As high-octane energy drinks stack the shelves of gas stations, gyms and supermarket chains, some health professionals and state policymakers are educating the public against regular consumption — especially by children.
In fact, they warn that drinks such as Red Bull, Monster and Rockstar can cause serious, even irreversible, side effects due to high levels of caffeine along with other additives.
“There’s really no evidence that it has any therapeutic efficacy,” said Dr. Steven Lipshultz, pediatrician-in-chief at the Children’s Hospital of Michigan and a leading expert on energy drinks and kids. “In other words if you have an ear infection, you take an antibiotic and that clears up the infection. That’s a therapy that’s efficacious. There’s no evidence that energy drinks have a therapeutic facet.”
Never miss a local story.
“It’s become common in our society,” said Judy Schaechter, interim chair for the Department of Pediatrics at UHealth — University of Miami Health System. “But how that affects somebody’s health, mentally and physically, is not beneficial and it’s certainly not beneficial to young children.’’
The American Beverage Association, which represents about 95 percent of the energy drink market, says that energy drinks are safe and contain less caffeine than their coffee counterparts.
"Energy drinks, while they’ve been a growing category, are still a niche product that account for just under 2 percent of the total non-alcoholic beverage market,” said Tracey Halliday, a spokesperson for the ABA. "There’s speculation that Americans are getting really large amounts of caffeine in their diet because of the introduction of energy drinks and that really couldn’t be farther from the truth.”
Researchers have found that increased caffeine levels among children and teens are linked to serious side effects such as arrhythmias, high blood pressure and insomnia, among other health problems.
“The issue is that most of these drinks are not regulated,” said Dr. Esteban Escolar, cardiologist and director of the Coronary Care Unit at Mount Sinai Medical Center in Miami Beach. “Some of these drinks are very concentrated. The dose of caffeine that is provided is excess.”
Compared to an average cup of coffee with about 95 milligrams of caffeine, energy drinks exceed 150 mg in 16-ounce cans. But unlike soda, which is limited to 71 mg of caffeine per 12 fluid ounces, energy drink manufacturers can exceed caffeine restrictions because of how the beverage is regulated as a dietary supplement.
So while a 12-ounce can of Coke has 34 mg of caffeine, many energy drinks, like Red Bull, Monster or 5-hour Energy, contain two to six times that amount.
And unlike coffee or soda, energy drinks may add more caffeine to their ingredient list through “energy blend” additives like guarana, kola nut and yerba mate. And the FDA doesn’t require manufacturers to specify the caffeine content of these additives, so they’re not reflected in the nutrition labels of the product.
“How that affects someone’s health, we don’t even know the extent of that yet,” Schaechter said.
The risk is greater, experts believe, if children have underlying, undiagnosed heart issues or chug energy drinks before participating in high-energy activities, like sports.
“Be careful,” Escolar said. “If you are not used to these things, it could be detrimental to your health.”
On a national level, three U.S. senators are taking action.
Sens. Edward Markey, D-Mass., Richard Durbin, D-Ill., and Richard Blumenthal, D-Conn., are calling to improve transparency in drink labels and stop marketing energy drink products to children under 18.
“The industry has shown no interest in really self-regulating, and labeling on cans is inadequate,” Lipshultz said. “So that’s where the legal and legislative communities have been getting involved.”
Halliday, of the American Beverage Association, sees it differently.
“The companies all voluntarily agreed to do a number of things, among them to place advisory statements on their energy drink packaging, which states that energy drinks are not recommended for children,” she said. “They also voluntarily pledged not to market these products to children or to sell them in K-12 schools.”
While medical guidelines have long suggested most healthy adults can consume up to 400 mg of caffeine without adverse effects, zero tolerance guidelines for children have only recently been created.
The American Association of Pediatrics set its recommendations for energy drink consumption in June 2011, immediately after Lipshultz, then the chair of pediatrics at the University of Miami Miller School of Medicine, published a report discouraging energy drinks for children.
The extent of damage energy drinks can cause in kids has not been thoroughly examined. Cardiac, heart and pediatric specialists have only recently begun to hone in on the consequences of consuming the highly caffeinated beverages.
There have been isolated cases of children dying from consuming energy drinks. A 16-year-old girl went into cardiac arrest after drinking an energy drink on the beach in Mexico. In another case, a 19-year-old man passed away after experiencing cardiac arrhythmia in 2013. The young man’s mother contended her son’s habitual consumption of energy drinks caused his death. The family sued Monster Energy.
"The only comment we have is that the matter has been resolved, but I cannot provide any further detail,” said Evan Pondel, a spokesman for Monster Energy.
In November, the American Heart Association was presented with another finding: More than 40 percent of about 5,100 calls to poison control centers for energy drink exposure involved kids under 6.
“When you looked at it, some of the ones that were most concerning were related to the nervous system, like seizures. Some of them were related to high-blood pressure, rapid heart rates, abnormal heart rhythms, and some were related to the gastrointestinal system,” Lipshultz said. He was the lead author on the study.
While energy drink companies say their products aren’t geared toward children, many air commercials on channels that teens are likely to watch. A March 2015 report in the Journal of Nutrition Education and Behavior said 46 percent of TV advertisements for such products aired on channels such as MTV2, ESPN News and Fuse.
“Although it cannot be proven that adolescents specifically viewed these advertisements, Nielsen data have previously indicated that adolescents view more energy drink advertisements than adults on many of the 10 channels identified in this study, including the top network MTV2,” according to a study in Medical News Today.
Schaechter has seen her fair share of adolescent patients who consume these beverages.
“A lot of the time the parents didn’t know they were having one during the day,” she said. “Sometimes the parents drink one themselves.”
Often, she added, the teens thought that the energy drinks were a way to rehydrate. They didn’t realize the drinks, full of caffeine and sugar, were dehydrating them more.
Similarly, chronic use of the beverage results in less high-quality sleep, so instead of drinking one and feeling awake, a teen would feel more tired, doctors say.
And for adolescents who are diagnosed with attention deficit hyperactivity disorder, or ADHD, and take prescription medications, the effects of mixing the meds with the drinks can be far worse.
“Stimulants on top of stimulants aren’t necessarily going to improve your concentration. If it did, doctors would prescribe more of it,” Lipshultz said. “It’s a health concern.”
And it can become a difficult cycle and hard to fix, Schaecter said. Lipshultz agreed.
“Kids and adolescents should not be drinking energy drinks,” he said. “Period.”
CAFFEINE LEVELS OF ENERGY DRINKS
A 12-ounce can of a regular cola soft drink has between around 35 and 40 mg of caffeine and 39 to 41 grams of sugar. Many energy drinks have between two and six times those caffeine levels.
Red Bull: 80 mg caffeine per 8.4 oz. container, 27 grams sugar
Monster: 160 mg caffeine per 16 oz. container, 54 grams sugar
Rockstar: 160 mg caffeine per 16 oz. container, 62 grams sugar
Amp Energy: 142 mg caffeine per 16 oz. container, 58 grams sugar
NOS: 160 mg caffeine per 16 oz. container, 54 grams sugar
5-hour Energy: 215 mg caffeine per 1.9 oz., 0 grams sugar
Sources: Company websites, nutritional labels and Consumer Reports magazine