Energy in a can or a bottle sounds appeals at any age, but
for children and young adults these drinks raise the risk of
caffeine overdose.
Mon. Feb. 14, 2011 — Popular energy drinks — which may
contain high levels of unregulated ingredients — could pose
a health risk to children, adolescents, and young adults,
who consume many of the drinks sold, a review suggests.
The review found that almost half of 5,448 caffeine
overdoses reported in 2007 involved people under age 19,
according to Sara M. Seifert, BS, of the University of Miami,
and colleagues.
Many energy drinks contain 70 to 80 mg of caffeine per 8-
oz. serving — about three times the concentration in cola
drinks, Seifert and co-authors noted in a special report
published in the March issue of Pediatrics .
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Surveys suggest that up to half of the energy drinks on the
market are consumed by adolescents and young adults —
and reports in the literature have linked the drinks to
serious adverse effects in young people, including seizures,
diabetes, cardiac abnormalities, and mood and behavioral
disorders, the authors wrote in background to their review.
"Energy drinks have no therapeutic benefit, and many
ingredients are understudies and not regulated," Seifert and
her co-authors concluded. "Both the known and unknown
pharmacology of various ingredients, combined with reports
of toxicity, suggest that these drinks may put some children
at risk for serious adverse health effects."
"In the short term, pediatricians need to be aware of the
possible effects of energy drinks in vulnerable populations
and screen for consumption to educate families," they
added.
Marketed in more than 140 countries, energy drinks
constitute the fastest growing segment of the U.S. beverage
market, with sales expected to exceed $9 billion in 2011.
And about half of the energy drinks sold in the U.S. are
consumed by individuals younger than 25—including
elementary school kids and teens.
Consumption of high doses of caffeine has been associated
with a variety of serious adverse effects, documented
primarily in the popular press but also in sporadic case
reports in the medical literature.
The growing energy-drink market, combined with the
reports of serious adverse events, provided a rationale to
investigate the potential risks, the authors continued.
Children with underlying health problems — including
cardiovascular, renal, or liver disease, seizures, diabetes,
mood and behavioral disorders, or hyperthyroidism — or
those who take certain medications, may be especially
vulnerable to the adverse effects of high doses of caffeine
and other ingredients found in energy drinks.
"Although the U.S. Food and Drug Administration limits
caffeine content in soft drinks, which are categorized as
food, there is no such regulation of energy drinks, which are
classified as dietary supplements," the authors wrote.
"Despite the large, unregulated market for energy drinks
and reports in the literature and popular media of serious
adverse events associated with their consumption, research
into their use and effects has been sparse."
Seifert and colleagues conducted a search of the medical
literature, trade media, and other potential sources of
information about the potential health implications of
energy drinks.
They identified 121 references, two thirds of which were in
the scientific literature.
Although caffeine is the main ingredient in most energy
drinks, various additives can further increase the caffeine
concentration, especially guarana, but also kola nut, yerba
mate, and cocoa.
Every gram of guarana (Paullinia cupana ) contains 40 to 80
mg of caffeine, as well as theobromine and theophylline.
Interaction with other plant compounds has the potential to
increase the half-life of guarana.
Because manufacturers do not have to specify the caffeine
content of other ingredients in energy drinks, the actual
caffeine concentration might exceed the amount on the
label, the authors noted.
The review identified several other ingredients common to
energy drinks, including taurine, L-carnitine, ginseng, and
yohimbine.
The authors also found a potential for drug interactions with
certain energy-drink ingredients, such as 5-hydroxy
tryptophan, vinpocetine, yohimbine, and ginseng.
Overall, the review suggested that 30 percent to 50 percent
of young people consume energy drinks, although the type
of drink and frequency of consumption varied substantially.
Adverse events associated with energy drinks could not be
tracked in the U.S. until recently because exposures were
coded as caffeine or "multisubstance exposure," and
included with caffeine-related adverse events. According to
the authors, the American Association of Poison Control
Centers created a separate reporting code for energy drinks
in 2010.
Among countries that have collected data on adverse effects
associated with energy drinks, Germany has maintained
records since 2002 and documented effects that included
liver damage, kidney failure, respiratory disorders, agitation,
seizures, psychotic conditions, rhabdomyolysis,
tachycardia and cardiac arrhythmias, hypertension, heart
failure, and death.
Ireland documented 17 incidents, including two deaths,
between 1999 and 2005. New Zealand reported 20 energy
drink-associated incidents, including nausea, vomiting,
abdominal pain, "jitteriness," racing heart, and agitation.
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Seifert and co-authors also reviewed potential and
documented adverse events associated with specific
ingredients found in energy drinks. They called for more
research into the safety of energy drinks, as well as
consideration of regulatory control.
"Until research establishes energy-drink safety in children
and adolescents, regulation, as with tobacco, alcohol, and
prescription medications, is prudent," they wrote in
conclusion.