Energy Drinks and Hospitalizations Checklist: How to Ask The Right Questions

It’s happened again: someone was admitted to the hospital after consuming an energy drink. Reporters covering the story warn readers about the dangers of energy drinks…something is missing. In this post, I’ll review real headlines about energy drink to demonstrate how the omission of a few minor details hurts consumers, as well as the scientists who study energy drinks.

If you read a news story about someone being hospitalized because of a vegetable, you’d have some questions.

On the surface, the mere idea sounds ridiculous.

“Hospitalized…because of a VEGETABLE? People eat veggies all the time without dying, why would someone go to the hospital?”

In fact, leafy green vegetables were the number one source of foodborne illnesses from 1998-2008. Moreover, this hypothetical news story is a perfect example of how asking the right questions can save lives.

When someone is hospitalized because of a vegetable, scientists and doctors are able to piece together the clues and figure out whether or not to issue a recall, if so, what food and even what brand and lot numbers. The end result is information which saves people from eating something that could hurt them. If only we could do the same thing for energy drinks.
(Hint: we are not)

When it comes to energy drink-related hospitalizations, we are not asking the right questions. There are several examples of real energy drink news stories where small but critical details were omitted. Not only does this hurt consumers, but it also hurts scientists who desperately need this data to study the health effects of energy drinks.

The good news is these missing critical details can be summed up in just five questions.
Yes, just FIVE QUESTIONS!
Let me walk you through these five questions and why they matter so much, using real news stories about energy drink-related hospitalizations.

Have we met? I’m Danielle, the “GreenEyedGuide”.
I started studying biochemistry in college the same year Monster Energy hit US markets. Ever since, I’ve put my education to use studying the science behind caffeine and energy drinks. I’ve always been disappointed with the black-and-white “Energy Drinks Will Kill You” messaging because the science is a lot more complex…after all, how can coffee be so good and other forms of caffeine be so bad? My goal is and always has been to answer questions about these controversial energy drinks using the latest research so people can decide what’s right for them based on facts, not fear.
Read more

PBR Hard Coffee – Ingredients, Safety, Where to Find It

Pabst Blue Ribbon has released a “Hard Coffee” in select markets. Where can you find it? What is it? What’s in it? Why did Four Loko get in trouble with the FDA for caffeinated alcohol but this drink is okay? Food Scientist GreenEyedGuide answers these questions in this review of PBR Hard Coffee.

Don’t have time to watch the full episode? You can read the highlights below.

PBR Hard Coffee: Ingredients, Safety, and Where to Find It – YouTube Episode

What is PBR Hard Coffee?

PBR Hard Coffee is not a blend of coffee and beer. It’s not a beer with coffee flavoring. According to the PBR website, it’s not even “beer”.

PBR Hard Coffee - "Not Beer" according to PBR website

PBR indicates this is not beer, it’s a flavored malt beverage.

What’s the difference between beer and a flavored malt beverage?

According to Charlie Bamforth, Anheuser-Busch Endowed Professor of Brewing Science from the University of California, Davis:

Beer is an alcoholic beverage made from malted cereal grain, flavored with hops, and brewed by slow fermentation.

According to Beer and Brewing’s online dictionary:

A flavored malt beverage (FMB) is an alcoholic beverage made from original base containing malt, but then stripped of malt character and then flavored. … FMB production starts out much like a beer and then goes through treatment (carbon filtration, reverse osmosis, etc) to remove as much beer and malt flavor and color as possible. The clear, colorless treated malt base is then sweetened, usually with high-fructose corn syrup, and then flavored.

PBR Hard Coffee Ingredients

PBR Hard Coffee ingredients are arabica and robusta coffee beans, creamy milk, and sweet vanilla flavor.

PBR Hard Coffee Caffeine Content

A “standard” cup* of coffee contains 100 mg caffeine. According to CNN (the only ones who had this amount in their coverage), there’s 30 mg caffeine in a can of PBR Hard Coffee.

*NOTE*Please note 100 mg is used as the industry standard. However, it’s common knowledge the actual amount in a cup of coffee varies wildly – researchers even found variation when they bought a cup of coffee from one location on multiple days. [Reference] [GEG Summary]
caffeine amount in Pabst Blue Ribbon (PBR) Hard Coffee compared to Red Bull and a standard cup of coffee - GreenEyedGuide.com

A 12-oz can of Red Bull has 110 mg caffeine – just a little more than a “standard” cup of coffee. PBR Hard Coffee has 1/3 of that amount – containing only 30 mg caffeine per can. The caffeine mg-per-oz amounts of PBR Hard Coffee, a standard cup of coffee, and a 12-oz Red Bull are 3, 13, and 9 mg-per-oz, respectively.

PBR Hard Coffee Alcohol Content

The alcohol content of PBR Hard Coffee is comparible to other flavored malt beverages: Mike’s Hard Lemonade, Henry’s Hard Soda, Truly Sparking, and Smirnoff Ice all have about 4-5% alcohol-by-volume (ABV).

The alcohol content of PBR Hard Coffee is also comparable to a the original PBR can of beer.

Is PBR Hard Coffee safe?

How many cans of PBR Hard Coffee can you drink before it becomes dangerous? In an earlier episode on the GreenEyedGuide YouTube channel, I reviewed the consensus of several different countries regarding mixing caffeine and alcohol.

Screenshot of GreenEyedGuide YouTube Episode: Mixing Caffeine and Alcohol
You can watch this full episode by clicking here

The scientific consensus of the European Food Safety Authority is that you can have up to 200 mg caffeine mixed with enough alcohol to give you a Blood Alcohol Content of 0.08. If you exceed 200 mg caffeine or BAC 0.08, mixing caffeine and alcohol becomes no longer safe**.

*NOTE* For all the side-effects and risks of mixing caffeine and alcohol, see the YouTube Episode above – skip to time stamp 4:51.
Caffeine Informer graphic showing what 200 mg caffeine looks like - 2.5 Red Bull, 1.25 cans of Monster, 6 cans of Coca-Cola, 2.5 cups of coffee.
THIS GRAPHIC from CaffeineInformer.com shows how much caffeine you can safely mix with alcohol.

The graphic above, from Caffeine Informer, shows how much caffeine you can safely mix with alcohol – at 30 mg per can, the caffeine amount in PBR Hard Coffee is very low, so it makes PBR Hard Coffee much safer than something like the original (pre-2010) Four Loko.

Why did Four Loko get in trouble with the FDA but this PBR Hard Coffee is okay?

On the FDA’s information sheet on caffeinated alcoholic beverages, they clarify the reason the manufacturers of caffeinated alcoholic beverages got in trouble is they were adding caffeine to the products. According to the FDA, caffeine is an “unsafe food additive” because it is not approved, at any amount, to be added to alcohol. Adding a natural source of caffeine, however, is just fine.

If you’re curious about FDA regulations around caffeine, this blog post does a good job of explaining the regulations for caffeine in food, drinks, and supplements.

The difference with PBR Hard Coffee is there’s no added caffeine, they’re adding coffee, which is a natural source of caffeine. Hello, loophole? Maybe…

The amount of caffeine in PBR Hard Coffee is so low you’d have to finish 7 cans before the caffeine crosses that 200 mg threshold where it starts interfering with how drunk you feel.

Where can I find PBR Hard Coffee?

This drink is still being tested in select markets – Pabst wants to see how successful this drink is going to be before going all in.

Right now (as of July, 2019) you can only get PBR Hard Coffee in the following states:

  • Pennsylvania
  • Maine
  • New Jersey
  • Florida
  • Georgia

If you live in one of those states, you can use the store locator at this link to find the nearest location of where you can buy it.

—————————————–

Love this info? Want to learn more?

I’ve researched the science and safety behind energy drinks and their ingredients since 2003. This book is the culmination of my research:

Read more

Chemicals and Food Safety in the 21st Century

I was honored to be asked to contribute to this discussion on “chemicals in our food”. This is the fourth in a series of collaboration between Don’t Eat the Pseudoscience and In Defense of Processed Food. This discussion is also published via Chemicals and Food Safety in the 21st Century by Danielle Robertson Rath

I’m at a party and I see a veggie platter, bags of chips, and a plate of raw hamburger meat. I’m confused, are people supposed to make burger patties themselves and barbecue them outside? This seems like an odd thing to do at someone else’s house. Other people at the party assure me this raw meat is actually steak tartare, perfectly fine to eat as-is, but I can’t bring myself to try it. This is a challenge for the heart, the body, and the brain. In my heart, there is too much fear this meat would make my body violently ill. In my brain, I don’t have enough information to accept this food is safe for me to eat.

Danielle Robertson Rath offers the fourth in a series of collaborations with Don’t Eat the Pseudoscience. Danielle is the go-to authority on caffeine and energy drinks so what better person to help us look at the safety of chemicals in our food?

Food poisoning is an awful experience, but what’s worse is when your food is making you sick and you can’t tell. Some people worry about chemicals in food making us sick. We have a right to be worried or, at least, to be skeptical.

In 1856, William Henry Perkin discovered the first synthetic organic dye. That discovery launched the practice of using dyes to color food. Nearly 100 years later, several children became ill from eating Halloween candy which was colored with FD&C Orange No.1, a dye that was, until that point, considered safe. As technology advances, we may discover some ingredients are less safe than we previously thought. We can reevaluate, just like the FDA did in 1950 –the year those children got sick from the orange dye, U.S. House Representative James Delaney began holding hearings on the safety of food additives. This prompted the US FDA to reevaluate all the listed color additives and remove the ones that caused serious adverse effects.

Science has come a long way since 1950. As technology advances, we have microscopes that are more powerful than ever. The difference is like admiring the leaves of a maple tree from the roof of a 10-story building versus being right there under that tree, holding its leaves in your hands. With this new sight, this new power, we face a dilemma. How do we know what to look for? How do we know what matters most? How do we reconcile the heart, body, and brain?

Holy Hill Wisconsin Rath Photo Shoot

Consider the ingredients in an energy drink. Red Bull is the world’s number one top-selling brand, so let’s use that. Red Bull’s full list of ingredients includes caffeine, B-vitamins, taurine, citric acid, sodium bicarbonate, magnesium carbonate, and sweeteners glucose and sucrose (or artificial sweeteners Aspartame and Acesulfame Potassium in Red Bull Sugarfree). Red Bull is undoubtedly a processed food, but its ingredients list may have less “chemical-sounding” ingredients than one would expect. Nonetheless, the Center for Science in the Public Interest has a few of these Red Bull ingredients on their Chemical Cuisine List in the “AVOID” section. And yet, the worst chemical in Red Bull is…

caffeine.

RedBull SugarFree Ingredients List

There are plenty of people on board with the “if you can’t pronounce it, don’t eat it” campaign, and you can find concerned citizens blogging about every one of the items on Panera’s “No No List”. These “clean label” initiatives certainly speak to the heart, but let’s give the brain more data to analyze the situation. Caffeine has killed people. Several people. Compared to caffeine, chemicals like acesulfame potassium look like a lazy college roommate who never stops playing video games.

While acesulfame potassium has been accused of giving cancer to lab rats, there are several people who have died or almost died because of caffeine:

  • A Nigerian man died after drinking 8 cans of an energy drink similar to Red Bull
  • A man from the UK died after eating a whole tin of caffeinated mints
  • A New Zealand woman’s death was linked to her habit of drinking 10 liters/day of Coca-Cola
  • A 19-year old man died after taking 25-30 No-Doz pills
  • A 17-year old woman nearly died after drinking 7 double espressos

Caffeine is more dangerous than most, if not all, the food additives that get a bad reputation in today’s media. Caffeine is the most widely used psychoactive substance on the planet. At least 85% of the population consumes caffeine on a daily basis, and it’s not just in drinks anymore. It’s in gum, candy, mints, bread, desserts, and other snack foods.

While some people metabolize caffeine quickly and feel none of its effects, everyone else can feel it affecting their body and mind. Caffeine’s positive effects include alertness, endurance, and reduced risk of Alzheimer’s disease. Caffeine’s negative effects include insomnia, jitters, addiction, headaches, anxiety, chest pain, acid reflux, gastrointestinal upset, and agitation. And these are just the effects we know about for sure.

There are over 100 different experimental studies on the effect of caffeine on heart rate, and still, we have no decisive answer. Most of those studies suggest caffeine has no effect, but other studies can’t agree on what the effect is. We can’t tell if caffeine makes the heart rate go up or down. It would be a win/win if we could say, “Either caffeine does nothing or it helps protect the heart,” but the research conflicts itself here.

Another aspect that makes caffeine more dangerous than other chemicals in our food is how caffeine affects different people. People with hypertension (high blood pressure) and people at risk for hypertension are advised against consuming caffeine because the blood pressure increases these people experience are stronger and longer than the increases experienced by everyone else.

Caffeine is at its worst when it’s combined with alcohol. Bartenders know the only thing worse than a drunk is a wide-awake drunk. At least when you’re drunk and passed out, you stop drinking, you stop harassing people, and you stop sharing your deepest thoughts with total strangers. When people drink caffeine and alcohol together, they are more likely to drink too much, more likely to take more risks like drive or ride with a drunk driver, and more likely to get injured.

Even without caffeine, alcohol is more dangerous for your health than scary chemicals like artificial colors or sweeteners, brominated vegetable oil (BVO), and azodicarbonamide (the “yoga mat” chemical in bread). Even at concentrations below the legal driving limit, alcohol impairs reflexes, changes brain function, and impacts behavior.

Heavy or binge drinking is associated with increased risk of liver cirrhosis, hypertension, stroke, type 2 diabetes, cancer, impaired immune function and increases the incidence of chronic inflammatory diseases like osteoporosis, sarcopenia, Alzheimer’s disease, cancer, and cardiovascular disease. Chronic alcohol abuse leads to increased susceptibility to bacterial and viral infections.

Your brain might be saying, “Of course caffeine and alcohol are dangerous, but that’s only when you have too much.” There’s the rub. Caffeine and alcohol are some of the worst chemicals in our diet. We know the risks, but we drink it anyway because we know there is an amount that is safe to consume. To paraphrase Paracelsus, the difference between a poison and a cure is the dosage. This lesson is ingrained in our brains for alcohol and caffeine. And yet, we forget this lesson when we become afraid of other food chemicals. We don’t stop and ask the same questions we would if it were alcohol or caffeine: “How much can I have and still be okay?”

If you want to consume a diet free of artificial sweeteners and colors, free of ingredients with long names you don’t recognize, that is your right. However, don’t forget to give your brain some time to weigh in – is your heart being manipulated before your brain has a chance to process the data? As technology advances, we will have more power than we can imagine. We might be able to detect arsenic in juice at microscopic levels that weren’t remotely possible 10 years ago. We might be able to discover or synthesize new ingredients that change the food industry just like William Henry Perkin’s discovery of food dyes. And just like the FDA did in 1950, we will need to reevaluate the safety of the old, the current, and the new. We would benefit from treating our discoveries like caffeine and alcohol, remembering that the quantity and context make all the difference.

Next week [on In Defense of Processed Food]: The elusive connection between health, safety, and food.

_MG_1797

Danielle Robertson Rath is a food scientist, consultant, speaker, and the founder of GreenEyedGuide.com. Her book “Are You a Monster or a Rock Star: A Guide to Energy Drinks – How They Work, Why They Work, How to Use Them Safely” is widely considered the ultimate resource for caffeine drinkers everywhere. Danielle aka “GreenEyedGuide” started studying energy drinks while pursuing her bachelor’s degree in biochemistry and master’s degree in food science. She has been fascinated by caffeinated beverages and their ingredients ever since.

—————————————–
Book GreenEyedGuide as a guest speaker – here

Get your copy of MY BOOK: “Are You a Monster or a Rock Star: A Guide to Energy Drinks — How They Work, Why They Work, How to Use Them Safely” on Amazon and NOW ON AUDIBLE

How Energy Drinks Affect Children and Young People: Research Recap

Energy drinks do not belong in the diet of a five-year-old. You already knew that. But do you know what happens when children do have energy drinks? Thanks to research by Durham University in the UK, we now have a good idea how many kids and teens in different countries drink energy drinks and how those drinks affect their health.

›We’re recapping the findings of this paper: “Consumption of energy drinks by children and young people: a rapid review examining evidence of physical effects and consumer attitude

*Note – the research paper by Durham University uses the expression “children and young people” to refer to those under 18. At the age of 33, I still consider myself a “young person”, so I’m going to use the expression “kids and teens” instead. Read more

Will Energy Drinks Hurt Blood Vessels?

A study presented at the November 2018 American Heart Association conference claimed, “Just one energy drink may hurt blood vessel function.” It’s been a few months since the last “energy drinks are killing people” freak out, so I suppose we were due.  Instead of pointing out all the limitations in the study (because this Healthline article beat me to it and did a great job) I’m going to skip the science for today and just talk about the 10 energy drinks that will not hurt your blood vessels.

Read more