FROM THE ANNUAL MEETING OF THE AMERICAN ACADEMY OF PEDIATRICS
SAN FRANCISCO -- The light bulb went off in Dr. Michele LaBotz's head soon after she watched a TV reality show in which a mother encouraged her 6-year-old daughter to down three cans of Red Bull energy drink before a competition.
Dr. LaBotz was laughing about this example of bad parenting with the mother of a high-school-age girl who then admitted that her daughter was ''down to two cans a day' of Red Bull.
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That revelation prompted Dr. LaBotz to take a closer look at the use of these stimulant-containing drinks and at a related category--sports drinks.
There are no standard definitions, but energy drinks are beverages containing carbohydrates, stimulants, and often other ingredients--Red Bull being the 800-pound gorilla on the $11 billion market in energy drinks. Sports drinks are beverages containing some combination of carbohydrates and electrolytes, with Gatorade claiming 75% market share.
The 'crime' is that these products are found in stores side-by-side with products categorized as food, which are subject to stricter safety standards, said Dr. LaBotz of Portland, Me.
Red Bull contains 80 mg of caffeine per 8-ounce can, more than twice as much as in a 12-ounce can of Coca-Cola. Other brands are packaged in larger sizes to get around caffeine regulations or condensed into super-caffeine 'energy shots' containing 200-350 mg of caffeine per 1-2 ounces.
Young athletes think these products will improve performance in sports or other parts of their lives, but new data from a randomized, double-blind, placebo-controlled study that will be published in the December issue of the Journal of Alcohol & Drug Education says that reality is flipped. Sport psychology consultant Conrad Woolsey, Ph.D., of Oklahoma State University, Stillwater, and his associates will report that energy drinks make users feel like they're doing better even though they're making more mistakes on tests of coordination and multidimensional skills.
Sports drinks are a bit more benign, but too often take the place of healthier alternatives, potentially depriving young athletes of the nutrients their bodies need to prepare for or recover from exercise. The only time they might be convenient is during exercise lasting longer than an hour, when kids need more fluids and the bright colors, sweetness, and saltiness of sports drinks may entice them to stay hydrated, Dr. LaBotz said.
Physicians should ask about use of sports and energy drinks and be prepared to educate young athletes about healthy alternatives, she added. Dr. LaBotz likes the AAP's 'Sports Shorts #6' on ''Nutrition and Sports,' and the useful handouts available on the Web from the U.S. Anti-Doping Agency, such as the 'Joy of Sport.'
She urges physicians to take a strong stand against child and adolescent use of energy drinks but suggests not overplaying the dangers of caffeine, especially when talking to parents who may be regular caffeine users themselves.
Dr. LaBotz offered practical alternatives to meet young athletes' needs for fluids and fuel.
* Before exercise: A 40-kg athlete (88 pounds) should eat a full lunch and have a snack 1 hour before afternoon exercise. A banana provides the same amount of carbohydrates as a 20-ounce sports drink. The goal is to bolster blood glucose and muscle glycogen by getting 4 g of carbohydrates per tog of body weight 3-4 hours before exercise and 0.5-1 g/kg around an hour before exercise.
A 40-kg athlete also should drink 3-6 ounces of 'water, milk, or other nutritive beverages' 1-2 hours before exercise (or 6-12 ounces for larger athletes), she said.
* During exercise: Children tend to not drink enough while exercising, but they often drink more if fluids are enhanced by color, flavor, or sodium, giving sports drinks a potential role. Drinking 5 ounces of fluids (for a 40-kg athlete) or 8 ounces (for a 60-kg athlete) every 20 minutes should be sufficient.
For exercise lasting longer than an hour, adding carbohydrates during exercise appears to be beneficial, aiming for 0.7 g of carbohydrates per kg of body weight per hour. For a 40-kg athlete, that translates into one banana, a 3-inch bagel, three Fig Newtons, or a 16-ounce sports drink.
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* After exercise: Bodily fluid loss from exercise is highly variable, so encourage parents to weigh young athletes before and after practice. For every pound lost, try to get them to drink 16-24 ounces of their choice of fluids. Eating salt along with that or adding salt to the liquid can help get them to drink.
Replenish muscle glycogen by ingesting 1-1.5 g of carbohydrates per kg of body weight immediately after a workout, and ideally repeated 2 and 4 hours later. For a 40-kg athlete, that's 40-60 g of carbohydrates, which can be had from a bagel with peanut butter, two or three 'trail mix' bars, or 1-1.5 cups of apple juice. Three to four cups of sports drink would be needed to match this, she said.
Dr. LaBotz said she has no pertinent conflicts of interest.
