Energy Drinks Pose Serious Health Risks for Young People

Emma Hitt, PhD

February 14, 2011

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. Miller School of Medicine in Florida, reported their findings in a report published online February 14 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.

In a telephone interview with Medscape Medical News, the paper's senior author Steven E. Lipshultz, MD, from the University of Miami, noted that child healthcare providers, as well as teachers and coaches, should have information on this so that they can guide conversations, at least on the available data.

"We were really surprised," said Dr. Lipshultz. "The [FDA] considers regular soft drinks to be foods, and tightly regulates the content and the labeling, but energy drinks are classified as dietary supplements and as such, are not subject to the same regulation or postmarketing surveillance," he said.

"Questions about consumption of these energy drinks should become a regular part of the questions pediatricians ask so that they can get into informed discussions with parents and their children," he added.

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 John 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. Abstract

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