Despite this, energy drinks continue to be readily accessible to youth, who continue to buy and consume them. What are energy drinks? Why are they dangerous to youth and why are energy drinks so enticing to them?

A Dose of Caffeine and Sugar

Energy drinks provide energy. Sounds simple and sounds safe, right? This is where simple ends and trouble begins.

Energy drinks contain highly concentrated amounts of caffeine and sugar, among other ingredients. The caffeine in energy drinks comes in many different forms, under many different names. Because of this, ingredient labels can be misleading and make it difficult to determine how much caffeine is in the drink.

PERSPECTIVE: Energy Drinks and Performance: The Good, The Bad, and The Ugly

Under the generic term “caffeine,” energy drinks can contain natural caffeine, as well as ingredients that contain caffeine. Caffeine containing ingredients such as yerba mate, taurine, cacao, or guarana are not required to be separately listed as additional sources of the stimulant. Many drinks also contain additional ingredients, including herbal supplements, which have not been safety tested for children. 

“Incredibly, some energy drinks contain up to 500 milligrams of caffeine per can, which is the equivalent of drinking fourteen cans of soda at one time.”

Manufacturers of energy drinks pulled a fast one on consumers. Since they registered and market their energy drinks as supplements, they are outside the jurisdiction of the FDA. Manufacturers do not have to reveal the actual amount of caffeine in an energy drink and there is also no limit to how much they can put in.

What’s the Big Deal About a Little Caffeine?

According to the American Academy of Pediatrics (AAP), if adolescents consume caffeine, they should not consume more than 100 milligrams per day. That’s the amount in a cup of coffee. Incredibly, some energy drinks contain up to 500 milligrams of caffeine per can, which is the equivalent of drinking fourteen cans of soda at one time. Shocked and disgusted yet? Read on.

Caffeine poisoning can occur at levels higher than 400 milligrams a day in adults, above 100 milligrams a day in adolescents, and at 2.5 milligrams per kilogram of body weight in children younger than twelve. High doses of caffeine in the body may cause the heart to race and blood pressure to increase.

Energy drinks with multiple caffeine sources have shown an even higher rate of side effects, typically involving the nervous, digestive, or cardiovascular systems. Research is inconclusive as to whether or not additional compounds react to the high amounts of caffeine in the drinks to cause side effects or if the high doses of caffeine itself cause the effects. But we do know that many of the added ingredients have never been tested for safety and have never been tested in combination with caffeine in children.

“In a 2014 study, the American Heart Association (AHA) tracked the U.S. Poison Control Centers and discovered more than forty percent of the 5,156 calls about energy drinks involved children younger than six.”

While caffeine is considered a short-term solution to increase wakefulness and alertness, it is also considered a drug. Caffeine poisoning occurs when too much caffeine is ingested in a short period of time and the body is unable to metabolize and flush the caffeine out of the body. This, specifically, is the danger of energy drinks, especially to youth.

Too Much Intake

While each person may react differently to caffeine, signs and symptoms of a caffeine overdose must not be ignored:

• Dizziness
• Diarrhea
• Increased thirst
• Insomnia
• Headache
• Fever
• Irritability

More severe symptoms that require immediate medical treatment include:

• Trouble breathing
• Vomiting
• Hallucinations
• Confusion
• Chest pain
• Irregular or fast heartbeat
• Uncontrollable muscle movements
• Convulsions

“Manufacturers do not have to reveal the actual amount of caffeine in an energy drink and there is also no limit to how much they can put in.”

In a 2014 study, the American Heart Association (AHA) tracked the U.S. Poison Control Centers and discovered more than forty percent of the 5,156 calls about energy drinks involved children younger than six. Many of these children suffered serious cardiac and neurological symptoms directly attributed to caffeine intake.

READ MORE: Evidence Mounts Against Energy Drinks

Intrigued with the findings, the AHA dug deeper and reviewed reports from a three-year period from the American Association of Poison Control Centers’ National Poison Data System. Their findings were astounding:

• Of the 5,156 reported cases of energy drink exposure, 40% were unintentional or accidental exposures by young children.
• Moderate to major outcomes were reported in 42% of cases involving energy drinks that had been mixed with ethanol (alcohol). (Moderate to major outcomes include abnormal heart rhythms, conduction abnormalities, and neurological defects, such as seizures.)
• Moderate to major outcomes were reported in 19% of non-alcohol-containing energy drinks.
• Moderate to major outcomes of cardiovascular effects were reported in 57% of cases.
• Moderate to major outcomes of neurologic effects were reported in 55% of cases.

Why Do Kids Continue to Drink Energy Drinks?

The energy drink industry exists to make money, so sports and energy drinks are heavily marketed to children and adolescents under the guise of enhancing sports performance. After all, if caffeine increases alertness and wakefulness, it stands to reason that athletes can apply this concept to their individual sports performance.

“Sports drinks contain carbohydrates, minerals, electrolytes, and flavoring and are intended to replace water and electrolytes lost through sweating during exercise. Energy drinks contain substances not found in sports drinks that act as stimulants, such as caffeine, guarana, and taurine.”

But, this is wrong. We now know large amounts of caffeine can have serious side effects in youth. And that’s not even taking into account the youth who have certain medical conditions or who take medications or supplements.

Marketing strategies for energy drinks include promoting the drinks as an alternative to alcohol, as well as image saturation through social media, social networking, and sporting events. Combine the “energy drinks provide energy and enhance sports performance” marketing ploy with the faulty caffeine reporting ingredient labels and it is no wonder kids (and parents) are confused.

Sports Drinks vs. Energy Drinks

Dr. Holly J. Benjamin, member of the executive committee of the AAP Council on Sports Medicine and Fitness, states that sports drinks and energy drinks are different products. Sports drinks contain carbohydrates, minerals, electrolytes, and flavoring and are intended to replace water and electrolytes lost through sweating during exercise. Energy drinks contain substances not found in sports drinks that act as stimulants, such as caffeine, guarana, and taurine.

“Energy drinks pose a real health risk for youth, and consumers are falling for the marketing ploys of energy drink companies.”

Dr. Benjamin reiterates that caffeine has been linked to a number of health problems in children, including effects on developing neurologic and cardiovascular systems. Dr. Marcie Beth Schneider of the American Academy of Pediatrics Committee on Nutrition agrees and stated:

“There is a lot of confusion about sports drinks and energy drinks. Some kids are drinking energy drinks – containing large amounts of caffeine – when their goal is simply to rehydrate after exercise. This means they are ingesting large amounts of caffeine and other stimulants, which can be dangerous.”

RELATED: Kids and Sports Drinks: Healthy Hydration or Soda Incognito?

Keep The Bad Juju Out

Energy drinks pose a real health risk for youth, and consumers are falling for the marketing ploys of energy drink companies. While energy drink manufacturers want you to believe their drinks are necessary for enhanced performance, sports or otherwise, the American Academy of Pediatrics, the American Health Association, and the American Association for Poison Control all agree that’s not the case.

But Drs. Schneider and Benjamin put it most succinctly: “ Energy drinks are not appropriate for children or adolescents.” Period.

References:

1. Energy Drinks. American Association of Poison Control. Accessed 10 January 2015.

2. “Kids Should Not Consume Energy Drinks and Rarely Need Energy Drinks, Says AAP”. Academy of Pediatrics. 30 May 2011. Accessed 10 January 2015.

3. “Poison Control Data Show Energy Drinks and Young Kids Don’t Mix.” American Heart Association, Inc. 2015. Accessed 10 January 2015.

4. Rivers, Autumn. “Caffeine Overdose.” July 16, 2012. Reviewed by George Krucik, MD, July 16, 2012. Accessed 10 January 2015.

5. Sara M. Seifert, BS, Judith L. Schaechter, MD, Eugene R. Hershorin, MD, and Steven E. Lipshultz, MD. “Health Effects of Energy Drinks on Children, Adolescents, and Young Adults”. Pediatrics. Mar 2011; 127(3): 511–528. Published online Feb 14, 2011. Accessed 10 January 2015.

6. “Sports and Energy Drinks: Should Your Child Drink Them.” Reviewed by Mary L. Gavin, MD. June 2011. Accessed 10 January 2015.

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In this study the researchers looked specifically at Monster, one of the more common choices for energy drinks. Another article I wrote recently tested the effectiveness of Red Bull. The results of that study were pretty insignificant, aside from the conclusion that Red Bull contributed to stress but didn’t affect performance. However, there were some oddities in the study design that left me wanting more information.

This new study did a more in-depth analysis of the effects of energy drinks. Instead of comparing energy drinks to a cola as previous research has done, the researchers compared them to a flavor-matched control beverage. They created their own drink out of non-caffeinated Diet Mountain Dew and lemon juice. The drink tasted similar but did not contain caffeine or sugar. The researchers also standardized the Monster to 2mg of caffeine per kilogram of body weight. To give you an idea of what that means caffeine-wise, it would be equal to about two cups of coffee.

Unfortunately, the researchers didn’t report on the previous caffeine use of the participants. They did advise the participants not to change their diet at all, with the exception that they should not consume caffeine 48 hours before the study began. Since caffeine tolerance could have altered the results, I suspect that this is something we will still need to see reported on in the future. However, since these were recreational exercisers in their twenties who were recruited for a university study where they got to drink energy drinks and exercise on a bike, I’m going to go on a limb and guess they were regular caffeine users.

One interesting feature of this study was that the Monster they used was a low-carb beverage. The carb content was even lower than the caffeine content, in fact. When examining energy drinks, the timing of sugar intake is of massive importance in terms of the results you get, since the resulting blood sugar highs and lows will probably overwhelm any benefit from the caffeine. With this low-carb version, you would expect a performance boost.

In the end, the only thing that made the energy group stand out from the placebo group was the resting heart rate of the participants. With the Monster, resting heart rate was higher by seven beats per minute. There was no difference in heart rate variability or performance. The energy drink group’s ride time-to-exhaustion was 1.7 minutes higher (meaning, it took the caffeine users 1.7 minutes longer to get tired) than the placebo group, but according to the researchers, this difference was not statistically significant.

These results were surprising, since caffeine should be more effective at that range. However, when we consider exercise intensity, the results appear a bit more significant. If these really are regular caffeine users (which, again, is nothing more than conjecture), the difference in of 1.7 minutes might be more than just a coincidence. It could actually be a trend that would be more significant in a larger group.

Ultimately, it’s hard to say what we have learned from this study. We can say that, in some conditions, a good-sized dose of caffeine isn’t enough to prove a statistical benefit during 45 minutes of exhaustive exercise. Perhaps if the participants were confirmed non-caffeine users, the difference would have been more significant.

References:

1. Michael Nelson, et. al., “Cardiovascular and ride time-to-exhaustion effects of an energy drink,” Journal of the International Society of Sports Nutrition 2014, 11:2

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In a study this month in the Journal of Strength and Conditioning Research, energy drink use was put to the test as an ergogenic aid for endurance exercise. Often, when a study is performed on ergogenic aids, it concerns only an individual substance. For example, a study may be done on just carbs or just caffeine, or it may compare the two, but energy drinks contain a number of ingredients that are beneficial when it comes to athletic performance.

One of the primary benefits of energy drinks is the stimulation provided by caffeine. Caffeine and exercise have similar effects on the body, and when you combine the two you can exercise longer and faster. Another factor in the purported effectiveness of energy drinks is carbohydrate availability and utilization. By consuming a beverage with carbohydrates before your workout, as you do when you drink an energy drink, you’re adding fuel for the body to burn. This approach seems to work particularly well for shorter duration endurance activities. Energy drinks are said to influence immune response and inflammation as well, and both of these effects would also benefit performance. The B vitamins in many energy drinks, particulary niacin, are also said to assist energy production.

With all these beneficial ingredients in one beverage, it seems like energy drinks must be a slam dunk when it comes to improving performance. Indeed, in their preliminary research, the researchers in this study found that carbohydrate and caffeine ingested together were an even better ergogenic than either alone. It’s an air tight combination – or so it would seem.

However, beyond the preliminary work, the results of this study were the opposite of what the researchers expected. They compared Red Bull to cola (which only contains carbs and caffeine, without the other energy drink ingredients), and compared both beverages to a placebo. Neither of the drinks improved performance more than the placebo did. To make matters even worse, both cola and Red Bull increased stress response. This effect was worse with the energy drink than it was with cola. Finally, the rate of fat burning was highest in the placebo.

The researchers admitted it was difficult to explain these results, but there were some oddities in the study design that might have had something to do with it. For one thing, the athletes consumed the drinks nearly an hour before exercise, which caused low blood sugar in those who were consuming the cola and energy drinks. Also, the cyclists in the study had all been consuming caffeine daily, which probably had a significant effect on how they responded to the caffeine in the energy drinks and cola.

In the end, it seems if you already have a caffeine habit, more caffeine and an added sugar spike before a workout might not have much benefit. However, conclusive evidence would require a larger study group and more diverse circumstances.

References:

1. Melody D. Phillips, et. al., “Pre-exercise energy drink consumption does not improve endurance cycling performance, but increases lactate, monocyte and IL-6 response,” Journal of Strength and Conditioning Research, DOI: 10.1519/JSC.0000000000000275.

Photo courtesy of Shutterstock.

The post New Study Suggests Energy Drinks Aren’t All That Energizing appeared first on Breaking Muscle.

The booming sports and energy drink market has experienced an increase of nearly ten percent in average daily volume sold per capita since 2000.¹ The recent dramatic increase in energy drink popularity has brought both attention and scrutiny. Did you know that over the past four years, the number of emergency room visits related to energy drink consumption has more than doubled, with over 20,000 emergency room visits in 2011?² That is an attention-grabbing statistic if you’re an energy drink fanatic. But, nearly half of them also involved alcohol.³ Eighteen deaths have reportedly been linked to energy drinks, with thirteen involving 5-hour Energy shots and five involving Monster Energy.⁴ The safety of extremely caffeinated beverages is being questioned as a public health concern. These recent reports have led to several extreme reactions, including an ordinance proposed in Chicago that would completely remove many energy drinks from the shelves.²

Before you trash your energy drinks and have caffeine withdrawals, let’s take a look at the fine print. Insomnia, anxiety, headache, dehydration, rapid heart rate, seizures, and even cardiac arrest have been associated with energy drink consumption. Highly caffeinated beverages used with other stimulants, such as nicotine, or with prescription drugs can over-stimulate the brain and body, causing amplified effects.¹ According to Consumer Reports, 400 milligrams per day of caffeine is considered safe for healthy adults.⁵ The potentially dangerous consequences are more likely to occur with very high intakes of caffeine in a short period of time, since our bodies absorb 99% of caffeine consumed within forty-five minutes.⁶

Mixing alcohol or stimulants with the beverages intensifies the side effects, including anxiety and rapid heart rate, and may lead to clinically dangerous conditions. Because caffeine can inhibit absorption of some prescription drugs and increase the effects of others, check with your physician or pharmacist for details regarding the safety of your caffeine intake. Existing health conditions, specifically heart and blood pressure abnormalities, may be dangerously exacerbated with significant caffeine intake. A single dose of 200 to 300 milligrams of caffeine slightly raises blood pressure, which can be hazardous to individuals with existing high blood pressure.⁷ As a reference, one 8-ounce cup of coffee has about 100 to 180 milligrams of caffeine, depending on the brew.⁴

As an avid exerciser, I like to down a quick energy drink at the start line of half marathon races for a last-minute dose of energy. Grabbing an energy drink on the way to the gym is not going to send you to the emergency room. As long as you keep the caffeine at a normal level and don’t have underlying medical conditions, you should be safe from an unexpected ER visit after an energy drink and a workout.

If 400 milligrams of caffeine each day is considered safe, how much is actually in our energy drinks? Surprisingly, that is very challenging information to find. In a Consumer Reports study looking at caffeine content of popular energy drinks, 40% of the drinks studied did not even list the amount of caffeine included. Of the ones that did report caffeine content, five drinks actually had over 20% more caffeine than the label stated.⁵ The actual caffeine content of energy drinks studied, in increasing order, includes:

• 8.4-ounce Red Bull Energy Drink – 83 milligrams
• 8-ounce Monster Energy – 92 milligrams
• 1.9-ounce 5-hour Energy – 215 milligrams
• 1.9-ounce 5-hour Energy Extra Strength – 242 milligrams

Caffeine is a well-studied stimulant and a common denominator between almost all energy drinks. However, it is not the only ingredient raising concern. Taurine, an abundant amino acid found naturally in animals, is another popular ingredient. Taurine is thought to improve mental functioning and reaction time, but the research is conflicting. Taurine is considered safe up to 3,000 milligrams per day, but the effects of long-term use are unknown.⁸ Glucuronolactone, a derivative of glucose, is a mysterious ingredient in energy drinks. The potential performance effects of glucuronolactone are unknown, as no human trials can be found.⁹

Although the media has grabbed our attention by highlighting the extreme outcomes of energy drink consumption, caffeine is not always harmful. Caffeine is most commonly used to improve energy, and it is quite effective, especially combined with sugar. Even I am guilty of minor caffeine addiction. I am not actually awake until after my first cup of coffee in the mornings. Another perceived benefit of drinking caffeinated beverages is increased metabolism. After consuming 200 to 350 milligrams of caffeine, healthy adult men have an average of 4 to 11 percent increase in metabolic rate, and women have an even higher increase of 10 to 23 percent.⁶ This effect of caffeine has become a weight loss tactic, but may not be effective since many highly caffeinated beverages are also packed with extra calories.

Energy drinks, especially in sensible amounts, seem to be safe. But, as the intake increases, so does the risk for undesired side effects. The Food and Drug Administration is conducting an in-depth safety review of energy drinks this spring, so further insight on the potential harmful effects of energy drinks is expected. If you’re an energy drink addict, don’t ditch all of them just yet. As with most things in life, moderation is the key.

References:

1. Sohyun Park, Stephen Onufrak, Heidi Blanck, and Bettylou Sherry, “Characteristics Associated with Consumption of Sports and Energy Drinks among US Adults: National Health Interview Survey, 2010,” Journal of the Academy of Nutrition and Dietetics 113, no. 1 (2013): 112-119.

2. “Chicago Energy Drink Ban? Ed Burke Wants to Curb High-Caffeine Beverages for Adults,” Huffington Post, last modified January 18, 2013.

3. Garance Burke, “Energy Drink-Related ER Visits Double in Just a Few Years: Survey,” last modified January 16, 2013.

4. Barry Meier, “Caffeinated Drink Cited in Reports of 13 Deaths,” New York Times, last published November 12, 2012.

5. Daniel DeNoon, “How Much Caffeine is in Your Energy Drink? Study: Caffeine Info Often Misleading or Missing on Energy Drink Labels,” WebMD, published October 25, 2012.

6. “What Are the Thermic Effects of Caffeine Use?” Academy of Nutrition and Dietetics Evidence Analysis Library, accessed January 19, 2013.

7. “What Evidence Suggests a Relationship Between Caffeine Intake and Blood Pressure in Healthy and Hypertensive Adults?” Academy of Nutrition and Dietetics Evidence Analysis Library, accessed January 19, 2013.

8. “Taurine in Energy Drinks: What is it?” Mayo Clinic, last modified March 27, 2012.

9. Barry Meier, “Energy Drinks Promise Edge, but Experts Say Proof is Scant,” New York Times, published January 1, 2013.

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