Red Bull Gives Kids More than Wings

Energy drinks may pose a risk for serious adverse health effects in some children, especially those with diabetes, seizures, cardiac abnormalities or mood and behavior disorders, according to research published in Pediatrics.

In the study, Steven E. Lipshultz, MD, of the Leonard M. Miller School of Medicine, in Miami, FL and colleagues determined that energy drinks have no therapeutic benefit to children, and both the known and unknown properties of the ingredients, combined with reports of toxicity, may put some children at risk for adverse health events.

The authors set out to review of the effects, adverse consequences, and extent of energy-drink consumption among children, adolescents, and young adults by performing PubMed and Google searches using the following terms: "energy drink," "sports drink," "guarana," "caffeine," "taurine," "ADHD," "diabetes," "children," "adolescents," "insulin," "eating disorders," and "poison control center" to identify articles related to energy drinks. They also reviewed manufacturer Web sites for product information.

According to self-report surveys, 30% to 50% of adolescents and young adults consume energy drinks, which typically contain high levels of stimulants such as caffeine, taurine, and guarana. The drinks were found to be associated with serious adverse effects, especially in patients with seizures, diabetes, cardiac abnormalities, or mood and behavioral disorders or those who take certain medications. Of the 5,448 caffeine overdoses reported in 2007 in the US, 46% occurred in those younger than 19 years, according to the authors, who noted that several countries and states have debated or restricted their sales and advertising of these drinks.

Other potential problems associated with energy drink consumption among children and adolescents include the following:

• High doses of caffeine may exacerbate cardiac conditions for which stimulants are contraindicated.
• Children with ADHD are more likely to abuse substances such as caffeine, which blocks the A2A adenosine receptors and thereby enhances the dopamine effect at the D2 dopamine receptor.
• The risk of cardiac dysrhythmias and intracardiac conduction abnormalities from high-caffeine energy drinks in children with eating disorders at higher risk for cardiacrelated morbidity/mortality and electrolyte abnormalities is disconcerting.
• Additional calories from energy-drink consumption may increase blood pressure, blood glucose levels, BMI, calcium deficiency, dental problems, depression, and low self-esteem. Sugar and caffeine may also synergistically increase postprandial hyperglycemia, which is of concern for children with diabetes.
• Early adolescence is the time of maximal calcium deposition in bone, and caffeine interferes with intestinal calcium absorption.

The authors concluded that energy drinks have no therapeutic benefit, and that “many ingredients are understudied and not regulated. The known and unknown pharmacology of agents included in such drinks, combined with reports of toxicity, raises concern for potentially serious adverse effects in association with energy-drink use,” they wrote.

Therefore, because these drinks are frequently marketed to athletes and at-risk young adults, it is important for pediatricians and other providers to screen for heavy use both alone and with alcohol, and to educate families and children at-risk for energy drink overdose, which can result in seizures, stroke and even sudden death.

Long-term research should aim to understand the effects in at-risk populations, the authors wrote.