Active Voice: Just Say No to Energy Drinks for Vulnerable Groups By John P. Higgins M.D., M.B.A., M. PHIL., FACC, FACP, FAHA, FACSM, FASNC, FSGC 
Viewpoints presented in SMB commentaries reflect opinions of the authors and do not
necessarily reflect positions or policies of ACSM.
Dr. John P. Higgins is a professor of medicine at McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth). He is chief of cardiology at Harris Health System’s Lyndon B. Johnson General Hospital and serves as director of exercise physiology for the Memorial Hermann IRONMAN Sports Medicine Institute-Texas Medical Center. Dr. Higgins also works as a sports cardiologist, providing team physician services for both the Houston Rockets NBA basketball organization and the Rice University Athletics Department. This commentary presents Dr. Higgins’ views on health and performance implications of consuming energy drinks in association with physical activity and exercise. Notably, he and three other experts addressed this topic in a “Contemporary Issues” (CI) paper that was published in the February 2018 issue of ACSM’s clinical review journal, Current Sports Medicine Reports (CSMR). Their paper represents the first in a new class of official ACSM pronouncements that express an opinion from an expert group on a scientific or clinical question of emerging importance in the field. The CI is based on examination of available published research and includes both consensus recommendations and identification of research gaps. For more on the CI pronouncement, see ”Science Spotlight” in the February 13, 2018 issue of SMB. As energy drinks become more and more popular, questions about their safety and efficacy are growing. Safety concerns associated with energy drink consumption include adverse effects on the cardiovascular, neurological, gastrointestinal, renal and endocrine systems, as well as psychiatric symptoms. For example, cardiovascular complications associated with consumption include elevated blood pressure and heart rate, arrhythmias, endothelial dysfunction, coronary artery spasm/thrombosis, myocardial infarction and sudden cardiac death. Further, all the actual ingredients – names, quantity and quality – are often not listed on the labels. Some groups are especially susceptible (see “vulnerable populations” below). Efficacy concerns are that the data are inconclusive. Some studies suggest energy drinks may improve physical or mental performance; others show that these drinks degrade performance. Poor study design, nonrandomized/inadequately blinded studies, selection bias, variable dosing and manufacturer sponsorship and execution of studies are main issues. Because energy drinks are frequently classified as supplements or nutritional products, they are not subject to the scrutiny that the FDA and other regulatory bodies ordinarily apply to other food, beverages and drugs. In summary, we have a weakly regulated product that anyone can buy and consume — a product of questionable efficacy that is associated with significant adverse events, especially in vulnerable populations. In our ACSM Contemporary Issues Paper (February 2018 issue of CSMR), we have highly encouraged consumers, parents, physicians, athletic trainers, personal trainers and coaches to follow these ACSM-endorsed recommendations. These energy drinks:
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