Feb. 14, 2011 -- A new research review finds that kids are big consumers of caffeinated energy drinks, and experts say the beverages may be giving young users unsafe amounts of stimulants.
The special article, which is published online in the journal Pediatrics, sounds the alarm about the increasing number of health problems tied to caffeine use in youngsters. It calls for more caution with the popular beverages, which are often sold in brightly-colored cans with bold graphics and frenetic sounding names that may be particularly attractive to tweens and teens.
According to the review, 30% to 50% of adolescents and young adults report using energy drinks, and consumers younger than age 26 represent half of the rapidly growing $9 billion market for these beverages in the U. S. These beverages can contain three to five times as much caffeine as an 8-ounce serving of soda.
But a spokesman for the American Beverage Association disagrees with the report, noting that caffeine has been well tested and is generally deemed safe.
Caffeine Overdoses in Kids
The researchers report that in 2008 there were more than twice as many cases of caffeine toxicity reported to the nation's poison centers each year in children as there are in adults.
“I really wouldn’t have expected the number of calls that reported caffeine toxicity in children less than age 6,” says study researcher Steven E. Lipshultz, MD, who is chair of the department of pediatrics at the University of Miami School of Medicine.
Researchers found roughly 1,200 cases of caffeine toxicity reported to U.S. poison control centers each year in children younger than age 6 from 2006 through 2008.
And roughly half of all caffeine overdoses in the U.S. in 2007 occurred in children younger than 19.
“It is shocking,” Lipshultz says.
It’s impossible to know, however, how many of those might have been related to energy drinks because they were not tracked as a separate category in the years covered by the review.
But other countries, including New Zealand and Germany, have documented increasing tween and teen consumption of energy drinks, sometimes with ill effects.
Reported outcomes linked to the consumption of energy drinks in Germany, for example, have included liver damage, kidney failure, respiratory disorders, agitation, seizures, psychotic conditions, high blood pressure, heart failure, and disruptions of heart rhythms, among others, according to the review.
“Children and adolescents are more susceptible to the adverse health effects of caffeine compared to adults,” says Mary Claire O’Brien, MD, an associate professor at Wake Forest University School of Medicine in Winston-Salem, N.C.
“Part of that may be that their livers are not used to caffeine consumption regularly. So the first time that kid buys an energy drink that contains 300 milligrams of caffeine and drinks it, he’s not like his mom or dad and sits down and has a cup and a half of coffee each morning. He’s never been presented with that chemical before, and it’s a drug,” says O’Brien, who has studied the health risks of energy drinks to kids but was not involved in the current review.
What’s more, researchers say, parents may equate energy drinks to soda or sports drinks, when, in reality, they are very different.
Under FDA rules, soda can’t contain more than 71 milligrams of caffeine in every 12 ounces.
Energy drinks, on the other hand, are regulated as dietary supplements, a designation that means there are no limits on how much caffeine they can contain. Some are packed with as much as 500 milligrams per serving.
“It’s become kind of acceptable,” O’Brien says. “You wouldn’t put an espresso machine in a middle school cafeteria. Nobody in their right mind would do that. Everyone would be up in arms, and yet they think nothing of putting these products in the vending machines.”
Beverage Industry Responds
“When it comes to caffeine, it’s important to put the facts in perspective. Most mainstream energy drinks actually contain about half the caffeine of a similar size cup of coffeehouse coffee. In fact, young adults getting coffee from popular coffeehouses are getting about twice as much caffeine as they would from a similar size energy drink,” says Maureen Storey, PhD, senior vice president of science policy for the American Beverage Association, in a news release.
“What we do know is that caffeine is one of the most thoroughly tested ingredients in the food supply today. It has been deemed safe by the U.S. Food and Drug Administration, as well as more than 140 countries around the world,” the statement says. “Many of our member companies voluntarily list the amount of caffeine on their products’ labels and have provided caffeine content information through their websites and consumer hotlines for years.”
In its statement, the American Beverage Association also took issue with the reports of caffeinated overdoses reported to poison control centers, saying that the researchers had mischaracterized the data.
“Further, the review misinterprets the data from a 2007 study by the American Association of Poison Control Centers, which reported more than 5400 caffeine cases from pharmaceutical exposures, not exposure to caffeine from foods or beverages.”
The American Association of Poison Control Centers (AAPCC), for its part, says the researchers got it right.
“As indicated in the paper by Seifert et al., the category caffeine refers to a broad category of caffeine-containing products. The category includes approximately 300 products ranging from coffee to caffeine tablets and various diet aids. At the time of these reports, caffeine-containing energy drinks in the products database were also included in this category,” says Alvin C. Bronstein, MD, acting director of toxicosurveillance for the AAPCC and the medical director for the Rocky Mountain Poison and Drug Center.
What Parents Should Know
Energy drinks may be especially dangerous during sports, says John P. Higgins, MD, assistant professor of medicine at The University of Texas Health Science Center at Houston.
The jolt of caffeine may interfere with something called coronary flow reserve, which is the ability of the arteries around the heart to dilate during intense exercise, a problem that may contribute to heart attacks and abnormal heart rhythms in athletes.
“The caffeine actually makes these arteries more likely to spasm and actually shut,” says Higgins, who recently reviewed the medical literature on energy drinks for paper published in November 2010 in the Mayo Clinic Proceedings.
Caffeine and taurine, which are commonly combined in energy drinks, also makes the heart pound harder than caffeine would alone Higgins, says.
Other experts add that energy drinks may be harmful not just for what’s in them, but what they may replace, drinks like water and milk that hydrate and have minerals and protein that are important for growing bodies. And many are high in calories, which may contribute to obesity.