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. Take care of yourself and be well..
