Sarah Katz had always dreamed of riding a roller coaster.
In a high school essay, she fondly reminisced about a visit to Six Flags in her New Jersey hometown with her mother during her sophomore year. She expressed a longing to experience the thrill of the “biggest, scariest” ride in the park and to “feel what it was like to fly.”
However, Sarah’s heart condition meant she had to be somewhat cautious. She avoided riding roller coasters and engaging in team sports. She could have had coffee but chose not to.
For safety, she relied on daily beta blockers, specifically nadolol, to maintain a low heart rate, steering clear of energy drinks, which her doctor had advised against.
According to her parents and their legal team, she adhered to medical guidance, at least intentionally. Tragically, she died in 2022 at just 21 years old.
Following her death, Sarah’s parents initiated a wrongful death lawsuit against Panera Bread, asserting that a 30-ounce Charged Lemonade from the chain led to an arrhythmia that caused her untimely demise.
This lawsuit is just the first of several filed against Panera related to beverage safety.
Currently, Sarah’s parents are also advocating for legislative changes in Washington.
Since January 2024, they have collaborated with Congressman Robert Menendez (D) to develop a bipartisan bill known as the Sarah Katz Caffeine Safety Act. This proposed legislation aims to mandate energy drinks to clearly disclose their caffeine content, and for restaurants to label items containing more than 150 mg of caffeine.
Notably, Sarah’s Charged Lemonade has a caffeine content of 390 mg, which is just shy of the recommended daily maximum for adults (400 mg) and surpasses the combined caffeine levels of Red Bull and Monster Energy.
The lawsuit contends that Panera deceptively advertised “Caffeine-free and/or low-caffeine drinks” at the University of Pennsylvania location where Sarah went, despite her having just started third grade.
Emergency responders arrived moments after Sarah collapsed, but sadly, they were unable to revive her.
“Very often the first episode is death.”
For a time, Sarah and her family believed they were fortunate.
Her condition, long QT syndrome, is often undiagnosed in children, making it particularly dangerous. Research indicates that various socioeconomic and racial factors can also impact survival rates in cases of cardiac arrest.
However, when Sarah suffered a seizure during swim class at age 5, her medical team, guided by her mother Jill Katz, worked diligently to provide care.
Jill recalls being told how “lucky” she was that Sarah’s condition was caught early.
“Very often the first episode is death,” she shared.
Doctors reassured the Katz family that they could manage Sarah’s condition with proper treatment. She simply needed to take her medication and avoid known triggers.
“Once you catch it, it’s like managing any other chronic condition, whether diabetes or food allergies,” Jill explained. “In certain cases, it can indeed be life-threatening, but by following medical advice, you should be okay.”
Even though the Katz family wasn’t heavy coffee drinkers, doctors were fine with moderate caffeine intake.
“They just told me to avoid energy drinks,” Jill recalled.
Caffeine regulations are vague
Two years after Sarah’s passing, cardiologists at Children’s Hospital in Philadelphia released a report titled “Cardiovascular Toxicity of Energy Drinks in Youth: A Call for Regulation.”
Dr. Victoria L. Vetter noted that the U.S. energy drink market is among the least regulated globally, despite 38 energy drink-related fatalities and 14,000 toxicity cases reported to the FDA between 2008 and 2015.
High doses of caffeine can pose risks to anyone, but regulations differ across products. Over-the-counter medications must disclose caffeine content and related risks, while caffeinated sodas face limits on caffeine levels.
Meanwhile, dietary supplements are the least regulated and might exceed the caffeine levels deemed safe for beverages. Many energy drinks qualify as supplements if they contain herbal ingredients or stimulants.
Dietary guidelines for conventional foods and drinks, like coffee, are also loosely defined.
Experts have sounded the alarm for decades, urging the FDA to tighten regulations on energy drink sales since at least 1997, when Red Bull made its U.S. debut.
Currently, over 500 energy drink brands exist, many targeting young consumers.
Jill, an attorney, has concentrated on researching energy drink laws since her daughter’s tragic accident.
“History is repeating itself like it did with tobacco,” she remarked. “They’re clearly focusing on children and teens to get them hooked.”
Neither Red Bull nor Panera responded to inquiries regarding the issue.
Bipartisan bill to increase transparency
Some potential critics of the proposed safety bill might fear a caffeine “ban.” Menendez insists that isn’t his intent.
“We want to clarify: this isn’t a ban,” a representative emphasized. “I still enjoy Diet Coke, and I sometimes opt for Celsius.”
It’s really about advocating for transparency.
“Caffeine is no longer the only issue. There are other stimulants in these drinks that consumers might not even know about. People are really seeking that greater transparency,” he asserted.
The American Beverage Association chose not to comment on the legislation but claimed its member companies already disclose caffeine amounts voluntarily.
The Red Bull website, for example, mentions that their products “meet and exceed the FDA’s safety and labeling standards,” and they voluntarily post caffeine content on their cans.
As for Panera, they have announced the removal of Charged Lemonade from their menu in 2024, promoting a much weaker lemonade instead, with clearly listed caffeine content (28 mg per 20 oz, due to “green coffee extract”).
Menendez believes that mere voluntary disclosures no longer suffice, particularly given the burgeoning energy drink market.
Shortly after he began working on the legislation, he received numerous testimonials from individuals who have faced similar losses.
“Every time I see someone with an energy drink, I cringe and wonder if they know what they’re consuming,” remarked Martha Lopez Anderson, Executive Director of Parent Heart Watch.
“This is a significant issue among young adults,” he added. “Even during my law school years, I consumed as many Red Bulls as I wanted to study for finals but never gave it much thought.”
Lopez dismisses claims of excessive regulation as misguided.
“It’s akin to labeling calories or noting if a product contains peanuts,” she argued. “Whether I’m about to embark on a gentle slope or a treacherous path, I don’t want to rely on tiny black letters.”
Sudden tragedy
Martha Lopez Anderson, who leads Parent Heart Watch, experienced a tragic loss when her 10-year-old son Sean suffered a sudden cardiac arrest in 2004. Although his death wasn’t linked to caffeine, she formed a sympathetic bond with the Katz family, and together, they traveled to advocate for the bill.
“Whenever I see someone drinking an energy drink, I feel a jolt of anxiety, thinking, ‘Do they know what they are consuming?’ Most don’t,” she remarked.
Much of Lopez-Anderson’s work centers on raising awareness about signs of lurking heart issues that can prove fatal when paired with energy drinks. Fainting, chest pain, breathlessness during or after physical activity, and persistent fatigue can all signal heart problems in young people. Knowing one’s family background can also be crucial.
“I considered myself a knowledgeable parent, but I was completely blindsided by SCA,” she reflected. “Did I think my child could suddenly collapse and die? No, never.”
The legacy continues through legislation
Sarah would have celebrated her 25th birthday in April, perhaps enjoying her favorite snacks like sushi and boba.
As for her future, she had ambitions to study law like her mother. She even spent some time in China, learning Chinese fluently before returning home due to the pandemic.
Once back in Philadelphia, she volunteered for CPR training at a community center named after a young man who passed away from SCA.
To honor Sarah’s memory, her parents collaborated with the University of Pennsylvania to install more outdoor automated external defibrillators and founded a charitable organization in her name.
They are also dedicated to advancing this bill, convinced it could help prevent similar tragedies.
One of Jill’s cherished memories involves Sarah’s bat mitzvah where she paraphrased the Talmud: “If you save one life, you save the whole world.” By that measure, Sarah and her parents continue to make a significant impact, even in their loss.
