Energy drinks may be unsafe for some children especially those with diabetes, seizures, heart abnormalities or mood and behavior disorders, according to a report by researchers at the University of Miami Miller School of Medicine published in the journal Pediatrics this week; however the beverage industry fiercely disputes this.

Senior author of the report Dr Steven E. Lipshultz, professor and chair of pediatrics, associate executive dean for child health at the Miller School, said until we know more about the effects of energy drinks on the health of children and teenagers, they should be discouraged from drinking them on a routine basis.

“We wanted to raise awareness about the risks. Our systematic review suggests that these drinks have no benefit and should not be a part of the diet of children and teens,” he said.

For their report Lipshultz and colleagues reviewed the current published literature on energy drinks and concluded they have no health benefits for children and that many of the ingredients they contain are understudied and not regulated.

They said that both in view of the known and unknown properties of the ingredients, plus reports of toxicity potentially related to energy drink consumption (for instance where poison centers have received calls about caffeine overdose in children), they may even put some children who consume energy drinks at risk of serious adverse health effects.

They called for more research to understand the effect of energy drinks in at-risk groups.

They added that regulation of the marketing and sales of energy drinks should be based on appropriate research, and the surveillance of toxicity related to energy drink consumption should be improved (for instance the current system in the US does not separately record if a caffeine overdose was due to consuming energy drinks).

In the meantime, pediatricians should be aware of the possible effects of energy drinks in children and teenagers, particularly in the more vulnerable groups, and to screen for heavy use both alone and with alcohol, and to educate families and youngsters at risk for energy drink overdose, which can lead to seizures, stroke and even sudden death, advised the authors.

For their systematic review, Lipshultz and colleagues searched PubMed, the online database of biomedical journal citations and abstracts, and Google using key words like “energy drink”, “sports drink”, “ADHD“, “diabetes”, “poison control center”, “children”, “adolescents”, “caffeine”, “taurine”, to find articles related to energy drinks. They also read the product information that energy drink manufacturers put on their websites.

They found that:

  • Children, adolescents and young adults account for half the energy drink market.

  • According to self-report surveys, between 30% and 50% of teenagers and young adults consume energy drinks.

  • Energy drinks frequently contain high levels of stimulants such as caffeine, taurine and guarana, and safe consumption levels have not been established for most adolescents.

  • There have been reports of energy drinks linked to serious adverse effects, particularly in children, adolescents and young adults with seizures, heart abnormalities, diabetes, mood and behavioral disorders, or who are on certain medications.

  • Of the 5,448 caffeine overdoses reported in 2007 in the US, 46% of them were in young people under the age of 19.

  • Several countries and American states have debated whether to restrict the sales and advertising of energy drinks.

The report has infuriated the beverage industry, who have labelled it “bad science” intended “to scare and create buzz”.

In a statement issued on Tuesday, the American Beverage Association (ABA) said there is a “lot of misinformation” circulating about energy drinks, especially about the amount of caffeine they contain and whether or not the products are regulated by the US Food and Drug Administration (FDA).

They stress that energy drinks and their ingredients “whether categorized as a conventional food or as a dietary supplement”, are regulated by the FDA, and that caffeine, the “core ingredient”, whose use has been approved both by the FDA and more than 40 countries around the world, is one of the “most thoroughly tested ingredients in the food supply today”.

They urge consumers to note that energy drinks contain about half the caffeine in a cup of coffee typically bought at a coffee house, and thus young adults are consuming twice as much caffeine this way as they are from “a similar size energy drink”.

They also dispute the point made in the report that children and teens are large consumers of energy drinks, citing data from a well known government survey, the National Health and Nutrition Examination (NHANES) Survey, that they say shows:

” … the caffeine consumed from energy drinks for those under the age of 18 is less than the caffeine derived from all other sources including soft drinks, coffee and teas.”

The ABA says that this survey also shows that the caffeine children and teens get from energy drinks is equivalent to drinking less than one can of energy per day, and that “total caffeine consumption from energy drinks among pre-teens is nearly zero”.

They advise consumers to “stay informed about the products they consume”, to read product labels, and the “voluntary advisory statements” that many companies put on them.

They don’t deny that caffeine may have adverse effects, and confirm that energy drinks contain a “good dose” of the stimulant, so anyone who is sensitive to caffeine should apply the same “common sense approach” to consuming energy drinks as they would to drinking coffee.

Lead author of the Pediatrics article, Sara M. Seifert, a third-year medical student at Miller School, explained why they conducted the review and published their report:

“Numerous reports are appearing in the popular media and there are a handful of case reports in the scientific literature that associate energy drinks with serious adverse events.”

“Additionally, many schools, states and countries have started regulating or banning energy drink content or sales to children, adolescents and young adults. In the face of such reports, it seemed prudent to investigate the validity of such claims,” she added.

“Health Effects of Energy Drinks on Children, Adolescents, and Young Adults.”
Seifert, Sara M., Schaechter, Judith L., Hershorin, Eugene R., Lipshultz, Steven E.
Pediatrics, Published online 14 Feb 2011.
DOI:10.1542/peds.2009-3592

Additional sources: University of Miami, American Beverage Association (press releases 14 Feb 2011).

Written by: Catharine Paddock, PhD