way gonna get this thing started. We're gonna do this. Yeah. Yeah, we're gonna do it. You know why we're gonna do it? Because this this this this viscous, viscous Harvey. Want anything special for your birthday? Just a decent cup of coffee. I don't want coffee. Why not? Because it's a stimulant. Just t. Thank your coffee. Coffee, mental.

Get coffee colored shirts. You know, caffeine course service delivery. Um, ice cold, coca. Go five hour energy. Do the deal. And Booth, you know this is excuse me. A damn fine.

Why would you say that? Why would you say that? Why would you say

that? Caffeine good or bad this week. What's the latest?

Every so often, there's a new study about coffee and whether or not

it's healthy for you, more than four cups a day might increase the risk of an early death. Could cut chances of premature death by heart disease by 15%.

Before you grab that cup of coffee, listen to bed. Coffee could help keep a range of illnesses, invade diabetes, Parkinson's heart disease. Even aside,

is cafe in good or bad? Every week, there's a news report that contradicts the last news report. I'm Dr Mella

of it. I'm Dr Jess

Mason and I am Dave Mason. In this episode of this one had a bit. We're going to discuss how caffeine works, whether there's any health benefits. We're gonna talk about energy drinks, and we're going to talk about what happens when you have too much caffeine. I mean, way too much caffeine.

Caffeine has been around for a very long time. There's a popular legend that the coffee bean was discovered by a melancholic goat herder from either North Africa or the Middle East. Depending on which source you read, he observed his goats dancing around after eating a certain very so. Then he tried the buries himself, and he became happy and forgot all his troubles. So he shared the Berries with a local monastery who decided to dry and boil the beam. Coffee may have been around even longer than that, depending on the translation you read. Some people think that coffee is described in the Bible and even Homer's Iliad.

What we know for sure, though, is that there is written accounts of coffee being brewed around 1000. D in Yemen, in the port city of Mocha. No. Come on, Mocha. Seriously, that's the Mocha Mocha lattes right next to me. Oh, cappuccino. Exactly.

Yeah, but actually, Dave, if you did order a coffee in the port city of Mocha at that time, you probably send it back because it wouldn't look or taste anything like coffee. Today. It was probably more like tea because they were steeping and unroasted bean. And it wasn't until the 14th century that somebody decided to roast the bean and coffee. They would never be the same. Coffee houses opened everywhere in the Middle East called Mech Tab. Your fund, which means the school of the

wise in the 17th century, coffee and tea. We're gaining popularity in Europe. Coffee shops opened in Venice, in London, in Paris, European studying, developing ah, whole culture in a special dishware around drinking coffee and tea. It became a whole thing in the placing of the piece. That exact details helps tremendously in giving the final impression of perfect. In addition to coffee, tea and Coco is other plants that make campaign that is well known. For instance, your tomato and the Colonna. Dave, have you ever heard of Kola nut No,

you have. In fact, I'll give you a hint. In 18 86 John Pendleton mixed cocoa beans with column nut and what did he make Pepsi Close? Uh, Coca Cola. But thank you for Troy.

So let's talk about what caffeine does to your body. Every person makes a chemical called a Dennis ing throughout the day, and as it builds up in your body, it makes you sleepy. Well, guess what the caffeine molecule does. It displaces the Dennis ing.

Let's take a trip with caffeine molecule. You sip your morning copy. It goes to your stomach and intestines and then into your bloodstream, and you stop feeling the effects of the campaign that about 15 minutes. It has its pick affected. About one hour. Caffeine molecules go through your whole body. They affect your entire body. But especially caffeine from your morning blend goes from your bloodstream into your brain and displaces the dentist scene that's been making you sleepy. That's what makes you feel more awake so small to moderate doses such as, say, a Coca Cola up to a large coffee. These have been shown to

increase alertness, concentration, reasoning and memory. The controversy over whether coffee is good or bad. Well, that's nothing new in Sweden. In the 17 hundreds, coffee was getting really popular. But King Gustav the third, thought that it was bad. So he set out to prove it. There was a set of identical twins, and they were condemned to death for crimes that they had committed. Gustav saw it as his opportunity to prove to the Swedish people that coffee is bad for you. So he gave the twins choice.

This is a King Gustaf your can, either before today, today or life in prison. But one of you has to drink tea while the other passed a drink. Three parts of coffee every day. Then we'll see how long it takes for you to die. How does that sound?

Oh, yeah. Taxi Milk duds. Gustav assigned to physicians to monitor the twins in there slow spiral into death. This is jokingly become known as the first Swedish clinical trial. So any guesses as to what happened? The first death was one of the doctor who stop and the second death it was King Gustav. Third death was the brother drinking tea, but he probably just died from old age because he was 83 years old. And as for the other brother who was drinking coffee well, no one knows what happened to him because he probably outlived anyone who cared about the experiment in the first place. And he died in obscurity. I'm sure to stop

drinking the coffee now that you're dead. Hello. So what can we conclude from this randomized trial of two people? Nothing. That I would rather drink coffee than be executed that day. It's true, from a scientific point of view, we can learn nothing, but it is such a great story. Hundreds of years later, we continue to question the health benefits and the risks of caffeine. We all know that caffeine is good for people who work night shifts because it's been proven actually to reduce errors on the job. And that's especially important for doctors and nurses and cops and pilots and truck drivers. That's why there's always I mean, always a pot of coffee in the ear is, is a good coffee in the year? No, no. In addition to keeping your weight, these small doses have a lot of other fix on your body. But it's important to keep in mind with pretty much all of these effects that the research is based on associations and not randomized trials.

That's why they say association does not imply causation.

So what is this association? I'll try and explain it this way. Everybody who eats carrots eventually dies. Therefore, eating carrots kills you. Oh, my God, I'm never eating a carrot. Terrible. Yeah, I'm totally staying away from carrots, so that's kind of a silly example, but it gives you sort of the idea. Those 2 may be true, but they're not actually the cause of each other. So the carrots did not cause the death their associate ID, but they're not causing you to die.

There's another really famous one, and it's about hormone replacement therapy. So there were lots of studies for old many years that said women who took hormone replacement therapy after they'd past menopause would live longer than women who didn't take hormone replacement therapy. Then what they did is they actually did randomized trials where they took people who are very similar, and some got the hormones and some didn't and they found out in the randomized trials, which is a much more scientifically rigorous study that it didn't actually working. In fact, hormone replacement therapy might shorten your life. How could this be? It turns out, when they went back and look at the original studies, the women who are getting home on replacement therapy tended to be richer, tended to have better education, tended to eight better, tended to exercise more. And so the hormone replacement therapy was actually a measure of your socioeconomic class, not an effect of the hormones themselves.

Right. So keeping that in mind pretty much everything we're gonna talk about from here on out is mainly associations, and we'll let you know if the data is any higher quality than that.

So it means everything you're about to tell me from this point on, I have to take with a grain of salt. Right? Or a spoonful of sugar are two lumps.

Yeah. Okay. Well, here's the first lump deck. Caffeine goes to your heart muscles. It triggers the release of chemicals that help with muscle contraction. If you're not a regular caffeine drinker,

you mean a lightweight?

Yeah. If you're a caffeine lightweight, it can raise your blood pressure. But this effect goes away with daily users. So over the long term, small to moderate doses may decrease your chance of a heart attack or a stroke by association. Remember

the lumps. Right lumps. Now you guys really sound like doctors. You're really being cautious with your phraseology. There's something called an inverse association as well, and in this case, between coffee and tea drinking and Parkinson's disease. When you look at people who've got Parkinson's disease and you compare the one people who don't the people who did not get Parkinson's disease tended to drink more coffee. But that doesn't necessarily mean that the coffee protects you from Parkinson's disease. It's just another association,

and the same type of inverse association exists with coffee and tea and type two diabetes. So looking at people who got diabetes and people who didn't, the people who didn't get diabetes tended to drink more coffee.

Caffeine stimulates smooth muscle, and that's what makes your bells move. So, Dave, yes, it does indeed hope you go poopy pants. I knew it because

it happens, and caffeine may affect your mental health again. It has that same inverse association with depression, but in some people, and it higher amounts, it can increase the risk of anxiety again. Thes air the effects that caffeine has at low to moderate doses because there's a lot of ways to consume. Caffeine and different products have different

doses. So let's start with the least amount of caffeine and go up on the scale. Hershey's chocolate bar has just nine milligrams of keeping

an iced tea like a Snapple, or Arizona has 15 to 20 milligrams.

You've got your white tea, which is about 30 to 55 milligrams all the way up to your black tea, which can have as much as 90 milligrams of caffeine perk up. Now. My favorite vector for caffeine is Diet Coke or Diet Pepsi. A standard Diet Coke or Pepsi only has about 40 milligrams of keeping

an espresso shot also has 40 milligrams.

A standard eight ounce can of Red Bull or Monster rock. STA gives you about 80 milligrams of caffeine, but we're gonna have to come back to this because that's not the entire story With these drinks. Standard eight ounce cup of coffee has about 100 to 200 milligrams of Kevin

and then a five hour energy that tiny little bottle that's got 215 milligrams. Then

there's a really strong cup of coffee. It's cold death wish coffee, so you can imagine so eight answers of death wish coffee has wait for it. 440 milligrams, so more than twice what a standard cup of coffee.

But you know, the most dangerous way to consume caffeine is pure caffeine powder. One tea spoon has 3200 milligrams. What, yes, 3200 milligrams. That's approaching the lethal dose.

So that's like 10 or 20 cups of coffee in one little taste. But wow, and you could just buy this online. Yeah, my name is David Teats, and I'm an emergency department pharmacist at the Cleveland Clinic, so the recommended max is around 400 milligrams. But the toxic amount in adults is 10 to 20 grams, or the equivalent of about 100 cups of coffee to high doses can actually be fatal, so it takes a lot of caffeine to kill you. But it's pretty easy to get to that level of caffeine with these highly concentrated caffeine powders that's actually unregulated because it's considered a dietary supplement by the FDA. and well tended 20 grams may sound like a lot. That's actually only about one tablespoon of that powdered form to be fatal. That's right. One tablespoon can kill you. That is, that's insane.

I can't even go into Target without getting carted to buy Nike Will. And you can buy this stuff online, so we're gonna come back to caffeine patter because it's really a pretty serious issue. But first we're gonna talk about those energy drinks again. Yeah, so what did you mean by it's? It's not really 80 milligrams of caffeine, even though it's what it says on the label. I mean, what is it like, 80 milligrams of caffeine? And then we just throw in something else called Bath Scene at 400 milligrams exit. It's kind of like that, but let's get some experts to talk about it for us. So you've met Stewart before. He's Captain Cortex.

He's a professor of emergency medicine at the Keck School of Medicine, and he's speaking with Shore North, who is both an emergency physician and, formally, a pharmacist. They're gonna tell us about energy drinks and what else is in them. I have really just thought of these as caffeine drinks. And I think what you probably should educate us about is how these air different than just a coffee, which we knew so well for so many years. So energy drinks have a number of different components, and in one of our caffeine's, everybody's familiar with caffeine. And then it's got some B vitamins in it. It's got a lot of sugars in it. It's got Taurean, which the amino acid.

So all those are pretty safe, except when you get to the caffeine. Caffeine can be dangerous. But then there's also some called garana. Garana is a naturally occurring seed that has caffeine in it, as well as three Offline and Theo bro mean so these air methods Anthony medals and things are a group of chemically related compounds, Captain being one of them, three offline. You may have heard of that one being another, and they have very similar effects, So usually we only talk about caffeine, but these other metals and things will they act just like caffeine, and we often forget about him. We shouldn't because their fixer often additive to caffeine. So this is caffeine on top of caffeine, plus the effects of the awful.

It is this why you get more jittery on an energy drink than a regular cup of coffee. That is correct. Someone, people, look up Starbucks and tall Cup of Starbucks will have about 100 and 50 160 milligrams of caffeine, and then they look and say, Well, monster only has about 100 milligrams a lot of these brands of what they call their energy blend. Which is this for Parrot Terry kind of trade secret that they don't have to tell you how much. But there's a CZ Muchas 500 milligrams of caffeine or metals and things in each can. And if you're drinking multiple cans, you're getting into a pretty dangerous range of potential caffeine toxicity or similar agents

like that. So even though my energy drink says it contains 80 milligrams of caffeine, it's actually got more stimulant than that. And the problem is that we often don't know exactly how much

are there any other uses for caffeine in the medical field, other than keeping yourselves awake by drinking crappy coffee at night? Well, that's clearly the most used form, but we don't use it that much in the ear, but it is used for a few specific medical conditions. For example, it's used to treat headaches. Well, that's cool. I mean, I get headaches all the time. If I don't have a cup of coffee. Yeah, that's classic. That's a captain withdrawal headache, and that's not what I'm talking about.

But that is a very effective yes, I'm talking about, actually, things like tension, headaches and migraine headaches. When you add caffeine to aspirin or Tylenol, it seems to be more effective than just the Tylenol of the aspirin alone. So you'll often see this as a migraine tablets. It's a little bit of Tylenol. It's a little

bit of caffeine. It's also used for another type of headaches. Sometimes that can occur after a spinal tap or lumbar puncture called a post dural puncture headache. One of the possible treatments for this headache is caffeine, and some studies have shown an improvement in pain, although again the data is limited here, so it's hard Thio make conclusions.

It can also be used in premature babies. Premature babies often don't breathe very well. Little caffeine drip. They breathe like trains. That's pretty good, but this isn't one of your, uh, inverse associations. This actually works, right? Well, this apnea of prematurity and caffeine effect, it seems like it's pretty real. There's been a number of studies on it, and it seems to save these babies. Let's score one for caffeine thing saving babies

and while on the topic of babies, is caffeine safe for pregnant women? According to the American College of Obstetrics and Gynecology. Most experts say that consuming 200 milligrams of caffeine or less per day is safe. So that's about one cup of coffee, depending on the size. But the data here is pretty limited. It's unclear if this dose of caffeine may increase the risk for a small birth weight, and it's also unclear if higher doses in this increase the risk for miscarriage again. This is just expert opinion based off of looking at associations. They obviously can't do randomized controlled trials on pregnant women. So it's really difficult to get high quality data here. And caffeine also goes into the breast milk, but again in low amounts. And it's not thought to be harmful by the same group of experts.

Now, do you know that caffeine is sometimes used as a work at supplement. Well, I have not heard of that before. We started working on this episode on I did ask My fitness trainer, Stephen Yates, who appeared in concussions if he had ever heard of this before. And this is what he said. Basically, the principal is if your heart rate is up to a certain level, you're in a target rate to burn fat. So say, if I'm doing resistance training and I'm not doing cardio me just walking to the next machine my heart rate will stay

at a higher rate just because so I'll be closer to my target fat burn rate the whole

time. But that's my trick. But I'm pretty sure that that's why they have it in all of the pre workouts. So people do commonly use caffeine as a trading aid, and bottom line is it does work that's Met bid on the moon's position in sports medicine. Physician seems in low doses that it does enhance performance, and it certainly seems to help with short term duration exercise of exercise lasting about five minutes and that's been studied in the laboratory. There's not definitive data or studies showing that it clearly improves times and endurance of its, but it's generally thought to do so. There's no evidence that suggests that it improves. Time was sprinting. In fact, it looks like it does not, and that sprinting means exercise of, ah, duration of 0 to 90 seconds. So it clearly seems to be a ergonomic aid or in a performance improver. But how much is difficult to quantify, and we don't have the studies to tell us that.

And what happens with too much caffeine, because it's not just about perky mornings and saving babies. At some point you're gonna cross the line where it's too much and it starts to make you sick. Now I'm not talking about the lethal dose, but just enough to make you feel awful. I spoke with some doctors, nurses and paramedics that I work with about their experiences taking care of patients and a few of them that were patients themselves.

The patient was basically college student, was trying to do too much stuff. So is taking both coffee and monster drinks camping that she bought from somebody off the street. I had some very strong, caffeinated coffee. I blew his death wish, Expresso coffees, went back to his dorm and used two red bulls right back to back. I really liked the taste of Red Bull. Justus. A drink now went down to the I drink two Red Bulls, one after another. They just took the caffeine and poured it into my Pepsi and I just down the whole cup. She got very anxious and very agitated in her heart was racing extremely fast. I came very lightheaded and the room began to spin. It feels like all of your skin is trying to crawl off of you like his heart was going to jump out of his chest. And so I put my hand on.

My pulse is a position, and I noted that my pulse was approximately 180 years like one sixties one seventies. It had to be greater than 1 50 His heart was 220. She was inflict McCullen SP T is where the upper chambers of the heart are beating way too fast and irregularly so she was going about 2 to 3 times as fast as her heart would normally go. My heart was racing. I felt it like skipping beats. It is torture. I couldn't even catch my breath. And then all of a sudden, projectile vomiting, I could not stop growing up. She had to get a medicine called a dentist scene, which would break her out of that. I have no heart rhythm. And plus, she was given some other medicine.

Self. It's sort of like a benzo days, things like Valium and think type of medications to help to calm her down. It's because she was extremely distressed, gave me some I V fluids and

let me rest a bit, and

I felt better. He did find we followed up on the next day. The observed him in the emergency room. He was discharged without complications.

I am very thankful that I did something stupid like that while I work in the E. R. But it took some time and I never drink again. I'm still

a coffee drinker and all that. But all in moderation, of course. So you might be asking. Is there an antidote to caffeine if I can get this over the counter? If one tablespoon could kill me, surely there's an antidote out there that adults can use to save your life. There is no

antidote. And tragically, there are cases of families devastated by the loss of a loved 1 18

year old Logan Steiner was just days from graduating from a northeast Ohio high school when he was found unresponsive in the family's home. The teen died after overdosing on caffeine powder. The coroner ruled he had 23 times the normal amount in his system.

Here is a statement written by Denis and Katie Steiner from Le Grande, Ohio, read by our producer CC. Logan was more than a prom king, an athlete and a graduating senior. He was our son and Dylan's little brother. Before May 27th 2014 we had never heard of caffeine powder. Now we think about it every day. How could Logan have died from caffeine? Could it happen to others? We started doing research. We decided that we must do everything

we can do at this product, off the market and away from other Children. Through the hard work of Katie and Dennis Steiner and the Ohio State legislation, retail sales of caffeine powder a now banned. This makes Ohio the 15th state to place a ban on captain pattern. It's important to remember that deaths from caffeine A really rare yes, caffeine powder is really concentrated and potentially really dangerous. But most caffeine that you drinking coffee and tea and even in your energy drinks is not at the level that you even have to worry about it.

So where does this leave us? With caffeine, We've heard the good, the bad and

the tragic. We heard how much caffeine in your drink varies a minute varies a lot and that energy drinks can have a bunch of other stuff that act like caffeine. But I'm not really counted as caffeine, but they had the same effect. We're gonna be really careful with energy drinks.

And we also heard that the reason that there's confusion about why caffeine keeps changing when it comes to being good or bad for you is because most of the studies are looking at association. They're the worst type of study, but they're the easiest to d'oh. So now that you know all this, are you going to change your caffeine habits?

I think Betsy says it best when it comes to caffeine. And frankly, for most things in life,

everything in moderation in life. There was a lot of people who helped us put this episode together So special, thanks to Nathan Bursitis Dr Lance Wilson,

Kathy Byrne, Matt Baird, Trish Bowl, Betsy Martinez, David Teeth CE, Dr Stewart Squadron and Dr Sean Nort. Our producers are C. C. Herbert Bill Connor. Sound design is by Bill Connor. This one hurt a bit is a production of fool Ibou incorporated information you here on this one hood of it should not be taken as actual medical advice. If you have actual medical questions that actual medical things, you should see an actual medical practitioner even though we are actually doctors were not your actual doctor. So be sensible and keep it real. And this I think this viscous.