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— Around ten o'clock every morning, a prep cook strolls through the kitchen of a Mission Valley restaurant crying, "Red Bull. Red Bull. Red Bull." He collects $2 each from waiters, busboys, and cooks to buy the silver cans from the roach coach.

Busboys ask waiters to buy them the energy drink with the tip money they share, and sometimes busboys buy waiters the drink so the waiter will work harder, turn over more tables, and earn more tips.

A product of Austria, Red Bull came out in 1987. The company's website says the energy drink was "developed especially for periods of increased mental and physical exertion...sport, work, study, driving and socializing." Key ingredients are taurine, glucuronolactone, and caffeine.

The website explains glucuronolactone as "a carbohydrate, a kind of sugar"; taurine "is a conditionally essential amino acid...naturally occurring in our body." A can of Red Bull contains 80 milligrams of caffeine; the same amount of coffee, depending on how it's brewed, can have twice as much.

In 2004, people in 120 countries drank close to two billion cans of Red Bull.

Maritza, 45, has served food on and off for more than 20 years. She began waiting tables while studying social work in college. "When I first started, people were different," she says. "No one was sending back food or complaining about service." Energy drinks help her maintain an upbeat attitude.

"You take it when you need energy," she says. However, "It's like crack; I'm addicted. But it alleviates some of the hard labor. It works like speed."

Food preparation workers, waiters, waitresses, and bartenders top the list of illegal drug and alcohol abusers, according to the Substance Abuse and Mental Health Services Administration. The administration's website, www.drugabusestatistics.samhsa.gov, says that food industry workers have "the highest rate of both current illicit drug and heavy alcohol use at 18.7 percent and 15 percent, respectively."

Maritza remembers that in the '80s, every food server drank coffee and smoked cigarettes. "I can remember making a salad for a customer with one hand and smoking a cigarette with the other," she says, gesturing as if she's tossing lettuce leaves and dragging on a cigarette at the same time. Serving tables and going to school, Maritza depended on coffee to wake up in the morning. "Smoking cigarettes was a way to relax and release stress." She adds, "Now more servers I know smoke marijuana than cigarettes."

Recently a friend who delivers energy drinks to grocery and liquor stores gave Maritza a bottle of ephedra. Maritza tried the energy supplement out of curiosity.

According to the FDA, "Ephedra, also called Ma huang, is a naturally occurring substance derived from plants. Its principal active ingredient is ephedrine, which when chemically synthesized is regulated as a drug. In recent years ephedra products have been extensively promoted to aid weight loss, enhance sports performance, and increase energy."

Products containing ephedra have been described as having an amphetamine-like effect. Asked to compare the effects of ephedra and energy drinks, Maritza says, "You feel completely different on ephedra than drinking a Red Bull. Ephedra makes your stomach hurt; you feel that it's not good for you."

Katie Spangler, a 24-year-old nursing student at San Diego State and part-time waitress, has taken ephedra since she was 18.

"It started that I used it to lose weight," she says. "In the beginning I lost a few pounds, but I kept taking it for the energy boost."

At the time, Spangler worked as a waitress in Mission Valley, went to school, and trained for and later ran a marathon. "I could've never done it without taking ephedra. There's no way that I would've had the same motivation."

But in 2003, supplements containing ephedra were banned in California, and they went off shelves across the nation in April 2004, when the FDA published a ruling claiming that ephedra presented "an unreasonable risk of illness or injury." The FDA linked ephedra to 155 deaths, including the 2003 death of 23-year-old Baltimore Orioles pitcher Steve Bechler.

When ephedra became unavailable, Spangler went without it for a year. Instead, she drank 32-ounce Diet Cokes, or "I'd drink about two Big Gulps every day," she says, and "I used other herbal supplements that claimed to be as effective as ephedra. But they didn't work as well.

"I feel like those people who're addicted to heroin," Spangler says. "When I stop taking energy supplements, I'm tired, cranky, exhausted, and unmotivated."

Last April, in Salt Lake City, district court judge Tena Campbell ruled that the FDA had not met the burden of proving that ephedra, in doses of 10 milligrams or less, posed an unreasonable risk. After learning that the ban had been lifted, Spangler began purchasing ephedra on the Internet. Jevelle International, operating out of Gardena, California, boasts on its website, www.acnedoctor.com, that one version of ephedra "works so well that the FDA doesn't want you to have it."

"Now with the Internet, I can get the good stuff," Spangler says.

Spangler's recently been taking "two to three pills a day," even though the bottle recommends one per day, two at most. Each pill of the Lipodrene brand she buys contains 25 milligrams of ephedra. Spangler pays $60 for a bottle of 100 pills. By the time she orders her next bottle, she imagines, "I might be up to three pills [75 milligrams] a day."

As a student nurse, Spangler knows the effects stimulants have on the body. "One cup of coffee has been proven to be healthy for the body," she says. "It's any amount more than the first cup that increases stress and causes your blood sugar to rise.

"When you come down or crash from energy supplements, you feel bad because your body chemistry is out of whack."

Spangler lists the major harm from ephedra. "It's hard on the liver because it's a diuretic. Diuretics put added stress on the heart, leading to potential heart valve disorders because of the added wear and tear from a continuously heightened heart rate.

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