Health pros, pols target energy drinks

Karen Bouffard
The Detroit News
  • Momentum grows to disclose energy drinks' caffeine levels, potential health effects on labels
  • Energy drink manufacturers argue their products are safe and insist they don't market to children

Detroit — Health professionals and some politicians are stepping up pressure on energy drink makers after a recent Wayne State University study found roughly 4,800 cases of harmful effects from the high-caffeine drinks — more than half involving accidental consumption by children younger than age 6.

Momentum is growing for improved labeling to disclose the drinks' caffeine content and potential health consequences, as well as continued efforts to decrease children's exposures to the products. Energy drink manufacturers argue their products are safe and insist they don't market to children.

DMC Children's Hospital of Michigan in mid-January banned energy drinks from its hospital vending machines, citing the dangers posed to children.

In addition, a 30-page report this month from three Democratic U.S. senators called for the federal Food and Drug Administration to require energy drink labels to disclose the drinks' caffeine content and potential health consequences.

The beverage industry and energy drink companies including Living Essentials LLC, the Farmington Hills parent company of 5-hour Energy shots, have defended their products.

Beverage industry "member companies voluntarily display total caffeine content — from all sources — on their packages along with advisory statements indicating that the product is not recommended for children, pregnant or nursing women and persons sensitive to caffeine," the American Beverage Association said this month.

Dr. Steven Lipshultz, pediatrics chairman for Wayne State University and chief pediatrician for DMC Children's Hospital of Michigan, was the lead author on a recent study that found 4,780 calls to Poison Control Centers about non-alcoholic energy drink exposures from October 2010 through September 2013. Of those, 51 percent concerned accidental exposures to children under 6.

"Even though there may be millions sold of these every year, 5,000 people having side effects and many having gone to the hospital — that's not acceptable," he said.

The cases represent the tip of the iceberg, Lipshultz added, because most people who experience heart palpitations, dizziness or nausea after consuming energy drinks don't call a poison control hotline. The study did not include visits to hospital emergency rooms.

The older the child, the more likely it was that the side effects were serious, the DMC study found. About 2 percent of the kids ages 5 and younger experienced moderate to severe side effects, compared with 7 percent of 6- to 12-year-olds, 33 percent of the teens and 64 percent of those 20 and older. Moderate effects are poisoning symptoms that require treatment while severe effects are life-threatening symptoms or poisoning that markedly disables an individual, Lipshultz said.

Major adverse reactions included cardiovascular effects such as heart rhythm and conduction abnormalities as well as neurological symptoms including seizures. Of particular concern are exposures in children.

"Energy drinks have no place in pediatric diets," said Lipshultz, who presented his findings to the American Heart Association's 2014 Science Sessions in November. "And anyone with underlying cardiac, neurologic or other significant medical conditions should check with their health care provider to make sure it's safe to consume energy drinks."

Battle lines drawn

The report released this month by Democratic Sens. Edward Markey of Massachusetts, Richard Durbin of Illinois and Richard Blumenthal of Connecticut claims the industry is unwilling to stop marketing to adolescents. But the American Beverage Association challenged the contention that energy drinks are unsafe and said manufacturers have acted responsibly to keep their products out of the hands of children.

"Leading energy drink manufacturers voluntarily go far beyond all federal requirements when it comes to labeling and education," the association said in a statement. "(Manufacturers) also have voluntarily pledged not to market these products to children or sell them in K-12 schools."

Lipschultz points to the case of Anais Fournier, 14, of Hagerstown, Maryland, who was born with a heart condition. She saw a cardiologist annually, required no medication and had no restrictions on her diet or physical activity, according to the girl's mother, Wendy Lane.

Anais died of cardiac arrhythmia on Dec. 17, 2011, after consuming two Monster Energy drinks over a 24-hour period.

Unbeknownst to her parents, Anais consumed her first-ever energy drink while at the mall with friends. The next day, she went back to the mall and consumed another energy drink. That night, while watching TV at home, she went into cardiac arrest.

"She was gasping for air like a fish out of water," said Lane. "My husband and I got her on the floor and started CPR, and called 911.

"These things are dangerous, and they should definitely not be in the hands of kids or any minor."

In a statement emailed to The News, a Monster Energy spokesperson said, "While Monster is saddened by Anais Fournier's untimely passing, a lawsuit claiming that a Monster Energy drink caused her death is completely unfounded. Prior to her death, Ms. Fournier suffered from serious hereditary heart conditions, which are notorious for causing cardiac arrest and sudden death."

FDA spokesman Theresa Eisenman said the agency has been looking at energy drinks for several years to determine if they pose a risk to consumers, but the agency "frequently finds that there are other complicating factors, such as existing disease or medications the person may have been taking.

"(The) FDA is continuing to monitor the marketplace and analyze the available information, including adverse event reports, and will take appropriate action if that information can be used to establish that any specific product or ingredient is harming consumers."

More than a dozen lawsuits have been filed against energy drink makers, including product liability and wrongful death litigation and class action lawsuits alleging improper labeling. Some have been settled out of court, but most remain in litigation.

Deaths caused by energy drinks may go unnoticed because doctors and medical examiners are unaccustomed to considering the beverages as possible toxins, Lipschultz said.

Caffeine poisoning can occur at levels higher than 400 milligrams a day in adults. Energy drinks can contain up to 400 milligrams of caffeine per can — compared with 100-150 mg in a typical cup of coffee.

But energy drinks often contain caffeine in combination with untested herbal ingredients and chemicals that are also stimulants. Lipschultz's study found that energy drinks with multiple caffeine sources were tied to a higher rate of side effects, typically involving the nervous, digestive or cardiovascular systems.

"(The ingredients are) not sold individually, they're sold as a combined product, and that's what makes energy drinks so dangerous," Lipschultz said.

He also noted that energy drinks mixed with alcohol can be a lethal combination.

"What happens to a lot of people who become ill from the combination of alcohol and energy drink is you drink more than your body can handle, it becomes toxic, and it can kill you."

Company rebuts 'myths'

Living Essentials sells 5-Hour Energy two-ounce shots, which are much smaller than the 8-ounce to 16-ounce cans sold by Monster and Red Bull, and has 200 milligrams of caffeine.

Living Essentials devotes an entire website page to rebutting "myths" related to safety of their products — including whether an individual can overdose on the product.

"Everybody is different, and therefore, 5-Hour Energy shots might work differently for each individual," the company says on its website, which includes information on the recommended dose and a caution not to take more than two bottles daily.

Melissa Skabich, communications director for 5-Hour Energy, said the shot "is for adults, and our product is safe when used as directed."

"It's clear from the label that 5-Hour Energy is not intended for children," Skabich said.

Ted Kallmyer, a health educator and editor of the website, said consumers are becoming more informed about the possible dangers of energy drinks. The website includes information on caffeine content in beverages and food, side effects, and a "Death by Caffeine" calculator to figure a lethal dose by body size.

"An ever-increasing amount of our traffic is coming from people who wish to quit caffeine or have quit and are debilitated by the withdrawal symptoms," Kallmyer said.

He said many energy drink companies voluntarily list their ingredients and caffeine content, but not all have jumped on the bandwagon.

"At this time sales restrictions on energy drinks or shots isn't the solution," Kallmyer said. "The issue is complex, but we feel education is always the best remedy as opposed to blanket banning."

Energy drinks and shots boost energy levels in part with concentrated caffeine levels. Caffeine poisoning can occur at levels higher than 400 milligrams a day in adults, according to medical professionals.