session 6 - jaffee · 10/24/12 1 caffeine’and’energy’drinks’’ marrch annual conference...
TRANSCRIPT
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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 misinformaEon 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 funcEon.
– World Health OrganizaEon There is no single, precise definiEon, as there are different meanings in drug control law, government regulaEons, medicine, and colloquial usage
– Random House Online DicEonary
Caffeine’s Popularity
One of the most popular drugs of all. -‐It is in numerous products including beverages and many medicaEons. -‐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 AdministraEon, 2007
Caffeine Popularity
• Caffeine is the world's favorite psychoacEve 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 esEmate the annual per capita so` drink consumpEon at 56 gallons.
Caffeine-‐Related Psychiatric Disorders, eMedicine – WebMD, June 21, 2007
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Caffeine is a SEmulant
• A central nervous system sEmulant with physical withdrawal symptoms.
• It is both a drug and a food addiEve according to the FDA.
• It is used in prescripEon and over-‐the-‐counter medicaEons 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 sensiEve 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 AdministraEon, 2007
Caffeine Variables In a healthy person, caffeine promotes cogniEve arousal and fights faEgue. It can produce symptomaEc distress in some people depending on: • Dose consumed • Vulnerability to caffeine • Pre-‐exisEng medical or psychiatric condiEons (mood disorders in parEcular) that are aggravated by mild psychosEmulant use.
Caffeine-‐Related Psychiatric Disorders, eMedicine – WebMD, June 21, 2007
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Health Benefits?
Recent observaEonal research has shown that coffee drinkers may live a liile longer.
But: 1. It is an associaEon, not causal. 2. No difference between caffeinated and
decaf. -‐ Caffeine did not play a role.
NaEonal Cancer InsEtute, 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
NaEonal InsEtutes of Health
Caffeinism
ConsumpEon of over 500 mg. per day over an extended period of Eme can lead to caffeinism. Generally a combinaEon of caffeine dependency and a wide range of unpleasant physical and mental condiEons.
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Caffeine-‐induced Disorders
American Psychological AssociaEon has idenEfied four caffeine-‐induced disorders: • Caffeine intoxicaEon • Caffeine-‐induced sleep disorder • Caffeine-‐induced anxiety disorder • Caffeine-‐related disorder DSM-‐IV
Caffeine Affects • Feel more alert and awake • Feel jiiery 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 AdministraEon, 2007
Caffeine Consequences
• Caffeine has been clearly associated with adverse health effects in suscepEble individuals.
• Among adolescents, caffeine consumpEon has been linked to elevated blood pressure� and sleep disturbances.
• Among pregnant women, high caffeine intake is associated with risk for late miscarriages, sEllbirths,� and small-‐for-‐gestaEonal-‐age infants.
Journal of the American Medical AssociaEon, January 2011
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Caffeine and Pregnancy
Caffeine consumpEon may make it harder for a woman to get pregnant. Animal research has found that caffeine interferes with muscle contracEons 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 condiEons such as diabetes by making blood sugar rise faster than usual.
NaEonal InsEtutes of Health
Caffeine Consequences
• People with heart problems should avoid it – it makes their hearts work too hard.
• People with anxiety problems or panic aiacks 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 diureEc causing the body to lose water. Food and Drug AdministraEon, 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 consumpEon 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 geneEcally inclined to consume more caffeine than others.
Some people are more sensiEve to caffeine: -‐Even a small amount may cause restlessness and sleep problems.
**Combining caffeine and sugar can have a negaEve affect on blood glucose and create carbohydrate cravings.
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Caffeine Overdose
• Breathing Trouble • Changes in alertness • Confusion • Convulsions • Dizziness • Fever • HallucinaEons NaEonal InsEtutes of Health, 2010
• Increased thirst • Irregular heartbeat • Muscle twitching • Rapid heartbeat • Sleeping trouble • Increased urinaEon • VomiEng
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. Buierfinger Bar – 2.4 mg. Special Dark Chocolate Bar – 31 mg. Excedrin, Extra Strength – 130 mg. (2 tablets) NoDoz, Maximum Strength – 200mg. Food and Drug AdministraEon, 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 Laie – 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 consumpEon.
• 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 suscepEble 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 diureEc it can cause dehydraEon, especially problemaEc in hot weather and for acEve kids.
KidsHealth.org, 2011
Energy Drinks are Sugar-‐sweetened Beverages
Recent large studies have shown a relaEonship 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 combinaEon of fructose and glucose. • Sucrose (table sugar) is also a combinaEon of fructose and glucose.
There has been a lot of concern about HCFS contribuEng to obesity problems. • Presently there is conflicEng 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. • MarkeEng • 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 digesEve 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 InsEtute and Mintel Group, 2008 2. Journal of the American Medical AssociaEon, January 2011 3. Mintel Group, 2010 4. Mintel Group, 2012
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MarkeEng and Consequences • $164 million spent on adverEsing 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 fold from 2005-‐2009.4
1. Energy Drink Fact Sheet, Rudd Center for Food Policy and Obesity, November 2011 2. Marin InsEtute and Mintel Group, 2008 3. Mintel Group, 2012 4. Substance Abuse and Mental Health Services AdministraEon, November 2011
Caffeine-‐free Energy Drinks
• RelaEvely new products that contain most of the other ingredients found in other energy drinks.
• Some contain hundreds and thousands of Emes the daily recommended amount of B vitamins.
• De-‐caf 5-‐hour Energy has over 8000 Emes 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-‐CarniEne, Glucose, Caffeine, Guarana, Insositol, Glucuronolactone, Maltodextrin
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What are These Things?
• L-‐CarniEne – biosynthesized from amino acids and helps transport faiy acids.
• Glucose – simple sugar • Taurine – an amino acid that helps with the digesEon of fats and acts like a diureEc.
• Panax (Asian) Ginseng – it both sEmulates and relaxes the nervous system. Excess ginseng may cause headaches, restlessness & raised blood pressure. Ginseng with caffeine may increase risk of over-‐sEmulaEon 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 arEficial 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 appeEte Medline Pus, NaEonal InsEtutes of Health
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Panax Ginseng
Not recommended for: • Pregnant or breasweeding women • Children People with: • Auto-‐immune diseases • Bleeding condiEons • Heart condiEons • Diabetes Medline Pus, NaEonal InsEtutes of Health
Panax Gingseng
Not recommended for people taking: • Alcohol • Caffeine • Insulin • Lasix • AnE-‐depressants • Diabetes medicaEons Medline Pus, NaEonal InsEtutes 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, vomiEng, and can make stomach ulcers worse.
American Cancer Society
L-‐CarniEne
Side effects are generally mild. High doses (5 or more grams per day) may cause diarrhea. Other rare side effects include increased appeEte, body odor, and rash. University of Maryland Medical Center
Citric Acid
• Many energy drinks contain citric acid which is used as a preservaEve.
• Citric acid strips enamel from teeth.
• Enamel protects teeth from caviEes and decay!
• Consuming a lot of citric acid can also reduce bone density and increase risk for kidney stones.
General DenEstry, May/June 2012
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Alcohol & Energy Drinks
• Mixing a sEmulant with a depressant • May be mixed or premixed • Generally caffeine, guarana, ginseng or ephedra • Consequences: – Alert intoxicated people – Heart strain – DehydraEon – 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 consumpEon, 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 consumpEon 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. AssociaEons between energy drink consumpEon 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 goien 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.
ConsumpEon of Energy Drinks Linked to Alcohol Dependence, Alcoholism: Clinical & Experimental Research, November 2010
Alcohol Energy Drink Safety?
In November 2010 the Food and Drug AdministraEon issued a warning to four companies staEng “the caffeine added to their alcoholic malt beverages is an ‘unsafe food addiEve’ and...that further acEon, including seizure of their products, is possible under federal law.”
Kicking a Caffeine Habit
• Figure out how much caffeine you're ingesEng during the day, – including so` drinks and energy drinks;
• If you can't track it, it's too much! • Try the following Eps: – Wake up and drink 8 ounces of water. – This strategy seems to slow coffee consumpEon 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 alternaEve beverages – beier 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 aienEon to your children, your garbage/recycling., the car, etc.
• Enforce those limits. • Be a good role model. • Talk to other adults including relaEves and parents of your kid’s friends.
• Take acEon if there is a problem.
Contact InformaEon
Jay Jaffee [email protected] 651-‐201-‐5496 Or go to our website: www.health.state.mn.us/alcohol