Discussion
Energy drinks are frequently used as a dietary supplement by the young generation and adults. These drinks are usually consumed as the source of the required energy for enhancing physical as well as mental performances (Ehlers et al., 2019). Energy drinks contain different types of substances that act as the energy source for an individual. However, the main ingredient of these energy drinks is caffeine, regarded as the main energy source. The use of energy drinks containing caffeine and some other stimulants was first introduced in the United States of America in 1997. It is widely used by most of the young population worldwide. It is reported that around 56 to 71% of the young population consumes energy drinks worldwide (Ruiz & Scherr, 2019). These energy drinks are usually used to improve the weight loss program, increase energy level concentration, boost athletic performance, and decrease the aftereffect of consumption of alcohol. Some of the common ingredients of energy drinks have been recorded to be caffeine, taurine, vitamin B complex, guarana, sugar, and ginseng. Although these ingredients are present as per the required quantities, most of the ingredients have not been well studied about their contribution and effect on the population’s health (Galimoy et al., 2019).
The energy shot is regarded as the concentrated form of energy drink usually marketed in minor bottles. These drinks are not labelled as beverages; rather, they have been marketed under the name of dietary supplements. Energy drink industries in the United Kingdom have an important contribution to the nation’s economy. This industry comprises around 6% of the entire soft drink industry (Verster et al., 2018). Manufacturers and distributors encompass this industry, along with the vendors selling such energy drinks to the public in different places based on the requirements and demands. There are several brands do you have been selling energy drinks in the UK and contributing to the nation’s economy. Although these energy drinks are regarded as the source of energy for an individual, it has been observed that excessive consumption of energy drinks has led to the development of certain diseases in the population (Verster et al., 2018).
The main focus of this paper is to discuss the consumption of energy drink and their contribution to the development of cardiovascular disease in an individual. The paper is sub-sectioned with the brief description of different cardiovascular diseases, energy drinks’ contributions, and their effect on the population’s health. The paper concludes with a summary of the main points described in the paper.
Ingredients of Energy Drink
Energy drinks belong to the class of the products that usually contains caffeine along with some other dietary supplements edit in it. In Europe, the use of energy drinks was introduced in 1987 and from there the markets of such drinks expanded in the whole world (Vercammen, Koma & Bleich, 2019). However, the use of energy drinks became popular from 1997 after the launch of Red Bull, one of the biggest producers of energy drink worldwide (Fisk, Hammond-Haley & D’Silva, 2021). With this the market of energy drink expanded drastically with several brands establishing worldwide. Globally the sales of energy drink have reached around 57.4 billion dollars in 2020 which is expected to have a growth by around 8% between 2020 and 2026 (Shah et al., 2019).
The manufacturers have recently shifted the Consumer Focus for marketing energy drinks from the athletes to the young population. That is why, the energy drinks have been aggressively marketed in the places with a higher population of teens and young generation. It has been observed and recorded in several reports that majority of the consumers of energy drink are between the age of 13 and 45 years old and the boys are the two thirds of the market. In United States energy drink is regarded as the second most frequently consumed dietary supplements by the young people and around 35% of the population consume it on regular basis (Scuri et al., 2018). The popularity of energy drinks in United Kingdom do not differ March from United States and the energy drink industry have been rising in the nation overtime.
The concept of energy drink has been designed in order to provide an energy boost to the consumer with a combination of several stimulants along with energy boosters. The main constituent present in most of the energy drink is caffeine. It has been observed that the energy drink mostly contains around 90 to 150 milligrams of caffeine per 9 ounce that is equivalent to around 6 ounces of coffee or around two 13-ounce cans of the caffeinated soda (Wee et al., 2021). It has been recorded that several brands on markets contains higher amount of glucose, although few brands offer the use of artificially sweetened version of the energy drink. Some other commonly used ingredients are the taurine, vitamin B complex, guarana, methylxanthines, yerba mate, inositol, carnitine, acai, ginkgo, biloba, ginseng and many more (Shah et al., 2019).
Pharmacokinetics of Energy Drink
Although most of the population have been consuming energy drink for centuries, in recent years significant concern about safety of the product have been raised in several parts of the world. Several reports showed that consumption of energy drink has adverse effects on health of an individual (Nuss et al., 2021). However, the manufacturers of the energy drinks claim that the products are suitable and safe for consumption by the population. With all these concepts, the safety of energy drink and the shorts are still debatable because of the number of cases that has been reported where these drinks have produced some adverse effect on the health of the patient. In recent years, emergency visit to the health centres associated with consumption of energy drink have increased sharply (Miller, Dermen & Lucke, 2018). The cases of the patient are usually recorded to be associated with the combination of other substances like alcohol drug abuses that further potentiates the effect of the energy drink. The consumption of energy drink has been recognised to develop several cardiovascular changes especially cardiac arrhythmias. This type of cardiovascular alteration might lead to morbidity and mortality in the population.
Caffeine present in energy drink is the main stimulant and is the major ingredient in it. The concentration of caffeine varies in different products although play have similar effects of stimulation in the body with minor variation (Ehlers et al., 2019). The other components including guarana, biloba, vitamin B complex, theophylline, carnitine and many more are present in different amounts. These ingredients increase the energy of an individual and stimulates they are mental performance. It has been observed that guarana is the plant that contains higher quantity of caffeine. It acts as an additional source of the caffeine in the energy drinks (Thomas et al., 2019).
The caffeine is rapidly absorbed and has a half-life of 4.5 hours. After the process of absorption, caffeine is metabolised in liver producing methylxanthine as the product. Caffeine follows the zero-order coin following the conversion of it into methylxanthine. Therefore, rate of elimination is recorded to be constant is not affected by the index of drug or the plasma concentration of it. As a result, after overdosing of caffeine it requires prolonged recovery time. Metabolism of caffeine is affected by some other substances including chronic alcoholism which results in reduce metabolism rates and elevated half-life. On the other hand, nicotine elevates the rate of caffeine metabolism and therefore, reduces the half-life (Nuss et al., 2021).
Mechanism of Energy Drinks in the Body
Caffeine is metabolised to methylxanthine that acts by inhibiting the phosphodiesterase, antagonising adenosine receptor and elevates the secretion of catecholamines. At the therapeutic dose, physiologic effect of energy drink includes tachycardia, diuresis, bronchodilation, high blood pressure, vomiting and stimulation of central nervous system (Ehlers et al., 2019). During the overdose condition the tachycardia is followed by arrhythmias as well as hypo tension in an individual. The major toxicity the discussed by the overdose of caffeine is due to elevation in the intracellular concentration of calcium that leads to the surge of catecholamines. This sensitize is the dopamine receptors which results in the supra ventricular arrhythmias and finally to death (Galimoy et al., 2019). The caffeine present in energy drink usually affects the vasculature and the other components usually affect the heart which causes alteration of the cardiovascular system. The effect of the ingredients present in energy drink on heart and related structures could be detrimental for an individual. It has been reported in several studies that the heart rate and the blood pressure have been elevated after few hours of consumption of energy drink (Basrai et al., 2019). Another study reported that consumption of energy drink elevates the ventricular contractility. Based on different studies, researcher summarised that energy drink causes elevation of myocardial contractility, stroke volume and heart rates while the caffeine increases the peripheral vascular resistance. The other ingredients of the energy drink contribute for the alteration of cardiovascular system and the sugar ingredients causes dyslipidaemia, insulin resistance, obesity and pro inflammatory activity (Lasheras et al., 2021).
The association of cardiovascular disorder with the consumption of the energy drink is debatable till date. Several reports have recorded that the consumption of energy drink causes arrhythmias although, the mechanism of the same is still not clear. Several studies contradict the association of arrhythmias with the consumption of energy drink, however few reports have shown the relation between arrhythmias and higher dose of energy drink. Susceptibility towards arrhythmias can be due to genetic composition which makes the individual susceptible to effects of energy drink (McLellan et al., 2019). This might result in the development of arrhythmias after acute consumption of energy drink. Several alterations of the cardiovascular system are observed in patients who has been consuming energy drink for a while with the most regularly observed condition being arrhythmias. The other changes include coronary vasospasm, cardiomyopathy, cardiac arrest, acute coronary thrombosis, ST elevation, prolonged QT interval and aortic aneurysm dissection (Olas & Bry?, 2019).
There have been several cases that links energy drink with the development of atrial fibrillation although, the association between the two is not clear enough. Few studies have provided evidence which shows the stimulation of cardiac adenosine by caffeine that inhibits production of cardiac fibroblast (Galimoy et al., 2019). This results in the inhibition of remodelling after the myocardial infarction that contributes for development of the actual fibrillation. However, some observational studies and meter analysis demonstrates the fact that caffeine helps fault protection from the atrial fibrillation. Another report suggested that after consumption of energy drink, initial electrocardiogram showed complex tachycardia associated with ventricular rate of 225 beats per minute (Voskoboinik, Koh & Kistler, 2019).
Several cases have been reported in which it was observed that energy drink caused myocardial ischemia and infarction in an individual (Lasheras et al., 2021). In a study it was observed that a patient developed cardiac arrest 8 hours later and the report suggested that he drank 8 cans of energy drink before the incident. Sinus rhythm was restored after defibrillator shock and administration of epinephrine and atropine. Another report suggested that a patient was brought to the hospital after complaining about chest pain. The patient drank around 15 cans of energy drink and the initial echocardiogram showed elevation of the ST segment. The patient developed the occurrence of ventricular fibrillation and finally passed away (Bkaily et al., 2020).
Few cases demonstrated the occurrence of cardiomyopathy after the consumption of energy drink play the patient. The patient was presented to the hospital with a complaint of chest pain associated with palpitation after the consumption of energy drink (Vercammen, Koma & Bleich, 2019). Patient had supra ventricular tachycardia and ventricular tachycardia in association with sinus tachycardia. The chest X-ray demonstrated pulmonary edema and the echocardiogram showed ejection fraction of about 35% (Galimov et al., 2019). The energy drink consumed by the patient contained some sympathomimetic substances including caffeine and 1,3 – dimethylamylamine or DMAA (Fisk, Hammond-Haley & D’Silva, 2021). From previous studies it was reported that caffeine causes arrhythmias by its action on the adenosine receptors and induction of catecholamine surge. DMAA poses similar structure as amphetamine which acts as the stimulant of the brain.
Few researchers have described detrimental effect of the consumption of energy drink. Few authors have reported several cases of aortic dissection in patients with higher risk of cardiovascular diseases (Galimov et al., 2019). It was reported that these patients developed aortic dissection after consuming energy drinks and these cases required some kind of surgical correction. The patient in most of the cases reported the association of chest pain which initiated after drinking energy drinks. The potential mechanism for the provoking of aortic dissection buy energy drink is due to the presence of caffeine as one of the main ingredients which might induce the elevation of blood pressure in the patient (Nowak, Go?li?ski & Nowatkowska, 2018). In most of the cases, the heart rate of the patient was much higher than the range and was reported to have much higher range of blood pressure. A patient with the history of bicuspid aortic valve and ascending aortic aneurysm had severe chest pain after consuming two cans of energy drink. However, further studies about the association of aortic dissection with the consumption of energy drink are lacking.
Several case reports suggested the occurrence of ventricular arrhythmias along with sudden cardiac arrest which led to death of the patient. This incident was observed to be secondary to energy drink. The cases describing such incidents reported patient with and without some kind of structural heart diseases (Ellermann et al., 2022). In a case study it was reported that a young patient was brought to the emergency service due to ventricular fibrillation who regained rhythm after the defibrillator shock. It was reported that the patient used to smoke marijuana and had a habit of consuming energy drinks that were rich in caffeine. Another study reported about a case of young women who developed sudden cardiac arrest after consuming one can of energy drink. She developed QT prolongation and went into ventricular fibrillations. Genetic testing of the female patient confirmed the presence of long QT syndrome. Few other studies reported association arrhythmias with the consumption of energy drink among patient possessing cardiovascular diseases (Ellermann et al., 2022).
Conclusion
From the above discussion it can be concluded that, consumption of energy drink has been associated with the development of several cardiovascular diseases. Energy drink s used as the source of energy among the young adults and some sections of the population associated with heavy physical activity. The energy drink manufacturing industry have been increasing overtime in different parts of the world and it has been observed that this industry is contributing to the economy of the nation. However, with consumption of energy drink the risk of developing cardiovascular diseases have been reported in most of the cases. Previous studies suggested association between the cardiovascular alteration and consumption of energy drink, which includes myocardial ischemia, aortic dissection, cardiomyopathy, cardiac arrest, cardiac arrhythmias, ventricular arrhythmias and myocardial infarction. These studies suggested that consumption of energy drink could be dangerous for the population when it is used either alone or in the combination with several other substances. In case of patient, who had a history of structural cardiovascular diseases have reported of extreme cases of chronic cardiovascular diseases after consuming energy drink.
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