Do You Need to Be Worried Your Kids Are Getting Too Much Caffeine?

Caffeine2-FBIf you’re among the 64 percent of American adults who drinks at least one cup of coffee every morning, you may know exactly how much to drink and what time to stop drinking to avoid any unpleasant caffeine side effects such as jitters and insomnia. What you may not know is that an increasingly wide variety of foods and beverages contain significant amounts of caffeine, making it nearly impossible to accurately gauge yours and your children’s daily intake.

The tragic story of 16-year-old Davis Allen Cripe underscores why counting caffeine milligrams is important. The South Carolina teen, who was found to have no undiagnosed heart condition, died from a rapid, irregular heartbeat called arrhythmia caused by an overdose of caffeine. Cripe’s friends told the coroner that within two hours of his death, he drank a large diet Mountain Dew®, a McDonald’s café latte and an energy drink.

Dale Yoo, MD, a cardiac electrophysiologist at Medical City McKinney, confirmed that caffeinated drinks can absolutely affect your heart rhythm.

“Anything that’s a stimulant or increases the stress on your heart will increase your adrenaline and your heart rate,” Dr. Yoo said. “Things like coffee, tea and herbal supplements will increase your adrenaline and heart rate. Drinks like 5-hour ENERGY®, Red Bull® and Monster Energy® have a lot of taurine and caffeine that can also increase the stimulant effect on your heart and increase the risk of arrhythmia.”

In addition to soft drinks and energy drinks, caffeine is being added to a growing list of products, including marshmallows, oatmeal, jelly beans, waffles, gum, mints, sunflower seeds, syrup and even water. It can be found in chocolate, ice cream (those with chocolate or coffee flavors) weight loss pills and over-the-counter pain relievers  This prompted the FDA last year to announce an investigation into the safety of caffeine in food products, with special attention paid to its effects on children and adolescents.

Because caffeine is not a nutrient, but a naturally occurring chemical found in items such as tea leaves, coffee beans and cacao (used to make chocolate), the FDA does not require the amount in a food or beverage to be listed on nutrition labels unless it is added. Many of these products also contain hidden caffeine or other stimulants. Here’s what to look for:

  • Sugar
  • Guarana
  • Taurine
  • Kola nut
  • Yerba mate
  • Cocoa or cacao

How much caffeine is too much?

According to the FDA, a safe amount of caffeine for healthy adults is up to 400mg a day. That’s anywhere from three to five eight-ounce cups of regular coffee, depending on the bean source and brewing method. For children and adolescents, the American Academy of Pediatrics’ recommendation is to avoid energy drinks entirely — which the CDC says sent 1,499 adolescents to the ER in 2011 — and limit caffeine for ages 12 to 18 to 100mg daily.

We’ll never know for sure exactly how much caffeine Davis Cripe ingested, but we can estimate it thanks to his friends’ report:

Large diet Mountain Dew: “Large” is a relative term, but even if he had a “small large” at 20 ounces, that’s 91mg of caffeine — nearly the AAP-recommended limit of 100mg. A Long John Silver’s large is 40 ounces with a whopping 180mg of caffeine and 7-11 has soda cups much bigger than that.

McDonald’s café latte: These espresso-based drinks come in small, medium and large. Espresso has about 64mg of caffeine per ounce.

Small cafe latte (12 ounces)

Medium café latte (16 ounces)

  • 142mg caffeine, 13g sugar

Large cafe latte (20 ounces)

  • 178mg caffeine, 16g sugar

Red Bull energy drink (12 ounces): The type and size of energy drink Cripe had is unknown, so we’ll use this popular one.

  • 111mg caffeine, 37g sugar

In our example, Cripe would have ingested a minimum of 273mg and a maximum of 468mg of caffeine in a short period. And this may be a very low estimate, as the American Academy of Pediatrics says some energy drinks can contain more than 500mg of caffeine.

Research debunks myth that coffee improves alertness and mood.

We all know the negative effects of caffeine. The FDA says that it can make you:

  • Jittery and shaky
  • Unable to fall asleep, stay asleep or get a good night’s sleep
  • Experience
    • rapid, uneven heart rate (arrhythmia)
    • raised blood pressure
    • headaches, nervousness, anxiety and dizziness
    • dehydration
    • heartburn
    • dependency and the need to drink increasingly more

But other than that, coffee is good for you, right? While coffee in moderation has been shown to reduce the risk of several diseases, including certain cancers and stroke, it’s most likely the health benefits of coffee’s antioxidants that are responsible, not the caffeine. Look for other ways to get antioxidants, including eating lots of healthy fruits and vegetables.

As to coffee’s magical brain-enhancing powers, study results from Johns Hopkins Medical School (featured on show that caffeine-related performance improvement (a boost in mood and alertness) is nonexistent without caffeine withdrawal. In other words, the kick that you get from your morning cup of Joe is really just caffeine taking you back to “normal” for a short time.

If someone in your family is feeling the effects of too much caffeine, one of our many Medical City ER locations across North Texas has you covered. With average wait times posted online, if you do have an emergency, you can spend less time waiting and more time on the moments that matter most.

Find a fast Medical City ER near you.

Sign Up for the LifeSigns E-Newsletter

Gut Feeling: How to Know if Stomach Pain is Serious

Abdominal pain is the single leading reason for emergency room visits in the U.S., accounting for more than 10 million of the 130.4 million annual ER visits. Most people call it stomach pain, but it’s not always a stomach problem. Your abdomen holds many other organs, too, including your intestines (colon and bowels), pancreas, liver, gallbladder, kidneys, spleen and appendix.

So it’s not surprising that, just as with chest pain or a headache, it can be difficult to tell what’s really going on in there when your tummy’s not feeling well. Add in other vague symptoms such as nausea and vomiting and you could have the stomach flu, food poisoning, gallstones, kidney stones or any number of other conditions.

David Cameron, DO, an emergency medicine physician at Medical City Lewisville and Medical City McKinney, discusses how to know if you have kidney stones.

The Big D.

We’re not talking about Dallas. Nope … diarrhea. No one likes to have it or talk about it, but this dreaded symptom can clue you in on what your stomach pain may mean.

“Diarrhea with vomiting is a good indication that you have a viral or bacterial infection and not a surgical emergency,” said David Hanscom, DO, an emergency medicine physician at Medical City Fort Worth and Medical City ER Burleson. “Viral infections are more common, but you could have a bacterial infection, such as from food poisoning. You’ll know pretty quickly after eating contaminated food — within a half hour to an hour.”

20171212 HCA Influenza Infographic

Christopher Ramos, MD, a gastroenterologist at Medical City Alliance, agrees that the difficulty when dealing with stomach pain — especially in the upper abdomen — is knowing whether it’s heartburn or something more serious. More clues to help you (or your doctor) pinpoint the cause of symptoms include:

  • Type of pain: is it sharp or dull, constant or intermittent, mild or severe?
  • Location of pain: is it right or left, lower or upper, concentrated in one spot or radiating outward toward your chest or back?
  • Onset of pain: did it come on suddenly, start after eating (maybe spicy or restaurant food) or have you felt this pain for any length of time?

Recently, Dr. Ramos has seen a rash of norovirus cases in North Texans returning from cruises.

“Norovirus is the leading cause of gastroenteritis in the U.S., so it’s very common but sometimes hard to diagnose,” he said. “Members of the same family can have the same disease process but different symptoms and duration.”

Dr. Hanscom agreed, adding that there is no point-of-care test for norovirus.

“We don’t have a test for norovirus in the ER,” he said. “Diagnosis is done by looking at the patient’s symptoms and other clues, such as if there’s a local outbreak, if the patient has been on a cruise or if it’s during the colder parts of the year when people congregate indoors and spread germs.”

Steven Kaster, MD, a gastroenterologist at Medical City McKinney, tells you how to know if stomach pain is serious enough for a trip to the ER.

When to go to the ER with stomach pain.

You should seek medical care when stomach pain is:

  • Accompanied by a high fever
  • Accompanied by repeated vomiting
  • Accompanied by other serious or unusual symptoms, such as difficulty breathing or change in behavior
  • Severe or prolonged (lasting 24 or more hours)
  • Localized to one particular area
    • Right lower quadrant could indicate appendicitis
    • Right upper quadrant could indicate cholecystitis or a gallbladder infection
    • Left lower quadrant could indicate diverticulitis or a colon infection

“It’s important to not get dehydrated, especially for infants, children and older adults,” Dr. Hanscom said. “If you have any of the above symptoms, come on down to the ER and we’ll assess your need for IV fluids. We can also give you an antiemetic — a drug to prevent nausea and vomiting. It’s not really something that you can get without a prescription.”

Poison prevention. 

Some GI issues are not caused by viral or bacterial invaders, but from an overdose of toxic substances.

“In children, the weekly pill reminders can be problematic because they are easy to access and can contain large amounts of medication,” said Dr. Hanscom. “It’s important to keep them where kids can’t get to them.”

Dr. Ramos sees a different problem in his adult patients.

“There are a lot of over-the-counter medications used for valid reasons,” he said, “but if they’re not used properly they can cause toxicity and poisoning. It’s a very common problem.”

One of the biggest culprits is one of the most commonly used drugs.

“Acetaminophen is used in almost everything,” Dr. Ramos said. “Overuse — 4 x 2 extra strength doses of Tylenol® a day — can easily lead to liver damage and possibly even become an indication for a liver transplant. Taking that dose alone can cause toxicity, but adding something like NyQuil™ for a virus can further increase the amount of acetaminophen. And depending on how long the virus lingers and you continue taking the meds — your liver tests can definitely be elevated.”

Unfortunately, someone with liver inflammation from substance toxicity will likely not have any symptoms other than fatigue until they’re at the point of liver failure and they need emergency medical intervention. Liver function tests are not a random screening and are typically ordered to rule out other conditions such as hepatitis C, fatty liver and gallbladder disease.

The only way to know for sure if you’re overdosing yourself or your children is to read all medicine labels and know the ingredients.

If you suspect poisoning.

Both Dr. Hanscom and Dr. Ramos agree that your first call should be to Poison Control at (800) 222-1222.

“Toxicology is a very broad area with many different agents that can cause harm,” said Dr. Hanscom. “Depending on the severity — whether your child ate one baby aspirin or a whole bottle — Poison Control will do a phone consult and let you know whether to treat at home or come in to the ER for emergency treatment or testing and bloodwork.”

Dr. Ramos encourages everyone to keep the number handy, even physicians.

“This is what Poison Control does,” he said. “They have the expertise and are the best resource for both patients and doctors. We (physicians) view Poison Control as a valuable resource.”

If someone in your family gets a gut feeling from a virus, bad food or even from their medications, one of our many Medical City Healthcare emergency locations has you covered. With average wait times posted online, if you do have an emergency, you can spend less time waiting and more time on the moments that matter most.

Find a fast Medical City Healthcare ER near you or call our free, 24/7 Ask-A-Nurse hotline.

Sign Up for the LifeSigns E-Newsletter

Revised 3/9/2018

Do You Know How to Avoid Overindulging at the State Fair of Texas?

You can have your hot dog and eat it too with our healthy tips and nutritious, delicious fair food makeovers.

Have you spent the last few weeks convincing yourself that corn dogs qualify as vegetables? Is your mouth watering for one of the Big Tex Choice Award finalists like the Deep Fried Bacon Burger Dog Slider on a Stick (a ground beef patty stuffed with a hot dog, cheese and bacon packed inside a Hawaiian roll skewered and topped with a pickle, dipped in tempura batter and deep fried)?

If so, then the State Fair of Texas must be upon us — it runs September 30 through October 23 — and you, my friend, are gleefully planning to derail your otherwise healthy eating habits with these and other artery-clogging, emergency-room-worthy, deep-fried fat-laden fair foods.

But it doesn’t have to be that way.

You can avoid the heartburn and indigestion (or worse) of a post-fair-fare coma (as well as a mad dash to the restrooms) and still enjoy your fair experience. Last year, one family did it “Amazing Race” style by splitting into teams and agreeing to share just one fried specialty item, choosing healthier options for main meals, skipping sodas and counting steps — with the winning team scoring extra tickets for rides and games.

If competition or food sharing isn’t your thing, try our tasty recipe substitutions that will leave you just as satisfied as their calorie- and fat-laden inspirations. Bonus: these original recipes were created by DFW-area high school culinary students, are easy for younger kids to make, contain at least half a cup of fruits or veggies per serving and are delicious and nutritious enough to be served year-round.

Kids Teaching Kids delicious, nutritious fair food makeovers.

We asked Amy Haynes, a Registered Dietitian Nutritionist at Medical City Dallas and Medical City Children’s Hospital, to help us choose a few fair-worthy Kids Teaching Kids recipes you can make at home. Here are her picks.

Vanilla ice cream cone vs. Berry Cone

Ice cream cones aren’t just for ice cream in this tasty, low-fat Kids Teaching Kids fruit-filled cone, with only 2 grams of fat. Fill that same cone with its namesake (ice cream), and you’re looking at 7 grams of fat and 27 grams of sugar per serving, on average. Most important, our version provides valuable nutrients from the fruit and 9 grams of healthy protein from the Greek yogurt.

Original version:

DQ vanilla ice cream cone, small
230 calories/7g fat/26g sugar/6g protein/0g fiber

Healthier version:

Kids Teaching Kids Berry Cone
130 calories/2g fat/10g sugar/9g protein/3g fiber
By chefs Alexandra E. and Josh C. from The Colony High School

Chefs Dolly Hernandez and James Delory from The Colony High School demonstrate how to make Berry Cones.

Amusement Park Funnel Cake vs. Waffle Taco

Another deep-fried favorite providing an alarming 44 grams of fat per cake is challenged by this Kids Teaching Kids recipe with no frying required. Our healthier recipe uses waffles as the “cake” and offers nutritious and tasty toppings with significantly fewer calories and fat grams per serving as compared to this amusement park classic.

Original version:

Amusement Park Funnel Cake with Powdered Sugar
760 calories/44g fat/16g sugar/0g fiber

Healthier version:

waffle_tacoKids Teaching Kids Waffle Taco
150 calories/1.5g fat/14g sugar/3g fiber
By chefs Kayla Pinales and Ariane Mitchell from Mesquite High School

Ingredients (makes 1 serving)

  • 1 whole wheat waffle
  • 1/2 cup blueberries
  • 2 oz. vanilla non-fat Greek yogurt


  1. Lightly toast waffle in the toaster
  2. After it has cooled, scoop yogurt on top
  3. Put blueberries on top
  4. Fold like a taco and enjoy

Corny dog vs. Dawg Wrap

This Kids Teaching Kids recipe reminiscent of a corny dog provides only 4.5g of fat and an impressive 8g of dietary fiber. Compare that to the traditional jumbo corn dog at 19g of fat and only 2g of fiber.

Original version:

Jumbo Corn Dog
460 calories/19g fat/10g sugar/2g fiber

Healthier version:

state-fair-dawg-wrapKids Teaching Kids Dawg Wrap
160 calories/4.5g fat/4g sugar/8g fiber
By chefs Kellie Baxter, Jesse Bellows, Jake Long and Hayden Hagmann from The Colony High School

Ingredients (makes 1 serving)

  • 1 low-calorie whole wheat tortilla
  • 1/2 slice 2% American cheese
  • 1/2 cup of fresh spinach, tightly packed
  • 1/2 turkey hot dog


  1. Place tortilla on plate
  2. Place cheese on tortilla
  3. Add spinach
  4. Heat hot dog in microwave for 15 seconds
  5. Place hot dog on the wrap and heat for 20-30 seconds; let cool 10 seconds
  6. Roll up the tortilla
  7. Wait 45 seconds before eating

We hope you enjoy our fair food makeovers and have a memorable trip to the State Fair of Texas, but if eating too much fried food leaves you in distress, one of our many Medical City Healthcare emergency locations has you covered. With average wait times posted online, if you do have an emergency, you can spend less time waiting and more time on the moments that matter most.

Find a fast Medical City Healthcare ER near you or call our free 24/7 Ask-A-Nurse hotline.

Sign Up for the LifeSigns E-Newsletter

Revised 9/12/2017

Additional Sources:

Know the 5 Killer Spices That Prevent Food Poisoning

Unpasteurized juice … raw sprouts … undercooked meat … uncooked eggs … raw oysters. Is this a formula for the latest trendy health shake? No, it’s more like a recipe for why 1 in 6 Americans gets food poisoning each year. But it goes beyond that to include foods we didn’t think we had to worry about, such as ready-to-eat salads, nut butters, frozen shredded coconut, ice cream (a dark time in Texas history when Blue Bell was off of shelves) and even flour.

According to Jill Elliott, a registered dietitian nutritionist with Medical City Dallas Hospital and Medical City Children’s Hospitals in Dallas, 128,000 Americans end up in the ER annually due to food poisoning from a smorgasbord of sources: deli meats, soft cheeses, cucumbers, spinach, even caramel apples and pistachios. The list — or should we say listeria — goes on.

How to identify food poisoning.

Many of these foods are supposed to be healthy for us, so how can we eat them and not get sick? First, it’s helpful to recognize the symptoms of food poisoning. If you’ve never had it, think of your worst bout with the stomach flu. The problem is, symptoms may appear almost immediately or they may take weeks to develop, so it’s often hard to pinpoint what you’ve contracted and where you may have picked it up unless you’re tracking everything you eat and drink.

A good rule of thumb is to seek immediate medical treatment if you suspect food poisoning because it can be much more serious than the flu. Infants, the elderly, pregnant women and those with a weakened immune system are especially at risk.

20171212 HCA Influenza Infographic

How to prevent food poisoning.

The second and most important thing we can do is practice contamination prevention measures. Elliott recommends these eight precautions:

  • Wash hands and preparation surfaces thoroughly before touching food
  • Cook foods thoroughly
  • Set your refrigerator to 40⁰F and your freezer to 0⁰F (or lower)
  • Drink and eat only pasteurized juices, milk and milk products
  • Use separate cutting boards and preparation surfaces for meat and other foods
  • Don’t ingest raw eggs
  • Don’t eat prepared food that has been outside a refrigerator for more than two hours or one hour in very hot weather
  • Always rinse fruits and veggies and dry with a clean paper towel, even if they will be peeled

Why the extreme caution with produce? Cutting or biting into food that has bacteria on the outside will drive the bacteria deeper into the food. This is also true of meat, which is why you should insist on a well-done steak in a restaurant that tenderizes theirs by piercing it with sharp instruments and why you should be equally wary of ground meat products, such as hamburgers.

If you’re not into grilling wait staff about their meat preparation procedures, you may want to grill at home instead. Researchers at Kansas State University found five “killer spices” that can make your ground beef (and other foods) safer and maybe even more delicious. These killer five include garlic, cinnamon, oregano, cloves and sage.

K-State killer spice “recipes” to combat food poisoning.

A 1 percent ratio (2 to 5 teaspoons) of garlic powder to two pounds of ground beef kills 90-97 percent of E.coli.

A 3 percent ratio (2 to 5 tablespoons) of dried plum mixture (prunes) to 2 pounds of ground beef kills more than 90 percent of major food-borne pathogens, including E. coli, salmonella, listeria, Y. enterocolitica and staphylococcus. Plus, it adds antioxidants and makes a moister meatloaf.

Just 0.3 percent of cinnamon (roughly a piled-high teaspoon) to 64 ounces of apple juice kills about 99 percent of E.coli.

While killer spices can help protect you from killer bacteria, keep in mind they’re no substitute for a vigorous hand scrubbing and a fully cooked meal. You can also monitor current food poisoning outbreaks via the Centers for Disease Control and Prevention website.

If you do get a bad batch of something, one of our many Medical City Healthcare emergency locations has you covered. With average wait times posted online, if you do have an emergency, you can spend less time waiting and more time on the moments that matter most.

Find a fast Medical City Healthcare ER near you or call our free, 24/7 Ask a Nurse hotline.

Sign Up for the LifeSigns E-Newsletter

jill-elliot-headshotJill Elliott, RDN, LD
Registered Dietitian Nutritionist, Community Outreach Programs Medical City and Medical City Children’s Hospital

Jill Elliott has a passion for great food and engaging others in better nutrition.  In her spare time, she can be found in her kitchen, slicing, dicing and cooking up appealing ways to include healthful, flavorful foods in everyday meals for the whole family.  Teaching piano lessons and getting outside with her loyal canine companion are two of her favorite activities.

Revised 3/8/2018

When Things Heat Up in the Kitchen This Thanksgiving, Make Sure You Wear Protection

This Thanksgiving it’s safety first, then seconds.

That’s right: Real men wear mitts. And we’re talking actual oven mitts, not the dirty dishtowel you grabbed off the sink, a paper towel or — say it ain’t so — the front of your shirt. Yeah, we know … we’ve seen you do it.

And it’s not (only) because we just washed that shirt that we tell you this. It’s because we care about you and we know the stats: According to the Red Cross, cooking fires are the leading cause of home fires and home injuries in Texas. But on Thanksgiving Day, the number of home cooking fires rises three times higher than average. So what can you do to make sure your holiday meal is praiseworthy and not blaze worthy?


Deep Fried Turkey Tips

First, let’s talk turkey. Texas has the dubious honor of leading the nation in deep-fried turkey fires during the seven years (2005-2012) that State Farm conducted the study. Incendiary turkeys were becoming such a problem that the insurance company famously partnered with William Shatner and other celebrities to teach deep-fried turkey safety through a series of amusing commercials and videos. They’re fun and educational to watch, but the fact remains: Tossing a turkey in a tub of sizzling grease is basically mixing oil and water, especially if the bird isn’t thawed completely. Not good.

What is good is technology that has advanced so quickly that just a couple of years later we can satisfy our craving for a moister bird with an oil-less electric turkey fryer. The units use infrared heat instead of oil for a heathier-cooked bird with all the flavor, juiciness, and crispy outside of the oil-saturated version. If the five-star reviews on many popular retail sites are any indication, people are raving about the results. We like that they’re safer to use — eliminating the splash, spill and flame hazards of cooking in a vat of hot oil — but they also make cleanup easier. With a stomach full of turkey and taters and the kickoff about to start, that’s yet another reason to be thankful.

If you must deep fry your dinner, follow these seven safety measures:

  • Always use your fryer outdoors, a safe distance from buildings and any other flammable materials.
  • Never use a fryer in your garage, on a wooden deck or other flammable surfaces.
  • Make sure the fryer stands on a flat surface, to reduce accidental tipping.
  • Keep small children, pets, and roughhousing away from the fryer, as even a slight bump can be disastrous.
  • Most units don’t have thermostat controls. If you use an oil-filled fryer and don’t watch it carefully, the oil will continue to heat until it catches fire.
  • Wear oven mitts and keep the pot lid handy to smother any flames — don’t throw water on them.
  • Never leave the fryer unattended.

We’ve highlighted that last one because nearly half of all fire injuries occur as a result of unattended cooking. Sound familiar? Most of us have walked away from a pot that just wouldn’t boil until we become engrossed in our favorite show. And while scald burns are the most common burn-related injury in young children, a grease fire has the potential to be even more harmful. So roll up your sleeves, put on your mitts, and man your cooking station at all times.

And remember, this Thanksgiving it’s safety first, then seconds. #RealMenWearMitts


When it gets a little too hot in the kitchen, one of our many Medical City Healthcare emergency locations has you covered. With average wait times posted online, if you do have an emergency, you can spend less time waiting and more time on the moments that matter most.

Find a fast Medical City Healthcare ER near you or call our free 24/7 Ask-A-Nurse hotline.

Sign Up for the LifeSigns E-Newsletter

Revised 11/21/2017