Battle rages between medics and beverage industry over energy drinks

Energy drinks, the buzzy beverages with names like Monster, Bawls, Red Bull and RockStar, continue to bedevil the medical community, who warn that their sugar and caffeine content make them unsuitable for children who are teased by the hip handles.

The companies, conversely, fire back that their drinks are safe and contain no more caffeine than the cups of coffee millions consume every day at Starbucks.

Energy drinks are beverages that often contain caffeine, taurine, herbal supplements, sugar, and guarana. These drinks, sold in supermarkets, convenience stores and shops that sell vitamins and supplements, are marketed to improve energy, promote weight loss, and boost stamina, athletic performance and concentration.

Red Bull, the granddaddy of the bunch, exploded onto the market in the late 1990s and contains about 66.7 mg of caffeine per 8.3-ounce can, less than the 107.5 mg in a typical cup of coffee.

Most list caffeine, the main active ingredient in energy drinks, at 70 to 80 mg per eight-ounce serving. But caffeine counts of 350 mg have been registered in some products — the equivalent of 10 cans of caffeinated soda.

The Food and Drug Administration imposes a limit of 71 mg of caffeine per 12 fluid ounces of soda but energy drink manufacturers can circumvent this limit by touting their products as “natural dietary supplements.”

In addition, energy drinks often add caffeine through “energy blend” additives like guarana, glucose, kola nut, yerba mate, L-carnitine and cocoa. Monster’s “energy blend” mix in a single eight-ounce can is 2,500 mg, not counting the 27 grams of sugar. (The recommended intake of sugar is 40 grams — for the entire day.)

A gram of guarana can contain 40 to 80 mg of caffeine but companies are not required to list the caffeine content from these additives. So, the caffeine count can be much higher than the can’s nutritional label, according to a 2012 University of Miami study of energy drinks and their health effects on children, adolescents and young adults, published in Pediatrics, the official journal of the American Academy of Pediatrics.

The authors were lead author Sara Seifert and doctors Judith Schaechter, Eugene Hershorin and Steven Lipshultz, who traveled to Washington earlier this month to address a panel convened by the Food and Drug Administration and the Institute of Medicine to review the health consequences of energy drinks for children.

“If you had to predict what ages we saw the most poisonings, you would probably say high school or college-age kids, young adults. But over 50 percent of all the people who felt they were getting poisoned by drinking energy drinks or unintentional exposures, were less than 6 years of age,” said Lipshultz, professor of pediatrics at the University of Miami Miller School of Medicine. “Unintentional” meaning the youngest children stumbled upon the sweet, attractively packaged beverages in the home refrigerator, Lipshultz said.

The UM study, which relied on self-report surveys, found that energy drinks are consumed by 30 to 50 percent of adolescents and young adults. Of the 5,448 caffeine overdoses reported by 57 poison control centers in the United States in 2007, about 50 percent of those occurred in children younger than 19.

Children — especially those with cardiovascular, renal or liver disease, seizures, diabetes, mood and behavioral disorders, along with hyperthyroidism or those who take certain medications for attention deficit disorder — could be at higher risk for adverse effects from consuming energy drinks, the UM study reported.

“You are getting stimulants on top of stimulants so that is not going to help you concentrate better,” Lipshultz said.

Caffeine intoxication is a clinical syndrome marked by nervousness, irritability, anxiety, insomnia, rapid heartbeat, or tachycardia, and stomach upset.

“I definitely think it’s a disservice done to our kids,” said Baptist Health South Florida chief wellness dietician Natalie Castro about the energy drinks. “Caffeine is a stimulant. There is a smaller body weight, they are younger, and there’s too much stimulation going on. This is not something that is recommended or needed as part of a healthy diet.”

A recent report from the American Medical Association supported a ban on the marketing of energy drinks to children younger than 18. The American Academy of Pediatrics added that “energy drinks have no place in the diet of children and adolescents.”

Other research studies have found that the high level of citric acid, used as a preservative in energy drinks, strips the protective enamel from teeth, which leads to cavities. The energy drinks had a more harmful effect on enamel than traditional sports drinks like Gatorade.

An analysis of energy drink toxicity in the National Poison Data System by a team of doctors from the University of Miami, University of New Mexico School of Medicine, University of Colorado School of Medicine, New Mexico Poison and Drug Information Center and Holtz Children’s Hospital of Jackson Health System was published in June by Informa Healthcare.

The report said the threshold of caffeine toxicity for healthy adults is 400 mg per day and the numbers decline the younger one gets. An adolescent’s threshold is 100 mg per day; children younger than 12 should tolerate no more than 2.5 mg per day. Energy drinks top most of these numbers.

Tracey Halliday, vice president of communications for the American Beverage Association, addressed the reports by sending the Miami Herald the organization’s letter to the FDA, along with its analysis of The Substance Abuse and Mental Health Services Administration’s January 2013 report, which used data from the Drug Abuse Warning Network (DAWN).

The DAWN report noted an increase in the number of emergency department visits involving energy drinks and concluded that the consumption of these drinks “is a rising public health problem.”

At the request of the American Beverage Association, Pinney Associates, a pharmaceutical and healthcare research group with offices in Maryland and Pennsylvania, was asked to conduct a review of the DAWN report.

Among the DAWN findings, energy drink-related visits comprised 0.25 percent of all drug-related emergency department visits in 2007. By 2011, that rate rose to 0.41, or nearly double. These visits, however, did not require further medical follow-up, compared with emergency visits related to other products or medications.

The Pinney analysis ruled that the “limitations of the DAWN system suggest caution in basing public health policy on the results relative to energy drinks.”

Halliday also cited the industry’s July letter to the FDA. The healthcare professionals’ reports, including the UM studies, “paint a distorted and highly inaccurate picture of caffeine use and safety, ignoring the vast number of robust and reliable scientific publications that have, for decades, established the safety of caffeine at the levels presented in energy drinks, including for younger consumers.”

The 32-page letter also blasted the studies that suggest young consumers are targeted and are among the highest consumers of energy drinks.

“On the contrary, the fact that 30 to 50 percent of adolescents ‘consume’ energy drinks is vague … [a]nd does not specify whether ‘consume’ means drink an entire can, or merely taste or sample. In any case, government data show that consumption of energy drinks by younger consumers has not increased those consumers’ overall caffeine intake. Therefore, the amount of energy drinks consumed by younger people is not a cause for alarm.”

Halliday also pointed to the American Beverage Association’s contention that energy drinks are not targeted to children. “Energy drinks are not intended for children. The leading energy drink makers have voluntarily pledged not to market these products to children or sell them in K-12 schools. In addition, these companies voluntarily display an advisory statement on energy drink packaging, stating that the product is not intended (or recommended) for children, pregnant or nursing women, and persons sensitive to caffeine.”

Lipshultz countered: “The industry says they don’t market to kids but it’s totally marketed to kids.” He noted names like Rock Star and Monster that appeal to a young demographic.

“People buy them because they have an effect on the body but none of the effects are therapeutic for kids,” he said, rebuking the drinks’ promises.

“‘Take this, you’ll be more awake,’ but we found medical studies suggesting that taking energy drinks all the time reduced the amount of REM sleep, so you get more tired. ‘Take this, it will help you lose weight.’ But with all the sugar, you get all these unneeded calories so you don’t lose weight.

“The issue is, for a lot of kids this may not necessarily be harmful, but, on the other hand, if you’re a child who has an unhealthy heart, even if you don’t know it, we don’t think it’s a good idea to take stimulants. A lot of people who get sick are not just the average but there are vulnerable populations,” Lipshultz said.

“It’s not like we take every child in school and do an ultrasound on their heart to see if their heart is normal or not.”

Myerly Kertis, a pediatric registered dietician for Holtz Children’s Hospital, says that parents need to read the labels for products they have around the house that can prove attractive to little fingers.

“I know a lot of times there’s sugar in there and sometimes added herbs or various things. As far as the clinical side, some of these herbs can harmfully interact with medications,” Kertis said. “Some are fine, but read the label and be knowledgeable about what you are putting into your body especially if you are on medications and taking things with herbs. Always check with a doctor.”

Follow @HowardCohen on Twitter.

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