The other night, I took care of another adolescent with an intoxicating and dangerous cocktail of alcohol and energy drinks. I’m not the only one—emergency doctors nationwide are seeing a surge in emergency department (ED) visits from patients that have been drinking energy drinks and other energy-stimulating supplements. Some products have been banned, including the energy-drink-and-alcohol beverage Four Loko, and the military has banned certain energy/weight-loss supplements from their on-base stores due to concerns that they may have been associated with the deaths of two soldiers. Unfortunately, these substances are still available in stores, and scores of our children and young people are buying them.
With the majority of these cases and ED visits being in the younger population (a recent study out of the Univeristy of Miami that said that 30-50% of children consume these items), I started to wonder—what are we and our children consuming, and what do we know about it?
(1) What’s in Them? Good Question.
Unlike medications (even over-the-counter) and soda drinks, which are strictly regulated by the FDA, these energy drinks and supplements are classified as “dietary supplements”. They don’t have to follow the same strict guidelines for concentration of stimulants, safety requirements, or even publication of their actual ingredients. Some things that they may contain:
-Caffeine: a 16-ounce can could have more caffeine than four or more caffeinated sodas. Under FDA rules, soda cannot contain more than 71 milligrams of caffeine. However, energy drinks, which are considered “dietary supplements” and not soda, can have as much as 500 milligrams. Many may have “caffeine-equivalents” such as guarana, yerba mate, and cocoa, which can have an additive effect on top of the cafeeine
-Sugar: these drinks (the non-diet ones) often have very high levels of sugar –often thirteen teaspoons of sugar or more.
-Amphetamine-like stimulants: Many dietary supplements (such as the kind banned from the military bases), are easily available at health food stores for fat-burning and increased metabolism and are often used by dieters and athletes alike.
(2) They raise blood pressure, temperature, and heart rate—sometimes dangerously
According to the American College of Emergency Physicians, “excessive caffeine intake from energy drinks can cause adverse reactions” including dangerous heart rhythms, dangerously high blood pressure, and dehydration. There have been an increasing number of cases including young people who died after drinking moderate to large quantities of energy drinks and participating in sports. The American Association of Poison Control Centers has also reported an association with seizures, kidney failure, and psychotic episodes. According to a review article in the Mayo Clinic Proceedings in November 2010, energy drinks were associated with four documented cases of caffeine-associated death, and five of seizures.
(3) They do NOT increase tolerance to alcohol.
Many people mix energy drinks with alcohol with the perception that it will enable to them to drink larger volumes of alcohol without becoming intoxicated. It’s actually quite the opposite—these drinks can actually mask the perception of intoxication—leading people to not realize that they are drunk even when they actually are. As a result, they drink more, increase their risk-taking, and increase their risk of DUI and even death. This was exactly what happened with Donte Stallworth, a Cleveland Browns’ wide receiver, who got behind the wheel after drinking several shots of tequila and Red Bull. He stated that he did not feel drunk at the time of the accident—an accident that killed a pedestrian.
(4) The effects can be even more detrimental in children
A recent review article in the journal of Pediatrics highlighted concerns about caffeine in children. It reported that of the 4600 calls to the American Association of Poison Control Centers in 2005, 2600 of those involved patients younger than 19. The study authors also noted that caffeine could have adverse effects on a developing neurologic and cardiovascular system, as well as potentially creating physical dependence at a very young age. They stated that “Rigorous review and analysis of the literature reveal that cafeeine and other stimulant substances contained in energy drinks have no place in the diet of children and adolescents”.