People are not wired the same.

Individual differences are the spice of life and medicine. I love people, their verbal discourses, because they are so delightfully individual.

To me, the biggest problem with medicine is something I actually never heard anybody else discuss. I call it “norming.”

Maybe there is no other way to get started on developing a new treatment that could help many people who have similar afflictions.

But people are so different that what is life-saving for one may be poison for another.

This is one reason I love the still embryonic science of pharmacogenomics. Basically this will be a way of looking at someone’s hereditary material (a simple DNA sample with a mouth swab) to see if they are getting the drug that works for them.

Just because something does not fall into a regulatory system simply does not prove it is safe. Consumer watchdogs are good, but you surely can’t depend on them to pick up on everything that is relevant to you, either.

You can read labels, but can you understand them? I check on data about things available over the counter all the time. I just don’t know all this stuff by heart. I don’t think I have ever met another doctor who does, either.

A sixteen year old girl suddenly died of a heart attack, while on vacation with her friends in Mexico.

Is Mamma crazy to tell the New York Daily News that she blamed energy drinks?

Absolutely not.

Me, in my practice, I have had a few patients with bipolar (manic-depressive) illness who had full blown manic attacks after consuming a bunch of them. I even testified for the defense of one who committed murder while “wired” out of his mind on no stronger drug than Mangostein-drink (a weight-loss formula that unfortunately relied on speed-type of effects).

Many, untold numbers who have used what have sounded like small amounts, maybe to stay awake on a long drive or something, and had at least a few symptoms of mania — insomnia, anxiety (sometimes acute attacks), sometimes even feeling superior and trying to do dangerous things like surfing at midnight — not normal even in California – and yes, physical attacks and assaults.

No real studies, but at least somebody else noticed.

I will admit to trying one of these at least once that I can clearly recall, when I was tired and decidedly obese and on a long car trip with my husband. The guy in the convenience store was surprised I bought it and told me he thought only the “young kids” used them. I was not yet caffeine free back then, which could explain why it did nothing for me except make me mildly jittery.

I have heard one of the elder statesmen of psychopharmacology sum up this one eloquently.

“All people really want are on-off switches.”

There is some real truth to this one. From coffee to alcohol, from abusing uppers to abusing downers, with some prescription drugs maybe somewhere in the middle, this is exactly what people would absolutely love. This is exactly what patients have in mind when they ask me for a sounder night’s sleep or more energy for school.

There is some science in this study by the Italian folks. Heart function is affected in healthy subjects by energy drinks.

They certainly have enough caffeine to do this. Using an average of 100 mg. in a standard cup of coffee – not your Starbucks Vente, but an old-fashioned coffee cup — the amount claimed per energy drink seems to be widely variable, perhaps more so since consumer studies suggest you can’t depend on what is written on the label. Caffeine affects so many organ systems that some suggest that if somebody tried to get it past the FDA as a drug today it would be allowed on the market. I remember that for me, taking coffee with my parents in the mornings was a rite of passage I was not permitted to indulge in until I was in college.

I was actually excited when I got my first emergency room job and it was available all day, although that stuff was so weak it was not known to do anything for anyone (except sometimes me). The hard-core addicts sent out for the real stuff.

And YES – I did drink “Army Coffee” and YES – it is as bad as legend has it. I’m sure any branch of the service, and police departments and other such institutions have equally horrid concoctions that they call “coffee” but could probably wither a steel girder. I also did wonders for my own blood pressure much later, when I went caffeine-free. I have treated patients for caffeine addiction, which can simulate a few mental illnesses — usually anxiety disorders.

Some have even suggested regulating it like alcohol. I love — and have used with patients — many amino acid treatments. As a matter of fact, the first time I saw “taurine” on the label of an energy drink I knew it was a possibly helpful adjunct treatment for epilepsy and actually wondered if someone had thrown it into energy drinks to keep people from seizing from everything else that is in those potions.

The truth of the matter is that taurine is wildly plentiful in the brain and may do contradictory things. As far as I can figure, nobody knows terribly much about what it does.

It could well be that when coupled with caffeine, it enhances the stimulant properties of same.

It certainly looks as if energy drinks, at least using them in excess, are not a terribly good idea.

Probably not for children or adolescents. Pediatricians have been instructed to screen for their use.

I’ve even read reports of death in a 14 year old. And of marketing to, addiction in women.

So what the heck is going on?

The key word is “marketing.”

Energy drinks have been marketed as “dietary supplements” and are now moving to “beverages,” where there seems to be less control.


To their credit, the FDA is looking at this. They are “accepting reports.”

At a psychopharacology meeting several years ago, I went on a cruise of Alcatraz Harbor with a bunch of FDA employees. They seemed like decent folks who were simply mired in bureaucracy.

That is exactly how this page reads. Canadians are working on regulations, which may not be strong enough.

What can somebody do?

Precious little.

With marketers playing the game for the big buckeroonies, you simply can’t even think about them voluntarily trying to safeguard your health.

IU indicates why I have to stop rolling my eyes heavenward in frustration when people try to tell me they eat “healthy.” Most of the time they are only eating what marketers tell them is healthy.

The author of the study, interviewed by the Houston Chronicle, suggests the answer is in straightening out of labels.

With government regulations.


I am not impressed by their efficacy to put it mildly.

Maybe we should make label reading in the supermarket a hobby, and give prizes to people who know what they mean.

Me, this is one of the reasons I take longer shopping than my husband. But of course, this has something to do with my interests and passions — not to mention my profession.

I cannot count how many times I have quoted Thomas Jefferson on the importance of an informed populace. “Whenever the people are well-informed, they can be trusted with their own government. Whenever things get so far wrong as to attract their notice, they may be relied on to set them to rights.” –Thomas Jefferson to Richard Price, 1789. Well, it is not happening.

Kids die, no regulations exist to cover this substance.

The only thing I have left to say is be curious and try to know all that you can for that is your best protection and will, I hope, consecrate you to the healthiest life possible.

Author's Bio: 

Estelle Toby Goldstein, MD is a board-certified psychiatrist in private practice in San Diego, CA.

Practicing Medicine Since 1981

In her medical career, she has studied in Europe and Canada as well as the USA. She has attended specialty training beyond medical school in the fields of general surgery, neurology and neurosurgery and psychiatry (specializing in psychopharmacology).

Experienced In Many Situations

She has worked in a variety of positions, including:

Medical school professor
General and Orthopedic surgeon
Brain surgeon
Army Medical Corps psychiatrist
Prison psychiatrist
Community Mental Health Center staff
Consultant to a major transplant hospital
Drug researcher
“Whatever It Takes!”

She currently has her own indepenent clinic in San Diego where she is concentrating on what she calls Mind/Body medicine — or Integrative Medicine. Her practice is cash-only, doesn’t accept insurance or government payments, and she operates on the concierge, or “private doctor” practice model to give her patients the absolute best quality of care and the highest level of confidentiality.

Dr. Goldstein’s philosophy is “Whatever It Takes!” Her goal is to do everything possible to solve whatever problem she is presented. This includes seeing patients as quickly as possible — not making them wait weeks for an appointment. This includes making appointments days, nights, weekends or holidays. This includes making house-calls. And it includes using the best, most innovative treatments available — most of which are unknown to standard, mainstream doctors.

Her focus is on transitioning patients away from prescription drugs and onto natural substances. She is also a master practitioner of Emotional Freedom Technique, a powerful and dynamic form of energy psychology that usually brings quicker results than traditional psychotherapy.