Caffeine is the most important drug that no one is willing to label. Across its forms–whether coffee, tea, coke, or energy drinks–93% of Americans report regular caffeine use. Abdul reflects on caffeine’s highs and lows. Then he sits down with Murray Carpenter, journalist and author of “Caffeinated: How our Daily Habit Helps, Hurts, and Hooks Us.”

TRANSCRIPT

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Dr. Abdul El-Sayed, narrating: A highly deadly strain of H5N1 bird flu that’s caused egg prices to skyrocket is now jumping into mammals, though not humans yet. The Department of Health and Human Services estimated that up to 15 million Americans currently covered on Medicaid could lose their health coverage in May. A devastating earthquake hits Turkey and Syria. The death toll has already surpassed 23,000 people. This is America Dissected. I’m your host, Dr. Abdul El-Sayed. [music break] Y’all. I try to bring you my best every week. I really do. But today. Well, today just ain’t it. Do you know why? It’s because I haven’t had my daily fix of the substance that is our subject of the day. Let me explain. I have quite the caffeine habit. Never touched the stuff through college. I always thought it would mess with my sleep. But in graduate school, a friend of mine introduced me to the expansive world of craft coffee. And I know everyone says this, but I really do drink it for the taste. Really. My drink of choice. It’s an iced latte, oh so slightly sweetened with honey, into which I usually pull four shots of espresso. I mix that honey espresso slurry into about six ounces of oat milk, and then I add a bit of ice. The espresso is the foundation, the base note, if you will, with the honey sweet that rounds the nutty treble. It’s harmonic. But I usually just start the day with a double shot of espresso. Neat. I love the taste of an espresso. The unapologetic boldness of the drink. If you don’t, I dare you to try blue print coffee’s Penrose espresso, caramel and chocolate base with floral flourishes. If it’s not clear enough to you. I love coffee and it really is about the taste. Or at least it used to be. Now well, now I drink it for the taste. And because I just love living in my mind when I’m caffeinated. It’s like the excitement and wonder of childhood, coupled with the seriousness and acuity of being my adult self. That moment, the first sip hits my lips in the morning. It feels like the intellectual equivalent of diving into a swimming pool. Refreshing, exciting and invigorating all in one. Now I just did something I never thought I’d do. I just described getting high on my podcast because even if we don’t think about it that way, caffeine is a substance, a relatively harmless substance that 93% of Americans use. Sure. But it’s a substance nonetheless. And if you don’t believe me, let me tell you why today has been so tough. I usually drink 8 to 12 shots of espresso a day, split over three drinks. Morning, noon, and 5:00. Like I already told you, I love coffee. It also helps that I’m a fast metabolizer of caffeine. One of the few things I actually learned about myself in one of those whole genome tests I did a while back. Today, though, I’m fasting. In the Muslim tradition, our fasts mean, no water, no food, and yeah no coffee between dawn and sunset. Most mornings when I fast, I set up my espresso machine to wake up just about 15 minutes before I do. That way it’s warmed up and ready to brew. I pull two double shots, which though only barely, usually carries me through sunset. When I break fast on a quad ice latte. But this morning I forgot to preset my machine and I didn’t have time to pull my second double shot before the dawn. Womp womp. I’m recording this around 5 p.m., about an hour ahead of sunset. I have a faint headache, I’m groggy as I’ll get up, and if I lay down, I knock out. Some of that has to do with a four week old infant. But I digress. But here’s the thing. I’m withdrawing because caffeine is a drug. A hell of a drug, but a drug nonetheless. There’s absolutely no shame in saying that because, well, it’s 2023 and all of us should be well past the Nancy Reagan and Dare induced stigma by now. But understanding that caffeine is a drug should inform how we use it. For me, it’s coffee, perhaps the most potent, naturally occurring source of caffeine. But over the past few decades, more Americans are consuming their caffeine in the form of energy drinks that promise to, quote, “give you wings”. They’re also using high content, pre-workout, supplements or pop, or as you people not from Michigan call it, soda. In fact, there are several known cases of full on deadly caffeine overdose. The problem here isn’t the substance itself. It’s like so many of the subjects on the show, how it’s manufactured, sold and marketed that so often cause the biggest challenges. And as consumers of this stuff, we have to be aware of it. At least that’s what my guest today thinks. Murray Carpenter, like me and most of you, is an avid caffeine drinker, so much so that he wrote a whole book about it. I came across his book, Caffeinated: How Our Daily Habit Helps, Hurts and Hooks us, and I knew I had to sit down with him. Note, when I recorded this interview with Murray, I was sufficiently more caffeinated than I am now. You can really hear the difference. Here’s my conversation with Murray Carpenter. 

Dr. Abdul El-Sayed: Can you introduce yourself for the tape. 

Murray Carpenter: Yes. Hi, my name is Murray Carpenter. I’m the author of Caffeinated: How Our Daily Habit Helps, Hurts and Hooks Us. 

Dr. Abdul El-Sayed: Well, I’ve been really looking forward to this conversation. And thank you so much for making the time to chat with us. 

Murray Carpenter: Oh, sure. Thank you for your interest. 

Dr. Abdul El-Sayed: So uh so how much caffeine do you have on board right now? 

Murray Carpenter: You know, I’m not optimally caffeinated. I mean, this is in the evening and I kind of taper. I really I really stop consuming caffeine around 1:00. 

Dr. Abdul El-Sayed: Oh, okay. So my caffeine intake is rather embarrassingly high. So I’ll start my day with a double shot espresso most days. And then around 12 I’ll do usually a quad shot uh iced latte, and then around five I’ll do another double or quad drink. So here’s the thing, today I actually fasted, um you know, we fast on [?]. And that’s always the hardest part is the caffeine. And I broke fast at about six. We’re doing this, this uh conversation around seven and I just rocked a quad shot iced latte. So uh I am very caffeinated and very excited to chat with you. [laughing]

Murray Carpenter: Oh, excellent. Well, yeah, that that sounds like a perfect metabolic situation to be in right now. 

Dr. Abdul El-Sayed: I um uh did one of those 23 and me things back in uh in med school, and it give me some obvious information, like I don’t have Tay-Sachs, which is a rather deadly uh congenital um disease, which clearly I don’t have that. But one of the interesting uh things that I learned about myself is that I have a series of uh polymorphisms that make me a um a fast metabolizer of caffeine, which is something I kind of generally knew about myself but didn’t have the proof for. Um. And it, it always makes for a really interesting conversation because I clearly drink a lot of the stuff um and people generally worry about my heart rate, blood pressure um and a series of other things. But stepping back, what is caffeine? 

Murray Carpenter: So caffeine, it’s a drug. It’s a naturally occurring drug that that um is in plants all over the world. And wherever it occurs naturally, people have figured out ways to to use it, to put it to use. And in the human body, it’s a stimulant. So, you know, long ago in Africa, people were were starting to use coffee as a stimulant. Um. In Central and South America, people have used cacao. And then in Asia, people, people use tea. 

Dr. Abdul El-Sayed: So where does it operate uh in the brain? And what do we understand it does? 

Murray Carpenter: Right. Well, so what it does is it basically it looks a lot like adenosine, which is a neurotransmitter that gives the body the signal that we’re tired and it can basically fit into an adenosine receptor and sort of elbow adenosine away from the bar. And in that way, it prevents your body from knowing that you’re tired or feeling that you’re tired. That’s one of one of the mechanisms. And one of the interesting things about caffeine is that it seems to work in different, you know, on different areas of your body in different ways. But that’s that’s sort of its primary mechanism. 

Dr. Abdul El-Sayed: Hmm. So it basically uh blocks your body’s ability to know that you’re tired. I guess that that makes a lot of sense, obviously, right if you’re short on sleep um caffeine is the go to. Um. But I always find that, you know, to me, there’s a moment when that first taste of coffee hits my tongue and it’s like it’s like being plugged in for the day. It’s just like [audible sigh like sound] a power up. It’s time to go. Um. Do we know what mediates that? 

Murray Carpenter: Well, I mean, I think in that case, it’s like many, uh many drugs, many pleasant stimuli. You know what’s coming after that first taste? You know, you’re within 20 minutes, you’re going to be optimally caffeinated. So I think that’s a big part of it is is sort of this uh this this sense of anticipation, uh because it really does take a few minutes. You know, if you’re drinking coffee, uh you’re probably not going to metabolize, you really get a big boost for about 15 to 30 minutes if you’re you know, if you’re if you dissolve it in your mouth, sounds weird, right? But people can do it under their tongue then then you get it into your bloodstream a little bit quicker. But yeah, I think a big part of it is the anticipation. 

Dr. Abdul El-Sayed: Hmm. So it’s interesting because I was staying with a friend and and uh he wanted to play a trick on me, so he served me decaf. And the minute it touched my tongue, I was like this ain’t it. What did you do? He’s like, how do you know? I was like, I just know like, this, ain’t it? Right. And I think it took me a second to really like within 20 minutes, I was like, mmm mmm [sounds of discontent] I guess the question is, can you taste the caffeine in the coffee? 

Murray Carpenter: That’s what I was going to say. I think you probably could in that in that particular uh instance. You know, so caffeine has a very bitter flavor and it’s sometimes used as a flavoring agent actually to make things bitter. And so, yeah, uh it is it is very possible that you could taste the difference. Um. And some, you know, just as there’s a huge range in caffeine sensitivity among many people and you’re on one end of the spectrum, uh there’s a huge range in how we can all taste different flavors. And so you may be able to taste this better than others. 

Dr. Abdul El-Sayed: Hmm. Um. So I both taste and enjoy and metabolize caffeine. Me and caffeine have, we have quite a thing going and I’m grateful to get to talk to you about it. So I got to ask you, why did you write a book about caffeine? 

Murray Carpenter: Well, you know, I’m I’m intrigued by it. I’m a late adopter. I really you know, coffee wasn’t a part of my life. And then when I was in college, just off campus in the University of Colorado, and campus, there was this great coffee shop. And my friends used to hang out there. And so I used to hang out there with them, start drinking their coffee. It was good, strong, like coffee house coffee. And then I noticed, wow. You know, when I have a good, strong cup of coffee and I go to the library and study, I’m on it, you know? And so I just became intrigued by it. And so I’ve always been really interested in caffeine and how it affects the body. And then I finally really decided to to write a book, because that was about the time that the all of the energy drink controversy was was coming around about Red Bull and regulation and all of that. So, yeah, it’s been kind of a lifelong fascination of mine. 

Dr. Abdul El-Sayed: So I want to get more into synthetic caffeine and the way that caffeine is used. But I got to ask you, what’s your fix like? What is your what is your day to day? I shared mine, uh what’s yours?

Murray Carpenter: Yeah. So I’m I’m I’m similar to you in multiple doses throughout the day, roughly 20 to 24 ounces of really nice, good strong coffee. And, you know, typically I’ll do like about eight ounces when I first get up, maybe another 4 to 5 ounces mid-morning and then 12 to 1, you know, the last say five ounce strong cup of coffee. And and then, you know, in the afternoon, if I am lagging or I have to cover a night meeting or something, I might often have just a bag of like black tea. So a smaller caffeine dose, but still significant. 

Dr. Abdul El-Sayed: I want to ask because, you know, we talked about um dosing. What is the standard dose of caffeine like when you grab that first eight ounce cup of coffee? How much caffeine are you uh consuming? 

Murray Carpenter: Well, an eight ounce cup of coffee and this is really the tough thing is, you know, a lot of these like energy drinks, they’ll say, you know, this has as much caffeine as a cup of coffee, but a cup of coffee, like a weak five ounce cup of coffee is a cup of coffee. And that could have like 50 to 60 milligrams. You know, a Starbucks like grande is still a cup of coffee. Right. And that could have 320 milligrams. So roughly for you know, for my purposes of measuring things out, I came up with this determinant called a standard caffeine dose or a SCAD, and that’s like roughly 75 milligrams of caffeine. So that would be like five ounces of coffee or one Red Bull or say, one shot of espresso. Again, with coffee, it can vary. But this this tends to be like a dosage that a lot of people sort of dial into. 

Dr. Abdul El-Sayed: Mmm. That’s that’s helpful to understand. You know, it’s interesting because the stereotype is that um espresso is the most uh caffeinated form of coffee, and it is per unit volume. But the thing about it is actually I the other drink that I often drink is cold brew. And the thing about caffeine is it’s what we call hydrophobic, meaning it doesn’t like water very much. And you know, to go on a bit of a tangent here on on the chemistry of coffee, when you brew a cup of coffee, you’re basically doing an extraction, you’re extracting chemicals out of a bean. And you can either do that with heat or with pressure or with time um because you’re always using water as as your main tool. And again, the caffeine doesn’t like the water. So um to coax it out, you either roast it very heavily and then use a lot of pressure and a lot of heat, which is what you do when you’re making espresso or you use a lot of heat and time when you’re making like a pour over or you use no heat and a lot of time when you’re making a cold brew. And the interesting thing about it is the heat itself actually denatures the caffeine. So any process that you use that uses hot water, you’re going to lose some of the caffeine content to the heat, which denature’s um this particular molecule so that the highest caffeine content actually is in cold brew, particularly if you have like a 24 hour brew because the last molecules come out tend to be those fats. The interesting thing about it too, is that you end up getting a more complex flavor um the longer you wait, right? Because a lot of the the flavor profile of a great coffee comes in the fat molecules, which are also hydrophobic. So it’s always interesting to me because like I enjoy espresso and espresso drinks, um but it’s not really about the caffeine as much as you know, it is about the caffeine to be, to be fair. But um but it’s not as much about the caffeine as it is about the taste, because you really want caffeine. You just, you know, swig like 8 to 12 ounces of cold brew and you will be wired. So that gets to a interesting point, right? Because I think all of us who drink caffeine have had that experience of being overcaffeinated. Um. And it’s kind of weird. But there are a lot of chemicals, especially psychoactive chemicals, that have a non-linear relationship to outcome. So alcohol is one of them, right? You drink a little bit of alcohol and you experience what is this nice stimulant effect, this buzz, and you drink a bit more and all of a sudden it does what alcohol does, which is um it is a profound downer um and uh caffeine is somewhat similar. Can you tell us a little bit about um that sort of nonlinear uh dose response relationship? 

Murray Carpenter: Yeah, and we should talk about Cold Brew later because it really is interesting. People do love this and it’s one of the cool things about this moment in coffee culture that we have all these options, espresso, cold brew and things that we didn’t have so much ten, 15, 20 years ago. Yeah. So in terms of the the dose, I mean, I think anyone who has consumed caffeine in any form for a long time. Totally gets that there’s a point at which they’re overcaffeinated. And you know, in some people this will uh it will feel like anxiety. Some people will get the jitters, some people just like feel uncomfortable in their skin. Uh. But I think we all know the feeling of being overcaffeinated. Interestingly, of course, this is going to vary widely from person to person, depending on how much, uh what their sensitivity is. You know, some people, 35 milligrams are going to be to the moon. Other people like you, you could have, you know, four shots of espresso and you’d probably be just just right. But yeah, for most of us, the optimal caffeine dose is we’re going to know it when we feel it. And then often if we have like just a little too much, then yeah, it gets unpleasant. 

Dr. Abdul El-Sayed: Yeah. For me, it’s an impending sense of doom. I, I um I have no other way to describe it except for being like everything is going to fall apart and I don’t know why. And then I go through my, like, mental checklist. I’m like, was it this? Is it this, is it thi? And then soon enough, it’s like, oh, you had twice as much coffee as normal today for whatever reason, because you drink socially. And then uh here we are um and everything feels like it’s going to fall apart, which is not a pleasant feeling, really not a pleasant feeling at all. Um. You know, you talk about some of the edge limit cases of caffeine use, and we started to learn a lot more about that. Can you can you tell us a little bit about how, um you know, folks who are pushing at the elite level of performance are using caffeine? 

Murray Carpenter: Yeah, I mean, so that one one of caffeine’s well known effects is to improve athletic performance and and and its improvement is pretty significant. Like if you’re say you’re running a one hour race, it could improve your time between like one and 3%. The interesting thing about it that’s different than a lot of performance enhancing drugs is that the dose, the amount that you would need to get the optimal athletic performance would actually be really close to a sort of moderate to high end caffeine user would be taking daily anyway. So this brings in some obvious challenges in terms of regulating it, you know, as a performance enhancing drug. But yeah, for athletes, uh there are people and I interview people for the book who um who don’t consume caffeine at all, but do use it just to as a, you know, a performance enhancing drug essentially. And then there’s also people who are regular caffeine users who supplement during a race like an endurance race with all sorts of all, all the products that they have now, which are, you know, gels and um drinks that you would that you would mix and powders you would mix into your water bottle and everything like that. So, yeah, it’s a well known performance enhancing drug. It’s it’s pretty fascinating. 

Dr. Abdul El-Sayed: There’s um you know, a lot of folks will supplement with what they call pre-workout. Um. So if you’re going to go to a, you know, weight room, you’ll you’ll hit some pre-workout it’s like 300 milligrams of caffeine in a serving. Um. You know, I’ve I’ve I’ve tried it a couple of times. And you know, you get to pretty close, especially considering my baseline caffeine use. You get to pretty close to impending sense of doom. But you kind of think about it, right? Like if you’re about to go run a race, having an impending sense of doom [laughing] probably gets you to run pretty fast. So [laugh] so maybe maybe some of the downsides uh actually are are somewhat beneficial in those circumstances? 

Murray Carpenter: Well but there are people who, you know, who I who I interviewed who are athletes, who, you know, if you get starting line jitters at any race. Right. And caffeine exaggerates that, you know, that that might not be a good feeling for a lot of people. But I love this phrase, the impending sense of doom, because that really does does capture sort of uh super caffeinated anxiety. 

Dr. Abdul El-Sayed: Yeah, it really is like it’s like there’s something there. The interesting thing is my my uh spouse, Sarah, um is not a big caffeine drinker. And really, you know, she will have this impending sense of doom and we’ll think of, she’s like, why do I feel this way? She’s a psychiatrist, so  very in tune with her uh baseline emotions and like will realize that she had some coffee ice cream. Right. So just, you know, the smallest whiff of caffeine. And here I am, you know, knocking back shots. Um. So it really is a pretty big difference. How big is the difference in the effect that caffeine has on people? And do we understand what predicts this? 

Murray Carpenter: Yeah, so it’s huge. I think we’ve all met people who say, you know, even decaf will give them a buzz. Um. And what I learned in the research for the book is, yeah, it’s true. Some people so so there is some caffeine in decaffeinated coffee, but it’s not much. But if you had a, you know, a tall cup of of decaffeinated coffee, you might get like, oh, you know, five to ten, maybe 15 milligrams of caffeine. And for some people that would just be way too much. Um. And then there are other people who, of course, uh can consume caffeine right up until the moment they go to sleep and sleep like babies. So it does seem to be genetic. I mean, that’s that’s the main thing. And a lot of it has to do with the enzymes that uh that metabolize caffeine. And how much of those we individually produce. So, you know, in a family, you know, you might have a family of people who who drink coffee right up until the moment they go to bed. And you might have a family of people who who just can’t uh consume caffeine. But yeah, it’s a very interesting uh thing. And this also, you know, the impending sense of doom. Some people are uh much more predisposed to caffeine induced anxiety. 

Dr. Abdul El-Sayed: Mmmm. We’ll be back with more with Murray Carpenter after this break. [music break]

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Dr. Abdul El-Sayed: I want to ask you, because it kind of feels like when you when you use caffeine. I always feel like I’m probably on borrowed time. Like there is there is something that has to give, that some balancing feature on the other end of the equation. Like, I can’t I can’t possibly get this sort of feeling of like superhuman focus and not have a cost. So I guess I have to ask you, like, what is the cost beyond, you know, edging close to that impending sense of doom? And I don’t know how many times we’re going to say impending sense of doom on this podcast, but what is that cost um both in the acute term, but but also in the chronic term? 

Murray Carpenter: Yeah, I mean, right. It’s a great question. And I think there’s sort of I don’t know if it’s a puritanical sense, but like, this is so good, it has to be bad in the long run, whatever, whatever it is that gives us that that sort of balancing feeling like uh but, but really, no. So the big liabilities with caffeine, the really big ones are sleep and anxiety. So if caffeine is not affecting your sleep and it’s not triggering anxiety and you’re not trying to get pregnant, then there is no indication that consuming caffeine in the form of coffee or tea is going to have some costs down the road. In fact, there seems to be a growing body of science that indicates that there may be beneficial effects to consuming uh coffee or tea. And we don’t know that that has to do with the caffeine. It could be it could have to do with the polyphenols in these substances. So uh that’s that’s a long winded way of answering your question. The bottom line is probably there’s not a payoff. You know, there’s no there’s no downside on the other end. Again, the big caveats are sleep. If you’re if you’re pounding caffeine and then you’re not sleeping well, that’s that’s a problem. And I think for a lot of people that that is the case. 

Dr. Abdul El-Sayed: The other cost for me is withdrawal. Right. So I told you about um about fasting. And, you know, we we uh in the Muslim tradition, we fast uh every day for a month from uh dawn to sunset. And for someone who drinks as much caffeine as me, I literally have to organize my fast around caffeinating. So I literally will uh wake up and I’ll forgo the extra hour or two of sleep. So I’ll wake up at like five and then I will do my quad shot straight espresso and then I will live my day. I’ll start feeling the effect by about four or five, sometimes in the form of a headache, oftentimes in the form of just a profound brain fog and like a sort of tiredness. And then as soon as I break fast, which around, you know, this time of year is early, right around six, but, you know, gets as late as nine, I’ll do another quad shot of espresso that’ll get me through the night. And thankfully, like, it doesn’t affect my sleep for a lot of folks, you know, having espresso at night and trying to go to bed at eleven would would be um disastrous. Uh. But the withdrawal is is terrible. And I feel like, you know, half a person and then I sort of extrapolate that out and I say, well, you know, how much of my life do I live around getting my fix? And it’s kind of a lot like I’ve spent way too much money on on the capacity to make espresso on demand. I will spend even more if I’m out and about and I need to get a coffee at my you know 12:00 or 5:00 um time. And and if I don’t, then I really I can feel the consequences I really like will will start to feel it. And there is a like a real aspect of this that I’m somewhat ashamed of um because I need my fix and if I don’t get it, I will feel the consequences. And lo and behold, like I will, if I don’t have my 5:00, uh I will start feeling tired and sleepy around seven, um which is just not natural. It’s not normal. It shouldn’t be that way, but it is. Um. So I got to ask like what what drives the withdrawal? Um. And you know, what are the what are the tips and tricks that you give me from your vast research about how to escape it? 

Murray Carpenter: Okay. So withdrawal, I mean, it’s complicated. At least one of the things that may be driving it is that we actually our brains are plastic enough that we may be producing more adenosine receptors and that when we actually stop consuming caffeine, then we’re like overly tired because we have more capacity. Um. But the bigger thing is, I mean, withdrawal, it is real and it does happen to, you know, most people who consume caffeine regularly, usually, you know, it peaks like day and a half, two days, but can last really a week. Um. The only tip that I can say if if you want to stop and you don’t want withdrawal is to very carefully like calibrate your caffeine dose that you have daily and then just taper very, very, very gradually. And I’ve done this a few times because I was I was curious about it. You know, most people, if they’re if they’re caffeine users, really never uh unless perhaps they’re a woman who’s pregnant or nursing may never go without uh caffeine. But yeah, withdrawal is is heavy and and it’s and it’s weird, you know, it it affects uh the body in some pretty unusual ways. 

Dr. Abdul El-Sayed: [sigh] So uh you talked about being a late comer to coffee. I went through most of graduate school without ever drinking coffee. And for me it was a recognition of the taste. Of course, when I was a little kid, I’d taste the stuff and I was like, ooh, why would anybody want to drink that? And then I don’t know what happens, you know, right around like late twenties or so. But all of a sudden, you know, things like Froot Loops start to take like, taste like trash and things like coffee start to taste amazing. Whereas I swear before my mid-twenties it was exactly the opposite. And so I just fell in love with the taste. And I love the taste. But part of me says, you know, I’d like to see what would it feel like to actually titrate down to zero caffeine and actually compare the quality of life. Like what you’re sharing with me, it seems like there’s really no downside aside from this one month every year where I like, I’m chained to my my uh espresso machine uh waiting for that moment where I can have that first sip um and feel human again. But, you know, it is sort of an interesting thing. I wanted to ask, you know, in terms of the use of different kinds of caffeine, I think for a lot of folks, it used to be these natural approaches to caffeine, right? People would have their daily coffee. Right? You couldn’t get to the to the gram to the to the microgram uh in terms of what you were getting. But increasingly now caffeine consumption is less about the naturally occurring forms of caffeine. And you’re starting to see a lot more consumption in terms of the um manmade stuff. Can you tell us about the rise of synthetic caffeine? Um. What brought it to the fore? And, you know, just just how popular it is now? 

Murray Carpenter: Yeah, well, it’s really popular. And basically what brought it to the fore was that uh soft drinks I mean, soft drinks have since Coca-Cola started, you know, over 100 years ago, caffeine has been a big component of soft drinks. It used to be they used to be more caffeinated. They used to be more like energy drinks, about 100 years ago. In those days, Coca Cola was getting um basically they were extracting caffeine from waste tea leaves. And in fact, Monsanto, an interesting historical tidbit. Monsanto was the chemical company that was first producing this for Coca Cola. 

Dr. Abdul El-Sayed: Mmmm. 

Murray Carpenter: Yeah. And then but then uh around World War Two, when supply chains were disrupted, some chemists uh in Germany started to figure out how to synthesize caffeine. And synthetic caffeine is, you know, is what it sounds like. It’s a pharmaceutical product and uh synthetic caffeine is cheaper and it’s essentially metabolically indistinguishable from caffeine. You know, it’s it’s a basic chemical. Um. You can tell them apart in a lab by basically carbon dating them because the chemicals would would come from like most uh pharmaceuticals at the base that would be from petroleum products. So the the carbons would have been kicking around for longer than the carbons in say caffeine extracted from coffee. Um. But yeah, uh you know, it’s a huge industry. And you mentioned that people using the pre-workout um things, there’s been a couple of tragic incidents where where people have sort of tried to make their own pre-workout things because you can buy caffeine powder for cheap and have mixed in like, you know, a heaping tablespoon of caffeine into these things and have uh have died uh because– 

Dr. Abdul El-Sayed: Wow. 

Murray Carpenter: Yeah, it’s in, in it’s in it’s refined form. It’s very powerful. 

Dr. Abdul El-Sayed: And what does what does caffeine toxicity do to you? 

Murray Carpenter: Boy, I think the the mechanism of toxicity is, is it stops your heart. But I’m not 100% sure. It’s it’s certainly a situation you don’t want to be in. 

Dr. Abdul El-Sayed: I would imagine it’s probably similar to other stimulants like the classic is like cocaine toxicity which um causes a cardiac arrest. And you could imagine a similar mechanism of action. Um. But it does bring up this this point, right, where um once you can manufacture caffeine, you start to um deal with the human assumption that if a little bit is good, then a lot is better. And I can imagine some workout bro somewhere being like, oh, caffeine makes my workouts great and we’ll put just even more in there. It’s going to be awesome. I’m going hit my PRs today, I’m a get gains and um and then and then doing something like that. Um. How how common is this and how has that changed our caffeine consumption when we can sort of directly modulate how much caffeine we consume? 

Murray Carpenter: Yeah, you know, oddly, I think it hasn’t changed our consumption as much as you would think, because that would be your your sense as well. If we if we’ve got these shots that are, you know, highly concentrated caffeine and we’ve got energy drinks which have, you know, relatively a lot more caffeine than, say, sodas, but not too much more mostly than a strong cup of Starbucks. You would think people would go you know bananas. But oddly, I think what the case is, is that most of us know what our bodies want in terms of caffeine. And we don’t want, back to the impending sense of doom. We don’t want to get to the impending sense of doom. We want to be one step back from there. So um so yeah, the genie is out of the bottle in terms of like powdered caffeine and and just this wide range of caffeinated products we now see. Um. But I think, you know, in most cases, people are not going completely bananas with it, you know. And so that’s not to say that there aren’t challenges with this. And I think one of the things um and you’re a doctor, so you know this better than me, but there are um a lot of young people are consuming uh energy drinks. So if you have someone who’s a teenager and they’re saying, you know, doing a 12 ounce Red Bull, 120 milligrams, you know, and gaming at night, and they’re not they’re not used to caffeine, that that’s certainly a level that would affect their sleep. And that’s also kind of like probably a level that a lot of those people would not have been consuming in coffee prior to energy drinks. So I’m not saying everything’s good. I think we’re adjusting to this as a society, uh all these new products. But um yeah, it’s it’s a change. It’s a change. 

Dr. Abdul El-Sayed: So what I’m hearing is when you take a psychoactive drug and dose it with huge amounts of sugar, that’s probably not good for the responsible use of that that chemical? [laughing] 

Murray Carpenter: Yeah, well, I mean, and also with energy drinks, it’s not just sugar. There’s a lot of stuff in them. It’s very rare but there’s a couple of cases in the literature of people having acute uh liver problems from the niacin in energy drinks. So uh there’s that. And, you know, while we’re talking about health, the other thing that’s really worth noting is for soft drinks. I mean, uh we don’t think about soft drinks, about caffeine in soft drinks, I think enough, because it’s such a small amount, you know, 35 to 50 milligrams. And it for you or I, we wouldn’t get a significant boost, but it’s there to reinforce the behavior of purchasing that product. So there’s been a number of studies that, you know, if you if you take a novel flavored uh soft drink type thing with 35 milligrams of caffeine, one without people are going to continually decide to get the the caffeinated one. It reinforces the behavior. The reason this is important is because we’ve got this whole epidemic of obesity, uh type two diabetes, you know, diseases of lifestyle that I think are in large part or or a big component of the diet that leads to these has soft drinks. And it’s the sugars there, not the caffeine that’s going to get you. 

Dr. Abdul El-Sayed: I really appreciate the point that you’re raising about the role of corporations and the way that they weaponize caffeine to drive consumption of their product. Um. You know, it’s interesting, right, because Coca Cola, Pepsi, that sort of classic soft drinks manufacturers, these folks are putting huge amounts of um corn driven sugar uh into their product. And that’s um sort of what’s causing a lot of the secondary consequences of soft drink consumption. But you [?] imagine the big coffee companies started that. Right. They understood that people liked this chemical and they could produce it en masse. And that had some pretty serious consequences for the folks who were um farming and harvesting um the the coffee in particular, but also tea abroad. I mean, there’s no coincidence that uh in the lore of our country’s founding is the Boston Tea Party um and the role in which tea it had had in global trade and the triangle trade um that was part of the um slave trade in this country. Can you tell us a little bit about the role that caffeine has had in um you know corporate wrongdoing, um both both in the present and the past? 

Murray Carpenter: Boy, that’s a big question. I’m not sure I’m the right guy to answer that. But I think the short answer I would say is soft drinks alone are more than a $200 billion dollar a year industry in the U.S.. Uh. Caffeine is a huge part of that. And so I think, you know, continually it’s just it’s such a huge um part of not just our culture, but our commerce. And it has been, as you point out, for decades, centuries. So um any type of corporate misbehavior [laughing] that you can think of has probably been allied with it. I only bring up the Coke thing because it it seems like um I think a lot of people just don’t get the role the caffeine plays in in perpetuating that behavior of of soft drink consumption. 

Dr. Abdul El-Sayed: Hmm. So you write a book about caffeine and you learn a lot about caffeine. And the book is extremely well reported. And I recommend everybody check it out. How did writing this book change your caffeine use, if at all? 

Murray Carpenter: It did. It made me a little more strategic about caffeine. It made me take it more seriously as a drug. Uh. You mentioned earlier the idea when you when you go out and you’re drinking coffee socially with friends. So maybe you had your quad shot earlier. Right. But then you go to a coffee shop and you have a few cups with a friend and and you become a little excessively caffeinated. Yeah. So I don’t drink uh caffeine or coffee um quite as um I don’t know, I drink it more strategically. I think that would that would be what I’d say. I’m aware of how much I like and and I tend to sort of stick to it. 

Dr. Abdul El-Sayed: So it’s almost like you went from casual uh drinking coffee to strategic dosing of caffeine. 

Murray Carpenter: Exactly. And, you know, this gets to sort of the underlying uh theme of the book is, we joke about coffee, we joke about being caffeinated. You know, I need my fix, whatever it is. But in a way, we don’t really take caffeine seriously as a drug. And I think that’s a mistake. Obviously, you do. You’re aware of this. You know, you’re a professional, so you understand a lot of things, but a lot of us just it’s something that’s just sort of wallpaper in our lives. We’re consuming coffee. We know we like it. We we know we feel bad when we don’t take it. But in terms of actually appreciating it and respecting it and using it uh in an optimal way for our own metabolisms, I think a lot of us sort of aren’t really at that level. And part of it is because we have this this unease about it. It is a drug, it is a mildly addictive drug. And um, you know, we as individuals and as a society, we’re we’re sort of torn about the issue of of of drug use. 

Dr. Abdul El-Sayed: Yeah. I mean, I think I think the point you make about the stigma of calling it a drug and naming it what it is is really quite profound. Right. And it keeps us from being as intentional, thoughtful, careful and responsible as we ought to be about consuming this thing that really, in a lot of ways is a performance enhancing drug. Right. Which brings me to my final question, which is about, you know, efforts to regulate it. Right. Obviously, it is deadly, and particularly if you’re taking a heaping spoonful before your workout uh that can kill you. Um. And at the same time, it is a performance enhancing uh drug. And, you know, you talked about the athletic uses of it. Have there been efforts to um at least protect folks from the worst excesses or at least maybe the impurities of synthetic caffeine? Um. Have they been successful? And what’s kept us from being able to make sure that, you know, folks use it responsibly? 

Murray Carpenter: So there have been efforts and for for more than 100 years to regulate caffeine. And it always sort of gets up to the point of, well, but coffee is is legal and it has more caffeine, what would you do next to regulate coffee? And so basically, FDA has a I’d say catch as catch can has regulated some products. So Four Loko, which was like a uh malt beverage that was caffeine infused, that was making people sort of wide awake drunks. FDA, you know, took action on that. They have gone after sellers of the pure um caffeine powder online, the after a couple of people overdosed. So there have been those. But, uh you know, still, I would say it’s not quite the Wild West, but uh I would say it’s it’s somewhat under-regulated. And the challenge, of course, is that uh say you regulate caffeine powder, someone can extract caffeine from coffee and still get, you know, a strong dose. So um, yeah, regulation is still um kind of an issue. 

Dr. Abdul El-Sayed: Yeah, it was an interesting question, right? Because we’re getting now to the philosophy of um of substance use policy. Right. Because on the one hand, anybody who listen to this podcast knows I’m a big supporter of, of legalizing and um and regulating on the supply side. And you know, when you think about, for example, marijuana, where, you know, marijuana toxicity to the point of of mortality is is nearly impossible. Um. And this has been regulated as scheduled one drug for a long time, whereas caffeine can kill you. At the same time, we really haven’t had the ability to dose enough caffeine to kill you up until very recently. And so you’re in this sort of odd scenario where you are dealing with a potentially deadly substance, albeit in a dose that anybody of sane mind should understand to avoid. Um. But it’s still potentially deadly. And it is um it is a habit forming substance. Right. And so, you know, obviously, as someone who drinks as much coffee as I do, I’m not supportive of of like regulating coffee, um but there is a question of asking. All right. So like, how do you protect folks who may not understand that this can, in fact, um have some dire consequences for you while at the same time enabling, you know, the regular use or even even heavy regular use of a substance which a lot of folks enjoy and enjoy responsibly. But I think it does start with understanding, right? And educating folks about the potential um consequence of this and talking about it as what it is, which is a substance um that needs to be treated with a lot of respect. It’s in some respects we’re almost talking about the difference between uh cannabis versus uh pure THC. And we need to, I think, um have the right language for it. And I really appreciate uh you bringing that right language to the conversation and sharing what was a really um uh important conversation, which I hope will protect a lot of folks from an impending sense of doom. [laugh] All right. Our guest today uh was Murray Carpenter, and he is uh the author, he is the author, my caffeine’s wearing off, and he is the author of Caffeinated: How Our Daily Habit Helps, Hurts and Hooks us. Uh. Murray, thank you so much for taking the time. 

Murray Carpenter: Thank you. That was really fun. 

Dr. Abdul El-Sayed, narrating: As usual. Here’s what I’m watching right now. Any chance you tried to buy eggs lately? 

[clip of unspecificed news reporter] Prices have risen for lots of foods, but the cost of eggs climbed the most in the last year, and consumers and businesses have scrambled to keep up. 

Dr. Abdul El-Sayed: Yeah, they’re super expensive. But Abdul, this is a public health podcast. Yes. Yes, I know. Bear with me. Even though inflation is beginning to fall and prices continue to climb. And that’s not just an economic story, it’s a public health story. See, as COVID is beginning to wind down, the world’s birds have been hit by one of the deadliest strains of H5N1 bird flu yet. 58 million birds in the U.S., mostly chickens that lay eggs, have died of what has become the deadliest bird flu outbreak in history. Fewer hens means fewer eggs, and by the laws of supply and demand. When supply goes down, price goes up. And that’s why eggs are so expensive. Now, the human health part, the death of 58 million birds is bad enough, but H5N1 has a history of jumping across species. And there’s some new disturbing evidence that it’s beginning to jump into mammals. Last October, there was a massive outbreak in a mink farm in Spain. And over the course of the past few months, scientists have identified H5N1 in dead seals in Scotland, otters and foxes in the U.K., sea lions in Peru, and various dolphins, grizzly bears and even domestic cats. Yeah, the kind that live in your house. Before you freak out, there haven’t been any cases in humans yet, but all of this well, it should raise our hackles. Remember how COVID started? Most likely from infected bats in Wuhan, China. This avian flu has already made the jump from birds to mammals. There remains the possibility it could jump into humans. That said, in order to pose a major public health threat, it would have to be transmissible between humans. And so far, the virus’s biology, the way it sticks to receptors on human cells just isn’t very effective at doing that. That is for now. Like coronaviruses, influenza are RNA viruses, meaning that the replication process is open to a lot more errors and that some of those errors may actually yield advantages, allowing them to mutate quickly. And if one of those errors gives it the capacity to bind more effectively to human cells. Well. That could be a problem. We’ll keep an eye on this. Meanwhile, as the Biden administration prepares to wind down the public health emergency from this pandemic, the Department of Health and Human Services has announced that it could mean the end of health care coverage for up to 15 million Americans who are protected by the emergency from being kicked off their Medicaid rolls. As we talked about last week, it’s a pretty crazy thing if you think about it, that we have to have a damn public health emergency for poor folks to get health care in this country. And that while nearly 400 people a day are dying of an extremely transmissible, extremely deadly disease, we seem to be okay kicking them off of it. I hate to be a broken record, but though I am not as caffeinated as I’d like to be, can I remind you that we need Medicare for All. Like now. Last week, Turkey and Syria were hit by a series of earthquakes measuring as high as 7.8 on the Richter scale. Whole apartment buildings were toppled as people slept. The death toll has now risen to 23,000 and counting. I began my public health career in a research group that studied disasters and the circumstances that create them. I spent my days researching disasters all over the world. The central argument that the group’s leaders were making was that true disasters, the kind that kill hundreds or thousands of people at a time. They have a lot more to do with the circumstances in which an event like a hurricane or tornado or yes, an earthquake occur than those things themselves. A political system that protects people from the kind of corruption that allows regulators to look away as developers cut corners in apartment buildings. A government that’s responsive and marshals rescue squads to dig survivors from the rubble which the people of Syria do not have right now. That’s another. The difference between thousands of deaths and tens of thousands of deaths isn’t just about the occurrence of an earthquake. It’s about all the circumstances in which that earthquake occurred. And as we think about our own democracy, our own public health system, we should keep that in mind because public health is all about preparation. And when that fails, people suffer. I hope that you’ll join me in supporting the ongoing earthquake response in Turkey and Syria. There are several organizations doing critical work in both countries, including the Turkish Red Crescent, Islamic Relief and the International Rescue Committee. One organization doing critical work is the Syrian-American Medical Society. I know its founders personally, and they’ve been doing critical work on the ground in Syria since the outbreak of the civil war there nearly a decade ago. They’ve got a four out of four rating on Charity Navigator. I hope you’ll consider going to their website and supporting their efforts to provide critical medical care on the ground. You can donate at Sams-usa.net. That’s it for today. On your way out, don’t forget to rate and review. It really does go a long way. Also, if you love the show and want to rep us, I hope you’ll drop by the Crooked store for some America Dissected merch. [music break] America Dissected is a product of Crooked Media. Our producer is Austin Fisher. Our associate producers are Tara Terpstra and Emma Illic-Frank. Vasilis Fotopoulos mixes and masters the show. Production support from Ari Schwartz and Ines Maza. Our theme song is by Taka Yasuzawa and Alex Sugiura. Our executive producers are Leo Duran, Sarah Geismer, Sandy Girard, Michael Martinez and me. Dr. Abdul El-Sayed. Your host. Thanks for listening. [music break] This show is for general information and entertainment purposes only. It’s not intended to provide specific health care or medical advice and should not be construed as providing health care or medical advice. Please consult your physician with any questions related to your own health. The views expressed in this podcast reflect those of the host and his guests and do not necessarily represent the views and opinions of Wayne County, Michigan, or its Department of Health, Human and Veterans Services.