A recent federal report said emergency room visits linked to energy drinks increased tenfold between 2005 and 2009, jumping from about 1,000 to 13,000 per year. It’s not shocking that 44% of patients who’d consumed energy drinks had also consumed alcohol or drugs; it’s not even that bizarre that men were twice as likely as women to combine alcohol or illegal drugs with energy drinks. But what surprised me is that the report pointed out that female ER visits were more likely to involve combining energy drinks with pharmaceuticals; why would energy drinks be bad to mix with prescription drugs? And what kind does that even mean—painkillers? Antidepressants? Birth control?
I put the questions to Dr. Michael Lowenstein, co-medical director of the Waismann Method, where he treats patients with opiate dependency. He says that, while an excess of energy drinks can cause several symptoms, one of the biggest issues actually starts with our stomachs.
In fact, Lowenstein thinks that these days, the majority of Americans have what he calls “dysfunctional guts”:
There’s a lot of bacteria and yeast that shouldn’t be there, and what feeds these bad bacteria and yeast is sugar. All this simple sugar feeds the pathogens and bad stuff in the gut.
And when the gut isn’t functioning well, the immune system doesn’t function well, serotonin levels drop, and the possibility of depression, auto-immune disorders, gastrointestinal problems, and even autism goes up. Add the excessive sugar found in energy drinks into the mix, and you have a mess on your hands:
Then people will want to take medications like Prilosec to treat these symptoms, to reduce acid in the stomach. But you need acid in the stomach, to absorb calcium and magnesium and all the important vitamins. Over time, people get stuck in this vicious cycle, where they don’t absorb enough important minerals, and this leads to more health problems and more medications.
Plus (making matters in your dysfunctional gut even worse), Lowenstein says that pharmaceutical drugs can also deplete some vitamins; something they don’t put at the forefront of those happy Cialis ads:
Lipitor will deplete the body of coenzyme Q-10. Everything depletes something. We’re already a little bit dysfunctional in our diet. And with sugar—you kind of get this feedback loop, you get this boost and then it’s gone and so you crave more. With our bad diets and a little bit of a gut disfunction, we have these underlying issues and drinking energy drinks just makes it worse. It’s not one specific prescription medicine (that’s a bad mix), it’s just that kind of loop where it’s making underlying issues worse.
The caffeine and stimulants don’t help, either. If you stay under 120-130 mg of caffeine—that is, one serving—you’re “probably okay,” Lowenstein says. But many people consume more than this. Some of the larger energy drinks, like Rockstar and Monster, contain two or three servings per can. The excessive caffeine alone can have dangerous side effects like irregular pulse, high blood pressure, and dehydration, but most energy drinks are also jam-packed with other stimulants like guarana (also caffeinated), taurine and B-vitamins. These carry their own risks, according to Lowenstein:
The B vitamins, the guarana, the taurine—any of those things in excess can cause nausea and vomiting. If you have hypertenion or anything like that, all the caffeine will make it worse. And … with too much caffeine, you’re not going to sleep well. You start messing with sleep-waking cycle, too.
In his work with opioid addicts, Lowenstein sees the way prescription painkillers, sleep and caffeine co-mingle:
It can become a cycle. People take prescription drugs for pain, the pain goes away but they continue to take them and they get very tolerant to the effects. It makes them function better, but it also makes them sleepy, so they’re drinking energy drinks and huge amounts of caffeine.
And then they can’t sleep and begin taking prescription sleep meds, like Ambien, or more painkillers.
“It’s pretty interesting what we do to ourselves to feel normal, and it works for a while, the body adapts, but only to a certain extent,” he added.
And because women are generally smaller than men, energy drinks in smaller doses might have greater effects, which—compounded by prescription or recreational pharmaceuticals—could explain why more women land in the hospital with energy drink and pharmaceutical related issues.
It wasn’t the cut-and-dry conclusion I expected when I asked what drugs shouldn’t mix with energy drinks, but I think Lowenstein’s answer turned out to be a lot more complicated—and interesting. It’s certainly made me think twice about my lingering sugar-free Red Bull habit.
Oh, and in case you’re curious:
- About 27% of energy-drink-related ER visits involved in combination with pharmaceuticals (compared to 16% involving combination with alcohol and 10% involving combination with illicit drugs).
- The group most likely to be there for energy drink/pharmaceutical combination was women aged 18 to 39.
- The type of prescription drugs associated with the highest number of visits were central nervous system stimulants (i.e., Ritalin and other drugs used to for ADHD, narcolepsy and appetite reduction), followed by painkillers and drugs used to treat anxiety or insomnia.
- More than 2/3 of all energy drink ER visits were classified as ‘adverse reactions,’ while one-third were classified as involving the ‘misuse or abuse of drugs.’ More than 2/3 of the visits spawned by energy drink/alcohol-or-drug combinations, however, were classified as misuse and abuse.
- Energy drink consumption over time “can cause dependence and withdrawal symptoms.”