Pawan Kumar Bansal interviews Dr Rohit Waliya : There have been reports of sudden cardiac death after consumption of high caffeinated energy drinks. But since most of the cases did not have any medical or genetic autopsy and had delayed access to medical care, the exact cause could not be scientifically established. But now we are able to provide evidence that excess of high caffeinated energy drinks can induce dangerous heart rhythm abnormalities which can predispose to sudden cardiac death.
This is a story of a young male who after a stressful and overburdened day started taking energy drinks in evening after duty ( identity kept confidential ). It gave an instant high, and helped him to be awake.
He took two of these that evening. He immediately noticed being uncomfortable and aware of a racing heart.
He immediately sought medical help and electrocardiogram (ECG) which is a test that depicts electrical activity of the heart on a piece of paper was done and it revealed abnormal heart beats. He was put on continuous heart rhythm monitoring which revealed runs of ventricular tachycardia ( abnormal heart rhythm originating from lower chamber of heart and is known to be associated with sudden cardiac death) as shown in Figure 1. He was admitted in ICU and antiarrhythmic medications were started to which heart rhythm abnormality responded and he was saved.
The window period of successful detection & treatment of dangerous heart rhythm disorders like haemodynamically unstable ventricular tachycardia or fibrillation is extremely short. None of the patient survived if treatment is delayed beyond ten minutes.
What are these high caffeinated energy drinks?
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A beverage that typically contains large amounts of caffeine, added sugars, other additives & legal stimulants such as guarana, taurine & L-carnitine. These legal stimulants can increase alertness, attention, energy as well as increase in blood pressure, heart rate & breathing.
How much caffeine in different brands of these energy drinks?
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Energy drinks are prepacked & ready to drink functional beverages while energy shots are a similar more concentrated ready to drink beverage sold in 2-5 fl oz volumes. The caffeine content of different energy drinks ranges from 111 mg to 280 mg per drink.
They also provide around 27 gm to 34.3 gm of sugar rush or artificial sweetener for an extra kick. The recommended sugar per day for men is 36 gm and women is 25 gm.
They also contains masked caffeine with ingredients like Guarana (which is derived from South American plants which also contain caffeine).
LOOK OUT WHEN YOU ARE CROSSING SAFE LIMIT & ENTERING POTENTIALLY DEATH ZONE
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FDA currently limits 400 mg of caffeine as a safe level for healthy adults, they discourage caffeine consumption in children & adolescents & no safe level has been determined.
Children are small & a single drink may be enough to raise blood pressure & heart rate to dangerous levels & cause serious arrhythmias (heart rhythm problems) and sudden death.
The reason may be excessive catecholamine release after the consumption of energy drinks.
Patients with heart rhythm disorders like Paroxysmal Supraventricular tachycardia, atrial fibrillation, ventricular arrhythmia, weak heart, cardiac genetic diseases called channelopathies with high risk of lethal arrhythmias, taking cardiac medications which have potential to interact to constituents of energy drinks
WARNING & CAUTIONS.
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WARNING LABELS: “Not recommended for children, pregnant or nursing women & person sensitive to caffeine”
DO NOT MIX CAFFEINE WITH EXERCISE AND DEFINITELY NOT HIGH CAFFEINATED ENERGY DRINKS WITH PRE-WORK OUT SUPPLEMENTS: You will easily cross the safe zone.
Pre workout supplement packs contain around 188 mg to 300 mg caffeine per scoop in various brands.
BUT IS THIS MUCH WARNING ENOUGH TO LET THESE DRINKS BE FREELY PROVIDED BY ILL EDUCATED VENDORS & CASUAL CONSUMERS?
WHAT IS CAFFEINE SENSTIVITY & SYMPTOMS & A SINGLE DRINK CAN BE DEADLY?
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A single can or drink can create problems if you have caffeine sensitivity.
If you have headache, jitters, insomnia, restlessness, anxiousness, racing heartbeat with caffeine drinks you should be cautious that you are caffeine sensitive. There is a genetic component to how your body processes caffeine, meaning that your genetic makeup can make you hypersensitive to caffeine.
The absence of regulatory oversight has resulted in aggressive marketing of energy drinks but this can have dangerous health related side effects, addiction potential and definitely not for children, adolescents, pregnant, should never be mixed with exercise, alcohol and also not recommended for patients having heart rhythm problems, poor cardiac reserve, patients on cardiac medications.
I request ICMR/ Central and State Health Department to establish norms for safe limits of these legally allowed addictive substances being freely sold in the market. Ban at schools , Gyms and to be sold casually. State and central health departments should intervene and all sudden deaths in Gym or after consumption of these drinks should be audited. Allowing free trade of poisonous energy drinks to harm the health of the nation should not be permitted.
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This message has been issued in public interest by arrhythmia support network.
Dr Rohit Walia is senior consultant cardiologist available exclusively at Christian Medical College Hospital , Ludhiana, Punjab and is available in person to poorest of poor patients or teleconsultation to remote patients.
Email: pulseislife1@gmail.com
