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ARE YOU A
MONSTER OR
A ROCK STAR?
THE SCIENCE BEHIND
ENERGY DRINKS AND THE
5 LEVELS OF FATIGUE
• Background and Methodology
• Common Ingredient Misconceptions
• Caffeine Consumption in the USA
• Common Energy Drink Misconceptions
• 5 Levels of Fatigue
BACKGROUND AND METHODOLOGY
• Literature Review
Caffeine Coffee Green Tea Guarana Yerba Mate
Taurine Carnitine Glucuronolactone Inositol Milk Thistle
Ginseng Ginkgo Biloba Quercetin
Thiamin Riboflavin Niacin Pantothenic Acid
Vitamin B6 Vitamin B12 Biotin Folate/Folic Acid
BACKGROUND AND METHODOLOGY
• Regulatory Documents
Guidance Documents FDA Warning Letters Code of Federal Regulations
American Beverage
Association Documents
Office of Dietary
Supplements
Health Canada
Mayo Clinic Proceedings
Scientific Committee on
Food (SCF), European
Commission
European Food Safety
Authority
COMMON INGREDIENT MISCONCEPTIONS
“A lie can travel halfway
around the world while the
truth is still putting on its
shoes.”
Not Mark
OTHER TAURINE FUNCTIONS
•Taurine protects the heart
• Restores ideal sodium/potassium balance
• Regulates calcium inside heart muscle cells
•Prescribed for congestive heart failure
GINKGO BILOBA
• In Chinese medicine, extracts from the leaves
of the ginkgo biloba tree improve memory and
concentration, treat anxiety and depression,
and alleviate headaches, dizziness, and
tinnitus (ringing in the ears)
3,000 people
8 years
120 mg ginkgo biloba / day
Did not reduce overall incidence of
dementia or Alzheimer's
VITAMIN
B12
HTTPS://WWW.CAFFEINEINFORMER.COM/ENERGY-DRINK-
INGREDIENTS
B12 HELPS FOLATE GET FREE
https://www.slideshare.net/drshahinhameed/megaloblastic-anemia-vit-b12-deficiency/12
KREB
S
Biotin makes a three-some
into a four-some
B12 reorgs that four-some
And poof, it can enter the
Krebs cycle
But look at how many
reactions involve B2, B3,
B5.
Those are the real heroes
CAFFEINE
CONSUMPTIO
N IN THE USA
HOW
MUCH
CAFFEINE
DO
PEOPLE
DRINK?
77
26
52
10
SODA
COFFEE
TEA
ENERGY DRINK
0 10 20 30 40 50 60 70 80 90
% of Age Group
70
46
53
9
77
26
53
10
SODA
COFFEE
TEA
ENERGY DRINK
0 10 20 30 40 50 60 70 80 90
% of Age Group
AS AGE
SODA
COFFE
E
COMMON
ENERGY DRINK
MISCONCEPTIO
NS
POP QUIZ
PUT THESE IN ORDER OF STRONGEST TO
WEAKEST
ASSUME YOU WILL DRINK THE WHOLE
THING
80 mg 78 mg
330 mg
80 mg 90 mg
Grande
POP QUIZ
PUT THESE IN ORDER OF STRONGEST TO
WEAKEST
ASSUME YOU WILL DRINK THE WHOLE
THING
300 mg140 mg
330 mg
160 mg
http://www.ajc.com/news/national/coroner-caffeine-overdose-from-soda-
coffee-and-energy-drink-led-death-teen/VBKsz6B6qAJBI4nduFBpeK/
Significant QTc prolongation of ≈10 ms 2 hours
after high‐volume energy drink consumption.
[>60 ms is a marker for life-threatening
arrhythmias]
Heart rate, diastolic BP, central
systolic BP, and central
diastolic BP showed no evidence
of a difference between groups
at any time point.
“Our results should be interpreted
with caution due to several
limitations. Importantly, our results
only appear to be significant relative
to the caffeine group, and the change
from baseline post energy drinks is
not alarming. Of note, the risk of
arrhythmia may be negligible
because the QTc difference is
• randomized, double‐blind,
controlled, crossover study
• 18 people in mid-20’s
• 320 mg caffeine
“Energy drink consumption is on the rise in
teens.”
“Mean caffeine intake has not increased among
children and adolescents in recent years.”
-Trends in Caffeine Intake Among US Children and Adolescents
“If there’s a kid out there anywhere who thinks they can avoid all
energy drinks but consume as many Mountain Dews, McDonald’s Caffe
Lattes or Starbucks Grande coffees in one day as they want, we have
failed.”
Pediatrics. 2014 Mar;133(3):386-93. doi: 10.1542/peds.2013-2877. Epub 2014 Feb 10.
What you need to know about the Caffeine Overdose in South Carolina
GreenEyedGuide.com
5
LEVELS
OF
FATIGUE
FATIGU
E
LEVEL 0
BASELINE
FATIGUE
LEVEL 1
DEHYDRATED
FATIGUE
LEVEL 2
• Too tired to go it alone
• Under 100 mg caffeine,
preferably tea-based
FATIGUE
LEVEL 3
• Lethargic and struggling
• Max 200 mg caffeine
• NON-carbonated,
preferably juice-based
FATIGUE
LEVEL 4
• Energy emergencies
• Up to 400 mg caffeine
(daily limit for adults)
• CARBONATED or
concentrated
(e.g., energy shots)
FATIGUE
LEVEL 5
BEYOND ALL HOPE
IG: @MEETGJALLA
GREENEYEDGUIDE.COM
greeneyedguide GreenEyedGuide
THANK YOU!

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What I Learned after 10 Years of Reseraching Energy Drinks

Editor's Notes

  1. How many of you, students, teachers, everyone – how many of you have had those nights where you just cannot fall asleep. Maybe you can’t stop thinking about something; maybe you can’t get comfortable; maybe there’s light and noise – for whatever reason, you can’t fall asleep. Now think about the last time you woke up exhausted. Your alarm goes off, you get up, start moving around and you just feel it, in your eyes, all over your body – you’re exhausted. And right then and there, part of you knows that this day is going to be awful, because it’s the beginning of the day, and you’re not going to have a chance to sleep for several hours. This was my life throughout high school. I was a straight-A student with all honors and advanced placement classes. I did gymnastics 20 hours a week and competed nation-wide. Also, I helped my mom (a single working mom) take care of my 3 siblings. I constantly got 5 hours of sleep or less and fell asleep in class. Starbucks didn’t exist. Energy drinks didn’t exist. Can you imagine such a world? My story isn’t that special – here in this room there are hundreds of you who struggle to balance work, school, family, etc. What makes my story special, however, is that I started studying biochemistry the very same year Monster Energy hit US Markets. From the moment an energy drink was put into my hands, I knew I wanted to study the science behind it.
  2. Some say it’s hard to be a woman in a science field. For me, personally, it’s been more difficult to be a scientist for something which people have already made up their minds. When I tell people I research energy drinks. Can you imagine what they say? I usually get 1 of 3 responses: Energy drinks, like how bad they are? Do you talk about how they’re like poison? You study energy drinks? Why? Aren’t there enough teenagers on YouTube who review energy drinks? Why don’t you study something that matters.. Wow, energy drinks. What did you learn? I’ve learned so much, sometimes I think I need a pensieve. As scientists, we often find ourselves at odds with fear and misconceptions. With energy drinks, there are misconceptions about the ingredients, misconceptions around the products themselves, and even misconceptions about how much caffeine our great nation consumes.
  3. What makes my work different from that of a dietitian or any other food scientist? My focus has always been very specific: energy drinks and their ingredients. My research includes a comprehensive literature review of the top 20 energy drink ingredients. For each ingredient, I reviewed clinical trials, studies on proposed biological mechanisms, interactions between ingredients – anything and everything that helped me understand what the ingredient would do in the human body. I did this literature review while I was earning my bachelor’s in biochemistry and master’s in food science. My education gave me a solid foundation for me to put what I was reading into context.
  4. I also reviewed regulatory documents from the US and other countries. In the US, there is no legal definition for the term “energy drink”, but groups like the American Beverage Association offer some guidance documents to help fill the gap. I also learned from the Warning Letters the FDA issued to manufacturers of supplements and caffeinated beverages. I studied proceedings from the Mayo Clinic, regulations from Health Canada, and the Official Scientific Opinions of the Scientific Committee on Food, and European Food Safety Authority.
  5. So what have I learned… Let’s start with my all-time favorite ingredient misconception…
  6. Red Bull sold 13 BILLION Dollars of product in 2015. I don’t know how this myth got started, but it doesn’t make cents – it’s not economical. The name *TAURINE* does comes from Bos taurus, the genus and species of ox. Taurine was first isolated from ox bile in 1822. (Bile is a fluid made by the liver that aids digestion) TARUINE IS ALREADY INSIDE YOU! We get taurine from high protein food like meat. Also, the human body makes taurine from amino acids cysteine and methionine. Why do we need taurine? Imagine you need to get from point A to point B. You normally walk, but it’s pouring rain, and you’re wearing your nice clothes. Taurine is like a taxi that can deliver you to your destination safely, so you don’t get soaked. This is how Taurine helps with fat absorption. The fat molecules in the food you eat can't be metabolized if they can't be absorbed, and your body is mostly water. So how do they get to the place they need to be without getting soaked? Taurine links with a bile salt so it's part-water-soluble and part-fat-soluble. The fat-soluble part is like the inside of the taxi cab – Hop in, let’s go get digested.
  7. Taurine has another important job – protecting the heart. Taurine helps your body restore the ideal balance of sodium and potassium, reducing water retention and relieving uncomfortable bloating. It also helps regulate the levels of calcium ions inside heart muscle cells, protecting the heart from calcium imbalances that can lead to heart muscle damage. This is why taurine is prescribed for congestive heart failure and, coincidence or not, the amount prescribed is about the same amount found in one of the leading brands of energy drinks. If you remember nothing else today, remember that taurine is prescribed to protect the heart.
  8. Another ingredient misconception involves Ginkgo. In Chinese medicine…… tinnitus. I’m sorry, but the cake is a lie.
  9. On of the most comprehensive studies on ginkgo involves 3,000 people over 8 years, where ginkgo was consumed at 120 mg a day. But ginkgo didn’t reduce the incidence of dementia or Alzheimer’s. So does ginkgo help with memory over the short term? For every well conceived study suggesting gingko has an effect, there’s another one, just as well conceived, that shows no significant difference.
  10. If I were to ask you what the #1 energy drink ingredient is – the most used ingredient across all energy drinks, would you guess caffeine? It’s actually Vitamin B12. There are more energy products with B12 than caffeine. Why? B12 must do some pretty amazing things in the body then… I mean there’s those B12 shots, right? B12 must be like an energy super-hero….
  11. As it turns out, B12 makes a great wingman.
  12. As you drink your tea, coffee, or hot chocolate, think about all the cells from your mouth down your esophagus and your GI tract. Those cells go through a lot of wear and tear, and Folate’s job is to help DNA synthesis so those cells can be repaired or regenerated. But folate would be stuck without B12. As folate goes through this cycle, it comes to a point where it’s stuck with its hands full. This is like when you’re holding two coffees and you’re trying to pull open a door. B12 comes along and helps folate get unstuck so it can go back to work. None of this has to do with energy…..
  13. B12 is also Biotin’s wingman. Boring Basic Biotin only knows one dance move it takes a carbon dioxide molecule from one place and adds it onto another place. In this reaction down here at the corner, Biotin makes a molecule that’s 3 carbons long 4 carbons long. B12 reorganizes that molecule and poof – it can enter the Krebs cycle, the massive wheel of energy in the body. So yes, B12 helps, but look at all the reactions involving B2, B3, B5… those are the real heroes when it comes to energy.
  14. If none of this has convinced you thus far that energy drinks aren’t as bad, I respect that. There are plenty of other ingredient misconceptions I haven’t talked about, but there’s a far greater issue. We have misconceptions about how much caffeine we drink as a society. If I asked you how many milligrams of caffeine you have every day, would you know the number? Probably not. Who cares, I know how many cups of coffee, isn’t that enough? No. Here’s why.
  15. This figure comes from a study published in 2012. When I read it, I loved it so much, I wrote an email to the author. She wrote me back – it was awesome. In this study, they surveyed ~42,000 people from all age groups and demographics. They made sure their sample was representative of the US population. They asked people how much caffeine they consumed, and they did something no other study has ever done before or since. When I read research articles about “Caffeine in the Military” they ask how many energy drinks did you consume. They don’t ask which ones, they don’t distinguish sports beverage from energy shot from coffee or tea. In this study, they got specific. They got the specific brands and flavors of energy drinks, coffee, tea, energy shots, sports beverages, chocolate beverages. Then they used the Caffeine Informer database to calculate exactly how much caffeine was in that brand, that size, that flavor. This graph is the most accurate representation we have for Caffeine Consumption, from any source, excluding medication, in the US. Two things to keep in mind – The American Academy of Pediatrics says those under 18 should not consume more than 100 milligrams of caffeine a day. If you’re a healthy adult, several organizations, from several different countries agree 400 milligrams is the max. So right away we see the caffeine crisis in America isn’t as bad as one might think.
  16. So this paper I love so much gets even better. For each age group, we now know where that age group gets their caffeine. These numbers are not exclusive. If you’re a 17 year old and sometimes you drink soda, sometimes you drink tea, this graph shows counts all those occasions. For tweens and teens, we see the biggest contribution to caffeine is soda. 77% of this age group get their caffeine from soda. Second is tea, then coffee, then energy drinks are last. What happens when this group reaches adulthood? What do you think the #1 category is going to be?
  17. For college age people, soda is still the #1 contributor. And tea is still #2! But look at how much coffee has grown. Energy drinks are still in last place! And these two age groups have the highest energy drink consumption across the whole age range. It never gets better (or worse?) than 10% of the age group.
  18. As people get older, they drink less soda and more coffee. We see this trend through the whole age range. The seniors and super-seniors are primarily coffee drinkers and also tea drinkers. Here’s a study I would love to run. People who are under 21 have never lived in world without Red Bull. I would love to know whether this coffee and soda trend applies to energy drinks that look like soda versus energy drinks that look like coffee.
  19. Here’s a question I get all the time. Why don’t people just drink coffee? Why do we even need energy drinks? Coffee is way better for you anyway. This is a fair question. But let’s play a game.
  20. Assuming you drank the whole container, which drink has the most caffeine? Surprising, right? Also surprising that this juice drink here has about the same amount of caffeine as Red Bull. True, one’s natural caffeine, one’s not, so let’s look at Red Bull and V8. Would parents freak out if they caught their kids drinking V8?
  21. You already know the caffeine amount in the coffee, so how does that compare to a monster energy, a “pre-workout” drink, and a coffee flavored protein drink? The protein drink has more caffeine than the Monster. Again, how many parents would freak out about their kids drinking this? How many would even realize how much caffeine is in here? It looks like a Muscle Milk competitor. If you’re a student athlete and you drink 2 of those Muscle Milk drinks a day, then switch it with this thinking they’re the same, we could have a problem. This is why this is so important – if we continue to say things like “all energy drinks are dangerous concoctions of chemicals, caffeine, and sugar”, we are missing out on a potentially life-saving opportunity to bring the focus to overall caffeine consumption. But Danielle, surely caffeine from an energy drink is worse than caffeine from coffee, right?
  22. Last year, a teen in South Carolina died from a caffeine overdose. Among the things he drank that day: Mountain Dew McDonald’s latte Undisclosed energy drink The energy drink was the last thing he consumed. We don’t know how much caffeine was in that drink, or what other ingredients were in it. Which means we can’t talk about ingredient interations. We’re missing some critical data, but this article states that a study published in the J of the American Heart Association found energy drink consumers could be at higher risk of abnormal heart beats and dangerous changes in blood pressure. JAHA is a pretty good journal, so I took a look at the study myself.
  23. This study was double-blind, placebo controlled, randomized, and cross-over. They did find that 2 hours after consuming an energy drink, participants had QT prolongation of ~10 milliseconds. 60 is a marker for life-threatening arrhythmias. However, they stated pretty clearly that there was no difference in heart rate or blood pressure at any point between placebo and energy drink groups. How does “no difference” get translated into “dangerous changes in blood pressure”?
  24. This quote is from the authors of that study. This was randomized, double-blind, placebo controlled, and cross-over – which is like gold standard as far as trials. BUT they only included 18 people, people in their mid-20s. If you haven’t hit 30 yet, let me tell ya, your metabolism gets a lot different. Also they used 320 milligrams of caffeine, which is over 150% the recommended limit per serving. Healthy adults are only supposed to have 200 milligrams of caffeine at a time.
  25. This isn’t the only study to get misinterpreted. There’s a study in Pediatrics which I can’t stand because it’s constantly misquoted. When that study came out in 2012, headlines all over the place said “energy drink consumption is on the rise in teens”. Know why it’s on the rise? Because this study looked at caffeine consumption starting in 1990. So yes, energy drink consumption is on the rise….. FROM ZERO. If you read the actual paper, the authors state mean caffeine intake has not increased among children and adolescents in recent years. We’re not drinking more caffeine, we’re just getting it from different places. Which brings me back to my point. If there’s a kid out there…..
  26. So how do we protect ourselves and our youth from the dangers of caffeine. I give you the 5 Levels of Fatigue. Ladies and Gentlemen, with this system I have helped bartenders cut back from 4 Monsters a day to half a can a day. I have helped my family, friends, and strangers on the internet avoid caffeine toxicity, dependence, and tolerance. Here’s how it works:
  27. Ever have one of those days where you’re just… amped. Maybe you just aced a final. Maybe that person you’ve been crushing on smiled at you. Maybe your favorite team just made the playoffs. At Fatigue Level 0, you need no caffeine – you’re feeling great, awake, alert, alive.
  28. Fatigue Level 1. Dehydration causes fatigue. If you’re feeling tired, whether it’s 5 in the morning or 3 in the afternoon, your first task is to drink water. It doesn’t have to be plain water. Put some cucumbers in it, get carbonated water, add regular MIO, whatever, just don’t reach for caffeine. Not yet.
  29. Fatigue Level 2. At this point, you have ruled out dehydration. Time to get some help. There are plenty of energy drinks with less than 100 mg per container, and with caffeine from a natural source. Here are some of my favorite examples. For best results, you’re looking for something with natural caffeine, something NON-carbonated, and something with no sugar. Carbonation and sugar do not belong in Fatigue Level 2.
  30. Fatigue Level 3. Struggle City, population = you. For best results, do not exceed 200 mg. That’s the limit for a single serving anyways. You STILL don’t want anything carbonated – not yet. Instead of carbonation, look for something with at least some juice content. That juice should give you a teeny bit of sugar, and drinks with juice are almost never carbonated. We don’t want carbonation yet.
  31. Fatigue Level 4. out of 5. This is it. This is “Fall Asleep Standing” mode. This is “need to pull an all-nighter” or double-shift time. Do. Not. Consume Fatigue Level 4 on a daily basis. Why? Because this is for emergencies only. What would happen if you had a fire drill at your school or work every day? You’d start ignoring it. And so it goes if you have this much caffeine every day. If you want the caffeine to work, you must not consume this caffeine on a regular basis. Because it’s an emergency, it’s okay to go above the 200 mg – at – a time limit. This is also the point where we introduce carbonation. Why? Ever wonder why champagne makes you drunk faster than beer or wine? It’s all about the bubbles. The bubbles irritate your stomach slightly, making it easier for your stomach to absorb 3 things – aspirin. Alcohol. Caffeine. Please do not consume all 3 at once. Everything else has to wait until it gets to your small intestine to be absorbed. Caffeine gets in through the stomach, and when there’s carbonation involved, it gets in that much easier. So if you had two energy drinks, each with 100 mg caffeine – the carbonated one is going to feel stronger. This is why the 5 levels of fatigue is a scale. There are incremental increases based on ingredients like sugar and caffeine.
  32. Level 5 is sleep. There comes a point where no amount of caffeine can save you. There comes a point where you must give in and get some rest. When you hear stories about people who fall asleep while drinking an energy drink, it’s because they did not have the courage to admit to themselves when they’ve reached their limit. It’s extremely difficult to ask for help, to accept our limitations. But if we’re going to stay healthy, we have to acknowledge when we reach that point.
  33. I am on a mission to promote safe caffeine consumption. If you would like to learn more about my campaign, what I do, my book, a particular drink, a particular ingredient, save this page in your favorites. If you want to be an advocate for safe caffeine consumption, there are 3 things you can do: Don’t judge – If you’re a coffee drinker, don’t judge someone holding an energy drink. Maybe their drink isn’t as strong as you think. Maybe they could use your help, not your criticism, if they’re always at Fatigue Level 4. Don’t mix caffeine and alcohol. Ever. Caffeine makes you feel like you’re not drunk (and isn’t that the fun part?) Your reflexes are still impaired and worse – if you’ve had too much alcohol, you won’t pass out when you’ve had too much. This is your body’s way of protecting you. Don’t break that protection. Don’t be boring. Caffeinated drinks are a spectrum. You wouldn’t wear the same color every single day, unless you’re batman or Black Widow, so don’t drink the same caffeine every single day. Follow the 5 Levels of Fatigue