Death by Lemonade? (Or, a Safe Supply of Caffeine)
Two lawsuits against Panera Bread claim highly caffeinated "Charged Lemonade" is responsible for killing two people. What's the deal here?
A 46-year-old man named Dennis Brown would hit up Panera Bread after finishing his shift at Publix in Fleming Island, Florida, where he bagged groceries and walked customers to their car. Brown’s after work trips to Panera were something of a ritual. He’d go multiple times a week, and he’d often order the uber-caffeinated Charged Lemonade.
In the span of a few weeks, Dennis Brown ordered a Charged Lemonade on September 28th, October 2nd, October 4th, October 5th, and October 7th. (that’s a lot of lemonade!)
October 9 was no different. Dennis Brown finished his shift in the afternoon and then he went to Panera where he purchased a Mango Yuzu Citrus Charged Lemonade, and he refilled his drink two times, for a grand total of three Charged Lemonades.
Brown left Panera and started walking home. On his way, he “suffered a cardiac event,” according to a wrongful death lawsuit filed against Panera by his family. Dennis Brown was found unresponsive on the sidewalk at approximately 5:45 PM. He was pronounced dead at the scene.
The lawsuit against Panera Bread explicitly holds the company responsible for his death, suggesting the high caffeine content in the lemonade triggered a fatal cardiac event. The lawsuit and the theory against Panera extend far beyond one or two wrongful deaths. The outcome of a case like this could result in a sweeping national standard for the way caffeinated beverages are sold, marketed, and labeled. At the heart of the lawsuit is the responsibility companies have in properly labeling products, and calls to mind the crucial importance of measured dosing.
Caffeine is probably the most widely consumed drug on the planet. Humans love caffeine. Heck, I love it. Right now it’s morning and I’m focused, typing quickly and thinking linearly and logically thanks to caffeine’s stimulant effect. "There are studies that show that people's both mental performance and athletic performance are improved by coffee," Michael Pollan, author and journalist of many books, including Caffeine, said in an NPR interview. “If you have a cup of coffee after you've learned something or read a textbook chapter, you are more likely to test better on it the next day."
Caffeine has markedly helped my life of writing. I can sit still. I can keep small details and minutiae in focus. With a cup of coffee in the morning I get a burst of creative energy and I get excited to write. I usually drink around 2 to 3 cups every morning. Now that I’m older than 30, I try not to drink any coffee or caffeine after 12-noon. I love coffee, but I also love sleep.
In the U.S., caffeine is regulated with a feather light touch. For food and beverages, caffeine will be specified in label’s list of ingredients, but there is currently no regulation that specifies the actual amount that must be listed. Because caffeine has proliferated in our food supply, added to all kinds of products and supplements (ahem, lemonade), the FDA is trying to figure out the best way forward.
Writing about the Panera case in Slate, Mark Joseph Stern noted how much more strictly other countries regulate caffeine:
“The United States’ regulatory bodies are far too feeble to sufficiently protect the public against hazardous products, and so they essentially outsource this task to consumers and the lawyers who represent them. In peer nations—like, for instance, the United Kingdom—the government imposes strict and consistent regulations on the front end: It requires warning labels on drinks with more than 150 mg of caffeine and bans the sale of these drinks to children under 16.”
Can you imagine, in America, being ID’d to buy a Red Bull? America’s laissez-faire regulatory style leaves the onus on the consumer who, when harmed or injured from a product, can join big class action lawsuits against the company. It’s not really the American Way to regulate products up front and put the onus on the company to not hurt people.
After catching heat from the first wrongful death case involving 21-year-old Sarah Katz, Panera has added explicit warnings to its Charged Lemonade drinks: “Use in moderation. NOT RECOMMENDED FOR children, people sensitive to caffeine, pregnant or nursing women.” The label also has clear measurements: A regular 20 oz Charged Lemonade contains 260 mg of caffeine and a 30 ounce contains 390 mg of caffeine. That’s a lot of caffeine. The FDA recommends 400mg of caffeine as a daily dose for a healthy adult, which amounts to four or five cups of coffee.
One large Charged Lemonade is close to the daily recommended dose. If Dennis Brown drank three, then he could’ve had three times the daily recommended dose.
The label on Charged Lemonade self-fill stations also has silly new-agey marketing: “Plant-based and Clean with as much caffeine as our Dark Roast coffee.” In Slate, Stern also made the point that this is somewhat misleading, since Panera does not sell a 30 oz version of its Dark Roast coffee. And, since it is a self-fill water-cooler type thing, people will take advantage and go HAM on refills, making it easier for consumers to ingest a mammoth dose of caffeine.
In this viral TIkTok post, a supremely caffeinated lady says she had no idea that lemonade she was drinking contained absurd doses of caffeine.
How much caffeine?
Let’s talk about dosage.
If the labeling of caffeine content is accurate—and who knows if it is, because this is America, and America is open for business, so why burden business with strict regulations that actually require precise labeling and measurement of ingredients?—Brown consumed anywhere from 780 mg to 1,170 mg of caffeine in a roughly 90 minute sitting.
There’s also a lot of sugar. The sugar content of Charged Lemonade ranges from 82 grams to 124 grams, according to the lawsuit, “exceeding the combined contents of both a 12-fluid-ounce Red Bull (27 grams of sugar) and 16-fluid-ounce Monster Energy Drink (54 grams of sugar).”
Drinking caffeine and sugar can raise your blood pressure. According to the Mayo Clinic, “Caffeine can cause a short but dramatic increase in your blood pressure, even if you don't have high blood pressure.”
Dennis Brown had high blood pressure, in addition to an intellectual disability. In fact, both individuals at the center of these two wrongful death lawsuits had medical conditions that required them to watch what they eat and drink. According to the lawsuit, Dennis Brown did not consume energy drinks, and neither did Sarah Katz, who had a disorder called Long QT type 1 syndrome that causes abnormal heart rhythms. Both drank the lemonade and both suffered cardiac events.
Is Caffeine Lethal?
Each year, Panera Bread presumably sells tens of millions of dollars worth of coffee, tea, and beverages, including the virally popular Charged Lemonade. As of now, there are two cases alleging that the lemonade is directly responsible for deaths.
Before going any futher, I feel like I should say this so I don’t get sued: I’m not a lawyer. I’m not a doctor. I’m simply on the drug beat. I cover drugs and what they do to us humans. I especially take note when anybody makes a claim that X or Y drug produced Z effect. I’m very interested in drug regulations, dosing, labeling, etc., which I think is where this case against Panera ultimately leads.
The two lawsuits against Panera were filed by a law firm called Kline & Specter. According to its website, the firm is actively seeking plaintiffs:
“If you or a loved one suffered severe injury or death after drinking the highly caffeinated beverage, you might have grounds for a lawsuit. Our firm, with more than 50 attorneys, five of whom are also highly skilled medical doctors – the most in the United States — has won billions against major manufacturers in product liability cases.”
In the lawsuits filed by Kline & Specter, they argue that Charged Lemonade is “an unregulated beverage,” that it is a “defective” product,” that it is a “dangerous drink” and that it poses “an unreasonable risk of bodily harm” to consumers. Kline & Specter also argue that the “caffeine content is not controlled and, in turn, has an innate and dangerous potential to vary.”
Panera is also accused of “misrepresenting” the beverage as a harmless “clean” fruit juice when, in reality, it is much closer in substance to an energy drink. The aveage person buying a lemonade might not think to check if there is a massive dose of caffeine added to it.
As of right now, the claim that the lemonade caused these two deaths is unproven. It’s impossible to know with the information currently available. Just because someone consumed a substance and later died does not mean said substance caused the death. To determine causality, we need more toxicology and other medical information that we don’t have.
I am in a big group DM with multiple doctors, toxicologists, and scientific researchers, and the ones who chimed into my “death by lemonade” inquiry were skeptical that the drink is directly responsible. One researcher suggested there could be a “social-contagion” effect going on, given how viral the Charged Lemonade TikTok went and how much press the first wrongful death lawsuit generated. There are just so many potential causes of cardiac arrest, they said.
There is another reason why these doctors and researchers are not sold on the story told in the lawsuits: Caffeine is considered lethal at extremely high doses.
It’s very possible that Dennis Brown drank close to 3 three times the amount of recommended daily caffeine intake by the FDA. But, it’s not as though 400mg or even 1,200mg is in the ballpark of a lethal dose. For someone without comorbidities and other health complications, and that’s a big caveat, caffeine’s LD50 (lethal dose) is about 10 grams, which amounts to 10,000 miligrams. Dennis Brown maybe consumed 12 percent of that.
Another factor is individual metabolism and sensitivity. Everyone’s body is different. If both Dennis Brown and Sarah Katz had a sensitivity and pre-existing health conditions, then it can’t be ruled out that caffeine could be implicated in their deaths.
I was curious just how many deaths attributed to caffeine there are out there. I found a 2018 study in the peer-reviewed journal Nutrients that identified 92 cases in the scientific literature. Considering how many people consume caffeine everyday, death by caffeine is incredibly rare. The paper found that fatal caffeine overdoses tend to hit three populations: newborn babies, athletes, and psychiatric patients.
The paper concluded that the vast majority of “life-threatening caffeine overdoses entail the ingestion of caffeine-containing medications, rather than caffeinated foods or beverages [3].” The paper also concludes that blood concentrations between 80mg/L to 100mg/L are considered lethal. These are very, very, high doses that would be quite difficult to reach via drinking a beverage. Maybe if you beer bong a bath-tub’s worth of Charged Lemonade you could hit that level. Maybe.
I could not find the mg/L blood concentration for either Dennis Brown or Sarah Katz.
The most common cause of death by caffeine came from dietary caffeine products and supplements, usually in the form of a pill swallowed orally. The researchers did draw a conclusion that appears to be relevant to the case against Panera:
“The dangers of caffeine are related to the wide diffusion of the substance, which results in a partially conscious high consumption, due to the difficulty of ascertaining the actual amount of caffeine ingested daily and the inability to predict specific effects with regard to the ‘trigger role’ that caffeine can have—even at ‘safe’ doses—on underlying and not necessarily known cardiovascular conditions.”
In other words, when a large amount of people are exposed to a substance, and it’s quite difficult for people to know critical information about the substance, like the dose they’re consuming, then that could lead to serious health problems, if in rare cases. Caffeine could cause adverse reactions “even at safe doses” when underlying cardiovascular conditions are present. Both Sarah Katz and Dennis Brown had health conditions, and caffeine could have triggered some fatal cardiac event.
As of now, it’s too soon and we simply don’t know if Charged Lemonade caused these deaths. You don’t want to make the same mistake people made in 1994 after the McDonald’s coffee burn fiasco. This poor woman was mocked and pilloried by corporate shills who labeled her lawsuit against McDonald’s as greedy and frivolous. In reality, she was horrifically burnt by searing hot coffee that spilled between her legs.
Safe Supply
The case against Panera gets at something relevant to my other reporting. Experts say that overdoses on drugs like fentanyl are happening because people taking it: a) have no idea that they’re even taking it, or b) they don’t know how much they’re taking. That makes it impossible to measure a proper dose. Unlike caffeine, fentanyl’s therapuetic dose is incredibly close to its lethal dose, which means the margin for error is very low. A few extra micrograms, a tiny amount, could cause an overdose in non-opioid tolerant consumers.
This fact about fentanylhas led experts and activists to call for a “Safe Supply,” which entails making available a regulated version of drugs with a clearly labeled dose. Of course, the idea is that this would be made available for already tolerant people who are on the severe end of the addiction spectrum. There’s a logic to it. Back when OxyContin was the drug du jour, there were far fewer overdoses. That’s because, in addition to oxycodone being a far ess potent opioid, every OxyContin pill was labeled: 10mg, 20 mg, 40mg, or 80mg. People could accurately dose in a way that is next to impossible with a bag of blue or pink or purple-tinged mystery powder bought on the street.
The Panera case illustrates how crucial dosing information is for all kinds of substances, even legal ones like caffeine, which people consume everyday. If the case against Panera moves forward, a jury and judge in Delaware might decide whether we actually one day know how much caffeine we’re consuming.
Until then, you’re guess is as good as mine.
How do we know the caffeine from Panera caused the cardiac arrest? How do we know if caffeine caused the cardiac arrest? The person who died may have had an underlying undiagnosed heart condition. I’ll be a smart ass but the person who died could have had myocarditis from Covid or the Covid shot which made him more susceptible to arrhythmias for all we know. I think an autopsy may be very inconclusive.
Another well reasoned, thoroughly reported piece, Zach. Thank you!