Second person dies after consuming Panera's "Charged Lemonade": Examining the hazards of this sweet beverage for certain patients

Food retailers continue to market highly caffeinated energy drinks despite their dangers. 

A Florida-man died recently after drinking three charged lemonades from Panera Bread. This is the second death linked to the energy drink like beverage. The customer, Dennis Brown, 46, collapsed on his way home from the eatery. In the lawsuit filed following his death, it was explained that Brown may not have known how much caffeine was in the drink, in part, because he had an intellectual disability.^[]

According to Panera Bread's website, The charged lemonade has upwards to 237mg of caffeine in it, and customers can refill their cups for free.

The first lawsuit

Following the death of their 21-year-old daughter, Sarah Katza, a family is suing Panera Bread after the company allegedly improperly marketed a dangerous energy drink. Hours after consuming a large Panera Charged Lemonade, Katz went into cardiac arrest and died, according to a lawsuit obtained by NBC News.^[] 

The lawsuit alleges that the beverage was dangerous and “‘defective in design.’” Furthermore, it suggests that Panera Bread improperly marketed the product, stating that it had “‘no warning of any potentially dangerous effects, even the life-threatening effects on blood pressure, heart rate, and/or brain function.’”^[]

Caffeine and health risks

Drinking too much caffeine in any form can have undesirable health effects, particularly for young people and children, says Tracy Zaslow, MD, a board-certified pediatrician and Primary Care Sports Medicine Specialist at Cedars-Sinai Kerlan-Jobe Institute in Los Angeles, CA.

“Caffeine acts as a stimulant on the central nervous system,” which can impact various organ systems and cause “increases in heart rate, blood pressure, speech rate, motor activity, attentiveness, gastric secretion, diuresis, and temperature,” Dr. Zaslow says. She adds that drinking too much caffeine can bring about a range of symptoms, including:

• Headache

• Insomnia

• Nervousness

• Irritability

• Frequent urination or inability to control urination

• Fast heartbeat

• Muscle tremors

• Caffeine toxicity

Caffeine’s impact on the heart

Prior to her death, Katz was diagnosed with the heart condition long QT syndrome type 1. This is an often-inherited, rare condition that impacts the potassium ion channels in the heart, disrupting the heart’s electrical activity and increasing the risk of an abnormal heartbeat. According to Stanford Medicine, people with the condition may be advised to be cautious when performing activities that impact the trigger, including physical exercise like swimming.^[]

“High doses of caffeine have a direct effect on the rhythm of the heart,” says Ilan Shapiro, MD, a pediatrician and Chief Health Correspondent and Medical Affairs Officer at AltaMed Health Services in Los Angeles, CA. “If we have an underlying problem with the muscle or the electricity of the heart, this can produce problems like a heart attack or an arrhythmia.”

Caffeine and lethal limits

According to the United States Food and Drug Administration (FDA), up to 400mg of caffeine—or about four or five cups of coffee—per day appears safe for adults without certain conditions. Studies say that “[l]ethal doses of caffeine have been reported at blood concentrations of 80 to 100 mig/ml, which can be reached with ingestion of approximately 10 grams or greater.”^[][]

Caffeine and legal limits

Despite these risks, the FDA only loosely regulates caffeine in food and beverage products.

The agency asks that products with added caffeine present caffeine as an ingredient on the label. However, products that inherently contain caffeine, such as coffee, tea, or guarana, do not have to explicitly list caffeine as an ingredient on the label. Where labeling is relevant, the FDA does not require manufacturers to list exact caffeine levels, nor does it specify a limit for caffeine in food or beverage products.^[] 

Caffeine and medical limits

Some health organizations have taken a firmer stance on regulating caffeine, particularly for young people, with some parents and pediatricians calling for age-based restrictions on caffeinated energy drinks.

Currently, the American Academy of Child and Adolescent Psychiatry recommends that children ages 12 to 18 limit caffeine consumption to a maximum of 100 milligrams per day (about one cup of coffee or two 12-ounce cans of cola). The agency also advises that children under 12 avoid caffeine altogether. Furthermore, it recommends against consuming energy drinks, like Panera’s Charged Lemonade, for all children and teens.

Energy drinks versus sports drinks

Some people mistake energy drinks for sports drinks, but the two categories should not be viewed as interchangeable, Dr. Zaslow says. Using proper language around energy drinks might help communicate risk. 

Sports drinks include (often-flavored) beverages that contain carbohydrates, minerals, electrolytes, and/or vitamins or other nutrients, whereas “energy drinks are beverages that typically contain stimulants, such as caffeine and guarana, with varying amounts of carbohydrates, protein, amino acids, vitamins, sodium, and other minerals,” Dr. Zaslow explains.

Energy drinks can be dangerous due to their high caffeine content, and for those who rely on them for substances that should be provided through food, she adds.

“Although the term ‘energy’ can be perceived to imply calories, ‘energy drink’ is a misnomer,” Dr. Zaslow says. “Energy drinks often contain little fuel (i.e. carbohydrates) but provide an ‘energized’ sensation when the energy drink is consumed due to the stimulants.”

Staying safe in an unregulated environment

When it comes to reducing risks from caffeine consumption, it is important to be mindful of intake and to avoid extreme consumption, Dr. Shapiro says. Staying away from highly caffeinated energy drinks can be a healthy choice for many people, particularly young people and anyone with a heart condition. 

“Having one cup or two cups of coffee a day will not make a difference,” Dr. Shapiro says. “But adding a lot of caffeine to our diet, [particularly for people with heart conditions], could produce problems with [heart] rhythm or the muscle itself.”