Mary Claire O'Brien, a professor at Wake Forest University School of Medicine who helped foment the moral panic that led the FDA to ban Four Loko and three other brands of caffeinated malt beverages last fall, says the fight against demonic drinks is far from over. "These premixed alcoholic energy drinks are only a fraction of the true public health risk," she and co-author Amelia Arria, a researcher at the University of Maryland School of Public Health, warn in a recent Journal of the American Medical Association commentary. "Regular (nonalcoholic) energy drinks might pose just as great a threat to individual and public health and safety." O'Brien and Arria offer "3 reasons" for this conclusion:
First, caffeine has been clearly associated with adverse health effects in susceptible individuals…. Second, the practice of mixing energy drinks with alcohol—which is more widespread than generally recognized—has been linked consistently to drinking high volumes of alcohol per drinking session and subsequent serious alcohol-related consequences such as sexual assault and driving while intoxicated….Third, regardless of whether energy drinks are mixed with alcohol, recent research suggests that, even after adjustment for potential confounders such as heavier drinking patterns, energy drink use might confer a risk for alcohol dependence and perhaps nonmedical prescription drug use.
Then again, it might not. Like the association between caffeinated cocktails and risky behavior, the association between energy drink consumption and alcohol dependence may have more to do with the pre-existing characteristics of people who favor these beverages than the psychoactive effects of caffeine. O'Brien and Arria concede as much, although they also raise the "concerning" possibility that "caffeine's neuropharmacologic effects might play a role in the propensity for addiction." The title of their piece, "The 'High' Risk of Energy Drinks," allows them to mislead the public about the magnitude of the danger while hiding behind a pun.
A new article in Pediatrics seconds the nomination of energy drinks as the latest lethal liquid threatening the youth of America:
Although healthy people can tolerate caffeine in moderation, heavy caffeine consumption, such as drinking energy drinks, has been associated with even more serious consequences such as seizures, mania, stroke, and sudden death….Children, especially those with cardiovascular, renal, or liver disease, seizures, diabetes, mood and behavioral disorders, or hyperthyroidism or those who take certain medications, may be at higher risk for adverse events from energy-drink consumption….Energy drinks have no therapeutic benefit, and both the known and unknown pharmacology of various ingredients, combined with reports of toxicity, suggest that these drinks may put some children at risk for serious adverse health effects….Unless research establishes energy-drink safety in children and adolescents, regulation, as with tobacco, alcohol, and prescription medications, is prudent.
Note that the authors, researchers at the University of Miami, equate "heavy caffeine consumption" with "drinking energy drinks," even though the leading brands contain considerably less caffeine than coffee does. Red Bull, for example, has 9.5 milligrams of caffeine per fluid ounce, while RockStar has 10, compared to about 18 for drip coffee. "In healthy adults," the article says, "a caffeine intake of 400 mg/day is considered safe," while "adolescent and child caffeine consumption should not exceed 100 mg/day." Since a can of Red Bull contains 80 milligrams of caffeine (comfortably below the recommended limit for children and adolescents) and a short coffee from Starbucks has 180 (far above it), the focus on energy drinks—which the authors suggest should be restricted like cigarettes, alcohol, or maybe Valium—is puzzling, especially since, by their own account, American teenagers typically do not consume very much caffeine. "In the United States," the article says, "adolescent caffeine intake averages 60 to 70 mg/day." But why let that stand in the way of a good panic?
Look for my dissection of the Four Loko freakout in the March issue of Reason.