Posts Tagged ‘Caffeine’

Blackout Beers: Caffeine + Alcohol = Dangerous?

PharmD 2011 |

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.

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02 2011

FRS Health Energy: What is Quercetin?

PharmD 2011 |

What do Pro Volleyball, Lance Armstrong, and Motor Sports have in common?  Besides making us feel like we should get off the couch more, all of them are sponsored by a revolutionary energy drink that promises “to produce more real energy.”  Real energy?  It turns out we can blame sleep deprivation for America’s craving for alternative energy.  Approximately 20-40% of adults report difficulty sleeping at some point each year due to a myriad of reasons (first date anxiety, work deadlines, World of Warcraft…you get the idea) (1).  It’s no surprise that more people are turning to a quick “natural” fix after a sleepless night to boost their energy level like Pac-man and his power pellets.  Free Radical System (FRS) claims to offer a natural, healthy form of energy.  Should we denounce milk and pour FRS into our cereal bowls instead? Besides questionable after taste, it might not be a bad idea to learn more about the active ingredient in FRS before doing so.

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01 2011

Energy Drinks: Giving you Wings or Withdrawal?

MD 2011 |

It’s the problem we all share. As you walk into your doctor’s office in the wee hours of the morning to squeeze in an appointment before work, chances are your doctor has the same drink in hand: a cup of coffee.  Let’s face it: America’s capitalistic, workaholic attitude thrives on caffeine so its no wonder that it’s the first thing we reach for in the morning…and at 2 o’clock in the afternoon…and after dinner.  Now, since we’re American, we have to do everything bigger and better bringing us to the Energy Drink. Heavily advertised as a beverage that will literally “energize you” with every sip, it’s not hard to imagine why this new segment of the beverage market has grown so rapidly (200 new brands were introduced to the US market in a one year period).  What exactly is behind these “magic potions?” Do the new “natural” ingredients really make an energy drink better than a cup of coffee?

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10 2010

Migraines: Can you make my head stop pounding!?

by Rebecca A. Shatsky, MD 2011 |

What do Julius Caesar, Elvis Presley, Ben Affleck and Whoopi Goldberg have in common? And no, we’re not referring to their magnificent stage presence or iconic hairstyles (although that may be true).  According to historical documentation and popular media, all of these people, in addition to millions of others, are reported to have suffered from migraine headaches.  Although only receiving attention in the past few decades, the debilitating condition is thought to have affected humans since the beginning of time.  In addition to those listed above, famous migraine suffers of the past include Thomas Jefferson, Charles Darwin, Lewis Carroll and even Sigmund Freud.  In 1999, the prestigious medical journal, The Lancet, proposed that Lewis Carroll’s wonderfully bizarre characters from the novel In the Looking Glass may have come from migraine-induced hallucinations that he had been known to experience from time to time.  This is what we call turning lemons into lemonade.

What is a migraine?

First of all, a migraine is a really bad headache (yes, we realize you probably know this).  On the other hand, a headache is not necessarily a migraine.  Confused yet?  Do we sound like Lewis Carroll?  If you are, you’re not alone.  The term “migraine” itself is one of the most commonly misused terms in modern medicine by both doctors and patients alike.  Many sufferers of the disease claim the symptoms  (including severe, throbbing pain, usually located on one side of the head, which may be accompanied by nausea, vomiting and “tunnel vision”) are hard to mistake. However, these days, the term is often thrown around to describe severe headaches of all types.  Migraines themselves come in different shapes and sizes. They can last from several hours to days, can begin as early as childhood or as late as menopause (in women, of course) and vary from person to person.  That being said, here is a breakdown of the most common types:

1. Migraine with Aura:

This variety, otherwise known as the “classic migraine,” involves the previously described pulsatile, unilateral headache.  This variety also comes with a constellation of neurological symptoms that begin 10-30 minutes before the onset of the headache, known as the “migraine aura.”  The aura is most often visual and may include seeing bright lights in your peripheral vision, seeing wavy images or a complete vision loss (scary but not necessarily dangerous).  There are also non-visual auras that can include weakness, speech abnormalities, vertigo and numbness.

2. Migraine without Aura:

This type of migraine is not preceded by any of the neurologic symptoms described above.  Migraines, both with and without aura, may be accompanied by nausea, vomiting and sensitivity to light and noise.  Migraine without aura is actually more common than migraine with aura.

3. Menstrual Migraine:

Gents, you get to sit this round out.  Some women experience migraines just prior to the start of their period.  These migraines occur with or without aura and are related to changes in hormone levels.  On a more positive note, they often get better or disappear completely during pregnancy…probably not the most efficient treatment plan but always an option.

What causes migraines?

The jury is still out regarding the exact cause of migraine headaches.  Nevertheless, current research asserts that migraines are caused by dilation of the blood vessels in the head (causing the throbbing sensation) and an activation of various “nuclei” in the brain (which causes the intense pain) (Note: “nuclei” are clusters of cells in the brain…different nuclei than you studied in 6th grade science class).  Imaging studies have also discovered significant changes in blood flow to the affected area of the brain preceding and at the onset of the migraine.  Essentially, the blood flow regulation in your brain temporarily goes haywire causing that classic throbbing sensation.  In addition, there is data to support a genetic predisposition that makes certain people and families more likely to suffer from migraines than others. There are also many well-known stimuli that can trigger migraines in those predisposed to the disease. Some common triggers include:

  • Lack of, or too much sleep (if there is such a thing as “too much” sleep)

  • Specific foods (chocolate or coffee)

  • Bright lights

  • Changes in weather or humidity

  • Hormones/ oral contraceptive pills

What can we do to avoid migraines and treat them when they occur?

The best course of action is to identify your personal migraine triggers and avoid them.  Much like allergies, migraine headaches are easier to prevent than they are to treat once they’ve begun.  Yes, we realize that this is easier said than done.  If you do experience a migraine, the best thing to do is treat it as soon as possible before the pain progresses.  While migraine headaches are not generally thought to be dangerous to the vascular or neurologic systems (there is some debate about possible increased stroke risk) treating the pain early could mean avoiding a full-blown attack.  For some people, treatment may be as simple as lying down in a quiet, dark room or taking an over-the-counter pain medication such as Tylenol, Advil or Aleve. Excedrin is also a popular choice because it contains a combination of caffeine (which works to constrict pulsating blood vessels) and the active ingredient in Tylenol (acetaminophen). Definitely check out the names of the active ingredients in over-the-counter medication for treating pain and those labeled specifically for the treatment of migraine headaches.  Often there is a noteworthy difference in price and no difference in active ingredients!

For those who do not respond to over-the-counter medications, prescription medication may be necessary. There are several preparations of prescription migraine treatment.  Those most commonly prescribed are: Imitrex (sumatriptan), Maxalt (rizatriptan), Cafergot (ergotamine + caffeine) and Topamax (topiramate). However there are literally dozens are medications approved (and used off label) for treatment of migraines (even Botox injections!!) and it may be necessary to try several different treatment options before finding one that works for you.

It is currently estimated that over 45 million Americans suffer from migraines.  While the idea of a headache so severe that it causes vomiting and vision loss may seem like a terrifying medical emergency to some people, for millions of Americans this type of devastating headache is a very painful and frequent reality.  If you do suffer from migraines, don’t lose hope!  Physicians and scientists are making great strides in the prevention and treatment of the disease, with new treatment options and support for migraine suffers being discovered daily.

Questions? E-mail the author:


1. Aminoff Michael J, Kerchner Geoffrey A, “Chapter 24. Nervous System Disorders” (Chapter). McPhee SJ, Papadakis MA, Tierney LM, Jr.: CURRENT Medical Diagnosis & Treatment 2010:

2. Bajwa ZH, et al. Pathophysiology, clinical manifestations, and diagnosis of migraine in adults. Accessed May 19, 2010.

3. Migraine. National Headache Foundation. Accessed May 19th, 2010.

4.  National Migraine Association. Accessed May 21st, 2010

5. Podoll, Klaus, and Derek Robinson. “Lewis Carroll’s Migraine Experiences.” The Lancet 353.9161 (1999): 1366.

6. Shuhendler AJ et al. “Efficacy of botulinum toxin type A for the prophylaxis of episodic migraine headaches: a meta-analysis of randomized, double-blind, placebo-controlled trial


06 2010

Prevent Jet Lag: Who wants to be tired on vacation?

by Kelly Erickson, MD 2010 |

Sleeping on the PlaneWith record-breaking storms keeping many Americans trapped indoors this winter, it is hard to imagine that summer will ever come.  Daydreaming about your spring getaway or summer vacation to Europe may be your only respite from the cold.  But when you consider vacation, especially one that takes you multiple time zones away from home, one of the major drawbacks is coping with the even harsher reality of “jet lag”.  Whether it requires you to sleep when you arrive at your destination rather than enjoying immediate exploration or demands that you take yet another day off from work once you return home, jet lag is undeniably inconvenient.  Here we will explain the causes of jet lag and how to best prevent it from hindering your well-deserved adventures.

What is jet lag?

According to a recently published article in The New England Journal of Medicine, jet lag is a “recognized sleep disorder that results from crossing time zones too rapidly for the circadian clock to keep pace.”  It is a constellation of symptoms that can Jet Laginclude insomnia, daytime sleepiness, fatigue, poor physical performance, cognitive impairment and gastrointestinal changes.  What the scientists meant to say was that you are going to feel lousy.   Jet lag is most commonly experienced after crossing at least 5 or 6 time zones (the East Coast-West Coast trip doesn’t apply here!).  Jet lag is most commonly confused with “travel fatigue”, which is the unfortunate result of the combination of sleep deprivation, stress caused by traveling, diet changes, etc.  While travel fatigue can be easily treated with a little rest and T.L.C., jetlag is a horse of a different color.

How does this “jet lag” nonsense happen?

The body’s circadian clock is located in the suprachiasmatic nucleus (SCN) of the hypothalamus (imagine a point directly between your eyes and two inches towards the back of your head…eureka, you’ve found it!).  It communicates with the retina, allowing it to sense light and dark.  Suprachiasmatic NucleusBased upon our regularly predictable cycle of waking and sleeping, the SCN promotes alertness or sleepiness in sync with our daily routine by regulating the secretion of melatonin from the pineal gland.  The system works such that light inhibits the secretion of melatonin.  Therefore, melatonin has often been referred to as the “dark hormone”, because it is only secreted when there is no stimulation by external light (aka nighttime).  The problem with this system is that our circadian clock does not adapt quickly to changes in the cycle (i.e. flying half-way around the world in single day).  Therefore, in the same way that “motion sickness” is the result of desynchronization between visual and spatial stimuli in the setting of movement (didn’t know that, did you?), jet lag is the body’s response to the imbalance between a predicted sleep-wake cycle and a change in external light and dark stimuli.

How to Beat It:

1.  Re-sync your clock. This is accomplished with 2 strategies.

  • Timing of Light Exposure: Based on what we now know about the circadian clock, we now understand how light can be used as a powerful tool to “trick” the circadian clock and therefore advance or delay it.  Although it may seem logical to think that sleep itself resets the clock, it is actually exposure to light and dark that is most effective.  What does this mean?  Studies have shown that light exposure should be used as follows after travel. Eastward travel: Upon arrival seek exposure to bright light in the morning.  This will help delay your circadian clock.  Westward travel: Seek exposure to bright light in the evening, which will help advance your circadian clock.

  • Taking Melatonin:  Because light inhibits melatonin secretion, recommendations for Melatoninmelatonin are the opposite of those for light exposure.  When melatonin is taken in the evening, it resets the body clock to an earlier time and when taken in the morning, it causes the clock to be set to a later time.  Guidelines for melatonin use are, once again, broken down depending upon the direction of travel.  Eastward travel: Take 0.5mg-3mg at bedtime to shift your circadian clock to an earlier time and help you fall asleep.  Westward travel: Take 0.5mg during the second half of the night to shift circadian clock to later time and allow you to continue to sleep.  When traveling westward, the most common sleep disturbance is difficulty staying asleep.  Therefore, melatonin should be taken after awaking in the middle of the night in your new time zone.


2. Plan out your ZZZZZ’s. When planning a trip, you buy your airlines tickets in advance, purchase your travel books and research all of the best sites to visit.  Why not spend a few extra hours sleeping before you leave to help ease the jetlag when you arrive?  More sleep plus less jet lag sounds like a good deal to us.  In general, this means shifting the timing of your sleep 1-2 hours earlier for a few days before eastward travel and 1-2 hours later for a few days before westward travel.

3. Medication. When all else fails, manage your symptoms with some good old-fashion meds.

  • Downers (aka sleeping pills):  Studies have shown that 10mg zolpidem at bedtime helps patients get a good night’s rest after long-distance travel and helps to reduce the symptoms of jet lag.  It’s best if you give the medication a test-run before you leave to ensure that you do not have any unwanted side effects while in the safety of your home country (amnesia and confusion…not so fun in a new city where you don’t speak the language).

  • Uppers: Caffeine, while generally discouraged for those attempting to overcome jetlag, can be used in small doses early in the day to increase daytime alertness and decrease sleepiness.  Small doses for those of you who missed that part the first time.

The Take Home Message: Jet lag sucks (as the scientists so eloquently explained) but can be mitigated with some planning, preemptive measures before you leave home, and a little proactive management once you’re on the ground in your exotic location of choice (our advice: print out this article so you can remember all these tips when it’s go time).  There’s no reason to feel like poop during your valuable travel time.  Vacation, here we come.  Now get packing!

Questions?  E-mail the author: Kelly Erickson, MD 2010 |

Bora Bora, French Polynesia


1.  Sack, Robert L.  Jet Lag.  The New England Journal of Medicine 2010; 362:440-7.

2.  Herxheimer, A., Sanders, M., Mahowald, M., Sokol, H.N., Jet Lag. UpToDate, 2010.

3.  Herxheimer, A, Petrie, KJ. Melatonin for the prevention and treatment of jet lag. Cochrane Database Syst Rev 2002; :CD001520.

4.  Jamieson, AO, Zammit, GK, Rosenberg, RS, et al. Zolpidem reduces the sleep disturbance of jet lag. Sleep Med 2001; 2:423.

5.  Morris HH, 3rd, Estes, ML. Traveler’s amnesia. Transient global amnesia secondary to triazolam. JAMA 1987; 258:945.


02 2010

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