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Evidence-Based Strategies for Common Clinical Questions

February 2019

Addicted to Awake:

The Consequences of Energy Drinks and Caffeine Consumption in Adolescents, and What We Can Do About It

Primary Author: Charles Spear, MD | Chief Resident, Children’s Mercy Kansas City

Column Editor: Rupal Gupta, MD | Medical Director, Operation Breakthrough Clinic | General Academic Pediatrics | Assistant Professor, UMKC School of Medicine

How often do you come across advertisements for energy drinks: once or twice a week, or perhaps every day on your morning commute? Rarely do we escape a day without energy drink companies promoting how they can “give you wings” or provide the five hours of energy you need to make it through the afternoon grind. Health care professionals may see past misleading marketing, but can we say the same about the effect these ads have on our children and adolescents, especially when advertisements target them?

Since energy drinks were introduced in the late 1980s, their marketing and consumption has skyrocketed, especially among youth. In 2013, the American Academy of Pediatrics (AAP) estimated that the energy drink market brings in greater than $5 billion annually, with more than 200 new brands introduced in the U.S. alone in 2006.2 The market has grown to its current size today by primarily targeting adolescents—specifically males—not only through direct digital and print marketing, but also through sports sponsorships and on-campus parties sponsored by manufacturers. Among teens, energy drink use increased by 16% between 2003 and 2008, “with a reported one-third of teenagers using energy drinks regularly.2 A survey of energy drink consumption patterns among nearly 500 college students found that half of subjects reported greater than one energy drink consumed each month.3 Among adolescents, most commonly cited reasons for consumption include insufficient sleep, studying or completing a major project, driving for a long period of time, and most disturbingly, to mix with alcohol while partying.

Caffeinated energy drinks, or CEDs, are beverages that claim to energize, decrease fatigue and enhance concentration for those that consume their product.4  This is in contrast to sports drinks, which are beverages intended to rehydrate and replenish essential electrolytes lost through intense exercise. Both CEDs and sports drinks contain many of the same components including water, carbohydrates, electrolytes, amino acids and vitamins and minerals; however, it is the nonnutritive stimulants, such as caffeine, guarana and taurine, that distinguish these from one another.4, 5

Caffeine, the most common stimulant found in CEDs, is absorbed by all body tissues and can affect everything from the central nervous system and behavior (anxiety, increased rate of speech), to the cardiovascular system (palpitations, increased heart rate and blood pressure).4 This molecule acts as a reversible adenosine receptor antagonist, thus blocking the action of adenosine on its receptor, and as a result can temporarily reduce fatigue and sleepiness. However, the physiologic effects of caffeine can undermine these short-term perceived benefits by lengthening the latency to fall asleep, impairing sleep quality and reducing sleep duration.6  

By positioning energy drinks as conventional foods, manufacturers place them under less stringent regulatory requirements than beverages classified as colas or as dietary supplements. While a 12-ounce cola beverage cannot legally contain more than 65 mg of caffeine, and a 6.5-ounce cup of coffee contains 80 to 120 mg of caffeine, the amount of caffeine in an energy drink can vary considerably. Among marketed energy drink brands, the total amount caffeine per 16-ounce serving may vary from 100 to 350 mg.9

Guarana (also called Brazilian cocoa) and yerba mate increase caffeine content of energy drinks, without necessarily being taken into account when listing caffeine content.  Taurine, another common ingredient in energy drinks, is an amino acid found in the human body and is present in a normal diet, between 40 and 400 mg daily. Human and animal studies do not support marketers’ claims that taurine enhances mental and physical performance. Furthermore, because taurine may alter the effects of alcohol, it may put individuals at higher risk when consuming both substances together.10

Even more concerning is the positive association observed with energy drink consumption and a number of risky health habits and behaviors. This includes less healthy dietary habits and increased risk of obesity, association with alcohol and tobacco use, and even engaging in high-risk sexual behavior.4, 7, 8 

All that said, what can pediatric providers do? Most important, when conducting the social history, ask teens whether they are drinking energy drinks and caffeinated beverages, just as one would discuss sugary beverages, alcohol and drug use. Given the prevalence of energy drink usage, primary providers have the opportunity not only to identify and quantify use, but also to help address teens’ misconceptions about these substances. Providers can teach the differences between sports drinks and energy drinks, highlight many of the known potential health risks associated with caffeine consumption, and provide a strong recommendation not to consume energy drinks. Furthermore, this discussion should prompt counseling on increased water intake to patients and families as the most appropriate replacement fluid for hydration.4, 5

The AAP Committee on Nutrition and the Council on Sports Medicine and Fitness have stated that after extensive review “caffeine and other stimulant substances contained in energy drinks have no place in the diets of children and adolescents.”4 While on a larger scale, continued advocacy will serve to combat the marketing of energy drinks to our pediatric population, hopefully we as pediatric providers can use what we know about the dangers of energy drink consumption to give ourselves “wings” of our own to continue to protect the health and well-being of our patients.

 

References

  1. Energy Drinks and Adolescents: What’s the Harm? Harris JL, Munsell CR. Nutrition Reviews. April 2015; 73(4):247-57.

  2. Energy Drinks. Blankson KW, Thompson AM, Ahrendt DM, Patrick V.  Pediatrics in Review. February 2013; 34(2).

  3. A Survey of Energy Drink Consumption Patterns Among College Students. Malinauskas BM, Aeby VG, Overton RF, Carpenter-Aeby T, Barber-Heidal K.  Nutrition Journal. October 2007; 6(35).

  4. Sports Drinks and Energy Drinks for Children and Adolescents: Are They Appropriate? Schneider MB, Benjamin HJ, et al. Pediatrics. June 2011; 127(6).

  5. Energy and Sports Drinks in Children and Adolescents. Pound CM, Blair B, et al.  Paediatric Child Health. October 2017; 22(7):406-10.

  6. Review: Trends, Safety, and Recommendations for Caffeine Use in Children and Adolescents. Temple JL. Journal of the American Academy of Child & Adolescent Psychiatry. January 2019; 58(1):36-35.

  7. Adolescent Energy Drink Use Related to Intake of Fried and High-sugar Foods.  Williams RD Jr, Odum M, Housman JM. American Journal Health Behavior. July 2017; 41(4): 454-60.

  8. Energy Drinks, Soft Drinks, and Substance Use Among United States Secondary School Students.  Terry-McElrath YM, O’Malley PM, Johnston LD. Journal of Addiction Medicine. Jan-Feb 2014; 8(1):6-13.

  9. Caffeine Content of Drinks, https://www.caffeineinformer.com/the-caffeine-database; Online resources: Accessed 28 January 2019.

  10. Taurine, Caffeine and Energy Drinks: Reviewing the Risks to the Adolescent Brain. Curran CP, Marczinski CA. Birth Defects Res. December 1, 2017; 109(20): 1640-1648.