Over-caffeinated and Overlooked

Sarah Katz was a promising student: she was doing her degree in international relations at UPenn, and had received a full scholarship from a Chinese university to study Mandarin - as it’s what she was passionate about.

Her dreams, however, came to an end after a fatal heart attack - which was triggered by a lemonade from Panera Bread.

The beverage, according to a court file, contained 390 milligrams of caffeine - almost the daily maximum suggested by FDA for healthy adults. The fast food chain, though, didn’t put any label warning Katz, who had a heart condition since childhood, that the drink could be dangerous.

Sarah’s death is an example of the fatal consequences that can arise from this lack of awareness and labeling. However, she’s not the last victim of Panera’s unlabelled caffeinated drink. At least two other alleged cardiac arrest cases were reported before the restaurant chain stopped selling the lemonade under the pressure of lawsuits.

The case of Sarah Katz underscores the dangers of unrecognized caffeine intake. As additional victims have come forward, it shows a pattern of risk associated with unlabelled caffeine content - while coffee is universally recognized for its caffeine content, many consumers are unaware that non-coffee beverages can also contain significant amounts.

Dr. Jon Kole, who published a study calling for comprehensive labeling, emphasizing the dangers of high caffeine intake:“This can lead to increased blood pressure and heart rate, or even cardiac arrest, which can be more dangerous for some vulnerable groups, such as pregnant women and adolescents.”

Kole did the research for a reason. As a pediatrician, he had witnessed cases in which children were sent to ER with a racing heart from energy drinks. But that's not the only potential danger of caffeinated beverages.

“Many people assume there’s some caffeine in energy drinks, but the labels often don't provide meaningful information on the amount,” said Kole. “This lack of standardized practice makes it difficult to gauge caffeine content across various product sizes, from large cans to small shooters. There are also unexpected sources like caffeine-infused snacks, and even some medications that people might not realize contain caffeine.”

While there’s no way to confirm the exact number of every year, how many people in the US suffer from the health risks or even die because of overdosing caffeine, a recent study conducted by the Mayo Clinic shows some alarming findings. The research, which delved into over 5,000 patient records, identified a concerning pattern where 5% of sudden cardiac arrest survivors had consumed energy drinks shortly before their cardiac events.

Notably, the study highlighted cases where individuals with predispositions to heart issues such as Long QT Syndrome - which possibly took Katz’s life - experienced life-threatening arrhythmias triggered by these highly caffeinated beverages.

Current guidelines on caffeine labeling required by Food and Drug Administration (FDA) is that caffeine must be listed as an ingredient only if it is added to a product artificially. While there is a daily recommended limit of 400mg for healthy adults, the total amount of caffeine, whether added or naturally occurring, does not need to be disclosed on food and beverage labels. This omission applies even if a product contains substantial amounts of caffeine, as is common in energy drinks and certain sodas.

“There's definitely no requirement for caffeine content labeling on things like soft drinks or bottled coffee beverages,” said Eva Greenthal, who oversees federal food labeling work at the Center for Science in the Public Interest. “For products that come with labels, while there is some testing for accuracy done at USDA and FDA, those agencies have limited resources so they're not able to test the accuracy of every single product.”

The FDA’s stance is that consumers should know that products like coffee and tea naturally contain caffeine, but there is no requirement to inform consumers about the specific quantity, unless the caffeine is directly added as a separate ingredient. This regulatory gap can lead to consumers unknowingly ingesting high levels of caffeine, particularly from products where the caffeine content isn't obvious, thus posing potential health risks to individuals sensitive to or advised to limit their caffeine intake.

Recent legal battles further illuminate the hazards posed by misleading caffeine labeling and lack of regulation. In the case of T.K. v. Prime Hydration LLC et al., the beverage company faced allegations of targeting minors with high-caffeine drinks without adequate warnings, capitalizing on celebrity endorsements to appeal to younger audiences.

“Prime Hydration LLC and its founders engaged in deceptive marketing practices by promoting these high-caffeine drinks as healthy lifestyle choices without adequate warnings about their potential dangers," said the plaintiff's attorney.

“These drinks contain undisclosed amounts of caffeine and other stimulants that are not fully regulated, posing significant risks to consumers, especially those unaware of their potential side effects.”

While the U.S. continues to debate the need for stricter caffeine labeling laws, other countries have already implemented comprehensive regulations to ensure consumer safety and transparency. These international standards provide valuable insights into how caffeine regulation can be effectively managed.

There is a growing recognition of the importance of caffeine labeling like other potentially harmful substances such as transfats and allergens. The Food Labeling Modernization Act of 2021 is a proposed legislation that would require an amendment to the Federal Food, Drug, and Cosmetic Act to require the labels of caffeine content on food packaging, regardless of whether the caffeine is added or naturally occurring.

“Americans are too often misled by unclear or deceptive food labels because federal labeling standards haven't been updated in decades,” said Sen. Sheldon Whitehouse, D-R.I., who endorsed the bill. “This bill will modernize labeling rules to help consumers gain a better understanding of what's in their food so they can make healthier decisions and better avoid potentially dangerous allergens.”

Greenthal sees the positive impact of stricter labeling regulations on consumer health and safety:“What we really see is changes to purchasing and diet quality. While it's hard to link any specific policy to biomarker and health outcomes, changes in what types of foods people are buying we can understand as important public health advances.”