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Over-Energized Kids Energy Drinks
Abstract & Commentary
By Russell H. Greenfield, MD, Editor
Synopsis: A review article examining the potential adverse effects of energy drinks on kids generated a lot of buzz recently in the lay media. The beverage industry countered with information of its own, but the research referenced in the journal article lays out a solid foundation against the drinking of energy drinks, especially in children.
Source: Seifert SM, et al. Health effects of energy drinks on children, adolescents, and young adults. Pediatrics 2011;127:511-528.
The burgeoning energy drink market gathers a significant proportion of its steam from youngsters and adults under the age of 25 years. The drinks are marketed in attractive ways and at popular venues, and together with the hype surrounding their use (clearer thinking, better athletic performance, etc), their appeal is hard for young people to resist. Studies suggest that upwards of one-third of all middle school children partake of energy drinks, with an increasing prevalence of use as they enter into early adulthood, sometimes in combination with alcohol. Little hard data exist, but a number of high-profile reports of serious complications associated with frequent ingestion of energy drinks prompted the authors of this review to delve deeper.
The investigators searched PubMed for English language articles and abstracts relevant to the topic of energy drink use in children and adolescents, as well as Google for trade media reports. Of the 121 references identified, more than 60% were from "the scientific literature," mostly from U.S. publications.
Only recently have U.S. poison centers been able to specifically track adverse events related to energy drinks; the authors note that previously such incidents often were coded under caffeine toxicity, for example. Other countries have been able to collect specific data in this regard and report small but significant numbers of cases of liver and kidney damage, behavioral disorders, seizures, dysrhythmias, and even rare cases of death associated with extremes of intakes. The study authors do a nice job of reviewing the physiologic effects of caffeine, balancing the few positive health effects often cited (improved reaction time, exercise performance) with the untoward consequences mentioned above while adding reports of irritability, palpitations, increases in blood pressure, and the possibility of withdrawal symptoms with even mild exposure.
The authors conclude that energy drinks offer no therapeutic benefit but do offer potential for significant harm, especially in youngsters with cardiac disease, seizure disorders, and behavioral issues who are taking medications. They recommend that physicians ask their patients about the use of energy drinks, and recommend consideration of added regulation of these products.
The number of adverse events reported in this article is relatively small considering the number of energy beverages consumed each day around the world, but many complications surely go unreported, and even when reported are often classified, as the authors note, under general terms that do not implicate energy drinks. However low the total number of reported adverse events, the critical nature of many of the events warrants our immediate attention, and the researchers are to be applauded for this wake-up call.
The principle active ingredient found in most energy drinks is caffeine, but other compounds, including cocoa and the herb guarana (Paullinia cupana), provide added caffeine content that is not necessarily reported on the food label. Limits on beverage caffeine content are enforced by the FDA, but energy drinks are generally considered dietary supplements and so may escape such regulatory standards. The generally accepted adverse effect level of caffeine according to the study authors is 3 mg/kg body weight per day. Energy drinks are frequently high-calorie beverages, too, and may contain significant amounts of sweeteners.
a.ults who would not offer their children coffee for fear of getting them "hooked" or developing a bad habit often have no difficulty allowing those same kids to drink caffeinated sodas and now energy drinks. Most adults rely on caffeine as a way to fend off fatigue related to inadequate sleep, and research suggests that adults are not the only ones who are sleep deprived; their children are, too. In part the answer may be to pound the message home about the importance of getting an adequate quantity and depth of sleep and to repeatedly instruct patients in the tricks of sleep hygiene that can help ensure a restorative night's sleep. The default position is to continue feeling tired in the morning, treating oneself with caffeine to "get going" in the morning and perhaps again in the early and late afternoons, followed by added difficulty getting to sleep due to the lasting effects of caffeine, and a worsening of the cycle. Certainly this is not what any parent would want for his or her children; dependence on any substance stirs deep fears within us all, but the message has not gotten out in a substantive way until the publishing of this paper.
a.other part of the solution has to be countering the marketing messages that make these drinks appear cool to kids. Here's hoping that this new kind of media attention energy drinks have earned goes a long way toward the curtailing of their use by children (and their parents).