By Devon Jackson, Outside

Ever chug a can of let’s say, Brand E, energy drink and not only feel that good-as-advertised jolt of extraness but experience a skip or two in your chest as well? Even though most of the evidence is anecdotal and the studies—which continue to pile up—don’t yet know exactly why, the link between energy drinks and a racing heart (or worse) seem pretty incontrovertible.

The latest report to make this connection concluded that energy drinks can cause “angina, cardiac arrhythmia (irregular heartbeat) and even sudden death.”

This finding confirms that of a similar report from a year ago — and confirms some people’s popular conceptions (or misconceptions) that energy drinks should be imbibed with caution — and most probably in moderation, and almost definitely not right before or during any sort of trying physical activity.

“Most ‘energy drinks’ have contents that can be good or bad, depending upon the dose — sugar, caffeine, and taurine,” says Kim Williams, chief of cardiology at Chicago’s Rush University Medical Center. “At this time, though, there is no definitive way of determining which if any ingredient is the most harmful or under what circumstances.”

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