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Unhealthy buzz with excessive energy drink consumption

Posted on June 17, 2013

Caffeine and taurine; to tired students cramming for exams it sounds like a winning combination. Health academic Caleb Ferguson, however, is calling for caution as the much lauded energy drinks can carry a number of nasty, and embarrassing, side effects.

In the British TV comedy The Inbetweeners, the main character Will McKenzie spectacularly overindulges in energy drinks prior to his exams. Thanks to the stress and overindulgence, he suffers explosive diarrhea during his final test, much to his embarrassment. A lesson well learned that energy drinks cause gastrointestinal upset.

June spells exam period at UTS and at universities across Australia. For many students this month is stressful and will prompt several hours slumped over a desk, cramming and studying hard for the end of semester exams. Whether intentional or not, sometimes students leave preparation until the 11th hour, resulting in several nocturnal hours spent in last-minute preparation.

For many, this is when energy drinks become the go-to. Caffeine is a stimulant drug commonly used to assist with maintaining alertness and combating sleep deprivation. Caffeinated, carbonated energy drinks are readily accessible and heavily marketed to students, sportspeople and drivers. This marketing is enforced through attractive, modern product design and sponsorship of extreme sports and events.

They’re also widely available through local convenience stores and service stations, as well as more broadly in supermarkets and in vending machines. Consumer research shows an estimated $15 million was spent on the marketing of energy drinks in Australia alone in 2009.

Researchers have also found students consume energy drinks between one and four days a month. And, that young adults had three or more such drinks with alcohol when partying.

Perhaps it’s no surprise then that students, particularly young males 19 to 24 years of age, are the highest consumers of all types of sugar-sweetened beverages. Fifty-eight per cent of this group consumes an average of 2.1 cans per day (800 milliliters). This consumption of sugary soft drinks contributes to the development of diabetes and obesity, both of which are risk factors for cardiovascular disease and stroke. Globally, soft drinks consumption poses a major health concern.

Energy drink manufacturers in Australia and New Zealand are required by law to advise in print on the packaging: “This food contains caffeine and is not recommended for children, pregnant or lactating women and individuals sensitive to caffeine”. They are also expected to advise consumers to limit intake to a maximum of two cans in one day. The ingredients commonly include caffeine, taurine and sugar; a standard can of RedBull contains 80 milligrams of caffeine in a 250 milliliter can.

A study funded by Red Bull showed that energy drinks can be helpful in improving physical performance in sport and increased cognitive function, including choice reaction time, concentration and memory. However, there is increasing concern in the health profession regarding the potential negative health implications. A growing body of evidence and increased reporting of adverse events underpin this concern.

The “Jägerbomb”, is a popular way to combine alcohol and energy drinks. It is comprised of a shot of the alcohol Jägermeister dropped into a glass of Red Bull, which is then consumed at rapid pace. The drink delivers an alcohol, sugar and caffeine fix and can be consumed with high frequency.

Research from 2010 suggests that adding alcohol to energy drinks leads to an increased rate of absorption through the carbonation and dilution of the alcohol. This allows the drinker to stay awake for longer and consume an even greater amount of alcohol through binge drinking. It also lessens the appearance of drunkenness, but not its effects.

My current doctoral research examines atrial fibrillation (an abnormal heart beat), which can be caused by the excessive consumption of energy drinks. This irregular heartbeat may be temporary (atrial flutter or paroxysmal atrial fibrillation), however it can have a lasting effect (permanent atrial fibrillation).

Consuming energy drinks has been associated with a number of other health complications including gastrointestinal upset, irritability, anxiety, headache, nervousness, insomnia, hallucinations, seizure, irregular or rapid heartbeat, heart attacks and death.

Last year the US Food and Drug Administration investigated a well-known brand of energy drinks due to their association with deaths. In one of the cases, a teenager, Anais Fournier, had consumed just two 24-ounce cans of energy drinks. The autopsy reports concluded “cardiac arrhythmia due to caffeine toxicity” which had exacerbated a pre-existing heart problem.

Clinicians have also raised concerns that energy drinks may not only trigger cardiovascular events, but also unmask underlying genetic cardiovascular disorders. This includes conditions such as Long QT or Brugada syndromes, which may cause dangerous heart rhythms (including ventricular fibrillation) and prove fatal.

Needless to say, excessive consumption of energy drinks is fast becoming a public health concern. Research examining the amount of calls to the Australian Poisons Information Centre recorded a 400 per cent increase in annually reported incidents between 2004 and 2010. It found a total of 297 reports about energy drinks recorded over the seven years, noting the number only included cases the centre was alerted to.

This research was limited, and the under reporting of the actual, related emergency room presentations is problematic – clinicians may not be educated to the need to alert the poisons information centre.

Increasingly, it’s becoming obvious that we need to encourage our friends and family to lay off the energy drinks, or at least use them with care. Not only for their personal health, but to avoid an embarrassing ‘Will McKenzie-esque’ experience.

Source: University of Technology Sydney

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