Is there evidence that energy drink consumption is linked to cardiovascular, metabolic, dental, neurologic, or gastrointestinal adverse effects, particularly in adolescents, young adults, or individuals with hypertension, heart disease, diabetes, pregnancy, or psychiatric disorders?

Energy Drinks Are Linked to Serious Cardiovascular and Neurological Harm, Especially in Adolescents

Energy drinks cause documented adverse effects on cardiovascular and neurological systems, and the American Academy of Pediatrics has definitively stated that stimulant-containing energy drinks have no place in the diets of children and adolescents. 1, 2

Cardiovascular Effects

Energy drinks produce measurable and clinically significant cardiovascular complications:

• Acute cardiovascular effects include increased systolic and diastolic blood pressure, heart rate elevation, and prolonged QTc intervals that can precipitate arrhythmias. 3, 4

• Documented serious outcomes include atrial and ventricular arrhythmias, myocardial infarctions, cardiomyopathies, and sudden cardiac death. 4

• The high caffeine content disrupts normal blood pressure regulation, leading to greater blood pressure variability and increased risk for masked hypertension and cardiovascular disease. 3

• These cardiovascular risks are particularly concerning in individuals with pre-existing heart disease or hypertension. 5, 6

Neurological and Psychiatric Complications

The neurological system is the second most commonly affected organ system:

• High caffeine intakes cause adverse neurological effects, with the most common being central nervous system stimulation and associated complications. 1

• Repeated consumption increases the risk of psychiatric complications, particularly among adolescents and those with pre-existing neurological conditions. 6

Metabolic and Dental Consequences

Beyond acute effects, chronic consumption creates long-term health risks:

• Energy drinks contribute to obesity through high sugar content, with adolescents consuming approximately 143 kcal from sugar-sweetened beverages daily. 2

• Regular consumption increases the risk of type 2 diabetes and future cardiovascular disease, as documented by the American Heart Association. 2

• Dental erosion and caries result from the combination of high sugar content and acidity. 7

Caffeine Toxicity Risk from Multiple Ingredients

A critical pitfall is underestimating cumulative caffeine exposure:

• Guarana contains caffeine plus theobromine and theophylline; when combined with added caffeine in energy drinks, this can lead to caffeine toxicity even when individual ingredient amounts appear safe. 1, 2

• Safe caffeine limits for healthy adults are ≤400 mg daily, but adolescents should consume <2.5 mg/kg body weight—a threshold easily exceeded with a single energy drink. 2

• Do not overlook the cumulative caffeine load when adolescents consume multiple caffeinated beverages throughout the day. 2

High-Risk Populations Requiring Absolute Avoidance

Certain populations face disproportionate risk:

• Children and adolescents should never consume energy drinks given their developing cardiovascular and neurological systems. 1, 2

• Individuals with cardiovascular disease, hypertension, or arrhythmias face increased risk of serious complications. 5, 6

• Pregnant women should avoid energy drinks due to high caffeine content and unknown effects of other ingredients. 7

• Those with psychiatric disorders may experience exacerbation of symptoms with repeated consumption. 6

Alcohol Co-Consumption Amplifies Risk

The combination of energy drinks with alcohol creates a particularly dangerous scenario:

• Adolescents and young adults frequently mix energy drinks with alcohol to "drink more while delaying drunkenness," which increases risk-seeking behaviors and adverse outcomes. 5, 8

• This combination masks alcohol intoxication while maintaining stimulant effects, leading to excessive alcohol consumption and associated complications. 5

Prevalence Data Highlighting the Public Health Crisis

The widespread consumption among youth is alarming:

• Nearly two-thirds of teens report ever using energy drinks, with 31% of 12-17 year-olds consuming them regularly and 5% consuming them daily. 1, 2, 3

• This high prevalence, combined with aggressive marketing toward adolescents and lack of regulatory oversight, compounds the public health risk. 8

Clinical Recommendation Algorithm

For any patient inquiry about energy drinks:

1. Advise complete avoidance for all children and adolescents based on AAP position statement. 1, 2

2. For adults with cardiovascular disease, hypertension, arrhythmias, psychiatric disorders, or pregnancy: recommend absolute avoidance. 5, 6, 7

3. For healthy adults: counsel that even occasional consumption carries cardiovascular and neurological risks that outweigh any purported performance benefits. 1, 4

4. Screen for co-consumption with alcohol or other stimulants, which dramatically increases risk. 5, 8

5. Recommend alternative beverages such as water, and for athletes specifically, evidence-based sports drinks for electrolyte replacement rather than energy drinks. 1, 3