In recent years there has been an explosion of energy drinks with high levels of caffeine—a drug with greater risks than many realize.
“Doctor Boud, your patient Mrs. Jones (name has been changed) is in the emergency room with a double pelvic fracture,” reported my nurse Jamie. My concern grew as I remembered treating Mrs. Jones for the past several years for her severe osteoporosis. Given her age, the length of the healing process, her current health problems, and potential complications, a pelvic fracture was serious indeed.
As I reviewed her medical chart, a long sequence of events flooded my mind. Mrs. Jones was one of my favorite elderly patients; I had been caring for her for many years. I was treating her for several serious conditions, including an irregular heart condition and insomnia, and I was treating her with aggressive therapy for severe osteoporosis. In addition, I had repeatedly tried to convince her to eliminate one particular habit that I knew was making her condition worse, a habit that often is not taken seriously and that can have an enormous impact on one’s health. This habit involves the abuse of a drug to which most people give little thought, even though it is now the most commonly abused drug on the planet. What was her habit? Excessive cola consumption. The drug? Caffeine.
One must keep in mind, of course, that from a medical point of view there are certain appropriate uses for caffeine. For example, doctors will sometimes prescribe caffeine for use in neonatal care. In addition, used in moderation, caffeine may not pose significant health risks. It was the resulting side effects from overuse of the drug that gave me such concern in Mrs. Jones’s case.
I found the situation terribly saddening. Mrs. Jones loved serving and had given energetic and dedicated assistance to others for many years. However, her double pelvic fracture not only prevented her from actively serving but in her case was life threatening. I could not help thinking about her high caffeine intake—six or seven colas every day—and how likely it was that this chemical had contributed to her current health problems, including dehydration, an irregular heart condition, insomnia, and osteoporosis, each of which increased the seriousness of the situation.
The Rise of Caffeine Abuse
Although Mrs. Jones’s condition represents an extreme, the reality is that doctors are seeing more and more patients with caffeine-related symptoms and medical conditions. This situation has been made worse by the exploding use of heavily caffeinated beverages known collectively as “energy drinks.”
The numbers are staggering. In 2006 alone, approximately 500 new brands of energy drinks were introduced into the market. In addition, 7.6 million young people have reported having used energy drinks, and consumption has more than doubled in the past three years. The energy drink industry has ballooned into a $3 billion-a-year enterprise. 1 Links to an external site. The companies that produce energy drinks use aggressive marketing techniques directed toward youth and college-age consumers, yet little data on the health hazards of these beverages has been publicized. This means that many people are drinking energy drinks with a poor understanding of the potential physical and medical side effects of the caffeine contained in the beverages they consume.
Not all caffeinated drinks are created equal; the quantity of caffeine varies greatly from product to product. To put this into perspective, consider that most cola soft drinks have from 22 to 55 milligrams (mg) of caffeine, compared to a common cup of tea that varies from 26 to 47 mg. Coffee may have from 57 mg for a cup of instant to 180 mg for a cup of brewed. By comparison, energy drinks may have from 80 to 500 mg of caffeine in one can. Companies compete to market the product that provides the biggest jolt. To do this, manufacturers combine caffeine with other substances such as alcohol in order to intensify its effects. These beverages often come in large containers and are frequently loaded with calorie-heavy sugars.
The Effects of Caffeine Abuse
What are the consequences of high caffeine consumption? First and foremost, caffeine is a central nervous system stimulant that can lead to addiction. As a doctor I recognize the physical, mental, and mental dangers of any addictive substance. Any addictive behavior, whatever the source, can lead to a loss of health and freedom.
Some addictions can control us to the point where they take away our agency. Addictions are controlling. Consequently, we should abstain from anything that would keep us from fulfilling our life goals. … Any kind of addiction inflicts a terrible price in pain and suffering.
I have treated a number of caffeine-related medical conditions. Milder conditions include jitteriness, agitation, insomnia, difficulty concentrating, and rapid heart rate. Use of caffeine can lead to a decrease in cerebral blood flow in adults and could increase the chance of compromising long-term growth in infants. Caffeine can also precipitate other conditions that can lead to further problems. Here’s an example: Using caffeine on a long-term basis to compensate for tiredness resulting from life-style choices results not only in sleep deprivation but also in physiological stress. These in turn can lead to an increased level of certain hormones that can lower one’s metabolism. A lower metabolism leads to an increased craving of carbohydrates and sugars and often will result in weight gain. Ironically, many people use these drinks in order to lose weight, whereas just the opposite may occur. Many physicians believe that this process has contributed significantly to the current problem of obesity in the United States. Weight gain has a negative influence on the medical conditions of sleep apnea, diabetes, depression, and even cardiac and cerebrovascular disease.
As my experience with Mrs. Jones demonstrates, high caffeine intake can cause a number of other serious problems as well, such as elevated blood pressure, gastrointestinal disorders, and even osteoporosis. Other commonly known physiological effects of caffeine consumption include acid reflux, urinary incontinence, restless leg syndrome, tremors, irritable bowel syndrome, and atrial fibrillation. Research also indicates a close relationship between caffeine use and elevated cholesterol levels and, potentially, coronary heart disease.
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Despite its frequent use as a performance enhancer among high school and college athletes, caffeine can also cause agitation and even episodes of rage. Furthermore, chemically dependent athletes are at risk of disciplinary action from their athletic programs because many sports programs have banned caffeinated energy drinks as a form of cheating.
In addition to rage and agitation, other mood disorders negatively affected by caffeine include ADHD, premenstrual dysphoric disorder, anxiety, and even depression. I have seen many patients whose depression has actually worsened after continued excessive caffeine intake. In addition, some of them have suffered severe rebound headaches and even required hospitalization for congestive heart failure. Unfortunately, there have also been deaths reported as a direct result of caffeine overdose.
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Dr. Boud works in family medicine at a primary care facility and volunteers as a consulting physician.
Caffeine Content in Common Beverages
While most sodas can be purchased in 12-ounce cans, energy drinks are sold in a variety of volumes, many of which are greater than 12 ounces. The orange line depicts the amount of caffeine in various beverages per 12 ounces. The yellow line depicts the total amount of caffeine in each can or bottle as it is normally sold.
|
Regular Cola |
41 mg Caffeine |
|
Tea, Brewed |
47 mg Caffeine |
|
Coffee, Instant |
57 mg Caffeine |
|
Coffee, Brewed |
107.5 mg Caffeine |
|
Weak Energy Drink |
120 mg Caffeine |
|
Average Energy Drink |
220 mg Caffeine |
|
Extreme Energy Drink |
500+ mg Caffeine |
Caffeine-Induced Stress
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Caffeine Introduced >> Increased Cortisol Hormone Levels >> Cravings for Carbs and Sugars >> Increased Abdominal Fat >> Further Increase in Cortisol and Exaggerated Responses to Stress >> More Cravings for Carbs and Sugars >> Worsening Obesity >> Risks of Heart Disease, Diabetes, High Blood Pressure, Osteoarthritic Problems
Caffeine Abuse Cycle
Initial doses of caffeine can yield increased athletic perfomrance, energy, alertness, and heart rate. High doses of caffeine can yield muscle twitching, anxiety/nervousness, irritability/rage, acid reflux, insomnia, hypertension, and diuresis.
As caffeine begins to wear off, effects can include rebound headaches, sluggishness, fatigue, light-headedness, and depression. These crash effects often motivate users to increase caffeine consumption, and the cycle repeats.