiency is a problem in the general EU population.

Vitamin B2 (riboflavin) – link

The claimed effect is “mental performance (where mental performance stands for those aspects of brain and nerve functions which determine aspects like concentration, learning, memory and reasoning, as well as resistance to stress)”. The target population is assumed to be the general population. The Panel considers that contribution to normal psychological functions, which encompass cognitive and affective domains, is a beneficial physiological effect.

None of the references provided addressed the relationship between the dietary intake of riboflavin and contribution to normal psychological functions.

On the basis of the data presented, the Panel concludes that a cause and effect relationship has not been established between the dietary intake of riboflavin and contribution to normal psychological functions.

Vitamin B6 – link

Although a separate claim for Vitamin B6’s contribution to normal psychological functions has been approved, when it comes to claims relating to ‘mental performance’ the Panel gave this assessment:

The evidence provided does not establish that inadequate intake of vitamin B6 leading to impaired function of the above health relationships occurs in the general EU population…

The Panel considers that the claim for vitamin B6 and mental performance encourages excess consumption of vitamin B6 and therefore does not comply with the criteria laid down in Regulation (EC) No 1924/2006.

Vitamin B6 is toxic if consumed to excess, causing damage to the nerves of the peripheral nervous system, leading to pain and numbness in the extremities and even permanent damage to the dorsal root ganglia.

Folic Acid and Vitamin B12

As with vitamins B1 and B6, general claims relating to the role of Folic Acid and Vitamin B12 in the maintenance of normal neurological and psychological functions have been accepted by the EFSA and as long term deficiencies in either can result in pernicious anaemia it’s worth ensuring that you get enough of both, but there’s no evidence that either will improve mental performance if you’re not deficient.

The ASA adjudication also notes that Vitaboitics were including both vitamin D3 and Zinc in their list of ‘neuro-specific micro-nutirents’. No relevant claims for viatmin D3 have been assessed by the EFSA and Zinc there is only a claim for tiredness and fatigue for which the EFSA found that cause and effect had not been established.

So, with the exception of general claims for vitamin s B1,B6, B12 and Folic acid, which the ASA has already rejected on the basis that none of these vitamins can be show to ‘boost’ mental performance in the general population, none of Neurozan’s so-called ‘neuro-specific micro nutrients’ has been validated by the EFSA.

As for Neurozan Plus, which tosses Omega 3 capsules into the ring as well, the EFSA has this to say about the active ingredient in Omega 3 oil.

The claimed effect is “brain function (adult & children)”. The Panel assumes that the target population is the general population. In the context of the clarifications provided by Member States, the Panel assumes that the claimed effect refers to the contribution to normal cognitive function. The Panel considers that contribution to normal cognitive function is a beneficial physiological effect.

No human studies have been provided on the effect of the consumption of a combination of DHA, EPA and GLA on cognitive endpoints.

On the basis of the data presented, the Panel concludes that a cause and effect relationship has not been established between the consumption of DHA, EPA and GLA and contribution to normal cognitive function.

There are also four other similar claims made in relation to products aimed specifically at child, all of which have been rejected for lack of evidence.

That just leaves us with the Ginkgo Biloba extract to deal with and here a recent systematic review and meta-analysis of research into its use in dementia proves particularly useful…

Results

Nine trials using the standardized extract EGb761^® met our inclusion criteria. Trials were of 12 to 52 weeks duration and included 2372 patients in total. In the meta-analysis, the SMDs in change scores for cognition were in favor of ginkgo compared to placebo (-0.58, 95% confidence interval [CI] -1.14; -0.01, p = 0.04), but did not show a statistically significant difference from placebo for activities in daily living (ADLs) (SMD = -0.32, 95% CI -0.66; 0.03, p = 0.08). Heterogeneity among studies was high. For the Alzheimer subgroup, the SMDs for ADLs and cognition outcomes were larger than for the whole group of dementias with statistical superiority for ginkgo also for ADL outcomes (SMD = -0.44, 95% CI -0.77; -0.12, p = 0.008). Drop-out rates and side effects did not differ between ginkgo and placebo. No consistent results were available for quality of life and neuropsychiatric symptoms, possibly due to the heterogeneity of the study populations.

…

Conclusions

We found a statistically significant advantage of Ginkgo biloba compared to placebo in improving cognition for the whole group of patients with Alzheimer’s disease, vascular or mixed dementia. Regarding activities of daily living, there was no significant difference for the whole group. However, in the subgroup of patients with Alzheimer’s disease, there was a statistically significant advantage of Ginkgo biloba compared to placebo. In a situation, where the clinical significance of the moderate effects of cholinesterase inhibitors and memantine as symptomatic treatments is increasingly been questioned, ginkgo biloba may not be an inferior treatment option for a considerable number of people with mild or moderate dementia. However, direct comparisons are lacking. A major multicenter study to compare the relative effectiveness of Ginkgo biloba and cholinesterase inhibitors for different dementia subgroups appears justified.

Before anyone gets too excited about the statistically significant results here, these findings cannot be generalised to the wider population, so they don’t support general health claims for products such as Neurozan and the high degree of heterogeneity in the data raises questions about the reliability of the studies on which the meta-analysis is based. What we have here is basis for justifying further research but not evidence to support general claims of efficacy/benefit, not least because the authors suggest that a dose of 240 mg – twice that contained in Neurozan – may be required to deliver clinically significant results in improvements in activities in daily living in the Alzheimer’s subgroup.

As in the case of 5-HTP, a claim submitted to EFSA based on this paper would almost certainly fail due the lack of generalisability of the results, which leaves Vitabiotics without any credible evidence to support their implied claim that Neurozan offers any beneficial effects in relation to memory, brain performance and brain function other than for individuals with one of more vitamin B deficiencies – and as you can pick up 180 100% RDA vitamin B complex tablets on Amazon for £3.95, there’s really nothing to commend either Neurozan or Neurozan Plus.

As for being supported by thousands of peer-reviewed research papers, its interesting to note that for at least four of the ‘active’ ingredients in Neurozan, no research was put forward to support any of the health claims that are relevant to the product’s supposed function while two of its ingredients haven’t even been reviewed by the EFSA despite one of them – Phosphatidylserine – appearing prominently on the product’s packaging.

In short, if you’re a Countdown viewer and you want to improve your ‘brain performance’ then you’ll much better off watching the programme, on the off chance you may extend your vocabulary, than you will be if you buy the sponsor’s products, regardless of what it says on the packaging – and if not, you may be able to take some comfort from the fact that Vitabiotics’ 6-figure sponsorship deal with Countdown will almost certainly help them keep Rachel Riley well supplied with arse-hugging pencil skirts for many years to come.