Hundreds of Brands - Millions of Young Users - Billion $ Industry - How Should We Hydrate?
New Federal Government Report : "A Rising Public Health Concern"...read
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Position Statement and Recommendations
for the Use of Energy Drinks by Young Athletes
National Federation of State High School Associations (NFHS) & Sports Medicine Advisory Committee (SMAC)
Energy drinks have become increasingly popular among adolescents and young adults in recent years. In 2006, nearly 500 new brands were introduced to the market place, and over 7 million adolescents reported that they had consumed an energy drink. Estimated sales of energy drinks for 2011 are expected to exceed $9 billion. These beverages are particularly popular among young athletes who see the consumption of energy drinks as a quick and easy way to maximize athletic and academic performance.
The NFHS SMAC strongly recommends that:
1. Water and appropriate sports drinks should be used for rehydration as outlined in "NFHS Position Statement and Recommendations for Hydration to Minimize the Risk for Dehydration and Heat Illness." (SEE BELOW)
2. Energy drinks should not be used for hydration prior to, during, or after physical activity.
3. Information about the absence of benefit and the presence of potential risk associated with energy drinks should be widely shared among all individuals who interact with young athletes.
4. Athletes taking over the counter or prescription medications should not consume energy drinks without the approval of their primary care provider.
The exact content and purity of energy drinks cannot be insured, as there are no regulatory controls over these products. Thus, there is the risk for adverse side-effects, potentially harmful interactions with prescription medications (particularly stimulant medications used to treat ADHD), or positive drug tests.
Frequently Asked Questions
What is an energy drink?
An energy drink is a beverage marketed to both athletes and the general public as a quick and easy means of relieving fatigue and improving performance. In addition to water, nearly all energy drinks contain carbohydrates and caffeine as their main ingredients. The carbohydrates provide nutrient energy while the caffeine acts as a stimulant to the central nervous system.
What are the differences between an energy drink and a sports drink?
Sports drinks are designed to provide re-hydration during or after athletic activity. While contents vary, most sports drinks contain a 6 to 8% carbohydrate solution and a mixture of electrolytes. The carbohydrate and electrolyte concentrations are formulated to allow maximal absorption of the fluid by the gastrointestinal tract.
Energy drinks often contain a higher concentration of carbohydrate (usually 8 to 11%), and thus a larger number of calories than sports drinks. They also contain high amounts of caffeine and, in some cases, other nutritional supplements. Energy drinks are not appropriate for re-hydrating athletes during physical activity and should not be used in such circumstances
What ingredients are found in energy drinks?
* Carbohydrates- Most energy drinks have from 18g to 25g of carbohydrate per 8 ounces. The high carbohydrate concentration can delay gastric emptying and impede absorption of fluid in the gastrointestinal tract.
* Caffeine- Nearly all energy drinks contain some quantity of "natural" or synthetic caffeine. The caffeine concentration may range from the equivalent to an 8 ounce cup of coffee (85mg) to more than three times that amount.
* Herbs - Many energy drinks include herbal forms of caffeine such as guarana seeds, kola nuts, and Yerba mate leaves, in addition to synthetic caffeine. The "performance enhancing" effects, safety, and health benefits of other herbs like Astragalus, Echinacea, Ginko biloba, ginseng, and countless others have not been well established by scientific studies.
* Vitamins - Athletes with even reasonably good diets should be assured that they are at low risk for vitamin deficiency and typically do not need supplementation. There is no evidence to suggest that vitamin supplementation improves athletic performance. Female athletes may benefit from iron and calcium supplements; but, those are more easily and inexpensively obtained in pill form rather than from energy drinks.
* Proteins and amino acids - Only a small amount of protein is used as fuel for exercise. Carbohydrates are utilized as the primary fuel source. To date, there is no definitive evidence that amino acid supplementation enhances athletic performance.
* Other ingredients- With the hundreds of energy drink brands that are available, the potential ingredients which they may contain are virtually unlimited. Possible additions include pyruvate, creatine, carnitine, medium-chain triglycerides, taurine and even oxygen.
What are the possible negative effects of using energy drinks?
Central nervous system- Caffeine often has the effect of making a person feel "energized." Studies have shown some performance-enhancing benefits from caffeine at doses of 6mg/kg of body weight. However, these and higher doses of caffeine may produce light headedness, tremors, impaired sleep, difficulty with fine motor control, and may exceed drug testing caffeine thresholds.
Gastrointestinal system - The high concentrations of carbohydrates often found in energy drinks may delay gastric emptying, resulting in a feeling of being bloated. Abdominal cramping may also occur. Both carbohydrates and caffeine in the high concentrations found in most energy drinks may cause diarrhea.
Dehydration - Energy drinks should not be used for pre- or re-hydration. The high carbohydrate concentration can delay gastric emptying and slow absorption from the gastrointestinal tract and may cause diarrhea. Caffeine can act as a diuretic and, therefore, may result in increased fluid loss.
Positive drug tests - Like all nutritional supplements, there is little or no regulatory oversight of energy drinks. The purity of the products cannot be assured and it is possible that they may contain substances banned by some sports organizations.
Consumption of energy drinks by adolescents and young adults has been linked to heart arrhythmia and liver problems.
Sales of certain energy drinks have been banned in Denmark, Turkey, Uruguay, Germany, and Austria. Some states in the U.S. have introduced legislation to restrict sales of energy drinks to adolescents and children. In September 2010, the Virginia High School League banned the use of energy drinks.
Recently, healthcare providers have voiced increasing concerns about the consumption of energy drinks in association with alcohol because of the interaction of the stimulant effects of energy drinks and the depressant effects of alcohol.
American Academy of Pediatrics. Clinical Report. Sports drinks and energy drinks for children and adolescents: Are they appropriate? Pediatrics 2011;6:1182-1189.
Bonci L. Energy drinks: help, harm, or hype? Sports Science Exchange 2002:1.
Casa DJ, Armstrong LE, Hillman SK, et al. National Athletic Trainers’ Association position statement: Fluid replacement for athletes. Journal of Athletic Training 2000;35:212-224.
McKeag DB, Moeller JL. ACSM’s Primary Care Sports Medicine. 2nd Ed, Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins, 2007.
Meadows-Oliver M, Ryan-Krause P. Powering up with sports and energy drinks. Journal of Pediatric Health Care 2007;21:413-416.
Worcester S. Energy drink sales hit $3 billion: at what health cost? Pediatric News 2007;41:1-4.
Seifert SM, Schaechter JL, Hershorin ER, Lipshultz EL. Health effects of energy drinks on children, adolescents, and young adults. Pediatrics 2011;127:511-28.
Revised and Approved October 2011
POSITION STATEMENT AND RECOMMENDATIONS FOR HYDRATION TO MINIMIZE THE RISK FOR DEHYDRATION AND HEAT ILLNESS
National Federation of State High School Associations (NFHS) & Sports Medicine Advisory Committee (SMAC)
DEHYDRATION, ITS EFFECTS ON PERFORMANCE, AND ITS RELATIONSHIP TO HEAT ILLNESS:
Appropriate hydration before, during, and after exercise is an important ingredient to healthy and successful sports participation.
Rapid weight loss represents a loss of body water. A loss of just 1-2% of body weight (1.5 to 3 pounds for a 150 pound athlete) can negatively impact performance. A loss of 3% or more of body weight can increase the risk for exertional heat related illness.
Athletes should be weighed before and after warm weather practice sessions and contests to assess fluid losses.
Athletes with high body fat percentages can become dehydrated faster than athletes with lower body fat percentages while working out under the same environmental conditions.
All athletes have different sweating rates and some lose much more salt through their sweat than others.
Poor acclimation/fitness levels can greatly contribute to an athlete's dehydration problems and risk for heat illness
Medications and fevers can each greatly contribute to an athlete's dehydration problems and risk for heat illness.
Environmental temperatures and humidity both contribute to dehydration and heat illness.
Clothing, such as dark, bulky, or rubber protective equipment can drastically increase the chance of dehydration and heat illness.
Wet bulb temperature measurements should be taken 10-15 minutes before practices or contests. The results should be used with a heat index to determine if practices or contests should be started, modified, or stopped.
Even dry climates can have high humidity if sprinkler systems are scheduled to run before early morning practices start. This collection of water does not evaporate until environmental temperatures increase and dew points lower.
A heat index chart should be followed to determine if practices/contests should be held. The NOAA National Weather Service's heat index chart can be found at: http://www.weather.gov/om/heat/index.shtml
The heat index for your location can be determined by entering your postal zip code into the OSAA site found at: http://www.osaa.org/heatindex/
A relative humidity of 35 percent and a temperature of 95 degrees Fahrenheit are likely to cause heat illness, with heat stroke likely.
A relative humidity of 70 percent and a temperature of 95 degrees Fahrenheit are very likely to cause heat illness, with heat stroke very likely.
WHAT TO DRINK DURING EXERCISES:
For most exercising athletes, the ideal fluid for pre-hydration and re-hydration is water. Water is quickly absorbed, well tolerated, an excellent thirst quencher, and cost effective.
The use of a sports drink with appropriate carbohydrates (CHO) and sodium as described below may prove beneficial in some general situations and for some individuals.
Traditional sports drinks with appropriate CHO and sodium may provide additional benefit in the following general situations:
Prolonged continuous activity of greater than 45 minutes
Extremely intense activity with risk of heat injury
Extremely hot and humid conditions
Traditional sports drinks with appropriate CHO and sodium may provide additional benefit for the following individual conditions:
Poor hydration prior to participation
Increased sweat rate
Poor caloric intake prior to participation
Poor acclimatization to heat and humidity
A 6-8% addition of CHO to water is the maximum that should be utilized. Any greater concentration will produce slow emptying from the stomach and a bloated feeling to the athlete.
The other ingredient that may be helpful is a low concentration ( 0.3 - 0.7 g/L) of sodium which may help with cramping.
All fluids should be served cold to optimize gastric emptying.
WHAT NOT TO DRINK DURING EXERCISE:
Fruit juices with greater than 8 percent carbohydrate content and soda can both result in a bloated feeling and abdominal cramping.
Beverages containing caffeine, alcohol, and carbonation are not to be used because of the high risk of dehydration associated with excess urine production, or decreased voluntary fluid intake.
Athletes should be aware that nutritional supplements are not limited to pills and powders; many of these new fluids contain stimulants such as caffeine and/or ephedrine.
These stimulants may increase the risk of heart or heat illness problems when exercising.
Many of these drinks are being produced by traditional water, soft drink, and sports drink companies and may provide confusion to the sports community. As is true with other forms of supplements these "power drinks or fluid supplements" are not regulated by the FDA. Thus, the purity and accuracy of contents on the label are not guaranteed.
Many of these beverages, which claim to provide additional power, energy, etc., have additional ingredients that are not necessary, some that are potentially harmful, and some that actually include substances banned by such governing bodies as the NCAA and the USOC.
HYDRATION TIPS AND FLUID GUIDELINES:
In general, athletes do not voluntarily drink sufficient water to prevent dehydration during physical activity.
Drink early, by the time you're thirsty, you're already dehydrated.
Drink before, during, and after practices and games. Specifically, the American College of Sports Medicine recommends the following:
Drink 16 ounces of fluid 2 hours before exercise.
Drink another 8 to 16 ounces 15 minutes before exercise.
During exercise, drink 4 to 16 ounces of fluid every 15 to 20 minutes.
After exercise, drink 24 ounces of fluid for every pound lost during exercise to achieve normal fluid statue within 6 hours.
The volume and color of your urine is an excellent way of determining if you're well hydrated. Large amounts of clear urine mean you're hydrated, small amounts of dark urine mean that you need to drink more! A Urine Color Chart can be accessed at: http://at.uwa.edu/admin/UM/urinecolorchart.doc
The NFHS SMAC strongly recommends that coaches, certified athletic trainers, physicians, and other school personnel working with athletes not provide or encourage use of any beverages for hydration of these youngsters other than water and appropriate sports drinks that meet the above criteria. They should also make information on the potential harm and lack of benefit associated with many of these other beverages available to parents and athletes.
Casa DJ, Armstrong LE, Hillman SK, Montain SJ, Reiff RV, Rich BSE, Roberts WO, Stone JA. National Athletics Trainers' Association Position Statement: Fluid Replacement For Athletes. Journal of Athletic Training. 35(2):212-224, 2000.
McKeag DB, Moeller JL. ACSM's Primary Care Sports Medicine. 2nd Ed, Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins, 2007.
Revised and Approved April 2008