Energy Drinks Pose Worrisome Risks to Adolescents’ Cardiovascular Health
Although studies by numerous investigators and reports from major medical societies have raised health-related concerns about the consumption of energy drinks by youth, manufacturers of the products continue to market them to children younger than the age of 18 years. Many parents, teens, and healthcare professionals are often left wondering how serious the risks of such a readily available beverage might be, and what additional studies are needed.
“The research on energy drinks is in its very early stages, so there is a lot we don’t know about their effects,” said Jennifer Harris, PhD, MBA, Director of Marketing Initiatives at the University of Connecticut Rudd Center for Food Policy and Obesity. “But what we do know is disturbing, especially when they are consumed by youth.”
Energy drinks contain high amounts of caffeine, sugar, and other stimulants, and ingredients such as taurine, guarana, ginseng, l-carnitine, inositol, B vitamins, and glucuronolactone. In contrast, energy shots do not contain sugar, but caffeine and other stimulants are highly concentrated. Research funded by energy drink manufacturers indicate that these products are safe when consumed as intended by teenagers and adults; however, independent research studies have linked them with severe short-term events including emergency department visits, poison control calls, and even death. “These consequences typically occur when the drinks are consumed with alcohol, as well as when they are consumed by young people who have not developed caffeine tolerance, especially when they consume more than one in a short-term time period and/or when they have an underlying undiagnosed heart condition,” said Harris.
High consumption, meaning ≥2 cans, of energy drinks has been associated with elevated blood pressure and increased frequency of palpitations and arrhythmias (rising with coingestion of alcohol or other illicit drugs), even in healthy individuals without cardiovascular risk factors. “Moreover, previous investigations have demonstrated that energy drink consumption enhances platelet aggregation, alters electrolytes, triggers endothelial dysfunction, and promotes atherosclerosis,” said Fabian Sanchis-Gomar, MD, PhD, an investigator at the Research Institute Hospital 12 de Octubre (‘i+12’) in Madrid. “In addition, it induces a positive inotropic effect on cardiac function, meaning that it increases heart rate, stroke volume, cardiac output, and contractility, and it also increases blood glucose concentration and reduces cerebral blood flow velocity.”
Research also suggests the potential for dependence and withdrawal following regular consumption of energy drinks, in addition to anxiety, aggressiveness, and sleep disturbances. Physicians who care for adolescents should make a point to inquire about energy drink consumption, especially when these symptoms are present.
The long-term effects of consumption are less clear; however, the effects of these drinks on the heart and their association with conduct disorders, violent behaviors, and consumption of illegal substances points to the potential for lasting dangers that warrant further study. Long-term systematic assessments of energy drinks and general caffeine intake by youth should therefore be a priority.
Sanchis-Gomar and his colleagues would also like to see more research on the various components found in energy drinks. “We highlight the importance of knowing the synergy of the different stimulant substances. Our viewpoint is that the combination of compounds contained in these beverages may produce a much greater cardiovascular risk, by generating uncertain interactions, than any component alone,” he said.
Companies advertise that energy drinks increase energy and enhance mental alertness, focus, hydration, physical performance, and health. Many people consume energy drinks for improved performance in academics or sports, but there is little research to support such beneficial effects. “In fact, consumption of energy drinks in association with sports activities increases their risks, and the NCAA [National Collegiate Athletic Association] discourages their use by athletes,” said Harris. The NCCA bans high levels of caffeine because it considers the effects performance enhancing; however, the organization’s ban is also linked to a concern about the uncertainty of energy drinks.
The American Academy of Pediatrics has also stated that energy drinks should never be consumed by youth <18 years of age because of potential adverse consequences on children’s developing neurological and cardiovascular systems. The American Medical Association also supports a ban of the marketing of high-stimulant/caffeine drinks to children because of the potential for heart problems and other effects.
“Since the energy drink companies refuse to take responsible actions, policy actions are required,” said Harris. “These could include mandated warning labels, restrictions on sales of energy drinks to minors and/or restrictions on where they can be placed in stores, restrictions on the inclusion and/or concentration of caffeine and other stimulants in the products, and legal action against misleading and/or deceptive marketing practices.” Some countries, such as Denmark, Norway, and Iceland, have bans on the sale of energy drinks to minors, whereas others have enacted or are considering measures to regulate the labeling, distribution, and sale of the beverages. Such measures can be difficult to enforce, however; when France banned the energy drink Red Bull in 2008, the manufacturers challenged the ban through the European Commission, which ordered the ban to be lifted because the caffeine and taurine concentrations in beverages had not been proven to be health risks. The European Food Safety Authority has encouraged international data pooling to obtain a better assessment of the risks to children, adolescents, and young adults.
Harris and Sanchis-Gomar also encourage much more education about the dangers of these products, especially aimed at physicians, parents, educators, and coaches. “Middle school-age children are prime targets for energy drink advertising and their use among these children is growing rapidly,” said Harris. “There is no reason that children should consume these products, and many reasons why they should not.” n
- © 2016 American Heart Association, Inc.