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Acaffoscaff RS
Tired all the time, easily fatigued, sleeping your way through life? Acaffoscaff RS is an exciting new treatment from Medlife Pharmaceuticals that may be just what you need. Hi, my name is Dr. Kyle Extreme. You might remember me from such dubious broadcasts as the 2012 Red Bull Snortathon and Monster Energy's Ritual Sacrificial Games.
Are you tired all the time, troubled by low energy, looking for a quick fix to get your coursework done because you left it all till the night before your deadline, unable to maintain a strong 24-hour live stream? Do you hate drywall? Are you insecure about your tragic attempt at a kickflip, or just in possession of too many teeth? Ask your convenience store owner if a can full of sugar, caffeine and all kinds of other random [ __ ] is right for you.
Intro
I was a mediocre medical student, not blessed with natural confidence. I drank alcohol occasionally at social gatherings but tended to just fall asleep, until one day someone introduced me to a drink called a Jägerbomb. I woke up outside the dissection room some nine hours later, holding a sign for the women's lavatory and missing half of my front incisor, with no recollection of what had happened, and I thought, this is what life should be about.
A can full of sugar, caffeine and all kinds of random [ __ ] is the most disgusting soft drink on the market. Side effects include anxiety, insomnia, hallucinations, dirt bikes, aggression, increased heart rate and/or blood pressure, poor fashion choices, arrhythmia, heart attacks, heart failure, and appearing on no less than two medical YouTube channels simultaneously. Energy drinks can interact catastrophically when consumed with alcohol and lead to lifelong regret. I mean, just look at this guy. What a loser.
Red Bull, Monster, Five Hour Energy, Tenzing, Relentless, Rock Star, Bang [ __ ]. There's no end of energy drinks on the market. Ignoring the Kyle memes, they're also wildly popular with many people: students, gamers, parents, night shift workers. These are commonly drunk drinks. Ironically, not with extreme athletes. I know a handful of at least one-time Red Bull sponsored athletes, and none of them drink it in private, which I think should tell you something.
Now, sugary drinks have a multitude of health risks when consumed regularly, which I'm sure you know all about. If you don't, the one-line summary is that most soft drinks you can buy on the market, not just the fizzy ones, are full of sugar, and it's refined carbs that are extremely bad for you in many ways: primarily things like weight gain, diabetes, heart disease, infections, poor dentition, and so on. Just drink water. I'm happy to be a paid shill for big dihydrogen oxide. But this video isn't about sugar. It's about whether the whole list of ingredients in energy drinks has got risks. Right now, the long-term effects of these drinks are not well known.
21 years old & seriously unwell
A 21-year-old university student and keen gamer, previously entirely well, presented to hospital with four months of shortness of breath on exertion, weight loss, and something called orthopnoea, which is breathlessness when you lie flat. That happens when there's too much fluid on board in the body: when you lie flat, the pressure in the heart and lungs goes up, making breathing harder. The excess fluid was apparent actually from the end of the bed, because his legs had ballooned up with maybe 10 kilograms of additional water in the tissues. Oh, sorry for American viewers: 10 kilograms is the same as 10 septillionths the mass of Neptune.
But why would a 21-year-old man have excess fluid? If a normal person drinks loads of fluid, they'll just pee it out, so it won't accumulate in the body. So normally, that implies something is wrong with the kidneys or the heart, and for this young guy, both were in big trouble. So what was going on? It quickly became apparent this lad was seriously unwell. His creatinine was 562, urea 48, and he required bilateral nephrostomies for urinary obstruction. That sentence translated into English means his kidneys were so rogered that he required tubes inserted through his skin directly into the kidneys to allow them to drain.
This is his heart on admission. With every beat, only nine percent of the blood inside the heart was being ejected forwards. And what's worse, both ventricles, the main pumping chambers, had blood clots inside them, which only happens when cardiac function is so catastrophically bad that blood moves so slowly that it actually clots. Now, I'm sure I don't need to explain that clots in the heart can be fatal because they can dislodge and travel anywhere, causing huge heart attacks or strokes. And indeed, he did suffer strokes, both from the clots but also from his heart just not being able to generate enough pressure to get blood to his brain. So you get something called a hypoperfusion infarct, a stroke caused by a lack of blood. The toxins that had built up due to his kidneys not working had also affected his brain. He was emergently started on dialysis and intensive care, and transferred to a specialist hospital for consideration of combined heart and kidney transplantation.
So this 21-year-old guy was spectacularly unwell. When you're confronted by a case like this, you need to do some House-esque detective work, except maybe not quite like House, because about 90 percent of the tests he sent were completely pointless, and he wastes insane amounts of money. But what House got right is the need for a very careful history. You need to ask more than just the usual questions, like "do you smoke?" and "do you have any medical problems?" It was only when this was done that the answer became clear.
The most common cause of heart failure in developed countries is coronary artery disease, i.e. narrowing of the arteries in the heart caused by cholesterol plaque and so on. But at 21 years old, that's way too young for that. Alcohol is another common cause, but he wasn't a heavy drinker, at least not of alcohol. So then you start thinking about things like myocarditis, viral infections, or inflammatory disorders of the heart, but none of that was found. However, a thorough doctor found out the patient had a bit of an addiction: slamming two liters, or four pints, of Monster a day.
Cardiology conference
Now, you might not know that all cardiologists actually know each other because we all meet up at a big shindig every year. Actually, here's a clip I took in 2019. [Applause] Real shame that the pandemic meant we had to do all that virtually. I've got to say that Zoom really can't capture a good sacrifice.
Interview with case author
Now, when I read this shocking case report using Sci-Hub, of course I realized that I'm friends with the lead author, Andy de Silva, who proves that you can be a super intelligent double doctor and still not know how to position your camera. I started by asking him if energy drink induced heart failure is something common.
It's not common at all. So that was one of the reasons. First of all, it wasn't particularly at the forefront of our minds when we were looking after this gentleman. The history of how much energy drink he was consuming actually came quite a few days into the admission, when we were simply trying to piece together anything unusual in his background or habits. The other thing to say is that the association with energy drink consumption was more something we gained greater confidence in seeing retrospectively. What I mean by that is that at the time we were considering so many other potential contributors that it wasn't clear until we'd essentially ruled out a lot of other more common causes of heart failure in young people.
From my experience of what energy drinks contain, it seems to be a lot of sugar and a lot of caffeine. So are those implicated in the mechanism, or do we even understand the mechanism for why energy drinks can cause this problem?
I don't believe we do. Caffeine is available in lots of different forms and lots of different drinks, and yet it seems not to be implicated in people's heart failures by and large. Whether there is something in the high concentration types, or particular other ingredients, may have something unique that contributes, but this is such a rare phenomenon, as far as I can see from it being described in the literature, that we really don't have a good answer. My suspicion is that there may be some unfortunate individuals who carry a genetic predisposition, where caffeine over a certain threshold, if it is caffeine or some substance in high amounts, may predispose to changes in the heart or structural changes that may be related to over-activation of the sympathetic nervous system, or lots of cyclic AMP signalling and generation in the heart muscle cells that they're unable to handle.
To any 21-year-olds who might be watching who enjoy slamming back a can of Monster or Red Bull, what advice would you have for them?
I'd like them to be aware that these rare cases are out there, and the consequences that have happened to such individuals, like the patient I'm looking after, have been quite serious. So knowing that an excess of intake every day could potentially cause some unlucky individuals serious, life-changing harm would be something worth being aware of. With that said, it seems that by moderating the amount of intake, which is very much like many things in life, the risk of coming to harm would be considerably reduced. So I would put it to them that if there are days of the week when they could have no energy drink at all, or be able to moderate their intake, that would help. Again, we don't know any safe dose, but it doesn't seem like there's any harm so far reported with energy drink consumption of, for example, two cans a day, which might be more appropriate and safer. The other thing is we don't really know if there's any true safe limit, and when I say two cans, which energy drink, which concentration? There's not really a lot of standardization.
Patient perspective
The paper featured something quite nice that you don't normally see, which is the patient's perspective:
"When I was drinking up to four energy drinks per day, I suffered from tremors and heart palpitations, which interfered with my ability to concentrate on daily tasks and my studies at university. I also suffered from severe migraine headaches, which would often occur during the periods when I did not drink energy drink. This also restricted my ability to perform day-to-day tasks and even leisurely activities such as going to the park or taking a walk. I was eventually admitted to the ICU. This experience was extremely traumatizing for several reasons. First, I was suffering from delirium; I had memory problems to such an extent I could not remember why I was in the ICU. Second, I was constantly scared because I was struggling to move or speak. This eventually led to insomnia; I would often not fall asleep until the early morning. Finally, I often became frustrated when I couldn't think of the words to say when I wanted something, and this often led me to becoming overwhelmed with emotions such as anxiety and depression. I think there should be more awareness about energy drinks and the effect of their contents. I believe they're very addictive and far too accessible to young children. I think warning labels similar to smoking should be made to illustrate the potential dangers of the ingredients in energy drinks."
Our patient made a slow recovery and thankfully didn't require kidney or heart transplantation, and he eventually went home two months after being admitted to hospital. He stopped drinking energy drinks, and several months down the line his heart function is normal now.
I don't want to give the impression that energy drinks are inherently bad. Like Andy said, everything in moderation. I don't think you should feel guilty eating any particular food or drinking any drink, except maybe if you stole it. But highly processed food items like these drinks, or anything that's very high in sugar, should be occasional treats, and if that's the case, they're probably no more dangerous than any other carbonated or caffeinated drink. Having said that, this is a counterpart video to one made by my friend Chubby Emu, whose video is about another potential complication of excessive energy drink consumption, so if you want to see that, please head on over to his channel.
Close
As for me, until next time, stay extreme.