Energy Drinks - NOT GOOD

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From Medscape Medical News

Energy Drinks Pose Serious Health Risks for Young People

Emma Hitt, PhD

February 14, 2011 — A lack of research and regulation associated with energy

drinks, combined with reports of toxicity and high consumption, may result in

potentially dangerous health consequences in children, adolescents, and young

adults, according to a review of scientific literature and Internet sources.

Sara M. Seifert, BS, and colleagues from the Department of Pediatrics and the

Pediatric Integrative Medicine Program at the University of Miami, Leonard M.

School of Medicine in Florida, reported their findings in a report

published online today and in the March print issue of Pediatrics.

According to the review, self-report surveys indicate that energy drinks are

regularly consumed by 30% to 50% of children, adolescents, and young adults. The

current trial questions the use of energy drinks in these young populations, as

they provide no therapeutic benefit and are associated with risks for serious

adverse health effects.

The authors note that because energy drinks are categorized as nutritional

supplements, they avoid the limit of 71 mg caffeine per 12 fluid ounces that the

US Food and Drug Administration has set for soda, as well as the safety testing

and labeling that is required of pharmaceuticals. As a consequence, energy

drinks can contain as much as 75 to 400 mg caffeine per container, with

additional caffeine not included in the listed total often coming from additives

such as guarana, kola nut, yerba mate, and cocoa.

" Of the 5448 US caffeine overdoses reported in 2007, 46% occurred in those

younger than 19 years, " the authors note.

One study included in the review, conducted in New Zealand, found that on

average, all children, teenagers, and young men would exceed an adverse effect

level of 3 mg/kg per day of caffeine after consuming a single retail unit of

energy drink or energy shot in addition to baseline dietary exposure.

Advertising, Risky Behavior Compound Overdose Potential

The authors suggest that youth-aimed advertising of energy drinks and a tendency

for risky behavior help compound the potential for caffeine overdose in young

people. The authors recommend a maximum caffeine intake of 2.5 mg/kg per day for

children and 100 mg/day for adolescents, although safe levels of consumption of

other energy drink ingredients have not been established.

Although US poison centers have only recently begun tracking toxicity of energy

drinks, Germany, Australia, and New Zealand have reported numerous adverse

outcomes associated with energy drink consumption. These include liver damage,

kidney failure, respiratory disorders, agitation, confusion, seizures, psychotic

conditions, nausea, vomiting, abdominal pain, rhabdomyolysis, tachycardia,

cardiac dysrhythmias, hypertension, myocardial infarction, heart failure, and

death.

Despite these reports, there has been a lack of research into the physiological

effects of individual energy drink ingredients. Drug interactions and

dose-dependent effects remain largely unknown, although the current study

reports that the ingredients 5-hydroxy tryptophan, vinpocetine, yohimbine, and

ginseng have the potential for drug interactions that could result in adverse

effects.

Seifert and colleagues also describe populations at highest risk for adverse

health effects from energy drink consumption; these include children,

adolescents, and young adults with cardiac conditions, attention-deficit

hyperactivity disorder, eating disorders, and diabetes, and those taking other

medications or consuming alcohol. The researchers also note that the caffeine in

energy drinks may interfere with bone mineralization during a critical period of

skeletal development.

" In the short-term, pediatric health care providers need to be aware of

energy-drink consumption by children, adolescents, and young adults and the

potentially dangerous consequences of inappropriate use, " the authors conclude.

They add that more research is required to determine maximum safe doses,

establish effects of long-term use, and better understand adverse health effects

of energy drinks. In addition, pediatric healthcare providers should screen for

consumption, especially in high-risk populations, and educate families about

potential adverse outcomes. Furthermore, until the safety of energy drinks is

ensured, appropriate regulation of sales and consumption should be put in place

to protect minors, they suggest.

Dangers Go Beyond Excess Caffeine Consumption

According to independent commentator Dana M. Vieselmeyer, RD, LD, MPH, the

special interest group chair of diabetes, wellness and weight management with

the Pediatric Nutrition Practice Group of the American Dietetic Association,

" this review highlights that consumption of energy drinks goes beyond the

dangers of excess caffeine consumption, especially for children and adolescents,

due to the supplemental additives these drinks contain and the unknown dangers

of those in combination with caffeine and other medications. The fact that there

is no known safe dose of any of those additives, or of caffeine, poses a risk. "

" The long-term health consequences of regular energy drink consumption in

children and adolescents is unknown, but what information we do have tells us

that these drinks can have many harmful and potentially fatal effects, " she told

Medscape Medical News.

" Until further research is conducted, clinicians should make it standard

practice to assess energy drink consumption when seeing their young patients,

and also to educate the patient and families on the dangers of energy drink use,

advising against its consumption, " Vieselmeyer said.

" This review provides a good summation of the current body of knowledge

regarding energy beverages, " said P. Higgins, MD, from the University of

Texas Medical School at Houston, whose group also conducted a similar literature

query on this topic.

" The marketing of energy beverages is targeting towards males in the

preadolescent, adolescent, and young adult ages, " Dr. Higgins told Medscape

Medical News. " The fact that a child can walk into a grocery store or

supermarket and buy these and consume [them] is frightening. "

According to Dr. Higgins, as clinicians, it is " our daily duty to promote the

health and well being of our patients while minimizing risk. The medical

profession, in a global manner, needs to alert our patients to the dangers of

these seemingly innocuous drinks and continue to advocate for strict control or

overall removal. "

This work was funded by the National Institutes of Health, the Health Resources

and Services Administration, the Children's Cardiomyopathy Foundation, and the

Women's Cancer Association. The authors and commentators have disclosed no

relevant financial relationships.

Pediatrics. 2011;127:511-528.