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Caffeine and Energy Drinks
MARRCH Annual Conference October 29, 2012
Jay Jaffee Minnesota Department of Health
We Will Look At:
• Caffeine and energy drinks - including mixing energy drinks with alcohol.
• The effects on users.
• Some of the misinforma on about some substances.
• What can be done to address this issue.
Caffeine/Energy Drinks
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What is a Drug?
A drug, broadly speaking, is any substance that, when absorbed into the body of a living organism, alters normal bodily func on. – World Health Organiza on
There is no single, precise defini on, as there are different meanings in drug control law, government regula ons, medicine, and colloquial usage – Random House Online Dic onary
Caffeine’s Popularity
One of the most popular drugs of all. -It is in numerous products including beverages and many medica ons. -May be used by more people than any other drug. -Nearly 80% of American adults drink coffee daily. -The average adult consumes 200 mg. per day. -More than 50% of adults consume just over three cups of coffee a day
Food and Drug Administra on, 2007
Caffeine Popularity
• Caffeine is the world's favorite psychoac ve substance. • Only petroleum exceeds coffee as a globally traded commodity. • So drinks now rank as the most popular beverage in the United States, and most contain caffeine. • Beverage trade groups es mate the annual per capita so drink consump on at 56 gallons. Caffeine-Related Psychiatric Disorders, eMedicine – WebMD, June 21, 2007
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Caffeine is a S mulant
• A central nervous system s mulant with physical withdrawal symptoms. • It is both a drug and a food addi ve according to the FDA. • It is used in prescrip on and over-the-counter medica ons to treat drowsiness and to improve the effect of some pain relievers. • It reaches peak level within an hour and remains for four to six hours.
Dosage
• Moderate amounts of caffeine (100-200 mg. per day) are not considered harmful. • Caffeine’s affects vary with size, gender and how sensi ve one is to it. • 600 mg. per day is considered too much. • 10 grams taken orally can be fatal. There is at least one reported death of a college student taking large amounts of alertness product.
Food and Drug Administra on, 2007
Caffeine Variables
In a healthy person, caffeine promotes cogni ve arousal and fights fa gue. It can produce symptoma c distress in some people depending on: • Dose consumed • Vulnerability to caffeine • Pre-exis ng medical or psychiatric condi ons (mood disorders in par cular) that are aggravated by mild psychos mulant use.
Caffeine-Related Psychiatric Disorders, eMedicine – WebMD, June 21, 2007
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Health Benefits?
Recent observa onal research has shown that coffee drinkers may live a li le longer.
But: 1. It is an associa on, not causal. 2. No difference between caffeinated and decaf. - Caffeine did not play a role.
Na onal Cancer Ins tute, May 2012
Caffeine Withdrawal
Drinking just 100 milligrams per day - the amount of a small cup of brewed coffee - and then giving it up can lead to withdrawal symptoms including: – headaches – depression – flu-like nausea and muscle pain
Na onal Ins tutes of Health
Caffeinism
Consump on of over 500 mg. per day over an extended period of me can lead to caffeinism.
Generally a combina on of caffeine dependency and a wide range of unpleasant physical and mental condi ons.
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Caffeine-induced Disorders
American Psychological Associa on has iden fied four caffeine-induced disorders: • Caffeine intoxica on • Caffeine-induced sleep disorder • Caffeine-induced anxiety disorder • Caffeine-related disorder DSM-IV
Caffeine Affects
• Feel more alert and awake • Feel ji ery and shaky • Makes it hard to fall asleep or stay asleep • Increases heart rate • Causes uneven heart rhythm • Raises blood pressure • Causes headaches, nervousness and/or dizziness • Dehydrates • Creates dependence
Food and Drug Administra on, 2007
Caffeine Consequences
• Caffeine has been clearly associated with adverse health effects in suscep ble individuals. • Among adolescents, caffeine consump on has been linked to elevated blood pressure and sleep disturbances. • Among pregnant women, high caffeine intake is associated with risk for late miscarriages, s llbirths, and small-for-gesta onal-age infants.
Journal of the American Medical Associa on, January 2011
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Caffeine and Pregnancy
Caffeine consump on may make it harder for a woman to get pregnant.
Animal research has found that caffeine interferes with muscle contrac ons that help eggs travel from the ovaries through the fallopian tubes and into the womb.
Bri sh Journal of Pharmacology, May 2011
Caffeine Consequences
• Caffeine can create a cycle of extreme energy swings. • Caffeine raises blood pressure • Increases feelings of stress, anxiety and road rage. • It can leave you feeling wired 12 to 16 hours a er the last cup, wreaking havoc on sleep. • And it can exacerbate health condi ons such as diabetes by making blood sugar rise faster than usual. Na onal Ins tutes of Health
Caffeine Consequences
• People with heart problems should avoid it – it makes their hearts work too hard. • People with anxiety problems or panic a acks may find it makes them feel worse. • It increases the release of stomach acid which may lead to “heartburn” or upset stomach. • It is a diure c causing the body to lose water.
Food and Drug Administra on, 2007
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Caffeine and Stroke
A study of middle-aged and older men who: • Were non-smokers and • Had hypertension Found: • The risk of thromboembolic stroke was more than doubled in those who consumed three cups of coffee a day as compared with non-drinkers.
Coffee consump on in hypertensive men in older middle-age and the risk of stroke, Journal of Clinical Epidemiology 1998 51: 487-94
Caffeine Consequences
Heavy daily caffeine use — more than 500 to 600 mg a day — may cause: • Insomnia • Nervousness • Restlessness • Irritability • Stomach upset • Fast heartbeat • Muscle tremors Source: Mayo Clinic
Caffeine Consequences
New research shows some people are gene cally inclined to consume more caffeine than others.
Some people are more sensi ve to caffeine: -Even a small amount may cause restlessness and sleep problems.
**Combining caffeine and sugar can have a nega ve affect on blood glucose and create carbohydrate cravings.
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Caffeine Overdose
• Breathing Trouble • Increased thirst • Changes in alertness • Irregular heartbeat • Confusion • Muscle twitching • Convulsions • Rapid heartbeat • Dizziness • Sleeping trouble • Fever • Increased urina on • Hallucina ons • Vomi ng
Na onal Ins tutes of Health, 2010
Caffeine Content
• Energy drinks have 50-505 mg caffeine per serving (2.5-35.7 mg caffeine/oz). • 12-ounce colas have 34-54 mg (2.9-4.5 mg caffeine/oz). • --FDA limit of 65 mg. per 12 oz. serving • A 6-ounce cup of coffee has 77-150 mg (12.8-25 mg caffeine/oz) and hot coffee is drunk more slowly. • Energy “shots” - (1-2 oz) beverages have an 100-350 mg (90-171 mg caffeine/oz).
Caffeine Content
Decaf coffee – 2-5 mg. Jolt Cola – 100 mg. Mountain Dew – 55 mg. 7-Up – 0 mg. Starbucks Coffee Ice Cream – 40-60 mg. Dannon Coffee Yogurt – 45 mg. Bu erfinger Bar – 2.4 mg. Special Dark Chocolate Bar – 31 mg. Excedrin, Extra Strength – 130 mg. (2 tablets) NoDoz, Maximum Strength – 200mg.
Food and Drug Administra on, 2007, 2011
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Caffeine Content
5 Hour Energy – 138 mg. (in 2 oz.) Amp – 143 mg. Arizona Green Tea Energy – 200 mg. Caribou Coffee La e – 180 mg. Coca Cola Classic – 35 mg. Diet Coke – 45 mg. 8 oz. cup of brewed coffee – 108 Monster Energy Drink – 160 mg. Mountain Dew – 54 mg. NOS Energy Drink – 260 mg. Red Bull – 80 mg. Rockstar Punched Guava – 330 mg. Sheets (two dissolvable strips) – 100 mg. Spike Double Shot – 350 mg. (in 4.26 oz.) Tea Brewed – 47 mg. Source: Energy Fiend Website and Sheets Website
Caffeine and Youth
The American Academy of Pediatrics recommends that youth should not consume energy drinks and rarely need sports drinks.
“Caffeine has been linked to a number of harmful health effects in children, including effects on the developing neurologic and cardiovascular systems.”
Sports Drinks and Energy Drinks for Children and Adolescents: Are They Appropriate? Pediatrics, June 2011
Caffeine and Youth
• There are no U.S. guidelines for youth caffeine consump on. • Canadian guidelines recommend that pre- schoolers consume no more than 45 mg. per day. • Youth experience the same affects as adults including increased blood pressure, anxiety, sleep problems, etc. • And they are more suscep ble to caffeine.
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Related Problems
• Kids who consume one or more 12 oz. sweetened so drinks are 60% more likely to be obese. • Kids who drink a lot of caffeinated beverages may not get vitamins and minerals from healthy sources including calcium. • Drinking too many sweetened caffeinated beverages can lead to tooth decay. • Being a diure c it can cause dehydra on, especially problema c in hot weather and for ac ve kids.
KidsHealth.org, 2011
Energy Drinks are Sugar-sweetened Beverages
Recent large studies have shown a rela onship to: • Long-term weight gain • Type 2 diabetes • Cardiovascular disease risk
Harvard School of Public Health, April 2010
High Fructose Corn Syrup
High fructose corn syrup is found in some energy drinks. • HCFS is a combina on of fructose and glucose. • Sucrose (table sugar) is also a combina on of fructose and glucose. There has been a lot of concern about HCFS contribu ng to obesity problems. • Presently there is conflic ng research about whether or not it is worse than sugar. • We do know that consuming too much of either contributes to obesity and other problems.
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Why Might Young People Use Caffeine?
Some Reasons Young People Might Use Caffeine • It seems to be the norm. • Marke ng • They see other family members using it. • Weight concerns • To stay alert to study or other reasons. • To wake up in the morning or an energy boost during the day. • Low blood sugar • Habit
Dissolvable Caffeine
Sheets – a new stamp-sized gel sheet that dissolves in the mouth. • Not recommended for anyone under 12. • Being promoted by LeBron James.
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Inhalable Caffeine
Aeroshot Pure Energy Caffeine Inhaler -inhalable caffeine in disposable canisters.
“Delivers 100 mg. of caffeine (4-6 puffs) which is absorbed in the mouth and diges ve tract.” -Concerns abut inhaling into lungs.
“Not intended for use by anyone under 12!”
Promoted as a party item. – Concerns it may facilitate binge drinking.
Caffeine Gum and Candy
Juice and Juice Drinks
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Energy Drinks
Energy Drinks
• On average they contain about 107 calories per 8 ounce serving. • An 8 ounce serving of Java Monster contains about 340 mg. of sodium. (FDA 2400 mg./day) • The majority of energy drink brands avoid FDA approval by labeling their products as dietary supplements, not beverages.
Energy Drink Popularity
• 500 new energy drink products introduced worldwide in 2006.1 • Energy drink sales were about $5.4 billion in the U.S. in 2006.2 • Sales increased 135% from 2005-2009.3 • Energy shot sales increased from $73 million in 2005 to $1.3 billion in 2011.4
1. Marin Ins tute and Mintel Group, 2008 2. Journal of the American Medical Associa on, January 2011 3. Mintel Group, 2010 4. Mintel Group, 2012
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Marke ng and Consequences
• $164 million spent on adver sing in 2010, a 37 percent increase from 2008.1 • Adolescents see 18 percent more ads than adults. 1 • 31 percent of 12-17-year-olds are regular consumers vs. 22 percent of 25-34-year-olds (one in ten adults overall).2 • 35 percent of males 18-24 use them.3 • ER visits because of energy drinks increased 10 4 fold from 2005-2009. 1. Energy Drink Fact Sheet, Rudd Center for Food Policy and Obesity, November 2011 2. Marin Ins tute and Mintel Group, 2008 3. Mintel Group, 2012 4. Substance Abuse and Mental Health Services Administra on, November 2011
Caffeine-free Energy Drinks
• Rela vely new products that contain most of the other ingredients found in other energy drinks. • Some contain hundreds and thousands of mes the daily recommended amount of B vitamins. • De-caf 5-hour Energy has over 8000 mes the daily amount of B-12 and, • 100% of daily amount of folic acid
Red Bull (Flugtag)
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Nos
Amp
Cocaine
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Rockstar
Monster
5-hour Energy
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Bawls
GoGirl
Monster Energy
16 ounce can -says a can is two servings Contains several B vitamins (200% daily value) and: 54 grams of sugar – 18% of Daily value of carbs 360 mg. of sodium – 16% of Daily value 2000 mg. of Taurine 400 mg. of Panax Ginseng 5000 mg. of “energy blend” – L-Carni ne, Glucose, Caffeine, Guarana, Insositol, Glucuronolactone, Maltodextrin
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What are These Things?
• L-Carni ne – biosynthesized from amino acids and helps transport fa y acids. • Glucose – simple sugar • Taurine – an amino acid that helps with the diges on of fats and acts like a diure c. • Panax (Asian) Ginseng – it both s mulates and relaxes the nervous system. Excess ginseng may cause headaches, restlessness & raised blood pressure. Ginseng with caffeine may increase risk of over-s mula on and upset stomach.
What are These Things?
• Guarana – a plant from the Amazon - the fruit contains twice the caffeine found in coffee beans. • Insositol – a carbohydrate that may help with depression • Glucuronolactone – a carbohydrate, claimed by energy drink companies to detoxify the body. • Maltodextrin – a carbohydrate-like substance used in some ar ficial sweeteners.
Panax Ginseng
Possibly unsafe when taken long-term, it may have hormone-like effects. Side effects: Insomnia Itching Menstrual cramps Rash Breast pain Dizziness Increased heart rate Mood changes Low blood pressure Vaginal bleeding Headache Diarrhea Loss of appe te
Medline Pus, Na onal Ins tutes of Health
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Panax Ginseng
Not recommended for: • Pregnant or breas eeding women • Children People with: • Auto-immune diseases • Bleeding condi ons • Heart condi ons • Diabetes
Medline Pus, Na onal Ins tutes of Health
Panax Gingseng
Not recommended for people taking: • Alcohol • Caffeine • Insulin • Lasix • An -depressants • Diabetes medica ons Medline Pus, Na onal Ins tutes of Health
B Vitamins
• B vitamins do not provide energy – they extract energy from food and you only need a small amount. • B vitamins are generally considered safe. – When taken in large amounts they have side effects. • B vitamins generally found in energy drinks: – B2 Riboflavin – B3 Niacin – B5 Pantothenic acid – B6 Pyridoxine – B9 Folic acid – B12 Cyanocobalamin
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B Vitamin Side-effects
• High blood sugar and skin problems. • Overdoses can lead to heart and liver problems. • Rarely, large doses of vitamin B3 (niacin) supplements can cause blurred vision, nausea, vomi ng, and can make stomach ulcers worse.
American Cancer Society
L-Carni ne
Side effects are generally mild.
High doses (5 or more grams per day) may cause diarrhea.
Other rare side effects include increased appe te, body odor, and rash.
University of Maryland Medical Center
Citric Acid
• Many energy drinks contain citric acid which is used as a preserva ve.
• Citric acid strips enamel from teeth.
• Enamel protects teeth from cavi es and decay!
• Consuming a lot of citric acid can also reduce bone density and increase risk for kidney stones.
General Den stry, May/June 2012
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Alcohol & Energy Drinks
• Mixing a s mulant with a depressant • May be mixed or premixed • Generally caffeine, guarana, ginseng or ephedra • Consequences: – Alert intoxicated people – Heart strain – Dehydra on – Possible seizures
Alcohol & Energy Drinks
• Associated with increased binge drinking • Twice as many episodes of weekly drunkenness • Significantly more alcohol-related consequences: – including being taken advantage of sexually, – taking advantage of another sexually, – riding with an intoxicated driver, – being physically hurt or injured, and – requiring medical treatment.
Caffeinated cocktails: energy drink consump on, high-risk drinking, and alcohol-related consequences among college students. O'Brien MC, McCoy TP, et al, May 2008
Alcohol & Energy Drinks
Alcohol energy drink research with college students found: • Those who report greater energy drink consump on also consume more alcohol, are more likely to mix energy drinks and alcohol, and experience heavy episodes of drinking.1 • Students who drank alcohol (with or without energy drinks) showed impaired impulse control.2 – Those who drank alcoholic energy drinks thought they were less impaired than those who drank the same dose of alcohol alone. – This could make them more likely to take risks such as driving while intoxicated.
1. Associa ons between energy drink consump on and alcohol use behaviors among college students. Drug and Alcohol Dependence, 123(1-3), 167-172 2. Alcoholism, Clinical and Experimental Research, July 2011
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Alcohol & Energy Drinks
“High-frequency” energy drink users – 52 or more days/ year: • Were more likely to have go en drunk at an early age (59.7% vs 38.4%) • Drank alcohol more frequently in the last year (141.6 vs 103.1 days, on average) • Drank more alcohol per drinking day (6.15 vs 4.64 drinks, on average). • 26.9% of high-frequency energy drink consumers met criteria for alcohol dependence vs. 11.6% of low- frequency consumers. Consump on of Energy Drinks Linked to Alcohol Dependence, Alcoholism: Clinical & Experimental Research, November 2010
Alcohol Energy Drink Safety?
In November 2010 the Food and Drug Administra on issued a warning to four companies sta ng “the caffeine added to their alcoholic malt beverages is an ‘unsafe food addi ve’ and...that further ac on, including seizure of their products, is possible under federal law.”
Kicking a Caffeine Habit
• Figure out how much caffeine you're inges ng during the day, – including so drinks and energy drinks; • If you can't track it, it's too much! • Try the following ps: – Wake up and drink 8 ounces of water. – This strategy seems to slow coffee consump on and also works if you have a morning diet or regular soda habit.
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Kicking a Caffeine Habit
• Some people can go cold turkey; others need to gradually reduce. • A heavy user may want to gradually reduce to minimize withdrawal symptoms • Consider alterna ve beverages – be er to avoid all sugar-sweetened beverages, whether it's added or high natural sugar because of high blood sugar concerns. • Withdrawal symptoms will pass in a few days.
What Can Parents Do?
• Talk about caffeine with your children. • Limit the amount you buy and have around the house. • Set limits for how much your children may consume. • Pay a en on to your children, your garbage/recycling., the car, etc. • Enforce those limits. • Be a good role model. • Talk to other adults including rela ves and parents of your kid’s friends. • Take ac on if there is a problem.
Contact Informa on
Jay Jaffee jay.jaff[email protected] 651-201-5496
Or go to our website: www.health.state.mn.us/alcohol
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