Feb 28, 2011

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

I love coffee. No. Really. I LOVE coffee. But, coffee doesnt love me back. About a year ago I started getting heart palpitations. Then I started getting some chest pain. I was pretty scared, so I went to the doctor. I had tests that involved nasty tape riping out my chest hair, others which I walked quickly on a treadmill and even got some cool 3-D ultra sound images of my heart. It was determined that I wasnt going to die. I had a mild irregular heart rhythm and I drank too much coffee. It seems after I drink coffee, I get a kind of caffeine hang-over. As the caffeine leaves my body, my heart starts going too fast. Apparently 15 plus years of drinking 6-10 cups of coffee a day may have been too much.

Even us pharmacists often forget that caffeine is the most popular drug in the western world. It has been estimated that 80% of us consume caffeine. Caffeine is an interesting drug. To begin with caffeine has a half life of six hours. It takes about 5 half lives for a drug to leave the body. That means it takes 30 hours (almost 2 days) for that cup of coffee to leave your body completely. If you never take a two day break from coffee, that means you always have caffeine in your system. Caffeine is chemically called a methylxanthine and is chemically related to the asthma drug theophylline. So if you have heard that coffee can help an asthma attack, that is true. However, asthma puffers are much, much more effective, so dont treat your asthma with coffee.

Health Canada says :

  • The general population of healthy adults is not at risk for potential adverse effects from caffeine if they limit their caffeine intake to 400mg per day(that is 3-4 cups of coffee per day);

  • People who get an adequate daily amount of calcium have greater protection against the possible adverse effects of caffeine on bone health.

  • Compared to the general adult population, children are at increased risk for possible behavioural effects from caffeine; and

  • Women of childbearing age are at increased risk of possible reproductive effects if they consume caffeine.

If you drink more that four cups of coffee per day, what does that put you at risk of? Things like muscle tremors, nausea, irritability, high blood pressure, racing heart, thin bones and anxiety.

Caffeine was in the news again because of a study released in February in the American Academy of Pediatrics Journal. Seifert et. al looked at the health effects of energy drinks on children, adolescents and young adults. They estimate energy drinks are consumed

by 30% to 50% of adolescents and young adults. These energy drinks often contain high and unregulated amounts of caffeine. These drinks may cause serious adverse effects. The side effects can be especially dangerous in children, adolescents, and young adults with seizures, diabetes, heart problems, mood disorders or those who take certain medications. Of the 5448 US caffeine overdoses

reported in 2007, 46% occurred in those younger than 19 years old.

Energy drinks are beverages that contain caffeine, herbal supplements, and sugar. They are marketed to improve energy, cause weight loss, improve stamina, athletic performance, and concentration. Energy drinks are the fastest growing segment in the US beverage market. In 2011, their sales are expected to top $9 billion. Half of the energy-drink market consists of children, adolescents, and young adults. Although healthy people can tolerate caffeine in moderation, heavy caffeine consumption, such as drinking energy drinks, has been associated with serious consequences such as seizures, mania, stroke, and sudden death. Although the US Food and Drug Administration (FDA) limits caffeine content in soft drinks, because they are categorized as food, there is no such regulation of energy drinks, which are classified as dietary supplements.

Some of the herbal supplements in energy drinks include: guarana, ginseng and yohimbine. Guarana is a South American plant that contains large amounts of caffeine, theobromine, and theophylline. Guarana adds to the stimulant properties of the energy drink, which already have lots of caffeine in them. Ginseng is an East Asian herb. Reported symptoms of ginseng toxicity include diarrhea, vaginal bleeding, headache, vertigo, mania, hypertension, rashes, insomnia, and irritability. Yohimbine is a chemcial found in certain plants. I remember yohimbine from pharmacy school. Before viagra, this was one of our few treatments for erectile dysfunction. The problem was it didnt work very well and it had lots of side effects. Those side effects could include: it can cause high blood pressure at normal doses and low blood pressure at high doses as well as really fast heart beat.

The amount of sugar and caffeine in the energy drinks will vary. For comparison, a cola beverage will have about 25 g of sugar and 23 mg of caffeine in an 8 oz can. A cup of coffee will have no sugar, but 100 mg of caffeine. The energy drinks can have up to 30 g of sugar and 400 mg of caffeine.

The final recommendation of the Seifert trial was that since there was little or no benefit to the energy drinks in children, their caffeine content is unregulated, they have herbs in them that may not be safe in children and each can may have the caffeine of 4 cups of coffee in them, these are not safe products for children to be taking. As someone who had some mild bad health effects from too much caffeine, that sounds reasonable. Talk to your kids about reducing or eliminating their use of energy drinks.

Pediatrics Article :

As always if you have any questions or concerns about these or other products, ask your pharmacist.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

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