Spring 2013
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Ask the Expert: Energy Drinks



I've heard a lot about the harms of energy drinks on kids. What are the risks? How much is too much?


By Dr. Stuart Rowe, a pediatric cardiologist at Children's Cardiology Associates and Dell Children's Medical Center

It is a reasonable question because the energy drink business is one of the fastest-growing segments of the beverage market, and marketed heavily to young adults. However, it is estimated that 30 to 50 percent of adolescents consume energy drinks. Most energy drinks are a combination of caffeine, sugar (some low-calorie, low-sugar preparations are available) and added supplements such as taurine (an amino acid), guarana (plant product as additional source of caffeine) and Vitamin B.

As a food supplement, energy drinks don't require FDA approval and aren't required to list caffeine content. Guarana quantity is not required to be listed and it may contribute additional caffeine. Consequently, the caffeine content of some energy drinks is higher than listed, if it is listed at all.

Caffeine is the best-understood component of energy drinks and of greatest concern. A central nervous system stimulant, it can cause nervousness, anxiety, headaches, difficulty sleeping, rapid heart rate and increase in blood pressure. These symptoms might be exacerbated with exercise and be dangerous in some individuals. The combination of energy drinks with medications, such as stimulant therapy for attention deficit-hyperactivity disorder, significantly increases the risk of side effects.

Of additional concern is the poorly understood interaction between caffeine and other added supplements. The FDA recently reported 18 deaths and more than 150 injuries with possible involvement of energy drinks. It is currently investigating if excess consumption of energy drinks poses a risk to vulnerable groups such as children and those with health problems, particularly those at risk for arrhythmias or with heart problems.

I believe energy drinks are indeed a health risk to children. One company uses the slogan "can never get too much of a good thing," which I think leads to excess use. In 2007, 46 percent of caffeine overdoses reported occurred in individuals younger than 19.

How much caffeine is too much? The FDA has stated that less than 400 milligrams per day is safe for adults. Various pediatric organizations have suggested that caffeine be limited to no more than 100 milligrams per day in adolescents, whereas the Institute of Medicine has stated that stimulant containing drinks and products have no place in children's diet. Many energy drinks contain 10 milligrams to 12 milligrams caffeine per ounce. Energy shots contain up to 70 milligrams to 100 milligrams per ounce of caffeine. For comparison, cola sodas contain approximately 3 milligrams to 4 milligrams of caffeine per ounce. Premium coffee, 20 milligrams of caffeine per ounce, has more caffeine than most energy drinks, but is usually drunk in smaller volumes.

Energy drinks provide an excessive source of caffeine and the interaction between caffeine and other supplements in energy drinks is not well-understood. Although less than 100 milligrams per day caffeine is probably safe in most children, I agree with the Australian law, which now requires labels of energy drinks to carry a warning that they are not recommended for children, pregnant or lactating women or individuals sensitive to caffeine.

Ask the Expert: Energy Drinks

Good Health for Kids is produced by Dell Children's Medical Center of Central Texas.