Liquor and energy drinks: What’s the problem?

By KRISTI EATON

VIEW ON HEALTH

Ready-made caffeinated energy drinks may soon be a thing of the past after the U.S. Food and Drug Administration recently sent warning letters to the drinks' manufacturers in light of several episodes where college students and other young people experienced a state of "wide-awake drunk."

But it's education, local dieticians say, that people need more than anything so they can properly understand why alcoholic energy drinks and regular energy drinks can be detrimental to their health.

THE BANNING OF ALCOHOLIC ENERGY DRINKS

In October, four students from Central Washington University were hospitalized and nearly died for what doctors initially believed to be a drug overdose. It turned out that the students had consumed several cans of Four Loko, an alcoholic energy drink with 12 percent alcohol, at a party. Many of the students at the party, ranging in age from 17 to 19, had blood alcohol content levels ranging from 0.12 to 0.35, well above 0.08, the legal limit in many states, according to news accounts. A level of 0.30 is considered potentially lethal, and one student nearly died from consuming the beverage.

In another incident, a 20-year-old man in Florida, Jason Keiran, reportedly shot and killed himself after drinking three 23.5-oz. cans of Four Loko. His parents are now suing Phusion Projects, which manufactures the malt beverage, for wrongful death of the Florida State sophomore.

Those incidents and others have drawn national attention, and Phusion Projects announced in November that they would be removing caffeine, guarana and taurine from the drinks nationwide. But it was too little, too late, as attorneys general from several states had been looking into caffeinated malt beverages for more than a year. In 2009, the attorneys general asked several manufactures to provide information on the safety of adding caffeine to their products. The latest incidents were the final straw, and many states banned Four Loko and similar drinks. On Nov. 17, the Food and Drug Administration warned four companies -- Charge Beverages Corp., which makes the drinks Core High Gravity HG Green, Core High Gravity HG Orange and Lemon Lime Core Spiked; New Century Brewing Co., producer of Moonshot; Phusion Projects; and United Brands Company Inc., which manufactures drinks Joose and Max -- that the caffeine added to the alcohol is an "unsafe food additive."

"FDA does not find support for the claim that the addition of caffeine to these alcoholic beverages is 'generally recognized as safe,' which is the legal standard," says Dr. Joshua M. Sharfstein, principal deputy commissioner in an FDA release. "To the contrary, there is evidence that the combinations of caffeine and alcohol in these products pose a public health concern."

Cans of the original Four Loko are now being hawked on Craigslist for two times the shelf price.

WHY ARE THEY SO DANGEROUS?

So, what makes Four Loko and similar caffeinated energy drinks dangerous? It's the mixture of a stimulant in the energy drink and the depressant in the alcohol, says Joanna Gorman, a registered dietician with University Medical Center of Southern Nevada.

"When you combine the caffeine with alcohol there is a delayed feeling of euphoria," she says. "By the time the caffeine wears off, you may have ingested more alcohol than you can handle. The caffeine masks the effects of the alcohol. By the time it wears off, people are more intoxicated, so they don't realize it."

In some people, Gorman says, caffeine gives them a heightened awareness. They can perform tasks quicker because it gives them more energy.

But, because caffeine is a stimulant and alcohol is a depressant, you have two systems fighting each other.

"People can get alcohol intoxication because they have drank more alcohol than the body can metabolize. That's where you get alcohol poisoning and people end up in the hospital, and they're in danger of dying," says Gorman.

Banning malt beverages with caffeine won't totally stop the problem, though, Gorman says, because people can still mix alcohol and caffeine on their own.

"The government can ban anything, but unless people learn why, people are always going to find ways around things," she says. "Of course it's going to help some people, but people still are going to be able to buy other ingredients and mix them."

Red Bull and vokda, for example, is a popular choice for many college students. A Wake Forest University study that polled 4,000 students reported that 24 percent mixed alcohol with energy drinks. When energy drinks were consumed with alcohol, students also drank more, according to the study: 5.8 drinks with an energy drink vs. 4.5 without an energy drink. The students who consumed alcohol with energy drinks were also found to have put themselves in dangerous situations more often: They were twice as likely to be hurt or injured, ride with an intoxicated driver, require medical attention, be taken advantage of sexually or take advantage of someone sexually, the study found.

"We knew anecdotally -- from speaking with students, and from researching internet blogs and websites -- that college students mix energy drinks and alcohol in order to drink more, and to drink longer," says Mary Claire O'Brien, M.D., associate professor of emergency medicine and public health sciences and lead researcher on the study. "But we were surprised that the risk of serious and potentially deadly consequences is so much higher for those who mixed energy drinks with alcohol, even when we adjusted for the amount of alcohol."

And it actually might be the energy drinks that cause people to drink more, according to one recent study from the University of Maryland and Johns Hopkins.

In the study, researchers examined the energy drink consumption and alcohol-drinking habits of 1,097 students in their fourth-year of college. Ten percent of the students were found to be high-frequency energy drinkers, meaning they consumed an energy drink at least 52 days per year, some people as much as one per day. Low-frequency drinkers -- those consuming energy drinks fewer than 52 days per year -- accounted for half of the students. The rest did not consume any energy drinks. Compared to the low-frequency group, those who drank more energy drinks drank more alcohol and more often--142 days versus 103 days in the past year and 6.2 drinks a day versus 4.6 drinks.

ARE REGULAR ENERGY DRINKS SAFE?

Having a regular energy drink, sans alcohol, on occasion is fine and not going to cause a lot of problems, Gorman says.

"But if people have more than one, what happens is, it's the caffeine in there," she says, adding that the caffeine content in one energy drink ranges from 70 to 200 milligrams. The caffeine in a cup of coffee ranges from 40 to 150 milligrams.

"Experts say that more than 400 milligrams can make people more nervous and irritable. The heart rhythms can speed up and you will have rapid heart beasts."

People can also have problems sleeping at night if they consume too much caffeine.

Too often, people rely on energy drinks to make their body work the way it is naturally supposed to, says the dietician.

"The problem is, people are always looking for the quick fix, when in reality the body, the reason our species has survived, we were programmed for food and sleep," she says.

Instead of trying to get a good night's sleep, she says people are instead reaching for the nearest can of Red Bull or Monster to function.

Melody Vicari, a registered dietician at Mountain View Hospital, agrees. She says people are turning to energy drinks when they should be looking at their daily habits when confronted with a lack of energy.

"I feel like people are trying to get extra energy from these drinks, but if they actually had a well-balanced diet and exercised, they'd have enough energy and wouldn't have to use a drink," she says.

She adds that there's a reason you hear stories of people going to McDonald's to eat often and then feeling sluggish.

Like Gorman, Vicari believes a person who is healthy -- no high blood pressure, no diabetes, no heart problems and of normal weight -- can have one energy drink and be OK. "But I think it's the people that do it in excess that can see lots of consequences," she adds.

She says she heard a story of a woman who consumed five energy drinks in one day and passed away from high blood pressure due to all the caffeine in the drink.

"The youth of today don't really have an idea of how much is too much," she adds.

However, besides the 400 milligrams noted, there's not one set recommendation on the daily limit of caffeine, Gorman notes, because everyone responds differently to the stimulant.

"Some people can drink coffee all day. I know people who drink coffee right before bed, but others have a soda and it keeps them up all night," she says.