New-onset seizures in adults: possible association with consumption of popular energy drinks

A scoping review of policies related to reducing energy drink consumption in children

BACKGROUND

Frequent consumption of Energy Drinks (EDs) is associated with numerous health problems, including overweight and obesity, particularly among children and adolescents. The extensive promotion, wide accessibility, and relatively low cost of EDs have significantly increased their popularity among this age group. This paper examines policies/programs that, directly and indirectly, contribute to reducing ED consumption in children and adolescents and shares global experiences to help policymakers adopt evidence-based policies.

METHODS

A systematic search was performed using PubMed, Scopus, and Web of Science databases from January 2000 to June 2024, along with reputable international organization websites, to find literature on policies aimed at reducing ED consumption among children and adolescents. All sources meeting the inclusion criteria were included without restrictions. Titles and abstracts were initially screened, followed by a full-text review. After evaluating the quality of the selected studies, data were extracted and, along with information from the selected documents, compiled into a table, detailing the country, policy type, and the effectiveness and weaknesses of each policy.

RESULTS

Out of 12166 reviewed studies and documents, 84 studies and 70 documents met the inclusion criteria. 73 countries and territories have implemented policies like taxation, sales bans, school bans, labeling, and marketing restrictions on EDs. Most employ fiscal measures, reducing consumption despite enforcement challenges. Labeling, access restrictions, and marketing bans are common but face issues like black markets.

CONCLUSION

This scoping review outlines diverse strategies adopted by countries to reduce ED consumption among children and teenagers, such as taxation, school bans, sales restrictions, and labeling requirements. While heightened awareness of ED harms has reinforced policy efforts, many Asian and African nations lack such measures, some policies remain outdated for over a decade, and existing policies face several challenges. These challenges encompass industry resistance, governmental disagreements, public opposition, economic considerations, and the intricacies of policy design. Considering this, countries should tailor policies to their cultural and social contexts, taking into account each policy's strengths and weaknesses to avoid loopholes. Inter-sectoral cooperation, ongoing policy monitoring, updates, and public education campaigns are essential to raise awareness and ensure effective implementation.

A review of natural plant extracts in beverages: Extraction process, nutritional function, and safety evaluation

The demand for foods and beverages with therapeutic and functional features has increased as a result of rising consumer awareness of health and wellness. In natural, plants are abundant, widespread, and inexpensive, in addition to being rich in bioactive components that are beneficial to health. The bioactive substances contained in plants include polyphenols, polysaccharides, flavonoids, aromatics, aliphatics, terpenoids, etc., which have rich active functions and application potential for plant-based beverages. In this review, various existing extraction processes and their advantages and disadvantages are introduced. The antioxidant, anti-inflammatory, intestinal flora regulation, metabolism regulation, and nerve protection effects of plant beverages are described. The biotoxicity and sensory properties of plant-based beverages are also summarized. With the diversification of the food industry and commerce, plant-based beverages may become a promising new category of health functional foods in our daily lives.

The Dark Side of Energy Drinks: A Comprehensive Review of Their Impact on the Human Body

In recent years, the consumption of energy drinks by young adults and athletes has risen significantly, but concerns have been raised about the potential health risks associated with excessive consumption. These concerns include cardiovascular problems, nervous system disorders, and the potential for addiction. This review aims to examine the reported effects of acute or chronic abuse of energy drinks on human health. The analysis shows a significant prevalence of adverse effects, particularly on the cardiovascular and neurovegetative systems. In particular, the analysis identified nine cases of cardiac arrest, three of which were fatal. The aetiology of these adverse effects is attributed to the inherent neurostimulant properties of these beverages, of which caffeine is the predominant component. A comparison of documented effects in humans with experimental studies in animal models showed an overlap in results. This review highlights the need for greater rigour in the assessment of sudden cardiac death, particularly in young people, as legal substances such as energy drinks may be involved. We propose stricter limits on the consumption of these beverages than for caffeine, based on the evidence found and the data in the literature. This review also calls for the establishment of regulations governing the consumption of these products in view of their potential impact on human health.

Consumption of Energy Drinks among Italian University students: a cross-sectional multicenter study

PURPOSE

The aim of the study was to evaluate the caffeinated Energy Drinks (EDs) consumption among a large sample of Italian undergraduates and its association with some of the major lifestyle risk factors.

METHODS

Students attending twelve public Italian universities were involved between October 2021 and May 2022. Information on socio-demographic characteristics, ED consumption, and on health-related behaviors of participants was collected by the use of a web-based questionnaire.

RESULTS

A total of 2165 students participated in the study and 15.2% of them reported having used caffeinated EDs in the last six months, mainly once a month (41.5%). In comparison with non-users, ED users showed a higher proportion of males (p < 0.001) and a higher father's educational level (p = 0.003), came mainly from Northern universities (p = 0.004) and life sciences degree courses (p < 0.001). Besides, ED users reported higher BMI values (p = 0.003), more particular dietary regimens (p < 0.001), higher levels of weekly moderate-vigorous physical activity (p < 0.001) and participation in sports (p < 0.001) and in team sports (p = 0.003), and higher proportion of smokers (p < 0.001) and alcohol drinkers (p = 0.005). ED use was negatively related with female gender (OR 0.546; 95% CI 0.374-0.798), the Mediterranean diet (OR 0.587; 95% CI 0.362-0.951) and coming from the center of Italy (OR 0.500; 95% CI 0.275-0.909) and positively associated with tobacco smoke (OR 1.712; 95% CI 1.176-2.492) and participation in a team sport (OR 1.686; 95% CI 1.051-2.707).

CONCLUSION

These findings could encourage figures engaged in education to increase the students' awareness on this issue in order to prevent the excessive use of EDs and associated unhealthy behaviors, especially in the most interested subgroups.

From the most to the least flexible nutritional profile: Classification of foods marketed in Brazil according to the Brazilian and Mexican models

Nutrient profiling is the science of classifying or ranking foods according to their nutritional composition, for reasons related to disease prevention and health promotion. To be effective, policies such as front-of-pack nutrition labeling (FoPNL) must have an adequate nutritional profile model, since it will determine which products will be eligible to receive a FoPNL. This study aimed to determine the percentage of packaged food and drink products available in Brazil that would be subject to FoPNL under two different legislations: Brazilian and Mexican. This is a cross-sectional study in which we collected information on food products (photos of the ingredients list, the front label, the barcode, and the nutrition facts table) from one of the largest stores of a supermarket chain in the city of Belo Horizonte-MG, Brazil, from March to May 2021 (~6 months after the publication of the Brazilian legislation about FoPNL and a year and a half before the legislation came into force). The products were classified in relation to the BNPM (added sugars, saturated fats, and sodium) and the MNPM (energy, free sugars, saturated fats, trans fats, sodium, non-sugar sweeteners, and caffeine). A total of 3384 products were collected and, after applying the exclusion criteria, 3,335 products were evaluated. Of these, 2,901 would be eligible to receive FoPNL in Brazil and 2,914 would be eligible to receive FoPNL in Mexico. According to the BNPM, 56.7% (95% CI 54.9; 58.5%) of the products were “high in” critical nutrients, 27.1% (95% CI 25.5; 28.7%) of the products in added sugars, 26.7% (95% CI 25.2; 28.4%) of the products in saturated fats, and 21.4% (95% CI 19.9; 22.9%) of the products in sodium. As for the MNPM, 96.8% (95% CI 96.1; 97.4%) of them were “high in” up to five critical nutrients and up to two warning rectangles (caffeine and non-sugar sweeteners), 45.8% (95% CI 44.0; 47.6%) of them in free sugars, 43.7% (95% CI 41.9; 45.5%) of them in saturated fats, and 47.9% (95% CI 46.1; 49.7%) of them in sodium. We concluded that the eligibility to receive FoPNL by BNPM and MNPM was relatively similar between products; however, almost all products would have at least one FoPNL and/or warning rectangles according to Mexican legislation, and nearly half of them would have at least one FoPNL, considering BNPM. The MNPM is much more restrictive than the BNPM. The Nutrient Profile Model (NPM) that regulates FoPNL, and other health policies, must be carefully defined to ensure that foods are properly classified according to their healthiness.

Caffeinated drinks, fruit juices, and epilepsy: A systematic review

The aim of this systematic review was to provide the required information regarding different aspects of the relationship between epilepsy/antiseizure medications and non-alcoholic drinks. The recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement were followed. MEDLINE and Scopus from the inception until 7 August 2021 were systematically searched. These key words were used: "epilepsy" OR "seizure" OR "antiepileptic" OR "antiseizure" OR "anticonvulsant" AND "coffee" OR "tea" OR "soda" OR "juice" OR "drink" OR "cola" OR "diet" (35 key word combinations). The primary search yielded 21 458 publications (PubMed, n = 4778; Scopus, n = 16 680). Only 50 studies met all the inclusion criteria and were included in the current systematic review. In total, 17 articles investigated various non-alcoholic drinks in human studies, 11 studies were case reports/series, and 22 articles were animal/in vitro studies. None of the studies provided a class 1 of evidence. There is limited evidence suggesting that certain drinks (eg, caffeinated energy drinks) might trigger seizures. Patients with epilepsy should avoid excessive consumption of certain fruit juices (eg, grapefruit, lime, pomegranate, kinnow, and star fruit) and caffeinated drinks. However, daily coffee and tea intake can be part of a healthy balanced diet, and their consumption does not need to be stopped in patients with epilepsy. Coffee/tea consumption is not harmful if consumed at levels of 200 mg (caffeine) in one sitting (about 2½ cups of coffee) or 400 mg daily (about five cups of coffee).

Habits of Energy Drink Consumption among Teens in Slovenia - Focus Group Findings

Introduction

Teachers in Slovenia have been noticing the increased consumption of energy drinks among pupils. Therefore, the purpose of this study was to investigate habits that contribute to the frequency of energy drink consumption.

Method

36 teens participated in the study: elementary school pupils (6th and 8th grades), general upper secondary school pupils, and secondary technical school pupils (1st and 3rd year). In the course of the study 6 group interviews were held to help investigate young people’s habits and their reasons for energy drink purchase and consumption. Moreover, we investigated the influence of age on the consumption and knowledge about energy drink ingredients, as well as their influence on the body.

Results

Interview analysis showed that energy drink consumers are predominantly secondary school pupils. Their choice most frequently depends on the price, their taste, or the brand. What influences elementary school pupils’ purchasing decisions are price, packaging, and advertisements, while secondary school pupils choose their drinks according to the lack of energy and how tired they feel. The predominant factors preventing energy drink consumption are health problems among family members and friends. Secondary school pupils know more about energy drink ingredients than elementary school pupils.

Conclusion

On the basis of these findings, we will design a survey questionnaire for Slovenian teenagers and teachers, didactic material, and suggestions for improving educational programmes.

Chronic Red Bull Consumption during Adolescence: Effect on Mesocortical and Mesolimbic Dopamine Transmission and Cardiovascular System in Adult Rats

Energy drinks are very popular nonalcoholic beverages among adolescents and young adults for their stimulant effects. Our study aimed to investigate the effect of repeated intraoral Red Bull (RB) infusion on dopamine transmission in the nucleus accumbens shell and core and in the medial prefrontal cortex and on cardiac contractility in adult rats exposed to chronic RB consumption. Rats were subjected to 4 weeks of RB voluntary consumption from adolescence to adulthood. Monitoring of in vivo dopamine was carried out by brain microdialysis. In vitro cardiac contractility was studied on biomechanical properties of isolated left-ventricular papillary muscle. The main finding of the study was that, in treated animals, RB increased shell dopamine via a nonadaptive mechanism, a pattern similar to that of drugs of abuse. No changes in isometric and isotonic mechanical parameters were associated with chronic RB consumption. However, a prolonged time to peak tension and half-time of relaxation and a slower peak rate of tension fall were observed in RB-treated rats. It is likely that RB treatment affects left-ventricular papillary muscle contraction. The neurochemical results here obtained can explain the addictive properties of RB, while the cardiovascular investigation findings suggest a hidden papillary contractility impairment.

Metabolic Syndrome Associated with Tobacco and Caffeine Products Use Among Refugee Adolescents: Risk of Dyslipidemia

INTRODUCTION

Due to their stressful lives, Palestinian refugees are prone to use cognitive enhancers (CE) and psychostimulant substances (PS). Recognising health problems associated with CE/PS use can indicate how preventive programs should be directed towards adolescents. Unfortunately, research has not thoroughly investigated the health problems related to tobacco and caffeine products, the most socially acceptable CE/PS among Palestinian refugee adolescents.

METHODOLOGY

In 2021, schoolchildren from five Palestinian refugee camps (N=271) aged 12-<16 years agreed to give blood samples and to be interviewed to address the association between metabolic syndrome (MetS) and tobacco smoking, coffee, energy drinks (ED), black tea, and chocolate consumption. MetS was diagnosed based on International Diabetic Federation Criteria. To address the association, we used binary logistic regression models adjusted to age, gender, BMI, and central obesity.

RESULTS

The prevalence of MetS was [17 (6.3%)]; (7.4%) in males, (5.1%) in females. The prevalence of substance use was as follows: ED [163 (48.9%)], coffee [255 (76.6%)], black tea [295 (89.1%)], cigarette [35 (10.5%)], waterpipe [59 (17.7%)], and chocolate [309 (93.6%)], with male predominance. Cigarette smokers have increased central obesity (p-value=0.024), and decreased HDL-cholesterol (p-value=0.015) than non-smokers. Similar results were observed for waterpipe smokers besides the increased levels of triglycerides (p-value=0.01). ED consumers have increased central obesity (p-value=0.03) and fast blood sugar (p-value=0.003) than non-consumers. Chocolate consumers have decreased central obesity (p-value=0.008) and increased HDL levels (p-value=0.04) than non-consumers. ED consumers were significantly at higher risk of MetS (OR=9.97, p-value=0.019) than non-consumers and chocolate consumers were at lower risk of MetS (OR=0.14, p-value=0.046) than non-consumers. Waterpipe smokers were at a higher risk of having increased plasma triglycerides than non-consumers (OR=3.4, p-value=0.03).

CONCLUSION

The high prevalence of ED consumption and waterpipe smoking in Palestinian refugee adolescents is problematic. Their use was associated with higher odds of MetS, dyslipidemia, and central obesity, which justifies greater attention.

Energy drinks and population health: consumption pattern and adverse effects among Saudi population

BACKGROUND

Caffeine containing energy drinks (EDs) are heavily consumed, particularly among young adults. The number of reports of caffeine intoxication from caffeinated EDs and problems related to caffeine dependence and withdrawal is increasing. The objective was to assess the knowledge and perceived beneficial effects of EDs consumers, to assess consumption patterns and determine the adverse effects experienced by different EDs consumer groups residing in Saudi Arabia.

METHODS

An observational cross-sectional study with data from a randomly selected Saudi population was conducted during the period of January 15th, 2015, to April 15th, 2015, using a pre-tested 43-item questionnaire. The data were obtained and collected using interview questionnaires. Sociodemographic characteristics and data on EDs consumption patterns, the level of awareness among study subjects, and the purported benefits and reported adverse effects of EDs were collected. Frequency, percentage, and arithmetic means were calculated using Chi-square and ANOVA tests, and data with p < 0.05 were considered significant.

RESULTS

Of the 816 individuals invited to participate in the study, 783 participants responded and completed interviews, response rate was 96%. Consumers attributed the popularity of EDs to massive advertising media (46.7%) and their stimulating and invigorating effects (37.5%). EDs are consumed by subjects for their effects on fatigue reduction (64.6%), increased alertness and focus (75.8%), and assistance during long driving trips (75.7%). Study subjects reported suffering from adverse effects, including mainly diuresis (53.7%), palpitations (50.7%), insomnia (50.7%). Importantly, an inverse association was identified between knowledge of EDs and consumption rate, and a proportional association was identified between experienced adverse effects and consumption frequency. Lower knowledge scores were identified in daily consumers than in 1-3 times monthly consumers; higher adverse events were experienced by daily consumers than by 1-3 times monthly consumers. The majority of consumers (84.6%) recommended that authorities should regulate EDs consumption.

CONCLUSIONS

Excessive EDs consumption is associated with an increased risk of experiencing several adverse events, which is commensurate with published studies. Increasing knowledge about EDs and their possible risks could decrease their consumption by the general public.

The Use of Caffeine by People with Epilepsy: the Myths and the Evidence

PURPOSE OF REVIEW

Caffeine is the most widely consumed central nervous stimulant. For people with epilepsy, it is often unclear whether drinking coffee carries a risk of triggering seizures.

RECENT FINDINGS

The relationship between caffeine, seizures, epilepsy, and anti-seizure drugs is not fully understood. Clinical studies are scarce. In animal models, caffeine can increase seizure susceptibility but can also protect from seizures. Effects seem dose-dependent and are influenced by the duration of intake and the developmental stage at which caffeine exposure started. Caffeine reduces the efficacy of several anti-seizure medications, especially topiramate. It is unclear how these findings, mainly from animal studies, can be translated to the clinical condition. At present, there is no evidence to advise people with epilepsy against the use or overuse of caffeine. Until clinical studies suggest otherwise, caffeine intake should be considered as a factor in achieving and maintaining seizure control in epilepsy.

Decrease in Lipid Droplets in Adrenal Cortex of Male Wistar Rats after Chronic Exposure to Energy Drinks

Background and objectives: Energy drinks are popular non-alcoholic beverages. They are consumed in large amounts, mainly by active, young people. Although they are easily accessible and marketed as safe, numerous cases of adverse effects have been published, including cardiac arrest, arrythmias, acute hepatitis, and renal failure. The aim of the current study is the assessment of energy drink influence on the histological structure of adrenal cortex in rats. Material and Methods: 15 male young Wistar rats were equally divided into three groups: control (C), experimental (E) and reversibility control (RC). C group received water and standard rodent food ad libitum while both E and RC groups had additionally unlimited access to energy drinks. C and E groups were decapitated after 8 weeks and RC was given another 8 weeks without energy drinks. Adrenal glands were embedded in paraffin blocks and 5 μm slides were prepared and stained according to standard H&E and Masson's trichrome protocols. Additionally, immunohistochemical stainings against Ki-67, p53, CTGF and caspase-3 were prepared. Results: Decreased vacuolization and numerous pyknotic nuclei were noted in E and RC groups. Overexpression of caspase-3 was noted both subcapsular in zona glomerulosa and along sinusoids in zona fasciculata. Increased collagen deposition in zona glomerulosa and zona fasciculata of E and RC was observed. Insular and irregular overexpression of CTGF was noted. The overall picture of CTGF expression matched the Masson's trichrome. No significant difference was observed in Ki-67 expression. Conclusions: The results of the current study suggest that the stimulation is so intense that it causes significant damage to adrenal cortical cells, resulting in their apoptosis. It seems, however, that the observed effects are at least partially reversible.

Inhibition of drug-induced seizure development in both zebrafish and mouse models by a synthetic nanoreceptor

A synthetic nanoreceptor, cucurbit[7]uril (CB[7]), fully encapsulated pentylenetetrazol (PTZ), a seizure-inducing model drug. As a consequence of the encapsulation, the development of PTZ induced convulsion behaviors in both larval zebrafish and mouse models were dramatically alleviated, suggesting that CB[7] holds great neuroprotection potential against neurotoxic drugs for clinical applications.

Age restriction warning label efficacy and high school student consumption of highly-caffeinated products

Age restriction warning labels (ARLs) are placed on highly-caffeinated food and drinks, such as Red Bull, to deter consumption by minors who are especially vulnerable to the risks of excessive caffeine consumption. Previous studies have shown that ARLs on media like TV programs and video games fail to discourage minors. However, it is unclear how ARLs on food and drink packages affect minors' purchasing behavior. High school students aged 14 to 17 years (n = 150, M_age = 15.2, 51% male) were asked to choose between seven novel product dyads (three food/drink dyads, two movie dyads, and two video game dyads); each dyad contained one product with an ARL and one without. Participants were then asked how ARLs and parental permissiveness of ARL products influenced their decision. Roughly half of the participants selected food and drink products with ARLs. Over two-thirds (69%) of the students reported that they were not discouraged by ARLs on highly caffeinated food and drinks. Participants reported their parents as significantly less permissive of age-restricted food and drink products than of age-restricted media merchandise (p < .01). Perceived parental permissiveness was not correlated with minors' perception of ARL or simulated product choice. Current ARLs on highly caffeinated food and drink items may be ineffective for adolescents and may actually increase product appeal. Pediatricians should educate patients and parents regarding the health risks of excessive caffeine consumption.

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Age restriction warning labels are displayed on highly caffeinated products.

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Warning labels failed to effectively deter minors from choosing marked products.

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Some minors stated warning labels encouraged their product choice.

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More research is needed to determine effective warning label wording for minors.

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Clinicians must warn teens against consumption of highly caffeinated products.

Is the Consumption of Energy Drinks Associated With Academic Achievement Among College Students?

Despite widely reported side effects, use of energy drinks has increased among college students, who report that they consume energy drinks to help them complete schoolwork. However, little is known about the association between energy drink use and academic performance. We explored the relationship between energy drink consumption and current academic grade point average (GPA) among first-year undergraduate students. Participants included 844 first-year undergraduates (58.1 % female; 50.7 % White). Students reported their health behaviors via an online survey. We measured energy drink consumption with two measures: past month consumption by number of drinks usually consumed in 1 month and number consumed during the last occasion of consumption. We used multiple linear regression modeling with energy drink consumption and current GPA, controlling for gender, race, weekend and weekday sleep duration, perceived stress, perceived stress management, media use, and past month alcohol use. We found that past month energy drink consumption quantity by frequency (p < 0.001), and energy drinks consumed during the last occasion (p < 0.001), were associated with a lower GPA. Energy drinks consumed during the last occasion of consumption (p = 0.01) remained significantly associated with a lower GPA when controlling for alcohol use. While students report using energy drinks for school-related reasons, our findings suggest that greater energy drink consumption is associated with a lower GPA, even after controlling for potential confounding variables. Longitudinal research is needed that addresses whether GPA declines after continued use of energy drinks or if students struggling academically turn to energy drinks to manage their schoolwork.

Caffeine and seizures: A systematic review and quantitative analysis

PURPOSE

Caffeine is the most commonly used central nervous system (CNS) stimulant. The relationship between caffeine, seizures, epilepsy, and antiepileptic drugs (AEDs) is complex and not fully understood. Case reports suggest that caffeine triggers seizures in susceptible people. Our systematic review reports on the relationship between caffeine, seizures, and drugs in animal and human studies. Quantitative analyses were also done on animal studies regarding the effects of caffeine on AEDs.

METHODS

PubMed was searched for studies assessing the effects of caffeine on seizure susceptibility, epilepsy, and drug interactions in people and in animal models. To quantify the interaction between AEDs and caffeine, the data of six animal studies were pooled and analyzed using a general linear model univariate analysis or One-way Analysis of Variance (ANOVA).

RESULTS

In total, 442 items were identified from which we included 105 studies. Caffeine can increase seizure susceptibility and protect from seizures, depending on the dose, administration type (chronic or acute), and the developmental stage at which caffeine exposure started. In animal studies, caffeine decreased the antiepileptic potency of some drugs; this effect was strongest in topiramate.

CONCLUSION

Preclinical studies suggest that caffeine increases seizure susceptibility. In some cases, chronic use of caffeine may protect against seizures. Caffeine lowers the efficacy of several drugs, especially topiramate. It is unclear how these findings in models can be translated to the clinical condition. Until clinical studies suggest otherwise, caffeine intake should be considered as a factor in achieving and maintaining seizure control in epilepsy.

Adverse effects of caffeinated energy drinks among youth and young adults in Canada: a Web-based survey

BACKGROUND

Energy drink consumption has increased dramatically among young Canadians, with anecdotal evidence of adverse health effects. There is a lack of population-based studies to examine the prevalence of adverse events from energy drinks, particularly among young people. The current study sought to assess adverse events from energy drinks among a population-based sample of youth and young adults in Canada.

METHODS

An online survey was conducted in 2015 with a national sample of youth (aged 12-17 yr) and young adults (aged 18-24 yr) recruited from a consumer panel. Respondents reported prior consumption of energy drinks as well as adverse outcomes, concurrent activities associated with the outcomes and whether medical attention was sought or considered. Adverse events from coffee were also assessed for comparison. Weighted analyses are reported.

RESULTS

Of the 2055 respondents, 1516 (73.8%) reported having ever consumed an energy drink, and 1741 (84.7%) reported having ever consumed coffee (unweighted). Overall, 55.4% of respondents who had ever consumed an energy drink reported that they had experienced at least 1 adverse event, including fast heartbeat (24.7%), difficulty sleeping (24.1%), headache (18.3%), nausea/vomiting/diarrhea (5.1%), chest pain (3.6%) and seizures (0.2%); 3.1% had sought or had considered seeking medical help for an adverse event. The prevalence of reported adverse events was significantly greater among energy drink consumers than among coffee consumers (36.0%) (odds ratio [OR] 2.67 [95% confidence interval (CI) 2.01-2.56]), as was the proportion who reported seeking or considering seeking medical help for adverse events (3.1% v. 1.4%) (OR 2.18 [95% CI 1.39-3.41]).

INTERPRETATION

More than half of youth and young adults who had consumed energy drinks reported adverse outcomes, some serious enough to warrant seeking medical help. The adverse outcomes were consistent with the physiologic effects of caffeine but were significantly more prevalent than with other sources of caffeine such as coffee, consistent with data from national adverse event databases.

Reasons for Energy Drink Use and Reported Adverse Effects Among Adolescent Emergency Department Patients

OBJECTIVES

There is concern of energy drink use by adolescents. The objective of this study was to evaluate the energy drink consumption use, frequency, age of first use, reasons for use, influences of choice of brand, and adverse events recorded in a predominant Latino adolescent population.

METHODS

Subjects between the ages of 13 and 19 years utilizing emergency department services for any reason at a large county hospital answered a questionnaire about energy drink usage.

RESULTS

There were 192 subjects, of which 49% were male and 51% were female. Latino adolescents were 85% of the participants, although other ethnic groups participated including African American, white, and Asian. Reasons for use include 61% to increase energy, 32% as study aide, 29% to improve sports performance, and 9% to lose weight. Twenty-four percent reported using energy drinks with ethanol or illicit drugs including marijuana, cocaine, and methamphetamine. Adverse reactions were reported in 40% of the subjects including insomnia (19%), feeling "jittery" (19%), palpitations (16%), gastrointestinal upset (11%), headache (8%), chest pain (5%), shortness of breath (4%), and seizures (1%).

CONCLUSIONS

Both brand name and packaging influenced the choice of energy drink in most subjects. Forty percent reported at least 1 adverse effect. While most adverse effects were not severe, a small number are serious. In addition, we showed intentional ingestion with ethanol and illicit drugs. Of additional concern is that both brand and packaging seem to directly affect choice of energy drink consumed.

Caffeine in the management of patients with headache

Caffeinated headache medications, either alone or in combination with other treatments, are widely used by patients with headache. Clinicians should be familiar with their use as well as the chemistry, pharmacology, dietary and medical sources, clinical benefits, and potential safety issues of caffeine. In this review, we consider the role of caffeine in the over-the-counter treatment of headache. The MEDLINE and Cochrane databases were searched by combining “caffeine” with the terms “headache,” “migraine,” and “tension-type.” Studies that were not placebo-controlled or that involved medications available only with a prescription, as well as those not assessing patients with migraine and/or tension-type headache (TTH), were excluded. Compared with analgesic medication alone, combinations of caffeine with analgesic medications, including acetaminophen, acetylsalicylic acid, and ibuprofen, showed significantly improved efficacy in the treatment of patients with TTH or migraine, with favorable tolerability in the vast majority of patients. The most common adverse events were nervousness (6.5%), nausea (4.3%), abdominal pain/discomfort (4.1%), and dizziness (3.2%). This review provides evidence for the role of caffeine as an analgesic adjuvant in the acute treatment of primary headache with over-the-counter drugs, caffeine doses of 130 mg enhance the efficacy of analgesics in TTH and doses of ≥100 mg enhance benefits in migraine. Additional studies are needed to assess the relationship between caffeine dosing and clinical benefits in patients with TTH and migraine.

Informing Intervention Strategies to Reduce Energy Drink Consumption in Young People: Findings From Qualitative Research

OBJECTIVE

To determine young people's knowledge of energy drinks (EDs), factors influencing ED consumption, and intervention strategies to decrease ED consumption in young people.

DESIGN

Eight group interviews with young people (aged 12-25 years).

SETTING

Community groups and secondary schools in Perth, Western Australia.

PARTICIPANTS

Forty-one young people, 41% of whom were male and 73% of whom consumed EDs.

PHENOMENON OF INTEREST

Factors influencing ED consumption and intervention strategies informed by young people to reduce ED consumption.

ANALYSIS

Two researchers conducted a qualitative content analysis on the data using NVivo software.

RESULTS

Facilitators of ED consumption included enhanced energy, pleasant taste, low cost, peer pressure, easy availability, and ED promotions. Barriers included negative health effects, unpleasant taste, high cost, and parents' disapproval. Strategies to reduce ED consumption included ED restrictions, changing ED packaging, increasing ED prices, reducing visibility in retail outlets, and research and education.

CONCLUSION AND IMPLICATIONS

Because many countries allow the sale of EDs to people aged <18 years, identifying ways to minimize potential harm from EDs is critical. This study provided unique insights into intervention strategies suggested by young people to reduce ED consumption. In addition to more research and education, these strategies included policy changes targeting ED sales, packaging, price, and visibility. Future research might examine the feasibility of implementing such interventions.

The Consumption of Energy Drinks Among a Sample of College Students and College Student Athletes

To assess energy drink (ED) consumption, potential ED correlates, and ED-related motivations among a sample of college students to determine differences based on athlete status (student athlete vs. non-athlete). Six hundred and ninety-two college students completed surveys at a large private university in the United States. Participants completed a paper based questionnaire assessing ED and ED-related variables. Over thirty-six percent (197 non-athletes, 58 student athletes) of participants reported ED consumption in the preceding 30 days. Multivariately, there was no difference in ED consumption based on athlete status. Heavy episodic drinking and prescription stimulant misuse were both correlated with increased ED consumption. ED motivations differed based on the frequency of ED consumption. ED use was common among student athletes and non-athletes in our sample. It is important to be aware of the correlation between heavy episodic drinking, prescription stimulant misuse, and ED consumption among college student populations because of the adverse consequences associated with these behaviors.

Acute effects of energy drinks in medical students

PURPOSE

To determine the acute effects of a variety of recognized energy drinks on medical students, based on the hypothesis that these beverages may affect negatively cardiovascular parameters, stress levels and working memory.

METHODS

Eighty young healthy medical students were included in the study. 62.5 % of the participants were male, and the age mean was 21.45 years. Each person was evaluated via measurement of systolic and diastolic blood pressure, electrocardiogram (ECG), heart rate, oxygen saturation, breath rate, temperature, STAI score (to assess anxiety state), salivary cortisol and N-back task score (to determine cognitive enhancement). These evaluations were performed before and following the intake of either carbonated water or one of three energy drinks containing caffeine in similar concentrations and an undetermined energy blend; A contained less sugar and no taurine.

RESULTS

Thirty-minute SBP increased significantly in the A and C groups. The B group exhibited a diminution of the percentage of the 1-h SBP increase, an increase of 1-h DBP and QTc shortening. HR showed an increase in the percent change in the A and C groups. Cortisol salivary levels increased in the B group. The STAI test score decreased in the C group. The percent change in N-back scores increased in the A group.

CONCLUSIONS

The data reinforce the need for further research on the acute and chronic effects of energy drinks to determine the actual risks and benefits. Consumers need to be more informed about the safety of these energy drinks, especially the young student population.

Carbonated soft drinks induce oxidative stress and alter the expression of certain genes in the brains of Wistar rats

In Saudi Arabia, the consumption of carbonated soft drinks is common and often occurs with each meal. Carbonated soft drink consumption has been shown to exhibit effects on the liver, kidney and bone. However, the effects of these soft drinks on brain activity have not been widely examined, particularly at the gene level. Therefore, the current study was conducted with the aim of evaluating the effects of chronic carbonated soft drink consumption on oxidative stress, brain gene biomarkers associated with aggression and brain histology. In total, 40 male Wistar rats were divided into four groups: Group 1 served as a control and was provided access to food and water ad libitum; and groups 2‑4 were given free access to food and carbonated soft drinks only (Cola for group 2, Pepsi for group 3 and 7‑UP for group 4). Animals were maintained on these diets for 3 consecutive months. Upon completion of the experimental period, animals were sacrificed and serological and histopathological analyses were performed on blood and tissues samples. Reverse transcription‑polymerase chain reaction was used to analyze alterations in gene expression levels. Results revealed that carbonated soft drinks increased the serum levels of malondialdehyde (MDA). Carbonated soft drinks were also observed to downregulate the expression of antioxidants glutathione reductase (GR), catalase and glutathione peroxidase (GPx) in the brain when compared with that in the control rats. Rats administered carbonated soft drinks also exhibited decreased monoamine oxidase A (MAO‑A) and acetylcholine esterase (AChE) serum and mRNA levels in the brain. In addition, soft drink consumption upregulated mRNA expression of dopamine D2 receptor (DD2R), while 5-hydroxytryptamine transporter (5‑HTT) expression was decreased. However, following histological examination, all rats had a normal brain structure. The results of this study demonstrated that that carbonated soft drinks induced oxidative stress and altered the expression of certain genes that are associated with the brain activity and thus should be consumed with caution.

Effects of Single and Multiple Energy Shots on Blood Pressure and Electrocardiographic Parameters

We assessed the effects of single and multiple caffeinated energy shots on hemodynamic and electrocardiographic (ECG) parameters. This was a randomized, double-blinded, placebo-controlled, crossover study in otherwise healthy volunteers (n = 26) where a caffeinated energy shot or matching placebo was ingested. The study drink was consumed twice daily for 7 days during each phase, with a 7-day washout period in between. The primary end points of interest were systolic and diastolic blood pressure (BP), heart rate, PR interval, QRS duration, and QT and QTc intervals. All parameters were evaluated at baseline, 1, 3, and 5 hours on the first and seventh day of each phase. Systolic BP after a single energy shot consumption was significantly higher than placebo at 3 and 5 hours (p = 0.050 and p = 0.038, respectively). Similarly, diastolic BP after a single energy shot consumption was significantly higher at 1 and 5 hours (p = 0.019 and p = 0.043, respectively). The systolic and diastolic BP elevations were not significant after consistent consumption (all p values ≥ 0.079). None of the ECG parameters were significantly affected (all p values ≥ 0.108) compared with placebo. In conclusion, a single shot of a caffeinated energy drink significantly raised systolic and diastolic BPs. However, these elevations were not sustained with chronic consumption. ECG parameters were not altered.

[Abuse of energy drinks: does it pose a risk?]

BACKGROUND

Energy drinks designate "any product in the form of a drink or concentrated liquid containing a mixture of ingredients having the property to raise the level of energy and liveliness". Their introduction has raised many reluctance and reserves after numerous cardiovascular and neurological injuries among regular consumers.

OBJECTIVE

This article attempts to synthesize the existing literature on energy drinks. The review focuses to show that excessive energy drinks consumption cause many complications.

METHODS

The literature review was conducted from 2001 to 2014, using PubMed, Google Scholar, EMBASE, and PsycInfo, using the following keywords alone or combined: energy drinks, caffeine, taurine, toxicity, dependence, complications.

RESULTS

Occasional or moderate consumption of these cans seem to present little risk to healthy adults. However, their repeated consumption in proportions that far exceed the recommendations for recommended use by the manufacturers, combined with the use of alcohol or illicit drugs consumption increases the risk of occurrence of somatic and psychiatric complications, especially among underage, and subjects with cardiovascular and neurological history.

CONCLUSION

Repeated consumption of energy drinks increases the risk of somatic and psychiatric complications. Further studies must be controlled to improve our understanding of other possible negative consequences on health.

Energy drinks and their adverse health effects: A systematic review of the current evidence

PURPOSE

With the rising consumption of so-called energy drinks over the last few years, there has been a growing body of literature describing significant adverse health events after the ingestion of these beverages. To gain further insight about the clinical spectrum of these adverse events, we conducted a literature review.

METHODS

Using PubMed and Google-Scholar, we searched the literature from January 1980 through May 2014 for articles on the adverse health effects of energy drinks. A total of 2097 publications were found. We then excluded molecular and industry-related studies, popular media reports, and case reports of isolated caffeine toxicity, yielding 43 reports.

CONCLUSION

Energy drink consumption is a health issue primarily of the adolescent and young adult male population. It is linked to increased substance abuse and risk-taking behaviors. The most common adverse events affect the cardiovascular and neurological systems. The most common ingredient in energy drinks is caffeine, and it is believed that the adverse events are related to its effects, as well as potentiating effects of other stimulants in these drinks. Education, regulation, and further studies are required.

Energy drink consumption in europe: a review of the risks, adverse health effects, and policy options to respond

With the worldwide consumption of energy drinks increasing in recent years, concerns have been raised both in the scientific community and among the general public about the health effects of these products. Recent studies provide data on consumption patterns in Europe; however, more research is needed to determine the potential for adverse health effects related to the increasing consumption of energy drinks, particularly among young people. A review of the literature was conducted to identify published articles that examined the health risks, consequences, and policies related to energy drink consumption. The health risks associated with energy drink consumption are primarily related to their caffeine content, but more research is needed that evaluates the long-term effects of consuming common energy drink ingredients. The evidence indicating adverse health effects due to the consumption of energy drinks with alcohol is growing. The risks of heavy consumption of energy drinks among young people have largely gone unaddressed and are poised to become a significant public health problem in the future.

An emerging adolescent health risk: caffeinated energy drink consumption patterns among high school students

OBJECTIVE

To examine the prevalence, patterns, and correlates of energy drink use among adolescents, and determine whether more frequent use of energy drinks is associated with poorer health and behavioral outcomes.

METHODS

Data were from a 2012 cross-sectional survey of 8210 students in grades 7, 9, 10 and 12 attending public schools in Atlantic Canada. Multinomial logistic regression analysis was used to examine correlates of energy drink use patterns, including substance use, sensation seeking, risk of depression, and socioeconomic status.

RESULTS

Nearly two-thirds of survey respondents (62%) reported consuming energy drinks at least once in the previous year, with about 20% reporting use once or more per month. Sensation seeking, depression, and substance use were all higher among energy drink users relative to non-users, and in higher frequency users relative to lower frequency users.

CONCLUSIONS

The prevalence of energy drink consumption among high school students was high. The association of energy drinks with other potential negative health and behavioral outcomes suggests that use of these products may represent a marker for other activities that may negatively affect adolescent development, health and well-being.

Energy drink consumption is associated with anxiety in Australian young adult males

BACKGROUND

Energy drinks are predominantly targeted to young adult consumers; however, there has been limited research into their effects on psychological functioning in this demographic group. This study examined cross-sectional associations between energy drink consumption and mental health in a population-based sample of young adults participating in the Western Australian Pregnancy Cohort (Raine) Study.

METHODS

We used self-report questionnaires to assess energy drink consumption and mental health (Depression Anxiety Stress Scale-21; DASS-21) at the 20-year cohort follow-up. In the regression analyses, we considered associations between energy drink consumption (mL/day) and continuous DASS-21 scores, adjusting for sociodemographic variables, alcohol and drug use, physical activity, body mass index (BMI), and dietary intake. Our sample included 502 males and 567 females (mean age 20 ± 3 years).

RESULTS

After adjusting for potential confounding factors and controlling for coexisting mental health problems, energy drink consumption (per 100 mL/day) was significantly associated with anxiety (but not depression or stress), and this relationship was found only in males (β = 0.32; 95% CI = 0.05, 0.58).

CONCLUSIONS

Our study found that energy drink consumption was associated with increased anxiety in young adult males. Further research into the possible contribution of energy drink use to the development of mental health problems in young adults is needed.

Effect of caffeinated versus noncaffeinated energy drinks on central blood pressures

STUDY OBJECTIVE

To evaluate the effects of caffeinated energy shots compared with noncaffeinated energy shots as assessed by changes in peripheral and central hemodynamic parameters in healthy subjects.

DESIGN

Randomized, double-blind, controlled crossover study.

SETTING

University campus.

PATIENTS

Ten healthy volunteers.

MEASUREMENTS AND MAIN RESULTS

Subjects were randomized to receive either a caffeinated or noncaffeinated energy shot; after a minimum 6 days washout period, subjects were given the alternate energy shot. Peripheral blood pressures, and central hemodynamic parameters, were assessed and recorded for each subject at baseline and at 1 and 3 hours after consumption of the energy shots. Peripheral systolic blood pressure (SBP) increased significantly with the caffeinated energy shot compared with noncaffeinated (8.30 ± 4.19 mm Hg and -0.20 ± 5.55, respectively, p=0.009) at 3 hours. Central SBP increased significantly with the caffeinated energy shot compared with noncaffeinated (8.00 ± 4.03 mm Hg and 1.50 ± 6.57, respectively, p=0.045) at 3 hours. Peripheral and central diastolic blood pressure were nonsignificantly higher with the caffeinated energy shot at 3 hours. Peripheral and central pulse pressure were consistently higher with consumption of the caffeinated beverage. Heart rate, augmentation index, pulse pressure amplification ratio, ejection duration and Subendocardial Viability Ratio were not different between the two interventions over time. P1 height was significantly higher with the caffeinated shot compared with the noncaffeinated shot at both 1 and 3 hours (p=0.035 and 0.013, respectively). Three and one subjects experienced an adverse effect with the caffeinated and noncaffeinated shot, respectively.

CONCLUSION

A caffeinated energy shot acutely increases peripheral and central SBPs compared with a noncaffeinated energy shot. Larger studies with a placebo comparator are needed to assess the significance of peripheral and central hemodynamic changes with noncaffeinated energy drinks.

Biochemical effects of energy drinks alone or in combination with alcohol in normal albino rats

PURPOSE

To determine the biochemical effects of energy drink alone or in combination with alcohol in normal albino rats.

METHODS

Twenty male albino rats weighing 160-180g were assigned into groups A-E of four rats per group. Group A and B rats were given low and high doses of ED, respectively, groups C and D were administered low and high doses of EDmA, respectively while group E rats were given distilled water and served as control. The treatment lasted for 30 days after which the animals were killed and their blood collected for laboratory analyses using standard methods.

RESULTS

There were no significant differences in body weight, packed cell volume and haemoglobin concentration with either administration of ED or EDmA in comparison to the control. Energy drink alone or EDmA has significant effects on total white blood cell count, plasma potassium, calcium, renal functions, liver enzymes and plasma triglycerides, with EDmA having more effects than ED alone, except for body weight where the energy drink alone has higher effect.

CONCLUSION

Consumption of energy drink alone or in combination with alcohol is associated with significant alterations in some biochemical parameters. Caution should be exercised while consuming either of them. Public health education is urgently needed to correct the wrong impression already formed by the unsuspecting consumers, especially the youths.

Caffeine Content Labeling: A Missed Opportunity for Promoting Personal and Public Health

Current regulation of caffeine-containing products is incoherent, fails to protect consumers' interests, and should be modified in multiple ways. We make the case for one of the regulatory reforms that are needed: all consumable products containing added caffeine should be required by the Food and Drug Administration (FDA) to include caffeine quantity on their labels. Currently, no foods or beverages that contain caffeine are required to include caffeine content on their labels. Strengthening these lax labeling requirements could prevent direct caffeine-induced harm, protect those most vulnerable to caffeine-related side effects, and enhance consumer autonomy and effective caffeine use. Consumers have an interest in regulating their intake of caffeine and thus, ought to know how much caffeine their foods and beverages contain.

Is dietary caffeine involved in seizure precipitation?

Caffeine acts as a central nervous stimulant by blocking A1 and A2A adenosine receptors. Its effect on seizures is complex. Animal studies and case reports indicate that acute caffeine exposure may induce seizures, whereas chronic exposure might have an opposite effect. Patients acutely hospitalized for seizures (n = 174) were asked for their consumption of caffeinated beverages 24 h prior to admission as well as their habitual caffeine intake. Twenty-four-hour caffeine consumption was also recorded in a later telephone interview on a seizure-free day (n = 154). Thus, the patients served as their own controls. Categorized data were analyzed using the Wilcoxon's signed-ranks test. No difference was found between the intake of caffeine 24 h prior to the seizure and the habitual consumption (p = 0.37) or the consumption on a seizure-free day (p = 0.13). Thus, caffeine does not appear to be a common seizure precipitant.

Major components of energy drinks (caffeine, taurine, and guarana) exert cytotoxic effects on human neuronal SH-SY5Y cells by decreasing reactive oxygen species production

Scope. To elucidate the morphological and biochemical in vitro effects exerted by caffeine, taurine, and guarana, alone or in combination, since they are major components in energy drinks (EDs). Methods and Results. On human neuronal SH-SY5Y cells, caffeine (0.125–2 mg/mL), taurine (1–16 mg/mL), and guarana (3.125–50 mg/mL) showed concentration-dependent nonenzymatic antioxidant potential, decreased the basal levels of free radical generation, and reduced both superoxide dismutase (SOD) and catalase (CAT) activities, especially when combined together. However, guarana-treated cells developed signs of neurite degeneration in the form of swellings at various segments in a beaded or pearl chain-like appearance and fragmentation of such neurites at concentrations ranging from 12.5 to 50 mg/mL. Swellings, but not neuritic fragmentation, were detected when cells were treated with 0.5 mg/mL (or higher doses) of caffeine, concentrations that are present in EDs. Cells treated with guarana also showed qualitative signs of apoptosis, including membrane blebbing, cell shrinkage, and cleaved caspase-3 positivity. Flow cytometric analysis confirmed that cells treated with 12.5–50 mg/mL of guarana and its combinations with caffeine and/or taurine underwent apoptosis. Conclusion. Excessive removal of intracellular reactive oxygen species, to nonphysiological levels (or “antioxidative stress”), could be a cause of in vitro toxicity induced by these drugs.

Adolescent and young adult perceptions of caffeinated energy drinks. A qualitative approach

Understanding consumer attitudes towards foods remains critically important for manufacturers, retailers and governing bodies. Regulation within the food industry should therefore support food choice whilst protecting members of society. There have been concerns regarding beverages marketed as 'energy drinks' and the levels of caffeine in these drinks. Focus groups were used to assess participants' perceptions and understandings of caffeinated energy drinks across three demographic age groups: 16-21, 22-28 and 29-35 year olds with the narrow age range providing a focused investigation of the demographic group specifically targeted by industry. Thematic analysis revealed a number of differences in participants' perceptions of energy drinks between age groups in relation to themes of advertising, age, alcohol, brand, efficacy, energy seeking, gender, sugar, peer influence, product attributes, safety and taste. Future implications for the use of qualitative research within the health promotion industry are discussed.