Too Much Energy Drinks Causes Tooth Erosion

Guess what I'm drinking in my 2 water bottles in 2001?

My patient who is a dentist tells me he is seeing a lot of younger patients having erosion in their teeth.  The features of their particular erosion is non-bacterial acid induced loss of dental hard tissue. A notable contribution is due to increased consumption of acidic drinks, especially energy drinks. 

Fortunately, I never had any Red Bull or Monster in my water bottles when I was still training seriously or racing.

Like I wrote previously, energy drinks are thought to be beneficial for performance. My platoon mates in the army when we were doing national service, would frequently load up with energy drinks such as Red Bull. There was no Monster drink then. They would consume it especially in the morning before physical training and Standard Obstacle Course (SOC) training sessions. Those who were less fit tended to count on those energy drinks. One of them commented that without Red Bull he would definitely fail his fitness tests.

Some of them would also mix Red Bull with alcohol when they book out on Fridays so they can party the night away.

This was similar when I was in university. Some of my classmates did the same when cramming for an exam or writing a paper.

Energy drinks from the study

A paper published last year (Martinez et al, 2024) was investigating the pH of energy (pictured above) and pre workout/ sports drinks (below) and the consumption frequency and habits among amateur athletes. Their study analyzed the pH of 67 commercially available energy drinks and pre workout/ sports drinks. There were 43 energy drinks and 24 pre workout/ sports drinks.

Pre workout/ sports drinks

The authors also did a survey among 113 amateur athletes who completed an anonymous questionnaire to find out about the use of different beverages during various sports activities. The participants participated in strength training, endurance sports and some of them participated in both. They reported consuming energy and/ or pre workout/ sports drinks before, during or after workout.

Ready for the results? The average pH for the beverages studied was 3.3. The pH level at which enamel erosion begins is approximately 5.5, which is known as the critical pH. When the pH in our mouths drop below this level, the enamel starts to dissolve, leading to tooth decay.

51 percent of the participants surveyed said, they consumed at least one of the beverages studied. Most participants aged ≤ 29 consumed them 3-5 times each week while the older participants consumed them 1-2 times per week.

Shocked? The study showed that ALL the  energy drinks and the majority of pre workout beverages evaluated have erosive pH levels that can damage tooth enamel. Please remember this when using energy drinks or pre workout/ sports drinks. 

I always carry water with me during my bike rides instead of energy or sports drinks. Drinking plain water after your sports drinks is a good way to mitigate the erosive nature of the energy drinks. You may also want to brush your teeth when you get home.

Reference

Marthiez Lm, Lietz, LL, Tarin CC et al (2024). Analysis Of The pH Levels In Energy And Pre-Workout Beverages And Frequency Of Consumption: A Cross-Sectional Study. BMC Oral Health. 24,1082. DOI: 10.1186/s12903-024-04843-0.

Take your pick

Does Dynamic Stretches Help Running Performance?

Our new physios doing the dynamic stretches

Previously I had written that performing any static stretches before exercise or competition can be detrimental to your athletic performance. Studies have also shown that doing static stretches before competing or exercising is more likely to cause an injury. In fact, performing just one static stretch of 30 seconds can reduce your maximum strength.

Meanwhile, fitness professionals, coaches and other studies have suggested performing dynamic stretches as an alternative warm up to static stretches instead.

Well, this published study had runners do both. An initial assessment was done to get the runners VO2 max levels. The researchers had a group of well trained university runners do a general warm up (GWU) on one day versus doing a general warmup (GWU) plus dynamic stretching (DS) before getting them to run until exhaustion on a treadmill on another day.

The GWU consisted of running on the treadmill at a speed equivalent to 70 percent of each runner's VO2 max for 15 minutes. Each runner then did a standing rest for 5 minutes. This was followed by the run to exhaustion on the treadmill at a speed equivalent to 90 percent of their VO2 max. 

When doing the GWU plus DS, dynamic stretches were done for all the lower limb muscle groups (10 reps each), see picture below. That took 3 min 45 seconds in all. After resting for 1 min 15 seconds, the runners started their run to exhaustion on the treadmill at a speed equivalent to 90 percent of their VO2 max. 

Well, this published study had runners do both. An initial assessment was done to get the runners VO2 max levels. The researchers had a group of well trained university runners do a general warm up (GWU) on one day versus doing a general warmup (GWU) plus dynamic stretching (DS) before getting them to run until exhaustion on a treadmill on another day.

The GWU consisted of running on the treadmill at a speed equivalent to 70 percent of each runner's VO2 max for 15 minutes. Each runner then did a standing rest for 5 minutes. This was followed by the run to exhaustion on the treadmill at a speed equivalent to 90 percent of their VO2 max. 

When doing the GWU plus DS, dynamic stretches were done for all the lower limb muscle groups (10 reps each), see picture at the top. That took 3 min 45 seconds in all. After resting for 1 min 15 seconds, the runners started their run to exhaustion on the treadmill at a speed equivalent to 90 percent of their VO2 max. 

The results showed that the GWU plus DS group lasted significantly shorter (10:40 min)  than the group that just did the GWU (12:40 min). Distance covered was between 2.3 to 5.4 km.

The authors of this study were hypothesizing that performing GWU plus DS may help improve endurance running performance. Unfortunately the results indicated otherwise. 

Another study by the first 3 authors (Yamaguchi et al, 2015) showed that performing the same five DS (10 reps) followed by a rest period of 1 min 23 secs actually prolonged the run time to exhaustion (an extra 18.2 percent) compared to a sit down rest. Run to exhaustion on the treadmill was also done at a speed equivalent to 90 percent of their VO2 max.

What is good about this study was that there was real attention to detail. The testing was done during the off season for the runners so no prior vigorous training was done. The runners were also asked to avoid performing intense exercises or training on each test day and the day prior. 

The runners were also instructed to have similar meals and drinks on the test days and previous day and to finish any meal 2 hours before running. Runners were also asked to avoid alcohol the day before running and caffeine on the test day. Each runner wore the same attire for the test runs and performed the test at the same time of day in consideration to circadian rhythm. The laboratory temperature was kept constant at 20-24 degrees Celsius throughout. In short, the authors tried to keep everything else constant other than the warm up. 

What wasn't as good? Bear in mind that the study only had 8 runners. They are definitely fast runners (looking at their profile), but the sample size is small. The rest period after the dynamic warmup was also extremely short (150 seconds). Fatigue after the DS was attributed by the authors as the cause for worse performance.

When I was competing in events like 1500m - 5000m on the track, I'll do a rather languid jog of 2-3 km to warm up followed by some limbering movements to loosen up. This was followed by repeating some striding (or goal pace running) 5-8 times for 150-200 meters. Then it would be resting and waiting for our event to start. Definitely longer than 1 minute 15 seconds before racing. Definitely did not do any sort of stretching then.

My advice would be to try out dynamic stretches or whatever that is new (shoes, bike, run technique etc) in your off season, not before an important competition, to see if it would be something that might work for your body. Most importantly, do what works for you. Every body is different.

References

Yamaguchi T, Takizawab K, Keisuke S. (2015). Acute Effect Of Dynamic Stretching On Endurance Running Performance In Well-trained Male Runners. J Strg Cond Resc. 29: 3045-3052. DOI:10.1519/JSC.0000000000000969

Yamaguchi T, Takizawab K, Keisuke S et al (2019). Effect Of General Warm-up plus Dynamic Stretching On Endurance Performance In Well-trained Runners. Res Quart Ex and Sport. 90(4): 527-533. DOI: 10.1080/02701367.2019.1630700.

*thanks to Thiviyan and Rashid Aziz for getting me the articles

Definitely No Bull

Energy drinks on offer - you buying?

My previous article on energy drinks like Red Bull was one of the more popular articles the year I wrote about it. Many readers commented that they were not aware how bad energy drinks were. In fact, the World Health Organization issued a statement calling energy drinks a potential danger to public health.

Now it seems that there may be more reasons to avoid energy drinks.

A recently published article suggest that caffeinated energy drinks can also raise blood pressure and alter your heart's electrical circuit.

That is definitely not surprising considering there was a case report showing atrial fibrillation (or abnormal heart rhythm in a 14 and 16 year old boy) and even a case of heart attack in a 19 year old previously after consuming energy drinks

The researchers tested two groups of healthy people between the ages of 18-40.  One group drank energy drinks that can be easily purchased containing 304-320 milligrams of caffeine while the other drank a placebo drink consisting of lime juice, carbonated water and cherry flavoring.

The participants drank 946 ml (or 32 ounces) of either one of those drinks on three separate days while researchers measured their heart's electrical activity and blood pressure. Measurements were taken before they drank, twice within the hour that they drank the beverage and four hours after.

Now, you'll be shocked to read that they group that drank the energy drink showed higher QT intervals up to four hours later. The QT interval is the time it takes the lower chambers of your heart to prepare for a beat. In general, the normal QT interval is below 0.4 to 0.44 seconds. If the interval is too short or long, it can cause arrhythmia. This is a condition where the heart beats abnormally.

Other than the change in QT intervals, those that drank the energy drink had a significant increase in systolic and diastolic blood pressure.

Coffee lovers will be glad to know that the researchers do not think that caffeine is the main culprit for the increase in QT interval. It may be the caffeine in combination with the other ingredients like sugar, high fructose corn syrup, artificial sweeteners and non nutritive stimulants like guarana, ginseng taurine, L-carnitine, inositol, verba mate and D-glucuronoalactone that caused the changes.

The researchers cautioned the elderly, young children and those of you who have underlying long QT intervals, hypertension and taking antibiotics and anti-arrhythmic medication to be careful with consuming energy drinks.

Also, consuming a few cans of the energy drinks can certainly exacerbate those with underlying heart conditions or those taking certain heart medications.

Reference

Shah SA, Szeto AH et al (2019). Impact Of High Volume Energy Drink Consumption On Electrocardiographic And Blood Pressure Parameters: A Randomized Trial. JAHA. 8(11). DOI: 10.1161/JAHA.118.011318.

Now that's a lot of bull you do not want

This Is No Bull .....

Energy drinks from Cold Storage

When I was doing my National Service in the army, some of my platoon mates who were having issues with their fitness would frequently load up with "energy drinks" such as Red Bull. Especially in the morning before physical training and/ or Standard Obstacle Course (SOC) training sessions. They definitely did before the SOC tests too.

I'll ask them why and they'll say that it gives them a "boost" to be able to finish the training strongly or pass the test. Some of them will also mix Red Bull with alcohol when they book out on Fridays so they can party the rest of the night away.

Later while studying in university, I found out some of my classmates did the same when cramming for an exam or writing a paper. A published paper found that 51 percent of college students consumed at least a bottle of energy drink a month.

So I'm sure you would have seen, heard or perhaps even tried some of the above. Well, if energy drinks such as Red Bull is your drink then you may want to read on.

Sure, the energy drinks may give you a temporary boost, but it can also give you a whole lot of other problems. Previous studies show that they can mess with your sleep, make you gain weight and increase your blood pressure. They can also lead to substance abuse, mental health problems, higher risk of developing diabetes, dental problems and even kidney damage.

Energy drinks are advertised to boost/ improve energy, stamina, athletic performance and even your concentration. Similar to sports drinks (Gatorade, Powerade, 100 Plus etc), the target consumer market for energy drinks are adolescents and young adults.

Energy drinks typically contain lots of sugar, high fructose corn syrup, artificial sweeteners, caffeine, certain vitamins, minerals and non nutritive stimulants (such as guarana, ginseng, taurine, L-carnitine, inositol, yerba mate and D-glucuronolactone).

An average 500 ml can of energy drink contains about 54 grams of sugar, way above the recommended 36 grams for men. You've read here that it is through consuming excessive sugar that causes you to get diabetes.

According to the article referenced below, some energy drinks reviewed contained as much as 207 mg of caffeine (recommended daily allowance for adults is 400 mg/ day, 100 mg/day for adolescents). When you consume more, you may feel anxious, depressed or even harbor suicidal thoughts.

Excessive caffeine along with other stimulants such as taurine, guarana and ginseng can also affect your blood pressure.

The authors concluded that current evidence suggest that health risks outweigh any short term perks or benefits you may experience from energy drinks.

Now you know.

References

Al-Sharr L, Vercammen K et al (2017). Health Effects And Public Health Concerns Of Energy Drink Consumption In The United States: A Mini-Review. Frontiers in Public Health. 31 August 2017. DOI: 10.3389/fpubh.2017.00225.

Heckman MA, Sherry K et al (2010). Energy Drinks. An Assessment Of Their Market Size, Consumer Demographics, Ingredient Profile, Functionality, And Regulations In The United States. Comp Reviews in Food Sci Food Safety.  29 April 2010. DOI: 10.1111/j.1541-4337.2010.00111.x

Now, that's a lot of Red Bull in there

I took the picture above and below while riding to my previous clinic a few years ago thinking I may one day use the pictures. Glad I can use the pictures now.

A closer look