Armstrong Admits to Doping, 'One Big Lie'













Lance Armstrong, formerly cycling's most decorated champion and considered one of America's greatest athletes, confessed to cheating for at least a decade, admitting on Thursday that he owed all seven of his Tour de France titles and the millions of dollars in endorsements that followed to his use of illicit performance-enhancing drugs.


After years of denying that he had taken banned drugs and received oxygen-boosting blood transfusions, and attacking his teammates and competitors who attempted to expose him, Armstrong came clean with Oprah Winfrey in an exclusive interview, admitting to using banned substances for years.


"I view this situation as one big lie that I repeated a lot of times," he said. "I know the truth. The truth isn't what was out there. The truth isn't what I said.


"I'm a flawed character, as I well know," Armstrong added. "All the fault and all the blame here falls on me."


In October, the U.S. Anti-Doping Agency issued a report in which 11 former Armstrong teammates exposed the system with which they and Armstrong received drugs with the knowledge of their coaches and help of team physicians.






George Burns/Courtesy of Harpo Studios, Inc./AP Photo











Lance Armstrong's Many Denials Caught on Tape Watch Video









Lance Armstrong Admits Using Performance-Enhancing Drugs Watch Video









Lance Armstrong's Oprah Confession: The Consequences Watch Video





The U.S. Postal Service Cycling Team "ran the most sophisticated, professionalized and successful doping program that sport has ever seen," USADA said in its report.


As a result of USADA's findings, Armstrong was stripped of his Tour de France titles. Soon, longtime sponsors including Nike began to abandon him, too.


READ MORE: Did Doping Cause Armstrong's Cancer?


Armstrong said he was driven to cheat by a "ruthless desire to win."


He told Winfrey that his competition "cocktail" consisted of EPO, blood transfusions and testosterone, and that he had previously used cortisone. He would not, however, give Winfrey the details of when, where and with whom he doped during seven winning Tours de France between 1999 and 2005.


He said he stopped doping following his 2005 Tour de France victory and did not use banned substances when he placed third in 2009 and entered the tour again in 2010.


"It was a mythic perfect story and it wasn't true," Armstrong said of his fairytale story of overcoming testicular cancer to become the most celebrated cyclist in history.


READ MORE: 10 Scandalous Public Confessions


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Armstrong would not name other members of his team who doped, but admitted that as the team's captain he set an example. He admitted he was "a bully" but said there "there was a never a directive" from him that his teammates had to use banned substances.


"At the time it did not feel wrong?" Winfrey asked.


"No," Armstrong said. "Scary."


"Did you feel bad about it?" she asked again.


"No," he said.


Armstrong said he thought taking the drugs was similar to filling his tires with air and bottle with water. He never thought of his actions as cheating, but "leveling the playing field" in a sport rife with doping.






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Some hostages reported to escape Sahara siege


ALGIERS (Reuters) - Some hostages were reported to have escaped from a remote Algerian gas plant on Thursday, where dozens of foreigners and scores of Algerians were seized by Islamist gunmen demanding a halt to a French military campaign in neighboring Mali.


Governments around the world were holding emergency meetings to respond to one of the biggest international hostage crises in decades, which sharply raises the stakes over the week-old French campaign against al Qaeda-linked rebels in the Sahara.


Algeria's Ennahar television said 15 foreigners, including two French citizens, had escaped the besieged plant deep in the Sahara desert. About 40 Algerians had also been freed, mainly women working as translators, it said.


An Algerian security source told Reuters the captors, encircled by Algerian troops, were demanding safe passage out with their prisoners. Algeria has refused to negotiate with what it says is a band of about 20 fighters.


The captors, who have been speaking regularly to media in neighboring Mauritania, told that country's ANI news agency that Algerian helicopters had fired on the compound, wounding two Japanese hostages. This could not be confirmed.


A group calling itself the "Battalion of Blood" says it seized 41 foreigners, including Americans, Japanese and Europeans, after storming a natural gas pumping station and employee barracks before dawn on Wednesday.


The attackers have demanded an end to the French military campaign in Mali, where hundreds of French paratroopers and marines are launching a ground offensive against rebels a week after Paris began firing on militants from the air.


Algerian Interior Minister Daho Ould Kablia said the raid was led by Mokhtar Belmokhtar, a veteran Islamist guerrilla fighter who fought Soviet forces in Afghanistan in the 1980s and had recently set up his own group in the Sahara after falling out with other local al Qaeda leaders.


A holy warrior-cum-smuggler dubbed "The Uncatchable" by French intelligence and "Mister Marlboro" by some locals for his illicit cigarette-running business, Belmokhtar's links to those who seized towns across northern Mali last year are unclear.


The hostage takers appear to have allowed some prisoners to speak to the media to put pressure on Algerian forces not to storm the compound. An unidentified hostage who spoke to France 24 television said prisoners were being forced to wear explosive belts. Their captors were heavily armed and had threatened to blow up the plant if the Algerian army tried to storm it.


Two hostages, identified as British and Irish, spoke to Al Jazeera television and called on the Algerian army to withdraw from the area to avoid casualties.


"We are receiving care and good treatment from the kidnappers. The (Algerian) army did not withdraw and they are firing at the camp," the British man said. "There are around 150 Algerian hostages. We say to everybody that negotiations is a sign of strength and will spare many any loss of life."


The hostage identified as Irish told the Qatar-based channel the captives included French, American, Japanese, British, Irish and Norwegian citizens.


"The situation is deteriorating. We have contacted the embassies and we call on the Algerian army to withdraw ... We are worried because of the continuation of the firing."


After what it said was a phone interview with one of the hostage takers, the Mauritanian news agency ANI said Algerian security forces had tried to approach the facility at dawn.


"We will kill all the hostages if the Algerian army try to storm the area," it quoted the hostage taker as saying. Algeria has not commented on reports its troops tried to approach. The militants earlier said they repelled an assault after dark.


NUMBERS UNCONFIRMED


The precise number and nationalities of foreign hostages could not be confirmed, with some countries reluctant to release information that could be useful to the captors.


British Foreign Secretary William Hague confirmed one British citizen had been killed and "a number" of others were among those held. Algerian media said an Algerian was killed in the assault. Another local report said a Frenchman had died.


The militants said seven Americans were among their hostages, a figure U.S. officials said they could not confirm.


Norwegian oil company Statoil said nine of its Norwegian staff and three Algerian employees were captive. Britain's BP, which operates the plant with Statoil and Algerian state oil company Sonatrach, said some of its staff were held but would not say how many or their nationalities.


Japanese media said five workers from Japanese engineering firm JGC Corp. were held, a number the company did not confirm. France has not confirmed whether any French citizens were held. Vienna has said one hostage is Austrian.


So far, Western countries seem reluctant to intervene on the ground in the Algerian standoff directly. French Defence Minister Jean-Yves Le Drian said Paris had confidence in the Algerian government to handle it.


British Prime Minister David Cameron's spokesman said Cameron had spoken to the leaders of Japan and Norway, and all had concluded that the best course was to work through the Algerian authorities.


Paris said the Algeria attack demonstrated it was right to intervene in Mali: "We have the flagrant proof that this problem goes beyond just the north of Mali," French ambassador to Mali Christian Rouyer told France Inter radio.


"Northern Mali is at heart of the problem, of course, but the dimension is really national and international, which gives even more justification to the French intervention," he said.


Hollande has received public backing from Western and African allies who fear that al Qaeda, flush with men and arms from the defeated forces of Libya's Muammar Gaddafi, is building a desert haven in Mali, a poor country that was helpless to combat fighters who seized its northern cities last year.


However, there is some concern in Washington and other capitals that the French action in Mali could provoke a backlash worse than the initial threat by militants in the remote Sahara.


The militants, communicating through established contacts with media in neighboring Mauritania, said they had dozens of men armed with mortars and anti-aircraft missiles in the compound and had rigged it with explosives.


"We hold the Algerian government and the French government and the countries of the hostages fully responsible if our demands are not met, and it is up to them to stop the brutal aggression against our people in Mali," read one statement carried by Mauritanian media.


They condemned Algeria's secularist government for letting French warplanes fly over its territory to Mali and shutting its border to Malian refugees.


Regis Arnoux, head of CIS, a French catering firm operating at the site, told BFM television he had been in touch with a manager of some 150 Algerian workers there. Foreigners were being kept separate from Algerian hostages, he said.


"They are tied up and are being filmed. Electricity is cut off, and mobile phones have no charge."


PRESSING ON


The attack in Algeria did not stop France from pressing on with its campaign in Mali. It said on Thursday it now had 1,400 troops on the ground in Mali, and combat was underway against the rebels that it first began targeting from the air last week.


"There was combat yesterday, on the ground and in the air. It happened overnight and is under way now," said Le Drian. Residents said a column of about 30 French Sagaie armored vehicles set off on Wednesday toward rebel positions from the town of Niono, 300 km (190 miles) from the capital, Bamako.


The French action last week came as a surprised but has received widespread international support. Neighboring African countries expected to provide ground troops for a U.N. force by September have said they will move faster to offer troops.


Germany, Britain and the Netherlands have offered transport aircraft to help ferry in African troops. Washington has said it is considering what support it can offer.


Many inhabitants of northern Mali have welcomed the French action, though some also fear being caught in the cross-fire. The Mali rebels who seized Timbuktu and other oasis towns in northern Mali last year imposed Islamic law, including public amputations and beheadings that angered many locals.


"There is a great hope," one man said from Timbuktu, where he said Islamist fighters were trying to blend into civilian neighborhoods. "We hope that the city will be freed soon."


The rebels include fighters from al Qaeda's mainly Algerian-based North African wing AQIM as well as home-grown Malian groups Ansar Dine and MUJWA. Islamists have warned Hollande that he has "opened the gates of hell" for all French citizens.


A day after launching the campaign in Mali, Hollande also ordered a raid in Somalia on Saturday to free a French hostage held there by al Qaeda-linked al Shabaab militants since 2009. That rescue was a failure, with two French commandos killed.


Al Shabaab said on Thursday it had executed its hostage, Denis Allex. France says it believes Allex died in the rescue attempt.


(Additional reporting by Bate Felix in Bamako; Pascal Fletcher, Andrew Callus and Dmitry Zhdannikov in London; Balazs Koranyi in Oslo; Laurent Prieur in Nouakchott; Daniel Flynn in Dakar; John Irish, Catherine Bremer, Marine Pennetier, and Nick Vinocur in Paris; David Alexander in Rome; Andrew Quinn in Washington; Jane Wardell in Sydney, Omar Fahmy in Cairo; Mirna Sleiman in Dubai and Kaori Kaneko in Tokyo; Writing by Peter Graff; Editing by Giles Elgood)



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Floods swamp Indonesia capital, 19,000 homeless






JAKARTA: Floods which have made more than 19,000 people homeless and killed three brought parts of the Indonesian capital to a standstill Thursday, with even the president forced to roll up his trousers.

The waist-deep muddy waters paralysed much of the centre of Jakarta, home to 20 million people and already notorious for its chaotic traffic.

Drivers were stuck in snaking queues for hours in the morning and cyclists pushed bikes with only the handlebars and seats visible.

President Susilo Bambang Yudhoyono was pictured in the grounds of the presidential palace with his trousers rolled up to the knee, brown water lapping his calves and threatening to flood the shrubbery.

"Jakarta is flooded: hopefully there won't be too many victims," he told photographers, ordering military, police and disaster officials to ensure safety.

The monsoon floods had driven more than 19,000 people from their homes, according to Jakarta governor Joko Widodo.

National disaster management agency spokesman Sutopo Purwo Nugroho said the death toll rose to three when a 35-year old man was electrocuted on Thursday. A two-year old boy was swept away and a 46-year-old man was electrocuted earlier this week.

The waters started to recede in the afternoon but floods remained in some areas including the central business district, where luxury hotels and the French, German and British embassies were surrounded.

Motorists trying to avoid the deluge drove along pavements and central reservations, or headed the wrong way down one-way streets. In some areas children punted rafts along roads which looked more like canals.

"Jakarta today is a huge swimming pool. Everyone's playing in the rain, walking in the water and laughing. The downside is, I have no idea how to get home, I might have to walk back three hours," 32-year-old administrative officer Yohanna, who uses a single name, told AFP.

Authorities raised the flood alert to its highest level early Thursday, said disaster agency spokesman Nugroho, describing the city as "besieged".

"The situation could get worse in the coming days as the rain shows little sign of abating," he told AFP.

But as rescuers rushed to evacuate residents, welfare ministry spokesman Tito Setiawan said the situation was under control.

"We have sent out trucks and rafts to move victims whose homes were inundated to temporary shelters. We will also provide food, water and humanitarian aid," he said.

Indonesia is regularly afflicted by deadly floods and landslides during its wet season, which lasts around half the year, and many in the capital live beside rivers which periodically overflow.

- AFP/fa



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ISI fomented BTAD trouble to destabilize country: Gogoi

GUWAHATI: Assam chief minister Tarun Gogoi today blamed both external forces, including Pakistan's ISI, and internal elements for fomenting trouble in BTAD area in the state to destabilise the country.

"The trouble in BTAD area last year was a part of a greater design by both internal and external forces like the ISI to not only to destabilise Assam but the country as well," Gogoi told reporters here.

"The role of insurgents and ISI is there. These forces were certainly involved in the Bodoland Territorial Administrative Districts (BTAD) trouble. Otherwise how did it happen," he asked.

The ongoing CBI probe will reveal the anti-national forces as well as those from outside involved in the BTAD violence, he said.

The involvement of some political forces in the month- long violence that claimed about a hundred lives and left about 4.5 lakh people homeless, would also be exposed by the CBI investigation, he said.

The role of the social networking media was also being investigated. "Otherwise from where were the bulk SMSes (about northeasterners living outside the region to be targeted following the violence and resulted in mass exodus) sent?"

As the social media cannot be regulated in a democracy, the state government in consultation with the Centre is trying to work out a strategy for such a situation.

The divisive forces were still active in BTAD, Gogoi said, adding both the government and the people would have to remain alert to thwart the designs of such forces out to create disturbances.

Referring to the 4.5 lakh people who had taken shelter in relief camps following the outbreak of the violence last year, he said 4000 are yet to return to their homes and the process of rehabilitation was on.

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Large study confirms flu vaccine safe in pregnancy


NEW YORK (AP) — A large study offers reassuring news for pregnant women: It's safe to get a flu shot.


The research found no evidence that the vaccine increases the risk of losing a fetus, and may prevent some deaths. Getting the flu while pregnant makes fetal death more likely, the Norwegian research showed.


The flu vaccine has long been considered safe for pregnant women and their fetus. U.S. health officials began recommending flu shots for them more than five decades ago, following a higher death rate in pregnant women during a flu pandemic in the late 1950s.


But the study is perhaps the largest look at the safety and value of flu vaccination during pregnancy, experts say.


"This is the kind of information we need to provide our patients when discussing that flu vaccine is important for everyone, particularly for pregnant women," said Dr. Geeta Swamy, a researcher who studies vaccines and pregnant women at Duke University Medical Center.


The study was released by the New England Journal of Medicine on Wednesday as the United States and Europe suffer through an early and intense flu season. A U.S. obstetricians group this week reminded members that it's not too late for their pregnant patients to get vaccinated.


The new study was led by the Norwegian Institute of Public Health. It tracked pregnancies in Norway in 2009 and 2010 during an international epidemic of a new swine flu strain.


Before 2009, pregnant women in Norway were not routinely advised to get flu shots. But during the pandemic, vaccinations against the new strain were recommended for those in their second or third trimester.


The study focused on more than 113,000 pregnancies. Of those, 492 ended in the death of the fetus. The researchers calculated that the risk of fetal death was nearly twice as high for women who weren't vaccinated as it was in vaccinated mothers.


U.S. flu vaccination rates for pregnant women grew in the wake of the 2009 swine flu pandemic, from less than 15 percent to about 50 percent. But health officials say those rates need to be higher to protect newborns as well. Infants can't be vaccinated until 6 months, but studies have shown they pick up some protection if their mothers got the annual shot, experts say.


Because some drugs and vaccines can be harmful to a fetus, there is a long-standing concern about giving any medicine to a pregnant woman, experts acknowledged. But this study should ease any worries about the flu shot, said Dr. Denise Jamieson of the Centers for Disease Control and Prevention.


"The vaccine is safe," she said.


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Online:


Medical journal: http://www.nejm.org


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Notre Dame: Football Star Was 'Catfished' in Hoax













Notre Dame's athletic director and the star of its near-championship football team said the widely-reported death of the star's girlfriend from leukemia during the 2012 football season was apparently a hoax, and the player said he was duped by it as well.


Manti Te'o, who led the Fighting Irish to the BCS championship game this year and finished second for the Heisman Trophy, said in a statement today that he fell in love with a girl online last year who turned out not to be real.


The university's athletic director, Jack Swarbrick, said it has been investigating the "cruel hoax" since Te'o approached officials in late December to say he believed he had been tricked.


Private investigators hired by the university subsequently monitored online chatter by the alleged perpetrators, Swarbrick said, adding that he was shocked by the "casual cruelty" it revealed.


"They enjoyed the joke," Swarbrick said, comparing the ruse to the popular film "Catfish," in which filmmakers revealed a person at the other end of an online relationship was not who they said they were.


"While we still don't know all of the dimensions of this ... there are certain things that I feel confident we do know," Swarbrick said. "The first is that this was a very elaborate, very sophisticated hoax, perpetrated for reasons we don't understand."






Mike Ehrmann/Getty Images











Notre Dame's Athletic Director Discusses Manti Te'o Girlfriend Hoax Watch Video









MTV's 'Catfish' Series Pulls Back Curtain on Online Profiles Watch Video







Te'o said during the season that his girlfriend, Lennay Kekua, died of leukemia in September on the same day Te'o's grandmother died, triggering an outpouring of support for Te'o at Notre Dame and in the media.


"While my grandma passed away and you take, you know, the love of my life [Kekua]. The last thing she said to me was, 'I love you,'" Te'o said at the time, noting that he had talked to Kekua on the phone and by text message until her death.


Now, responding to a story first reported by the sports website Deadspin, Te'o has acknowledged that Kekua never existed. The website reported today that there were no records of a woman named Lennay Kekua anywhere.


Te'o denied that he was in on the hoax.


"This is incredibly embarrassing to talk about, but over an extended period of time, I developed an emotional relationship with a woman I met online," Te'o said in a statement released this afternoon. "We maintained what I thought to be an authentic relationship by communicating frequently online and on the phone, and I grew to care deeply about her."


Swarbrick said he expected Te'o to give his version of events at a public event soon, perhaps Thursday, and that he believed Te'o's representatives were planning to disclose the truth next week until today's story broke.


Deadspin reported that the image attached to Kekua's social media profiles, through which the pair interacted, was of another woman who has said she did not even know Te'o or know that her picture was being used. The website reported that it traced the profiles to a California man who is an acquaintance of Te'o and of the woman whose photo was stolen.


"To realize that I was the victim of what was apparently someone's sick joke and constant lies was, and is, painful and humiliating," Te'o said.






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Syrian army on offensive in Aleppo after university blast


BEIRUT (Reuters) - Syrian armed forces launched a renewed offensive in the northern city of Aleppo on Wednesday, state media said, a day after 87 people were killed in explosions at the city's university.


The state news agency SANA said the military had killed dozens of "terrorists" - a term Damascus uses for rebels trying to overthrow President Bashar al-Assad - in the new fighting.


Reuters cannot independently verify reports due to media restrictions in Syria.


"The Armed Forces carried out several special operations against the mercenary terrorists in Aleppo and its countryside, inflicting heavy losses upon them in several areas," SANA said.


Aleppo is split roughly in half between government and rebel forces. SANA said dozens of "terrorists" were killed in the rebel strongholds of Sukari, Bab al-Hadeed and Bustan al-Qasr.


Government forces also killed militants in al-Laramon, a area of Aleppo from which Damascus says two rockets were fired into the University of Aleppo on Tuesday, it added.


If confirmed, the government's report of a rocket attack would suggest rebels in the area had been able to obtain and deploy more powerful weapons than previously used.


The Syrian Observatory for Human Rights, a Britain-based monitoring group, said 87 people were killed and dozens wounded in the explosions, but it could not identify the source of the blasts. It said the toll could rise to more than 100 as there were still body parts that were unaccounted for.


State television showed a body lying on the street and burning cars. An entire facade of a multi-story university building had crumbled and cars were overturned. An interior shot of a corridor showed that the ceiling had caved in.


Amateur video footage showed students carrying books out of the university after one of the explosions, walking quickly away from rising smoke. The camera then shakes to the sound of another explosion and people begin to run.


Syria has been plunged into bloodshed since a violent government crackdown in early 2011 on peaceful demonstrations for democratic reform which turned the unrest into an armed insurgency bent on overthrowing Assad.


Each side in the 22-month-old conflict blamed the other for Tuesday's blasts at the university, located in a government-held area of Syria's most populous city.


Some activists in Aleppo said a government air strike caused the explosions, while state television accused terrorists of firing two rockets at the university. A rebel fighter said the blasts appeared to have been caused by surface-to-surface missiles.


The nearest rebel-controlled area, Bustan al-Qasr, is more than a mile away from the university.


The Observatory said rebel sources on the ground reported they were fighting with government forces in the early hours of Wednesday around Bustan al-Qasr, implying a renewed push by government forces to expel the insurgents.


(Reporting by Oliver Holmes; Editing by Jon Boyle)



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Tennis: Djokovic dazzles in straight-sets win over Harrison






MELBOURNE: Novak Djokovic was in the zone with a dazzling demolition of Ryan Harrison as he stormed into the third round of the Australian Open on Wednesday.

The world number one was in irresistible form, outclassing the young American 6-1, 6-2, 6-3 in just one hour 31 minutes of high-class tennis on Rod Laver Arena.

Djokovic, a three-time winner and going for three straight Australian titles, will next play Czech journeyman Radek Stepanek in the last 32.

The Serb said it was one of the best matches he has played in the early rounds at a Grand Slam.

"I've played many matches in Grand Slams in my career, so it's tough to compare which one is the best I would take under the circumstances," he said.

"I tried to focus on the start and I knew that he had nothing to lose and would come out with his big serves, but I managed to make some very important early breaks at the start of the match.

"I was a set up after 20 minutes and it was a mental advantage, I felt much more comfortable on the court.

"This was definitely a better performance than the first round.

"I managed to play in a very high level already in the second round of a Grand Slam, which is very encouraging for next challenge."

Djokovic jumped out of the blocks and won 12 of the first 13 points to put the young American on the back foot and down an early service break.

He broke Harrison again in the sixth game and wrapped up the opening set in just 20 minutes.

The Serb top seed carried on where he left off breaking the American's opening service to win seven of the first eight games.

Djokovic broke Harrison's serve for a fourth time to carry on the blitz and raced to a two sets to love lead via three set points in 30 minutes.

Harrison was broken again in the opening game of the final set as Djokovic closed in on victory.

But the young American refused to give in and held three service games under pressure, to the appreciation of the centre court crowd.

Djokovic again put Harrison's service under pressure and took out the match on his second match point.

"He played really well," Harrison said. "Kind of getting broke in that first service game, giving a guy that's that good a little bit of a lead and letting him front-run is just not the ideal way to start."

- AFP/fa



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Puri shankaracharya blames western influence for rapes

KOLKATA: Western influence was one of the main reasons behind the rise in incidents of rape in the country, sankaracharya of Puri Swami Sri Nischalananda Saraswati said here on Wednesday.

The western influence — films, club culture and drugs has destroyed the age old values and principles of the country. "There is need to change this. Before Independence we were able to maintain our culture and values but in the last 65 years we have lost a great part of it."

"Such horrific incidents ( Delhi gang rape) don't happen all of a sudden. They happen when the thin line of culture and values are crossed in the name of civilization and development."

The people, the holy man said, should ponder over this and ensure that such incidents don't happen.

"Earlier sisters and brothers roamed freely but nothing used to happen. There has been decline in human values, emotions ... Our culture and civilization teaches us to respect women, who are our sisters and mothers," he said

Asked for his comment on the brutal killing of Indian soldiers by Pakistani army, the sankaracharya said the incident was barbaric and against human values.

Accusing the government of not being strong enough to deal with such incidents, he said "We need to think why is the image of the government and the country so weak that a neighbouring country doesn't think twice before perpetuating such an act."

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ER visits tied to energy drinks double since 2007


SAN FRANCISCO (AP) — A new government survey suggests the number of people seeking emergency treatment after consuming energy drinks has doubled nationwide during the past four years, the same period in which the supercharged drink industry has surged in popularity in convenience stores, bars and on college campuses.


From 2007 to 2011, the government estimates the number of emergency room visits involving the neon-labeled beverages shot up from about 10,000 to more than 20,000. Most of those cases involved teens or young adults, according to a survey of the nation's hospitals released late last week by the Substance Abuse and Mental Health Services Administration.


The report doesn't specify which symptoms brought people to the emergency room but calls energy drink consumption a "rising public health problem" that can cause insomnia, nervousness, headache, fast heartbeat and seizures that are severe enough to require emergency care.


Several emergency physicians said they had seen a clear uptick in the number of patients suffering from irregular heartbeats, anxiety and heart attacks who said they had recently downed an energy drink.


More than half of the patients considered in the survey who wound up in the emergency room told doctors they had downed only energy drinks. In 2011, about 42 percent of the cases involved energy drinks in combination with alcohol or drugs, such as the stimulants Adderall or Ritalin.


"A lot of people don't realize the strength of these things. I had someone come in recently who had drunk three energy drinks in an hour, which is the equivalent of 15 cups of coffee," said Howard Mell, an emergency physician in the suburbs of Cleveland, who serves as a spokesman for the American College of Emergency Physicians. "Essentially he gave himself a stress test and thankfully he passed. But if he had a weak heart or suffered from coronary disease and didn't know it, this could have precipitated very bad things."


The findings came as concerns over energy drinks have intensified following reports last fall of 18 deaths possibly tied to the drinks — including a 14-year-old Maryland girl who died after drinking two large cans of Monster Energy drinks. Monster does not believe its products were responsible for the death.


Two senators are calling for the Food and Drug Administration to investigate safety concerns about energy drinks and their ingredients.


The energy drink industry says its drinks are safe and there is no proof linking its products to the adverse reactions.


Late last year, the FDA asked the U.S. Health and Human Services to update the figures its substance abuse research arm compiles about emergency room visits tied to energy drinks.


The Substance Abuse and Mental Health Services Administration's survey was based on responses it receives from about 230 hospitals each year, a representative sample of about 5 percent of emergency departments nationwide. The agency then uses those responses to estimate the number of energy drink-related emergency department visits nationwide.


The more than 20,000 cases estimated for 2011 represent a small portion of the annual 136 million emergency room visits tracked by Centers for Disease Control and Prevention.


The FDA said it was considering the findings and pressing for more details as it undertakes a broad review of the safety of energy drinks and related ingredients this spring.


"We will examine this additional information ... as a part of our ongoing investigation into potential safety issues surrounding the use of energy-drink products," FDA spokeswoman Shelly Burgess said in a statement.


Beverage manufacturers fired back at the survey, saying the statistics were misleading and taken out of context.


"This report does not share information about the overall health of those who may have consumed energy drinks, or what symptoms brought them to the ER in the first place," the American Beverage Association said in a statement. "There is no basis by which to understand the overall caffeine intake of any of these individuals — from all sources."


Energy drinks remain a small part of the carbonated soft drinks market, representing only 3.3 percent of sales volume, according to the industry tracker Beverage Digest. Even as soda consumption has flagged in recent years, energy drinks sales are growing rapidly.


In 2011, sales volume for energy drinks rose by almost 17 percent, with the top three companies — Monster, Red Bull and Rockstar — each logging double-digit gains, Beverage Digest found. The drinks are often marketed at sporting events that are popular among younger people such as surfing and skateboarding.


From 2007 to 2011, the most recent year for which data was available, people from 18 to 25 were the most common age group seeking emergency treatment for energy drink-related reactions, the report found.


"We were really concerned to find that in four years the number of emergency department visits almost doubled, and these drinks are largely marketed to younger people," said Al Woodward, a senior statistical analyst with the Substance Abuse and Mental Health Services Administration who worked on the report.


Emergency physician Steve Sun said he had seen an increase in such cases at the Catholic hospital where he works on the edge of San Francisco's Golden Gate Park.


"I saw one young man who had mixed energy drinks with alcohol and we had to admit him to the hospital because he was so dehydrated he had renal failure," Sun said. "Because he was young he did well in the hospital, but if another patient had had underlying coronary artery disease, it could have led to a heart attack."


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Follow Garance Burke on Twitter at http://twitter.com/garanceburke


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