adolescents, sports drinks and energy drinks: a...

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Adolescents, Sports Drinks and Energy Drinks: A Bad Mix?

Holly J. Benjamin, MD, FACSM, FAAP

Presenter Disclosure Information

Holly Benjamin, MD, FACSM, FAAP

Adolescents, Sports Drinks & Energy Drinks: A Bad Mix?

FINANCIAL DISCLOSURE:

No relevant financial relationship exists

Adolescents, Sports Drinks and Energy Drinks: A Bad Mix? • Holly Benjamin, MD, FACSM, FAAP

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Objectives

• To discuss the health impact of sugar sweetened beverages (SSB’s) on adolescents

• To review, in particular, the risks versus benefits of sports and energy drinks in the general youth population

• To identify strategies for education on the use versus misuse of sports and energy drinks in adolescents


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What drinks are considered sugar sweetened beverages (SSB’s)?

• Sodas – Coke, Pepsi, Mountain Dew, Sprite, Dr. Pepper,

Fanta

• Fruit Drinks (not 100% juice) – Kool Aid, Hi-C

• Iced Teas and Sweet Teas – Snapple, Arizona, Nestea, SoBe, Tazo

• Sports Drinks – Gatorade and Powerade

• Flavored Water – Vitamin Water

• Just one soda a day can add on up to 15 lb a year! • NOTE: drinks that contain artificial sweeteners such

as aspartame, sucralose or stevia are NOT considered sugary drinks but are SSB’s


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Adolescent consumption**

• In 2004 adolescents consumed an average of 300 kcal’s/day from SSB – Approx 13% of total daily caloric

intake – Approx 15 tsp of sugar a day – Since 2000; now independent of age,

gender, racial/ethnic background and socioeconomic status

• SSB intake reduces consumption of important beverages such as water and nutrient rich milk – Calcium, iron, folate, vitamin A

**Healthy Eating Research Synthesis; Nov, 2009. Robert Wood Johnson Foundation


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What is a serving size?

8 oz 12 oz 20 oz 32 oz 46 oz

Amount of Sugar:

6 tsp 8 tsp 14 tsp 23 tsp 51 tsp


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What is a serving size?

8 oz 12 oz 20 oz 32 oz 46 oz

A standard serving size is 8 oz!


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Average CHO (carbohydrate) content of beverages

• Beverage Size Avg CHO (tsp) • Water 250 mL or 1 cup 0 tsp • 1% milk 250 mL or 1 cup 3 tsp • Chocolate milk 250 mL or 1 cup 7 tsp • Unsweetened soy-beverage 250 mL or 1 cup 0 tsp • (Calcium & Vitamin D fortified) • Flavoured soy beverage 250 mL or 1 cup 4 tsp • (Calcium & Vitamin D fortified) • 100% orange juice, unsweetened 250 mL or 1 cup 6 tsp • Fruit Flavoured beverage 250 mL or 1 cup 8 tsp • Diet pop, 1 can 355 mL or 1 ½ cups 0 tsp • Regular pop, 1 can (12 oz) 355 mL or 1 ½ cups 8 tsp • Sweetened Iced Tea (12 oz) 355 mL or 1 ½ cups 8 tsp • Sport drinks (12 oz) 591 mL or 2 1/3 cups 8 tsp • Iced Cappuccino ( with milk) 312 mL or 1¼ cups 8 tsp • Ice slush 650 mL or 2.5 cups 12 tsp • Large fountain pop 1.9 L or 7 ½ cups 51 tsp


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Nutrient composition of non-diet soda, OJ, and low-fat milk**

Non-diet soda

Orange juice 1% milk

Calories (kcal) 160 168 153

Vitamin C (mg) 0 146 3

Vitamin A (IU) 0 291 750

Calcium (mg) 0 33 450

Potassium (mg) 0 711 352

Magnesium (mg) 0 36 51

**Nestle M. Public Health Reports; 2000 9

Health risks associated with SSB’s

• Obesity

• Diabetes (Type II)

• Cardiovascular disease

• Osteoporosis

• Hypertension

• Decreased bone density

• Dental decay

• Headaches

• Anxiety

• Sleep disturbances


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Healthier Drink Guide

•Water, water, water • AKA: voda, ama, das Wasser, nero,

wai, maim, paani, mizu, mool, vanduo, woda, água, vasser, etc.

Adolescents, Sports Drinks and Energy Drinks: A Bad Mix? • Holly Benjamin, MD. FACSM, FAAP

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http://boil-water.com/wp-content/uploads/2012/03/distilled-water.jpg

Water you would love to drink!


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Healthier Drink Guide

• Water

– At least ½ your daily fluid intake should come from water (5 cups/day for kids and 10 cups for adults) minimum

• Skim milk, soymilk 1% lowfat milk

– Approx 2 cups per day

• 100% fruit juice

– 4 oz per day (small amounts)


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http://boil-water.com/wp-content/uploads/2012/03/distilled-water.jpg

Water Tips

• Kids should drink water routinely as initial beverage of choice

• Kids drink greater quantities of cooled beverages including water

• Add slices of fruit

– Lemon, lime, watermelon

• Add small amounts of flavor such as fruit juice

Bar Or, O and Rowland T. Pediatric Exercise Medicine; 2004


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Water

• Essential part of daily diet

• Body is 60% water

• Adequate hydration is needed to maintain normal cardiovascular, thermoregulatory and other physiologic body functions

• Goal is to maintain euvolemia


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How much water does the body really need?

• Influenced by diet, meds, illnesses, chronic health conditions

• With exercise, needs increase quickly

– Heat, humidity, sun exposure, acclimatization

– Exercise time and intensity, sweat rates


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Dehydration

• Caused by a mismatch between body water loss and water intake

• Dehydration is associated with

– Fatigue

– Impaired sports performance

– Occasional electrolyte abnormalities

– An increased risk of heat illness

• The presence of thirst indicates at least a 3% dehydration state


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Sports drinks versus Energy drinks: Defining the difference**

• “Sports drink” is a flavored beverage that contain carbohydrates (CHO), minerals, electrolytes (E), and sometimes vitamins or other nutrients (protein)

• “Energy drink” contains some form of stimulant substance(s) such as caffeine or guarana in addition to CHO, minerals, electrolytes, protein or AA’s

**Benjamin, Schneider, et al. AAP Clinical Report: Sports and energy drinks

for children and adolescents: are they appropriate? Pediatrics. May, 2011.


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Marketing Sports and Energy Drinks

• Sports drinks are marketed to optimize athletic performance and replace fluid, CHO and E lost in sweat

• Energy drinks suggest a boost in energy, decreased fatigue, enhanced concentration and mental alertness


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Energy drinks & youth: a bad mix

Stimulant containing energy drinks have NO place in the diets of children or adolescents!


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http://righteousgreenliving.com/wp-content/uploads/2012/02/ban.jpg

Sports drink use

• Excessive caloric intake through use of a sports drink as a routine beverage can also contribute to the risk of pediatric overweight and obesity

• Calories range between 10-70 kcals/serving SD and 10-270 Kcals/serving for ED

• Studies show that adolescents do not distinguish differences between sports and energy drinks

• Reasons for use include good taste, quench thirst and extra energy boost


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Sports drink consumption trends**

• Between 1988-1994 and 1995-2004, the share of SSB consumption from sports drinks increased threefold among adolescents

• Between 2000-2004, in schools, the purchase of traditional carbonated soft drinks fell 24% but sports drink sales increased 70% (almost 20% of total sales) – Ex: two 12 oz SSB servings at $0.50 a day costs

$24 billion a year!!

**Wescott, et al. Measuring the purchases of soft drinks by students in US schools. An analysis for the ABA; 2010.


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Components of Sports Drinks

• Carbohydrate (CHO) – The body’s most important source of

energy – Best ingested in regular diet balanced

with protein and fat, not through CHO containing beverages

– EXCEPTION: athlete who performs vigorous exercise for > 1 hr needs to replenish depleted glycogen stores as well as water and electrolyte loss** • Use of a CHO-E sports drink in this

setting is recommended

**ACSM Position Stand: Exercise and fluid replacement. MSSE; 2007.


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Examples of Sports Drinks Content Per Serving (240 mL - [8 oz])**

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Product/Manufacturer Kcal’s CHO (g) Na (mg) K(mg) Vitamins Other

All Sport Body

Quencher/All Sport, Inc.

60 16 55 60 C

All Sport Naturally Zero/All

Sport, Inc.

0 0 55 60 B3, B5, B6, B12

Gatorade/PepsiCo, Inc. 50 14 110 30

Gatorade Propel/PepsiCo, Inc. 103 35 B3,B5,B6,B12, C, E

Gatorade Endurance/PepsiCo,

Inc

50 14 200 90 Ca, Mg

Gatorade G2/PepsiCo, Inc 20 5 110 30

Powerade Zero/Coca-Cola, Co 0 0 100 25 B3, B6, B12

Powerade/Coca-Cola, Co 78 19 54 Iron

Powerade Ion4/Coca-Cola, Co 50 14 100

25 B3, B6, B12

Accelerade/Pacific Health, Inc. 80 15 120 15 E Ca, Protein

**Benjamin, Schneider, et al. AAP Clinical Report: Sports and energy drinks for children and adolescents: are they appropriate? Pediatrics. May, 2011

Dental risks associated with sports and energy drinks

• Sports and energy drinks pH ranges 3-4 which is associated with enamel demineralization

• Citric acid is also highly erosive

• Bartlett, et al found enamel erosion in 57% of 11-14 yr olds in a cluster sample of adolescents

• This risk is independent of CHO content

Adolescents, Sports Drinks and Energy Drinks: A Bad Mix? •

Holly Benjamin, MD, FACSM, FAAP 25

Caffeine intake in youth and adolescents

• Sodas are the primary source of caffeine in a youth diet

• Ellison et al reported children 6-10

yrs old ingest caffeine 8/10 days • Caffeine intake rises steadily with

age and is over 60% in adolescent females and 70% in adolescent males



Caffeine ingestion

• Variety of forms

• Can increase aerobic endurance, strength, improve reaction time and delay fatigue in adults

• Effects variable and dose-dependent

• Not studied in children

Adolescents, Sports Drinks and Energy Drinks: A Bad Mix?

• Holly Benjamin, MD, FACSM, FAAP 27

Caffeine


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Caffeine toxicity

• Ergogenic effects at 3-6 mg/kg. for avg 10 yr old 35 kg (80 lb) – 3 sodas (12 oz) 36 mg caffeine each (4.5

servings)

– 1 Five Hour Energy (2 oz) 160 mg

– 1 Monster Energy (20 oz) 160 mg/2.5 servings

– Lethal dose => 200-400 mg/kg

– In 2005, over 4600 calls reported to poison control centers for caffeine concerns and 2500+ involved persons under age 19**

**Lai et al. 2005 annual report of American Association of Poison Control Centers. Clin Toxicol; 2006


Holly Benjamin, MD. FACSM, FAAP 29

http://www.5hourenergy.com/healthfacts.asp

Energy Blend 1870 mg**daily value not established

Taurine, glucuronic acid, malic acid, n-acetyl l-tyrosine, l-

phenylalanine, caffeine, citrocoline

Regular, decaf or

double shot??


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http://www.5hourenergy.com/healthfacts.asp

Summary: Food is Fuel…

• Athletes who eat wisely will perform better

• Athletes who don’t get the right “fuel” will run out of gas

• Energy needs vary

• This is true of non-athletes as well!!


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Energy Balance

• Intake = Foods + fluids + supplements

• Expenditure = basal metabolism + thermic effect of food + physical activity

• Energy in = Energy out


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School Vending Machine Recommendations

• Keep all vending machines off during regular school hours

• Keep machines off during lunch periods

• Prohibit sale of “foods of minimal nutritional value” during school hours

• Place vending machines in “out of the way” locations in schools (best if far from dining area)

• Discourage schools from depending on vending machine revenue to fund education



Do school bans lower SSB consumption?

• Taber et al found in longitudinal survey data from 6900 children in 5-8th grade** – 11 states that banned soda only – 7 states banned all SSB’s – 22 states without bans

• Consumption rates were lower when all SSB’s were banned

• If only soda was banned, other SSB’s were substituted so overall use constant

• Sadly, out of school consumption rates were unchanged in any situation

**Taber, et al. Arch Pediatr Adolesc Med. 2012


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Take Home Points

• Energy drinks have NO PLACE in the diets of youths and adolescents

• Sports drinks add unnecessary calories to the diet and are forms of SSB’s

• Sports drink use is indicated only for high intensity workout situations of > 60 min

• Sports drinks erode dental enamel

• Sports drinks add unnecessary sodium to the diet

• WATER is adequate for most hydration needs



Thought for the Day

• “If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.”

•Hippocrates –(c. 460-377 B.C.)


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Adolescents, Sports and Energy Drinks: A Bad Mix??

• Thank-you

• Holly J. Benjamin, MD, FAAP, FACSM

• University of Chicago Center for Sports Medicine

– (Naperville, Matteson and Hyde Park)

• [email protected]

• (773) 702-0003


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