Unhealthful News 209 – Maybe it is sometimes about the caffeine. Maybe.

Previously I have posted about the media hype about energy drinks and there is a bizarre fixation on caffeine, to the exclusion of the other ingredients, either when they combined with alcohol or not.  The most criticized drinks — the original, Red Bull, and the controversial alcopop versions (which seem to have largely disappeared from the market following controversy) — actually have/had fairly modest amounts of caffeine, less than a small coffee.  But the “energy drink” label general means something contains other active ingredients, including other herbal stimulants (guarana, a source of caffeine and a other identified and perhaps unidentified stimulants; ginseng), taurine (an amino acid that is believed to usually be beneficial, but high doses of an isolated single amino can sometimes do weird things), and megadoses of some vitamins.

Personally, I have always been more worried about the other ingredients, though I hasten to add that there is not solid evidence indicting them.  I based my concern on the observation that (a) there is reasonable evidence that sometimes some people have a bad reaction to these drinks and (b) very few people have a very bad reaction to that quantity of caffeine, as evidenced by the tens of millions of people who drink that much caffeine every day.

This week it was widely reported that a 14-year-old Maryland girl, Anais Fournier, died after drinking two extra large energy drinks in December.  Was it caused by the drinks?  Quite possibly, though if so it seems most likely that they triggered a time-bomb condition rather than being like, say, a car crash that struck down someone who otherwise should have expected a 80 more healthy years.  Blogger Radley Balko suggested on Twitter the Huffington Post (which he writes for) should have headlined it, “Energy drinks demonized after girl w/ heart condition dies.” 

But if it was caused by the drinks, was the caffeine to blame? 

Unlike many of the other drinks, this is at least plausible in the recent case because the estimated amount of caffeine she consumed was 480 mg.  Alarmists in the press chose to point out that this was equivalent 14 cans of Coke.  They did not bother to mention that Coke is not really a very potent caffeine delivery system, and that this is in the neighborhood of a large Starbucks coffee.  Drinking a large coffee would not necessarily be the best thing for a girl with a diagnosed heart condition to be drinking, but hardly outside the realm of normal teenage behavior based on my observations at the local Starbucks.  (They also did not mention that volume of the Monster energy drink Fournier consumed was that of 4 cans of Coke or more than two large Starbucks — far short of downing more than two six-packs, but definitely a deliberate ingestion of a lot.)

We have no information on whether she had ever before drunk a large coffee, so the caffeine alone might have been too much.  But it still seems that there should have been some press mention of the other ingredients of the drink.  A search of the name of the girl or the drink in recent news yielded dozens of news stories, but when adding in the name of the other active ingredients, the only story that repeatedly appear was a post by a marijuana legalization advocate wondering why the drinks with all of these ingredients are legal and their drug of choice was not.  (Note to advocates of drug legalization:  Trying to embolden those who want to ban other substances is probably not your best strategy.)  Guarana showed up in longest story about the girl’s death, from her local newspaper, but only in the context of it being a source of caffeine; its several other active chemicals were not mentioned.

Fourneir’s death was officially attributed to cardiac arrhythmia due to caffeine toxicity.  Presumably this will be cited as evidence that the caffeine content in these drinks is toxic.  It will no doubt be used to make that claim about energy drinks that contain a more typical 80 mg. of caffeine.  But, obviously no such conclusion can be drawn, even about the 480 mg.  The epidemiology of caffeine is clear:  so few people die from it that we cannot even detect the effect. 

I also dread watching commentators pick up on the word “toxicity” in the diagnosis (which is strictly accurate, assuming it was the caffeine: death due to the acute effects of a chemical taken into the body) and start screaming “this is evidence that caffeine is toxic!!!!!”  Yes, people, of course it is — how could it be any different than every other chemical or compound, all of which are toxins in some form and quantity.

However, I am not the slightest bit worried that this will result in attacks on our society’s (and my personal) favorite caffeine delivery system, coffee (except, perhaps, at some fringe health kook sites, which don’t really worry about evidence anyway).  There will be actions in state capitols to ban energy drinks because of the caffeine — if not now, then after a couple of other headlined deaths.  But no one will give coffee a second thought.  The funny thing is that the people leading the charge are undoubtedly the same ones who worry about “chemicals” in food and the environment (not particular chemicals, just chemicals), and who are overlooking the list of untested chemicals that might really be causing a problem.

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