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Hagerstown mother wants FDA to regulate energy drinks

July 22, 2012|By CRYSTAL SCHELLE | crystal.schelle@herald-mail.com
  • Wendy Crossland of Hagerstown stands in front of a photo of her late daughter, Anais Fournier, who died in December 2011 due to caffeine toxicity. Crossland is trying to get the U.S. Food and Drug Administration to recognize energy drinks as beverages instead of a dietary supplement.
By Ric Dugan/Staff Photographer

Wendy Crossland said she's always made it clear to her three kids that energy drinks were off-limits, and most importantly, never allowed in the house.

"All I knew was that it had a lot of caffeine, which isn't good for anybody," she said, sitting in her Hagerstown home.

But Mom can't be everywhere.

Crossland, 38, blames a caffeine energy drink for contributing to the death of her oldest daughter, Anais Fournier, just days before Christmas. Anais had consumed two 24-ounce energy drinks in 23 hours.

Anais, who was a freshman at South Hagerstown High School, died seven months ago at age 14. The official corner's report states that she died due to "cardiac arrhythmia due to caffeine toxicity complicating mitral valve regurgitation in the setting of Ehlers-Danlos Syndrome."

Since Anais' death, Crossland has been trying to convince the U.S. Food and Drug Administration to reclassify energy drinks. The FDA classifies energy drinks as dietary supplements instead of beverages, which are more closely monitored by the FDA.

Crossland has taken her story to anyone who will listen, even taking it to a national platform by appearing on the TV news show "Today" and on Anderson Cooper's talk show — and gaining the support of an Illinois senator — all in hope of saving another teenager's life.



Anais' story 

A bubbly teenager with big eyes and long dark hair, "Snowflake," as her family called her, was an honor roll student. She liked watching movies and hanging out with friends at the mall and at home. Her mom said she was an all-around good teenager.

"We would watch 'Vampire Diaries' every Thursday," Crossland said. "It was our thing."

On the night of Dec. 17, 2011, Crossland was watching a movie in the living room of her home while Anais and her boyfriend were watching a movie in her family room at the top of the stairs.

Crossland said that less than two minutes after she talked to the kids, Anais' boyfriend ran down the stairs saying something was wrong with Anais.

"He said, 'She just exhaled and kind of went limp,'" Crossland said.

Crossland ran upstairs.

"Her eyes were rolling back in her head and she was like a fish out of water," she said.

Anais' heart was still beating, but she didn't have a pulse. By the time they got her on the floor, her heart had stopped. Anais' stepfather started chest compressions and Crossland performed CPR while they were on the phone with 911.

When the EMTs arrived, Crossland said she went downstairs to talk with her daughter's boyfriend who had stayed with her son.

"I said, 'You need to tell me what you guys did tonight,'" Crossland recalls. "Because the only time they were away from me was when they were at the mall."

She said the young couple had gone to see a movie but found out that it was rated R and Anais wasn't old enough to get in.

Crossland said she kept asking Anais' boyfriend what her daughter had taken. "I told him, 'I swear, I won't be mad, we just need to know,'" she said.

He said she had drank a 24-ounce energy drink, Crossland said.

"They were at the mall for one hour and five minutes," she said. "She consumed that can while they were there."

It took about 30 minutes for EMTs to stabilize her before she arrived at Meritus Medical Center, east of Hagerstown. From there, she was flown to Johns Hopkins Medical Center in Baltimore.

Anais was at Hopkins for six days. "She never regained consciousness," Crossland said.

Doctors at Hopkins put Anais into an induced coma to prevent myoclonus, or involuntary muscle jerks. Crossland said doctors were baffled.

An MRI showed that the oxygen had been cut off to her brain but her brain stem was still functioning, Crossland said. And 48 hours later, doctors attempted to bring her out of the coma, but she was experiencing myoclonus.

Every day, Crossland said, she sat beside her daughter's bed and squeezed her hand.

"I said, 'Anais, can you hear me? Can you squeeze my hand?'" Crossland said. "She never responded."

On day five, Crossland was getting ready to return home to Hagerstown and was in the hospital's parking deck when she got the call to return to the hospital. Doctors discovered that Anais was brain dead, but had to wait 24 hours for a second test to confirm their diagnosis.

Crossland said the family made a decision to immediately donate her organs because organ donation was something Anais believed in. It was also a way for her daughter to live on.

"Two people who were blind got her corneas and now they can see," she said. "A man in his 60s, a retired nurse, got her left kidney and her liver. And a single mother in her 40s got her right kidney and her pancreas."



Can caffeine be a killer?

Dr. Charles I. Berul is division chief cardiologist at Children's National Medical Center in Washington, D.C. He is not associated with, nor has he reviewed Anais' case, but he specializes in congenital heart disease and anomalies.

Asked by this reporter about the effects of caffeine, Berul did not address Anais' death, but he did discuss caffeine and how it might affect the body.

"Caffeine is a stimulant," Berul said. "It is legal. It's one of the few legal stimulants in this country — nicotine is another — (and) it's similar to some of the prescription stimulants, like the ADHD medicines ... which are like amphetamines. And it's similar to the illegal stimulants like speed and cocaine that are all sort of derived from the same thing. They have this same effect to stimulate the heart and the brain."

Berul said caffeine can make the heart beat faster and stronger. It affects the brain by making it feel more alert, one reason why prescriptions that contain caffeine are given to teenagers with attention issues.

Caffeine can be found in many plants, including the same plant that is processed to produce cocaine — the coca.

Berul said for thousands of years, dating back to early American Indians and South Americans, people chewed coca leaves "to get the cocaine effect." Today, people drink coffee and caffeinated soft drinks for the same reason.

"Like the saying goes,'Everything's fine in moderation,' but these new drinks that are being marketed toward teenagers have a lot of caffeine in them," he said.

Berul said teenagers might be getting more caffeine than they realize because the amount is not listed on the nutritional information listed on the energy drink cans.

"But in fairness, the caffeine dose is not on a cup of coffee you get either," he said.


Reading the labels can help. For instance, a 24-ounce energy drink has three 8-ounce servings. Berul said consuming some energy drinks that come in larger cans is like drinking several cups of coffee.

"Six cups of coffee is a lot of coffee for a teenager all at once," Berul said. "And (energy drinks) have a lot of other things in them that are unclear (that) they go together, including a lot of sugar, including some amino acids put in there to classify the drinks as nutritional supplements instead of foods."

Berul said he is seeing an increase of admissions of children and teens into Children's National Medical Center's cardiac arrhythmia clinic because of symptoms after drinking energy drinks.

"Symptoms are mostly palpitations where they feel their hearts racing," he said. "In most cases they aren't in any danger, it's just a nuisance."

In the 1980s, Berul said, most of the cases doctors would see were connected to cocaine-related arrhythmia. One famous case is Len Bias, the University of Maryland basketball star who died of a cocaine overdose.

"Caffeine is obviously as not as dangerous as cocaine, but it is the same class of drug," Berul said. "It is a stimulant drug like cocaine but a milder version. But if you take too much of it you get the same toxic effects as a cocaine overdose and that's usually cardiac arrhythmia."

He said studies are showing that it's not an isolated incident to the Washington, D.C., area.

"We're seeing from publications that the emergency rooms are seeing a huge increase in caffeine toxicity in teenagers - most of those aren't dangerous," he said, "Most are kids coming in (who) feel bad. It's not just the energy drinks in teenagers. Teenagers are drinking a lot more coffee drinks that are pretty large and have caffeine in them. It shouldn't just be targeted at the so-called energy drinks because coffee drinks and huge soft drinks also (have a lot of caffeine)."

At the medical center, Berul said some teenagers could be at risk for caffeine toxicity, which he said is an overdose, because they have an underlying susceptibility.

In Anais' case this could be her mitral valve regurgitation along with the Ehlers-Danlos Syndrome.

Crossland said her daughter was diagnosed with Ehlers-Danlos Syndrome during her cardiologist visit a year before she died.

"She had no restrictions to anything. No foods. No activities. No medications. No anything," Crossland said. "The last time he saw her he said there are no changes, so let's see her every two years."

Berul explains that Ehlers-Danlos Syndrome is a connective tissue disorder "where everything's too stretchy." Basically, he said, it's a problem with the elastic properties with the bodies and the skins, joints and heart valves.

"The heart valves are floppy and you get prolapse of the valves where, instead of acting as one-way valves, some blood can go (the wrong) way in the heart and that's called regurgitation," he said. "And because the valves are floppy, we think they trigger some arrhythmias or palpitations. So people with mitral valve prolapse .... or associated with these connective tissue disorders like Ehlers-Danlos —  are at particular susceptibility for having arrhythmia. ... Most of the time in cases like these sort of tragic fatal events, you are adding a combination of a pre-existing susceptibility and then a trigger."

Berul said symptoms of excessive caffeine intake can be palpitations, jitteriness, sweatiness and an increase in blood pressure. Rarely, he said, some people will complain of chest pains but the chest pains are actually a person having a heart attack.

Those who experience some of these symptoms should talk to their doctor, Berul said.

"Those people are particularly susceptible and should be evaluated," he said.



Finding others with the same agenda

In her research, Crossland turned to social media to connect with others whose children had died under similar circumstances.

One person she contacted is Canadian James Shepherd, whose 15-year-old son allegedly died after drinking Red Bull after a paintball tournament. Shepherd has waged a public war against the makers of the drink that he said had been handed out to the players that day.

The Toronto Sun reported that Shepherd urged the House of Commons health committee to strongly regulate advertising of the drinks and further study the caffeine drinks that are classified in Canada as natural health products.

In the U.S., caffeinated energy drinks are designed as dietary supplements.

In 2008, USA Today reported that 100 scientists and physicians wrote to the FDA asking for regulation of energy drinks.

That same year, France ended its 12-year ban on Red Bull.

In 2010, both New York and Kentucky proposed banning energy drinks, but the proposal did not become law. In 2011, the University of New Hampshire also wanted to ban the drinks on campus but students protested and had the drinks returned to campus.

In 2011, the Canadian Medical Association Journal published an editorial stating that "Energy drinks that contain high amounts of caffeine — some more than five times the amount in a can of cola, or nearly double the amount in a cup of brewed coffee — can pose serious health risks to children and adolescents and require stronger warning labels."

Globally, the companies that make energy drinks have been asked to either change their ingredients or the way they are marketed to teens.

This year, the Australia Medical Association called for a ban on the drinks to those younger than 18 years old.

In 2011, the U.S. Substance Abuse and Mental Health Services Administration's Center for Behavioral Health Statistics and Quality, published a report on "emergency department visits involving energy drinks."

The center found that there has been a sharp increase in the number of emergency department visits involving energy drinks between 2005 (1,128 visits) and 2009 (13,114 visits). That is a tenfold increase.

In the center's report, combined data from emergency departments visits from 2004 to 2009 show that half of the energy drink-related visits by those between ages 18 and 25 were for patients who had consumed energy drinks in combination with alcohol or other drugs.

According to Anais' toxicology report, that was not the case.



Tackling a Monster

Monster Energy Co., which produces Monster Energy Drink, is at the center of Crossland's fury because that is the brand that Anais had consumed.

When reached for a comment concerning Anais' death, Monster Energy Co.'s California office had "no comment."

However, the company released a full statement to the talk show "Anderson." The statement can be found at andersoncooper.com/2012/05/28/monster-energy-drink-statement.

In the statement, Monster countered Crossland's accusations.

A portion of the statement said, "As stated in an independent report published in the Journal of Analytical Toxicology, 'caffeine amounts in coffee-based drinks can vary wildly,' and one 16-oz. cup of the leading brewed coffee brand has been shown to contain from 300 to 564 mg. of caffeine, which would be an average of 27 mg. per ounce. By comparison, two 24-oz. cans of Monster (each can contains three servings) contain a total of 480 mg of caffeine, or 10 mg. per ounce. In other words, the average amount of caffeine in a single venti-size cup of the leading brewed coffee exceeds the amount of caffeine in two 24-oz. cans of Monster Energy drinks combined. Additionally, in the case of Monster Energy drinks, the caffeine amount is consistent and controlled."

In its statement Monster went on to question what type of activity Anais was doing prior to her death, whether she had any other caffeine sensitivities, and whether a toxicology screen had been performed.

Crossland said a toxicology screen was performed.

"There wasn't even Tylenol in her blood stream," she said.



Changing laws

The FDA classifies energy drinks as dietary supplements. Beverages such as Coke and Pepsi are actually classified as food and are more closely regulated by the FDA.

In 2009 the FDA released  "Guidance for Industry: Factors that Distinguish Liquid Supplements from Beverages." The guidance doesn't establish any legal enforceability.

In the guidelines, the FDA wanted to help manufacturers and distributors of dietary supplements and beverage determine whether "a liquid product may be labeled and marketed as a dietary supplement."

The FDA noticed a trend in beverages that contain botanical ingredients or extracts, some that are not approved by the administration. The FDA also noticed that certain foods are being added to these drinks and questioned "whether these ingredients are unapproved food additives when used at higher levels."

Crossland wants the FDA to start cracking down on the energy drinks and pay more attention to the ingredients.

To change the laws, Crossland knew she needed a member of Congress to help. She has turned to Sen. Dick Durbin, D-Ill., majority whip of the U.S. Senate, the second-highest ranking senator. She had come across his name several times during her research.

Durbin has long been a proponent of regulating energy drinks. In April he wrote a letter to FDA Commissioner Margaret Hamburg calling for the FDA to clarify the definition of conventional foods and beverages vs. supplements. He also called for the FDA to investigate energy drinks.

The senator has used Anais' story to help in his quest to have caffeinated energy drinks regulated. He appeared before the Senate on May 22, using her story to show that there is a need for tighter restrictions on energy drinks.

"The FDA has the authority to regulate caffeine levels in beverages and to require beverage manufacturers to prove the additives they have put inside that can or bottle are safe," Durbin told the Senate. "But most energy drinks avoid FDA oversight by calling their products dietary supplements."

Durbin told the Senate he wanted to introduce an amendment that "would ensure the FDA knows about all of the energy drinks being sold in the United States and can provide information about ingredients that could help the agency address potential safety concerns."

"I just want them regulated," Crossland said. "The industry is getting by adding just a vitamin to all of that. ... You think that (if) your kid goes into a candy store and buys something, that someone would have checked it out. I did."

The bigger hope is what Durbin told the Senate, "We can help prevent these tragedies by requiring that better information is reported to the FDA when these dietary supplements go on the market."

In the end, regulating the drinks is all Crossland can hope for.

"If they regulate them, they'll be no more dangerous than a soda," she said.





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