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Energy Drinks - Why would people do this to themselves?

by Borg
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Borg
#1
Jan16-13, 05:59 PM
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I have been drinking coffee for years but I haven't been interested in even trying energy drinks. A recent government report shows dramatic increases in Emergency Department Visits Involving Energy Drinks. With all of the reports of ER visits and, in some cases, deaths, it makes me wonder why anyone would drink this stuff.
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Ryan_m_b
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Jan16-13, 06:03 PM
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I think a lot of it is that people would be unaware if there were any risks. Sure most people would probably say they aren't good for you but in my experience that doesn't rate more than a vague "I probably shouldn't drink this all the time". Couple that with the fact that energy drinks are sold alongside ordinary sodas and sold as mixers it's not surprising that people wouldn't think there's anything that bad.
Simon Bridge
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Jan16-13, 06:20 PM
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Short-term perceived benefits - and a mixture of machismo and social pressure. Same reason the smoke and/or drink alchohol or drive automobiles.

Mind you, there are lots of ER visits from people who have fallen over - makes you wonder why anyone would stand up doesn't it?

The report itself bears some closer examination.
It appears in The Dawn report, the official (if lay-oriented) publication of SAMHSA - which is an arm of the US Department of Health and Human Services.

The report notes a trend from 2005 through 2009 - suggesting but not actually constituting a correlation. Correlation, anyway, is not causation.
The trend is not shown alongside other statistics, like overall ER admissions and overall consumption of energy drinks, which would illuminate it.

The report only notes the presence of the drink in ER admissions - not the cause of the admission - nor does it relate the quantities of the drink involved (many people admitted for choking may have alchohol in their system but did the alcohol cause the choking or is it that choking is more likely during a relaxed dinner?)
- but there are telling statements.

The report notes that half the admissions also had other drugs in their system - perhaps the other drugs were the cause of the admission?

2/3rds of the admissions were classified as "adverse reactions" but to what?
Considering that half involve other substances, the "adverse reaction" could be to one of them or just a normal allergy.

Perhaps people who engage in risky behavior also partake of energy drinks ... there is no indication that the overall ER admission rate has increased along with energy drink consumption.
(That wouldn't be conclusive - since there are lots of things that could contribute to an increase in admissions - however, considering the report is working hard to show you that energy drinks are BAD BAD BAD, if there were such a correlation I'd have expected the report to make a big deal about it.)

Overall, the report reads like the dihydrogen-monoxide scare articles.
i.e. it says that there are reports that energy drinks enhance the effects of caffien and include additives that may be harmful when combined with other substances - but does not say which reports or whether these reports are at all credible. Also does not say which substances.
I hope this is not an indication of the general quality of SAMHSA reporting.

Evo
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Jan16-13, 07:19 PM
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Energy Drinks - Why would people do this to themselves?

This should explain what the issues are.

According to self-report surveys, energy drinks are consumed by 30% to 50% of adolescents and young adults. Frequently containing high and unregulated amounts of caffeine, these drinks have been reported in association with serious adverse effects, especially in children, adolescents, and young adults with seizures, diabetes, cardiac abnormalities, or mood and behavioral disorders or those who take certain medications. Of the 5448 US caffeine overdoses reported in 2007, 46% occurred in those younger than 19 years. Several countries and states have debated or restricted energy drink sales and advertising.

CONCLUSIONS:
Energy drinks have no therapeutic benefit, and many ingredients are understudied and not regulated. The known and unknown pharmacology of agents included in such drinks, combined with reports of toxicity, raises concern for potentially serious adverse effects in association with energy drink use. In the short-term, pediatricians need to be aware of the possible effects of energy drinks in vulnerable populations and screen for consumption to educate families. Long-term research should aim to understand the effects in at-risk populations. Toxicity surveillance should be improved, and regulations of energy drink sales and consumption should be based on appropriate regulations. Although healthy people can tolerate caffeine in moderation, heavy caffeine consumption, such as drinking energy drinks, has been associated with serious consequences such as seizures, mania, stroke, and sudden death.6,–8,11,–14

Consuming 4 to 12 mg/kg of caffeine has been associated with undesirable symptoms, including anxiety and jitteriness.63 Headache and fatigue, common withdrawal symptoms, can occur after short-term, high-dose use.64 Caffeine intoxication is a clinical syndrome of nervousness, irritability, anxiety, insomnia, tremor, tachycardia, palpitations, and upset stomach.6,7,9,14,26,65 Additional adverse effects include vomiting and abdominal pain, hypokalemia, hallucinations, increased intracranial pressure, cerebral edema, stroke, paralysis, rhabdomyolysis, altered consciousness, rigidity, seizures, arrhythmias, and death.1,2,8,29,48
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3065144/
Astronuc
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Jan16-13, 09:15 PM
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Quote Quote by Borg View Post
I have been drinking coffee for years but I haven't been interested in even trying energy drinks. A recent government report shows dramatic increases in Emergency Department Visits Involving Energy Drinks. With all of the reports of ER visits and, in some cases, deaths, it makes me wonder why anyone would drink this stuff.
Poor judgement on the part of those who consume such drinks. Same kind of poor judgement that teens and young adults express when getting so drunk they pass out and in some cases injure themselves or others.
Simon Bridge
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Jan16-13, 09:45 PM
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Well done Evo - that would be the second citation in the report's end-notes.

METHODS: We searched PubMed and Google using “energy drink,” “sports drink,” “guarana,” “caffeine,” “taurine,” “ADHD,” “diabetes,” “children,” “adolescents,” “insulin,” “eating disorders,” and “poison control center” to identify articles related to energy drinks.
... i.e. it is a meta-study where the selection criteria may be biased towards those papers unfavorable to energy drinks.
[edit: i.e. consider - what sort of research would combine "poison control center" with "children" and "caffeine"? Try doing a search on "stuffed toys", "children" and "poison center" for example.]

Half of the energy drink market consists of children (<12 years old), adolescents (12–18 years old), and young adults (19–25 years old).7,–,10
... what proportion of the US population is under 25? What proportion of ED visits?
It's actually quite difficult for me to track this down - perhaps a native would have more luck. The stats for 2007 (the year used) are divided into unhelpful blocks at the 17/18 year divide. Same with the ED visit stats: eg. http://www.cdc.gov/nchs/data/databriefs/db38.pdf
[edit - the study means to justify why they focus on under 25s.]

Still ... this study, by itself, and with the citations within, would be a good reason to look further.
[edited for emphasis]

[edit: People who are unused to scientific literature are often at a loss when it comes to assessing various claims, especially when they contain alarming sounding elements... some questions to consider when reading these documents are:]

There is reason for concern - but how much concern?
How much of a concern is this compared to other health priorities?
How scared should people be compared with all the other things they have to be scared of?
How much do we want the government to coddle the population?

Is the level of hysteria in the SAMHSA report [see link post #1] supported by the evidence available?
There are six studies in the endnotes.

1. an FDA study from 2007 on the effects of caffeine on the body from 2007
... since caffeine is a regulated additive, then regulating it in energy drinks as well is probably on the cards.

2. a study on the effects of energy drinks on adolescents
... cited, in the report, as evidence that adolescents drink energy drinks. gosh!
http://www.pediatricsdigest.mobi/content/127/3/511.full

3. (2011) researchers discover that energy drink companies do market research (using social media)
... cited as evidence that energy drinks companies do market research.

I think the idea in the above two is to show that the companies are targeting people deemed vulnerable to adverse effects from their product. This is not sinister - the companies are researching their marketplace. We can also expect marketing to be attractive to the people in the market... the report implies that the marketing reinforces risk-taking behavior.

4. 2009 press release by MINTEL: a marketing firm(?)
- energy drink ingredients unhealthy
- so is candy.

Could manufacturers promoting energy drinks as healthy be prosecuted for false advertising?

5. energy drinks are associated with problem behaviors
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2575122/
Frequency of energy drink consumption was positively associated with marijuana use, sexual risk-taking, fighting, seatbelt omission, and taking risks on a dare for the sample as a whole, and associated with smoking, drinking, alcohol problems, and illicit prescription drug use for white students but not for black students.
... wild! However - does this mean that energy drinks promote risk-taking or that whites pre-disposed to risk-taking will also consume energy drinks? Corellation is not causation.

6. people who consumed energy drinks mixed with alcohol in bars were more likely to leave intoxicated and more likely to drive.
http://www.ncbi.nlm.nih.gov/pubmed/19954894
Possibly they feel alert? I wonder if, prior to energy drinks, people who had a strong coffee at the end of the night would be more likely to drive? What proportion of people stopped on suspicion of DUI chew gum?

The researchers correctly call energy-drink consumption an indicator of risky behavior rather than a cause. Similar to gum-chewing and tattoos.

I didn't see what proportion of bar-patrons this indicator would apply to but it seems part of the "stimulants make you less drunk" myth.

Personally I expect better from my government.

Probably the best research was reference #2 (the meta-study - trying to find other papers citing this one)... and those researchers have some advise:
http://www.pediatricsdigest.mobi/con...11.full#sec-24
... compare with the SAMHSA report in content and tone.

They (see endnote #2) basically advocate a calm and targeted education and awareness approach - particularly with health professionals and people who work with adolescents. The regulation comment is wide open - compare regulation for tobacco, alcohol, and prescription meds? It is not clear which end of the spectrum the researchers favor, but the preceding call for more research suggests they are saying they just don't know.

And that is what I got from the SAMHSA report - but with more alarm and less qualification - there is not enough information to know how much we should be concerned or how best to react.
Evo
#7
Jan16-13, 10:53 PM
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Yes, it's a meta study, and it focuses on young people since they are primarily the age group that use these products.

My take was that, as it said
these drinks have been reported in association with serious adverse effects, especially in children, adolescents, and young adults with seizures, diabetes, cardiac abnormalities, or mood and behavioral disorders or those who take certain medications.
To me, this means that the users have the other isues listed that the drinks exacerbated. That was in the first paragraph. That said they HAD those conditions, or med use, not that the drinks caused them. The drinks are thought to have made the pre-existing conditions worse. Did you read that differently?

the short-term, pediatricians need to be aware of the possible effects of energy drinks in vulnerable populations and screen for consumption to educate families. Long-term research should aim to understand the effects in at-risk populations.
Simon Bridge
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Jan17-13, 12:59 AM
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Did you read that differently?
I'm sorry - do you mean to ask me?

My primary intention was to give the SAMHSA report (linked, post #1) the skeptical treatment ... it seemed to be somewhat sensational and looked like it was going out of it's way to give the most alarming spin on the available statistics.

Seifert and Schechter authored a metastudy which was published (2011) in Paediatrics.
The passages you quote come from the conclusion notes which form part of the abstract.

I do not intend comments on the SAMHSA report to be confused with comments on this one ... I'll go back and tidy it up. I have intended to contrast Seifert 2011 with SAMHSA - particularly in the tone and content of the conclusions and advise.

Thanks for the heads up - I'll have to go back and see if I can be clearer.
RabbitWho
#9
Jan19-13, 12:02 PM
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I had no idea they were dangerous. I don't think it's "poor judgement", I thought it was the same as drinking a can of coke and no more unhealthy than that. It's poor judgement to drink a large amount of alcohol, because there is no way you are not aware of the dangers. It is not obvious that drinking something strawberry flavored and marketed at kids is harmful.
There are no warnings on the labels as there are with alcohol and cigarettes and before now I have never heard of anyone getting sick because of this. I assume dangerous things have warnings on them. I don't have time to search for online articles about every single thing I eat or drink.
Simon Bridge
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Jan19-13, 05:07 PM
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I had no idea they were dangerous.
You had no idea that caffeine and sugar were dangerous?
Maybe there is something to be alarmed about after all?

Everything is "dangerous" to some degree...
How dangerous? Does the report quantify the risks?

Here's an exercise - look up the health risks from coca cola.
Compare.

I would imagine the caffeine risk is lower by volume consumed simply because the caffeine level is lower. But what are the studies telling you?

My reading of the study - it looks more dangerous than coke and less than a random food allergy ... The main concern expressed in the reports is for people, especially children (i.e. under 12), who have some medical condition that makes them vulnerable to caffeine reactions.

I guess I could make a case for a warning label in the same way that there are labels warning of egg or nut content. The manufacturers would love it! In NZ they put warning labels on pretty much voluntarily... it allows them to highlight the high caffeine and guarana content.

How old are the people in the energy-drinks ads in the US? Here they are all 18-25 though what they do tends to appeal to adolescents (risk takers), say, 12+ ... in NZ you are "of age" at 16yo and we educate our children accordingly so it is difficult for me to assess the relative maturity and competence of US adolescents.

There is always a case for improving education.
Do you really need scare tactics to get things done in the US?

Regulation on ingredients would need to take account of the possible reinforcing effect of other additives on caffeine. If you want the stimulant levels similar to, say, coke, then the legislation would have to be worded like that: putting the onus on the manufacturer to do the research.

I don't think scientific reports (or any) should be taken at face value - especially if they support a previously held position. Standard skepticism should apply.
RabbitWho
#11
Jan20-13, 06:41 AM
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Quote Quote by Simon Bridge View Post
You had no idea that caffeine and sugar were dangerous?
Maybe there is something to be alarmed about after all?

Everything is "dangerous" to some degree...
How dangerous? Does the report quantify the risks?

Here's an exercise - look up the health risks from coca cola.
Compare.

I would imagine the caffeine risk is lower by volume consumed simply because the caffeine level is lower. But what are the studies telling you?

My reading of the study - it looks more dangerous than coke and less than a random food allergy ... The main concern expressed in the reports is for people, especially children (i.e. under 12), who have some medical condition that makes them vulnerable to caffeine reactions.

I guess I could make a case for a warning label in the same way that there are labels warning of egg or nut content. The manufacturers would love it! In NZ they put warning labels on pretty much voluntarily... it allows them to highlight the high caffeine and guarana content.

How old are the people in the energy-drinks ads in the US? Here they are all 18-25 though what they do tends to appeal to adolescents (risk takers), say, 12+ ... in NZ you are "of age" at 16yo and we educate our children accordingly so it is difficult for me to assess the relative maturity and competence of US adolescents.

There is always a case for improving education.
Do you really need scare tactics to get things done in the US?

Regulation on ingredients would need to take account of the possible reinforcing effect of other additives on caffeine. If you want the stimulant levels similar to, say, coke, then the legislation would have to be worded like that: putting the onus on the manufacturer to do the research.

I don't think scientific reports (or any) should be taken at face value - especially if they support a previously held position. Standard skepticism should apply.

I am afraid that I was not giving you the excuse you thought I was giving you to allow you to voice your feelings of superiority over Americans. I am Irish.

I'm aware that coke is really unhealthy but at the same time I know people who drink 2 liters a day and they suffer from depression and obesity.. they don't go to the emergency room, and I've never read anything about anyone drinking coke and having to go immediately to the hospital.

Redbull is marketed in Ireland using cartoons, maybe you could claim the cartoons are aimed at adults but they certainly appeal to children. I don't have a TV anymore but I went to a friend's house to watch that skydive they sponsored and you can't tell me that doesn't appeal to kids!
The other energy drinks here all look like weapons from power rangers episodes. They're not packaged like say cigarettes, alcohol, condoms, screwdrivers, ikea products and other things that only adults buy.
If a warning would encourage some people to buy it that's one thing, but at least it would allow everybody to know that this is not a safe product. I mean you can't say "let's not tell anyone about the speed limit because you know some people would see that as a target"

I wouldn't have thought of drinking energy drinks as being different from drinking coke. I mean coke is something that will make you ill after longterm use, I can't see it causing harm to most people who just drink it once a year for a treat.

I mean I've never read the ingredients in RedBull and I doubt a lot of people have, they highlight the Spring Water and the high levels of Vitamin D so the tendency is to trust them and assume that's where the effect comes from? I assume there are people whose job it is to protect us from dangerous products. I don't have time to become an expert in nutrition so I can buy the safest food and and expert in mechanics so I can buy the safest car and an expert in meteorology and volcanoes and earthquakes so I can buy the safest house.. I assume that the experts make sure that dangerous things aren't sold, or that if I'm buying a house next to a volcano someone will at least tell me about it!
OCR
#12
Jan21-13, 02:51 AM
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Quote Quote by RabbitWho View Post
I've never read the ingredients in RedBull and I doubt a lot of people have
Well here they are, for anybody or everybody...

http://www.redbull.com/cs/Satellite/...4&pcs_pvt=faqs

http://en.wikipedia.org/wiki/Red_Bull#Ingredients

http://en.wikipedia.org/wiki/Red_Bull


When you have too much energy from Energy Drinks, you can easily deplete the excess with Anti-energy drinks... lol

http://en.wikipedia.org/wiki/Chill-o...-energy_drinks

Mary Jane's Relaxing Soda might be the best... just a guess.

http://en.wikipedia.org/wiki/Mary_Ja..._Relaxing_Soda

http://www.relaxingsoda.com/#/mary-jane-s-relaxing-soda

Better check with DAWN, about saftey, though...

Well, maybe not... lol
A report released by DAWN in 2002 claims that marijuana overdose alone resulted in documented deaths in Atlanta and Boston, respectively. However, there is no known record or evidence to support the existence of a case of human fatality by result of marijuana overdose.


OCR
RabbitWho
#13
Jan21-13, 08:04 AM
P: 103
"
What proof is there that Red Bull Energy Drink does what it says it does?

Numerous scientific studies* in the fields of sports medicine and psychology confirm the effects described for Red Bull Energy Drink. All scientific studies were done by independent third parties, are published in peer-reviewed journals and can be found in public databases.
"

I think those studies should be revised because I've never once grown wings after drinking Red Bull, or any energy drink for that matter.
Borg
#14
Jan21-13, 09:12 AM
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Quote Quote by RabbitWho View Post
I think those studies should be revised because I've never once grown wings after drinking Red Bull, or any energy drink for that matter.
Maybe they're referring to the ones that you get after you die.
lisab
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Jan21-13, 11:29 AM
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Quote Quote by Borg View Post
Maybe they're referring to the ones that you get after you die.
....well, unless...
Simon Bridge
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Jan21-13, 07:34 PM
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Quote Quote by RabbitWho View Post
I am afraid that I was not giving you the excuse you thought I was giving you to allow you to voice your feelings of superiority over Americans. I am Irish.
Hmmm... well I did assume you were from the US. Which just goes to show: nevver assume... :D

Did not mean to sound smugly superior to the yanks - but it should cancel out since so many of them do it the other way. I intended to point out that my POV may make my judgement somewhat off. Since the SAMHSA report is from the US government, it is presumably aimed at US citizens, and it may be appropriate for the US. I wouldn't really know.

I've never read anything about anyone drinking coke and having to go immediately to the hospital.
It is almost certainly the case that someone has had a drink of coke and had to go immediately to hospital ... or that people show up to ER with coca cola in their systems. Coke is a pretty popular drink after all.

None of the papers cited in SAMHSA say that the ER visits are [i]due[/] to the consumption of energy drinks. Only that the stuff was in their system at the time of the visit (see the endnotes.)

I bet that, in the 70's, there was an upwards trend of men with long hair getting treatment in ERs. It may be that the trend in people with energy drinks in ER just follows the trend in risk-takers drinking the stuff.

Redbull is marketed in Ireland using cartoons, maybe you could claim the cartoons are aimed at adults but they certainly appeal to children. I don't have a TV anymore but I went to a friend's house to watch that skydive they sponsored and you can't tell me that doesn't appeal to kids!
All sorts of things appeal to kids without being marketed at them ... but lets be clear: the cited research defines "child" as a person 12 years old or less. How do the Red Bull cartoons compare with the kinds of cartoons usually directed at these youngsters?

The research shows that 1/2 the US market is in the 0-25yo group.
Interesting to check the proportion of the US population in that range aye?
But it is not too surprising since the 15-25yo group are overrepresented in all risky pursuits

The other energy drinks here all look like weapons from power rangers episodes. They're not packaged like say cigarettes, alcohol, condoms, screwdrivers, ikea products and other things that only adults buy.
That only adult Irishmen buy aye... noted.
In NZ, the energy drinks look a lot like RTDs. I've also seen cola packaged like beer.

There is a tendency for risks to children to be over-emphasized though so we have to be careful when assessing them.

If a warning would encourage some people to buy it that's one thing, but at least it would allow everybody to know that this is not a safe product. I mean you can't say "let's not tell anyone about the speed limit because you know some people would see that as a target"
Oh no - that's not what I meant. I just didn't think that the drinks being unhealthy was a secret. NZ cans usually have some sort of warning.

I wouldn't have thought of drinking energy drinks as being different from drinking coke. I mean coke is something that will make you ill after longterm use, I can't see it causing harm to most people who just drink it once a year for a treat.
If any of the studies in the SAMHSA report demonstrated that anyone was hospitalized as a result of having a single drink I missed it. Can you point it out for me. The only one that examines the statistics seesm to be concerned about "at risk" people - like teens who could drop dead from the exertion of normal PE classes for example.

I assume there are people whose job it is to protect us from dangerous products. I don't have time to become an expert in nutrition so I can buy the safest food and and expert in mechanics so I can buy the safest car and an expert in meteorology and volcanoes and earthquakes so I can buy the safest house. I assume that the experts make sure that dangerous things aren't sold, or that if I'm buying a house next to a volcano someone will at least tell me about it!
1. nobody expects you to be an expert - you don't have to be to assess risk from available information - and, indeed, assess available information. I think we should demand good information from the experts who talk to us. (...and remember to take "expert" in two parts...)

2. the experts cannot prevent dangerous things being sold unless they can show that they are very dangerous indeed - the studies do not show this. How much do you think the general population should be "saved from themselves" by the government? (Note: in the US, iirc, there is less of a mandate for the governments to meddle in public health than in countries with a more socialized health system. We are probably not comparing with the same things.)

3. having bought a house near a number of volcanoes, currently living in one, and having talked to many others who have, and researched real estate in these areas - I can report that nobody will tell you. It is up to you to find out. (The cone is usually a bit of a clue - but not all volcanoes are, erm, volcano shaped.)

I'm not saying that energy drinks are not dangerous, I am saying, like the better studies, that there is grounds for more research and, where a particular risk is identified, more education. Your comments have convinced me that more education is probably warranted than I thought - particularly along the lines of critical inquiry.

OTOH: this is the POV of someone who lives on the edge of a volcano :)


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