Confessions of a Quackbuster

This blog deals with healthcare consumer protection, and is therefore about quackery, healthfraud, chiropractic, and other forms of so-Called "Alternative" Medicine (sCAM).

Sunday, October 02, 2005

A Sports Drink for Children Is Jangling Some Nerves

September 25, 2005

A Sports Drink for Children Is Jangling Some Nerves

The company's marketing materials describe the drink as a way to kick-start the morning for children as young as 4. The company Web site, adorned with a picture of an elementary school wrestler and a gymnast, says its drink can help a child "develop fully as a high-performance athlete" and fill nutritional gaps "in a sport that is physically and mentally demanding."

The drink, called Spark, contains several stimulants and is sold in two formulations: one for children 4 to 11 years old that includes roughly the amount of caffeine found in a cup and a half of coffee, and one containing twice that amount for teenagers and adults.

Despite the promotional materials, Sidney Stohs and Rick Loy, executives with AdvoCare International of Texas, which makes the products, said Spark was not devised or marketed for children's athletic performance but rather for their overall good health.

"It's not just a caffeine delivery system; it has many more nutritional properties," said Stohs, senior vice president for research and development at AdvoCare, the nation's leading company in direct marketing of dietary supplements for athletes.

Many of AdvoCare's customers say they love the products, but pediatricians, medical experts and others involved in youth sports express strong concern about the levels of caffeine and the idea of encouraging children to use performance-enhancing products, especially at a time when professional athletes are under scrutiny for using stimulants and muscle builders.

"That's scary," said Dr. Mary L. Gavin, a pediatrician and medical editor of the KidsHealth Web site for the Nemours Center for Children's Health Media at Alfred I. duPont Hospital for Children in Wilmington, Del. "The effects of caffeine have never been tested on kids. Marketing to kids is a major concern."

Elisa Odabashian, a senior policy analyst with Consumers Union, said in a separate interview: "What are we coming to? What kind of society are we spawning here where everybody has to be artificially stimulated?"

Frank Uryasz, president of the National Center for Drug Free Sport and administrator of college drug testing programs, said young athletes should avoid caffeine and other stimulants.

"I am concerned that they are gateway substances," Uryasz said in a telephone interview. "I think it develops a mind-set especially among young athletes that they have to take something - a powder, a pill, a liquid - to improve their performance, when actually study after study shows that almost all of these products add no value to a young person's athletic performance."

Although many companies sell highly caffeinated drinks - Jolt and Red Bull are examples - for adults and children, Uryasz said AdvoCare concentrates on child and teenage athletes more than the other companies.

AdvoCare began carving a niche in youth sports with the introduction of Spark for children in 2001. The KickStart line for children now has five products. Loy, AdvoCare's senior vice president for field operations, said that those five products accounted for 1 percent of company sales.

Loy said the company's goal was to inform parents about products they could give to their children as diet supplements. He said Spark was a proven, safe way to improve energy and focus and to fill nutritional gaps.

In an advertisement on its Web site for youth products, AdvoCare described an elementary school wrestler as a "high-performance athlete" and quoted him as saying: "I feel the products are helping me grow stronger, and my focus when I'm wrestling is better. I take them before and after games and practices, even if I'm just playing football for fun with my friends."

AdvoCare directs its 91,000 distributors - most of them working part-time from home and including many parents with school-age children and coaches - to what it calls a nutrition timeline that promotes KickStart Spark, with 60 milligrams of caffeine, for children 4 to 11, and AdvoCare Spark, with 120 milligrams of caffeine, for athletes 12 and up.

An 8-ounce cup of coffee or a 12-ounce cola contains about 45 milligrams of caffeine. A typical child 6 to 11 years old consumes 26 milligrams of caffeine a day, according to surveys by the United States Department of Agriculture.

The American Academy of Pediatrics discourages caffeine consumption by children. Canadian health authorities in 2003 recommended limiting daily intake of caffeine by children to 2.5 milligrams per kilogram of body weight, or roughly 45 milligrams for a typical 4- to 6-year-old. The recommendation was based on caffeine's adverse behavioral effects on adults. The effects include insomnia, headaches and nervousness.

Spark comes in powder form to mix into liquids. Other AdvoCare suggestions include making Spark popsicles and gelatin jigglers. Spark also contains taurine, the key ingredient in Red Bull energy drinks.

Robert McIntosh of Mitchell, Ind., whose racecar-driving teenage daughter has endorsed Spark, said she had tried it "a time or two." He said in a telephone interview that he had taken the stimulant ephedra but that he did not believe young people should take performance-enhancing drugs. "I don't think it's good for any athlete," he said.

But Angela B. Foster, whose 12-year-old daughter, Taylor, is featured in another endorsement for AdvoCare products, said in a telephone interview that Spark was safe and helpful for not only Taylor, who practices 20 hours a week and is hoping for a college scholarship in gymnastics, but also for her 11-year-old brother, who plays soccer and runs track, and her 7-year-old sister. "We use Spark for all of them," Foster said.

The Foster children use the teenage and adult version, with 120 milligrams of caffeine, even though it is labeled as not for use by children. "They don't use the kids' stuff," Foster said. "They said it tastes too much like Kool-Aid."

In her endorsement for AdvoCare's children's products, Taylor said: "I have more energy and I like them a lot. I would suggest that anyone try them!"

AdvoCare, based in suburban Dallas, sells its products by person-to-person multilevel marketing, not in stores. The company gives about $500 a year in free products to the families of children who endorse its products, said Allison Levy, the director of legal and governmental affairs for the company.

Foster said she stopped selling AdvoCare products last year when she grew too busy at Aspire Gymnastics and Dance in Bentonville, Ark., which she co-founded. But she said she still tells other parents, if asked, to try Spark and the AdvoCare's vitamins and rehydrating drink for their children.

"They are really good products," Foster said.

Asked about the caffeine, she said, "I think you would get more caffeine in a chocolate bar."

Dark chocolate has about 20 milligrams of caffeine per ounce.

Gavin, the pediatrician, said that research on caffeine in children is based on small numbers of subjects, but that it shows high doses can make children more emotionally unstable, hyperactive and irritable, and less attentive in school.

"Their little bodies handle it differently, and they don't need it," Gavin said. "It's a stimulant. The likelihood that a child is going to have side effects is much higher at that age." She added, "Once you get into that attitude of performance-enhancing, it becomes win at all costs, and I can see it pushing kids to other supplements."

Andrew Shao, vice president for scientific and regulatory affairs at the Council for Responsible Nutrition, a Washington trade group for the supplements industry, said in a telephone interview: "Our policy is we're not aware of any safety issues with sports nutrition products in kids. However, other than, say, a multivitamin, it's really not a good idea for prepubescent kids to use sports nutrition products, especially stimulant-containing products like caffeine-containing products."

Shao, who holds a Ph.D. in nutritional biochemistry, added: "Do we really need kids using performance-enhancing products? Kids should be kids."

Pharmaceutical drugs containing caffeine are required to have warnings saying, "Do not give to children under 12 years of age" and "Limit the use of caffeine-containing medications, foods or beverages while taking this product because too much caffeine may cause nervousness, irritability, sleeplessness and, occasionally, rapid heartbeat."

No such caffeine warnings are required of dietary supplements, which are considered foods, not drugs, under federal law.

The National Collegiate Athletic Association is the only major sports organization to ban caffeine supplements. The International Olympic Committee banned caffeine from 1984 to 2004, then removed the ban "in order to be pragmatic" about coffee drinkers, the spokeswoman Giselle Davies said.

The Nutrition Business Journal says AdvoCare is one of the largest companies in the industry, with annual revenues of $125 million to $150 million, including about $29 million in sports or athletic dietary supplements in 2004, more than any other direct-channel supplement company in America. Loy declined to discuss revenues or profits.

AdvoCare was founded by Charles E. Ragus of Dallas, a direct-marketing veteran, in 1993. Ragus died in 2001; the company presidency is vacant. Stohs joined the company full time in 2003 after retiring as dean of the School of Pharmacy and Health Professions at Creighton University.

AdvoCare has about 60 other products that it says help users with nutrition, energy, weight loss, muscle-building and skin care. It has 175 adult athlete endorsers, including Drew Brees of the San Diego Chargers and Steve McNair of the Tennessee Titans. Some of its products contain synephrine, a stimulant regarded as safe by the Food and Drug Administration but banned by the N.C.A.A. and the World Anti-Doping Agency, and creatine, a muscle builder banned by the N.C.A.A. Both chemicals are legal and marketed by many companies. Stohs said such products were not for children.

AdvoCare has drawn criticism for its marketing at youth athletic events. Earlier this year, it paid $5,000 to sponsor a high school wrestling tournament in Sacramento. After negative publicity, AdvoCare officials said they would not sponsor any more school events.

AdvoCare has also sponsored World of Wrestling national championship tournaments attended by several thousand children 4 to 18 years old. Loy said these were not school events. The company's full-page advertisements in the tournament programs say: "World champion athletes use AdvoCare nutritional products. Do you?"

Jack Roller, owner of the World of Wrestling youth tournaments, said, "AdvoCare is one of our big sponsors, has been for some time, and AdvoCare has some wonderful products." He added: "But I don't think all their products are for kids. If you've got something with caffeine in it, you've got a huge concern."

Roller sells caffeine-free supplements from Mannatech, a company based in Coppell, Tex., and is also a sponsor of the youth wrestling events.

AdvoCare's sponsorship cost the company about $1,000 and included the right to hand out samples, Roller said. "Very gently I try to ask them just not to give them to kids," he said.

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