More research : regulation needed on energy drinks

A new review of the existing evidence suggests that energy drinks may represent a looming public health threat in Europe, especially for kids and young adults.

The main health risks from energy drinks come from very high caffeine levels and a higher likelihood of consuming alcohol and tobacco with the drinks, as well as engaging in other risky behaviors, the study team says in the journal Frontiers in Public Health.

There are also ingredients other than caffeine in some of the drinks – such as guarana and taurine - whose effects are so poorly studied it’s hard to say whether they’re safe in large quantities and in children and teens, the authors add.

“The way these beverages are marketed can also sometimes be a challenge given they apparently target young people,” said Joao Breda, who led the study.

Breda is with the World Health Organization Regional Office for Europe, but the paper does not reflect WHO views or policy, he notes.

About 500 new brands of energy drinks were released worldwide in 2006, he and his colleagues write.

In the U.S., sales of energy drinks have increased by about 10 percent per year between 2008 and 2012. A European Food Safety Authority study in 2011 found that 68 percent of adolescents aged 10 to 18 years old, 18 percent of children under age 10 and 30 percent of adults in the European Union were consuming energy drinks.

Breda said his team reviewed existing studies because public health researchers had asked for more concrete and updated information on the issue of energy drinks.

“We then realized very few studies were available and thought it could be a good idea to summarize the scarce and still insufficient evidence available,” he told Reuters Health in an email.

The researchers selected papers that had looked at the adverse effects of energy drinks and found that much of the potential risk comes from the caffeine in the drinks.

In Europe, for example, energy drinks are responsible for 43 percent of the caffeine consumed by kids and 18 percent of the caffeine consumed by teens, according to the 2011 study.

On average, people in that study consumed an average of one liter (34 ounces) of the drinks per month, but some drank more than four liters per month and more than 13 percent of young adult consumers reported drinking up to one liter per session.

The research Breda’s team reviewed also showed that teens who consumed energy drinks were more likely to use tobacco and other harmful substances, to drink alcohol and to be at a greater risk for depression and physical injuries requiring medical treatment. (See Reuters Health stories of March 5, 2014, here: reut.rs/12cF9is and December 12, 2013, here: reut.rs/1CWEhd2).

About 70 percent of young adults who drink energy drinks mix them with alcohol, the study team found.

“Due to their stimulant effect they may cover up the fatigue and drunkenness effect of alcohol leading to heavier alcohol consumption and incorrect perception of actual state especially in inexperienced drinkers, namely adolescents,” Breda said.

But the drinks are marketed with an emphasis on their ability to boost energy and enhance focus, and the marketing is largely targeted to young males, according to the report.

Many of the concerns about energy drinks do seem to be related to caffeine, said Christopher Gindlesperger from the American Beverage Association, but he pointed out that most mainstream energy drinks contain about half the caffeine of a similar sized cup of coffee.

“Importantly, leading energy drink makers also voluntarily display total caffeine amounts from all sources on their packages,” he told Reuters Health.

Gindlesperger said energy drink makers also display an advisory statement on their packages indicating that the product is not intended (or recommended) for children, pregnant or nursing women, or persons sensitive to caffeine.

“And they do not market energy drinks to children or sell or market them in K-12 schools,” he noted.

“It appears clear that excessive or irresponsible consumption of energy drinks does represent a public health problem,” said Michael Siegel, a researcher at the Boston University School of Public Health who was not involved in the review

“The problem of very high caffeine content in some brands could be dealt with effectively through legislation that places a limit on the maximum allowable amount of caffeine in these beverages,” Siegel said.

But, he added the problem of youth mixing alcohol and energy drinks is more insidious and more difficult to deal with.

“The FDA has already removed from the market all malt-type beverages that contain caffeine,” he said in an email.

But, Siegel added that many young people mix caffeine into alcoholic beverages on their own.

“What is perhaps needed are educational campaigns that teach youth about the negative consequences of mixing caffeine and alcohol,” he said.

Rebecca McKetin said that in addition to the caffeine, people should also be aware of the high sugar content of these beverages.

“People are effectively consuming a lot of soft drink, which increases their risk of obesity, diabetes, tooth decay etc.,” said McKetin, of the Australian National University’s Center for Research on Ageing, Health and Well-being in Canberra.

McKetin said there is a convenience factor in the delivery of caffeine in these drinks that opens up opportunities to consume them in a manner that is different to what we have seen with traditional caffeinated beverages such as tea and coffee.

“It is much easier to open a can of Red Bull than to make an espresso, and the sugary additives in energy drinks masks the bitterness of the caffeine,” she told Reuters Health in an email.

Back to School Success

Q: My son is an angel at school but a terror at home. He was even student of the month last school year. But when he gets home, our home is absolute chaos and he is just nasty to me.

A: Many children work to be 'normal' all day long at school so when they get home, they are exhausted. The result is they collapse into negative behaviors. When they are stressed at school, they hold it together all day long and then in their 'unwinding' of the day, they become "terrors."

Due to early experiences of trauma, children can become sensitive to environmental stressors. Their regulatory systems have been compromised and they have difficulty remaining calm and behaved when faced with the challenges of a school setting.

Additionally, children become fragmented and split between home and school. Many parents report that they literally have two different children in these two different environments. This fragmentation is not healthy to the child's overall development of the self so it is important that this be addressed effectively for the child. 

When we look at the dynamic of the school setting, consider the energy it takes for your child to maintain appropriate behaviors at school is far greater than the average student. He may look well put together externally, but internally, he is running at high speed to ensure he becomes the perfect student. Thus, when he gets home, it is as if he has run a marathon; he is exhausted, unable to hold it together anymore. 

In order to create more balance for your child, consider ways to reduce some of the major stressors he experiences at school:

Social stress - Peer interactions are exceptionally stressful, especially for children who function at a lower emotional level than their peers. Some children may need less social time and more time-in with a regulated adult at the school. 

Transitioning from one activity to another - Transitions such as going from the playground to the classroom, from art to P.E., and from the cafeteria to the classroom, are difficult for many children. Many of the traumatic experiences of children happened around transition, so they are going to be sensitive in this area and may need additional support. 

After school care - Staying at school for an additional hour or two is stressful after a full day of school. Children just need to go home after school. After-school care is typically less structured and less predictable, which is a horrible combination for a child who is already stressed out by this time of the day. 

Teachers - The type of teacher your child has can determine the entire outcome of the child's school year, both positively and negatively. A calm, regulated teacher, who has control of the classroom, well-established boundaries, and reasonable expectations for your child will help your child maintain his own level of regulation during the school day. 

Riding the school bus - If your child is sensitive to loud environments and chaotic social situations, the school bus is not an option. He needs you to take him to school and pick him up from school. Helping your child transition from home to school through a peaceful car ride can set your child up for a successful day. Remember that the number one responsibility you have as a parent is to drop your child off at school as regulated and calm as possible. This gives him at least a fighting chance and a larger window of stress tolerance as he faces a stressful day. 

Stress-inducing requirements - Alternatives that reduce stress instead of increase stress need to be explored and established for your child either through a 504 Plan or an IEP (Individualized Educational Program). Many times it is the small things that can make a huge impact. For example, timed testing can completely throw a child into a stress reaction, impacting your child’s ability to think clearly, and should be avoided. 

Also, just the thought of coming home and doing homework for many children creates a stress reaction. Some families have been able to write into the child's IEP that homework will not be required because it creates too much chaos in the home.

Another major point to consider is that your child's relationships at school are very different from his relationships at home. School relationships are indiscriminate. They don't require close connection, thus they are safer. Close relationships, like parent-child relationships, require intimacy which requires vulnerability. For children with traumatic histories, their trauma happened in the context of close relationships. This sets your child up to be in fear of connection of you, not with the milkman or of teachers, but of you, the person closest to him. 

As you are able to parent within a love-based framework, you are establishing an environment that decreases the threat of this relationship. If you need more examples of how to parent in a loving way while still maintaining rules and boundaries in your home, see my Q&A book, "Dare to Love." Real examples of how to apply the Beyond Consequences principles are given throughout the entire book.         

I also encourage you, as the parent, to check in with yourself. Determine how you are feeling and what messages are swirling around in your mind. It's easy to get into a framework that says to your child, "If you can behave for your teacher at school, then my gosh, I'm your parent...you can certainly behave for me!" 

It's very easy to take it personally and to interpret your child's negative behavior as an attack on you. As a parent, you are working so hard as to help your child, to heal them, and to love him/her. Yet, the reality is that they don't know what to do with the stress from school and they are still living in fear of connection with you. The struggle is not with you; it is with themselves. Continue to go beyond the obvious and reach to the core of the issue---fear and stress.