ENERGY DRINKS have been associated with liver damage in a new case report authored by Dr Jennifer Harb, Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA, and colleagues. This marks the second incidence of acute hepatitis being linked with high levels of energy drink intake. In this instance, a previously healthy 50-year-old man developed hepatitis after consuming 4–5 energy drinks a day for >3 weeks. This man reported no changes in his alcohol consumption or diet and was not taking any medication, over-the-counter or prescription. The man sought medical attention after presenting with symptoms such as acute abdominal pain, anorexia, dark urine, jaundice, and vomiting.
When the patient was examined, it was discovered that his transaminase levels were elevated, an indicator of liver damage. Evidence of chronic hepatitis C virus infection was found, and a liver biopsy revealed acute hepatitis. The doctors involved in the case report theorised that excessive intake of vitamin B3 (also known as niacin) induced acute hepatitis, as the patient had consumed about 160–200 mg daily, over twice the recommended dose. Although it was not previously thought that these niacin levels caused toxicity, they were similar to those detailed in the only previous case of energy drink-associated hepatitis (300 mg). The patient’s symptoms cleared after 3 days of observation and treatment in hospital.
While cases of energy drink-associated liver damage are very rare, the authors believe that this case report is relevant in the wider context of the harm that can be caused by dietary and herbal supplements. Although about 23,000 emergency department visits annually are related to dietary supplements, they are often disregarded by patients and doctors alike due to their natural ingredients. The authors hope that this case study will alert doctors to the potentially damaging effects of energy drinks, enabling them to eliminate the cause of hepatitis more rapidly. Commenting on the future, the authors noted: “As the energy drink market continues to rapidly expand, consumers should be aware of the potential risks of their various ingredients. Vitamins and nutrients, such as niacin, are present in quantities that greatly exceed the recommended daily intake, lending to their high risk for harmful accumulation and toxicity.”