Are ultra-high caffeine drinks bad for children?
Controversy has met release onto the market of several brands of ultra-high caffeine 'energy shot' drinks.
The shots contain as much and in some cases the equivalent of more than 3,300 mg (milligrams) of caffeine per litre,
despite the mandated maximum level allowed being 320 mg per litre. Reclassifying the drinks as 'dietary supplements',
however, has meant that they can be marketed and sold here.
While most of the energy shots are labeled as not being suitable for consumption by children, concerns have arisen that
they are primarily being marketed at, and sold to, adolescents and children.
Since their release, there have been reports of the shots having adverse effects on some adolescents and children who drink them.
The SMC approached a number of experts in nutrition, medicine and food safety, to get their views on the safety of consuming
very high amounts of caffeine.
A paper, published in the Journal of the American Pharmacists Association last year, looks more closely into the matter and can be read here (registration to read the full article is free).
Dr Elaine Rush, Professor of Nutrition at Auckland University of Technology, comments:
"Because caffeine is found in the leaves, seeds, and fruits of over 60 plants worldwide it is probably the most widely
used, socially acceptable, pharmacological stimulant. The most common sources in the New Zealand diet are coffee, tea,
cocoa, kola nut extract as in cola drinks, and the caffeine and guarana ingredients added to energy drinks.
"Caffeine is a pharmacologically active substance; it is not a nutrient so there are no specific guidelines about its
consumption.The Food Standards Authority New Zealand requires that a formulated caffeine beverage (for the purpose of
enhancing mental performance) must contain no less than 145 mg/L and no more than 320 mg/litre of caffeine. They also
require that the label include advisory statements to the effect that the food contains caffeine and is not recommended
for children, pregnant or lactating women and individuals sensitive to caffeine.
"I am very concerned about the sale of caffeine in large doses, for example in "energy shots" which are sold as dietary
supplements. None of the ingredients are recognisable as coming from whole food and they do contain sugar. Although
caffeine does improve physical performance, convincing evidence is accumulating from comprehensive reviews of the
literature that there are more problems than benefits associated with consuming caffeine. AUT as part of its commitment
providing students and staff with the best learning environment has an initiative in place to improve the healthiness of
food and beverages sold on campus. Part of this commitment is not to sell dietary supplements.
"The NZFSA is currently developing a new standard for food-type substances sold as dietary supplements. The Food Act
does not provide for restrictions to be placed on the age at which a person can buy a product sold under the act and
consumers who believe that the marketing of energy shot products is inappropriate can lodge a complaint with the
Advertising Standards Authority."
Dr Jim McVeagh, Auckland GP and author of popular health blog MacDoctor, comments:
"The Herald on Sunday tells the story of a young woman who suffered a heart attack after consuming daily amounts of 10-14 cans of Red Bull a
day. The same effect is reached with only 4-5 of Demon's "Shots".
"I have had to deal with a number of cases of teenagers having psychotic episodes following multiple cans of energy
drinks. This problem will almost certainly get worse with these types of "dietary supplements". Caffeine in large
amounts pushes up your blood pressure and reduces endothelial function dramatically, predisposing people to heart
attacks. It is not a benign pick-me-up, nor is it a dietary supplement - it is a stimulant drug, pure and simple.
Dr David Jardine, Clinical Director of the Canterbury District Health Board and physician at the Department of General
Medicine, University of Otago, comments:
"We did do a bit of reading on caffeine before we did the Christchurch Coffee study last year.
"From what I can see, caffeine is the most used drug in the world and we have no clear idea of how it works. It has been
blamed for everything from cardiovascular disease to birth defects but the scientific evidence for chronic consumption
being harmful is not there.
"We looked at the immediate effects of oral caffeine [200mg] on blood pressure, heart rate and sympathetic nerve
activity. It did very little, i.e a small increase in mean blood pressure [10 mmHg] over 2 hours, a decrease in heart
rate, and usually no clear increase in nerve activity.
"I know of no bad effects in children and pregnant women, remembering that a caffeine-like drug, theobromine, is in dark
chocolate. Theobromine is very toxic to dogs. The dogs die of excess sympathetic nerve activity [ie a catecholamine
rush] which is what you would expect to see in caffeine toxicity, but I have never seen this in humans. Humans seem to
be able to deal with caffeine very well."
Dr Peter Black, Professor of Clinical Pharmacology at the University of Auckland, comments:
"Attempts to implicate caffeine as a cause of cancer and heart disease over many years have failed to find a link. There
is however evidence linking a high intake of coffee to reduced fertility in women trying to conceive. Excessive intake
of caffeine can cause irritability, anxiety and insomnia - and that potentially might be an issue in some individuals
with high intake of energy drinks."
Dr John Birkbeck, Adjunct Professor in Child Nutrition at Massey University, comments:
"It is time for others to front up on such topics, but a few things need to be said. First these products are especially
dangerous for children [see CloseUp last night]. Second we must remember that people are divided into two groups by the
rate they metabolise caffeine. Some can metabolise it quickly: I must be one of those because coffee at bedtime does not
prevent my sleeping, and I never have tachycardia etc from it. Others are slower and for them these products must be
especially dangerous. I suspect in anyone with a preexisting condition such as overactive thyroid or some heart defect
they could even be lethal. But the issue is really far wider than all this. The category of "Dietary supplements" must
be abolished as the Aussies have.
"A product must be either a food, or a drug, and dealt with under the relevant legislation. 'Energy' drinks could be
foods but their composition would be regulated. These energy "shots" would clearly be drugs and put out of existence by
lack of safety documentation. But the "dietary supplement" industry in this country has been fighting this for decades
as it is a very lucrative market which manages to avoid the constraints even on food producers let alone
pharmaceuticals. The sooner this 'grey area' is abolished the better: this could be an excellent argument through which
to do that."
New Zealand Food Safety Authority Director (Compliance and Investigation) Geoff Allen comments (read in full on the SMC
website here):
"NZFSA agrees with health professionals that children shouldn't consume a lot of caffeine, whether it's from coffee,
tea, chocolate, colas, energy drinks or other foods. However, caffeine is found naturally in many foods, even chocolate,
so children do consume it in small amounts without harm.
"The Food Standards Code takes into account the total diet and the whole range of different foods a person might eat
over a day or a week. For this reason, there are caffeine limits set for the amount of caffeine allowed in formulated
caffeinated beverages which are considered to be a part of people's diet. Energy drinks should not contain more than the
maximum allowed of 320 mg/kg. Caffeinated beverages must also have a statement that they're not suitable for children or
pregnant women.
"Dietary supplements on the other hand are not foods in the usual sense of the word. They are something that people can
choose to take from time to time if they think they need to. Dietary supplements have to be labelled with recommended
dose information. Pills, tablets and concentrated liquids (such as the 60ml shots) are not classed as food or beverage.
There are maximum daily doses for some vitamins and minerals in dietary supplements but for the majority of substances
there is no limit other than that they are safe. All of the shots that we've seen also have a caffeine advisory
statement of some form, even though they're not required to.
"New regulation to restrict sale or supply of these high caffeine energy drinks is not necessarily the whole or the best
answer. Firstly in order to do this there would have to be clear evidence that caffeine is indeed a significant health
risk. NZFSA has commissioned an updated risk profile for caffeine to identify any changes in risk that have occurred in
the last seven years. We expect this profile to be completed early next year."
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Notes to Editors
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