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Experts Say Four Loko Worse than Mixed Drinks

Alcoholic energy drink maker Phusion Projects, which produces the controversial malt beverage Four Loko, announced late Tuesday (Nov. 16) that it will be removing caffeine, guarana and taurine from its drinks nationwide.

The news follows an announcement yesterday by Sen. Charles Schumer (D-N.Y.) that, after a year of review, the Food and Drug Administration will ban manufactured beverages containing caffeine and alcohol, making drinks such as Four Loko and Joose illegal to sell.

The FDA has not yet announced a ban on alcoholic beverages with caffeine added, but Phusion Projects is scrapping the caffeine ahead of the expected announcement. The FDA will hold a news conference today at 1 p.m.

The drinks had already prompted a spate of state and university bans around the country. Four Loko was banned in Utah, Michigan and Oklahoma, and next month distributors in New York would have been prohibited from selling it.

The state of Washington banned all manufactured alcoholic energy drinks after nine underage students at Central Washington University who drank Four Loko were hospitalized with alcohol poisoning earlier this year.

Brewing controversy

Phusion Projects says its drinks are not harmful, but health experts disagree.

"We have repeatedly contended – and still believe, as do many people throughout the country – that the combination of alcohol and caffeine is safe," the company said. "If it were unsafe, popular drinks like rum and colas or Irish coffees that have been consumed safely and responsibly for years would face the same scrutiny that our products have recently faced."

But what makes drinks such as Four Loko so much worse than the mixed drinks served in bars that preceded them is the combined effects of their higher levels of alcohol and caffeine on the brain, said Dr. Mary Claire O'Brien, an associate professor of emergency medicine at Wake Forest University Baptist Medical Center in North Carolina.

"Caffeine in the beverage is at high-enough levels that it interferes with [people's] ability to tell that they're drunk, so they keep drinking," O'Brien told MyHealthNewsDaily.

Drinks with less caffeine make it easier for people to tell when they've had too much alcohol, she said.

The Food and Drug Administration has been investigating the legality of manufacturing alcoholic energy drinks for the past year and had required companies selling the products to provide evidence that caffeine added to alcohol is safe.

Elements of the drink

Irish coffee — a hot cocktail of coffee, Irish whiskey, sugar and cream — is too warm to chug, O'Brien said, so one drink isn't likely to get you immediately drunk. And a Red Bull and vodka, rum and Coke or any similar mixed drink ordered at a bar isn't likely to have as much caffeine as a 23.5-ounce can of caffeinated malt liquor, she said.

Four Loko contains 156 milligrams of caffeine, compared with 76 in a can of Red Bull.

Phusion Projects says the drink has the same amount of alcohol as wine and some craft beers, and as much caffeine as a tall Starbucks coffee. (According to Starbucks, a tall coffee has 260 milligrams of caffeine.)

But health experts have likened drinking Four Loko to guzzling five or six light beers and up to two cups of coffee.

The effects many people claim to experience from the drinks make sense scientifically, O'Brien said. Most people mistakenly think alcohol and caffeine work in opposition to each other, because caffeine is a stimulant while alcohol is a depressant and can make you sleepy.

But alcohol creates sleepiness by promoting the release of the hormone adenosine in the brain, and caffeine binds to receptors for adenosine in the brain. So when both are present in the bloodstream, caffeine binds to these receptors and blocks adenosine, creating a state of wide-awake drunkenness, she said.

"It's not the same as having coffee after a meal and then a couple glasses of wine," O'Brien said. Alcohol and caffeine are "competing for similar sets of neurotransmitter receptors, so caffeine temporarily blocks the effect of alcohol."

And caffeine and alcohol are broken down by the body at different rates, she said. The rate at which the body breaks down caffeine depends on the amount in the blood — the more there is, the faster it metabolizes — but alcohol is metabolized at a steady rate regardless of whether you've had one beer or 15.

"You keep drinking because you think you're awake," and you are really are, she said. "But when the caffeine has worn off and your alcohol level is super-high, now you're really in trouble. And I think that's where the blackouts come from."

'You're an energized drunk'

While health experts have warned of the dangerous consequences, some argue it's all a matter of drinking responsibly.

Chris Hack, owner of the Spinning Room bar in Tannersville, N.Y., which sells Red Bull and Monster mixed drinks in addition to Four Loko, said he doesn't see a problem with people 21 and older partaking, as long as they are aware of their alcohol intake.

Bartenders are responsible for the people drinking in a bar, he said, "so whether it's alcohol, mixed drinks, beer, energy drinks, whatever, we have to be vigilant in making sure they don’t take it too far here, because we're responsible for when they leave."

Some consumers say the drinks have their purpose.

The reason for the existence of cheap, convenience-store alcoholic energy drinks is to get people drunk quickly and inexpensively, said Paul Anderson, who directs  a marketing and higher education research firm in Lincoln, Neb. Cans of Four Loko and Joose cost $2 to $3 a pop.

Anderson, 23, said he has tried his share of alcoholic energy drinks but generally drinks them only before he goes out dancing or if he knows he'll be at a party for a while.

"You're hyper, you're bouncing off the walls," said Anderson. "You're an energized drunk. It creates a sense of restlessness."

Anderson said he has never had an adverse reaction to an alcoholic energy drink, nor has he seen anyone get into a dangerous situation because of one. But he said that even his friends who are very good at holding their alcohol become stumbling drunks after a few.

"They're blacked out, but they're still running around and babbling, shouting, and I think that’s where they're more likely to make poor decisions," he said. Then "people are more likely to let them make poor decisions, because they're not the drooling drunk that they would be without the caffeine."

This article was provided by MyHealthNewsDaily, a sister site to LiveScience.

Amanda Chan was a staff writer for Live Science Health. She holds a bachelor's degree in journalism and mass communication from the Walter Cronkite School of Journalism and Mass Communication at Arizona State University, and a master's degree in journalism from Columbia University.