What are we doing to protect children from the influx of energy drinks? Not enough suggests Dr Melissa Stoneham. In the latest edition of Journal Watch she examines the risks posed by energy drinks and why new strategies aimed at protecting young people need to be considered. Dr Stoneham writes:
Are energy drinks a health hazard?
If you put this question to Courtney Atkinson, a world class triathlete or even Sally Fitzgibbons, who holds three junior surf titles, they would most likely say that energy drinks are useful supplements to their diets.
After all, these young athletes are sponsored by Red Bull.
But if you put the same question to the authors of the latest Journal Watch article, led by Jennifer Pomeranz from the Rudd Center for Food Policy and Obesity at Yale University, they would tell you that energy drinks contain high levels of caffeine, sugar and novel ingredients, and are a public health hazard for young people.
The authors note that energy drink consumption is a potential health hazard for the general population and especially alarming for young people due to high levels of caffeine and novel ingredients not normally found in the food supply.
Energy drinks like Red Bull, Monster, Rockstar, Full Throttle and Burn include additional additives such as taurine, herbal supplements, ginseng, creatine, sugars and guarana which is a plant product containing concentrated caffeine.
The total amount of caffeine in a can or bottle of an energy drink varies from about 80 to more than 500 milligrams. To give you a comparison, a small can of Red Bull contains 80mg of caffeine and a medium-sized cup of filter coffee (125ml) is thought to contain between 60 and 100mg of caffeine.
Doesn’t seem so bad…but according to Goldberger a University of Florida toxicologist, there is a big difference between a hot beverage that is sipped and a cold beverage which is gulped down. Another public health issue of concern is the high sugar content in caffeinated energy drinks, which is similar to other soft drinks and is known to contribute to obesity. In Red Bull, there are 27 grams of sugar.
Habitual caffeine consumption can lead to physical dependence, and some research suggests that excessive caffeine consumption is associated with a number of negative health consequences, including anxiety, heart attack, bladder instability and reduced foetal growth.
In Toronto in 2008, a 15-year-old boy died during a paintball tournament, hours after consuming samples of Red Bull handed out by Red Bull representatives. It was reported in the UK in June 2013, that another death occurred after drinking several cans of energy drink following an intensive gym workout.
It is hard to know how many of our young people are drinking energy drinks on a regular basis or their level of consumption.
A study undertaken by the Drug Abuse Warning Network, which is a public health surveillance system that monitors drug-related emergency department (ED) visits in the United States, found that eleven per cent of total ER visits related to energy drink consumption involved youth aged 12–17 years and 75 per cent of those visits were due to energy drink intake alone.
In Australia, calls to the NSW Poisons Information Centre poison information centre revealed increasing reports of caffeine toxicity from energy drink consumption among adolescents. The median age of callers was 17 years and more than half of all calls were due solely to energy drink consumption as opposed to the mixing of energy drinks with alcohol.
Despite these alarming facts, energy drink manufacturers continue to advertise directly to adolescents in media that are also viewed by younger children.
Let’s take Red Bull as an example. Red Bull made its first appearance in Australian in late in 1999 and has a diverse international marketing campaign. On the website, Red Bull claims to be “a functional beverage, specially developed for those who want to be physically and mentally active. It can be drunk in virtually any situation: during sports, at work, whilst driving and during leisure activities”.
The product associates itself with extreme sports like mountain biking, BMX, motocross, windsurfing, snowboarding, skateboarding, kayaking, wakeboarding, cliff-diving, surfing, skating, freestyle motocross and Formula 1 racing. By associating the drink’s image with these activities, the company is clearly seeking to promote a “cool” public image and raise brand power to young people.
The authors of the Journal Watch article are advocating for increased regulation to inform and protect consumers by addressing problematic ingredients, clarifying labelling requirements and restricting youth access.
At a minimum, they recommend an increase in self-regulatory efforts be instituted to protect young people from marketing. When the Canadian Beverage Industry was asked if they advertise and market to children their response was “we fully comply fully with all laws and regulations in each of the more than 70 countries in which our products are sold.
We do not target teens and don’t sell energy drinks in schools.”
Similarly, in 2012, Naren Gunja and Jared Brown in the Medical Journal of Australia reported caffeine toxicity from energy drink consumption was increasing, particularly among adolescents, calling for a review and regulation of the labelling and sale of these drinks. They suggested that educating adolescents and increasing the community’s awareness of the hazards from energy drinks was of paramount importance.
In Australia, the Food Standards Australian and New Zealand have regulated some aspects around energy drinks stating the label must include declarations of the average quantities, per serving size and per 100 mL of caffeine (mg) along with a range of additives including Pantothenic acid, Taurine, Glucuronolactone and Inositol.
The label must also include advisory statements saying the product contains caffeine and is not recommended for consumption by children, pregnant or lactating women and individuals sensitive to caffeine. Based on a maximum amount per one-day quantity, the label also advises the consumer of the maximum number cans, bottles or mL to be consumed per day.
Finding this Standard was difficult enough – interpreting it was also a challenge and I have to ask – are we doing enough?
Are we making this information easily accessible to parents to ensure they can make an informed decision? Are parents aware of the potential public health risks associated with the excessive consumption of energy drinks among young people? It is time for a tougher suite of strategies such as restricting of sales of energy drinks to young people under a certain age, placing these drinks is less accessible areas such as behind counters or on top shelves or even considering a soft drink/energy drink tax.
Call me a nanny stater if you want – but when it comes to protecting our children, nothing is more important.
• Dr Melissa Stoneham is Deputy Director of the Public Health Advocacy Institute WA
The Public Health Advocacy Institute WA (PHAIWA) JournalWatch service reviews 10 key public health journals on a monthly basis, providing a précis of articles that highlight key public health and advocacy related findings, with an emphasis on findings that can be readily translated into policy or practice.
The Journals reviewed include:
Australian & New Zealand Journal of Public Health (ANZJPH)
Journal of Public Health Policy (JPHP)
Health Promotion Journal of Australia (HPJA)
Medical Journal of Australia (MJA)
Journal for Water Sanitation and Hygiene Development
Tobacco Control (TC)
American Journal of Public Health (AMJPH)
Health Promotion International (HPI)
American Journal of Preventive Medicine (AJPM)
These reviews are then emailed to all JournalWatch subscribers and are placed on the PHAIWA website.
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PHAIWA is an independent public health voice based within Curtin University, with a range of funding partners. The Institute aims to raise the public profile and understanding of public health, develop local networks and create a statewide umbrella organisation capable of influencing public health policy and political agendas. Visit our website at www.phaiwa.org.au
Previously at Journal Watch:
• Bike share schemes boost public health