Most of us have consumed energy drinks at one point or another,
either because of a looming deadline or during a fun night out. Although
energy drinks are often perceived as harmless, a new case report links
the beverages to liver damage, after a previously healthy man developed
hepatitis from consuming too many.
![[two blue energy drink cans]](https://lh3.googleusercontent.com/blogger_img_proxy/AEn0k_vmc_7r2_rlfNFvDHw8hNpLl2RESzcY4RRwerwMT5GCjb1B53WPhyy4det1JdpKpm2DdRoGnSdUZYWOZ0NGaWGGwA5cHlODR-zns6eLc-l8QLfaW2gwoneeOX-3le_vpQAH34zUbpg4KVskD_33xafphNaZoimVRn8Vqk_0s5IbNCdYB_fr=s0-d)
This is the second time acute hepatitis has been linked to energy drink consumption.
In the United States, most energy drinks are consumed by
young males
between 18-34 years of age. Almost one third of teenagers between 12-17
years old consume energy drinks regularly, according to the National
Center for Complementary and Integrative Health (NCCIH).
Between 2007-2011, the number of energy drink-related emergency
department visits in the U.S. doubled. Main concerns regard the combined
use of energy drinks with alcohol, which leads to excessive binge
drinking.
As for the contents of an energy drink, it is believed that caffeine and sugar pose the greatest threat to consumers' health.
According to a new case report, however, there may be something in energy drinks that can cause liver damage.
The report details a 50-year-old man who was admitted to the hospital for acute
hepatitis. The patient had reportedly consumed four to five energy drinks per day for more than 3 weeks.
This is a very rare occurrence; there is only
one other case, in which a 22-year-old woman developed acute hepatitis from consuming energy drinks in excess.
Man consumed four to five energy drinks daily for 3 weeks
This latest case - reported by Dr. Jennifer Nicole Harb of the University of Florida College of Medicine and colleagues - was
published in the journal
BMJ Case Reports.
The man was previously healthy. He reported no changes in his diet or
alcohol consumption, nor was he taking any prescription or
over-the-counter medicine. He had also not consumed any illicit drugs
and had no history of liver disease in his family.
However, for 3 weeks leading up to his hospitalization, he
had started consuming energy drinks in order to keep up with his heavy
workload as a construction worker.
After the 3-week period, he started developing symptoms such as general malaise,
anorexia, acute abdominal pain, nausea, and vomiting. The patient became alarmed when these symptoms were accompanied by
jaundice and dark urine.
Excess niacin to blame for acute hepatitis
Upon examination, it was revealed that the number of enzymes called
transaminases was elevated, which indicates liver damage. A liver biopsy
revealed acute hepatitis, and doctors also found evidence of chronic
hepatitis C infection.
"Though the patient was found to have HCV [hepatitis C virus]
infection, we did not think HCV was responsible for his acute
hepatitis," the doctors mention in the report.
The doctors go on to explain that acute hepatitis was most
likely induced by the excessive intake of vitamin B3, also known as
niacin.
The patient consumed around 160-200 milligrams of niacin per day, which is twice the recommended daily dose.
Although these levels of niacin are not supposed to cause toxicity,
they are similar to those reported in the only one other case of energy
drink-associated hepatitis. There, the woman had consumed 300 milligrams
of niacin daily, which was, at the time, the lowest reported dose to
cause niacin toxicity.
In the case of the new patient, symptoms were cleared by the third day
of hospitalization, following careful observation and treatment.
He discontinued the use of energy drinks and was advised to avoid any similar products that contain
vitamin B3 in the future.
Dietary supplements and liver toxicity
Nearly 50 percent of the cases of liver failure in the U.S. are
caused by drug-induced liver injury (DILI), according to the case
report.
The authors of the case study point out that dietary and
herbal supplements can be harmful to one's liver, despite their natural
ingredients. Around 23,000 emergency department visits each year are
related to dietary supplements.
Although vitamins and dietary supplements have been recognized as
hepatotoxins, they continue to be ignored by patients and doctors alike,
the authors warn. This is due to the common misconception that because
they have "natural ingredients" they must be harmless.
Most of the time primary treatment for DILI simply involves stopping
the intake of the substance that is causing the injury and waiting for
the liver to normalize. Recovery usually takes place in a few days.
A case such as the one published in
BMJ Case Reports might
alert doctors of the damaging effects of energy drinks and help them
eliminate the cause of hepatitis quicker and more effectively.
Hopefully, doctors will treat such instances more promptly and no longer
ignore the possible negative effects that vitamins, supplements, and
related products can have on the liver.
Doctors recommend that patients should be educated about the risks of liver toxicity involved in energy drink consumption.
The authors add:
"As the energy drink market continues to rapidly expand,
consumers should be aware of the potential risks of their various
ingredients. Vitamins and nutrients, such as niacin, are present in
quantities that greatly exceed the recommended daily intake, lending to
their high risk for harmful accumulation and toxicity."
Read about the negative effects energy drinks may have for the heart.
Written by Ana Sandoiu
5 Health Problems Linked to Energy Drinks
Concerns over the potentially harmful effects of energy drinks,
especially when they’re combined with alcohol, have been growing in
recent years.
A
story in the New York Times
today (Nov. 15) added to that concern, noting that the Food and Drug
Administration (FDA) has received reports of 13 deaths linked to 5-Hour
Energy, an energy drink. The drinks contain about 215 milligrams of
caffeine, the equivalent of about two cups of coffee.
Here, a rundown of five worrisome health issues that have been linked to downing stimulating drinks:
Heart problems
In recent years, the company that markets 5-Hour Energy has filed about
30 reports with the FDA of serious injuries associated with its
products, including heart attacks, according to the New York Times
story.
And in 2007, a 28-year-old Australian man suffered cardiac arrest after
consuming eight cans of an energy drink, containing 80 mg of caffeine
each, over seven hours. The patient did not have a history of chest
pain.
Caffeine and other compounds in
energy drinks can boost heart rate
and blood pressure, said Dr. John Higgins, associate professor of
medicine at the University of Texas Medical School in Houston.
Caffeine can cause heart cells to release calcium, which may affect
heartbeat, leading to arrhythmia, Higgins said. The drinks may also
disrupt the normal balance of salts in the body, which has been linked
to arrhythmia as well.
However, there is not enough evidence to say unequivocally that energy
drinks cause heart problems. More research is needed to determine the
amount of energy drinks people need to consume in order to experience
these negative effects, Higgins said.
The risk of miscarriage
The FDA has also received one report linking a miscarriage to consumption of 5-Hour Energy.
Studies examining the effects of caffeine on miscarriage have been
mixed. A 2006 study of more than 1,000 pregnant women found that those
who consumed more than 200 mg of caffeine per day (from coffee, tea,
soda or hot chocolate) were about twice as likely to have a miscarriage
compared with pregnant women who did not drink caffeine. However, a
study published in 2008 found no link between caffeine consumption
(regardless of the amount) and the risk of miscarriage at 20 weeks of
pregnancy.
Because study findings have not been conclusive, the American College
of Obstetricians and Gynecologists advises that pregnant women limit
caffeine consumption to 200 mg per day.
An increased risk of alcohol injury and dependence
Studies suggest that combining alcohol and energy drinks can be dangerous.
Although caffeine is a stimulant, research suggests it does not
"counteract" the sedating effects of alcohol. There is concern that
mixing alcohol and energy drinks may keep people awake for a longer
period of time, allowing them to consume more alcohol than they
ordinarily would, according to an editorial published last year in the
Journal of the American Medical Association.
A 2011 study of about 1,100 college students found those who downed
energy drinks frequently were about 2.5 times more likely to meet the
diagnostic criteria for alcohol dependence than those who did not
consume energy drinks. The link may be due to the practice of mixing
alcohol and energy drinks, or drinking caffeine to recover from a
hangover, according to the JAMA editorial. It could also be that
caffeine's effects on the brain play a role in addiction, the editorial
says.
Risk of drug abuse
Another study of 1,060 students found that energy drink consumption in
the second year of college was associated with an increased risk of
prescription drug abuse (use of stimulants or prescription painkillers without a prescription) in the third year of college.
One explanation for the link "is that energy drinks, like prescription
drugs … might be regarded by some students as safer, more normative, or
more socially acceptable than using illicit 'street' drugs," the
researchers wrote in a 2010 issue of the Journal of Addiction Medicine.
Impaired cognition
Although some students rely on energy drinks to pull all-nighters to study for exams, there’s some evidence that the excessive
levels of caffeine in the drinks impair cognition.
A small 2010 study found that drinking moderate amounts of caffeine,
about 40 mg, improved performance on a test of reaction time, but
drinking higher amounts — equivalent to the levels found in a (250 ml)
can of Red Bull, or 80 mg — worsened performance on the reaction test.
Energy drinks are supposed to do just what the name implies -- give
you an extra burst of energy. As it turns out, most of that "energy"
comes from two main ingredients: sugar and
caffeine. A typical energy drink can contain up to 80 milligrams of caffeine (about the same amount as a cup of
coffee). By comparison, a 2006 study found that the average 12-ounce soda contains 18 to 48 mg of caffeine.
Other than caffeine levels, how do energy drinks differ from sodas
and sports drinks? Soft drinks are mainly water, sugar and flavoring.
They don't do anything for your body; they're just supposed to taste
good. Sports drinks are designed to replenish fluids lost during
activity. They typically contain water, electrolytes and sugar. Energy
drinks have added caffeine and other ingredients that their
manufacturers say increase stamina and "boost" performance. They're
designed for students, athletes and anyone else who wants an extra
energy kick.
Energy drinks became popular in Asia long before they reached the
United States. In 1962, Japanese pharmaceutical company, Taisho,
released its Lipovitan D drink. It was designed to help employees work
hard well into the night. Lipovitan D contains taurine, the same
ingredient found in many of today's energy drinks.
The very first "
energy" drink to reach the United States wasn't really an energy
drink at all -- it was more of a hyped-up soft drink called Jolt Cola.
The "jolt" in the cola was a lot of added sugar and caffeine. Introduced
in the 1980s, Jolt Cola quickly became a staple of college campuses.
An Austrian businessman named Dietrich Mateschitz picked up on the
cash potential of energy drinks while on a business trip to Asia. Along
with two Thai business partners, Mateschitz started the company Red
Bull GmbH, with the idea of marketing the drink to young Europeans. Many
clubs on the American West Coast caught wind of the Red Bull phenomenon
and began importing it to sell as a cocktail mixer.
Red Bull began distributing its drink in the United States in
1997. According to its manufacturer, revenues doubled each year,
reaching more than $1 billion in 2000. Although Red Bull has
consistently been the leader in the energy drink market, several other
companies have launched their own energy drink lines. Many of them are
endorsed by celebrities.
Here are some of the ingredients you may find in popular energy drinks and what they do in the body:
- Ephedrine - A stimulant that works on the central
nervous system. It is a common ingredient in weight-loss products and
decongestants, but there have been concerns about its effects on the heart.
- Taurine
- A natural amino acid produced by the body that helps regulate heart
beat and muscle contractions. Many health experts aren't sure what
effect it has as a drink additive (and the rumor that taurine comes from
bull testicles is false).
- Ginseng - A root believed by some to have several medicinal properties, including reducing stress and boosting energy levels.
- B-vitamins - A group of vitamins that can convert sugar to energy and improve muscle tone.
- Guarana seed - A stimulant that comes from a small shrub native to Venezuela and Brazil.
- Carnitine - An amino acid that plays a role in fatty acid metabolism.
- Creatine - An organic acid that helps supply energy for muscle contractions.
- Inositol
- A member of the vitamin B complex (not a vitamin itself, because the
human body can synthesize it) that helps relay messages within cells in
the body.
- Ginkgo biloba - Made from the seeds of the ginkgo biloba tree, thought to enhance memory.
Looking at the ingredients, energy drinks appear to be part soft
drink and part nutritional supplement. According to reviewers, the taste
falls within the same range. People who have tried energy drinks have
described the taste as ranging from "medicinal" to "molten Sweet Tart."
Although the manufacturers claim that energy drinks can improve
your endurance and performance, many health experts disagree. Any boost
you get from drinking them, they say, is solely from the sugar and
caffeine.
Caffeine works by blocking the effects of
adenosine, a
brain chemical involved in sleep. When caffeine blocks adenosine, it
causes neurons in the brain to fire. Thinking the body is in an
emergency, the pituitary gland initiates the body's "fight or flight"
response by releasing adrenaline. This hormone makes the heart beat
faster and the eyes dilate. It also causes the liver to release extra
sugar into the bloodstream for energy. Caffeine affects the levels of
dopamine, a chemical in the brain's pleasure center. All of these
physical responses make you feel as though you have more energy.
Energy drinks are generally safe, but like most things, you should
drink them in moderation. Because caffeine is a stimulant -- consuming a
lot of it can lead to heart palpitations, anxiety and insomnia -- it
also can make you feel jittery and irritable. Over time, caffeine can
become addictive. It is also a
diuretic -- it causes the kidneys
to remove extra fluid into the urine. That leaves less fluid in the
body. so drinking an energy drink while you're
exercising can be particularly dangerous. The combination of the diuretic effect and
sweating can severely dehydrate you.
Many people mix energy drinks with vodka or other
alcohol to make a high-energy cocktail. Since alcohol is a
depressant,
it has a tranquilizing effect on the body that can make you unaware of
how much you're drinking. One study found that men who combined energy
drinks with alcohol felt alert and sober, even though they were actually
drunk. And since both alcohol and energy drinks dehydrate you, when
combined they can cause your body's fluids to drop to dangerous levels.
In 1991, two people in Sweden who drank alcohol with an energy drink
reportedly died of dehydration, although it was never conclusively
proved that the energy drink led to their deaths.
Other ingredients can also be problematic. For example, the
stimulant ephedrine, an ingredient in many decongestants, can cause
heart problems. In 2001, two California high school students fainted
after ingesting energy drinks containing ephedrine. Because very little
research has been done on the long-term health effects of consuming
excess amounts of taurine and other ingredients in energy drinks, many
health experts advise pregnant women and young children to avoid them.
![[two blue energy drink cans]](http://cdn1.medicalnewstoday.com/content/images/articles/313/313849/two-blue-energy-drink-cans.jpg)
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