The military’s obsession with energy drinks is contributing to PTSD | Hacker News Reader

The military’s obsession with energy drinks is contributing to PTSD

militarytimes.com

100 pointsspking74 comments

Would this even be a story if people were drinking coffee instead? The active ingredient in Red Bull is caffeine. Yet a cup of coffee has more caffeine than a Red Bull. Their marketing has been very effective in convincing people that energy drinks are more than just a caffeinated drink with a bunch of other chemicals that don’t really work. Because of that, people vilify these various drinks, and now we get an article telling us that the drinks are contributing to PTSD, instead of the obviously greater contributing factor: being in a war zone under constant threat of death.

+ Sugar

Yeah, I thought real kick comes from the high sugar content. I used to consume a lot of sugar, but over time I kind of laid off of sugar. Recently, I drank one monster can. Holy shit - I was buzzed and exhausted after.

I don’t know, but I do know caffeine can be a trigger for many people with PTSD. The military is probably not a great place to encourage use of substances that can trigger PTSD episodes, but they do a lot worse to soldiers, so...

Isn't in all red bulls quite a bit of sugar/aspartam? Not a healthy stuff, although it shouldn't cause any PTSD. And what about taurine? Not really very explored substance.

Personally I drink similar stuff maybe 2x per year, when I have a long (>1000km) drive ahead. Otherwise wouldn't touch that chemical junk with a 10 foot pole.

I can’t imagine ingesting chemicals. Do you have any recommended chemical-free foods?

vacuum

...something feels unnatural about this

It’s pretty clear what people mean when they say chemicals in food, so this pedantry is less impressive than perhaps you intended.

Red Bull is honestly not that popular in this crowd though, the major energy drinks you see are Monster, Rockstar, and as mentioned, Rip It (really an offbrand of the former two from the maker of Shasta/La Croix). These typically have 160mg of caffeine, which is high for coffee although not by a large margin. The culture around them seems to encourage much greater consumption though, with oversize cans (e.g. 24oz with over 250mg caffeine) not unusual and many people having multiple drinks a day. It does seem like something about them, perhaps the addition of a great amount of sugar, encourages more consumption.

I'm also a little confused by your accusation, since the article discusses a comparative study of two groups, both in a warzone, and finds increased mental health effects in the group with higher caffeine consumption. No one is denying that combat conditions contribute to adverse mental health effects, but the whole point of the article is that these seem to be exacerbated by caffeine use.

Sleep deprivation is becoming a real concern in multiple military branches, and I suspect that the mental impact is not due to the caffeine per se but due to the culture around it: consumption of hundreds of mg of caffeine is viewed as an acceptable alternative to sleep. This is definitely also an issue with coffee, but energy drinks seem to be predominant today.

(24 oz = 709 ml)

I knew the Iraq war was going downhill when in 2004/2005 the DFACs switched from "free unlimited Red Bull" (4-6 per meal, plus whatever you filled pockets with and drank in between) to Rip-Its and a limit of 2 for takeout.

4-6 per meal, plus whatever you filled pockets with and drank in betwee

How many is that per day? Like 20??

The peak "redbull-stockpiling" was "so we'd have stuff for later" or "for the office/truck/etc." I've certainly consumed 1g/day of caffeine fairly often. The biggest problem is once you get to that level, you need to hydrate (and...dehydrate) constantly, starting about an hour later, for hours.

Most people wouldn't get the 4 meals a day served (breakfast, lunch, dinner, midrats) all at DFACs. I usually ate once or twice a day in the DFAC, and in the summer, especially if you didn't have a physically demanding job, it was hard to even want to eat once a day in 100-120F heat. I often ended up reverse-cycle so had dinner for "breakfast" and then maybe went to midrats or maybe didn't, usually was too busy.

Coffee from "green beans" (the starbucks knock-off) with a total of 6 shots of espresso into a regular-sized paper coffee cup worked pretty well, too -- I could leave the cup in my truck for a few hours and in 120F inside a closed car it would stay rather hot.

It was pretty amazing to me how different things were at different times/places within the war. There were huge bases (where I nominally lived) with 5mph speed restriction (you could actually be pulled over and ticketed; I was once!), strict "you must wear your reflective belt" policies, multiple swimming pools, world-class hospitals, almost walmart-sized PXes, on-base vehicle registration, etc. There were guys living 6-12 in a house out in the country, and people on long range patrols in trucks and (rarely) dismounted, etc. And everything in between.

Gotta have my /sipps/ tho.

I'm actually curious now if the 30 year old boomer meme is in any way an outgrowth of the Iraq war. The aesthetic the meme embraces reminds me a lot of the guys I knew my age and older who served. Gonna have to reflect on this a bit.

Know Your Meme places the origin of 30-year-old boomer in April 2018. Rage comics became a thing in 2008, 2 years after the peak death toll in Iraq. I don't recall any link between the development of rage comics and Iraq though.

Never thought I'd see a reference to the /sipps/ meme on HN, yet here we are.

Personally, I think the 30 year old boomer meme is rooted more in the fact that internet culture moves so fast these days that anything even a few years old is considered dated. Combine that with the definite cultural differences between Millennials and Gen Z, and the boomer meme makes sense.

The sleep deprivation combined with PTSD is a bigger factor I would say energy drinks are a symptom of a much bigger problem.

> and I suspect that the mental impact is not due to the caffeine per se but due to the culture around it

I would assume that people who consume excessive amounts of a sweat fluid from neon colored cans with ridiculous names tagged on it also have lower capability of self reflection and additional tendency towards drug abuse. That might also contribute to less efficient processing of traumatic experiences.

And a boat load of refined sugar.

This is the problem. I am an endurance athlete and I tried Rockstar but the sugar content just means spike, then crash, then crucially, you are more dehydrated after drinking it than you were before! So you either realize this was a mistake and switch to water (and stick to Powerade in future which has the ideal sugar content for fast absorbing without the aforementioned problems) or chug another Rockstar... you can easily get through several 500ml cans that way.

The MilFit/CrossFit group I train with now frequently issues warnings about no energy drinks before big workouts.

It also contains taurine, unlike coffee, which "crosses the blood–brain barrier and has been implicated in a wide array of physiological phenomena including inhibitory neurotransmission, long-term potentiation in the striatum/hippocampus, membrane stabilization, feedback inhibition of neutrophil/macrophage respiratory burst, adipose tissue regulation and possible prevention of obesity, calcium homeostasis, recovery from osmotic shock, protection against glutamate excitotoxicity and prevention of epileptic seizures." [0]

"Long-term potentiation in the hippocampus" in conjunction with traumatic stress is plausibly causally related to PTSD.

[0] https://en.wikipedia.org/wiki/Taurine

Taurine sounds like the perfect cool sounding ingredient that can be safely added with absolutely no effects:

"The amounts of guarana, taurine, and ginseng found in popular energy drinks are far below the amounts expected to deliver either therapeutic benefits or adverse events".

"Absolutely no effects" shouldn't be your default assumption. Lots of compounds have been shown to have subtle long-term effects that weren't obvious at first.

You have to do epidemiological studies to find problems with compounds that have a negative effect only in certain circumstances, because it probably won't be noticed in clinical trials. The foundational example is thalidomide, which is a harmless sedative except in pregnant women. Clinical trials aren't normally done on pregnant women, and they also aren't done on soldiers in active combat.

There may well be no problem, but this is the sort of epidemiological evidence that justifies further study.

Caffeine and incredible amounts of sugar.

According to the story, it's sleep and relaxation deficit that's causing PTSD, not some chemical in the drink. If you deliberately supplement caffeine to maintain an otherwise unsustainable op tempo, the connection is not all that complicated or unreasonable.

"The active ingredient in Red Bull is caffeine."

No - it's Taurene (caffeine as well of course)

Taurene is a whole different game.

Taurene will mess you up long term far more than just caffeine. Taurene has less worse short term effects ... and there doesn't seem to be consensus on long term, but I personally had a serious bout with it messing up my endrocrine.

1 small red bull now and again is enough.

Soldiers need to get more sleep, for god's sakes there's guns and lives on the line. Yes, sleep dep training is important, but with live munitions ... my god man.

Does this story show any causation or is it just correlation? From my experience in the Army and deployed it was the units closest to the FLOT who would have the most energy drink usage- if you don't have other creature comforts (sleep, hot chow, safety) you tend to resort to things that you can access, like cheap energy drinks. These units would also see the most combat and have the highest prevalence of PTSD.

This rings true from my experience in Afghanistan too. We did route clearance in RC North, and were often out for days at a time. Very little bad sleep, end up scraping together whatever cigarettes were available so few people had their preferred brand, the same tired MREs, plastic tasting water which was used for brushing teeth as well as drinking, etc. We did, however, get cases of Rip It and huge boxes of Cliff Bars from the chow hall, sometimes two or more to a truck (3-6 guys). Eventually, all you want is a "flavor" of some kind, and it starts to matter less and less where it comes from. We were all aware that it was better for us to drink the shitty water, but the desire for some kind of gratification eventually overwhelms even the most conscientious efforts to be healthy or maintain balance.

I would agree but I think we can agree that all those who spent their entire deployments on BIAP or Bagram are getting their fair share as well. From my deployment experience, I drank Rip-Its more frequently when we were in the full swing of operations out forward from the relative safety of larger bases. I definitely drank more Rip-Its in Afghanistan on a very small FOB.

Nothing in the article links energy drinks to PTSD.

> High energy drink use, which was classified as consuming two or more drinks per day, was significantly associated with those survey respondents who reported mental health problems, anger-related behaviors and fatigue, the authors found.

The above passage is about as close as the article gets to its title, and it's left vague by combining mental health problems, anger-related behaviors and fatigue into the same statement.

All scientists should be required to take at least two semesters of Chicken-Or-Egg Studies.

All those explaining correlation-is-not-causation to scientists for the 500th time should take at least one semester of "You are not as smart as you think, nor are you very original, or know anything about the copious amounts of statistics scientists have to endure today. You're also conveniently living in a world that apparently allows for cheap and fast intervention studies on rare phenomena with long lead times and no apparent ethical qualms of subjecting people to potential harmful interventions. Because only that could allow you to forgo the imperfect (yet historically highly successful) observational studies"

(-Studies)

Also the causal direction between say, fatigue and energy drink consumption, is not at all obvious....

It definitely goes both ways

See what happens when an energy's drink effect wears off

Exactly—-and there’s probably a fairly vicious feedback loop too. Tired people reach for caffeine, rebound effects (or mistimed doses) make them even more tired. Lather, rinse, and repeat....

This makes it hard to figure out if the obvious intervention (ban energy drinks) would actually do anything, or if the answer is really more rest—an idea the military has been loathe to adopt in general.

Considering the effect of caffeine on sleep, it's a very small leap to make

It actually a fairly large leap, considering that caffeine can impair sleep quality, causing more fatigue or fatigued people could be consuming caffeine to reduce the fatigue.

In many people, both may be happening, so teasing out the direction of causation is difficult.

The two go really well together. I recently quit coffee and started sleeping 10 hours a night. It's hard to get to sleep on time when I've had coffee, but if I get enough sleep, I don't need to have coffee to feel awake.

Or people who feel bad but still need to get stuff done may be more likely to drink a lot of energy drinks.

Given the importance of mental health in the military, I'd think it should be enough evidence for some kind of intervention trial though.

Except that sleep also has an effect on caffeine consumption.

There is a link to the study right above what you quoted. The "vague" statement is a list of different ailments more commonly reported by people drinking energy drinks.

Yeah, the article is a bit misleading, looking at the linked study the authors point out those limitations,

> The findings also support the need for further research in this area, particularly longitudinal studies that would allow for stronger assessment of causal relationships.

> the measures for depression and PTSD each included two items related to sleep and the models were run with sleep problems as a predictor, which could lead to potential confounding in the analyses; however, this is consistent with research in this area.

Personally, one of my worst moments deployed was when our Ripit/RedBull/Tobacco supply got blown up (well, technically the DFAC and PX actually collapsed after being blown up due to shoddy construction) and we had to have people fly them in from BAF. I'm sure the lack of energy drinks contributed to PTSD for those who didn't have alternative logistics.

The current facts about coffee and sugar are the following: drinking coffee is good for your mental and physical, while sugar is linked to depression, addiction, anxiety, heart problems, obesity and not surprisingly, PTSD:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4522929/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4086302/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5056806/

You're leaving out many things about coffee. Specifically, caffeine, which energy drinks are often loaded with. Caffeine on its own can cause anxiety (See "Caffeine-induced anxiety disorder") and is linked to depression. Let alone workers consuming caffeine during work time with headaches(or other withdrawal symptoms) on their days off who still haven't figured it out the stuff is just plain not good for you.

I've stopped drinking coffee as it would frequently give me anxiety and sometimes panic attacks. I now drink tea or water at work. However, I still need to work harder on cutting down on sugar.

I suspected coffee was giving me anxiety which bordered on paranoia. I stopped drinking coffee and it went away immediately. A week later (today) I had a cup to see how I'd respond. Severe anxiety came back within half an hour. Very interesting.

I found that small amounts of alcohol have a similar effect. Keep drinking though and the depressant effects then start to kick in and the anxiety/paranoia subsides.

There's a third way, very popular among hackers, yerba mate. Used by South American people.

It has good caffeine content, but apparently has a slower absorption. Helps you to keep focused, without the strong highs and lows you have with pure coffee.

Yerba mate is my favorite. I wish it was more popular in the US.

I stopped drinking coffee, the acidity was ruining my GI.

Switched to Mate or PG Tips tea as my morning drink, typically with loose leaf mate in a French press.

South American (Cruz de Malta , Taragui) are readily available on Amazon prime and much cheaper than the American brand Guayaki

From personal experience I'd say coffee is not always good for your mental state. If I drink a cup every day for a week I get into a constant state of anxiety and nervousness. I also get dizzy during workouts. I also can tell when my girlfriend had coffee because she will be much more combative in discussions.

As with a lot of other things observe yourself and don't blindly trust studies. even if the study finds positive results for 90% of people you may be in the 10%.

try adding L Theanine

I have similar symptoms when drinking coffee - although they kind of emerged. I’m drinking decaf coffee now, which tastes good enough for me to create the joy of a morning cup. I’m asking myself though, if this effect of caffeine has other reasons.

Maybe it's an age thing. I used to drink liters of coffee without problem but slowly my tolerance went down until now I can't even drink one cup without negative consequences.

I drink dandelion coffee now. It's quite good.

Pretty sure my (alleged) PTSD is from the stress of war and almost getting blown up a couple times (well, driving into a major ambush and getting a piece of shrapnel bounced off my helmet probably didn't help either) and not from my previous copious consumption of sugary caffeinated drinks.

PTSD can come from many factors, I'm not saying that it's caused specifically and only by sugar. People who didn't go to war also have PTSD, as we also have soldies who went to war and didn’t come back with PTSD.

It's the Taurene that differentiates most energy drinks.

Does the military still hand out amphetamines and/or modafinil, or is caffeine really the alertness/wakefulness drug of choice?

>Does the military still hand out amphetamines and/or modafinil, or is caffeine really the alertness/wakefulness drug of choice?

Actual stimulant use is restricted to special forces and flight crews. But anecdotally, the energy drink consumption in the Army is out of control. I can remember people literally ordering pallets of Monster to show up on training exercises. Nicotine too. It's not uncommon to see someone with a dip of Skoal in both sides, smoking a Newport 100, and drinking a Monster all at the same time. It's just a necessary escape when you're living in an environment that has your fight-or-flight response engaged 24/7 causing total CNS overload, with zero access to alcohol or hard drugs and 4 hours of sleep a night.

I would say that as of 2018, the big energy drink is Rip It, and truly the volume and frequency of consumption across the forces cannot be overstated. As you say, when your life and the lives of your comrades is on the line, what else can you do? Most people require drugs to remain some semblance of alert for 18 hours a day, and of course it takes a toll.

It’s almost as though a constant state of deployment and endless warfare is a damaging and undesireable condition.

> I can remember people literally ordering pallets of Monster to show up on training exercises.

What like as a replen demand? Aren't they restricted to using issued rations on an exercise? And how are they getting them deployed?

> Aren't they restricted to using issued rations on an exercise?

That and what you can manage to bring with you.

Back when I was in the infantry you carried whatever you took to the field so we tended to pack light(ish). I used to take a little camp stove so I could have hot coffee in the morning and other people would pack stuff like ramen or whatever.

Even when we were living in holes ~1km off the Iraqi border they managed to get us cigarettes though that's not one of the "issued rations"...also pretty sure that's when I got that camp stove so other things were possible. Before that, when we were staying is some dilapidated warehouse in Saudi, they had pallets of Pepsi get delivered on a regular basis for the chow hall.

On my last trip to Iraq they had pretty much whatever you wanted at the PXs and we (civilian contractor types) used to smuggle a bunch of canned drinks out of the chow halls instead of buying them but don't really remember if they had energy drinks in the coolers since that's not my thing.

Think I got a bit rambley there...

Red Bull cans fit in 37/40mm round ammo pouches/elastic loops, something I learned in Iraq (I never had a 40mm, but there are a lot of molle pouches for 40mm which were useful for other stuff).

Also Amazon or reship-stuff-from-Amazon to APO/FPO addresses was great.

And all I had was the tasters choice packet that sometimes came in an mre, pour in mouth drink water to wash it down. Where do soldiers today get this stuff you mention? Sure you could bring your own but you can only pack so much.

If they didn't want you to order it by the pallet, it wouldn't have an NSN :)

Ambien was also handed out for long-haul flights for a lot of people, which was pretty nice when crossing a bunch of time zones. I don't know at what level of authority that was authorized.

>Does the military still hand out amphetamines and/or modafinil, or is caffeine really the alertness/wakefulness drug of choice?

WW2 German Army ran on amphetamines, according to this book: https://www.amazon.com/Blitzed-Norman-Ohler/dp/1328915344/re.... Interview with the author: https://cen.acs.org/articles/95/i12/Blitzed-author-explains-...

I'd say the #1 contribution to PTSD is the traumatic stress.

Perhaps the people who have PTSD are more likely to drink energy drinks?

That and dietary supplements. So many people take dietary supplements without ever getting a simple metabolic panel to even see if they need the supplements.

I just read a BBC story about a man who nuked his liver by taking concentrated green tea capsules. He requires a full transplant and four years later his kidneys are failing and he has chronic abdominal pain. It seems that one or more compounds in green tea (safe as a beverage, problematic as a concentrate) may negatively impact liver function in some genetically vulnerable populations. Truthfully though, it’s not known exactly what happened, only that it does happen.

For anyone interested, that story was discussed in https://news.ycombinator.com/item?id=18299354.

Just to be safe, until I see more data I'm going to assume PTSD causes energy drinks.

I know you’re being snarky, but the idea of someone self-medicating is not totally bonkers, which would indeed put the causality on PTSD, not the drink.

The classic example is that schizophrenics are much more likely (3x or so) to smoke. Interview with patients suggest that it helps control symptoms and there are somewhat plausible biological mechanisms that could explain why.

Stimulant use (mostly cocaine) is a bit more common in some neuropsych conditions. I don’t know of any studies about caffeine and PTSD specifically, but it seems pretty similar.

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