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Energy Drinks Being Investigated in the U.S. by FDA

Energy drink cans. (iStockphoto/Thinkstock)
Energy drink cans. (iStockphoto/Thinkstock)

Being tired is a universal complaint. We are always looking for a quick fix to energize us. Then there are energy drinks. When you see them being advertised on TV, you are really tempted to buy one. This is how the energy drink market has become a multibillion dollar industry. Sales of energy drinks in the United States grew an estimated 16 per cent last year to $8.9 billion, a record level, according to Beverage Digest, a trade publication.

For example, 5-Hour Energy drink is supposed to provide you with immediate boost in your energy level. The drink has no sugar and only four calories. So, where does the energy boosting ingredient come from? It is caffeine. But the company does not tell us how much caffeine is in the drink.

Rockstar Energy, 5-Hour Energy and Monster Energy are marketed as dietary supplements. Other energy drinks like Red Bull, NOS and AMP are marketed as beverages. There isn’t a mandatory reporting requirement for beverages to let you know how much caffeine is in the product, though makers can do so voluntarily.

Now the Food and Drug Administration (FDA) is looking into it. On November 16, 2012 NBC news reported, “The federal government and the New York Attorney General’s office have announced that they are investigating the popular energy drink after the Food and Drug Administration received claims that 5-Hour Energy has over the past four years led to 13 deaths and 33 hospitalizations.”

The FDA has received 92 reports over four years that cite illnesses, hospitalizations and deaths after consumption of 5-Hour Energy. The FDA is also looking into highly caffeinated Monster Energy Drink. The FDA has received reports that Monster Energy Drink may be responsible for five deaths and one nonfatal heart attack. The FDA warns that this is just a preliminary investigation as direct effect of deaths to these drinks has not been established so far. The agency is cautioning consumers that these “energy shots” or “energy drinks” are not alternatives to rest or sleep.

In 2010, makers of caffeinated alcoholic drinks took those products off the market after the FDA sent the companies warning letters saying that combinations of caffeine and alcohol in the drinks was a public health concern and could lead to alcohol poisoning, car accidents and assaults, says NBC news.

The New York Times first reported that 13 deaths were linked to 5-Hour Energy. Since 2009, 5-Hour Energy has been mentioned in some 90 filings with the FDA, including more than 30 that involved serious or life-threatening injuries like heart attacks, convulsions and, in one case, a spontaneous abortion.

We do not know how much caffeine is in Monster Energy and 5-Hour Energy. But a recent article published by Consumer Reports placed that level at about 215 milligrams, says the Times report. An eight-ounce cup of coffee, depending on how it is made, can contain from 100 to 150 milligrams of caffeine. Maximum amount of caffeine you can consume safely a day depends on how sensitive your body is to caffeine. Caffeine is a drug. Use it carefully. Instead of being energized, you may be dead resting for ever.

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Criteria for Determining a Vasectomy has Succeeded

Portrait of a doctor or nurse. (iStockphoto/Thinkstock)
Portrait of a doctor or nurse. (iStockphoto/Thinkstock)

No-scalpel vasectomy procedure became popular in North America after U.S. surgeons went to China and learned the technique. The procedure is simple with a low complication rate. Infection and scrotal bleeding occur in four to 22 per cent of patients, chronic scrotal pain in two to five per cent, and failure to achieve sterilization in 0.03 to 12 per cent.

Vasectomy is one of the oldest and most commonly performed surgical procedures worldwide. However, there is no general agreement on the best approach to ensure contraceptive success. Surgeons differ significantly in their use of cautery, clips, ties and fascial interposition (position of outer tissue between the two ends of the divided vas). One international multicenter trial in 2004, of vasectomy with and without fascial interposition, demonstrated a twofold reduction of failure with the use of fascial interposition.

The American Urological Association, Inc. (AUA) recommends physicians not consider pathology confirmation of the vas deferens as a measurement of success. The finding of no sperm after vasectomy is the standard of success (2003). The AUA says the persistence of sperm in the semen after vasectomy is a surgical failure, regardless of a pathology report stating both vas deferens were removed.

Semen analysis after vasectomy is required to establish sterilization. Patient should deliver the specimen to the laboratory within one hour of collection. The general consensus in medical literature is one semen specimen three months after surgery should be analysed to confirm success. This protocol varies widely. Several studies document decreased patient compliance with each additional test.

An article in the Journal of the Royal Society of Medicine (2001) states post-vasectomy sterilization is confirmed by semen analysis, but the disappearance of sperm from the semen can be slow. Age and frequency of ejaculation influence the time to achieve complete disappearance of sperm from the semen. The authors state some patients will have small numbers of non-motile sperm in their semen for months or years after vasectomy. The authors go on to report that no pregnancies have been reported in the partners of these men. Many surgeons advise their patients that alternative contraception can be safely discontinued at this stage.

A Dutch study published in 2005, based on guidelines issued by Dutch Urological Association, says patients can stop using contraception at three months if their first semen analysis has no sperm or if less than 100,000 non-motile sperms are present. Researchers found 51 per cent of the samples contained no sperm and 45 per cent contained less than 100,000 non-moving sperms. Follow-up at least one year later showed none of these men, 96 per cent, reported getting a woman pregnant.

If there are motile sperms present six months after a vasectomy, repeat surgery is considered. When counseling a patient regarding the potential risks and benefits of a vasectomy, it is important to emphasize that a vasectomy can fail early or late. Late failure happens less often.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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Magic of Maui – Seven Days Not Enough

Sunrise above the clouds at Haleakala National Park. (iStockphoto/Thinkstock)
Sunrise above the clouds at Haleakala National Park. (iStockphoto/Thinkstock)

The most memorable day was spent at the Haleakala volcano summit (10,000 ft) to watch the most beautiful sunrise.
The most memorable day was spent at the Haleakala volcano summit (10,000 ft) to watch the most beautiful sunrise.

After watching the sunrise from the volcano crater at 10,000 ft. Alia (pink jacket), Hussein (yellow jacket) and the rest of the group get ready to bike down the mountain on Volcano Chrome Cruiser Bikes.
After watching the sunrise from the volcano crater at 10,000 ft. Alia (pink jacket), Hussein (yellow jacket) and the rest of the group get ready to bike down the mountain on Volcano Chrome Cruiser Bikes.

The bikers riding down the mountain road under the watchful eyes of Sabiya and Noorali in the van - drinking coffee and taking pictures.
The bikers riding down the mountain road under the watchful eyes of Sabiya and Noorali in the van – drinking coffee and taking pictures.

We were back at the the Ka’anapali Beach Hotel to soak in the sunset.
We were back at the the Ka’anapali Beach Hotel to soak in the sunset.

Then to the magic show: left to right -- Noorali, Sabiya, Alia and Hussein “performing” magic.
Then to the magic show: left to right — Noorali, Sabiya, Alia and Hussein “performing” magic.

Taking a holiday is a wonderful thing. It takes a while to organize one but once you get there, you are glad you made it. That is how my family and I felt when we arrived at mid-night at our hotel in Maui, Hawaii.

We stayed at Ka’anapali Beach Hotel (Hawaii’s most Hawaiian hotel). We had our rooms facing the beach. The sunset every evening was breathtaking. One can sit on the balcony all day to observe the interaction between humans, their pets and nature – sun, sand, water, waves, breeze and fluttering palm trees.

The location of the hotel also provided an opportunity for long walks on the beach, with the presence of multiple shops and other hotels and restaurants meant you could just stay on the beach and get everything you wanted right there. This allowed my daughter, Alia, to continue with her early morning jogs and workouts while we were still in bed.

We decided to take it easy on the first day to recover from the long journey. We spent our time at the beach, the swimming pool and the local village shops. We had lunch at Leilani’s on the Beach where they serve you a giant “killer” Hula pie as desert for free! In the evening, we had dinner at the hotel’s Tiki Terrace restaurant where Hula dancers entertained us.

Other activities during the week included parasailing, zipline adventures from a base camp at 1,600 ft. elevation, and Kupanaha Magic Show Dinner Theater at the hotel. One evening was spent at Maui Theatre watching a show called Ulalena. The show takes you through the same journey as the Hawaiian people – from the creation of the islands to the early island explorers. Through their special effects you will visit volcanoes, vast oceans and primeval rain forests while meeting the Gods who rule each location.

The most memorable day was spent at the Haleakala volcano summit to watch the most beautiful sunrise and then bike 28 miles downhill. Early Hawaiians applied the name Haleakalā (“house of the sun”) to the general mountain. The tallest peak of Haleakalā is at 10,023 feet (3,055 m). The drive to the summit is a two-lane highway containing many blind turns and very steep drop-offs. It takes about two to three hours to drive to the summit if you have no fear of heights.

We decided to go by van as part of a guided tour. Pick-up time was at 2:30 a.m. at our hotel. A continental breakfast was provided before we started the journey. At the summit, it is cold (about zero degree Celsius) and windy. We were provided with warm overalls. Sometimes it rains and the clouds distort the view of the sunrise. We were lucky. No rain and the sunrise was beautiful. There were lots of people. After you have taken pictures it is time to leave.

If you have the stomach to drive by yourself then you can stay as long as you want, hike around and visit the rest of the park. If you have a fear of heights or want to enjoy the view and let somebody else drive then take a guided tour. As the morning broke, we drove downhill about half way. Then we were given Volcano Chrome Cruiser Bikes and helmets. Hussein and Alia biked with the rest of the group while Sabiya and I took photos from the van.

One thing we didn’t do is the famous Hana Highway drive. We had done it 15 years ago and had no desire to do that again as there was no time. We did visit Maui’s Winery, hiked the Maui Rain Forests and Waterfalls and spent an evening to have dinner and a show at Old Lahaina Luau. Our most memorable dining was at the secluded Mama’s Fish House and at Sansei Seafood Restaurant and Sushi Bar.

There was so much more to do but as always, “Hopefully, next time.”

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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Sarcopenia Among Seniors can be Prevented

A senior doing push-ups at a gym. (iStockphoto/Thinkstock)
A senior doing push-ups at a gym. (iStockphoto/Thinkstock)

Sarcopenia is not a disease. But it may kill you. It makes you frail because there is incremental loss of strength, increasing the risk of hospitalization and death. Sarcopenia is a Greek word which means “poverty of flesh.” It is part of aging. The skeletal muscles degenerate 0.5 to one per cent per year after the age of 25. Older adults lose about three per cent of their lean body mass each decade.

In the United States, an estimated 53 percent of men and 43 percent of women over 80 are sarcopenic, says an article in the New York Times.

The European Working Group on Sarcopenia in Older People (EWGSOP) says that for the diagnosis of sarcopenia, there should be presence of low muscle mass and low muscle function (strength or performance). The exact reason for sarcopenia is not known. Lack of exercise increases the likelihood of sarcopenia. Muscle fibres are replaced with fat and there is an increase in fibrous tissue – akin to scar tissue.

As the aging process keeps marching on, there is a tendency to be less physically active. That should be avoided if you want your muscles to maintain bulk and strength. Studies have shown exercise in the very old can increase strength and muscle function and improve balance. This will reduce the risk of falling and breaking bones. Your capacity to live independently will increase.

It has been shown sarcopenia is an important independent predictor of disability, linked to poor balance, gait speed, falls, and fractures. Sarcopenia is very similar to osteoporosis where there is loss of bone caused by inactivity. Osteoporosis can be prevented with regular exercise just like sarcopenia. Combination of sarcopenia and osteoporosis in old age causes significant frailty and risk of falling.

There are two ways to prevent and treat sarcopenia. One is regular exercise and second one is intake of adequate amount of dietary protein.

Regular exercise increases the ability and capacity of skeletal muscle to synthesize proteins in response to short term resistance exercise. Thirty minutes of walking three times a week and light resistance exercise three times a week can do wonders for physical strength in frail individuals. For an elderly person who is not able to lift light weights, should try water aerobics.

Having a good high protein diet is important. In the elderly, it should be more than the amount recommended to prevent deficiency disease, says the Times article quoting one of the experts interviewed by the paper. For older adults, four ounces of fish, chicken or turkey a day, and an additional protein snack in the afternoons to combat a dip in energy will help. Also include vegetarian protein sources like soy or quinoa, to provide variety without dietary fat, says the expert.

Other strategies include: use of testosterone or anabolic steroids, agents such as DHEA and human growth hormone, selective androgen receptor modulators (SARMs), and the fatty acids EPA and DHA contribute to increased muscle strength. Some of these treatments have side effects and some have not proven to be of benefit. So, high protein intake (if there is no kidney disease) and regular exercise to build strength remains the main therapy to prevent and treat sarcopenia.

Remember, November is Seniors’ Falls Prevention Month.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!