Alcohol and Caffeine - a Potent Mix

Last year the Food and Drug Administration sent warning letters to 27 manufacturers of alcoholic beverages containing caffeine (see this blog Nov. 15, 2009), asking the companies to justify the safety of their products. But apparently the agency has not yet followed through with its promises to review the safety information requested from the companies and then to take appropriate action if it was not forthcoming.

One of the companies selling caffeine-and-alcohol drinks was in the news again last month after students at two universities ended up in emergency rooms with alcohol poisoning. The drinks in question, called Four Loko, contain 23.5 ounces of 12% alcohol laced with caffeine. Allegedly the caffeine overrides the natural sleepiness effect of alcohol, causing the user to underestimate how drunk he/she really is.

The company says that it is being unfairly singled out.

Some college students will abuse alcohol no matter what form it is in. But are packaged caffeine-and-alcohol drinks GRAS (Generally Recognized As Safe) or not? It should be up to the FDA to decide, and so far it hasn’t.

Meanwhile, states and municipalities are taking action. Last Thursday Michigan became the first state to ban alcohol-and-caffeine drinks. The city of Chicago is considering a similar ban.

Popular Joint Pain Supplements Don't Work

The popular joint-pain supplements glucosamine and chondroitin are ineffective in reducing knee or hip pain due to osteoarthritis, according to a recent report in the British Medical Journal. The latest meta-analysis reviewed 10 previous large, randomized, controlled studies. The authors conclude that the two supplements have no effect on either patient perception of joint pain or minimum width of joint space (a clinical measure of improvement) when compared to a placebo.

Glucosamine and chondroitin are among the most popular over-the-counter supplements, with annual sales of nearly $2 billion per year. Some people swear by the two supplements because they genuinely do feel better when taking them, and I sincerely believe they’re telling the truth. But the improvements could be due to the well-known placebo effect, or to the fact that in some patients, joint pain declines over time due to natural healing processes. Anecdotal evidence can’t be generalized to a larger population.

The authors of the study see no harm in patients continuing to take the supplements if it makes them feel better. They say that neither supplement does any harm (except to lighten your wallet a little).

Dietary Supplements Deceptive Sales Practices

Dietary supplements are regulated as food products, not as drugs. Manufacturers are free to make vague claims of effectiveness, such as “improves heart health” or “boosts brain function”, but they cannot make medical claims such as “lowers high blood pressure” or “prevents Alzheimer’s”. And although their products are supposed to be safe, they’re not required to submit any data to prove it.

Now a Senate document reveals that even though the products may be labelled correctly, in sales conversations (“off-label”, so to speak) retail sales representatives of dietary supplements products are openly engaging in “deceptive and questionable sales tactics” – in other words, they’re lying to make a sale.

In testimony before a U.S. Senate committee, the General Accounting Office (GAO) reported that it had staff members ask questions of sales representatives such as: Is ginkgo biloba safe to take with aspirin? Can ginseng cure cancer? Is it okay to replace my blood pressure medication with garlic supplements? All too often they got “yes” answers when the correct answers are “no”. These answers are not just harmless sales advice – they are potentially dangerous advice and they are against the law. Action may be taken against some sellers as a result of the investigation. But for all practical purposes, it’s still “buyer beware” when it comes to the safety and efficacy of dietary supplements.

You can hear clips of some of the undercover calls at http://www.gao.gov/products/GAO-10-662T.

Caffeine Made Easy

Remember Sweet’n Low, the first really convenient sugar substitute? Well, now somebody has finally come up with a similar easy-to-use product containing caffeine. Fein energy crystals (pronounced FEEN) are being promoted as an energy-boosting product that can be added to any drink, including water. Fein has no calories, no artificial ingredients, and no taste, according to the company marketing it. Drop a single stick of FEIN into your drink of choice and you’re getting 75 mg of pure crystalline caffeine, roughly the amount of caffeine in some energy drinks. And Fein costs less than 70 cents per stick. You probably won’t find it in stores yet, but it’s available over the internet.

Henceforth, getting that caffeine buzz (if that’s important to you) will be as easy as sweetening your tea. This is not an endorsement; just a fact.

Caffeinated Alcoholic Beverages Under Scrutiny

This week the Food and Drug Administration (FDA) notified 27 manufacturers of caffeinated alcoholic beverages that they must either explain to the FDA why they believe that the addition of caffeine to alcoholic beverages is “generally recognized as safe” (GRAS) or take their products off the market. According to the FDA, for caffeine to be allowed as an additive to an alcoholic beverage “there must be evidence of its safety at the levels used and a basis to conclude that this evidence is generally known and accepted by qualified experts.” If the companies cannot provide such data within 30 days, the FDA will “take appropriate action” to ensure that the products are taken off the market.

Caffeinated alcoholic beverages are marketed primarily to young people under such names as Max Vibe, Torque, and Evil Eye. Some promotional campaigns depict consumption of multiple drinks in conjunction with high-risk sports such as snowboarding and motocross biking. The action by the FDA comes after the agency received a letter from 18 state Attorneys General asking that the FDA use its authority to see that the products are removed from the market. The Attorneys General argue that caffeine can mask the effects of alcohol and could lead to increased risk-taking behavior.

The two largest manufacturers have already agreed to remove their products from the marketplace. It would not be surprising to see the others follow suit within 30 days.

Getting That Caffeine Buzz

The latest entry into the world of marketing hype - “energy shots”, a mere two ounces of bad-tasting liquid loaded with caffeine. Manufacturers won’t say how much caffeine for proprietary reasons (and probably to add to the drinks’ mystique), but most energy shots are thought to contain on the order of 120-200 mg. That’s the equivalent of one to two ordinary cups of coffee or a 16-oz energy drink.

Energy shots may also contain B-vitamins, amino acids and various plant extracts, but these aren’t likely to give you much of an energy boost despite the products’ claims. And then there’s the cost – upwards of $3 apiece.

If it’s a caffeine buzz you need, what’s wrong with plain-old maximum strength (200 mg) No-Doz? It was your grandfather’s drug of choice nearly 50 years ago for pulling an all-nighter, and it still works. Plus it only costs about 20 cents per dose.

Ginkgo Doesn't Prevent Dementia

According to a study in the Journal of the American Medical Association, daily doses of the popular herbal antioxidant Ginkgo biloba neither prevent nor delay the onset of dementia (cognitive impairment). The most common type of dementia is Alzheimer’s disease.

Herbal extracts of Ginkgo remain popular as a memory enhancer, even though previous scientific evidence showed that Ginkgo just doesn’t enhance memory. So don't expect this latest finding regarding dementia to put much of a dent in Ginkgo’s annual sales of over $200 million. Good marketing apparently trumps good science.

What's in That Energy Drink?

How much caffeine is there in those so-called “energy drinks”? Take a look at the article in press in the journal Drug and Alcohol Dependence (2008) by C.J. Reissig, et al., entitled “Caffeinated energy drinks – A growing problem”, available online at www.sciencedirect.com. According to Table 1 in the article, some of them are pretty high-powered. Most energy drinks have about the same caffeine concentration as brewed coffee, but considering that some drinks come in 16- or even 24-oz sizes, that's a lot of caffeine.

Sales of these products continue to climb. Health officials are growing increasingly concerned by reports of acute caffeine intoxication, dependence, and withdrawal among children. There is also a trend toward the combined use of energy drinks and alcohol among young adults.

Which ones do your students drink? Do they know what’s in them?

Ginkgo and Prevention of Stroke

The herbal remedy Ginkgo biloba may help prevent strokes, according to researchers at Johns Hopkins University. The researchers induced strokes in mice after treating some of the mice with various doses of Ginkgo. The mice pretreated with Ginkgo had nearly 50 percent less brain damage after stroke than the untreated mice. The researchers speculate that Ginkgo may be protective against stroke because it increases the level of an antioxidant enzyme that eliminates free radicals. And free radicals reportedly have damaging effects in living cells, even after a stroke-causing clot is removed or dissolved.

Researchers caution that so far, the research has only been done on mice. Still, it’s encouraging to see herbal remedies being subjected to the same kind of careful scientific scrutiny that has traditionally been applied to therapeutic drugs. This is exactly what we had hoped for, as discussed in Human Biology 5th ed. in the Current Issue essay entitled “Antioxidants: Hope or Hype?” (pp. 42-43). In time perhaps we’ll know the real story behind herbal remedies, and not have to rely on anecdotes and hype.

Teens and Energy Drinks

There’s growing concern among school officials and health care workers that teen use of energy drinks such as Red Bull and Spike Shooter are early warning signs of the willingness to take risks. According to researchers, high consumption of energy drinks is associated with aggressive and risky behaviors, including substance abuse, violence, and unprotected sex. No one is saying yet that these energy drinks cause such behaviors, but parents should probably be aware that teens who are willing to abuse caffeine may be more likely to engage in other risky behaviors as well. The research is published in the March issue of The Journal of American College Health and discussed in a recent news article (“Taste for Quick Boost Tied to Taste for Risk”, New York Times online May 27, 2008.)

The energy drink Spike Shooter contains 428 mg of caffeine in 12 ounces, or about 12x that of Coke or Pepsi and 2-5 times that in a cup of coffee. Teens have been sent to the emergency room with heart palpitations, jittery behavior, and sweating as a result of drinking too many energy drinks. Some teens are combining these drinks with alcohol in the mistaken belief that it makes them less drunk.

Do your students use energy drinks, and do they know what's in them?

Probiotic Dietary Supplement Not Always Beneficial

Probiotics are dietary supplements containing beneficial yeasts or bacteria. Available over-the-counter, probiotics are sometimes recommended by nutritionists and doctors as a way to re-establish the body's natural digestive flora after a course of antibiotics. They're supposed to be good for you.

However, a research group testing the hypothesis that probiotics are beneficial in preventing the infectious complications of a specific life-threatening disease (acute pancreatitis) actually found just the opposite. In a carefully designed double-blind, placebo-controlled study of 298 patients at high risk for acute pancreatitis, the patients given a probiotic preparation had a higher death rate (16%) than the controls (6%).

The finding, although startling, should not be used to conclude that probiotics are a bad idea under other circumstances. Obviously we need to know a lot more about probiotics and how they might affect the outcome of specific diseases before we can draw more general conclusions. But for now at least, probiotics should not be given to in patients at high risk for acute pancreatitis.

The original article can be found in the online version of The Lancet (DOI:10.1016/S0140-6736(08)60207-X).