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From the Journal Pediatrics

Energy Drinks Pose Serious Health Risks to Children,Teens and Young Adults Says New Study

Energy drinks may pose a risk for serious adverse health effects in some children, especially those with diabetes, seizures, cardiac abnormalities or mood and behavior disorders, says a study in the journal Pediatrics.1Energy drink cans

Reviewing data gleaned from a meta-search of the medical literature via PubMed (an online data base of medical journals) and print and trade media via Google, researchers at the University of Miami conclude that energy drinks have no therapeutic benefit to children, and both the known and unknown properties of the ingredients, combined with reports of toxicity, may put some children at risk for adverse health events.

Market

  • Youth account for half of the energy drink market, and according to surveys, 30 percent to 50 percent of adolescents report consuming energy drinks;
  • The energy drink segment is the fastest growing US beverage market, with 2011 sales expected to top $9 billion; and
  • Half of market consists of children under 12, adolescents (12 - 18 years old) and young adults (19-25 years old).

What are energy drinks?

  • Typically, energy drinks contain high levels of stimulants such as caffeine, taurine, and guarana, sugars and sweeteners, herbal supplements and other ingredients.
  • Energy drinks are distinct from sports drinks and vitamins.
  • Energy drinks are not recommended for rehydration.
  • Many energy drinks not only contain 70 to 80 mg caffeine per 8-oz serving, three times the concentration in cola drinks. 
  • Caffeine content may be nearly 5 times greater than in 8 oz of cola drinks when packaged as "energy shots" or as 16-oz drinks.
  • The actual amount of caffeine dose in a single energy drink may be much higher than listed because they often contain additional amounts of caffeine in the form of additives, including guarana, kola nut, yerba mate, and cocoa.  Each gram of guarana can contain 40 to 80 mg. of caffeine, which may stay in the body for a longer period of time because of interactions with other plan compounds.
  • Safe consumption levels have not been established for most adolescents.

Consumption

  • 28% of 12- to 14-year-olds, 31% of 12- to 17-year-olds, and 34% of 18- to 24-year olds report regularly consuming energy drinks
  • Among 10- to 13-year-olds, 31% of girls and 50% of boys have tried energy drinks; 5% of girls and 23% of boys reported drinking them regularly but at a rate of less than 1 can per week.

Overdoses

  • US poison control centers did not track overdoses attributed to energy drinks until 2010
  • Germany has tracked since 2002; reports liver damage, kidney failure, respiratory disorders, agitation, seizures, psychotic conditions, rhabdomyolysis, tachycardia, cardiac dysrhythmias, hypertension, heart failure, and death.
  • Ireland's poison control center reported 17 energy-drink adverse events including confusion, tachycardia, and seizures, and 2 deaths between 1999 and 2005
  • New Zealand: 20 energy-drink/shot-related adverse events between 2005 to 2009 
  • Youth-aimed marketing and risk-taking adolescent developmental tendencies combine to increase overdose potential.

Effect on children and teens

  • Experts recommend that adolescent and child consumption of caffeine not exceed 100 mg/day and 2.5 mg/kg per day.
  • Effects of caffeine consumption by children remains unclear; heart rate significantly lowered in boys in one study compared to men; boys also exhibited increased motor activity and speech rates and decreased reaction times than men.
  • Caffeine can improve attention, but can also increase blood pressure and sleep disturbances in children
  • Caffeine may affect future food and beverage preferences in children by acting on the developing child's brain reward-and-addiction center, an effect which may be more pronounced in boys than girls, with one study of 12- to 17-year-olds revealing that boys found caffeinated soda more reinforcing than did girls regardless of usual caffeine consumption.
  • High doses of caffeine may exacerbate cardiac conditions for which stimulants are contraindicated, with the effect on ion channelopathies and hypertrophic cardiomyopathy, the most prevalent genetic cardiomyopathy in children and young adults, of particular concern because of the increased risk of hypertension, syncope (fainting), arrhythmias (irregular heartbeat/palpatations), and sudden cardiac death.
  • Children and adolescents with eating disorders, especially anorexia nervosa, may regularly consume high amounts of caffeine to counter caloric-restriction-associated fatigue, suppress appetite, and produce looser stools and some diuresis.   The risk of cardiac dysrhythmias and intracardiac conduction abnormalities from high-caffeine energy drinks in children with eating disorders are "disconcerting."
  • Caloric increases from energy-drink consumption may increase blood pressure, blood glucose levels, BMI, calcium deficiency, dental problems, depression, and low self-esteem in children; sugar and caffeine may also work in tandem to increase hyperglycemia, which is of concern to children with diabetes.
  • Caffeine interfers with intestinal calcium absorption, which is especially important during the growth spurt in early adolescence, although whether it is caffeine itself or replacement of milk intake by caffeinated beverages is the leading contributor to lower bone acquisition during adolescence.  
  • High consumption is suggested by self-reported surveys but is underdocumented in children, although deleterious associations with energy-drink consumption have been reported globally in case reports and popular media.
  • Interactions between compounds, additive and dose-independent effects, long-term consequences, and dangers associated with risky behavior in children remain to be determined.

Children with following pre-existing conditions are at higher risk from excessive consumption of energy drinks:

  • cardiovascular, renal or liver disease
  • seizures
  • diabetes
  • mood and behavioral disorders (e.g. ADHD).
  • hyperthyroidism
  • taking certain medications

Not regulated

  • The FDA limits soda to 71 mg of caffeine per 12 ounce can because soft drinks are classified as food.
  • Energy drinks are unregulated by FDA because they are claimed to be "natural dietary supplements."
  • US Senate considering bill to require supplement manufacturers to register annually with FDA and allow recall of those suspected of being unsafe; ingredients may also be restricted to those already approved by FDA.

Recommendations

The study makes both short-term and long-term recommendations.

In the short term, they recommend:

  • Increased awareness by pediatricians of energy-drink consumption by children, adolescents, and young adults and the potentially dangerous consequences of inappropriate use
  • Inclusion of questions about the use of energy drinks in the taking of diet and substance-use histories during routine well-visits and pre-participation physical evaluations (note: the fourth edition of the Preparticipation Physical Evaluation monograph will feature a revamped health questionnaire focused on cardiac health problems that may be exacerbated by physical activity, adding questions about stimulant use, including energy-drink consumption).
  • Increased education of parents and children at risk for the potential adverse effects of energy drinks
  • Counseling of children with pre-existing cardiac conditions about the risk of caffeine-containing products, including irregular heart rhythms, syncope, dysrhythmias, and sudden death.

Over the long term, the study recommends:

  • More research to better define maximum safe doses, the effects of chronic use, and effects in at-risk populations (e.g. those with preexisting medical conditions, athletes who consume energy drinks during and after exercise, or those who consume them in combination with alcohol);
  • Better documentation and tracking of adverse health effects;
  • In the absence of research establishing energy-drink safety in children and adolescents, regulation, as with tobacco, alcohol, and prescription medications.

1. Seifer S, Schaechter J, Hershorin E, Lipshultz S. Health Effects of Energy Drinks on Children, Adolescents, and Young Adults. Pediatrics 2011;127(3):511-528.

Posted February 14, 2011

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