HEALTH -- January 31, 2013 at 1:32 PM ET
Should Parents Worry About Energy Drinks?
Red Bull photo courtesy of flicker user sarah_lincoln.
If you're like many Americans, you probably consume at least one caffeinated beverage each day, starting with that morning jolt in a cup of coffee.
I used to look forward to my morning visit to Starbucks almost as a ritual. But no more. My doctor made the morning pilgrimage off limits because it was causing some health issues.
It had never occurred to me that caffeine -- which is in coffee, soft drinks and energy drinks -- is an unregulated drug. And I certainly had no idea that too much of it can make you sick.
Energy drinks have been getting an especially bad rap lately -- including an FDA investigation -- because they contain large amounts of caffeine. Yes, they give you a burst of energy, but there's also a chance they can send you straight to the emergency room if you drink too much.
Roland Griffiths of Johns Hopkins Medicine knows a lot about the dangers. He's been studying caffeine for much of his career -- especially things like how much of it is enough to cause a reaction (yes, one can of soda will do the trick) and why habitual coffee drinking doesn't just alleviate that groggy feeling in the morning, it can actually help create it.
That research has also informed his belief about how concerned parents should be about caffeinated beverages, including energy drinks. Griffiths spoke with me earlier this week about some of the risks. Our conversation has been edited for clarity and length.
BETTY ANN BOWSER: Dr. Griffiths, thank you so much for joining us. Caffeinated beverages have been around for many, many years, but lately there's been particular concern about adverse effects. What's new here?
ROLAND GRIFFITHS: What's new here -- and this has been building for a number of years -- is that these caffeine-containing beverages have been re-branded and are now being aggressively marketed mostly to young people, with the message that they're useful for enhancing athletic performance, extreme sports and mental performance. The marketing of energy drinks is markedly different from the way soft drinks have been marketed historically.
BETTY ANN BOWSER: How so?
ROLAND GRIFFITHS: This goes back many years. In the early 1900s, there was a famous suit against the Coca-Cola company, with the claim being that Coca-Cola was adding caffeine to its beverage -- which it was -- and that it was putting children at risk. And as a consequence of that and some regulatory measures that were taken in the 1950s, the soft drink companies became very sensitized to the fact that they were actively marketing a product to children that contained a drug.
But the FDA included caffeine under the GRAS category -- or "Generally Recognized as Safe -- and they did so on the basis that the soft drink industry claimed that they were adding caffeine to their products only because it was a flavor enhancer. And so the industry essentially disavowed any central nervous system drug properties. For years, if you looked at product descriptions written by the major soft drink manufacturers, they would refer to caffeine as simply a flavor enhancer. If the industry had acknowledged that caffeine was a drug, then that could have changed the regulatory basis under which caffeine had been approved by the FDA for marketing.
Then in the '80s, Red Bull came on the market. And for reasons that still remain puzzling to me, FDA did not object to Red Bull marketing its product even though Red Bull exceeded the 200 parts per million GRAS caffeine limit, and it advertised its product directly as performance enhancement. And that really broke the mold. Up until that point, the soda companies were not advertising their drinks as a stimulant.
From where I sit as a psychopharamcologist who does research with caffeine, it is important to recognize that caffeine is indeed a mood-altering and behavior-changing drug that produces reliable effects. This whole new series of products -- and there are now hundreds of them -- are being marketed for energy and performance enhancement.
BETTY ANN BOWSER: This is increasingly being seen as a problem. In fact, the Substance Abuse and Mental Health Services Administration released a report recently that says that this is a continuing health concern and that visits to the emergency room because of energy drinks have doubled in recent years. What do these drinks do to the human body that sends people to the ER?
ROLAND GRIFFITHS: My thought would be that it's who's taking them and how they're being taken, rather the toxicity of the product, per se. What's happened is we're marketing these to younger people -- some of whom are relatively caffeine naïve or may not consume caffeine at all, and they're essentially instructed, implicitly or explicitly, to "slam the can." More is better.
As a consequence, we're now seeing acute caffeine overdoses in ways that seem surprising given the prevalence of Starbucks and coffee and soft drinks in our culture. But the difference is that you don't find people walking into Starbucks and gulping down two venti Starbucks. We've been enculturated to generally sip these products. And so the onset characteristics are different.
It certainly remains a theoretical proposition that some of these additives are contributing to that toxicity. I don't have any data that suggests that they are. But I'm most suspicious about caffeine being the bad agent.
BETTY ANN BOWSER: You mentioned that the effects can be different if you drink a large amount of caffeine at one time. What exactly can happen to the body? What's the risk?
ROLAND GRIFFITHS: Caffeine intoxication is a diagnostic category. If you look up the definition of caffeine intoxication as a psychiatric disorder, you'll find it says, "recent consumption of caffeine, usually in excess of 250 milligrams ... with five or more of the following signs: restlessness, nervousness, excitement, insomnia, flush face, diarrhea, gastrointestinal disturbance, muscle twitching, rambling flow, thoughts and speech ... periods of inexhaustibility, motor agitation."
In other words, it's a caffeine overdose. So people feel awful; they feel sick, their hearts are pounding or beating irregularly. They feel anxious. It's a really unpleasant feeling. And it can be life-threatening.
BETTY ANN BOWSER: But how much is too much? As you mention, one of these energy drinks really doesn't have that much more caffeine than a large cup of coffee. Even if a child "slams the can," is it really that dangerous?
ROLAND GRIFFITHS: It can be significant if they're otherwise caffeine naïve. One of the things we know about caffeine is that it produces tolerance -- that is, if you consume it regularly, your body adapts and it produces much less effect, both physiologically and mentally. Most regular caffeine users have developed significant tolerance. And so that's why people who are regular coffee consumers think, "What's the deal here? This is just the equivalent of a venti Starbucks." But if you're naïve and sensitive to caffeine, that's a huge dose. So my thought would be, for someone who's unaccustomed to using caffeine, if they consume an energy drink relatively rapidly, they may get peak blood levels of caffeine in the toxic range.
ROLAND GRIFFITHS: This is a really complex area given that we're not going to make caffeine illegal. I think certainly at a minimum there should be some kind of labeling. Whether practically you can restrict the sales and consumption of these products to youth or adolescents, I just don't know. But at a minimum I believe there needs to be more labeling and public information and education about it.
BETTY ANN BOWSER: Entirely aside from government action, the people who can probably make a big difference here are parents. What's the take-home message for them? How much should they worry about this?
ROLAND GRIFFITHS: We need to recognize that caffeine really is a drug. And we need to accord it respect as a drug. We need to know what kinds of products contain caffeine and what don't, what happens to us when we take caffeine and what happens to us when we abstain from caffeine after a regular period of use -- because caffeine does produce withdrawal symptoms. As adults, we need to use the drug intelligently and come to know how to use it individually to optimize any performance benefit and to avoid adverse effects.
So should parents be worried? I don't know if "worried" is what I would want for parents, but I would think that the approach should be similar to how they educate their children about the use of alcohol, if they condone the social use of alcohol. We need to educate kids about the use of caffeine and not leave it simply to the market. I think it's an individual parental decision about whether parents want to try to completely restrict caffeinated products or educate kids about caffeine and give them some controlled exposure. You can spin out various consequences of introducing them early or trying to have them abstain from it, and I don't know what the best strategy is.
BETTY ANN BOWSER: Finally, Dr. Griffiths, you've done some fascinating research on caffeine that the average coffee or soda drinker would probably like to hear. Tell us a little about that work.
ROLAND GRIFFITHS: I've done some research showing that caffeine is active at dosages much lower than previously thought. That particular research was important to the initial disagreement we had with the soda companies that were saying they were just adding caffeine as a flavor enhancer -- that turns out clearly not to be true. The doses that are added to sodas are behaviorally and psychologically active.
Our research also demonstrated that caffeine produces a reliable withdrawal syndrome when people abstain from habitual consumption. The syndrome that is characterized by headache, fatigue and bad mood and inability to concentrate. That diagnosis is going to be recognized by the newest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is set to come out later this year. So caffeine withdrawal syndrome diagnosis is now going to be officially recognized.
We've also studied the tendency of caffeine to perpetuate consumption of products that contain it. And we've shown that people can, in fact, become addicted to caffeine in the sense that they want to quit caffeine and they can't. These individuals have a psychological or health reason to quit caffeine, they know that caffeine is exacerbating that condition, they experience withdrawal symptoms when they try to quit, but they can't quit.
It underscores the fact that caffeine is the most widely consumed, mood-altering drug in the world because most of the world's population are habitual, daily consumers. What most people don't recognize is the extent to which they are mildly addicted in so far as they're consuming caffeine in the morning to suppress low-grade withdrawal symptoms. Most people who are habitual caffeine consumers wake up in the morning and feel that they're just not quite themselves -- they're not as alert, they can't concentrate, they're not as energetic as they'd like to be. Then they consume caffeine and low and behold, they feel great. They say, "You know caffeine's a great drug; it wakes me up every morning." And what they're not appreciating is that if they didn't consume caffeine daily, they'd wake up significantly more alert and energetic, and better able to concentrate.
We have a study ongoing now looking at caffeine/alcohol interactions, which of course is a contentious issue -- the mixing of the energy drinks with alcohol.
BETTY ANN BOWSER: Dr. Griffiths, thank you very much for your time. This is really interesting. You're making me think twice about picking up another caffeinated beverage.
ROLAND GRIFFITHS: Well I don't want to imply that you should stay out of Starbucks forever. You can be an intelligent user of caffeine and come to know exactly how it affects you. Turns out if you dial back your caffeine, you become more sensitive to it, so it actually becomes a more effective drug. It's a wonderful drug to have available. Using it optimally is the challenge.
Do you have a health question you would like to see NewsHour health correspondent Betty Ann Bowser address in her weekly blog? Send them to her at email@example.com.