Q&A: Pediatric cardiologist calls for better energy drink regulation
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Key takeaways:
- Energy drinks are considered liquid dietary supplements, which do not require caffeine labels.
- High amounts of caffeine can be found in unexpected products like fruity drinks and lemonades.
Highly caffeinated drinks can pose serious cardiovascular risks to children and adolescents, yet unlike soda, they are not subjected to caffeine content limits or labeling requirements in the United States.
In a commentary published in The Journal of Pediatrics, two experts are calling for that to change.
“It is estimated that possibly 70%, or maybe even three-quarters or more, of adolescents drink energy drinks — if not every day, at least several days a week” Victoria L. Vetter, MD, FAAP, FACC, a pediatric cardiologist and electrophysiologist at Children’s Hospital of Philadelphia and a professor of pediatric cardiology at the University of Pennsylvania’s Perelman School of Medicine, told Healio.
Vetter and colleague Maryam Y. Naim, MD, MSCE, associated chief of research in the division of cardiac critical care medicine at Children’s Hospital of Philadelphia, wrote that 85% of adults consume caffeine on a daily basis, with an average of 185 mg per day.
Although Vetter said caffeine is generally considered safe for adults to consume, children’s bodies are still developing and respond differently to caffeine. Healio spoke with Vetter about the dangers these drinks pose to children and how government regulations could help.
Healio: Are energy drinks more dangerous than other caffeinated beverages?
Vetter: We do not have randomized controlled trials in this country to scientifically, absolutely answer that question. Soft drinks are regulated as to the amount of caffeine that you can have (71 mg in a 12-ounce can of soda), but that type of regulation does not exist for these highly caffeinated drinks. They have more caffeine than sodas, and they often are unexpected — they are in fruity drinks, in lemonade or other places where one might not actually anticipate that amount of caffeine. It depends on the amount of caffeine you are getting, but there are other substances in energy drinks that may have adverse effects on the body or the cardiovascular system as well.
Healio: What are the consequences of children and adolescents consuming these drinks regularly?
Vetter: The high amount of caffeine causes the antagonism of what we call adenosine receptors, and that causes the release of catecholamines, which are the body's natural stimulants. They cause the body to release more of those into the system, and that then stimulates the heart. They can cause you to have an imbalance in the myocardial demand for oxygen and the amount of blood flow that is being provided to the heart muscle. They can overly stimulate the receptors in the heart that cause extra beats to occur, which is what we call ventricular arrhythmia. There can be a number of rhythm-related abnormalities. It can also increase blood pressure and cause other adverse cardiovascular effects.
Healio: Have you seen any of these issues in your practice?
Vetter: A 7-year-old patient told me about an energy drink that influencers on his video game had recommended. He did not know what an energy drink was, but he knew that they had recommended that he drink this one. He asked his mom and dad to get it, and they did not know the difference, and they got him this drink. I was seeing him because he was having an abnormal heart rhythm. In kids who have an underlying abnormal heart rhythm that they may or may not be aware of, this can be particularly dangerous.
Healio: How are these drinks regulated?
Vetter: There are not any state or national regulations. The FDA regulates food and drugs, whereas energy drinks came after the Dietary Supplement Health and Education Act in 1994 that regulates dietary supplements. Caffeine is generally recognized as safe, and so these energy drinks slipped in under the radar.
Most people do not know the difference between 80 mg of caffeine, which would be the amount in a general cup of coffee, 45 mg that might be in a soda, or 400 mg that might be in a supersized coffee or some of these refresher or charged drinks that you can get in a lot of the convenience stores.
Healio: How do you think energy drinks should be regulated?
Vetter: What we are hoping is that the FDA will reconsider whether some of these drinks should be considered under the same regulations on conventional foods and beverages with appropriate labeling and appropriate warning.
We need some kind of system that the population will understand, and it's probably not going to be milligrams. I suggested a green, yellow, red warning system, so people would know that if it is yellow or red that this is not something that children or pregnant or breastfeeding women should be consuming.
Health Canada does have regulations — 180 mg is the top amount that you can sell. And I believe that they do have a warning label. In Europe, they have warning labels, and Latvia and Lithuania have even banned the sale of energy drinks to young people.
Healio: What should pediatricians know about energy drinks?
Vetter: Pediatricians should know that kids are being targeted. They're being targeted for a lot of things on social media, but unless they have their own young or adolescent children, they may not be acutely aware of how much young people are being targeted and how much peer pressure there is to buy these drinks.
I think it's important for parents to be aware of the messages that their kids are getting from social media and from their friends. And they need to be aware of the potential harms of these substances and recognize that a highly caffeinated energy drink is not a healthy thing. They need to set the example too by not using energy drinks as a way to manage their own fatigue. Healthy eating, healthy exercise, healthy sleep — all the things that we advise families about are the things that should make everyone turn away from these energy drinks.
For more information:
Victoria L. Vetter, MD, FAAP, FACC, can be reached at vetter@chop.edu.
References:
- Vetter VL, et al. J Pediatr. 2024;doi:10.1016/j.jpeds.2024.114224.
- Health Canada. Caffeinated energy drinks. https://www.canada.ca/en/health-canada/services/food-nutrition/supplemented-foods/caffeinated-energy-drinks.html. Published May 2, 2024. Accessed Oct. 8, 2024.
- Associated Press. Latvia bans sales of energy drinks to under-18s. https://apnews.com/general-news-66a923c883a047a3b6906a692ba4de6c. Published June 1, 2016. Accessed Oct. 8, 2024.
- Lithuania Tribune. Lithuania bans sale of energy drinks to minors. https://www.lrt.lt/en/news-in-english/19/43504/lithuania-bans-sale-of-energy-drinks-to-minors. Published Sept. 8, 2015. Accessed Oct. 8, 2024.
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