The death of a British personal trainer in January of 2021 made the news last month. A security guard who also worked as a father of two young children miscalculated the amount of legally purchased pure caffeine powder that he would add to a beverage by a significant amount. He began clutching his chest and complaining of a rapid heart rate after drinking the concoctions. Within minutes of developing symptoms, he went into cardiac arrest and was not able to be saved despite the efforts of medical professionals on the scene.
A 100 gram container of pure caffeine powder was purchased by the man and he was going to add between 60 and 300 milligrams to his drink, though the amount appears to be an assumption based on typical pre-workout doses. According to several news reports, no scoop was provided by the company to aid in measuring a safe amount of powder. Coroner John Gittins focused a lot on this during an inquest last month.
Mr Gittins added that he has since been “massively reassured” that action has been taken to help prevent similar cases from occurring in the future with this brand of caffeine powder due to the provision of a scoop and an A4 instruction sheet in all new packets. Had these scoops been provided at the time, Mr Mansfield would likely still be alive today, the coroner said in his conclusion.
Coroner Gittins probably shouldn't feel confident in that assertion, but the provision of a measuring scoop and additional warnings along with these products might reduce the chance of accidental fatal overdose. It is a much better option. I will get into the details soon. There is a primer on caffeine toxicity.
I have never been a fan of coffee or tea, but I do consume a lot of it in the form of chocolate and Diet Coke. When I wrote about the dangers of energy drinks in the children's population, I mentioned my use of caffeine pills, which typically contain 200 milligrams of caffeine, when I needed a boost in energy. I avoided coffee on other days in order to prevent the development of tolerance.
I started taking a pill every day because I became more dedicated to running and was logging 6-7 miles most days. I began to have more headaches. I stopped taking the pills prior to workouts and now only get the coffee in my diet as a result of making the connection between my headaches and caffeine withdrawal. I enjoy the boost in endurance I get from taking a caffeine pill prior to a run, but sometimes it's hard to find the time to take it, but I'm happy to make that trade off.
The British personal trainer, Mr. Mansfield, used caffeine for a boost in athletic performance. His goal was likely to be the same as mine, which was to make a drink with about the same amount of caffeine. According to the reports, he used a digital scale to do this. This was the first time he had worked with pure caffeine powder or a digital scale, and it certainly sounds like this was the case.
The endeavor was doomed from the beginning because he used a kitchen scale with a minimum weight capacity of 2 grams, and his goal was around 3% to 15% of 2 grams. The minimum weight capacity is usually round to the nearest gram. The scale he owned was not the kind of scale that was used in small pocket scales. If he used an inappropriate scale, and seriously botching the conversion from grams to milligrams, he could have easily put more caffeine into his drink than he realized.
The news articles that were based on information from the government inquest claimed that he was shooting for 300, but that's just an assumption. Pre-workout supplements can be as high as 500 milligrams. We will never know what really happened because nobody witnessed him preparing the drink. There is no chance that he just dumped some of the powder in his drink.
Coffee, tea, energy drinks, food, and supplements are the most common forms of coffee consumed by most people, which is close to all adults and even older kids. Some people are more sensitive than others and have underlying conditions that put them at risk of adverse effects, but most experts agree that an intake of 2.5 milligrams per kilogram of body weight over a day is unlikely to cause any concerning symptoms in older kids and adults. I'm going to focus on severe toxicity in this post because there is more to this issue than just withdrawal symptoms.
Regardless of the source, caffeine is absorbed quickly in the gastrointestinal tract and acts as a potent antagonist of adenosine in both the peripheral and central nervous system. There are different parts of the body that can have different effects when stimulated with caffeine, and some of them are clinically meaningful. It's role as a central nervous system stimulant is what we tend to care about most.
The longer we go without sleep, the more adenosine builds up in our brain and the more a specific type of adenosine is stimulated in the ventrolateral preoptic area. If the caffeine molecule is plugged up with, you feel more alert until the amount of adenosine overwhelms the blockade or the caffeine is degraded.
There is no evidence to support the idea that using a lot of caffeine leads to dependence or abuse, but tolerance does develop, and many people will experience withdrawal symptoms if they have been consuming at least 100 milligrams a day for at least a few days. withdrawal can involve fatigue, decreased alertness, drowsiness, depressed mood, and irritability, and headaches is the most common symptom. In people who consume large daily doses of caffeine it can feel like the flu, and withdrawal can occur within 24 hours.
A number of potential adverse effects can be experienced when someone consumes large amounts of caffeine, depending on things like size, tolerance, and genetics. As has been experienced by Mr. Mansfield, heart palpitations, tremors, and an upset stomach are common complaints. Alterations in the hearts rhythm can result in cardiac arrest, hallucinations, and seizures, if more severe toxicity is present. Death can happen.
When someone has eaten around 1.2 grams in a short period of time, more serious toxic effects, such as seizures, are more likely to be seen. According to a review of toxicology reports, fatal overdoses tend to involve much larger amounts of caffeine.
In cases of overdose, often intentional but sometimes undetermined and unintentional, at least 5 g or more (i.e., often around 10 g but up to 50 g) have been ingested leading to fatalities particularly if the individuals are not treated in time or at all. However, doses up to 50 g have also been treated successfully otherwise. Some have indicated that after a dose of around 1 g, toxic symptoms begin to manifest, a dose of 2 g requires hospitalization, while higher doses (e.g., typically 5 g or more) could be lethal. However, some have determined that as little as 3 g could be lethal under certain circumstances.
We don't know if he had any underlying health problems that made him at higher risk of cardiac arrest from a caffeine overdose, or if he was taking additional medications or supplements that raised the chance of an adverse reaction. We don't know if his metabolism was impacted by genetic factors that increased or decreased the effect of caffeine on his body. It was estimated that he consumed so much caffeine in a matter of minutes that nothing mattered.
This conclusion is based on the finding of a high level of caffeine in a post-mortem analysis. A regular 8 ounce cup of coffee drunk in a short period of time would raise a typical adult's blood level of caffeine by about 2 to 4 milligrams per liter. The equivalent of anywhere from 98 to 196 cups of coffee was consumed by Mansfield. A cup of coffee can contain anywhere from 70 to 140 milligrams of caffeine. He took a minimum of almost 7 grams of caffeine using the lower figure, which could easily have killed him. The upper limit of cups and caffeine per cup could be used to calculate the amount of caffeine that Mansfield drank.
In my review of British food and drug regulations, it was clear that there are no laws that prevent the sale of pure caffeine in bulk quantities. There is no law that says what kind of measuring aids should be included with these products. The manufacturer has announced that it now provides a measuring scoop and more detailed information on how to measure a safe dose and the risk of overdose. This isn't enough.
Most kitchens don't have a standard measuring scoop or spoon that can accurately measure amounts as small as 60 or 300 milligrams. It sounds like a reasonable safety measure to give a small scoop of pure caffeine. Below is a 100 milligram scoop placed next to a dime for scale to give you an idea of how small these scoops are.
If accompanied by clear warning labels, use of a scoop such as this might reduce the risk of extreme overdose. If he found himself putting tens or hundreds of scoops on to his scale, he would have realized something was off, which would require him to reach 7 to 28 grams of powder. There could be a false sense of security when it comes to less severe overdoses if a consumer uses a heaping scoop or packs the powder into each scoop, which could inadvertently add hundreds of extra milligrams of caffeine depending on the desired amount. A scale that can accommodate such small amounts wouldn't protect against conversion errors.
The solution to this problem is to stop the sale of pure caffeine. It's too risky to rely on measuring out small amounts at home. This problem could be solved by selling a small amount of caffeine powder or liquid in individual containers for adding to drinks, or by making a small amount of caffeine tablets that can be dissolved in liquid. Is it really necessary to add caffeine to a homemade drink?
This post is an update to a post by Scott Gavura in 2015, where he discussed two fatal cases of caffeine overdose and blamed the United States for weak regulations. The FDA only issued warnings about the dangers of pure caffeine powder being sold in bulk for consumer use. Scott predicted that there would be more deaths.
No recalls, or “stop sales” orders. Just a warning to consumers…As long as we maintain a regulatory double-standard for supplements and “natural” products, there is not likely to be much change, and we can probably expect more people to die from caffeine powder overdoses.
As I finish this post, I have some good news. The FDA has done more than warn the public about the risk of overdose. They went after companies that sold pure caffeine products and gave them 15 days to stop or face consequences. The decision to consider these products to be adulterated under section 402(f)(1)(A) of the Federal Food, Drug, and Cosmetic Act is what led to the change in approach.
(f)Dietary supplement or ingredient: safety
(1) If it is a dietary supplement or contains a dietary ingredient that –
(A) presents a significant or unreasonable risk of illness or injury under-
(i)conditions of use recommended or suggested in labeling, or
(ii)if no conditions of use are suggested or recommended in the labeling, under ordinary conditions of use;
Pure caffeine powder will not be sold to individual consumers in the United States, and their websites contain warnings such as this.
Warning: Owing to the risk of personal HARM, INJURY, or DEATH with the use or misuse of Pure Caffeine Powder sales are limited to qualified commercial, scientific and business buyers only. Sales to the general public are not allowed. To be considered for approval submit the form below with documents, or if previously approved log into your account to purchase.
The risk of overdose in the United States isn't completely removed. I wouldn't trust the guy behind the counter making me a smoothie if he didn't know how to use scales and scoops, though a business would be more likely to use appropriate scales and scoops. We all know how it goes in the supplement industry. There will always be unscrupulous companies willing to take a chance for profit, and there are still plenty of products that are not as risky as a homemade drink made with added pure caffeine powder, which can result in overdose. We have moved in the right direction.
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