Documente Academic
Documente Profesional
Documente Cultură
abstract
KEY WORDS
energy drink, caffeine, taurine, children, adolescents, overdose
ABBREVIATIONS
FDAFood and Drug Administration
ADHDattention-decit/hyperactivity disorder
www.pediatrics.org/cgi/doi/10.1542/peds.2009-3592
doi:10.1542/peds.2009-3592
Accepted for publication Dec 3, 2010
Address correspondence to Steven E. Lipshultz, MD, Department
of Pediatrics (D820), Leonard M. Miller School of Medicine,
University of Miami, Medical Campus MCCD-D820, 1601 NW 12th
Ave, 9th Floor, PO Box 016820, Miami, FL 33101. E-mail:
slipshultz@med.miami.edu
PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).
Copyright 2011 by the American Academy of Pediatrics
FINANCIAL DISCLOSURE: The authors have indicated they have
no nancial relationships relevant to this article to disclose.
511
Seifert et al
METHODS
We searched PubMed by using energy
drink, sports drink, guarana, caffeine, taurine, ADHD (attentiondecit/hyperactivity disorder), diabetes, children, adolescents, insulin,
eating disorders, and poison control
center singly or in combination. We limited searches to English-language and
foreign-language articles with Englishlanguage abstracts and selected articles
by relevance to energy drink use in children and adolescents. We similarly
searched Google for print and trade media. We reviewed articles and Internet
sources by the above search through
June 2010 and updated sections as new
information became available through
January 2011.
RESULTS
Two-thirds of the 121 references we
found on energy drinks were in the scientic literature, although reports by
government agencies and interest
groups also contained much useful information (Table 1). Most information
came from the United States, but European, Canadian, Australian, New Zealand, and Chinese sources are also
represented.
DISCUSSION
What Are Energy Drinks?
Energy drinks may contain caffeine,
taurine, sugars and sweeteners,
herbal supplements, and other ingredients (Table 2) and are distinct from
sports drinks and vitamin waters (Table 3).6,8 In 2008, the National Federation of State High School Associations,
while recommending water and
sports drinks for rehydration, specically did not recommend energy
drinks and cited potential risks, the
absence of benet, and drug interactions (Table 4).36,37
Caffeine is the main active ingredient
in energy drinks; many of them contain
70 to 80 mg per 8-oz serving (3 times
the concentration in cola drinks) (Table 5).8,31 Caffeine content can be
nearly 5 times greater than that in 8 oz
of cola drinks when packaged as energy shots (0.8 3 oz) or as 16-oz
drinks.6,29,38
Energy drinks often contain additional
amounts of caffeine through additives,
including guarana, kola nut, yerba
mate, and cocoa.6,7,14,25 Guarana
(Paullinia cupana) is a plant that
contains caffeine, theobromine (a
chronotrope), and theophylline (an
inotrope).7,8,14,39 Each gram of guarana can contain 40 to 80 mg of caffeine, and it has a potentially longer
half-life because of interactions with
other plant compounds.7,14 Manufacturers are not required to list the
caffeine content from these ingredients.7,14 Thus, the actual caffeine
dose in a single serving may exceed
that listed.9,29
Consumption of Energy Drinks by
Children, Adolescents, and Young
Adults
In the United States, adolescent caffeine
intake averages 60 to 70 mg/day and
ranges up to 800 mg/day.24,40 Most caffeine intake among youth comes from
SPECIAL ARTICLES
TABLE 1 Primary Literature and Media Sources Selected for Review, According to Relevance
Source Description
Primary literature
Systematic reviews
Review articles
No. of
Results
81
0
36
0
16
Cohort studies
Surveys
Case reports
Perspectives
10
Basic science
Animal studies
5
3
Human studies
Government agency reports
2
10
Interest groups
Popular media
Newspaper articles
3
27
14
Web sites
Books
Total
12
1
121
Main Topics
Source Country
Energy drinks are a growing problem; safety issues with energy drinks;
stimulant adverse effects; caffeine dependence; caffeine and uidelectrolyte balance; caffeine and exercise performance; caffeine and
mental performance; caffeine and apnea of prematurity; caffeine
and bronchopulmonary dysplasia; caffeine and coronary heart
disease; herb adverse effects; adolescents with ADHD and misuse of
medication; ADHD and substance use; cardiovascular effects of
antidepressants in children and adolescents; caffeine consumption
and eating disorders; caffeine and bone gain in children and
adolescents; incidence of pediatric cardiomyopathy; frequency of
myocardial injury in children; epidemiology of hypertrophic
cardiomyopathy
United States
United States
United States
United States, Germany
United States
United States
United States
Australia, Canada, European Germany,
New Zealand, United States
United States
United States
513
TABLE 2 Common Ingredients, Therapeutic Uses, and Adverse Effects of Energy Drink Ingredients8,14,25,30,49,53,82,83
Ingredient
Description
Therapeutic Uses
Caffeine
An adenosine receptor
antagonist: a central
nervous system
stimulant
Guarana
None known
Taurine
L-Carnitine
Ginseng
Yohimbine
soda; however, energy drinks are becoming increasingly popular.7,24,41,42 Several self-report studies have examined
energy drink consumption by children,
adolescents, and young adults.7,24,41,42
One study found that 28% of 12- to
14-year-olds, 31% of 12- to 17-year
514
Seifert et al
SPECIAL ARTICLES
Energy Drinks
Gatorade; Powerade
Interactions
5-Hydroxy tryptophan
Vinpocetine
Yohimbine
Ginseng
TABLE 5 Caffeine Content Reported by Manufacturers and Selected Additional Ingredients of Selected Products6,29,46
Product
Comparison products
NoDoz
Excedrin
Hersheys Kisses
Coca-Cola
Mountain Dew
Diet Pepsi Max
Tea, brewed
Coffee, generic brewed
Starbucks tall coffee
Energy drinks
Low calorie
Regular
Super-caffeinated
Selected Ingredients
Caffeine
Acetaminophen, aspirin, caffeine
Caffeine, sugar
Caffeine, sugar
Caffeine, sugar
Ginseng
NAa
NAa
NAa
B vitamins, dextrose, fumarate, gingko, ginseng, glucuronolactone,
guarana, glucose, inositol, L-arginine, L-carnitine, milk thistle,
n-acetyl-L-tyrosine, sucrose, taurine, yohimbine HCL, vinpocetine,
5-hydroxy tryptophane
B vitamins, dextrose, fumarate, gingko, ginseng, glucuronolactone,
guarana, high-fructose corn syrup, glucose, inositol, L-arginine,
L-carnitine, milk thistle, n-acetyl-L-tyrosine, sucrose, taurine,
yohimbine HCL, vinpocetine, 5-hydroxy tryptophane
B vitamins, dextrose, fumarate, gingko, ginseng, glucuronolactone,
guarana, glucose, inositol, L-arginine, L-carnitine, milk thistle,
n-acetyl-L-tyrosine, sucrose, taurine, yohimbine HCL, vinpocetine,
5-hydroxy tryptophane
Sugar
Content per
8 oz, g
Average
Caffeine
Dose per
8 oz, mg
Amount
per
Serving, oz
Average Caffeine
Dose per
Container, mg
0
0
NAa
NAa
NAa
NAa
21 in 9 pieces
1925
32
0
0
0
0
NAa
23
28
47
54
100
174
NAa
12
16
12
8
8
12
7719 200
0.1716.00
80400
8.316.0
75300
0.172.50
80400
1730
71286
31519 200
Seifert et al
FIGURE 1
Mathematical model estimates for dietary consumption of caffeine and energy drinks in children aged
5 to 12 years (A), adolescents aged 13 to 19 years (B), and young males aged 19 to 24 years (C) using
caffeine-concentration data from food and beverages combined with 24-hour diet-recall information
from the 1997 New Zealand National Nutrition Survey and the 2002 New Zealand National Childrens
Nutrition Survey. A, Distribution of dietary baseline caffeine-exposure estimates for children (512
years old).46 P95 indicates the 95th percentile exposure and represents a high consumer. Caffeineexposure units are mg/kg of body weight per day. B, Distribution of dietary baseline caffeine-exposure
estimates for teenagers (1319 years old).46 C, Distribution of dietary baseline caffeine-exposure for
young males (19 24 years old).46 Reproduced with permission from David Crowe, manager of consumer communications for the New Zealand Food Safety Authority.
SPECIAL ARTICLES
FIGURE 2
A, Estimated distribution of caffeine exposure for children (512 years old) after the consumption of
1 to 4 retail units of energy drinks or energy shots.46 B, Estimated distribution of caffeine exposure for
teenagers (1319 years old) after the consumption of 1 to 4 retail units of energy drinks or energy
shots.46 C, Estimated distribution of caffeine exposure for young males (19 24 years old) after the
consumption of 1 to 4 retail units of energy drinks or energy shots.46 Caffeine-exposure units are mg/kg
body weight per day. An adverse effect level of 3 mg/kg body weight per day is shown as a basis for risk
evaluation. The area under the curves to the right of the adverse-effect lines represents the proportion of
consumers potentially at risk from adverse effects of caffeine or the probability of a random consumer
exceeding the adverse-effect level. Reproduced with permission from David Crowe, manager of consumer
communications for the New Zealand Food Safety Authority.
Caffeine, the most commonly used psychoactive drug worldwide, may be the
only psychoactive drug legally available over-the-counter to children and
sold among food and beverage products.39,48 Caffeine is an adenosine and
benzodiazepine receptor antagonist,
phosphodiesterase inhibitor, and central nervous system stimulant.29,38,49 In
healthy adults, a caffeine intake of
400 mg/day is considered safe;
acute clinical toxicity begins at 1 g, and
5 to 10 g can be lethal.29
Physiologically, caffeine causes coronary and cerebral vasoconstriction,
relaxes smooth muscle, stimulates
skeletal muscle, has cardiac chronotropic and inotropic effects, reduces
insulin sensitivity, and modulates
gene expression in premature neo517
nates.9,29,5052 Large amounts of caffeine increase urine ow and sweat excretion and alter blood electrolyte
levels.11,53 Although caffeine is a mild
diuretic, consumption of 500 mg/day
does not cause dehydration or chronic
water imbalance.54,55
Caffeine is a ventilatory stimulant with
anti-inammatory and bronchoprotective effects.56 Caffeine has been linked
to dyspnea on exertion from central
and peripheral chemoreceptor stimulation.56 In addition, increased breathing work may divert blood ow away
from locomotor muscles and negate
any ergogenic advantage.56 Caffeines
cardiovascular effects include decreased heart rate from stimulation of
medullary vagal nuclei and increased
blood pressure.24,57 61
Adults who consume low-to-moderate
amounts of caffeine (13 mg/kg or
12.5100 mg/day) have improved exercise endurance, cognition, reaction
time, and mood with sleep deprivation.9,24,56,62 However, these studies
typically involve habitual caffeine
consumers, and results reect
withdrawal-symptom reversal.58
FIGURE 3
A, Cumulative probability curves of children (512 years old) consuming 1 to 4 retail units of energy
drinks or energy shots in addition to baseline dietary exposure.46 B, Cumulative probability curve for
teenagers (1319 years old) consuming 1 to 4 retail units of energy drinks or energy shots in addition
to baseline dietary exposure.46 C, Cumulative probability curve of young males (19 24 years old)
consuming 1 to 4 retail units of energy drinks or energy shots in addition to baseline dietary exposure.46 Caffeine-exposure units are mg/kg body weight per day. An adverse-effect level of 3 mg/kg body
weight per day is shown as a reference point. The portion of each curve to the right of the adverse-effect
level represents the proportion of the population group potentially at risk from adverse effects of caffeine.
The exposure of any percentile may be read off the x-axis by extrapolating from the intersection of the
selected percentile on the y-axis with the curve of 1, 2, 3, or 4 retail units consumed; cumulative probability 0.2 represents the 20th percentile, 0.4 40th percentile, etc. Reproduced with permission from David
Crowe, manager of consumer communications for the New Zealand Food Safety Authority.
518
Seifert et al
SPECIAL ARTICLES
TABLE 6 American Association of Poison Control Centers Data on Caffeine Toxicity, 2006 200847
Year
Total calls
to PCCs to
Report
Caffeine
Toxicity, n
Calls That
Reported
Caffeine Toxicity
in Children 6 y
old, n
(% of Total Calls)
Calls That
Reported
Caffeine Toxicity
in 6- to-19-YearOlds, n
(% of Total Calls)
Calls That
Reported
Caffeine Toxicity
in Adults
(19 y old), n
(% of Total Calls)
Patients
Subsequently
Treated, n
(% of Total Calls)
Patients With
Moderately
Severe
Symptoms, n
(% of Total Calls)
Patients With
Life-Threatening
Effects, n
(% of Total Calls)
Deaths, n
(% of Total Calls)
2008
2007
2006
4852
5448
5696
1208 (24.9)
1176 (21.6)
1247 (21.9)
1170 (24.1)
1328 (24.4)
1427 (25.1)
1090 (22.5)
1404 (25.8)
1427 (25.1)
1281 (26.4)
1561 (28.7)
1799 (31.6)
470 (9.7)
544 (10.0)
654 (11.5)
11 (0.2)
16 (0.3)
18 (0.3)
1 (0.02)
1 (0.02)
1 (0.02)
dulled cognition) reversal. The children who did not habitually consume
caffeine reported no marked
changes in cognitive performance,
alertness, or headache.63
Caffeine may affect future food and
beverage preferences by acting on the
developing childs brain reward-andaddiction center; this effect may be
gender specic.5 A study of 12- to 17year-olds revealed that boys found caffeinated soda more reinforcing than
did girls regardless of usual caffeine
consumption.72
Physiologic Effects of Other
Ingredients in Energy Drinks and
Potential Synergistic Effects
Popular media and case reports have
associated adverse events with energy
drink consumption (Appendix). Yet,
few studies have examined the physiologic effects of individual ingredients
or potential synergistic effects; furthermore, results of experimental
studies have been inconclusive and occasionally contradictory.24,25,59,73
Some studies of adults revealed improved mental alertness, reaction
times, and concentration with energy
drinks59,74; others revealed no improvement compared with caffeine or glucose alone.73 One study of 14 young
adults compared a complete energy
drink mixture to the glucose fraction,
the caffeine fraction, and the herbal
fraction.9,59 Although individual components did not enhance cognition, the
combined ingredients did.9,59 Caffeine
and taurine combined may synergistically decrease heart rate initially; one
study found that 70 minutes after consumption, heart rate returned to normal and blood pressure increased.25,75
Taurine similarly produced a reex
bradycardia when injected into the rat
cerebroventricular system.75 Another
study of 15 healthy young adults in a
7-day trial in which they consumed 500
mL of an energy drink each day with
160 mg of caffeine and 2000 mg of taurine, reported an average increase in
systolic blood pressure of 9 to 10 mm
Hg and an average increased heart
rate of 5 to 7 beats per minute 4 hours
after consumption.25,38
Caffeine- and taurine-containing beverages increased left atrial contractility in 13 athletes, thereby increasing
left ventricular end-diastolic volume
and stroke volume.76 The caffeine-only
group showed no changes in left ventricular function.76 Taurine may cause
this increase in stroke volume by suppressing sympathetic nervous stimulation and inuencing calcium stores
in cardiac muscle.8 Results of human
and animal studies have suggested
that long-term taurine exposure may
cause hypoglycemia25 but a decreased
risk of coronary heart disease.77 In animal experiments, taurine also has
shown anticonvulsive and epileptogenic properties.25
Among 50 young adults who drank one
sugar-free energy drink, hematologic
and vascular effects included increased platelet aggregation and
519
mean arterial pressure and a decrease in endothelial function.78 Guarana has antiplatelet aggregation properties in vitro, but how it functions
physiologically in energy drinks is unknown.79 A study of 20 healthy subjects
revealed that caffeinated espresso
had no effects on endothelial function.80 Caffeine alone did not affect
platelet function.81
Ginseng, a common ingredient in many
energy drinks, may lower blood glucose levels, but its actions in energy
drinks are unclear.82
Potential Problems of Energy
Drinks Among Children and
Adolescents
Cardiovascular Effects of Energy
Drinks on Children and Adolescents
High doses of caffeine may exacerbate
cardiac conditions for which stimulants are contraindicated.17,18,83 86 Of
particular concern are ion channelopathies and hypertrophic cardiomyopathy, the most prevalent genetic
cardiomyopathy in children and young
adults, because of the risk of hypertension, syncope, arrhythmias, and sudden death.11,86,87
Effects of Energy Drinks on Children
and Adolescents With ADHD
ADHD occurs in 8% to 16% of US schoolaged children and may be more prevalent in children with heart disease.88,89
Some 2.5 million US children take stimulants for ADHD, which may increase
heart rate and blood pressure.8991
Children with ADHD have higher rates
of substance abuse, including the
abuse of caffeine, which blocks the A2A
adenosine receptors and thereby enhances the dopamine effect at the D2
dopamine receptor, similarly to the
way guanfacine works for ADHD.92,93
For the subpopulation with methylphenidate cardiotoxicity, energy drink
use may increase cardiac events.95,96
As with the ADHD stimulants, the com520
Seifert et al
SPECIAL ARTICLES
Restrictions
Argentina
Australia
Canada
Denmark
European Food
Safety Authority
France
Germany
Ireland
Netherlands
Norway
Sweden
Finland
Turkey
United Kingdom
Uruguay
United States
521
CONCLUSIONS
On the basis of this review, we conclude that (1) energy drinks have no
therapeutic benet, and both the
known and unknown pharmacology of
various ingredients, combined with reports of toxicity, suggest that these
drinks may put some children at
risk for serious adverse health effects11,16,24,25,38; (2) typically, energy
drinks contain high levels of caffeine,
taurine, and guarana, which have
stimulant properties and cardiac and
hematologic activity,7,8,11 but manufacturers claim that energy drinks are nutritional supplements, which shields
them from the caffeine limits imposed
on sodas and the safety testing and
labeling required of pharmaceuticals7,8,11; (3) other ingredients vary, are
understudied, and are not regulated;
(4) youth-aimed marketing and risktaking adolescent developmental tendencies combine to increase overdose potential; (5) high consumption
522
Seifert et al
ACKNOWLEDGMENTS
This work was supported by National Institutes of Health grants HL072705, HL078522,
HL053392, CA127642, CA068484, HD052104,
AI50274, CA068484, HD052102, HL087708,
HL079233, HL004537, HL087000, HL007188,
HL094100, HL095127, and HD80002; Health
Resources and Services Administration
grant HCOF-C76HF15614; the Childrens
CardiomyopathyFoundation;andtheWomens Cancer Association.
SPECIAL ARTICLES
REFERENCES
1. Lee J. Energy drinks vs. sports drinks:
know thy difference. Available at: http://
speedendurance.com/2009/07/09/
energy-drinks-vs-sports-drinks-know-thydifference. Accessed January 17, 2011
2. McCarthy M. Overuse of energy drinks
worries health pros. Available at: www.
usatoday.com/sports/2009-07-01Drinks_N.htm. Accessed January 17,
2011
3. US Food and Drug Administration. Overview of dietary supplements. Available at:
www.fda.gov/Food/DietarySupplements/
ConsumerInformation/ucm110417.htm.
Accessed January 17, 2011
4. Nitzke S, Tanumihardjo S, Salomon J,
Coleman G. Energy drinks, sports drinks,
and other functional/enhanced beverages
are often a waste of money. Available at:
www.uwex.edu/ces/wnep/specialist/n/
mmpdfs/0810.pdf#page1. Accessed
January 17, 2011
5. Oddy WH, OSullivan TA. Energy drinks for
children and adolescents, erring on the
side of caution may reduce long term
health risks. BMJ. 2009;339:b5268
6. Reissig CJ, Strain EC, Grifths RR. Caffeinated energy drinks: a growing problem.
Drug Alcohol Depend. 2009;99(13):110
7. Babu KM, Church RJ, Lewander W. Energy
drinks: the new eye-opener for adolescents. Clin Pediatr Emerg Med. 2008;9(1):
35 42
8. Clauson KA, Shields KM, McQueen CE,
Persad N. Safety issues associated with
commercially available energy drinks. J
Am Pharm Assoc (Wash DC). 2008;48(3):
e55 e63; quiz e64 e67
9. Malinauskas BM, Aeby VG, Overton RF,
Carpenter-Aeby T, Barber-Heidal K. A survey of energy drink consumption patterns
among college students. Nutr J. 2007;
6:35. Available at: www.nutritionj.com/
content/6/1/35. Accessed January 17,
2011
10. Press Ofce. New report predicts energy
drink sales in the U.S. to exceed $9 billion
by 2011 [press release]. Available at: www.
reportbuyer.com/press/new-reportpredicts-energy-drink-sales-in-the-us-toexceed-9-billion-by-2011. Accessed
January 17, 2011
11. Lipshultz S. High risk: Ban energy drinks
from schools. Miami Herald. April 20, 2008:
4L, L4
12. Broderick P, Benjamin AB. Caffeine and
psychiatric symptoms: a review. J Okla
State Med Assoc. 2004;97(12):538 542
13. Hedges DW, Woon FL, Hoopes SP. Caffeineinduced psychosis. CNS Spectr. 2009;
14(3):127129
14. Heneman K, Zidenberg-Cherr S. Some
facts about energy drinks. Available at:
http://nutrition.ucdavis.edu/content/
infosheets/EnergyDrinks.pdf. Accessed
January 17, 2011
15. Brecher EJ. Study: caffeine in sodas risky
for black kids. Miami Herald. May 18,
2004:7E
16. Cohen H. Dangerous jolt: energy drink dangers for children. Miami Herald. April 1,
2008:E10, 10E
17. Frassica JJ, Orav EJ, Walsh EP, Lipshultz
SE. Arrhythmias in children prenatally exposed to cocaine. Arch Pediatr Adolesc
Med. 1994;148(11):11631169
18. Lipshultz SE, Frassica JJ, Orav EJ. Cardiovascular abnormalities in infants prenatally exposed to cocaine. J Pediatr. 1991;
118(1):44 51
19. Lipshultz SE. Ventricular dysfunction clinical research in infants, children and adolescents. Prog Pediatr Cardiol. 2000;12(1):
128
20. Lipshultz SE, Wilkinson JD, Messiah SE,
Miller TL. Clinical research directions in
pediatric cardiology. Curr Opin Pediatr.
2009;21(5):585593
21. Lipshultz SE. Realizing optimal care for
children with cardiovascular disease:
funding challenges and research approaches. Prog Pediatr Cardiol. 2005;
20(1):7190
22. Mone SM, Gillman MW, Miller TL, Herman
EH, Lipshultz SE. Effects of environmental
exposures on the cardiovascular system:
prenatal period through adolescence. Pediatrics. 2004;113(4 suppl):1058 1069
23. Chrissos J. Cold medicines taboo for kids
under 4: further restricting the use of cold
medicines for young children, drug companies now say they shouldnt be used in
children younger than 4. Miami Herald. October 8, 2008: Living-Health
24. Temple JL. Caffeine use in children: what
we know, what we have left to learn, and
why we should worry. Neurosci Biobehav
Rev. 2009;33(6):793 806
25. Federal Institute for Risk Assessment. New
human data on the assessment of energy
drinks. Available at: www.bfr.bund.de/
cm/245/new_human_data_on_the_
assessment_of_energy_drinks.pdf. Accessed January 17, 2011
26. Health Canada. Energy drinks safety and
health effects. Available at: www.
523
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
51.
524
excessive_energy_shot_intake.pdf.
Accessed January 17, 2011
OConnor E. A sip into dangerous territory.
Monit Psychol. 2001;32(6). Available at:
www.apa.org/monitor/jun01/dangersip.
aspx. Accessed January 17, 2011
Pollak CP, Bright D. Caffeine consumption
and weekly sleep patterns in US seventh-,
eighth-, and ninth-graders. Pediatrics.
2003;111(1):42 46
Bernstein GA, Carroll ME, Thuras PD, Cosgrove KP, Roth ME. Caffeine dependence in
teenagers. Drug Alcohol Depend. 2002;
66(1):1 6
Strain EC, Mumford GK, Silverman K, Grifths RR. Caffeine dependence syndrome:
evidence from case histories and experimental evaluations. JAMA. 1994;272(13):
10431048
Simon M, Mosher J. Alcohol, energy
drinks, and youth: a dangerous mix. Available at: www.marininstitute.org/
alcopops/resources/EnergyDrinkReport.
pdf. Accessed January 17, 2011
Viell B, Grabner L, Fruchel G, Boczek P. New
caffeinated beverages: a pilot survey of familiarity and consumption by adolescents
in north-Rhine Westphalia and Berlin and
considerations of consumer protection [in
German]. Z Ernahrungswiss. 1996;35(4):
378 386
Miller KE. Wired: energy drinks, jock identity, masculine norms, and risk taking. J
Am Coll Health. 2008;56(5):481 489
Thomson B, Schiess S. Risk prole: caffeine in energy drinks and energy shots.
Available at: www.nzfsa.govt.nz/science/
risk-proles/fw10002-caffeine-inbeverages-risk-prole.pdf. Accessed January 17, 2011
Bronstein AC, Spyker DA, Cantilena LR Jr,
Green JL, Rumack BH, Heard SE; American
Association of Poison Control Centers.
2007 Annual Report of the American Association of Poison Control Centers National
Poison Data System (NPDS): 25th Annual
Report. Clin Toxicol (Phila). 2008;46(10):
9271057
Holmgren P, Norden-Pettersson L, Ahlner
J. Caffeine fatalities: four case reports. Forensic Sci Int. 2004;139(1):7173
Greenwood MRC, Oria M. Use of dietary
supplements by military personnel. Available at: www.nap.edu/catalog/12095.html.
Accessed January 17, 2011
Connolly S, Kingsbury TJ. Caffeine modulates CREB-dependent gene expression in
developing cortical neurons. Biochem Biophys Res Commun. 2010;397(2):152156
Dworzanski W, Opielak G, Burdan F. Side
Seifert et al
76. Baum M, Weiss M. The inuence of a taurine containing drink on cardiac parameters before and after exercise measured
by echocardiography. Amino Acids. 2001;
20(1):75 82
SPECIAL ARTICLES
78.
79.
80.
81.
82.
83.
84.
85.
86.
87.
88.
89.
90.
91.
92.
93.
94.
95.
96.
97.
98.
99.
100.
ease in the Young congenital cardiac defects committee and the council on cardiovascular nursing [published correction
appears in Circulation. 2009;120(7):
e55 e59]. Circulation. 2008;117(18):
24072423
Wilens TE, Gignac M, Swezey A, Monuteaux
MC, Biederman J. Characteristics of adolescents and young adults with ADHD who
divert or misuse their prescribed medications. J Am Acad Child Adolesc Psychiatry.
2006;45(4):408 414
Wilens TE, Prince JB, Spencer TJ, Biederman J. Stimulants and sudden death: what
is a physician to do? Pediatrics. 2006;
118(3):12151219
Biederman J, Wilens T, Mick E, Spencer T,
Faraone SV. Pharmacotherapy of
attention-decit/hyperactivity disorder reduces risk for substance use disorder. Pediatrics. 1999;104(2). Available at: www.
pediatrics.org/cgi/content/full/104/2/e20.
Accessed January 17, 2011
Fredholm BB, Svenningsson P. Striatal
adenosine A2A receptors: where are they?
What do they do? Trends Pharmacol Sci.
1998;19(2):46 48
Wilens TE, Biederman J, Baldessarini RJ, et
al. Cardiovascular effects of therapeutic
doses of tricyclic antidepressants in children and adolescents. J Am Acad Child
Adolesc Psychiatry. 1996;35(11):
14911501
Dadfarmay S, Dixon J. A case of acute cardiomyopathy and pericarditis associated
with methylphenidate. Cardiovasc Toxicol.
2009;9(1):49 52
Take G, Bahcelioglu M, Oktem H, et al. Dosedependent immunohistochemical and untrastructural changes after oral methylphenidate administration in rat heart
tissue. Anat Histol Embryol. 2008;37(4):
303308
Krahn DD, Hasse S, Ray A, Gosnell B,
Drewnowski A. Caffeine consumption in
patients with eating disorders. Hosp Community Psychiatry. 1991;42(3):313315
Stock SL, Goldberg E, Corbett S, Katzman
DK. Substance use in female adolescents
with eating disorders. J Adolesc Health.
2002;31(2):176 182
Striegel-Moore RH, Franko DL, Thompson
D, Barton B, Schreiber GB, Daniels SR. Caffeine intake in eating disorders. Int J Eat
Disord. 2006;39(2):162165
Popkin B. We are what we drink. InThe
World Is Fat: The Fads, Trends, Policies,
and Products That Are Fattening the Human Race. New York, NY: Penguin Group;
2002:43 65
101. Moreno MA, Furtner F, Frederick PR. Sugary drinks and childhood obesity. Arch Pediatr Adolesc Med. 2009;163(4):400
102. National Center for Chronic Disease Prevention and Health Promotion. Obesity:
halting the epidemic by making health easier. Available at: www.cdc.gov/nccdphp/
publications/AAG/pdf/obesity.pdf. Accessed January 17, 2011
103. Heaney RP. Effects of caffeine on bone and
the calcium economy. Food Chem Toxicol.
2002;40(9):12631270
104. Lloyd T, Rollings NJ, Kieselhorst K, Eggli DF,
Mauger E. Dietary caffeine intake is not
correlated with adolescent bone gain. J
Am Coll Nutr. 1998;17(5):454 457
105. Hein K. A bulls market: the marketing of
Red Bull energy drink. Available at: http://
ndarticles.com/p/articles/mi_m0BDW/
is_22_42/ai_75286777/?tagcontent%
3Bcol1. Accessed January 17, 2011
106. Thomsen SR, Fulton K. Adolescents attention to responsibility messages in magazine alcohol advertisements: an eyetracking approach. J Adolesc Health. 2007;
41(1):2734
107. Fischer PM, Richards JW Jr, Berman EJ,
Krugman DM. Recall and eye tracking
study of adolescents viewing tobacco advertisements. JAMA. 1989;261(1):84 89
108. Weise E. Petition calls for FDA to regulate
energy drinks. USA Today. October 22,
2008: News, Health & Behavior
109. Our view on pills and potions: do you really
know whats in that dietary supplement?
Available at: www.usatoday.com/news/
opinion/editorials/2010-06-07-editorial07_ST_
N.htm?locinterstitialskip. Accessed January
17, 2011
110. European Food Safety Authority. EFSA
adopts opinion on two ingredients commonly used in some energy drinks [press
release]. Available at: www.efsa.europa.
eu/en/press/news/ans090212.htm. Accessed January 17, 2011
111. Red Bull pulled from shelves in Hong Kong.
Available at: http://content.usatoday.com/
communities/ondeadline/post/2009/06/
67549503/1. Accessed October 27, 2009
112. Anderson BL, Juliano LM, Schulkin J. Caffeines implications for womens health
and survey of obstetrician-gynecologists
caffeine knowledge and assessment practices. J Womens Health (Larchmt). 2009;
18(9):14571466
113. Pepine CJ. Panel endorses preparticipation sports physicals for every child. Cardiol Today. 2010:13(6). Available at: www.
cardiologytoday.com/print.aspx?rid
65042. Accessed January 17, 2011
525
526
Seifert et al
Marin Institute
Newspaper articles
Journal articles/
case reports
Source of
Information
Diabetes
None reported
None reported
None reported
2 depressed patients
and 1 patient with no
psychiatric illness
One young professional
volleyball player
None reported
2 patients
Migraine headaches
None reported
Paranoid-type schizophrenia
and alcohol dependence
in full, sustained
remission
None reported
Unknown
None reported
None reported
Unknown
Symptoms
APPENDIX Representative Sample of Adverse Events Reported in Association With Nonalcoholic Energy Drink Consumption
Red Bull
SPIKE Shooter
SPIKE Shooter
43
43
32
34
16
75
26
13
114
25 and 38
27
29
Ref No.
SPECIAL ARTICLES
527
528
Seifert et al
Source of
Information
APPENDIX Continued
Diabetes
None reported
None reported
None reported
Seizure
Symptoms
119
28
25 and 38
Ref No.