75. Beyond the Buzz: Energy Drinks, Teen Health, and Safer Ways to Stay Energized with Roshni Patel

Highly caffeinated energy drinks are taking the teenage world by storm! While the AAP (Peds) says that these beverages are NOT safe, a growing number of kids and teens use them.  To help us learn the latest about the health risks, join this conversation with Registered Dietitian, Roshni Patel! We talk about:

• What is really INSIDE these eye-catching, bright, metallic cans?
  • Hint: potentially toxic amounts of caffeine plus sugar  
• What are risks for teens?
• What are HEALTHY but practical alternatives for our sleep-deprived, overstretched teens? 
  
  

Roshni Patel, MS, RD works at the Mayo Clinic in Jacksonville, Florida in the Division of Obesity Medicine.

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Transcript

Dr. Elise Fallucco 0:00

Welcome back to Child Mental Health for Pediatric Clinicians. I'm your host, Dr. Elise Fallucco, child psychiatrist and mom. Today, we're talking about a popular but dangerous trend among teens, and that is the use of highly caffeinated energy drinks. Many of you already know the American Academy of Pediatrics has come out strongly against energy drinks, stating that kids under age 18 should avoid them entirely. And yet We have data to suggest that up to a third of US teens are consuming them. Now, you may be asking yourself, if energy drinks are so bad for kids and teens, then why are so many of them using them? While part of the answer is related to the $100 billion industry that is promoting and marketing these drinks like Monster Energy, Red Bull, Celsius, Alani Nu, and Prime Energy There are also viral influencers on social media, TikTok, YouTube, encouraging teens to try them out and talking about the alleged benefits of these drinks for your skin, hair, nails, energy, and performance at sports. But we're gonna cut through all of the noise, and today we're gonna uncover the true risks in these energy drinks. And most importantly, what we as clinicians and parents can do to try to minimize their use among kids and teens, and help kids find healthier ways to increase their energy. To do that, I'm joined by registered dietician and mom, Roshini Patel, welcome to the pod, Roshini.

Roshni Patel 1:31

How are you?

Dr. Elise Fallucco 1:33

Good. I'm so glad that you are here, and one of the things I forgot to mention is that you are also a strong advocate and activist for limiting the use of energy drinks in our teens. You have brought awareness to our local community here in North Florida, about the dangers of energy drinks in kids and teens, provided education to kids directly to help them better understand that these drinks are more dangerous than you're aware of.

Roshni Patel 1:59

The packaging is extremely targeting to certain kids. A close friend of mine, I saw her daughter drinking a Celsius, and I asked her, I was like, "Is she allowed?" And her response was, "Well, yeah, it's, it's just water. It's just, you know, fruit-flavored water." And then I realized parents, clinicians, very educated professionals are not realizing the newer packaging that's out. It's incredibly deceiving in making people think that this is just not that big of a deal when it largely is. There's a $100 billion industry that does not want us to know what kids are drinking. I, Though the marketing is supposed to be between the 25, 35 range, most of their consumers are children.

Dr. Elise Fallucco 2:39

And I can speak to the marketing too, we'll go shopping with our kids- and, we'll reach for non-energy drinks, things like Olipop or things like Poppi, like the, prebiotic drinks. Right. And they have these beautiful pastel colors and metallics and pretty- Mm-hmm fruits and cartoons, very appealing. And to be honest, the energy drinks like Alani or some of the other brands- Mm look really similar to these, you know, quote-unquote, healthy drinks. Mm-hmm. And so as a parent, as a consumer, it's really easy to get confused.

Roshni Patel 3:10

Red Bull and some of the other, Monster, came out sort of in the '80s and '90s, they very highly targeted males, young males. Red Bull gives you wings, or Monster, the beast. But now what you're seeing is they missed 50% of the market. Like, oh well, how can we target the female, young girl market? So the packaging is now boost metabolism, great skin, hair, and nails. It's pretty packaging. It's what teenagers call, I guess, aesthetic. It's fun to drink, it's fun to walk around with, and I think that is where the marketing targets teens. Though the marketing is supposed to be between the 25, 35 range, most of their consumers are children.

Dr. Elise Fallucco 3:46

What do you think that most parents, and maybe even most kids, don't know about the risks and dangers of these drinks?

Roshni Patel 3:55

the biggest risk is not just the caffeine that's in the drinks, but the large amount of caffeine in the small volume that kids are ingesting in this very fruit-flavored, sparkly packaging and drink. It tastes good, feels good, but they don't really realize how much of this drug they're ingesting all at once. some of these drinks have up to 300 milligrams of caffeine. The American Academy of Pediatrics recommendation is 100.

Dr. Elise Fallucco 4:18

to expound upon that, the American Academy of Pediatrics they're saying that kids under 12 shouldn't have any caffeine. And then for 12 and older, the maximum amount that they would recommend would be 100 milligrams, which, you know, put into context, for those of us who maybe aren't counting our milligrams of caffeine regularly- would be about, like, two cans of soda.

Roshni Patel 4:37

Two cans of soda, maybe a cup of regular black coffee.

Dr. Elise Fallucco 4:40

And yet you're saying that some of these energy drinks, in terms of cans of soda what are they introducing into our bodies?

Roshni Patel 4:46

Monster energy drink, one of the higher Monsters. They have 300 milligrams of caffeine. That's up to six cans of soda- all at one time. Or some of them have other additives, such as taurine or guarana. Guarana is another stimulant that is twice the amount of caffeine as synthetic caffeine, or coffee. The labeling for FDA is very loosey-goosey when it comes to energy drinks 'cause they're considered supplements. They're not regulated like coffee and tea by the FDA. So with that being said,, they don't actually have to list the amount of caffeine completely that is in these products. So they can list the synthetic caffeine, but the added caffeine from guarana may not be added. So now you have a drink that says 200 milligrams of caffeine, could be up to 400 milligrams. Now you're looking at up to 12 cans of soda in one sitting.

Dr. Elise Fallucco 5:34

And just concentrated in a single can.

Roshni Patel 5:36

Correct.

Dr. Elise Fallucco 5:37

And so basically your body's getting exposed to just an incredible dose really quickly- Mm-hmm and trying to accommodate to that from cardiovascular standpoint, and then also from a brain standpoint.

Roshni Patel 5:47

Correct. Correct. our hearts are not designed to have that jolt of caffeine at one time, especially not early on or if you've not been acclimated to it. And even if you are, I think with children, can lead to some tragic effects.

Dr. Elise Fallucco 5:59

Yeah. we're talking to pediatric clinicians who are really familiar with the negative health impacts of caffeine on the body- obviously very familiar with the cardiac, effects and how potentially that's risky even for people with healthy hearts, but particularly for kids with underlying, cardiac conditions. I want to speak about the negative mental health effects of caffeine in kids. As adults, you can think about what do we physically experience when we drink caffeine. Well, sometimes we have increased energy, and we feel a little bit better, but that very quickly can tip over, into something that can be a little bit more toxic. The increased energy turns into feeling more jittery, more anxious, more irritable. contributing to insomnia, It can have really negative mood effects. And just speaking as me personally, I sadly have a very narrow therapeutic window for caffeine. Like a very narrow range that where I can feel okay, and very quickly I tip into being very difficult and wondering why is everybody going so slow, and everything is so annoying. But without going into a huge journal club, I just wanna share some of the highlights of the associations between caffeine and mental health problems. So we know, it's been associated with increased depressive symptoms, so not just the anxiety and irritability, but, manifesting signs of depression. And multiple studies have shown a correlation or association between energy drink use and suicidal thoughts, suicidal plans, and even suicide attempts. Is it that people are feeling irritable, and they're using the energy drink to, address their mood symptoms, and they already had underlying baseline depressive symptoms and suicidality., Because they're cross-sectional studies, we don't really get to get a better understanding of that. So we have a sense from the data that's out there about the negative mental health impacts of caffeine. But back to talking specifically about caffeinated energy drinks, what else is in there besides the caffeine and the guarana and the taurine that could be potentially harmful to kids and teens?

Roshni Patel 8:00

One of the next top ingredients you'll find in many of these drinks is gonna be sugar. Though there are a lot of sugar-free varieties out now, some of these drinks have up to 54 grams, or to better context, 14 teaspoons of sugar in a 16, 12 ounce drink. These drinks may have five times the amount of sugar than even one can of soda does. Not to mention just the dental impacts of this. Looking at metabolic endocrine impacts, you're causing an increased sugar spike, some down the line insulin resistance, obesity and possible diabetes. You may find even a sugar-free version, but those metabolic endocrine impacts are still going to be there. You can still have an insulin spike even if it is a sugar-free drink.

Dr. Elise Fallucco 8:42

"Who is doing PR for all the energy drinks?" Because there, there's something about the way that they're marketed is that they somehow seem like they're safer than they are.

Roshni Patel 8:51

And I really think, just from anecdotally looking at it, they have shifted the marketing to women and girls. There, there's a 50% of this market that they weren't hitting. Mm-hmm. And they realized in this day and age, the way to target girls is to talk about hair, skin, nails, fat metabolism, boosting energy, X, Y, and Z. And so that's why they'll add prebiotics to something and think, "Oh, it's healthy for your gut." Not really. Most of these are gut disruptors, especially this level of caffeine and the other additives.

Dr. Elise Fallucco 9:20

As pediatric clinicians, we know that these energy drinks are not healthy. Just like we're counseling kids to try to limit sugary sodas and, eat the rainbow- and all of the healthy fruits and vegetables. Yeah. That, you know, another big thing that we do need to be talking about is use of energy drinks. The reality is there's always a reason why people do things. Teenagers are turning to these drinks because they're staying up all night working on homework, preparing for tests, and also trying to juggle a thousand activities. So they're tired during the day. They wanna have increased energy. They wanna feel like they're being more productive. You can always say, "Okay, this is not the right answer. You shouldn't do that," but we need a good alternative.

Roshni Patel 10:00

Yeah.

Dr. Elise Fallucco 10:01

What would you recommend that pediatric clinicians talk to kids and teens about, what can they do instead of pounding an Alani energy drink? How can they boost their energy?

Roshni Patel 10:12

So for the most part, I'm looking at a child's overall whole child metabolic, nutritional, physical health. Over a course of a month, are they eating the rainbow? Are they eating, um, n- ultra-processed foods or sugary candies, X, Y, and Z? Are they consuming a healthy diet with lean proteins, healthy fats, high-fiber carbohydrates? Are they skipping meals? Are they grabbing sugary snacks and drinks That whole child and the whole nutritional impact, picture is more important. And then we next up look at, well, are they properly hydrated? Are they drinking enough water? especially if they're in sports and activities. A little sports drinks here and there is not gonna hurt either, especially if they're outside in the heat. But what we've realized is in the current environment, the pressures the teens are under, whether it's sports, fine arts, academics, all of those combined, there are going to be those days where even if they're doing everything right most days of the week, they're going to need what they would call a boost. "I'm just tired. I stayed up all night. What else can I do?" I am not opposed to caffeine. Like we have said, American Academy of Pediatrics has recommended over 12 years old having maximum of 100 milligrams of caffeine. Are they days where I may allow my own children to have half a cup of coffee with milk, which slows down metabolism, prevents a sugar and caffeine spike? Sure. are they times where they may grab a soda in the middle of the day to get through that next test at the end of the day? Understandably. What we wanna look at though is are these kids doing this every day? If they're needing caffeine of some sort, whether coffee, energy, what have you, every single day, we need to reevaluate what is their functional day looking like. Is it over-packed? Is it over-jammed? Mm-hmm. Is there any mental health issues that we need to be addressing? Clearly, is there any sleep issues we need to be addressing? 'cause at the end of the day, one Coke or one coffee one day is not gonna make your health any detrimental as adding one vegetable one day is gonna make you healthy. but the overall monthly, yearly effect of what they are doing regularly does matter.

Dr. Elise Fallucco 12:13

I love your holistic approach- Yeah and, you know, reminding us to zoom out and think about overall nutrition, decreasing ultra-processed foods, sugars, and then staying hydrated. Yeah. I think that's the thing that I forget about.

Roshni Patel 12:25

And I also encourage teenagers to have healthy snacks on hand with them. Are they having, you know, cheese and crackers or protein bars with a little bit less sugar? Which I prefer like a 2:1 carb to protein ratio for those. Cottage cheese and fruit. Real food is what I encourage. But there's gonna be times where you need something more handy, like, then protein bars and protein drinks do come into play. that would be a better boost in the middle of the day- than any kind of caffeine boost to get them through the activity, to have enough carbs and protein to fuel not only their muscles, but also their brains.

Dr. Elise Fallucco 12:55

I really appreciate your specific recommendations, and I wanna just re-highlight them for our listeners, in addition to the holistic approach, what you wanna think about is on occasion, if you really do need that boost, thinking about a half a cup of coffee with milk, and I like how you talked about the importance of the protein from the milk and- Mm-hmm, and the fat yeah, and the fat. Or, you know, potentially a soda, and then you talked about protein bars, the 2:1 carb to protein ratio. But I think for me, and I think definitely, for other families, it'd be helpful to have, if we go to Starbucks, here is a drink I would recommend, or, if I'm in a pinch- which protein bars would I steer towards? And obviously, there's no conflict of interest. We don't have anybody- sponsoring us, but I would love for Starbucks to sponsor me. So we're just speaking freely here.

Roshni Patel 13:41

as far as Starbucks go, I definitely would stick to coffee with some kind of milk or fat in it. Mm-hmm. I think that makes a big difference in terms of how children are absorbing that caffeine and how much of a spike they're gonna get. I know they have drinks as well, like the pink drink, which are fun coconut water-based drinks. You definitely wanna dig a little deeper 'cause they have a whole line of drinks that are highly caffeinated as well that look like fruit juice. when it comes to protein bars, I'm currently on the Perfect Bar kick. it's found in the refrigerated section. The ingredients are very clean from what I can see. and they actually taste pretty good.

Dr. Elise Fallucco 14:16

They taste delicious. Yeah, it's

Roshni Patel 14:18

like a candy bar, like Reese's.

Dr. Elise Fallucco 14:19

I Love the taste of Perfect Bars, and so do my kids. Unfortunately, the lactose in them really upsets our tummies. Yeah. And so even though they taste delicious- Mm-hmm we can't do them. Are there any other recommendations you might have?

Roshni Patel 14:32

I like the protein drinks a little bit more, I think. They're easily accessible. The kids g- like drinking them a little bit better than some of the bars, 'cause that chalky taste is not a huge fan for most teenagers. My older son and I, we will do a Fair Life drink. It's lactose-free, fairly low in sugar. I'm not a big proponent of artificial sweeteners, so that's probably the only one I limit my kids to have. Even if they're having sodas, I actually am okay with them having a soda with sugar rather than, a diet soda. Protein bars and shakes are great. They're a great option for when you're on the go, when you need to grab and go. But for the most part, focusing on real whole foods is probably the best option for me, is what I would suggest. We always have Brie bites in our house, and so Brie bites and fruit are a huge snack in our house. my older one is a big tortilla chip person. But that with some guacamole, the, you know, the individual packs of guac, that works great. again, I'm looking for fibrous things. I'm looking for whole foods.

Dr. Elise Fallucco 15:30

So as far as things to drink that'll boost your energy for protein drinks, you like the Fair Life drinks.

Roshni Patel 15:35

Premier Protein is another good one.

Dr. Elise Fallucco 15:37

Mm, or Premier Protein. and then thinking about, protein bars, the Perfect Bar. I also wanted to put a little plug in for the RXBAR. Yeah. They are not delicious,

Roshni Patel 15:47

they lost me at egg white.

Dr. Elise Fallucco 15:49

But I do like that they have really simple, clean ingredients- Yeah and not a lot of chemicals, so, RXBARs. Maybe not delicious, but

Roshni Patel 15:58

But clean ingredients. I will give them that. But clean.

Dr. Elise Fallucco 16:00

My, my teenage son will eat chocolate sea salt and the peanut butter. Yeah. and I stick to the blueberry. Okay. Oh. And then you mentioned the Starbucks drinks, like more of a latte. Either an iced latte or, a regular latte with milk, preferably milk with some sort of fat. Okay. And then soda, your personal preference is with sugar as opposed to the sugar-free most of which, "sugar-free sodas" are still causing the insulin spike, So we talked about protein drinks. We talked about protein bars. Yeah. We talked about Starbucks options, and then just healthy grab-and-go snacks, like the cheese bites or brie bites and fruit, and chips and guac.

Roshni Patel 16:34

Some of my friends will also do, like, the crunchy or the regular edamame or chickpeas. So it's a crunchy, salty snack in place of, say, chips or what have you. And now, you know, we have a whole line of protein popcorn to protein chips. Protein's having its moment, and they're adding it to everything. Including water, actually. There's a protein water out there too. Is it an option? Is It better than brie bites and a fruit? Probably not. But is it better than an energy drink? Absolutely.

Dr. Elise Fallucco 16:58

I really appreciate all your practical tips of like, "Here are things I would give my kids," and that are realistic and that they'll actually eat.

Roshni Patel 17:05

Yeah. But I mean, my kids still do have sodas, and they do have popcorn and potato chips and what have you. There's a moderation to all of it, let's be honest. however, I, with that caveat, I don't see a moderation with energy drinks. I can't be one to say, "Well, just have one, you know, once a day will be fine." As we've seen in current events, there were kids who were doing maybe one or two a day, and it's led to tragic results. I just don't trust enough of what's in these drinks to give them to our children.

Dr. Elise Fallucco 17:28

And it's not just you who's saying this. You know, the American Academy of Pediatrics, the American College of Sports Medicine, the American Heart Association, they have all discouraged energy drink use among kids, teens, and young people. I went online and I saw this global map, and it was color-coded based upon which countries in the world have banned or restricted, the sale of energy drinks to people under the age of 18. And Asia and Europe, or a lot of countries in both of those continents, are,

Roshni Patel 17:55

are banning. Have made significant bans

Dr. Elise Fallucco 17:59

They've taken huge steps in banning the sale of energy drinks- to kids and to teens, including in the UK, and yet in the US there is no current restriction.

Roshni Patel 18:08

There is an incredibly large lobbying power in Congress from these industries. I mean, at $100 billion a year, of course they're going to. At this point, I think with many things in our food system, it falls upon the parents and clinicians and physicians asking kids, "Are you drinking any of these?" And parents asking, "Have you tried any of them?" And talking to your kids about the dangers. I think when it comes to teens, telling them, "Just no," is not gonna work, but you have to explain to children, "You know, you may want to try these, but let me lay out what is in these. Let me lay out the marketing and how insidious it is towards you." And one of the things kids do not appreciate is being lied to. Yep. And I think when some of these drinks don't accurately have the amount of caffeine that they say, they have claims that we all know as adults are probably not correct, they appreciate that. And what we realized from doing the classes with the kids was open their eyes up, and they realize and start telling their other friends who are drinking them, like, Do you realize how bad these things are?" So the peer pressure to make kids understand these are not as great as they sound. may not have-- we may have touched on slightly was some of the kids when we were commented that their, coaches were recommending them to have energy drinks. Now, whether it be for they looked a little tired or for sports performance, we know very little data with teens and sports performance. There's very little data that is actually helpful. What we do know is caffeine is a highly diuretic. It is dehydrating these kids. it can lead to muscle loss, muscle cramps, electrolyte loss, and not to mention the added cardiovascular metabolic harm. So at this option for me is this is not an option for kids to have before a sports performance to get through a lacrosse game or a basketball game. They should be having whole foods and hydrating properly throughout the game

Dr. Elise Fallucco 19:53

So before we wrap up, I just want to say thank you so much, Roshini- for being p- passionate about this, and for advocating for kids' health, and for going directly to teens and letting them know about what's going on, and also, advocating in our community and on a larger level about the risks associated with energy drink use. and I appreciate also the practical advice you're able to give about here's what you can do instead, and here's what works and what we've found works. Just wanna thank you for coming and sharing your knowledge

Roshni Patel 20:22

you're welcome. Thank you for having me.

Dr. Elise Fallucco 20:24

And thanks to our listeners for tuning in, and I hope you learned something from this podcast. I certainly did I think the big clinical takeaway I learned from this is to make sure to ask all teens if they've tried these type of energy drinks, and if so, to make sure that they're aware of the risks associated with high amounts of caffeine, sugar And in addition channel your motivational interviewing So that when a teen is telling you that they're trying out these energy drinks, use that as an opportunity to start a conversation about what is making them feel that they need this. What are they hoping to get from Chugging a Red Bull or a similar highly caffeinated beverage And then use that to begin a larger conversation about other healthy choices that they could do to try to achieve their goals. And for those of you who are friends and colleagues of our podcast, I'll be sharing a tip sheet from Roshini Patel about these recommended healthy alternatives to energy drinks and re- including recommended brands as a part of our regular newsletter. And if you're interested in this, please check out our website at psyched, the number four, peds.com, and sign up to become a friend and colleague and join our newsletter And we'll include the link to this website in our show notes. Thanks so much for listening. See you next time