Hi, Dr Bernard here.
I recently published a video on Chubbyemu about a man who accidentally dry scooped a
lethal dose of caffeine.
Link is in the description below.
That is a de-identified case from a colleague of mine, but, the general circumstance surrounding
that accident, was really familiar to me.
When the idea of mixing supplements came up, as like the patient in this video did, it
brought me back to an earlier time in my life where I did the exact same thing.
In fact, some of my close friends immediately recognized it.
When I was in college I used to buy supplements to the tune of hundreds of pounds of protein
powder.
The more you bought the cheaper it was per pound.
We’re talking like $2 or $3 per pound, back in the mid 2000s, and I would save up all
the money I made working minimum wage at target.
It used to come in these big plastic bags I remember hauling it down the dorm hallway.
What you would do is you would mix a blend of casein and whey together.
And then you add in your own flavoring.
But then I started getting into things like mixing in amino acids.
Or something else called beta alanine.
There was a time when waxy maize was really popular, that is a heavy starch that would
supposedly absorb into your body really quick.
I think it was pre or peri workout.
To be honest, I dont remember any of those helping very much.
Sometimes what would happen is that I would mistakenly mix the wrong stuff together, because
I didn’t label things properly.
But when it came to amino acids there was a very particular taste to them.
The leucine would float to the top, it kinda had a greasy feel in your mouth, but you distinctly
knew it was a powder because it was grainy.
And all 3 of the aminos together would stick to the back of your throat so you had to wash
it down with even more water.
And then now you feel bloated.
Beta alanine also had its own taste.
It was kind of like fish, and it would make the shake sour to me so I never mixed it in
with Cookie Dough flavored protein powder mixed in milk.
Except for the times when I would mistake the wrong things and mix the wrong supplements
together.
And I remember when those times happened because the shake was just absolutely disgusting.
And everything had already been mixed at that point, so, good luck dealing with those shakes
for the next couple weeks.
That's where the patient in the caffeine video got into trouble because that was exactly
what he did— mistake amino acids with caffeine, and that’s what led to the overdose.
Typically you take 5 grams amino acids.
5 grams of caffeine however, is more than 10x the recommended daily limit.
This is all the pretext for my own caffeine withdrawal experience.
I'm gonna say I was pretty surprised that caffeine was included in the patient’s mix,
however he wanted to do it.
In general, maybe it could pass for a pre-workout, but even then, caffeine is a stimulant, it’s
not a great one when it comes to giving you a pump in the gym, and really it’s included
in so many regular drinks, you really shouldn’t need to add it to anything to get the desired
effect from it, but how exactly do you get that effect?
Caffeine is a methylxanthine.
It’s a stimulant natural product derived from plants.
So when we look at the chemical structure, it resembles adenosine.
For our purposes here, adenosine is an inhibitory neurotransmitter in the brain.
Some natural chemicals are heavily conserved, so ADENOSINE Triphosphate is used for energy,
it’s also used in RNA.
The ubiquity of it in humans, and other mammals, means when a plant makes something that’s
similar in shape, it’s going to have activity.
All of this gives us some context as to what we're working with here, and also how it can
even cause a withdrawal effect in the first place, which at one point in time, needed
confirmation to even exist in the first place.
So if we know that caffeine is a stimulant, and it resembles adenosine which is an inhibitory
neurotransmitter, then we can deduce that caffeine would somehow negate the effect of
adenosine.
That is, caffeine blocks neuroinhibition, thereby causing the opposite stimulation.
When allowed to work properly, adenosine slows the heart rate down.
You want that in times when a patient’s heart is beating so fast and so erratically
that it’s not contracting in a way that moves blood.
If caffeine is there to block adenosine, meaning caffeine won’t allow adenosine to slow down
the heart, then the result is that the heart beats faster.
Increasing adenosine also increases a person’s need to sleep.
So blocking adenosine via caffeine would disturb one’s sleep cycle, and we know when it comes
to caffeine consumption, that topic in particular is widely documented.
It goes so far as to people saying that our entire economic machinery has been widely
impacted by caffeine, because it causes one to stay awake to do more.
Adenosine also helps keep blood vessels at a normal diameter, so blocking it with caffeine
causes vasoconstriction.
Keep in mind, all of this is talking about a regular dose of caffeine, lets just say,
the 400 milligram daily limit.
When we come to overdose, like in the Chubbyemu case, everything changes.
So again, right now we are not talking about overdose, just a regular dose.
So just by this mechanism of how caffeine works, the analogy that we could use for it
is that it is a molecule where if the nervous system is not allowed to “step on the brakes,”
so to say, then we can interpret that a couple ways.
If in the case the figurative vehicle that is analogous to your daily vitality, wakefulness,
and concentration, aren’t really moving that fast in the first place, caffeine not
allowing the brakes to be engaged, means you just keep going.
There’s no indication of speed, you could just be coasting, and you keep going, even
you dont want to.
So while we know caffeine as a stimulant, it’s not as strong a stimulant at regular
doses as some other things that are used to treat pathological conditions, or that are
just not lawful in the United States.
In other words, we can say that caffeine doesnt cause excess stimulatory neurotransmitter
release in key parts of the brain, rather it mostly prevents inhibition by blocking
adenosine.
Biological systems tend to adapt to the conditions placed on them.
So if the body needs adenosine for normal function, but you have an exogenous compound,
caffeine, present that is blocking the function of adenosine, then that biological system
will want to respond by creating more adenosine receptors in the hopes that it can get some
signal from some adenosine.
So in order to get the same effect from that exogenous compound, you will now need more
of it, because the brain has created more adenosine receptors to block.
Sometimes, people will overshoot it, and then mass ingest a lot of exogenous compound, causing
the body to then adapt again and create even more receptors in response.
Now, you have a situation where there are too many adenosine receptors present, and
if you dont have some caffeine present every day, all the time, then there’s an overactivity
of adenosine.
This is what we call dependency, and many other substances that are misused undergo
a similar mechanism in the body.
You’ve build up to a point where you are dependent on an exogenous substance.
If you don’t have it, you get symptoms of being ill.
There’s a pain and discomfort associated, that are so unpleasant, all you need is just
some of that substance to not feel that discomfort.
And that’s how the withdrawal mechanism happens, as we know it today.
All of this bringing me to my own experience with caffeine withdrawal.
I've had this a lot of different times in my life, and what's funny about it is that
when I experience it, I don't necessarily realize that it’s because of a lack of caffeine.
When 2020 happened, I definitely got myself into a nice coffee ritual because I could
finally brew it at home for breakfast.
Actually, it came out of the 2 gallons coffee video I made on Chubbyemu in May of that year,
I bought the coffee maker as a prop and then used it to make and drink actual coffee.
I remember I measured it out to be somewhere between 300 and 400 milligrams caffeine daily.
This wasn’t first time into it, there was also coffee, soft drinks, and even earlier
in my life, energy drinks.
I still have the coffee maker, but I dont really consume as much caffeine now as I did
back then.
Here’s how it went down.
In May 2021, I was brought on by my friend in DC, to help make a video about a veteran
who was advocating for VA policy on those who were exposed to Burn Pits when they were
deployed overseas.
That’s exposure to burning garbage to everyone close by.
That video is published as A Soldier Was Exposed To A Burnpit, This Is What Happened To Her
Organs on Chubbyemu.
What was really cool about that project was that a local rental house called DC Camera,
agreed to let us borrow cinema lenses for that weekend for this particular shoot, as
well as do some lens tests.
So on the day of, we got to location, Rest In Peace, the patient covered in that video
passed away almost a year after this shoot.
We got there mid morning, like 10am.
I hadn’t had any coffee or caffeine, but I brought plenty of water.
The shoot lasted until around 8pm.
And basically, any time I have been consuming caffeine regularly, I dont drink anything
containing it after 2pm.
So when we finished the shoot, no caffeine could be consumed that day.
And the next day, I could feel it.
It started with a hangover like headache the moment I got up.
I was tasked with returning the lenses since my friend was the one who helped get them
in the first place.
On the drive there, the headache kept getting worse and worse, it was really like a hangover,
or the kind of headache I get when I dont drink enough water.
Before arriving to DC Camera, I had to stop at a Target that was close by, because I was
going to puke.
I've seen a lot of time in my videos, about a tinge in someone's cheek and a sour taste
and saliva rushes under their tongue as they emptied their stomach in a way like never
before.
And that was exactly what was happening to me I remember standing at the sink in a target
gripping the sides of the sink and I can feel my guts wrangling in a way that it doesn't
normally do.
It felt like there was an earthquake in my abdomen, and I just remembered the absolute
struggle to just not empty my stomach into the sink over there.
All during this time, there were shoppers going in and out of the store bathroom looking
at me like, “what the heck is this guy doing.”
All this time, I had no idea that this was caffeine withdrawal.
I hadn’t had that kind of headache for a long time, because I dont really drink liquor,
and because stay at home was such a thing in the year prior, I always had adequate water
intake.
What I didnt have, was the coffee I normally would for 2 mornings in a row.
The symptoms were severe headache that kept getting worse as the morning continued, that
ended in nausea.
The reason how I know it was caffeine withdrawal was because at that Target, I bought 2 bottles
of Mountain Dew, chugged them, and within an hour, basically everything went away within
an hour.
Chugging them in the first place was pretty terrible though, because anyone who has that
“hangover headache” knows when you put anything into your stomach during that time,
you feel like it’s going to come right back out.
Given the pretext, we have a decent idea of why this happened.
I did have a caffeine tolerance, from that one pot of coffee I’d drink everyday.
You suddenly take it away, like not having it for 2 days, in my situation it was to record
a video, but other reasons can vary, and now all those extra adenosine receptors that were
created in response to this inhibition, are now being stimulated and activated by adenosine
in the absence of caffeine because the body doesnt make it naturally.
Do you remember that point that caffeine causes vasoconstriction?
Well, if caffeine isn’t there to do that constricting, then it means way more blood
flows into the brain than what one would be used to.
Actually, if there is more adenosine than normal, it also means hypothetically, it’s
just simply more blood than normal flowing in.
There could have also been another mechanism of the vagus nerve, and how neurotransmitters
there, including adenosine, mediate emesis.
That’s what would have caused actual vomiting that I fought so hard to keep back, and ultimately,
was successful in doing so.
But that sour taste and the flood under my tongue meant that there was a signal being
conducted there.
You don’t get that much saliva collecting under your tongue in any normal circumstance.
And with the administration of caffeine, which pharmacokinetically we know is bioavailable
and quickly absorbed from the gut, the normal adenosine blockage that my body was used to
kicked in, and I’m guessing there wasn’t such a flood of blood into my brain, and the
symptoms alleviated quickly.
That’s how it happened for me.
There’s other reports of caffeine withdrawals describing anxiety, insomnia, mood changes,
I didn’t have that, but for each person, one may have some of those symptoms, all of
those symptoms, or maybe something different.
Now if you’re wondering what you do to not have caffeine withdrawal, you have to get
to a point where you’re not consuming any caffeine.
And you do that by slowly weaning off it.
Like I said, while it builds a dependency and causes withdrawal, it’s not really as
addictive like other stimulants, because it’s really blocking inhibition, rather than amplifying
stimulation at normal amounts.
So suppose you drink 6 cans of caffeineated soft drink.
Move down to 5 for a couple days, then to 4.
By then, you might feel a low grade headache, maybe feel kinda groggy during the day.
Then move down to 3, then 2.
And then up to you if you wanna keep going.
In my life, having some caffeine is fine.
Too much, and I can’t sleep well, which then causes me to function kinda weird during
the day.
In my entire life, too much caffeine mostly affects me not being able to speak coherently,
there’s a lot of breaks in speech, a lot of ums and uhs, and I can’t seem to really
say what I want to in regular conversation.
And that all results from caffeine causing me to not sleep that well.
So it’s worth checking out a life with a little less caffeine, if you’d like.
Thanks so much for watching.
Take care of yourself and be well.