ENERGY DRINKS AND ADOLESCENTS — WHAT SHOULD HEALTH PRACTITIONERS KNOW?
 
   

Energy Drinks and Adolescents —
What Should Health Practitioners Know?

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:
   Frankp@chiro.org
 
   

FROM:   Journal of Clinical Chiropractic Pediatrics 2012 (Dec);   13 (1): 1042—1044

Sharon Gordon, BAppSc(Chiro), DICCP

Private practice,
Gippsland, Victoria, Australia.
Sharon.gordon@rmit.edu.au


Energy Drinks are readily available in supermarkets throughout the world. There are currently no restrictions or guidelines on safe consumption by children. Energy drink consumption by adolescents is on the rise, as companies continue to aggressively market their product to this demographic. It has become socially acceptable for children to consume these drinks, as there is a perception that the products are safe. In addition, they have become a popular accessory in the youth extreme-sport culture. Overall, research on adolescent energy drink consumption is lacking, however side effects similar to that seen in adults, have been reported in the adolescent population. The chiropractor must be aware of these side effects, including how they may relate to presenting symptoms, and educate their patients on the dangers of energy drink consumption.

Key Words:   energy drink, caffeine, adolescent, chiropractic


Objective

To review the literature on energy drink consumption amongst adolescents, and discuss the physiological effects that may present to the chiropractic office.


Methods

Scientific journal databases were searched, including PubMed, Medline, Proquest, Cochrane, CINAHL, Medscape, and Index to Chiropractic Literature. An open internet search was also performed.


Discussion

Adolescents may present to chiropractic offices with a variety of symptoms. A survey of practitioners by Alcantara, Ohm and Kunz (2010) found chiropractors were commonly sought for help with digestive issues, ADHD, and headaches in children. [1] Ferrance and Miller (2010) cited musculoskeletal complaints, ADHD, sleep problems, asthma and sinusitis as the most common reasons for parents seeking CAM (complementary and alternative therapies) for their children. [2] Some of these symptoms prompting chiropractic consult may mimic, or in fact be due to side effects of increasing energy drink consumption in the adolescent population.

Energy drink consumption by adolescents is growing in popularity. They are the targets of aggressive product marketing, yet we still do not know the safe level of consumption in this population. Currently, these caffeinated drinks are ‘Legal, easy to obtain and socially acceptable to consume by adults and children’. [3]

The most popular energy drinks in Australia are ‘V’, ‘Red Bull’, ‘Mother’, and ‘Monster’. [4] Most research to date has been conducted in the form of surveys in the U.S.A, especially of first year college students. In one survey, 51% of college students regularly consumed energy drinks [5] and another college survey found 39% of students had consumed at least one drink in the preceding month. Males were more likely to consume than females, and this was strongly associated with masculinity and risk-taking behavior. [6]

Most energy drinks contain 80-140g/250mL caffeine. This is equivalent to 1 cup of coffee, or two cans of cola. Some energy drinks of greater volume contain up to 500g of caffeine. [7, 8] In a survey of 12-18 year olds, 73% consumed greater than 100mg caffeine on a daily basis. [9] There has been an overall 70% increase in caffeine consumption by children and adolescents worldwide in the last 30 years, and studies have shown that anywhere from 20-100% of caffeine consumers display evidence of caffeine dependence. [10]

There are several reasons why energy drink consumption has become so popular in the adolescent population. These include tiredness, to improve energy levels, combine consumption with alcohol, and enhance athletic and mental performance. [11]

Some research into the benefits of energy drinks found that consumption of energy drinks did show transient improvements in concentration and alertness. An RCT shows that consumption can improve cognitive performance in behavioural control tasks. [12] Other studies also demonstrated marginally better sporting performance. [13] The perceived benefits of energy drinks are widely thought to be due to the combination of caffeine and sugars, which ‘stimulates the central nervous system, alleviating fatigue, increasing wakefulness, and improving concentration and focus’. [14] Interestingly, in a double-blind young adult running time trial, sugar-free Red Bull did not improve run time. This supports the theory that any benefits are be gained from the combination of sugar and caffeine. [15]

In the U.S.A, the American Association of Poison Control Centers tracked 331 calls in January to February of 2011 reporting caffeine drink overdose. The majority involved children and teens. [16] Overall, ‘Of the more than 5000 US caffeine overdoses reported in 2007, 46 per cent occurred in youths aged 18 or younger.’ [17]

A New South Wales (Australia) poisons information line received 300 calls reporting symptoms of caffeine overdose, one-third required hospitalisation. Adolescents and children were the most commonly affected. [18]

Caffeine as a drug has the greatest likeness to cocaine, and symptoms of withdrawal are not dissimilar. [19]

Energy drinks also carry side effects that can range from transient and benign to fatal. The practice of combining energy drinks with alcohol continues to grow in popularity, giving the consumer an added ‘buzz’. The concern with combining a caffeine stimulant with alcohol is that the consumer can underestimate their level of intoxication. [20, 21] A study by Kathleen Miller (2008) found that energy drink consumption was also associated with drug use, fighting, seatbelt omission, risk-taking, smoking and drinking in the Caucasian population. [22]

Other documented side effects include:

increased blood pressure, [23, 24]
increased platelet aggregation, [25]
dehydration, [26]
anxiety, [27]
cardiac arrythmia, [28-30]
headaches, [31, 32]
nausea, [33]
sleep deprivation, [34-37]
fidgeting, [ 38, 39]
increased pain tolerance, [40]
stroke, seizure, [41]
bed wetting, [42]
dizziness, [43, 44]
weight gain, [45]
and in extreme cases, death. [46]


With these symptoms as potential side effects of energy drink consumption, the chiropractic clinician must take thorough adolescent patient history to correctly determine the etiology of symptoms, educate their patient and manage them appropriately. As energy drinks are seen as socially acceptable to consume in this age group, an adolescent chiropractic patient may not mention energy drink consumption in a standard health history.


Conclusion

Energy drink consumption is a growing trend in adolescent culture, particularly among active youths. There is no known safe consumption level of energy drinks in the adolescent population yet there are currently no restrictions on the marketing, sale or consumption of energy drinks by minors. Chiropractors should be aware of potential side effects of energy drink consumption, which may lead to clinical presentation. The education of adolescent patients on the potential dangers of energy drink consumption is also required of the chiropractic clinician. Further research is needed in this area before regulation in the sale of such drinks can be mandated.


REFERENCES:

  1. Joel Alcantara, J, Ohm J, Kunz D.
    The Chiropractic Care of Children
    J Altern Complement Med. 2010 (Jun);   16 (6):   621–626

  2. Ferrance R, Miller J.
    Chiropractic diagnosis and management of non-musculoskeletal conditions in children and adolescents.
    Chiropr Osteopat 2010; 18:14

  3. Temple J.
    Caffeine Use in Children: What we know, what we have left to learn, and why we should worry.
    Neurosci Biobehav Rev 2009 June; 33(6):793-806

  4. Energy Drinks – Are they Safe? Health and Well Being.
    August 2010.
    Website accessed Feb 6th 2012.
    http://health.ninemsn.com.au/family/familyhealth/689831/energy-drinks

  5. Malinauskas B, Aeby V, Overton R, Carpenter-Aeby T, Barber-Heidal K.
    A survey of energy drink consumption patterns among college students.
    Nutr J 2007; 6:35

  6. Miller, K. Wired:
    Energy Drinks, Jock Identity, Masculine Norms, and Risk Taking.
    J Am Coll Health 2008; 56(5):481-489

  7. MacDonald N, Stanbrook M, Hébert P.
    “Caffeinating” children and youth.
    CMAJ 2010 October 19; 182(15):1597

  8. Temple J.
    Caffeine Use in Children: What we know, what we have left to learn, and why we should worry.
    Neurosci Biobehav Rev 2009 June; 33(6):793-806

  9. MacDonald N, Stanbrook M, Hébert P.
    “Caffeinating” children and youth.
    CMAJ 2010 October 19; 182(15):1597

  10. Temple J.
    Caffeine Use in Children: What we know, what we have left to learn, and why we should worry.
    Neurosci Biobehav Rev 2009 June; 33(6):793-806

  11. Malinauskas B, Aeby V, Overton R, Carpenter-Aeby T, Barber-Heidal K.
    A survey of energy drink consumption patterns among college students.
    Nutr J 2007; 6:35

  12. Howard M, Marczinski C.
    Acute effects of a glucose energy drink on behavioral control.
    Exp Clin Psychopharmacol 2010 Dec. 18(6):553-61

  13. Paddock R.
    Energy drinks’ effects on student-athletes and implications for athletic departments.
    The Sport Journal.
    Website accessed February 6th 2012.
    http://www.thesportjournal.org/article/energy-drinks-effects-student-athletes-and-implicationsathletic-departments

  14. The Mayo Clinic.
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    Website accessed February 7th 2012.
    http://www.mayoclinic.com/health/caffeine/NU00600/METHOD=print

  15. Candow D, Kleisinger A, Grenier S, Dorsch D.
    Effect of sugar-free Red Bull energy drink on high-intensity run time-to-exhaustion in young adults.
    J Strength Cond Res 2009 Jul. 23(4) 1271-5

  16. Energy drinks could even cause death in teens and children:
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    Website accessed February 5th 2012.
    http://www.ibtimes.com/articles/112088/20110214/energy-drink-risks-teens-adolescentscaffeine-overdose.htm

  17. Energy drinks put kids at risk: report. 2011.
    Website accessed February 7th 2012.
    http://www.abc.net.au/science/articles/2011/02/15/3139247.htm

  18. Phillips N.
    Rise in cases of caffeine toxicity spurs calls for warning labels on energy drinks. January 2012.
    Website accessed February 6th 2012.
    http://www.smh.com.au/national/health/rise-in-cases-of-caffeine-toxicity-spurs-calls-for-warning-labels-onenergy-drinks-20120115-1q1fq.html#ixzz1lZ6KEG00

  19. Persad L.
    Energy drinks and the neurophysiological impact of caffeine.
    Neurosci 2011; 5:116

  20. Miller, K.
    Wired: Energy drinks, jock identity, masculine norms, and risk taking.
    J Am Coll Health 2008; 56(5):481-489

  21. Arria A, O’Brien M.
    The “high” risk of energy drinks.
    JAMA 2011; 305(6):600-601

  22. Kathleen E. Miller, Ph.D.
    Energy drinks, race, and problem behaviors among college students.
    J Adolesc Health 2008 November; 43(5):490-497

  23. Arria A, O’Brien M.
    The “high” risk of energy drinks.
    JAMA 2011; 305(6):600-601

  24. Persad L.
    Energy drinks and the neurophysiological impact of caffeine.
    Neurosci 2011; 5:116

  25. Worthley M, Prabhu A, De Sciscio P, Schultz C, Sanders P, Willoughby S.
    Detrimental effects of energy drink consumption on platelet and endothelial function.
    Am J Med 2010 Feb. 123(2):184-7

  26. Pennington N, Johnson M, Delaney E, Blankenship MB.
    Energy drinks: a new health hazard for adolescents.
    J Sch Nurs 2010 Oct; 26(5):352-9. Epub 2010 Jun 10

  27. Persad L.
    Energy drinks and the neurophysiological impact of caffeine.
    Neurosci 2011; 5:116

  28. Malinauskas B, Aeby V, Overton R, Carpenter-Aeby T, Barber-Heidal K.
    A survey of energy drink consumption patterns among college students.
    Nutr J 2007; 6:35

  29. Persad L.
    Energy drinks and the neurophysiological impact of caffeine.
    Neurosci 2011; 5:116

  30. Cinteza E.
    Update in Pediatrics: To Take or Not to Take Soft Drinks, Sports or Energy Drinks?
    Maedica (Buchar) 2011 April; 6(2):157-158

  31. Malinauskas B, Aeby V, Overton R, Carpenter-Aeby T, Barber-Heidal K.
    A survey of energy drink consumption patterns among college students.
    Nutr J 2007; 6:35

  32. Temple J.
    Caffeine Use in Children: What we know, what we have left to learn, and why we should worry.
    Neurosci Biobehav Rev 2009 June; 33(6):793-806

  33. Persad L.
    Energy drinks and the neurophysiological impact of caffeine.
    Neurosci 2011; 5:116

  34. Arria A, O’Brien M.
    The “high” risk of energy drinks.
    JAMA 2011; 305(6):600-601

  35. MacDonald N, Stanbrook M, Hébert P.
    “Caffeinating” children and youth.
    CMAJ 2010 October 19; 182(15):1597

  36. Pennington N, Johnson M, Delaney E, Blankenship MB.
    Energy drinks: a new health hazard for adolescents.
    J Sch Nurs 2010 Oct; 26(5):352-9. Epub 2010 Jun 10

  37. Orbeta RL, Overpeck MD, Ramcharran D, Kogan MD, Ledsky R.
    High caffeine intake in adolescents: associations with difficulty sleeping and feeling tired in the morning.
    J Adolesc Health.2006;38(4):451-453

  38. Temple J.
    Caffeine use in children: What we know, what we have left to learn, and why we should worry.
    Neurosci Biobehav Rev 2009 June; 33(6): 793-806

  39. Pennington N, Johnson M, Delaney E, Blankenship MB.
    Energy drinks: a new health hazard for adolescents.
    J Sch Nurs 2010 Oct; 26(5):352-9. Epub 2010 Jun 10

  40. Ragsdale FR, Gronli TD, Batool N, Haight N, Mehaffey A, McMahon EC, Nalli TW, Mannello CM, Sell CJ, McCann PJ, Kastello GM, Hooks T, Wilson T.
    Effect of red bull energy drink on cardiovascular and renal function.
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  41. Pennington N, Johnson M, Delaney E, Blankenship MB.
    Energy drinks: a new health hazard for adolescents.
    J Sch Nurs 2010 Oct; 26(5):352-9. Epub 2010 Jun 10

  42. Energy Drinks — Are they Safe? Health and Well Being.
    August 2010. Website accessed February 6th 2012.
    http://health.ninemsn.com.au/family/familyhealth/689831/energy-drinks

  43. Pennington N, Johnson M, Delaney E, Blankenship MB.
    Energy drinks: a new health hazard for adolescents.
    J Sch Nurs 2010 Oct; 26(5):352-9. Epub 2010 Jun 10

  44. Phillips N.
    Rise in cases of caffeine toxicity spurs calls for warning labels on energy drinks. January 2012.
    Website accessed February 6th 2012.
    http://www.smh.com.au/national/health/rise-in-cases-of-caffeine-toxicity-spurs-calls-for-warning-labels-onenergy-drinks-20120115-1q1fq.html#ixzz1lZ6KEG00

  45. MacDonald N, Stanbrook M, Hébert P.
    “Caffeinating” children and youth.
    CMAJ 2010 October 19; 182(15):1597

  46. Smith G.
    Three deaths linked to energy drink. Daily Mail. Website accessed February 9th 2012.
    http://www.dailymail.co.uk/health/article-59862/Three-deaths-linked-energy-drink.html



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