DAWN report on energy drinks and ER visits: Correlation is not causation, but ‘something is going on here’

An Update on Emergency Department Visits Involving Energy Drinks: A Continuing Public Health Concern​​, ​which appears in the January 10 issue of The DAWN (Drug Abuse Warning Network) Report, says energy drink related visits to emergency rooms in the US doubled from 10,068 in 2007 to 20,783 in 2011.

While 42% of patients in energy drink related visits in 2011 reported that they had consumed a combination of energy drinks and alcohol, illegal drugs or prescription medication, the remaining 58% of cases involved energy drinks alone, claims the report.

You have a hunch that something is going on here…​

DAWN project leader Albert Woodward told FoodNavigator-USA that while the data did not prove that energy drinks had caused​ adverse effects, the fact that the number of energy drink related ER visits had shot up sharply since 2005, in line with the explosive growth of the energy drinks market, was potentially a cause for concern.

He added: “If you’re in public health as we are, you have a hunch that something is going on here.”​

Energy drinks can be dangerous when used alone or in combination with other drugs or alcohol​

The report said: “Consumption of energy drinks is a rising public health problem because medical and behavioral consequences can result from excessive caffeine intake… ​

“Large amounts of caffeine can cause adverse effects such as insomnia, nervousness, headache, fast heartbeat and seizures that are severe enough to require emergency care.”​

It concluded: “This report validates claims that energy drinks can be dangerous when used alone or in combination with other drugs or alcohol.”​

However, if high caffeine intakes from energy drinks were the cause of the adverse effects, Woodward could not explain why patients that had consumed a lot of caffeine from coffee or other sources did not show up at ER.

He added: “We’re not saying that they don’t. But we didn’t look at coffee consumption, just at non-alcoholic energy drinks, and these drinks combined with drugs, alcohol, or prescription medication. ​

“Another drawback of the data is that we don’t collect dosages.”​

Correlation, not causation​

But American Beverage Association (ABA) public affairs director Christopher Gindlesperger told FoodNavigator-USA that the report did not include any information about the general health of those who may have consumed energy drinks, or what symptoms brought them to the ER in the first place.  ​

He added: “We don’t know how many of these people had pre-existing conditions, or whether people that said they had just been drinking energy drinks had in fact also been taking other substances​.

“There is no way to assess whether they chose not to report this fact, and the consumption of those substances along with energy drinks means the energy drinks may be irrelevant.”​

Meanwhile, as Woodward had acknowledged, the report did not look at how much caffeine had been consumed by the individuals in question, or whether they had also consumed caffeine from coffee or other caffeinated products, he pointed out.

He also took issue with the opening paragraphs of the report, which stated that energy drinks typically contained more caffeine than coffee, which was not supported by the data, he said.

“In fact, most mainstream energy drinks contain about half the caffeine of a similar size cup of coffeehouse coffee.”​

FDA: 400mg of caffeine a day poses no particular risks for most healthy adults​

There is a consensus among health professionals that for most healthy adults, consuming 400mg or less of caffeine daily poses no particular risks.

The Food and Drug Administration (FDA) also made this clear in its responses​ to two letters sent by senators Dick Durbin, D-IL and Richard Blumenthal, D-CN, asking the agency to probe the safety of energy beverages.

This didn’t stop the pair from sending a third letter to FDA with the same request late last year.

However, New York-based attorney Marc Ullman of Ullman, Shapiro & Ullman told us earlier this month that he is not expecting sweeping new rules from the FDA.

“I just don’t see the mechanism that justifies action from FDA within our legal and regulatory framework." ​

ABA: If restrictions are needed on energy drinks, what about coffee?​

Gindlesperger added: “People that want to start regulating caffeine content or labeling on drinks would have to look at coffee as well to be consistent.​

“However, we recognize that there is a public debate on this issue, which is why we have formulated this voluntary guidance​ for the responsible labeling and marketing of energy drinks.​

“Manufacturers should label caffeine content and include an advisory statement that energy drinks are ​not recommended for children, pregnant or nursing women and people sensitive to caffeine."​

Similarly, the guidance also notes that labels of energy drinks should not promote the mixing with alcohol and that the products should not be marketed to children under 12.

The 20,783 cases estimated for 2011 represent a small portion of the annual 136 million emergency room visits tracked by the CDC (Centers for Disease Control and Prevention).

According to Symphony IRI, unit sales of energy drinks rose 18.7% and dollar sales grew by 17.2% across all US food retail outlets 2012, far outstripping the overall CPG market, in which volumes were flat (-0.3%), and dollar sales rose 3.4%. ​Click here​ for more details.