Ask an Expert: Energy drinks: Is there a downside?

Q: “My teenage kids and their friends are all into ‘energy drinks’ like Red Bull and Rockstar. They like how these drinks make them feel ‘up’ – but is there a downside?”

Answer from Kimra Hawk, RD, LD, outpatient dietitian at Providence St. Vincent Medical Center, and Terese Scollard, MBA, RD, LD, regional clinical nutrition manager for Providence Nutrition Services:
As with most sodas and snack foods, these carbonated, caffeinated drinks probably aren’t a major cause for concern if used in moderation. However, the marketers of these products are betting on young people to drink a lot of them. From the hip product names to the edgy packaging to the key ingredient – caffeine, which is considered an addictive drug – their goal is anything but moderation.

Concern: Caffeine addiction and overdose

Energy drinks deliver a hefty dose of caffeine – probably more than is suitable for kids.

Certainly, numerous studies – and millions of coffee drinkers – tout the health benefits of caffeine. As outlined in Caffeine: The Good, the Bad and the Maybe (Nutrition Action Healthletter, March 2008), these benefits may include improved alertness, reaction time, sociability and physical endurance.

The downside, however, is addiction. According to the article, “After less than a week of consuming caffeine every day, most people will experience headache, fatigue, decreased alertness and/or drowsiness if they stop.” To avoid these withdrawal symptoms, dependent users reach for another dose.

This addictive quality may be the key reason why manufacturers include caffeine in energy drinks. The article’s authors continue: “Caffeine increases the probability that the product will be bought and consumed. And it induces dependence and builds customer loyalty.”

The danger for teenagers and young adults is not only caffeine addiction, but overdose, as well. According to the Marin Institute report, “Doses of 500 mg or more can result in caffeine intoxication.” The report cites one three-year study by a Chicago poison center, which found “more than 250 cases of caffeine overdose, with 12 percent requiring hospitalization. Symptoms included insomnia, palpitations, tremors, sweating, nausea, vomiting, diarrhea, chest pains and neurological symptoms. The average age of patients was 21.”

While caffeine overdose is not common, it is being reported more frequently as high-potency energy drinks grow in popularity. The Sept. 1, 2008 Los Angeles Times included an article about a teenage boy who had been suffering from serious stomach pain for two months. An endoscopy revealed severe inflammation, bleeding and ulcers in his duodenum, the part of the small intestine leading from the stomach. The cause? The boy had been drinking several Redline energy drinks a day. One 8-ounce can of Redline contains 250 mg of caffeine. Two cans – just 16 ounces – meet the threshold for a toxic dose.

Read labels to find out how much caffeine your kids are taking in. If the caffeine content isn’t listed on the package, look it up online.

Concern: Known side effects

Even in low doses, caffeine can have unpleasant side effects. The most commonly reported negative effects include anxiety, panic attacks, bowel irritability and insomnia. It’s logical to assume that, since kids have smaller bodies, they may be even more susceptible to caffeine’s effects. Quoting the Marin Institute report again: “With the rising popularity of energy drinks and with more young people ingesting high levels of caffeine, more serious health problems are now being reported in the nation’s poison centers.”

If your kids are experiencing nervousness, sleeplessness or digestive problems, the caffeine in their energy drinks could be the culprit.

Concern: Unknown potential health consequences

While scientists have determined the upper level of safety for caffeine (at least in adults), the same can’t be said for taurine, guarana, and other additives found in energy drinks. Since energy drinks are not regulated by the Food and Drug Administration, manufacturers can add ingredients in whatever dosages they want, without testing for their health benefits or safety.

After reviewing the existing research on some of the most popular additives in energy drinks, the Marin Institute reports, “There is no scientific basis for concluding that the non-caffeine additives in energy drinks contribute to either long-term health benefits or short-term mental alertness and physical performance. They may create health risks, particularly since dosage levels are often not disclosed.”

Concern: Sugary calories and weight gain

As dietitians, our main concern is the high amount of sugar in most energy drinks. High sugar content means high calories, and that leads to weight gain. When we drink high-calorie beverages, we don’t get the sense of fullness that we do when we eat calorie-dense foods, so it’s easy to drink more calories than we realize.

In 2006, a panel of leading U.S. nutrition experts proposed a set of guidelines for healthy beverage consumption. These guidelines recommend drinking mainly zero-calorie beverages. Energy drinks, which generally have high calories and few or no nutrients, should be limited to a maximum of 8 ounces per day; people who are trying to lose weight should avoid them entirely.

Concern: Mixing energy drinks and alcohol – a dangerous trend

Following a trend among young people to mix energy drinks with alcohol, several beverage companies now sell alcoholic energy drinks, and the packaging is almost indistinguishable from the nonalcoholic brands. Be sure you know what your kids are drinking.

According to the Nutrition Action Healthletter, “people who are inebriated and caffeinated will think they’re okay, but their reaction time and judgment will still be impaired. And that could make them even more dangerous to themselves and to others… College kids who are using combinations of caffeine and alcohol are more likely to be involved in accidents than those consuming just alcohol.”

The Center for Science in the Public Interest (CSPI), which publishes the Nutrition Action Healthletter, is so concerned about this trend that it is suing two leading manufacturers of alcoholic energy drinks.

The big question: Why are kids looking for a boost in a bottle or can?

Ask your kids: Why do you drink energy drinks? Is it to improve your mental alertness? To boost your physical energy? To make you feel more social, or to get a quick buzz?

If it’s mental clarity they’re hoping for, maybe the real problem is that they’re just not getting enough sleep. Since these drinks can actually worsen sleep problems, a better solution may simply be to go to bed earlier.

If it’s physical energy they’re after, no drink will provide that – sustained physical energy comes from eating a nutritious, well-balanced diet.

If it’s sociability or a buzz they’re looking for in these drinks, they may get caffeine-fueled nervousness and anxiety instead, followed by a crash when the sugar and caffeine wear off.

Our recommendation, for kids as well as adults, is to use energy drinks sparingly, if at all. If you do use them, read the labels and choose low-calorie or no-calorie options. Better yet, for optimal energy, health and weight management, get your nutrients and energy from foods, and drink water rather than caloric beverages to satisfy your body’s need for fluids.

– August 2008