FDA questions caffeine in alcoholic beverages

The Food and Drug Administration on Friday took the first step toward banning alcoholic beverages that contain caffeine, sending letters to nearly 30 manufacturers of such products giving them a month to prove that the products are safe.

The drinks have been a subject of recent controversy. The attorneys general of California and 17 other states have been pressing the FDA to take action against the products because they pose an unusual risk to young people. The caffeine in the drinks tends to mask the impairment produced by alcohol, leading to "increased risk-taking and other serious alcohol-related problems such as traffic accidents, violence, sexual assault and suicide," they wrote in a letter to FDA.

Lawsuits by the states have led the two largest manufacturers to alter the composition of their products or stop selling them. Last year, Anheuser-Busch removed caffeine and some other additives from the flavored malt beverages Tilt and Bud Extra. MillerCoors agreed to stop selling its major product, Sparks.

Under the federal Food, Drug and Cosmetic Act, a substance added intentionally to food (such as caffeine in alcoholic beverages) is deemed "unsafe" and is unlawful unless that particular use has been approved by the FDA or the substance is generally recognized as safe. Caffeine has not been approved for use in alcoholic beverages and the FDA "is not aware of any basis that manufacturers have to conclude that the use of caffeine is generally recognized as safe," Dr. Joshua M. Sharfstein, principal deputy commissioner of food and drugs, said in a news conference.

The caffeinated beverages, which are similar to their non-alcoholic counterparts, account for about 1% of the beer market, with annual sales of about $1 billion, according to Eric Shepard of the trade publication Beer Marketer's Insights.

Among the companies receiving the FDA letter were Joose Beverage of Los Angeles, Mix Master Beverage Co. of Stateline, Nev., and Blank Beverages Co. of San Diego.

More information is available at the FDA website.

-- Thomas H. Maugh II

Sleep apnea and alcohol really don't mix

For sufferers of obstructive sleep apnea, it doesn't take much for performance, precision and alertness to degrade dramatically. It doesn't take much alcohol, and it doesn't take many hours of sleep deficit either, for things to get really dangerous, new research has found.

Sleep apnea is a condition in which a sleeper stops breathing repeatedly in the night for long periods of time. It affects more than 12 million adults -- and disproportionately strikes males, obese people and those older than 40. Daytime sleepiness is its most immediate consequence. But over time, suffering from sleep apnea heightens a person's risk of high blood pressure and metabolic problems, including type 2 diabetes.

It turns out that the risk of a driving accident also increases --and even more if sleep apnea is compounded by alcohol consumption or short sleep.

In a 90-minute driving simulator, the performance of subjects with sleep apnea was compared to that of subjects without the condition. People in each group conducted a simulator session under three conditions: after unrestricted sleep, after a single night with only four hours of sleep, and after consuming enough alcohol to attain a blood-alcohol level of 0.05% (lower than the 0.08% observed by most states as the definition of intoxicated).

In all cases, those with sleep apnea were more likely than their healthy-sleeping peers to swerve and veer off-course. And even with a full night's sleep, those with sleep apnea were 10% likelier to have a crash than subjects who slept without breathing interruption. At a blood alcohol level well short of drunk, the sleep apnea group was 21% more likely to crash the simulated car than were their peers who slept well. On only four hours of sleep, sleep apnea sufferers were 32% more likely to crash than were healthy sleepers.

For those with sleep apnea, the Australian researchers suggested that even moderate alcohol consumption or a single night of short sleep can be dangerous and should be avoided if safety and alertness are at issue. Their study is published in the Annals of Internal Medicine dated Oct. 6, 2009.

-- Melissa Healy 

Wonder if you could have sleep apnea? Here's a quick test.

Mediterranean diet reduces depression, study suggests

Jetting to the sunny climes of the Mediterranean couldn't hurt if you feel a bout of depression settling in.

But a new study in the Archives of General Psychiatry finds that if your aim is to minimize your risk of depression in the first place, you might stay right where you are and make your plate look like it's been to the Mediterranean. You should scale back on the meats and dairy fats, eat some nuts, and increase your consumption of fish, vegetables and legumes doused in olive oil.

Oh, and pour yourself a glass of wine. Not half a bottle; one glass, maybe two.

The Mediterranean diet has been linked to reduced risk of heart disease, stroke, Type 2 diabetes and cancer. it was only a matter of time before researchers would begin to wonder whether a Mediterranean diet could also reduce the risk of depression -- which, like all of the above diseases, is linked to higher levels of inflammation throughout the body. They found tantalizing suggestions of such a link: Compared with Northern Europe, the countries surrounded by the Mediterranean report lower rates of mental illness and suicide. 

The study linking adherence to a traditional Mediterranean diet with reduced depression risk is the first to test that link prospectively. It followed a group of subjects over several years, tracked their eating patterns and recorded how many reported several symptoms or a diagnosis of depression. This one tracked 10,094 graduates of the University of Navarra in Spain for roughly 4 1/2 years and found that the more closely subjects stuck to the principal elements of a Mediterranean diet, the lower their likelihood of developing depression.

So what is it -- the sunshine, the hillside towns that keep even octogenarians walking daily on errands? The tradition of far niente? The wine, the fish, the nuts, the legumes, the olive oil? While acknowledging that lifestyle factors or genetics may contribute to the lowered risk of depression, the researchers focused largely on the dietary components, and sought to single out one or two more powerful than the others in warding off depression.

In the end, they noted, "the role of the overall dietary pattern may be more important than the effect of single components." They even suggested that depression may yield in the face of a "synergistic combination" of polyunsaturated fats from olive oil and nuts, antioxidants from fruits and flavenoids, B vitamins and natural folates from vegetables and wine.

-- Melissa Healy

Alcohol may land you in the ER, but it also may help you survive

Without a doubt, alcohol use can lead to accidents, even fatal ones. And it can screw up the body's ability to recover from traumatic injury, some studies have shown. But it's also been linked to shorter hospital stays and better outcomes after such injuries.

So researchers at the Los Angeles Biomedical Research Institute, on the Harbor-UCLA Medical Center campus, gathered data on the blood alcohol level of almost 8,000 trauma patients -- and compared the death rates of those who had indulged against those who hadn't.

Turns out, the drunken ones fared better. Only about 1% of the intoxicated patients died; compared with 7% of the nonintoxicated patients. 

More study is needed, concludes the study published in the American Surgeon, as to what precisely the protective mechanism might be.  (Here's the press release; the article itself isn't easily accessible.)

Also worth noting is this point in the study's discussion section: "The mortality rate reported here is based on patients who are actually brought to the hospital, and the sample is thus limited by selection bias. It is certainly possible that a higher proportion of those who died in the field were intoxicated and were thus never transported to the hospital."

Ah.

-- Tami Dennis

Photo credit: Associated Press

The more students change, the more drinking stays the same on some college campuses

Anti-binge drinking campaigns have been fixtures on college campuses for years, warning of the physical, mental and legal ramifications of drinking too much. But are students getting the message?

Maybe not, since drinking habits haven't changed much in 12 years on U.S. campuses where drinking is heaviest, according to a new study in this month's issue of the Journal of Studies on Alcohol and Drugs. Researchers looked at periodic surveys given to students on 18 heavy-drinking campuses from 1993 though 2005. The surveys asked not only about their drinking habits, but also the consequences of excess imbibing, such as having a hangover, missing class, damaging property, and driving while drunk.

Results showed little statistical change over time. In 1993, 58.1% of participants described themselves as heavy episodic drinkers, defined by five (for men) or four (for women) drinks or more per drinking occasion at least once in the last two weeks. In 2005, 55.8% described themselves that way. The number of abstainers grew slightly, as did the number of frequent heavy episodic drinkers, those who drank five (men) or four (women) drinks on three or more occasions in the last two weeks, rose a bit more.

Problems associated with drinking also stayed about the same, with some exceptions--those who reported driving after any drinking slowly rose from 1993 to 1997 before tapering off, ending with the same percentage in 2005 as in 1993.

The researchers speculated on factors that could contribute to the stagnant statistics, such as campuses not doing enough to curb heavy alcohol consumption, or anti-binge drinking campaigns not getting through to students. They argue that colleges might need additional support from other sources such as law enforcement, parents and boards of trustees.

"More research is needed," wrote the study authors, "to understand what colleges are doing to combat heavy episodic drinking, whether they are using recommended interventions—the barriers to implementing recommended interventions—and whether their efforts effectively reduce alcohol use and related consequences."

-- Jeannine Stein

Photo credit: Craig Hartley / Bloomberg

College students pack a heavy bag of mental illness

Loading up the car for college? The American Psychiatric Assn. reminds us that while college can be a time of great hope and exuberance, that's not always the case: Its 2008 American College Health Assn. Survey found that 30% of college students reported that at some point in the last 12 months, they had felt so depressed it was hard to function. And 49% reported that in the same period, they had experienced overwhelming anxiety.

Ten percent of those surveyed said they had been diagnosed or treated for depression, and 6% reported they had seriously considered suicide. And a study published December 2008 in the Archives of General Psychiatry found that alcohol disorders affected roughly one in five college students. The next-most-common class of disorders were personality disorders, affecting about 17.7% of college students.

We know from the website Active Minds, devoted to "changing the conversation about mental health on college campuses" and to providing mental-health resources to college students, that an average of 1,100 college students die by suicide each year. Sure, there's beer-pong and all-night partying. But there's crushing pressure as well, and it can take a toll on students' mental health. (To find a chapter, or start one on your campus, look here.)

The Los Angeles Times' Shari Roan wrote back in September 2007 about the growing demands on college mental health services, and some of the dilemmas they face in serving troubled students on the cusp of adulthood. Now would be a good time for parents and students alike to revisit that article. 

-- Melissa Healy

Watching cable TV may expose teens to too many alcohol ads

Teens soak up more than plot lines while watching cable TV -- they're also being exposed to too much alcohol advertising.

That's the conclusion of a new study that looked at what teens watched on cable, and how often alcohol ads popped up during those shows. Previously, the Center on Alcohol Marketing and Youth analyzed more than 1 million alcohol industry ads between 2001 and 2004 on broadcast, cable and local television and found big numbers of underage youth were exposed to them. This prompted the National Research Council and the Institute of Medicine in 2003 to call for reforms of the alcohol industry's marketing codes and practices, and the Beer Institute and the Distilled Spirits Council of the United States agreed to limit ads when underage viewers made up 30% or less of the audience.

In this study, researchers found that 608,591 ads were placed in 205,592 unique time slots on national cable networks between 2001 and 2006. From 2004 to 2006 beer and spirit ad placement increased overall and in time slots with more than 30% underage viewers, compared with ads from 2001 to 2003.

They also discovered that as adolescent viewership increased by one percentage point, beer ads increased 7%, ads for spirits went up 15%, and ads for alcopop (flavored and often sweetened alcoholic beverages) increased 22%.

While the study didn't examine whether or not advertisers were specifically targeting teen audiences (and they say they don't), lead author Dr. Paul Chung said in a news release, "[T]he ultimate effect of their advertising strategies, intentional or not, appears to be greater exposure than might be expected if adults were the sole targets of ads." Chung is assistant professor of pediatrics at Mattel Children's Hospital UCLA. The study appears in the October issue of the American Journal of Public Health.

-- Jeannine Stein

Photo credit: Ken Hively / Los Angeles Times

Binge drinking: It's not just for kids anymore

The early baby boomers may be known as the generation of sex, drugs and rock and roll. But it turns out, they're hitting the bottle pretty hard as they age, as well. And that portends significant alcohol-related health problems ahead as those mid-lifers become seniors.

A new study finds that among men and women 50 to 64 years old, almost 1 in 4 men and 1 in 10 women is a "binge" drinker -- meaning that at some point in the last 30 days, he or she has downed four (for women) or five (for men) servings of alcohol in a single two-hour sitting. Such alcohol abuse -- roughly defined as the amount needed to attain a blood-alcohol level of .08 (the level at which most states consider a driver intoxicated) -- frequently escapes the notice of physicians, even though it presents an escalating health risk as the drinker ages.

The study, published in the American Journal of Psychiatry, found that binge drinkers are more likely to use tobacco or illicit drugs than those who do not drink. (It also found that among women, binge drinking was more common among the employed and those using prescription drugs for nonmedical purposes; among men, it was more common among the unmarried and those with higher incomes.)

Binge drinking among this still highly mobile group is associated with an increased risk of traffic accidents and other alcohol-related injuries. But as these drinkers reach their senior years, when they are more likely to have chronic medical conditions and to take a wider range of prescription drugs, binge drinking incurs greater risks to health, as well. In particular, as this generation escalates its use of analgesic medications for the aches and pains of aging, liver damage can become a greater risk.

Duke University psychiatrist Dan Blazer, one of the authors of the study, said its findings suggest that physicians should ask their patients more pointed and specific questions about alcohol use, because a habit of binge drinking often "flies beneath" the radar of standard alcohol-disorders screens.

The 50- to 64-year-olds surveyed in the latest study are less likely to be risky drinkers than young adults, who in a recent finding, binge-drank at a rate of 41.7% for college students versus 37.1% of those not attending college. Among these populations, experts in substance abuse expect a certain amount of excessive use -- part of exploring limits (and testing their perceived immortality) -- before moderating alcohol consumption as young adults and settling down to the responsibilities of parenthood, careers and adulthood. 

It's not clear how much baby boomers ever settled down and moderated their drinking habits; the latest study takes a current snapshot of American adults, rather than a look across the lifespan of the middle-aged. (One study that looked at a 1999-2000 national survey of Americans found that 67% of baby boomers who drink did so at levels that exceeded moderation.)

But the present study does show that 50- to 64-year-olds engage in binge drinking more than the generation ahead of them does. In those over 65, 14% of men and 3% of women were found to be binge drinkers. (For those 50 to 64, the rates were 23% for men and 9% for women.)

--Melissa Healy 

Alcoholism disrupts ability to read emotions, conduct relationships

Of the many things that long-term alcohol addiction can steal -- careers, lives, health, memory -- one of its most heartbreaking tolls is on relationships. Alcoholics, researchers have long known, have a tendency to misread emotional cues, sometimes taking offense when none was intended, failing to pick up on a loved one's sadness, joy, anger or disappointment.

The misunderstandings can result in more drinking -- and more deterioration of relationships and lives.

How does alcohol do all that? A new study finds that the brains of long-term alcoholics, even those who have been abstinent for long periods, are often different from those who do not suffer the affliction -- different in ways that make them poorer judges of others' facial expressions. In particular, the parts of our brains that are typically activated when we observe, record and react to expressions on another person's face -- the amygdala and hippocampus, collectively known as the limbic system -- do not respond with the same intensity in alcoholics when they observe another person's face.

The study's authors observed those differences by watching the brains of 15 abstinent alcoholics and 15 non-alcoholics at work while the subjects looked at pictures of faces expressing positive, negative and neutral emotions and answered an unrelated question ("How intelligent do you think this person is?"). As they did so, researchers from Massachusetts General Hospital and Boston University peered into their brains using functional Magnetic Resonance Imaging, which tracks brain activity from second to second. The result is published online in the journal Alcoholism: Clinical and Experimental Research.

When looking at faces that projected emotions, the amygdala and hippocampal regions of the non-alcoholics showed evidence of strong activity. When those same subjects looked at neutral facial expressions, the non-alcoholics' limbic systems were relatively quiet.

But the alcoholics' limbic systems, on the whole, responded no differently to facial expressions that conveyed strong emotion than to those that were neutral. The individuals in the two groups were matched on factors such as age, IQ, education and socioeconomic status. But their brains reacted completely differently when their eyes were confronted with evidence of anger, joy, sadness or disappointment.

At the same time, the study found some evidence of the brain's vaunted resilience and flexibility. For the abstinent alcoholics, lower levels of activity in the limbic system generally came with higher levels of activity in the frontal cortex -- the seat of judgment where cooler assessments are made. That finding is in line with a lot of research that finds that even after alcoholism has wreaked havoc on a person's brain, a lengthy period of abstinence often brings some cognitive recovery, as the brain "rewires" itself to compensate for damaged functions.

Ksenija Marinkovic, one of the study 's authors, cautioned that the study leaves one of researchers' most burning questions unanswered: Whether the blunted emotional sensitivity evident in the alcoholics came first -- and then gave way to alcoholism -- or whether alcoholism brought about changes in the brain that blunted peoples' sensitivity to others' emotions.

The idea that alcohol abuse damages the brain makes intuitive sense. But some research suggests instead that a child's cognitive deficits -- especially in the realm of emotional intelligence -- may set off a cascade of events leading to alcoholism later. Past research has shown that the children of alcoholics often exhibit the same deficits in reading emotions -- and that children of alcoholics are at far greater risk of becoming alcoholics themselves. That would suggest that emotional difficulties and miscommunications can lead to feelings of failure and discouragement, which  can lead to alcohol use and eventual dependence. 

"It's a chicken-or-egg problem. We just don't know which comes first," said Marinkovic, who has since moved to UC San Diego.

Wonder whether you're at risk of alcoholism and its effects, or whether your drinking could be impairing your relationships? The National Institute on Alcohol Abuse and Alcoholism has a new user-friendly website, Rethinking Drinking,  where you can find out more. 

-- Melissa Healy

Binge drinking affects later cognitive performance

College students who describe themselves as regular binge drinkers performed considerably worse on a test measuring attention and memory skills compared with students who didn't binge. The test, by the way, was conducted while all the students were sober.

The results suggest that binge drinking may affect the brain in ways that are normally seen in alcoholics, say the authors of the study, from University of Santiago de Compostela, Galicia, Spain. The study is published online today in the journal Alcoholism: Clinical & Experimental Research.

Binge drinking is defined as men who drink five or more standard alcoholic drinks within a two-hour interval. For women, the amount is four drinks or more. In the study, 42 binge drinkers were compared with 53 students who did not binge or drink alcohol regularly. The students' brain waves were measured while they performed mental tasks.

"We found that healthy young university students -- meaning those with no alcohol use disorder, alcohol dependence or associated psychiatric disorders -- who engaged in binge drinking showed anomalies during the execution of a task involving visual working memory, despite correct execution of the task, in comparison with young non binge drinkers. They required greater attentional processing during the task in order to carry it out correctly," said Alberto Crego, a co-author of the study, in a news release.

The binge drinkers also showed more difficulty distinguishing between relevant and irrelevant information.

"Healthy adolescents and young people who partake in intermittent consumption of large amounts of alcohol -- otherwise known as binge drinking -- even only once or twice  a week, and who do not display chronic alcohol consumption or alcohol dependence may nonetheless suffer alterations at the electrophysiological level in attentional and working memory processing," Crego said.

-- Shari Roan

Photo credit: Lee Romney  /  Los Angeles Times