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: J Clinical Chiropractic Pediatrics 2012 (Dec); 13 (1): 1042—1044 ~ FULL TEXT
OPEN ACCESS Sharon Gordon, BAppSc(Chiro), DICCP
Private practice,
Gippsland, Victoria, Australia.
Sharon.gordon@rmit.edu.auEnergy 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.
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