JAMA Commentaries Focus on Energy Drinks
The Journal of the American Medical Association (JAMA) recently highlighted
energy drinks in its December 19, 2012, online issue, where two commentaries
discussed caffeine-related adverse events and the risks of mixing energy
drinks with alcohol. Authored by Memorial Sloan Kettering Cancer Center
infectious disease specialist Kent Sepkowitz, the first viewpoint article notes
that “the swift change in public perception of energy drinks from harmless
mild stimulant to lethal, unregulated drug is unprecedented.” Summarizing
recent cases of unintentional caffeine overdoses and caffeine poisoning, the
article claims that “a person would need to ingest at least 12 of the highly
caffeinate energy drinks within a few hours” to reach a lethal dose of caffeine.
Sepkowitz argues, however, that this estimate does not take into account
variables such as medications that may slow the metabolism of caffeine or
preexisting cardiac or liver conditions “that could increase susceptibility to
caffeine-related adverse events.”
“The appropriate role of the FDA and other regulatory in the oversight of
energy drinks is yet to be defined,” concludes Sepkowitz. “A logical first step
might be to require placing the caffeine content of energy drinks on their label… Publicity about energy drink-related deaths should inform the public of the potential dangers of these products.”
Meanwhile, a second viewpoint article co-authored by Jonathan Howland
(Department of Emergency Medicine, Boston University) and Damaris
Rohsenow (Center for Alcohol and Addiction Studies, Brown University)
outlines the risks of alcohol mixed with energy drinks (AMED). Howland and
Rohsenow hypothesize that (i) the caffeine component of AMED offsets
the sedating effects of alcohol and reduces the sensation of intoxication,
(ii) a reduced sensation of intoxication impairs judgment relative to risky
behaviors, and (iii) a reduced sensation of intoxication induces more alcohol
consumption.
Although they admit that the data are inconsistent on these points, the
authors nevertheless believe that the public needs “more definitive information
and education about the safety threshold for caffeine consumption and,
in particular, the effects of caffeine on adolescent behavior and development.”
As they thus conclude, “Policy makers should hold energy drink manufacturers
accountable for claims regarding the health and psychological benefits
of their products… For the present, however, consensus about these questions,
and identification of gaps in knowledge, could be achieved by targeting
research on this topic and by convening experts to assess existing evidence.”
