Logan Stiner, an 18-year-old star high school wrestler in LaGrange, Ohio, died from a caffeine powder overdose in May 2014, according to the local medical examiner, as reported by the Elyria Chronicle Telegram. His overdose death from such a commonly used product as caffeine prompted a warning from the U.S. Food and Drug Administration: Consumers should avoid using pure powdered caffeine products for any reason because they can be dangerous, even deadly. After Stiner’s death, the FDA said in an email that they are “awaiting a final report from the coroner to confirm the amount of caffeine found in the bloodstream,” and that they may take further action to protect consumers. Unfortunately, the FDA warning about toxic caffeine overdoses may get lost among online marketing pitches for powdered caffeine. This form of caffeine is legal and easy to buy in bulk. As one manufacturer touts it, caffeine is the “oldest and best known stimulant in the world." You can buy it for $15 per pound from a number of online companies. It’s true that makers of powdered caffeine products often note the danger of abuse and caution customers not to inhale the powder. But the allure of a legal, cheap stimulant may be particularly attractive to young people, with the promise of boosting athletic performance and improving mood. But the price can be high for your heart.
Heart-Stopping Effects of Powdered Caffeine
“Patients with caffeine overdose — I have seen more than a few — often complain of their hearts racing or pounding in their chests,” says William T. Abraham, MD, Everyday Health columnist and the director of the division of cardiovascular medicine at the Ohio State University in Columbus. “When extreme, this can turn into an abnormal and sometimes life-threatening heart arrhythmia that essentially ‘stops’ the heart,” adds Dr. Abraham. Caffeine does this by causing the body to release a burst of adrenaline. “Caffeine also blocks a key enzyme in heart cells that modulates the effect of adrenaline on the heart,” explains Abraham. With symptoms like tachycardia — a faster heart rate — each heartbeat also comes with increased force. The amount of pure, powdered caffeine that would be toxic for an adult varies depending on the person’s health, age, and size, notes Christopher P. Holstege, MD, chief of the division of medical toxicology at the University of Virginia School of Medicine in Charlottesville. “Death has occurred after ingestion of 6.5 grams in an adult,” Dr. Holstege says. “Considering I just bought a pill-bottle sized container of pure caffeine containing 100 grams, it would not be difficult for someone to become toxic and potentially die from ingesting pure caffeine.”
Death by Caffeine
Well before the FDA became concerned about caffeine powders, there were problems with highly caffeinated drinks. In 2010, caffeinated drinks containing alcohol had to be taken off the market because of the health risks. Coffee and tea are the old standbys when it comes to caffeinated beverages, containing 40 milligrams (mg) to 150 mg per 5-ounce (oz) serving. Sodas have varying levels. Coke Classic has 23 mg in a 12 oz drink, while the same amount of Jolt Cola has 100 mg, according to the FDA. Energy drinks or “shots,” such as Red Bull and Monster, have about 80 to 90 mg of caffeine in 8 oz. At the top of the caffeine content list, 5-hour Energy Extra Strength has 242 mg in only 2 oz., according to a Consumer Reports investigation; however, the caffeine content is not disclosed on the product. Wrongful death suits filed in recent years have highlighted the dangers of even nonalcoholic caffeinated drinks. The family of Cory Terry, a Brooklyn, N.Y., man who died in 2011 at only 33 years of age, sued Red Bull for $85 milllion for wrongful death. Terry died while playing basketball shortly after drinking a Red Bull. Anais Fornier of Hagerstown, Md., was only 14 when she died from a heart attack after drinking two Monster Energy drinks. Her family also filed a wrongful death suit against Monster Beverage Corp.
An Evolving Market for Caffeine Products
The list of drinks and other products containing caffeine continues to grow. They range from items like Jolt gum, which claims to have the “energy boost of an energy drink” in two pieces of gum, to candies like Foosh energy mints. They’re advertised as the “world’s most caffeinated confectionary products," though the actual caffeine content is not disclosed. Another newer caffeinated product is Sheets dissolvable strips — which the manufacturer says contains 50 mg of the stimulant per sheet. To date, nutrition facts panels don’t have to reveal the amount of caffeine in a product because it is not a nutrient as required by the FDA. Caffeine powders bring a whole new category of risk, because even tiny amounts of powdered pure caffeine can be lethal. “These products may carry minimal or insufficient labeling, and consumers may not be aware that small amounts can cause an overdose,” said the FDA in an email. “The difference between a safe amount and a lethal dose of caffeine in these powdered products is very small. Furthermore, safe quantities of these products can be nearly impossible to measure with common kitchen measuring tools. Volume measures, such as teaspoons, are not precise enough to calculate how many milligrams of caffeine are in the dose,” the FDA noted. To measure a safe dose, you must use a micro scale. The amount of pure powdered caffeine that is equivalent to that in one cup of coffee is only 1/32 of a teaspoon. A clinical review of evidence on the effects of caffeine found that up to 400 mg of caffeine a day — about four cups of coffee — won’t have health risks for most. But that really depends on the person. Effects of caffeine depend on your gender, age, and health condition. Women should limit caffeine to 300 mg a day during their reproductive years, say researchers at the Bureau of Chemical Safety, in Ottawa, Canada. And caffeine should not even be in childhood and adolescent diets, according to an American Academy of Pediatrics clinical report.
Use, Misuse, and Abuse
Stiner’s is not the only documented case of pure caffeine powder toxicity. Overdose from caffeine powder caused tachycardia, seizure, and ventricular fibrillation in a 27-year-old woman, as reported in British Medical Journal Case Reports in 2013. The patient was a woman who had overdosed on drugs before and suffered from depression. She survived with serious heart and lung complications after hospital workers filtered her blood and restarted her heart repeatedly with CPR. Evidence that caffeine can be extremely toxic comes from other rare case reports, as well. At only 31, a man intentionally took his life by overdosing on caffeine, reported Forensic Science, Medicine, and Pathology in April 1014. Levels of caffeine in his blood were 179 mg/liter. In two additional cases, medical reports cited fatalities from caffeine overdose with even higher levels, over 500 mg/L of caffeine in the blood. While caffeine may not be suspected at the time of heart-related deaths and is rarely measured, at least in these cases, the concentrations were fatal. Holstege says that he has seen cases of caffeine toxicity in his own practice as recently as this year. In an extreme case he reported in 2003, a woman ate about 50 gm of caffeine in a massive overdose suicide attempt, taking 250 tablets of 200 mg each. She had multiple organ failure, but survived after emergency treatment from Holstege and his team. RELATED: This Is Your Heart on Energy Drinks
What to Do if You Suspect a Caffeine Overdose
Caffeine is a drug, not just a food ingredient or a supplement, says the FDA’s recent advisory to consumers. You can get used to consuming certain levels of it, and you may go through withdrawal when you give it up. You can overdose and, as medical examiners’ reports continue to show, too much caffeine can kill you. “Clinically, caffeine intoxication is associated with nausea, vomiting, low blood pressure, mental status changes such as confusion and agitation, cardiac dysrhythmias, and seizures,” says Holstege. Watch out for these symptoms of a caffeine overdose:
Rapid heartbeatErratic heartbeatSeizureVomitingDiarrheaStupor
If you or someone else is having a bad reaction to caffeine, get medical care at once by calling 9-1-1, or contact a poison control center by calling 1-800-222-1222. The FDA is collecting information about experiences consumers have had with powdered pure caffeine. You can report adverse events:
Call the FDA at 240-402-2405Email CAERS@cfsan.fda.gov
