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Canadian Medical Association Journal calls energy drinks: drugs delivered as tasty syrups

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With Health Canada's recent approval of pre-mixed alcoholic versions for sale and the death of a 15 yr old boy, the topic continues to be hot

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Following up on a recent post about the safety of energy drinks (particularly for children and adolescents) and their categorization as a "natural health product" (June 2010), we note that now even the Canadian Medical Association Journal has come out against the sale of energy drinks to minors.

From the CMAJ editorial called "Caffeinating" Children and youth:

• most of us have enough common sense not to willingly allow children to consume 10 cans of cola in one sitting — the amount of caffeine in 500 mL of some energy drinks.
  
  
• These sugar-loaded syrups typically contain 80 to 140 mg of caffeine per 250 mL — the equivalent caffeine in one cup of coffee or two cans of cola. However, beverage companies are offering formulations with caffeine concentrations as high as 500 mg per can in US products such as Wired X505^TM and Fixx^TM.


• even [caffeine] tablets with two and one-half to five times less caffeine have mandatory health warnings guarding against use in children and cautions to limit use because too much caffeine may cause nervousness, irritability, sleeplessness and, occasionally, rapid heart rate.


• many energy drinks are still considered foods that only list ingredients.


• A study of 100 US adolescents aged 12 to 18 found that 73% consumed 100 mg or more of caffeine per day, with most consumption in the evening, the time of day most likely to negatively affect sleep. Poor sleep quality and quantity in adolescents has been associated with mood disorders, exacerbation of asthma, obesity, lower sense of well-being and poor school performance.

In context, Health Canada's own recommendations for caffeine intake suggest (emphasis ours):

• The general population of healthy adults is not at risk for potential adverse effects from caffeine if they limit their caffeine intake to 400mg per day;
  
  
• For women of childbearing age, the recommendation is a maximum daily caffeine intake of no more than 300 mg, or a little over two 8-oz (237 ml) cups of coffee.
  
  
• Health Canada has not developed definitive advice for adolescents 13 and older because of insufficient data. Nonetheless, Health Canada suggests that daily caffeine intake for this age group be no more than 2.5 mg/kg body weight.

and:

For children age 12 and under, Health Canada recommends a maximum daily caffeine intake of no more than 2.5 milligrams per kilogram of body weight. Based on average body weights of children, this means a daily caffeine intake of no more than:

• 45 mg for children aged 4 - 6;
• 62.5 mg for children aged 7 - 9; and
• 85 mg for children aged 10 - 12.

Equally, they acknowledge studies on the effects of too much caffeine examining the following outcomes:

• general toxicity (e.g., muscle tremors, nausea, irritability)
• cardiovascular effects (e.g., heart rate, cholesterol, blood pressure)
• effects on calcium balance and bone health (e.g., bone density, risk of fractures)
• behavioural effects in both adults and children (e.g., anxiety, mood changes, attentiveness)
• potential links to cancer
• effects on reproduction (e.g., male and female fertility, birth weight)

And then promptly muddies the water by stating they don't actually regulate or even know how much caffeine is in the energy drinks - and neither will you:

You should also be aware that some of the caffeine in energy drinks may come from herbs, such as guarana and yerba maté. The label on these energy drinks would list the herbs as ingredients, but the caffeine in the herbs may not be listed as a separate ingredient. By law, caffeine does not have to be listed on labels unless it has been added to the product separately as a pure substance.

Predictably, the beverage industry shot back with a media release that nitpicked about the status of energy drinks in Denmark, and claimed that:

These energy drinks are intended for adults and clearly indicate on the label that this category of beverage is not recommended for children, pregnant or breastfeeding women and people who are sensitive to caffeine

...while still marketing them to children and young adults (e.g. the alcoholic version).

 On the other hand, all it does when you ban the beverages for those 18 and younger, is make it more appealing.  It's the same problem with smoking: you have to target the marketing. Kill the fantasy of what it makes them look like in other's eyes, and the appeal goes with it.

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