Liquid Lightning Bolts: Energy Beverages, The Promises, Hype and Truth

If your car were making noises or running slowly you could go to a trusted mechanic and have it repaired properly so it would run well for a long time.  However, you could also go to the auto-parts store and spend $19.99 on a product with a name like "Octane-Insane Booster", pour it into your gas tank and see if it solves your problem.  You would probably find that you had wasted 20 bucks and decide to get and oil change and a tune up. 

If your body feels tired and is moving slowly, you can rest, eat well, take care of yourself properly, or there are cans and bottles of products that promise to rev you up and keep you fully functional even though your body is clearly telling you that you need rest and care. 

Let's review some of these products. 

Sport drinks like Gatorade and Powerade are marketed primarily as products that rehydrate.  They suggest that they replace carbohydrates, electrolytes, as well as missing water.  They do not suggest that the user will not need to sleep or will have more energy other than feeling better for being hydrated. 

True energy drinks like "Red Bull", "Rockstar", "Monster", "Full Throttle", and "5 Hour Energy" all derive their energy delivery from caffeine.  With the exception of "5 Hour Energy" there is also a significant amount of carbohydrate.  That means the "energy" is a sugar rush and a "sugar rush" tends to have a quick onset, last a short time and then end with a dull, slow feeling. 

Each of the energy drinks add 10 - 20 dietary supplements in form of vitamins and herbs with unproven effects.  Some of the ingredients could cause dehydration which could be detrimental to someone participating in athletic or heavy physical activity.  There is no clearly stated advantage to most of these ingredients other than a vague "energy" claim without any data to support the claims.  

Energy drinks are probably not significantly dangerous, but it is probably better to work toward getting adequate rest, addressing sleep problems and then forcing alerness won't be necessary. 



Darius Zoroufy, M.D.



Reference: 
Higgins, John P, et al, "Energy Beverages:  Content and Safety", Mayo Clin Proc, Nov 2010; 85(11)1033-1041.

Sleep Apnea is Associated with Heart Disease in Large University of Wisconsin Study

When a study follows a particular demographic or statistical group, that study can be considered a cohort study. One carefully followed group is the Wisconsin Sleep Cohort. The Department of Medicine, and the University of Wisconsin has been following this cohort for over 20 years. I was fortunate to attend my residency at the University of Wisconsin and to meet some of the researchers who are still actively involved in this project.

[“Sleep Disordered Breathing and Mortality: Eighteen-Year Follow-up of the Wisconsin Sleep Cohort”, Young, Terry PhD, et al., Department of Population Health Sciences and Department of Medicine, University of Wisconsin-Madison, Madison, WI. SLEEP, Vol 31, No. 8, 2008.]

When the researchers wrote their 18^th year report and released it to SLEEP Journal it was released for expedited publication. The cohort sample includes 1522 adults assessed at baseline for sleep disordered breathing/sleep apnea and stratified as mild, moderate, and severe sleep apnea. All-cause mortality risk was adjusted for confounding factors such as age, gender, weight (body mass index), other disease states, etc that could have affected the results.

The researchers found startling results. People with severe untreated sleep apnea had a 3.8 times greater chance of dying than the baseline population without sleep apnea. They also had a 5.2 times greater chance of dying of cardiovascular disease. These people did not necessarily have current cardiovascular disease or other cardiovascular risk factors.

Moderate sleep apnea conveyed an overall 1.7 times greater risk. Mild sleep apnea conveyed a 1.4 times greater risk.

These findings were significant and were consistent with other important studies like the Sleep Heart Health Study.

Patients at the Swedish Sleep Medicine Associates Clinics get a thorough evaluation. If they are found to have sleep apnea they are advised to get treatment and to consistently adhere to their treatment plan in order to eliminate symptoms of sleep apnea such as daytime sleepiness, snoring, loss of mental acuity. They are also told that treating sleep apnea also has the critically important role of reducing cardiovascular risk.

Darius Zoroufy

Children with Sleep Apnea have Higher Blood Pressures

Many of you have already learned about increased cardiovascular disease risk markers in patients with uncontrolled sleep apnea. When I speak with patients, they often seem to take on an opinion that the cardiovascular risk issues are have more to do with older adults and people who already have significant heart disease. Patients in their 20’s, 30’s, 40’s and even 50’s sometimes seem disinterested in the cardiac effects of sleep disordered breathing, as if they are too young to be affected by sleep related breathing affects on the heart.

In the article by Marilisa Montesano, M.D. and her colleagues at The Pediatric Department “La Sapienza” University, Il Faculty, Medicine, Rome, Italy in SLEEP (Vol 33, No. 10, Oct. 1, 2010, pp. 1349-1355.) In the study children ages 7 – 14 underwent overnight sleep studies. 18 had obstructive sleep apnea and 25 were in the control group.

The investigative group did many sophisticated analyses leading to many surprising results. One of the most significant was that children have markedly greater blood pressure if they have sleep apnea compared to those who do not.

	Obstructive Sleep Apnea Group	Control Group
Systolic Blood Pressure	111.7 mm Hg	100.5 mmHg
Diastolic Blood Pressure	64.7 mm Hg	57.7 mmHg
Heart Rate	77.0/min	67.5/min
Apnea/Hypopnea Index	5.3/hour	0.3/hour

Statistical analysis showed a clear and direct relationship between the AHI (Apnea-Hypopnea Index: the number of apneas and hypopneas per hour) and cardiovascular parameters in these children.

It is evident that there are already cardiovascular changes in children who are suffering from obstructive sleep apnea. We must take the cardiovascular effects of sleep apnea very seriously in every sleep apnea patient and make sure we are fully managing sleep apnea in every single patient to the best of our ability.

Darius Zoroufy, M.D.

Late Night is Better for Rest and Less Effective for Work

Many studies have demonstrated that sleep quality has a close relationship with memory and mental performance. In fact, many of us have recognized in our own lives that our memory and recall are not as sharp when we are sleep deprived compared to times when we are well rested. In this month’s journal SLEEP (Vol 33, No. 10, Oct. 1, 2010) another study and associated editorial were published on this very subject. (“A Time for Learning and a Time for Sleep: The Effect of Sleep Deprivation on Contextual Fear Conditioning at Different times of the Day” Roeline Hagewoud, et al, pp 1315-1322)

This study showed that rats demonstrated reduced learning when allowed to sleep less following a learning stimulus when compared with rats which had the opportunity to sleep amounts consistent with the normal rat sleep cycle. The researchers concluded that not only was the amount of sleep deprivation a significant factor, but the timing of sleep deprivation (deprived during normal sleep hours) that affected learning and the consolidation of memories. It appears that each stage of sleep may have a layering effect in the production of long term, integrated memories.

A corollary of the study is that late night work is not nearly as productive as we tend to think it is. It is far better to put work away at bedtime, get adequate, restorative sleep and start fresh in the morning.

The age-old question “How much sleep do I need may be a much more complicated question that it initially seems but the answer definitely requires getting a full night of sleep on a consistent schedule. Adults should be getting to bed by 10-11 p.m. and sleeping 8 hours. Children have varying sleep schedule requirements depending on their ages. However, essentially all children should be in bed going to sleep at least by 9 p.m. and most school aged children should be getting 9-10 hours of sleep/night. If you or the children are too tired to wake up easily, you are probably not getting enough sleep.

Sleep well and have a good day.

Darius Zoroufy, M.D.