1. Energy and Protein Drinks How Good Are They?
Dr. Renee Wenzlaff, DNP
Ashley Eide, Marquette University Nurse Practitioner Student

2. Objectives The learner will be able to:
Describe the adverse effects with energy drink consumption
Describe the major ingredients in energy drinks and list adverse affects
Understand more effective ways to enhance energy

3. Energy Drinks
A soft drink that contains ingredients such as caffeine, designed to boost energy and offer metabolic or central nervous system (CNS) stimulation
Rath, M., (2012)

4. Energy Drink Facts Fastest growing beverage
51% of college students consume
Teens and young adults spend $3.5 billion
FDA 78 mg/kg of caffeine demonstrate serious side effects
FDA regulate caffeine in soft drinks (65mg), not in Energy Drinks
Don’t require manufactures to list other caffeine ingredients
Kola Nut, yerba mate, guarana or cocoa
Men more likely to consume
Teens and adults are the major consumers of ED making this the fastest growing beverage.
There are over 500 types of energy drinks. In 1997 Red bull was the current leader. ASK the audience. WHAT ARE SOME EXAMPLES Red bull, Monster, jolt, Rock Star, Rip it, full throttle, Cocaine. Back in 2007, Cocaine energy drink, with a cut of cocaine variety was marked as a legal alternative to a class A drug. On April , the FDA cited the company that made Cocaine for promoting this as a street drug. Red bull is a “functional Beverage” you could drink while driving, sports, leisurely. Monster “double shot of the killer energy brew with twice the buzz.

6. Women hospitalized with Hepatitis after drinking TEN bottles of High-Caffeine energy drink everyday for two weeks
She came to the ER vomiting and upper abdominal pain. Dr. were stumped she got better and sent her home. Came back and revealed that she had been drinking ten bottles of energy drink a day. Tested her levels and She had enough vitamin B3 to last for a 50 hour day.

8. Major Ingredients: Caffeine
Toxicity and poisoning
Nervousness, anxiety, restlessness, insomnia, gastrointestinal upset, tremors tachycardia, psychomotor agitation
78 mg/kg r/t adverse affects in kids
No mandatory requirement
Red Bull® and SoBe No Fear ® has mg/3 ounces
Consume enough caffeine to develop dependence
Caffeine content and concentration vary among various energy drink brands. Generally does not produce sever symptoms, but before 2008 one death is attributed to ED use.
No mandatory requirement by the FDA for ED to include caffeine content or warning labels alerting consumers of the danger of excessive use of ED.
Toxicity can be experienced with anxiety and mood disorders
Estimated that youth are consuming enough caffeine to develop dependence and consuming more caffeine than adults on a mg per kg basis.

9. Caffeine Doses range 80-300mg in 8 ounces Byproduct of Guarana
Increases content
mg results in alertness, decreased fatigue, improved concentration
Increases gastric acid production and reflux
Acts as a diuretic
Most are sold oz so it increases propensity for larger amounts of caffeine consumption so larger dose of caffeine ingestion.
Main product of guarana, to increases caffeine content.
Increases stomach acid relaxes smooth muscle of lower esophageal sphincter leading to reflex
Caffeine acts like a diuretic

13. Major Ingredient: Guarana
Found in Venezuela and northern brazil
3-5 g provides 250 mg increasing the market
Guarana seeds 3x caffeine compared to coffee beans
Increase energy and alertness

14. Major Ingredient: Taurine
Amino acid with function not fully understood, but needed for normal growth and development
Found in infant formula
Benefits serum lipids and cardiomyopathy
May increase the effects of caffeine
No adverse affects documented
Athlete deaths in Europe causing a ban or limited sales
Rath, M. (2012)
Taurine is a free sulfer amino acid found in mammalian tissues. And may regulate osmoregulation, antioxidation, and modulation of calcium fluxes and protein phosphorylation. Some studies find that it may treat hypertension, heart disease, diabetes
HOWEVER:

15. Major Ingredient: Ginseng
Common type: Panax ginseng
Improve immune function, cognitive function, concentration, memory
Therapeutic doses mg/day
Sub therapeutic: mg
Adverse affects:
Insomnia headache
Painful breasts High Blood Pressure
Vaginal bleeding dizziness
Amenorrhea Mania
Increased heart rate

16. Major Ingredient: Sugar
Sugar is the major energy for the brain, muscle, red blood cells
32 grams in 8 ounces
ounces of energy drink has grams of sugar.
High doses give a “sugar high” the you go into “crash mode”
Excessive sugar linked to
Diabetes, oral dental erosions, cavities, obesity premature aging, low serotonin levels

17. Major Ingredient: Bitter Orange
Claims to increase energy expenditure, breakdown fat and increase glucose uptake into the muscle
200mg in energy drinks, below therapeutic levels
Taken with caffeine or guarana
Synephrine and Octopamine-similar to effedra
FDA research found that bitter sweet increased heart rate and blood pressure
Daniells, S. (2012)
With caffeine or guarana additive stimulants may occur
Active ingredient are synephrine and octopamine, which are structurally similar to epinephrine and norepinephrine. It replaced ephedra which was a weight loss supplement and may pose similar adverse effects as did ephedra. Not much evidence to show bitter orange is safer then effedra
FDA found that synephrine either as bitter sweet extract or as pure synephrine increased heart rate and BP when caffeine was added.

18. Perceived Benefits
Advertising focuses on energy drinks enhancing performance, boost mental alertness, decrease fatigue
Energy drinks with caffeine content <300mg may be safe
No evidence that guarana is safe for children
Small amounts of energy drinks may have affects on alertness, performance etc.
Evidence lacks for conclusion that energy drinks are more effective then soft drinks

19. Adverse Health Effects
Require more to function
Adverse affects outweigh the minimum benefits
High caffeine content may lead to caffeine intoxication
Increased risk when used with alcohol
Use of energy drinks to replace sleep
Adverse affects on central nervous system, cardiovascular, gastrointestinal
College students are attracted to energy drinks, but unaware of the effects.
Body becomes accustomed to ED requiring more to function
Adverse affects are more detrimental then increased functioning
CNS-anxiety, headache, tremors, confusion, seizures, CV-palpitations, chest pain, increased heart rate, dysrhythmias, HTN. GI caffeine compromises lower esophageal sphincter tone leading to reflux heartburn or esophagitis

20. Adverse Health Effects
Obesity
Fatigue and depression return with discontinuation
Contraindications with preexisting conditions
Heart disease
Stroke, high blood pressure
Seizure disorder
Diabetes
Thyroid disease

21. While consuming energy drinks alone will not damage your liver immediately, prolonged consumption of certain ingredients in popular energy drinks may have ill long-term effects on your liver. For example, many energy drinks contain herbal concentrate products like kava kava or taurine. An overabundance of either of these herbal supplements can lead to liver damage or liver failure, according to the University of Michigan Health System. For example, consuming large amounts of taurine may lead to complications in individuals with type-2 diabetes.

22. Energy Drinks Among College Students
Highest among college students
Associated with a variety of negative behaviors
Sexual risk-taking
Fighting
Not wearing a seat belt
Smoking
Drinking
Alcohol-related problems
Marijuana use
Prescription drug use

23. Research Consume for weight loss
May also engage in other unhealthy weight loss attempt
Vomiting
Diet pills
ACHA found energy drinks are related to weight loss attempts, poor body image, unhealthy weight loss behaviors
Jeffers, A.J., Vatalaro, H., & Benotsh. (2014)
A study examined energy drink consumption and relations to weight loss attempts and behaviors, body image and eating disorders. 865 undergraduates were study and found that there is an association with concerns of personal appearance, wt. loss attempts and disordered eating such as vomiting. A hierarchical logistic regression found that there is a significant correlation between energy drink consumption for losing wt. use of diet pills and use of vomiting/laxatives

24. Research
2007 a survey of energy drink consumption patterns among college students
51% of 496 college students > 1 energy drink per month
Insufficient sleep, more energy, drink with alcohol, studying
Jolt and crash episodes, heart palpitations, headaches
Recommended future studies to assess caffeine content
Malinauskas et al. (2007)

26. Protein Drinks Promote weight loss, build muscles, fight aging
Contain arsenic, cadmium, lead, mercury
Products are not federally regulated for testing safety
Body can only break down 5-9 grams per hour, rest is converted to fat or excreted
To Be Continued ……
Heavy metals found in protein drinks have toxic affects on the bodies organs

27. References
Daniells, S.
Jeffers, A.J., Vatalaro, H., & Benotsch, E. G. (2014). Energy drinks,
weight loss, and disordered eating behaviors. 62(5),
Malinauskas, B. M., Aeby, V. G., Overton, R. F., Carpenter-Aeby, T., & Barber- Heidal, K. (2007). A survey of energy drink consumption patterns among college students. Nutrition Journal, 6(35), p. 1-7.
Michaels.
Rath, M. (2012). Energy drinks. What is all the hype? The dangers of energy drink consumption. Journal of American Academy of Nurse Practitioners. 24. P