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    Riding high on energy drinks

    The recent explosion of energy drinks into the consumer market begs the question: how do these highly marketed and easily accessible beverages affect the health of young consumers?

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    Monster. Rockstar. Full Throttle. NoFear. Red Bull. No, these aren't names of professional wrestlers or the latest video games. They're a new breed of beverages, so-called energy drinks, and their sales have grown more than 700% since 2000.1 There are literally hundreds of different energy drinks now available in the US and the world over, with new brands being released all the time. Red Bull, for example, accounts for two thirds of the energy drink consumption in the US.2



    Energy (or, more appropriately, stimulant) drinks are beverages promoted with the promise of delivering a burst of energy when consumed. Many brands contain a list of ingredients touted as "natural," including herbal supplements, vitamins, and amino acids. The mainstay of all energy drinks, however, is caffeine—usually in higher amounts than in traditional sodas. Energy drinks also often contain high levels of sugar, though some artificially sweetened versions exist. But it's the so-called "natural" ingredients that may appeal to people seeking a healthy energy kick.

    More and more of these drinks are being aggressively marketed to young people as an aid for school, socializing, or sports. Students use them to stay up for an all-night cramming session before an exam. Young people in high school and college drink them to stay out late partying. Athletes use them to improve performance.

    The big five

    Though the definition of energy drinks can vary, for this discussion we will define them as beverages that contain caffeine and other substances marketed to enhance performance. However, there is limited data to prove these claims. A very small study demonstrated that energy drinks improve concentration, reaction time, memory, mood, as well as aerobic and anaerobic endurance.3

    In this article, we'll examine the five ingredients most commonly found in energy drinks: caffeine, guarana, ginseng, taurine, and carnitine. We will review the mechanism of action of each ingredient, when known, and its therapeutic uses, adverse effects, and drug interactions, with attention to any known health effects on children and adolescents.

    Caffeine


    Table 1 Comparison of caffeine content in different beverages
    Caffeine is one of the most frequently used psychoactive substances in the world.4 Hence, it is not surprising that the most common ingredient found in energy drinks is caffeine (see Table 1). Caffeine is a plant alkaloid that occurs naturally in the leaves, seeds, and fruits of many different plant species. This substance is known to have multiple effects at the cellular level, including inhibition of phosphodiesterase, leading to an increase in cyclic-3',5'-adenosine monophosphate (cAMP) in tissues such as muscle, and antagonism at adenosine receptors in the central nervous system.5 Caffeine also increases the production of plasma catecholamines. These multiple physiologic reactions explain the stimulant effects of caffeine within the human body.

    Individual responses to caffeine vary widely and also depend on the amount that is routinely consumed.6 Therefore, it is difficult to link precise caffeine intake levels to specific health effects. For example, in a healthy adult, a small amount of caffeine may have positive effects, such as increased alertness or ability to concentrate. However, some people are more sensitive. For them, a small amount of caffeine could cause insomnia, headaches, anxiety, rapid heartbeat, increased blood pressure, irritability, indigestion, and nervousness.7 This is a particular concern for children whose intake of caffeine varies more than in adults.

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    Marian Larkin, MD
    DR. LARKIN is a clinical instructor of pediatrics at the Children's Hospital at Montefiore, and the South Bronx Health Center for ...
    Sandra F. Braganza, MD, MPH
    DR. BRAGANZA is an assistant professor pediatrics at the Children's Hospital at Montefiore and at the Albert Einstein College of ...

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