Energy drinks in adolescents: More research please !

Mar 31 2011 Published by under Uncategorized

Annie Ferland (a colleague and friend of mine who is a nutritionist and presently a postdoc at the University of Colorado School of Medicine) and I, have been interested in the impact of energy drinks on health-related issues since a couple of years now. After having read numerous papers and letters to the editor related to this highly covered topic, we decided to submit our own comment to further discuss a recently published letter dedicated to the energy drinks issue... which was ultimately rejected.

We then asked ourselves: How can we discuss relevant science issues when even letters to the editor are rejected!?

When I started Le Physiologiste, one of the (mid-term) goals with that blog was to discuss interesting issues in physiology. I'm even dreaming about the possibility of debating hot physiology topics online. I hope that in a near future, we’ll have enough interested followers to discuss these science issues…but that is another story. In the meantime, Annie and I are taking this opportunity, as guest bloggers here at Scientopia*, to post our rejected letter since we consider that it could be of interest for some Scientopia readers and could even promote a discussion about energy drinks!

So here it goes!

In a recent commentary, Arria and O’Brien (1) reacted to the announcement from the Food and Drug Administration, "that caffeine is an unsafe food additive to alcoholic beverages" .

In this commentary, the authors have brilliantly outlined important issues regarding the safety associated with mixing alcohol with energy drinks. The majority of the existing literature represents studies with small sample sizes including young, healthy individuals in whom it is unlikely to observe short-term harmful side effects.

However, we consider that Arria and O’Brien did not put enough emphasis on one particular issue. Indeed, we should not ignore the impacts of energy drinks in adolescents, which are at the moment not well characterized.

It is well known that the United States now depicts the highest mean body mass index of all high-income countries (2). The association between the consumption of sweetened beverages with obesity is well described in the literature. The Dietary Guidelines for Americans report that 36% of added sugar intakes in the diet come from soda, sports and energy drinks. A 16-ounce energy drink may contain ~60 g of sugar, the equivalent of 11 tablespoons, which represent twice the recommended limit of daily sugar intake in a 2,000 calories diet. Of concern, the consumption of energy drinks is rapidly growing in young middle school students, and the wide availability of these drinks in grocery stores makes these beverages readily accessible for purchase. Even if the amount of caffeine in each beverage is about the same as a cup of coffee, the consumption of a 16-ounce energy drink by these young students might exceed their maximal daily intake in caffeine. Different format of energy drinks are available ranging from 8 to 24 ounces.

Research also shows that the regular consumption of energy drinks increases heart rate by 7%, systolic blood pressure by 10% and diastolic blood pressure by 8% (3). Such an increase in blood pressure and heart rate may not necessarily be associated with a worsened cardiovascular risk profile in young healthy individuals. However, the regular consumption of energy drinks may have a negative impact in obese or sensitive individuals with health-related problems. Energy drinks were also shown to shorten total sleep time by 29 min and reduce sleep efficiency, which may lead to a vicious circle of consumption (4).

Most agree that the regulation of energy drinks is currently inadequate. There is a need for public advertisement about the health-related impact of these beverages, which will help counteract the strong marketing of energy drinks. Considering the growing number of reports describing serious adverse effects following inappropriate energy drink consumption (5-6), there is an urgent need for well-designed studies in order to potentially protect consumers, specially the most vulnerable ones, adolescents.

What is your opinion on that matter ?

Annie and Patrice

*That comment has already been posted at Le Physiologiste some weeks ago.


(1) Arria AM, O'Brien MC. The "high" risk of energy drinks. JAMA 2011; 305(6):600-1.

(2) Finucane MM, Stevens GA, Cowan MJ, et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants. Lancet. Feb 3 2011.

(3) Steinke L, Lanfear DE, Dhanapal V, Kalus JS. Effect of "energy drink" consumption on hemodynamic and electrocardiographic parameters in healthy young adults. Ann Pharmacother. Apr 2009;43(4):596-602.

(4) Jay SM, Petrilli RM, Ferguson SA, Dawson D, Lamond N. The suitability of a caffeinated energy drink for night-shift workers. Physiol Behav. May 30 2006;87(5):925-931.

(5) Terlizzi R, Rocchi C, Serra M, Solieri L, Cortelli P. Reversible postural tachycardia syndrome due to inadvertent overuse of Red Bull. Clin Auton Res. Aug 2008;18(4):221-223

(6) Berger AJ, Alford K. Cardiac arrest in a young man following excess consumption of caffeinated "energy  drinks". Med J Aust. Jan 5 2009;190(1):41-43.

5 responses so far

  • Sue W says:

    Interesting. I live near the U.S. border and I now notice that there is a refrigerated point-of-sale cabinet for Red Bull in large shops (Walmart, Price Chopper). This is relatively new and is presumably a new marketing campaign to sell what look like "premium" or "adult" soft drinks. The cabinets for other soft drinks are still there as well of course.

  • Derek says:

    IIRC there are some examples of deaths due to overconsumption too. The positive feedback loop for consumption sounds particularly interesting.

    As for the addition of caffeine to alcoholic drinks, this was on recently. Apparently the problem is that you can end up passing out with very little warning as the effects of caffeine and alcohol interact.

    Aside from the fact that the calories in soda are sugar without any other associated nutrients, there is also evidence that "liquid calories" lead to weight gain much more so that solid calories: in a trial comparing the daily consumption of 400 cal . of jelly beans vs. 400 cal of soda, the soda group seemed to put almost all the calories on as fat, whereas the jelly bean group reduced their calorie intake to compensate and keep total calorie intake similar.

    See NYC " pouring on the pounds" marketing campaigns too. For the most part there is already widespread recognition regarding the soda consumption problem though it could always use help, so that leaves the caffeine. Frankly I think we have some serious cultural issues around that but I don't know much about it....

    The main problem here keeps coming back to the plutocracy. The most sensible and least paternalistic intervention is to just put warning labels on stuff. But we cannot simply put warning labels on products in congruence with the science because the pluts will kick and scream and use their influence to prevent it.

  • [...] I have already mentioned in a previous post over at Scientopia’s Guest Blogge, the regulation of energy drinks is currently inadequate [...]

  • [...] I have already mentioned in a previous post over at Scientopia’s Guest Blogge, the regulation of energy drinks is currently inadequate [...]

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