Are ultra-high caffeine drinks bad for children?

Controversy has met release onto the market of several brands of ultra-high caffeine ‘energy shot’ drinks.

energy shotsThe shots contain as much and in some cases more than 3,300 mg (milligrams) caffeine per litre, despite the mandated maximum level allowed being 320 mg per litre. Reclassifying the drinks as ‘dietary supplements’, however, has meant that they can be marketed and sold here.

While most of the energy shots are labeled as not being suitable for consumption by children, concerns have arisen that they are primarily being marketed at, and sold to, adolescents and children.

Since their release, there have been reports of the shots having adverse effects on some adolescents and children who drink them.

The SMC approached a number of experts in nutrition, medicine and food safety, to get their views on the safety of consuming very high amounts of caffeine.

A paper, published in the Journal of the American Pharmacists Association last year, looks more closely into the matter and can be read here (registration to read the full article is free).

Dr Elaine Rush, Professor of Nutrition at Auckland University of Technology, comments:

“Because caffeine is found in the leaves, seeds, and fruits of over 60 plants worldwide it is probably the most widely used, socially acceptable, pharmacological stimulant. The most common sources in the New Zealand diet are coffee, tea, cocoa, kola nut extract as in cola drinks, and the caffeine and guarana ingredients added to energy drinks.

“Caffeine is a pharmacologically active substance; it is not a nutrient so there are no specific guidelines about its consumption.The Food Standards Authority New Zealand requires that a formulated caffeine beverage (for the purpose of enhancing mental performance) must contain no less than 145 mg/L and no more than 320 mg/litre of caffeine. They also require that the label include advisory statements to the effect that the food contains caffeine and is not recommended for children, pregnant or lactating women and individuals sensitive to caffeine.

“I am very concerned about the sale of caffeine in large doses, for example in “energy shots” which are sold as dietary supplements. None of the ingredients are recognisable as coming from whole food and they do contain sugar. Although caffeine does improve physical performance, convincing evidence is accumulating from comprehensive reviews of the literature that there are more problems than benefits associated with consuming caffeine. AUT as part of its commitment providing students and staff with the best learning environment has an initiative in place to improve the healthiness of food and beverages sold on campus. Part of this commitment is not to sell dietary supplements.

“The NZFSA is currently developing a new standard for food-type substances sold as dietary supplements. The Food Act does not provide for restrictions to be placed on the age at which a person can buy a product sold under the act and consumers who believe that the marketing of energy shot products is inappropriate can lodge a complaint with the Advertising Standards Authority.”

Dr Jim McVeagh, Auckland GP and author of popular health blog MacDoctor, comments:

“The Herald on Sunday tells the story of a young woman who suffered a heart attack after consuming daily amounts of 10-14 cans of Red Bull a day. The same effect is reached with only 4-5 of Demon’s “Shots”.

“I have had to deal with a number of cases of teenagers having psychotic episodes following multiple cans of energy drinks. This problem will almost certainly get worse with these types of “dietary supplements”. Caffeine in large amounts pushes up your blood pressure and reduces endothelial function dramatically, predisposing people to heart attacks. It is not a benign pick-me-up, nor is it a dietary supplement – it is a stimulant drug, pure and simple.

Dr David Jardine, Clinical Director of the Canterbury District Health Board and physician at the Department of General Medicine, University of Otago, comments:

“We did do a bit of reading on caffeine before we did the Christchurch Coffee study last year.

“From what I can see, caffeine is the most used drug in the world and we have no clear idea of how it works. It has been blamed for everything from cardiovascular disease to birth defects but the scientific evidence for chronic consumption being harmful is not there.

“We looked at the immediate effects of oral caffeine [200mg] on blood pressure, heart rate and sympathetic nerve activity. It did very little, i.e a small increase in mean blood pressure [10 mmHg] over 2 hours, a decrease in heart rate, and usually no clear increase in nerve activity.

“I know of no bad effects in children and pregnant women, remembering that a caffeine-like drug, theobromine, is in dark chocolate. Theobromine is very toxic to dogs. The dogs die of excess sympathetic nerve activity [ie a catecholamine rush] which is what you would expect to see in caffeine toxicity, but I have never seen this in humans. Humans seem to be able to deal with caffeine very well.”

Dr Peter Black, Professor of Clinical Pharmacology at the University of Auckland, comments:

“Attempts to implicate caffeine as a cause of cancer and heart disease over many years have failed to find a link. There is however evidence linking a high intake of coffee to reduced fertility in women trying to conceive. Excessive intake of caffeine can cause irritability, anxiety and insomnia – and that potentially might be an issue in some individuals with high intake of energy drinks.”

Dr John Birkbeck, Adjunct Professor in Child Nutrition at Massey University, comments:

“It is time for others to front up on such topics, but a few things need to be said. First these products are especially dangerous for children [see CloseUp last night]. Second we must remember that people are divided into two groups by the rate they metabolise caffeine. Some can metabolise it quickly: I must be one of those because coffee at bedtime does not prevent my sleeping, and I never have tachycardia etc from it. Others are slower and for them these products must be especially dangerous. I suspect in anyone with a preexisting condition such as overactive thyroid or some heart defect they could even be lethal. But the issue is really far wider than all this. The category of “Dietary supplements” must be abolished as the Aussies have.

“A product must be either a food, or a drug, and dealt with under the relevant legislation. ‘Energy’ drinks could be foods but their composition would be regulated. These energy “shots” would clearly be drugs and put out of existence by lack of safety documentation. But the “dietary supplement” industry in this country has been fighting this for decades as it is a very lucrative market which manages to avoid the constraints even on food producers let alone pharmaceuticals. The sooner this ‘grey area’ is abolished the better: this could be an excellent argument through which to do that.”

New Zealand Food Safety Authority Director (Compliance and Investigation) Geoff Allen comments:

“NZFSA agrees with health professionals that children shouldn’t consume a lot of caffeine, whether it’s from coffee, tea, chocolate, colas, energy drinks or other foods. However, caffeine is found naturally in many foods, even chocolate, so children do consume it in small amounts without harm.

“The Food Standards Code takes into account the total diet and the whole range of different foods a person might eat over a day or a week. For this reason, there are caffeine limits set for the amount of caffeine allowed in formulated caffeinated beverages which are considered to be a part of people’s diet. Energy drinks should not contain more than the maximum allowed of 320 mg/kg. Caffeinated beverages must also have a statement that they’re not suitable for children or pregnant women.

“Dietary supplements on the other hand are not foods in the usual sense of the word. They are something that people can choose to take from time to time if they think they need to. Dietary supplements have to be labelled with recommended dose information. Pills, tablets and concentrated liquids (such as the 60ml shots) are not classed as food or beverage. There are maximum daily doses for some vitamins and minerals in dietary supplements but for the majority of substances there is no limit other than that they are safe. All of the shots that we’ve seen also have a caffeine advisory statement of some form, even though they’re not required to.

“New regulation to restrict sale or supply of these high caffeine energy drinks is not necessarily the whole or the best answer. Firstly in order to do this there would have to be clear evidence that caffeine is indeed a significant health risk. NZFSA has commissioned an updated risk profile for caffeine to identify any changes in risk that have occurred in the last seven years. We expect this profile to be completed early next year.”

“Restricting the sale or supply of just the high caffeine energy drinks would also create inequities – for example why shouldn’t the restriction apply to all products that have equivalent caffeine levels such as coffee?

“Restrictions on the sale of such products would likely prove very difficult to enforce. The only other food that carries such an age restriction is alcohol – and this demands a highly complex system of special legislation, licensing and policing effort – a system that is by no means watertight (as any 16 or 17 year old will tell you).

“Alternative interventions or adjuncts to current regulation include voluntary codes for formulation, marketing and sale; providing information for consumers that helps inform choice; compulsory warning labelling.

“In order to ensure that consumers can make informed choices about these new caffeinated products, we’re working closely with the New Zealand Association of Convenience Stores on a code of practice to ensure that dietary supplement products are displayed and sold appropriately.

“The NZ Juice and Beverage Association (NZJBA) has also advised that it was developing a code of marketing practice for energy shots with its counterpart organisation in Australia, the Australian Beverage Council (ABC). NZJBA advised that the code was about two weeks from being finalised, and that once finalised and agreed by the NZJBA executive it would be mandated to all members. NZJBA advised that the code will cover the levels of caffeine in energy shot products, the placement of products in stores, the marketing or products (for example restricting two for one type offers), defining ‘child’ for the purposes of the code, and establishing daily recommended dosages.

“NZFSA are working on a new standard for what will be called ‘supplemented foods’. This will make it easier for consumers to differentiate foods that are supplemented for nutritional benefit from products that have therapeutic or physiological benefits. The new standard may also introduce other requirements such as requiring mandated advisory statements.

“As with all things consumed, we advise moderation and common sense. This applies to coffee, tea, colas, energy drinks and dietary supplements. Caffeine is a stimulant and affects individuals to varying degrees depending on their sensitivity to it. The most common effects are to ward off drowsiness and, reportedly, increasing alertness. At high levels, people may feel twitchy, irritable and have an increased heart rate, among other symptoms. The US Food and Drug Administration lists caffeine as ‘generally recognised as safe’, a category which means it is exempted from limits applied to other food additives. People who are concerned that they might be suffering effects from a high caffeine intake are advised to consult their doctor.”