Blackout Beers: Caffeine + Alcohol = Dangerous?

by Tania Houspian, PharmD 2011 | houspian@myhousecallmd.com

We know that the energy drink, Red Bull, has been around since 1987.  We don’t know, however, when the first individual had an epiphany and said to his friend, “Hey, this would be great mixed with alcohol!” Whoever he is, he probably regrets failing to patent his idea. At one point in time, it was the drink to order because it had everything most young (but, of course, over 21) drinkers would ask for. Alcohol to develop a buzz? Yes. Caffeine from an energy drink to make sure the buzz doesn’t make you sleepy? Yes. Flavored? Yes.  Flash-forward a decade or so at which point companies have caught on and have started manufacturing drinks called caffeinated alcoholic beverages (CAB’s) or alcoholic energy drinks (AED’s) that contain both caffeine and alcohol already combined for you (no bartender needed). We’ll be referring to them as CAB’s for the rest of the article for consistency’s sake. There were more than 25 different brands of CAB’s on the market a couple of years ago including popular brands like Sparks, Four Loko, Joose, and Max. Combining alcohol and energy drinks has always been controversial due to concerns over the cardiovascular effects of such a combo. Recently, the controversy has heated up due to multiple hospitalizations linked to consuming CAB’s.  As potential consumers of these drinks, you may be wondering why they are so bad for you and what the future holds for CAB’s.  Grab a drink and keep reading.

What’s in those drinks?

CAB’s typically contain a combination of:

  • Alcohol
  • Caffeine
  • Various other “stimulants”

The Alcohol

Most of the CAB’s use malt liquor as their source of alcohol. Malt liquor is a type of beer with a notably high alcohol content. Your regular run-of-the-mill beer usually contains 4-5% alcohol while malt liquor is defined as having an alcohol percentage greater than 5%. Most malt liquors have 5-8% alcohol but some of the malt liquors found in the CAB’s contain as much as 12% alcohol.  That fact in itself was an issue with the drinks because many consumers weren’t aware of the higher alcohol content and drank the CAB’s thinking they’re the same as drinking a Miller Light.  Whoops.

The Caffeine

The caffeine found in the CAB’s is pretty much the same caffeine you’d find in a cup of coffee. Most of the drinks contains somewhere around 150mg of caffeine. To put that into perspective, 12 fl oz of coffee (the size of a tall Starbucks cup of coffee) has about 93mg of caffeine (7).

Other Stimulants

If you’ve ever read the ingredients on your energy drink, you know they’re packed full of vitamins and any other herbal supplement they can cram in the can. Two main components of most energy drinks are: taurine and guarana.  Taurine is found in a lot of energy drinks, including Red Bull, and is advertised as a performance enhancer. In reality, we scientists don’t exactly know what taurine does. There are studies investigating taurine as a treatment for everything from diabetes to epilepsy. None of the data is conclusive and you’re not going to see taurine in your local pharmacy any time soon…but you’ll continue to see it in energy drinks for no scientifically-proven reason. Guarana, on the other hand, we are more familiar with. It’s a berry that has twice the caffeine content of coffee beans. Chocolate covered Guarana berries anyone?

The Increasing Controversy

Starting in late 2007, CAB’s were being criticized for both focusing their marketing on underage kids and flavoring their drinks to appeal to younger populations. When was the last time you heard someone over the age of 25 say they wish their beer tasted like fruit punch? The drinks had become a staple at undergraduate parties and stories of underage drinkers becoming severely ill and hospitalized were all over the news. The incident that gained the most nationwide coverage involved nine students that were hospitalized after a house party at Central Washington University in October of 2010. The students had been consuming a combination of drinks including vodka, rum, beer and a CAB. The students who were hospitalized had blood alcohol levels ranging from 0.12-0.35% (6).  Not your average kegger. Many college campuses have banned CAB’s in response to these stories. Did these students just over do it or was it the combination of the CAB and the alcohol that caused them to end up in the hospital?

Caffeine + Alcohol = ???

The initial concern about mixing caffeine and alcohol was due to the ingredients’ opposing affects on the heart. Caffeine is a stimulant and can speed the rate at which your heart beats. Alcohol, on the other hand, is a depressant and can slow down your heart rate.  The combo is kind of like stepping on the break and the gas pedals of your car at the same time.  We initially thought that these opposing affects would be detrimental to the heart and cause long-term damage.  While we haven’t proven this to be true, there are other concerning effects of the combination that are now coming to light.

Starting in 2007, the FDA began to take a closer look at these products and decide whether they met its criteria of being “generally recognized as safe”(GRAS). For a product to be GRAS it has to meet two criteria:

  1. Evidence of its safety at the levels used. In this situation, caffeine is known to be safe however caffeine mixed with alcohol is not. Up until this point, the FDA had approved the use of caffeine in cola-like products but never in alcohol-containing products. The companies decided on their own that combining the two products was safe and never submitted it for FDA approval.
  2. A basis to conclude that this evidence is generally known and accepted by qualified experts (2).

The FDA recently reviewed the data available on combining caffeine and alcohol and concluded that there wasn’t enough information showing that it was safe to consume the combination…and then deemed CAB’s a public health concern. The main concern in the literature was that caffeine, being a stimulant, masks the depressive affects of alcohol (i.e. you are drunk but feel completely fine).  Instead of getting sleepy or feeling slow when drunk, someone drinking a CAB will feel alert. So why is this a problem?

  • Problem #1: Not being able to feel the downside of being drunk (sleepy, slow, or passed out) leaves the CAB drinker willing and able to continue drinking…sometimes to the point of alcohol poisoning. Some people, especially younger drinkers (read college freshmen), need those signals to know they’ve had enough.  Without them, they continue to drink with horrible repercussions.
  • Problem #2: Like problem #1 explains, the CAB-consumer will feel alert and not drunk yet the person will still have impaired motor coordination and slower reaction times like a normal drunk person.
  • Problem #3: Being completely alert may cause the person to think they aren’t drunk, when indeed they are, leading to dangerous behavior like drunk driving or operating heavy machinery (Never a good idea and definitely a public health concern) (1).

In addition, alcohol and caffeine are both diuretics. Think about how much you pee during a night of drinking or after drinking a nice big cup off coffee. Combine those affects and you will find yourself extremely dehydrated but with lots of alcohol in your body. Are you starting to see how those students ended up in the hospital?

Now what?

On November 13, 2009 the FDA sent a letter to over 30 companies asking them to show proof of the safety of their products (2).  About a year later, on November 17, 2010, the FDA sent warning letters to four companies (the table below outlines with the products being addressed by the FDA) stating that they had not responded to the initial letter. The companies were warned that the caffeine added to their malt alcoholic beverages is an “unsafe food additive” and that, unless corrective action was taken, the FDA would take “enforcement action without further notice.” In addition, the FDA said it had the right to conduct a “seizure of illegal products and injunctions and prosecutions against manufacturers and distributors of those products.”  When the FDA uses words like “unsafe,” “prosecution,” and “illegal,” companies listen (1). The companies responded by stopping production of the products and removing the products from store shelves immediately.  Sometimes a strongly worded letter does the trick.

But I love my CAB’s! That’s not fair!

You might have been one of the more responsible CAB drinkers and knew when you’d have enough. You probably feel unfairly punished for some random college kids’ mistakes. If it’s any consolation, some of the products are still on the market without the caffeine so you can still get fruit punch flavored malt liquor if that’s your thing.  Other fans took a different approach and bought a stockpile of the products before they were pulled off the shelves (4).  Now there’s a black market selling these products for a significant markup. If you really miss your alcohol-caffeine combo, you can always go back to the old-fashioned Vodka Redbull. Before you place your order, remember to drink responsibly because it’s your health and your future on the line.  If you recognize that you need help with a drinking problem, there are a number of places you can seek help across the country, from full rehab centers, like Narconon, to smaller detox centers closer to home.  

Questions? E-mail the Author: houspian@myhousecallmd.com


References:

1. Charge Beverages Corporation 11/17/10 Warning Letter. November 17, 2010. http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm233990.htm

2. FDA to Examine the Safety of Caffeinated Alcoholic Beverages. FDA Consumer Updates. November 19, 2009. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm190364.htm

3. FDA Warning Letters issued to four makers of caffeinated alcoholic beverages. FDA News Release. November 17, 2010. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm234109.htm

4. Four Loko ban fuels buying binge. Washington Post. November 18,2010. http://www.washingtonpost.com/wp-dyn/content/article/2010/11/18/AR2010111806114.html

5. Serious Concerns Over Alcoholic Beverages with Added Caffeine. FDA Consumer Updates. November 17, 2010. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm233987.htm

6. Student illnesses at party blamed on Four Loko. October 26, 2010. Washington Post.

7. USDA National Nutrient Database for Standard Reference, Release 23 (2010). http://www.nal.usda.gov/fnic/foodcomp/cgi-bin/list_nut_edit.pl

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02 2011

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