Energy drinks ‘pose greater health risk’ than coffee

David Hammond

Physiological adverse events linked to consuming energy drinks were “significantly more prevalent” than those linked to coffee, according to data recently published in the Canadian Medical Association Journal.

Perspective from Kristi King, MPH, RDN, CNSC, LD

However, the types of adverse events that occurred were similar between coffee and energy drinks, researchers added.

“There is little research to date on adverse events among children and youth. We wanted to compare the side effects of energy drinks with coffee to examine the assumption that it is only the caffeine in energy drinks that is associated with adverse events,” David Hammond, PhD, School of Public Health and Health Systems, University of Waterloo, Ontario Canada, told Healio Family Medicine.

Researchers analyzed online surveys completed by 2,055 participants aged 12 to 24 years in Canada that assessed previous consumption of energy drinks and coffee.

Hammond and colleagues found that of the 1,516 participants who reported consuming an energy drink, 55.4% reported at least one adverse event. The occurrence of adverse events was significant in energy drink consumers vs. coffee consumers (OR = 2.67; 95% CI, 2.01–2.56), as was the proportion that reported receiving or contemplated receiving medical attention for adverse events (OR = 2.18; 95% CI, 1.39–3.41). In addition, 3.1% of energy drinkers had received or contemplated seeking medical help for their adverse event vs. 1.4% of coffee drinkers.

Researchers found that rapid heartbeat was the most prevalent adverse event reported (24.7%), followed by problems sleeping (24.1%), headache (18.3%), diarrhea/nausea/vomiting (5.1%), chest pain (3.6%) and seizures (0.2%).

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“Most risk assessments to date have used coffee as a reference for estimating the health effects of energy drinks; however, it is clear these products pose a greater health risk,” Hammond said in the interview. “The number of health effects observed in our study suggests that more should be done to restrict consumption among children and youth. At the moment, there are no restrictions on children purchasing energy drinks, and they are marketed at the point-of-sale in grocery stores, as well as advertising that targets children.”

He also suggested primary care physicians notify patients that energy drinks should be avoided in younger patients or during physical activity, especially in patients who are subject to cardiovascular conditions.

Disclosure: The authors report no relevant financial disclosures.

Perspective

Kristi King, MPH, RDN, CNSC, LD

Energy drinks seem to be available at every corner. But what effect do these drinks have on the adolescent and young adult populations? This recent Canadian study seems to be similar to what we see here in the United States. A study published in Pediatrics in 2011 by Seifert and colleagues showed that approximately 30% of 12-to-17-year-olds were consuming energy drinks on a regular basis. Seven years later, there are many more brands of energy drinks readily available, therefore, I would anticipate that percentage to be even higher in the U.S. One limitation of the Canadian study is that it analyzes 12-year-olds with 24-year-olds. It would be nice to see the breakdown of adolescents vs. young adults as their health issues can be very different.

Caffeine can cause many symptoms ranging from headache, chest pain, fast heartbeat and spike in alertness followed quickly by a drop in energy. Forty percent of the respondents experienced at least one side effect from energy drinks, whereas only 30% experienced an adverse effect from coffee. The most common symptoms reported in the Canadian study were jitters or shaking and fast heartbeat. These are not surprising given the known effect of caffeine as a stimulant. General practice in the U.S. is to recommend that children younger than the age of 12 avoid all caffeine, including caffeine in soda and energy drinks, and 85 mg to 100 mg consumption per day is recommended for those older than 12 years. For reference, 8 oz. of coffee would be about 85 mg to 100 mg. Many energy drinks have much more than the recommended amount of caffeine because it can be sold as a “nutritional supplement” which are not subject to FDA regulation. It is important to understand that although we know caffeine is a stimulant and can raise blood pressure, increase heart rate, cause jitteriness, nausea, etc., there is no clear effect caffeine has on the developing brain. There are set toxicities for adults consuming caffeine, but not children or adolescents.

So what can primary care physicians and parents do?

Primary care physicians: Start with a diet history, discussing foods and beverages consumed regularly. Be sure to ask about herbs or supplements patients may be taking as well. Raise awareness of how much water the patient should be taking in on a daily basis and set expectations. Discuss side effects of caffeine including interactions with other medications.

Parents: Focus on water. The body needs water to prevent dehydration. Allowing the child to consume energy drinks may take away from them consuming needed water. Don’t buy it! If it’s not in the house for you or your child, both will be less likely to consume. Talk to your teens about appropriate beverage choices. If your teen feels the need for a “pick me up” discuss other things they can do instead, such as physical activity.

Reference: Seifert SM, et al. Pediatrics. 2011:doi:10.1542/peds.2009-3592.

Kristi King, MPH, RDN, CNSC, LD

senior clinical dietitian, Texas Children’s Hospital

Disclosures: King reports no relevant financial disclosures.

Sources/Disclosures

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Source:

Hammond D et al. CMAJ. 2018;doi:10.9778/cmajo.20160154.