|The most important qualities of a champion don't come in a bottle and are not for sale.|
Doctors warn of cardiac risks for young athletes
The Gatorade cooler and the coffee pot in the locker room have competition.
From youth playing fields to major-league clubhouses, caffeinated energy drinks such as Red Bull and its scores of cousins have become a familiar presence in sports.
"The bottom line is, it's a long season. You're going to do what you have to do, whether you feel like you have to jump into a cryogenic freezing tank or a hyperbaric chamber or drink a Red Bull," said Texas Rangers pitcher C.J. Wilson, a World Series starter who says he has never used alcohol or drugs but consumes energy drinks socially and to prepare himself to pitch. "I see nothing wrong with drinking Red Bull."
Some athletes and industry officials compare the beverages to a cup of coffee.
But doctors and other experts increasingly warn of misunderstandings about energy drinks' contents, lax labeling requirements and the risks of high doses of caffeine -- particularly to young athletes.
In June, a clinical report in Pediatrics, the journal of the American Academy of Pediatrics, warned that "stimulant-containing energy drinks have no place in the diets of children or adolescents."
In October, the National Federation of State High School Associations cautioned that caffeinated energy drinks -- often confused with such products as Gatorade, a fluid-replacement drink -- should not be consumed before, during or after physical activity because they could raise the risk of dehydration and increase the chance of potentially fatal heat illnesses. The organization also warned of possible interactions with prescription medications -- including stimulants used to treat ADHD, or attention-deficit hyperactivity disorder.
In Orange County, Calif., at least four high-school football players were taken to the emergency room last season with persistent tachycardia, or rapid heartbeats, said Michael F. Shepard, a team physician and member of the California Interscholastic Federation's state medical advisory board.
"All four had had super-caffeinated drinks," Shepard said. "If you add dehydration or flu or muscle-building supplements like creatine to that, there can be an increased risk of fatal cardiac arrhythmia.
"These four kids all did fine," Shepard said. "But the heart's a muscle, too."
At issue is a dizzying array of products with widely varying levels of caffeine, sugars, carbohydrates and other additives, including herbal supplements.
Red Bull, which in 1997 became the first such drink on the U.S. market, has been surpassed in national sales by Monster energy drinks in what is now a $7.7 billion industry, according to the trade publication Beverage Digest. Rockstar energy drinks rank third.
Most of the best-selling energy drinks contain about 80 milligrams of caffeine per 8 ounces, though they are often sold in containers as large as 20 to 24 ounces. Other more extreme products abound, some of them in mix-your-own powders or concentrates, in strengths researchers say range from about 50 to 500 milligrams per serving. At their maximum strength, energy drinks contain about 300 milligrams more than the 2-ounce shots of 5-hour Energy frequently seen near checkout counters.
Beverage industry officials contend that their products are not dangerous when used in moderation by healthy people.
"Regulatory agencies around the globe agree that caffeine is a safe ingredient to use in food and beverages," said Tracey Halliday, a spokeswoman for the American Beverage Association. "When it comes to energy drinks, the amount of caffeine in most mainstream energy drinks is about half that in a cup of coffee in a coffee shop, if you compare ounce to ounce."
A 16-ounce can of the top-selling energy drinks contains about 160 milligrams of caffeine. A 16-ounce cup of Starbucks' robust Pike Place Roast contains 330 milligrams, though critics say a hot drink is sipped more slowly than a cold beverage.
Researchers complain that identifying caffeine content and other ingredients is difficult for consumers because U.S. Food and Drug Administration regulations do not require products marketed as dietary supplements -- as many energy drinks are -- to adhere to the same labeling requirements as food and beverages.
Canada moved last month to limit the caffeine in energy drinks to no more than 180 milligrams in containers up to 20 ounces. In the U.S., cola-type drinks are limited by the FDA to 71 milligrams of caffeine per 12-ounce serving. But no such limit applies to energy drinks marketed as dietary supplements, and manufacturers are not required to list the caffeine content or all ingredients on the label, sometimes opting for the term "energy blend" or "proprietary blend."
"They regulate a can of cola," said John P. Higgins, a sports cardiologist at the University of Texas Health Science Center at Houston and co-author of a 2010 article on energy drinks published in the Mayo Clinic Proceedings. "These are like a free-for-all."
Additives such as the herbal supplements guarana, green tea and yerba mate can boost the effective level of caffeine. Less common additives such as yohimbine and bitter orange can increase heart rate, cause changes in blood pressure and interact with certain antidepressant medications, according to the National Institutes of Health.
Monster, the U.S. leader in sales, does not list the amount of caffeine on its can, although independent sources place it at about 80 milligrams per 8-ounce container, or 240 in Monster's 24-ounce can. The drinks are manufactured and distributed by Southern California's Hansen Beverage Co., which declined to comment, saying it does not respond to news media inquiries.
Causes, effects debated
The FDA, which quashed the controversial practice of manufacturers including caffeine in alcoholic drinks such as Four Loko by issuing warning letters to four companies in 2010, has not acted on petitions by academics and other experts to limit caffeine or change labeling requirements for energy drinks. (Four Loko is now sold as an alcoholic beverage that does not include caffeine.)
"Those petitions are still within the FDA and still under consideration, and the agency can't comment," said Susan Carlson of the FDA's office of food additive safety.
Nationally, emergency-room visits associated with energy-drink use increased more than tenfold from 1,128 in 2005 to 13,114 in 2009, according to a report released last month by the federal government's Substance Abuse and Mental Health Services Administration. Forty-four percent involved combinations with other substances such as alcohol, pharmaceuticals or illicit drugs, which the American Beverage Association said made energy-drink consumption "potentially irrelevant." However, more than half of the visits didn't involve another substance.
Most adverse reactions involve people who consumed two to eight energy drinks or more than 200 milligrams of caffeine, said Higgins, co-author of the Mayo Clinic report.
The exhaustive review of studies on energy beverages by Higgins and Houston exercise physiologist Troy D. Tuttle noted the risk of such effects as insomnia, nervousness, nausea, rapid heartbeat -- and in more rare cases, seizures, cardiac arrhythmias and cardiac arrest, particularly in people with underlying medical conditions. The review also cited four documented cases of caffeine-associated deaths involving individuals who had consumed energy drinks.
"For a healthy person, probably one is not going to kill you. But we don't know," Higgins said. "I think it's the combination of things in these energy beverages," he added, cautioning about interactions. "A lot of athletes drink coffee."
Marketing to the young
Yet another issue raised by doctors and researchers is the marketing of energy drinks to young people, particularly through sponsorships of athletes and extreme sports. New York's Major League Soccer team is the Red Bulls, owned by the drink company. NASCAR driver Kyle Busch endorses the drink NOS, and Monster has a stable of lesser-known athletes and bands.
Meet The New Sports Drink: Pickle Juice
When it comes to folk remedies, professional athletes are miles ahead of the game. Whether putting butter on a burn or rubbing dirt on a cut, they'll do just about anything if they think it'll help them get through a game.
Including drinking pickle juice.
The practice of downing cucumber brine isn't a new one. It's been used for decades and got media attention back in 2000 when Eagles trainer Rick Burkholder credited pickle juice as the secret weapon that helped his team stomp the Cowboys in Texas Stadium. On that day, temperatures on the field soared above 110 degrees -- the perfect conditions for a cramp-fest.
But the Philadelphia players, dosed with the neon elixir, avoided the crippling injury and won running away, 41-14.
As it turns out, this is one of those rare occasions where the science caught up to the practice.
A study done last year at BYU proved the efficacy of the folksy curative. Subjects exercised to the point of mild dehydration and had cramps induced. Those who drank pickle juice felt relief within 85 seconds, almost twice as fast as water or other sports drinks.
"Pickle juice is a natural source of sodium as well as other electrolytes," says Buccaneers team nutritionist Kevin Luhrs. "Sodium is a component of sweat. The rationale is that sodium from the pickle juice helps replace sodium losses from sweat and even helps retain water in the body."
Although Luhrs said he doesn't use pickle juice with any Buccaneers, he says the practice is common around the league. Dez Bryant reportedly loves it. Jason Witten even endorsed a bottled version called Pickle Juice Sport back in 2006. Packers defensive end Jarius Wynn used to swear by it.
"I used to drink pickle juice in high school to keep the cramps down," Wynn says. "It was good when I was young, especially playing in the South where is gets really hot."
Wynn has switched to coconut water or other electrolyte-laden
drinks. But Pickle Juice Sport founder Brandon Brooks says he provides his product to nearly two dozen teams and more than 100 professional athletes.
His sales are up so much (54 percent from last year alone) that he can't produce enough of the drink to sign on with any more large retail outlets.
Now with the science to back it up, pickle juice appears to be here to stay. It probably won't hit the shelves of 7-Eleven anytime soon, but the curious can simply grab the jar of dills from the refrigerator door next time they wake up with a knot in their calf.
Makes you wonder if a shot of olive juice might be good for more than just martinis.