Self Care Pharmacy Blog

Archive for the ‘Energy Supplements’ Category


Magnesium and physical activity – does it make a difference?

Monday, December 1st, 2014

By Matthew Johnson, Pharm.D. Student.

Magnesium is a mineral involved in many bodily functions such as muscle and nerve regulation, blood sugar control, energy production, and the making of proteins.Recommended Dietary Allowance (RDA) is the average daily amount needed to meet the body’s needs of a dietary substance for most healthy people.The RDA for magnesium varies by age and gender. For women 19-30 years old it is 310 mg (men 400 mg). For women aged 31 years and older the value is 320 mg (420 mg for males). A deficiency of magnesium can result in seizures, abnormal heart rhythms, low blood calcium and potassium levels, and muscle contractions/cramps. Furthermore, magnesium deficiency has been linked to both lower physical activity and exercise ability.2  This is even more important for the elderly population because of the impact the aging process has on physical activity.Specifically, the aging population is at greater risk for magnesium deficiency than young people due to low dietary intake, reduced absorption, and a greater amount excreted in stools and urine. It is important to note, however, that excessive magnesium intake from supplements may cause diarrhea, abdominal pain, and/or cramping. Furthermore, intake of amounts greater than 5000mg per day can lead to magnesium toxicity and death. 4

The current standard of care for improving physical activity is sufficient aerobic and muscle-strengthening activities.5  The Center for Disease Control and Prevention recommends for adults 65 years and older to do muscle-strengthening activities that work all of the major groups of muscles (hips, back, shoulders, arms, legs, chest and abdomen) on two or more days per week. Muscle-strengthening activities include lifting weights, resistance band usage, push-ups, sit-ups, yoga, and gardening activities such as digging or shoveling. The CDC also recommends that all adults 18 years and older get either 5 hours of moderate-intensity aerobic activity or 2 hours and 30 minutes of vigorous-intensity aerobic activity. Moderate activity is a 5 or 6 on a 10-point scale in which 0 is defined as sitting and 10 is full effort activity. Vigorous activity is a 7 or 8 on this same scale.

A study recently published in the American Journal of Clinical Nutrition looked at the effects of oral magnesium supplementation on physical performance.3  This study only involved healthy elderly women that were involved in a weekly exercise program. There were two groups of healthy women in the study: one group received oral magnesium supplements of 900mg magnesium oxide/day for 12 weeks while the second group did not receive supplements or any other differences in treatment. The purpose of the study was to see if magnesium supplementation would improve physical performance. Short Physical Performance Battery (SPPB) tests were used in part to examine physical performance. A SPPB test involves checking lower limb activities such as walking and balance. The study found better physical performance in the group taking the magnesium supplements. There were no harmful effects seen in either of the groups. One major factor that limited the results of the study was that it only included healthy elderly women that exercised and so the same results may or may not occur in populations such as adolescents, men, or people that do not exercise. A different study published earlier this year in the Journal of Sports Sciences supports the findings that magnesium supplementation can improve physical performance.6

For individuals seeking to improve physical activity, it appears that magnesium supplements in the appropriate RDA range can be taken to boost physical activity performance.  Have you tried magnesium supplements before? If so, what form did you take and did you notice any differences after taking them?


  1. S. Department of Health & Human Services, Nation Institutes of Health, Office of Dietary Supplements. Magnesium Fact Sheet for Health Professionals. Reviewed November 04, 2013. Accessed October 2014.
  2. Lukaski HC. Magnesium, zinc, and chromium nutriture and physical activity. Am J Clin Nutr. 2000;72(suppl):585S–93S.
  3. Nicola V, Berton L, Carraro S, et al. Effect of oral magnesium supplementation on physical performance in healthy elderly women involved in a weekly exercise program:a randomized controlled trial. Am J Clin Nutr. 2014; 100: 974-981.
  4. Kutsal E, Aydemir C, Eldes N, et al. Severe hypermagnesemia as a result of excessive cathartic ingestion in a child without renal failure. Pediatr Emerg Care. 2007;23:570-572.
  5. Center for Disease Control and Prevention. Physical activity: How much physical activity do older adults needs? Updated June 17, 2014. Accessed November 2, 2014.
  6. Setaro L, Santos-Silva P, Colli C, et al. Magnesium status and the physical performance of volleyball players: effects of magnesium supplementation. Journal Of Sports Sciences[serial online]. March 2014;32(5):438-445. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed November 12, 2014.

Energy Drinks: Performance over Health?

Tuesday, October 28th, 2014

By Ryley Uber, PharmD Student

An energy drink (ED) is a supplement commonly used to combat sleepiness and to increase the physical and mental performance of an individual. These drinks can be defined as, “an alternative to coffee as a source of caffeine and also contain other functional ingredients such as antioxidants, ginseng, taurine, and B vitamins.”1 The exact ingredients, however, differ among the companies who offer these products. Despite the health effects of these drinks having been continually called into question, their market has been steadily increasing.2 One instance where these health concerns can be seen is in the case study of a 17-year-old.3 The patient was admitted to an emergency room with an increased heart rate and arrhythmia that started shortly after consuming an ED. He had no history of cardiac issues. This patient was found to have Wolff-Parkinson-White (WPW) syndrome, which is the most common pre-excitation disorder (improper electrical conduction in the heart) with an incidence of 0.1–0.3% in the general population and an associated sudden cardiac death risk of less than 0.6%.3 This disorder can lead to increased heart rates which was likely exacerbated by the ED. After treatment, he was released from the hospital once his heart rate and rhythm returned to normal. Since this was only a report of a single medical case, it cannot be applied to all circumstances. However, it does offer some insight to what side effects can come of consumption of EDs. This should cause concern among consumers regarding the safety of these drinks.

In a recent review published in 2013, a total of 15 studies on EDs were evaluated based on the effects they produced.4 Unfortunately, due to the differences among the studies, no solid conclusions could be drawn. This was due to the fact that substantial differences existed between participants, ED used, study design strength, and outcomes. However, since then there have been multiple other studies conducted evaluating this potential health hazard. One such study conducted by Grasser et. al suggested that Red Bull slightly increased blood pressure.5   Blood flow in the brain decreased, likely due to constriction of arteries. Based on this data, the researchers called into question the manufacturers’ claims that this drink increases mental abilities. While not immediately dangerous to an adult in perfect health, the researchers mention that increased blood pressure could pose a problem to patients with heart diseases.

The athletic advantages of these energy supplements should not be ignored. In one study that was published in 2013 and conducted by Burrows et. al, professional rugby players were each given an ED prior to a simulated game and a placebo prior to a different simulated game.6 During both of these trials, the distance that the players ran while playing a simulated rugby match was measured. In the placebo trial, the players ran an average of 4749 meters. After consuming an ED, however, the players ran an average of 5139 meters. One limitation to this study is the fact that every rugby match has many variables that could lead to a higher amount of distance ran. The matches that included the EDs could have simply required more running due to an increase in overall game intensity. This study concluded that EDs increased the athletic performance of the athletes who participated. A similar study published in 2010 and conducted by Kazemi et. al involved female athletes, it was also concluded that athletic performance was increased among the participants after drinking an ED.7 Performance was measured by the participants’ oxygen intake, heart rate, and time to exhaustion, among other variables. According to these studies, athletic performance does increase with the use of EDs. However, an athletic advantage does not justify the use of these supplements. This is because of the proven temporary increase in blood pressure that many of these drinks cause, which is harmful to one’s heart.8 The effects of EDs on other organs in the body have yet to be thoroughly researched (kidneys, liver, etc…).

Due to the lack of conclusive data regarding the long-term and short-term health effects of EDs, consuming these drinks to increase performance cannot be recommended. More conclusive studies must be conducted in order to learn more about the health effects of EDs. Some individuals have encouraged the FDA to further regulate this quickly growing industry in order to produce energy supplements that are both effective and pose little to no risk to the customer’s health.9 Although the large amount of caffeine found in EDs is not generally recommended, caffeine can provide a neutral effect or perhaps even a positive effect on one’s health when taken in moderation.10 Between 3 and 4 cups of coffee that are 8 ounces each is considered a moderate amount of caffeine. Though the promise of increased performance may be tempting for some, the health and promised effectiveness still remains unknown and requires further conclusive research to fully reveal the nature of these supplements.

Are the performance advantages that energy drinks advertise worth the potential risk to your personal health? How often do you use energy drinks for “quick” energy?


  1. Tamamoto LC, Schmidt SJ, Lee S. Sensory profile of a model energy drink with varying levels of functional Ingredients—Caffeine, ginseng, and taurine. J Food Sci. 2010;75(6):S271-S278. Accessed: October 6, 2014.
  2. Heckman MA, Sherry K, De Mejia EG. Energy drinks: An assessment of their market size, consumer demographics, ingredient profile, functionality, and regulations in the united states. Comprehensive Reviews in Food Science and Food Safety. 2010;9(3):303-317. Accessed: October 6, 2014.
  3. Candilio L, Chen AWY, Iqbal R, Gandhi N. An interesting case of tachyarrhythmia. BMJ Case Reports. 2014;2014. Accessed: October 6, 2014.
  4. Burrows T, Pursey K, Neve M, Stanwell P. What are the health implications associated with the consumption of energy drinks? A systematic review. Nutr Rev. 2013;71(3):135-148. Accessed: October 6, 2014.
  5. Grasser E, Yepuri G, Dulloo A, Montani J. Cardio- and cerebrovascular responses to the energy drink red bull in young adults: A randomized cross-over study. Eur J Nutr. 2014;53(7):1561-1571. Accessed: October 6, 2014.
  6. Del Coso J, Ramírez JA, Muñoz G, et al. Caffeine-containing energy drink improves physical performance of elite rugby players during a simulated match. Applied Physiology, Nutrition & Metabolism. 2013;38(4):368-374. Accessed: October 6, 2014.
  7. Kazemi F, Gaeini A, Kordi M, Rahnama N. The acute effects of two energy drinks on endurance performance in female athlete students. Sport Sciences for Health. 2010;5(2):55-60. Accessed: October 7, 2014.
  8. Chrysant SG, Chrysant GS. Cardiovascular complications from consumption of high energy drinks: Recent evidence. J Hum Hypertens. 2014. Accessed: October 18, 2014.
  9. Thorlton J, Colby DA, Devine P. Proposed actions for the US food and drug administration to implement to minimize adverse effects associated with energy drink consumption. Am J Public Health. 2014;104(7):1175-1180. Accessed: October 6, 2014.
  10. Mejia EGd, Ramirez-Mares M. Impact of caffeine and coffee on our health. Trends in Endocrinology & Metabolism. 2014;25(10):489-492. Accessed: October 6, 2014.

Caffeine Spray: A New Way To Get Your Morning Fix?

Friday, September 27th, 2013

Blog Post Written by Mike Pelyhes PharmD Student at Cedarville University.

Caffeine is a common CNS stimulant used by up to 90%(1) of adults in the United States.  It is currently the only CNS stimulant that is approved for nonprescription use by the FDA.  Caffeine is generally considered safe and effective for the treatment of occasional drowsiness and fatigue, but it should never be used as a replacement for sleep.  If you find yourself struggling with occasional drowsiness and fatigue, then evaluating sleep habits is a great place to begin.  For starters getting 7-8 hours of sleep can do wonders(2).  Additionally, going to bed and waking up at the same time everyday can help your body by allowing it to adjust to a normal sleep pattern. If caffeine is still desired; perfectly valid options include coffee, tea, diet soda, or caffeine pills.  In general it is best not to ingest more than 200 mg on a regular basis.  That includes being careful of a tall (12oz) Starbucks coffee that packs a whopping 260 mg of caffeine per cup(2).  It is also wise to be aware that chronic caffeine use, particularly in high doses, can cause tremors, elevated blood pressure, headaches, and irritability. Additionally, if you have problems with uncontrolled high blood pressure or have had heart problems then caffeine may not be a good product for you to use.

In news articles published by the Huffington Post and NPR a new form of taking caffeine is being introduced.  This caffeine form is a topical spray that is meant to be applied to the skin on the side of the neck where the carotid artery and jugular vein run.  This spray is designed for the caffeine to be absorbed through the skin and directly into the bloodstream.Theoretically this results in a higher amount of caffeine actually reaching the bloodstream compared to if the caffeine was ingested orally(3)  The product designer is Ben Yu, a Thiel Institute Fellow.  Yu claims that because the caffeine is absorbed right into your bloodstream that it acts quicker (within 7-10 minutes)(4) than orally ingested caffeine, and that it avoids the “energy” bursts and crashing effects of normal caffeine ingestion.  Additionally, Yu is hoping to get this product through to the public as a dietary supplement without the stringent FDA regulations that other caffeine products such as No Doz have gone through.

While the Huffington Post and NPR report this as exciting news for caffeine users, I would recommend caution with this new way to take caffeine.  As per Yu’s own admission, rigorous studies on the safety and efficacy of this product have not been completed.  Caffeine can have dangerous effects on blood pressure and there is limited data on the use of topical caffeine products, and little to no data regarding the actual enhanced absorption claims by Yu.  However, a study on topical caffeine application for psoriasis treatment found the only clinically significant common side effect reported for topical caffeine use was a mild irritation(5) on the skin caused by the caffeine.  Another study on the effect of hair follicles on the absorption of topical caffeine into the skin found hair follicles to have a clinically significant effect on increasing caffeine absorption into the skin(6).  While this study did not measure absorption into the bloodstream, it did show that caffeine can be absorbed into the skin in as little time as 5 minutes.  Therefore further study on topical caffeine absorption is likely needed.

Due to lack of data on topical caffeine use in a self care setting or even under the care of doctors, I would not recommend this product to my own patients.  There is limited data on the  effects of topical caffeine that is rapidly absorbed directly into the bloodstream.  With a time of absorption up to 5 times quicker(2) than orally ingested caffeine.  There is also evidence of skin irritation from topical caffeine use   Additionally, since oral ingestion of caffeine is shown to have absorption rates as high as 99%(7), the claims of superior absorption of topical caffeine are perhaps misleading, wrong, or poorly explained. I would personally recommend oral caffeine intake as it has been well studied.  Its benefits and side effects are well known, and it already comes in a wide variety of choices that can fit many tastes.

Here are some things to consider if you are interested in this product.  Is the possibility of mild skin irritation worth it for a new way to get a caffeine fix?  Is this product necessary with the wide variety of oral products already available?  Is it something that you think you would find more convenient than already available alternatives?  Are you concerned over the apparent lack of clinical research on the product?


[1] Frary CD, Johnson RK, Wang MQ. Food sources and intakes of caffeine in the diets of persons in the United States. J Am Diet Assoc. 2005;105:110-3

[2] Kirkwood, K., & Melton, S. (2012). Insomnia, drowsiness, and fatigue. In D. Krinsky (Ed.),

Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care (17 ed., pp. 876-879). Washington, DC: American Pharmacists Association.

[3] Gates, S. (2013, August 21). ‘sprayable energ’y caffeine spray will perk you up without the aftertaste. Huffington Post. Retrieved from /sprayable-energy-caffeine-spray_n_3790271.html

[4] Hu, E. (2013, September 11). Coming soon: A jolt of caffeine you can spray on your skin. NPR. Retrieved from -soon-a-jolt-of-caffeine-you-can-spray-on-your-skin?ft=1&f=1007

[5] Vali A, Asilian A, Khalesi E, Khoddami L, Shahtalebi M, Mohammady M. Evaluation of the efficacy of topical caffeine in the treatment of psoriasis vulgaris. The Journal Of Dermatological Treatment [serial online]. 2005;16(4):234-237. Available from: MEDLINE with Full Text, Ipswich, MA. Accessed September 24, 2013.

[6]  Trauer S, Patzelt A, Otberg N, Knorr F, Rozycki C, Balizs G, Buttermeyer R, Linscheid M, Liebsch M, Lademann J. Permeation of topically applied caffeine through human skin – a comparison of in vivo and in vitro data. Br J Clin Pharmacol. 2009;68:181–6

[7] Anthony Liguori, John R. Hughes, Jacob A. Grass, Absorption and Subjective Effects of Caffeine from Coffee, Cola and Capsules, Pharmacology Biochemistry and Behavior, Volume 58, Issue 3, November 1997, Pages 721-726, ISSN 0091-3057,
Keywords: Absorption; Caffeine; Coffee; Cola; Subjective effects