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Buy essay online cheap causes and effects of red tides Department of Pediatrics and the Pediatric Integrative Medicine Program, University of Miami, Leonard M. Miller School of Medicine, Miami, Florida. Department of Pediatrics and the Pediatric Integrative Medicine Program, University of Miami, Leonard M. Miller School of Medicine, Miami, Florida. Department of Pediatrics and the Pediatric Integrative Medicine Program, University of Miami, Leonard M. Miller School of Medicine, Miami, Florida. Department of Pediatrics and the Pediatric Integrative Medicine Program, University of Miami, Leonard M. Miller School of Medicine, Miami, Florida. To review the effects, adverse consequences, report the committee board to sivaraman extent of energy drink consumption among children, adolescents, and young adults. We searched PubMed and Google using “energy drink,” “sports drink,” “guarana,” “caffeine,” “taurine,” “ADHD,” “diabetes,” “children,” “adolescents,” “insulin,” “eating disorders,” and “poison control center” to identify articles related to energy drinks. Manufacturer Web sites were reviewed for product information. According to self-report surveys, energy drinks are consumed by 30% to 50% of adolescents and young adults. Frequently containing high and unregulated amounts of caffeine, these drinks urban verve kingsley writer crossword been reported in association with serious adverse effects, especially in children, adolescents, and young adults with seizures, diabetes, cardiac abnormalities, or mood and behavioral disorders famous essay in malaysia person about those who take certain medications. Of the 5448 US caffeine overdoses reported in 2007, 46% occurred in those younger than 19 years. Several countries and states have debated or restricted energy drink sales and advertising. Energy drinks have no therapeutic benefit, and many ingredients are understudied and not regulated. The known and unknown pharmacology of agents included in such drinks, combined with reports of toxicity, raises concern for potentially serious adverse effects in association with energy drink use. In the short-term, pediatricians need to be aware of the possible effects of energy drinks in vulnerable populations and screen for consumption to educate families. Long-term research should aim to understand the effects in at-risk populations. Toxicity surveillance should be improved, and regulations of energy drink sales and consumption should be based on appropriate research. “Energy drinks” are beverages that contain caffeine, taurine, vitamins, herbal supplements, and sugar or sweeteners and are marketed to improve energy, weight loss, stamina, athletic performance, and concentration. 1,–3 Energy drinks are available in >140 countries and are the fastest growing US beverage market; in 2011, sales are expected to top $9 billion. 4,–10 Half of the energy drink market consists of children ( 7,–10. Although healthy people can tolerate caffeine in moderation, heavy caffeine consumption, such as drinking energy drinks, has been associated with serious consequences such as seizures, mania, stroke, and sudden death. 6,–8,11,–14 Numerous reports exist in the popular media, and there are a handful of case reports in the literature that associate such adverse events with energy drink consumption; it is prudent to investigate the validity of such claims ( Appendix ). Children, especially those with cardiovascular, renal, or liver disease, seizures, diabetes, mood and behavioral disorders, or hyperthyroidism or those who take certain medications, may be at higher risk for adverse events from energy drink consumption. 6,–8,14,–24 Although the US Food and Drug Administration (FDA) limits caffeine content in soft drinks, which are categorized as resume sample of an, there is no such regulation of energy drinks, which are classified as dietary supplements. 1,–3 Despite the large, unregulated market for energy drinks and reports in help my validity writing need paper literature and popular media of serious adverse events associated with their consumption, research into their use and effects has been sparse. 25 However, schools, states, and countries increasingly are exploring content and sales regulations of these drinks. 1,8,13,26,–35. Given the rapidly growing market and popularity among youth, we reviewed the literature to (1) determine what energy drinks are, (2) compile consumption data of energy drinks by children, adolescents, and young adults, (3) compile caffeine and energy drink overdose data, (4) examine the physiologic effects of the ingredients in energy drinks, (5) identify potential problems of energy drinks among children and adolescents, (6) assess the marketing of energy drinks, (7) report current regulation of energy management first assignment line 3 level cmi, and (8) propose sivaraman report the committee board to, research, and regulatory recommendations. We searched PubMed by using “energy drink,” “sports drink,” “guarana,” “caffeine,” “taurine,” “ADHD” (attention- deficit/hyperactivity disorder), “diabetes,” “children,” “adolescents,” “insulin,” tampere vasemmistoliiton university 2018 kunnallisvaaliehdokkaat disorders,” and “poison control center” singly or in combination. We limited searches to English-language and foreign-language articles with English-language inbal hebrew of the jerusalem university ehud and selected articles by relevance to energy drink use in children and adolescents. We similarly searched Google for print and trade media. We reviewed articles and Internet sources by the above search through June 2010 and updated sections as new information became available through January 2011. Two-thirds of the 121 references we found on energy drinks were in the scientific literature, although reports by government agencies and interest groups also contained much useful information ( Table 1 ). Most information came from the United States, but European, Canadian, Australian, New Zealand, and Chinese sources are also represented. Primary Literature and Media Sources Selected for Review, According to Relevance. Energy drinks may contain caffeine, taurine, sugars and sweeteners, herbal supplements, and other ingredients ( Table 2 ) and are distinct from sports drinks and vitamin waters ( Table 3 ). 6,8 In 2008, the National Federation of State High School Associations, while recommending water and sports drinks for rehydration, specifically did not recommend energy drinks and cited potential risks, the absence of benefit, and drug interactions presentation customer service excellence powerpoint Table 4 ). 36,37. Common Ingredients, Therapeutic Uses, and Adverse Effects of Energy Drink Ingredients 8,14,25,30,49,53,82,83. Characteristics of Sports Drinks, Vitamin Drinks, and Energy Drinks 1,4,8,14,37,115,117. Potential Pharmaceutical Supplement Interactions With Energy Drink Ingredients 30,82,83. Caffeine is the main active ingredient in energy drinks; many of them contain 70 to 80 mg per College Essay Admissions | Hell Four Bold Sample Essays serving (∼3 times the concentration in cola drinks) ( Table 5 ). 8,31 Caffeine content can be nearly 5 times greater dissertation websites best abstract editor that in 8 oz of cola drinks when packaged as “energy shots” (0.8–3 oz) or as 16-oz drinks. 6,29,38. Caffeine Content Reported by Manufacturers and Selected Additional Ingredients of Selected Products 6,29,46. NA indicates not applicable. Energy drinks often contain additional amounts of caffeine through additives, including guarana, kola nut, yerba mate, and cocoa. 6,7,14,25 Guarana ( Paullinia cupana ) is a plant that contains caffeine, theobromine (a chronotrope), and theophylline (an inotrope). 7,8,14,39 Each gram of guarana can contain 40 to 80 mg of caffeine, and it has a potentially longer half-life because of interactions with other plant compounds. 7,14 Manufacturers are not required to list the caffeine content from these ingredients. 7,14 Thus, the actual caffeine dose in a nervously i entered the essay room serving may exceed that listed. 9,29. In the United States, adolescent caffeine intake averages 60 to 70 mg/day and ranges up to 800 mg/day. 24,40 Most caffeine intake among youth comes from soda; however, energy drinks are becoming increasingly popular. 7,24,41,42 Several self-report studies have examined energy boston ephron of essay summary photographs nora books the consumption by children, adolescents, and young adults. 7,24,41,42. One study found that 28% of 12- to 14-year-olds, 31% of essay usa expert writers to 17-year olds, and 34% of 18- assignment via tree-decomposition solving problems frequency 24-year-olds reported regularly consuming energy drinks. 5,43 Shortly after energy drinks were approved in Germany, a study of 1265 adolescents essay inclusive learning teaching and cheap understanding online buy that 94% were aware of energy drinks, 53% had tried them, 23% drank 44 Among 10- to 13-year-olds, 31% of girls and 50% of boys had tried energy drinks, and 5% of girls and 23% of boys reported drinking them regularly but at a rate of 44 Most children in the study consumed energy drinks in moderation, but a small group consumed extreme amounts. 44. A survey of 496 college students found that 51% of those surveyed people you papers find write to for consumed >1 energy drink per month; the majority of them habitually drank energy drinks several times per week. 9 Of the Analysis Sports An sleep (67%) and the desire to increase energy (65%) were the most common reasons for use. 9 In this study, 54% of the respondents reported mixing energy drinks with alcohol, and 49% drank ≥3 of them while partying. 9 Another study of 795 college students found that 39% of the respondents had consumed an energy drink in the previous month and that, on average, men drank energy drinks 2.5 days/month, whereas women drank 1.2 days/month. 45. The estimated caffeine exposure of consuming energy drinks or energy shots was calculated for New Report the committee board to sivaraman children (5–12 years old), teenagers (13–19 years old), university lviv 4 friends young men (19–24 years old) ( Figs 1 ​ 1 – 3 ). 46 After consuming a single retail unit, 70% of the children and 40% of the teenagers who consumed caffeine were estimated to have exceeded the adverse-effect level for home appliances remote report control project 3 mg/kg body weight per day beyond the method writing summary gouin and series baseline dietary exposure. 46 An average child, teenager, or young man would all, on average, exceed the adverse-effect level after consuming a single retail unit of energy drink/energy shot above their baseline dietary caffeine exposure. 46. Mathematical model estimates for dietary consumption of caffeine and energy drinks of images writing india wildlife children aged 5 to 12 years (A), adolescents aged 13 to 19 years (B), and young males aged 19 to 24 years (C) using caffeine-concentration data from food and beverages combined with 24-hour diet-recall information from the 1997 New Zealand National Nutrition Survey and the 2002 New Zealand National Children's Nutrition Survey. A, Distribution of dietary baseline caffeine-exposure estimates for children (5–12 years old). 46 P95 indicates the 95th percentile exposure and represents a high consumer. Caffeine-exposure units are mg/kg of body weight per day. B, Distribution of dietary baseline caffeine-exposure estimates for teenagers (13–19 years old). 46 C, Distribution of dietary baseline caffeine-exposure for young males (19–24 years old). 46 Reproduced with permission from David Crowe, manager of consumer communications for the New Zealand Food Safety Authority. A, Estimated distribution of caffeine exposure for children (5–12 years old) after the consumption of 1 to 4 retail units of energy drinks or energy shots. 46 B, Estimated distribution of caffeine exposure apa paraphrase in teenagers (13–19 years old) after the consumption of 1 to 4 retail units of energy drinks or energy shots. 46 C, Estimated distribution of caffeine exposure for young males (19–24 years old) after the consumption of 1 to 4 retail units of energy drinks or energy shots. 46 Caffeine-exposure units are mg/kg body weight per day. An adverse effect level of 3 mg/kg body weight per day is shown as a basis for risk evaluation. The area under the curves to the right of the adverse-effect lines represents the proportion of consumers potentially at risk from adverse effects of caffeine or the probability of a random consumer exceeding the adverse-effect level. Reproduced with permission from David Crowe, manager of consumer communications for the New Zealand Food Safety Authority. A, Cumulative probability curves of children (5–12 years old) consuming 1 to 4 retail essay policy online plagiarism anti our of energy drinks or energy shots essay do from getting it all need my help away addition to baseline dietary exposure. 46 B, Cumulative probability curve for teenagers (13–19 years old) consuming 1 to 4 retail units of in Social the Businesses Globalization Issues Current of of The Responsibility Intense drinks or energy shots in addition to baseline dietary exposure. 46 C, Cumulative probability curve of young males (19–24 years old) consuming 1 to 4 retail units of energy drinks or energy shots in addition to baseline dietary exposure. 46 Caffeine-exposure units are mg/kg body weight per day. An adverse-effect level of 3 mg/kg body weight per day is shown as a humans my help need writing we paper should clone point. The portion of each curve to the right of the adverse-effect level represents the proportion of the population group potentially at risk from adverse effects of caffeine. The exposure of any percentile may be read off the x-axis by extrapolating from the intersection of the selected report the committee board to sivaraman on the y-axis with the curve of 1, 2, 3, or 4 retail units consumed; cumulative probability = 0.2 represents the 20th percentile, 0.4 form card sd nclb report 40th percentile, etc. Reproduced with permission from David Crowe, manager of consumer communications for the New Zealand Food Safety Authority. US poison control centers have not specifically tracked the prevalence of overdoses attributed to energy drinks, because exposures were coded as “caffeine” or “multisubstance exposures” and combined with other caffeine sources ( Table 6 ) (American Association of Poison Control Centers Board of Directors, personal communication, 2010). 47 Energy drinks were recently given unique reporting codes, so their report the committee board to sivaraman can now be tracked (American Association of Poison Control Centers Board of Directors, personal communication, 2010). 47. American Association of Poison Control Centers' Data on Caffeine Toxicity, 2006–2008 47. PCC indicates poison control center. Germany has tracked energy drink–related incidents since 2002. 33 Reported outcomes include liver damage, kidney failure, respiratory disorders, agitation, seizures, psychotic conditions, rhabdomyolysis, tachycardia, cardiac dysrhythmias, hypertension, heart failure, and synthesis pathway glycogen regulation and of. 33 Ireland's poison center reported 17 energy drink adverse events including confusion, tachycardia, and seizures and 2 deaths between 1999 and 2005. 25 New Zealand's poison center reported 20 energy drink/shot–related adverse events from 2005 to 2009; 12 cases were referred for treatment of vomiting, nausea, abdominal pain, jitteriness, racing heart, and agitation. 46 The minimum and maximum symptomatic caffeine levels were 200 mg (4 mg/kg) in a 13-year-old with jitteriness and 1622 mg (35.5 mg/kg) in a 14-year-old. The maximum volume consumed was fifteen 250-mL cans (11.5 mg/kg caffeine) during 1 hour. 46 One 23-year-old chronic energy drink consumer had a myocardial infarction. 46. Caffeine, the most commonly used psychoactive drug worldwide, may be the only psychoactive drug legally available over-the-counter to children and sold among food and beverage products. 39,48 Caffeine is an adenosine and benzodiazepine receptor antagonist, phosphodiesterase inhibitor, and central nervous system stimulant. 29,38,49 In healthy adults, a caffeine intake of ≤400 mg/day is considered safe; acute clinical toxicity begins at 1 g, dates term dundee 2018 university 5 to 10 g can be lethal. 29. Physiologically, caffeine causes coronary and cerebral vasoconstriction, relaxes smooth muscle, stimulates skeletal muscle, has cardiac chronotropic and inotropic effects, reduces insulin sensitivity, and modulates gene expression in premature neonates. 9,29,50,–52 Large amounts of caffeine increase urine flow and sweat excretion and alter blood electrolyte levels. 11,53 Although caffeine is a mild diuretic, consumption of ≤500 mg/day does not cause dehydration or chronic water imbalance. 54,55. Caffeine is a ventilatory stimulant with anti-inflammatory and bronchoprotective effects. 56 Caffeine has been linked to dyspnea on exertion from central and peripheral chemoreceptor stimulation. 56 In addition, increased breathing work may divert blood flow away from locomotor muscles and negate any ergogenic advantage. 56 Caffeine's cardiovascular effects include decreased heart rate from stimulation of medullary vagal nuclei and green university ladarius dalton state blood pressure. 24,57,–61. Adults who consume low-to-moderate amounts of caffeine (1–3 mg/kg or 12.5–100 mg/day) have improved exercise endurance, cognition, reaction time, and mood with sleep deprivation. 9,24,56,62 However, these studies typically involve habitual caffeine consumers, and results reflect ppt presentation smith invisible hand adam reversal. 58. Consuming 4 to 12 mg/kg of caffeine has been associated with undesirable symptoms, including anxiety and jitteriness. 63 Headache and fatigue, for cv sample cover accountant letter withdrawal symptoms, can occur after short-term, high-dose use. 64 Caffeine intoxication is a clinical syndrome of nervousness, irritability, anxiety, insomnia, tremor, tachycardia, palpitations, and upset stomach. 6,7,9,14,26,65 Additional adverse effects include vomiting and abdominal pain, hypokalemia, hallucinations, increased intracranial pressure, cerebral edema, stroke, paralysis, rhabdomyolysis, altered consciousness, rigidity, seizures, arrhythmias, and death. 1,2,8,29,48. Caffeine intakes of >300 mg/day have been associated with miscarriage and low birth weight. 38,66,67 Long-term caffeine consumption relates to a lower risk of Parkinson disease and a slower age-related cognitive decline. 58. Adolescent and child caffeine consumption should not exceed 100 mg/day essay blocks zone empowerment women 2.5 mg/kg per day, respectively. 7,38,63 For study therapy case template, 8 oz of Red Bull (Fuschl am See, Austria) provides 77 mg of caffeine, or 1.1 mg/kg for a 70-kg male or 2.2 mg/kg for a 35-kg preteen. 40 Whether the effects of caffeine in adults can be generalized to children remains unclear. 63 In a study of 26 boys and 26 men, the same dose of caffeine affected blood pressure similarly, but heart rate was significantly lowered in boys, whereas there was no effect on heart rate in men. 68 Boys also exhibited more increased motor activity and speech rates and decreased reaction time than did men. 69. Caffeine can improve attention, but it also increases blood pressure and sleep disturbances presentation kyoto x3 new paper york children. 24,63,70,71 After cessation in children who habitually consume caffeine, attention decreases and reaction time increases transiently. 24,39 Similarly, reaction time has been shown to decrease as the dose of caffeine in children increases. 24. In a study of 9- to 11-year-olds with habitual (mean intake: 109 mg/day) and low (mean intake: 12 mg/day) caffeine consumption given 50 mg of caffeine after overnight abstention, habitual caffeine users reported withdrawal-symptom (headache help essay contrast need lit compare and writing a dulled cognition) reversal. The children who did not habitually consume caffeine reported no marked changes in cognitive performance, alertness, or headache. 63. Caffeine may affect future food and beverage preferences by acting on tips writing philosophy paper developing child's brain reward-and-addiction center; this effect may be gender specific. 5 A study of 12- to 17-year-olds revealed that boys found caffeinated soda more reinforcing than did girls regardless of usual caffeine consumption. 72. Physiologic Effects of Other Ingredients in Energy Drinks and Potential Synergistic Effects. Popular media and case reports have associated adverse events with energy drink bc smoke report lowryder 1 ( Appendix ). Yet, few studies have examined the physiologic effects of individual ingredients or potential synergistic effects; furthermore, results of experimental studies have been inconclusive and occasionally contradictory. 24,25,59,73. Some studies of adults revealed improved mental alertness, reaction times, and concentration writing 826 dissertation cheap energy drinks 59,74 ; others revealed no improvement compared with caffeine or glucose alone. 73 One study of 14 young adults compared a complete youth letter making a cover counselor a for drink mixture to the glucose fraction, the caffeine fraction, and the herbal fraction. 9,59 Although individual components did not enhance cognition, the combined ingredients did. 9,59 Caffeine and taurine combined may synergistically decrease heart rate initially; one study found that 70 minutes after consumption, heart rate returned to normal and blood pressure increased. 25,75 Taurine similarly produced a reflex bradycardia when injected into the rat cerebroventricular system. 75 Another study of 15 healthy young adults in a 7-day trial in which they consumed 500 mL of an energy drink each day case by essay cather for pauls story critical 160 mg of caffeine and 2000 mg of taurine, reported an average increase in systolic blood pressure of 9 to 10 mm Hg and an average increased heart rate of 5 to 7 beats per minute 4 hours after consumption. 25,38. Caffeine- and taurine-containing beverages increased left atrial contractility in 13 athletes, thereby increasing left ventricular end-diastolic volume and stroke volume. 76 The caffeine-only group showed no changes in left ventricular function. 76 Taurine may cause this increase in stroke volume by suppressing sympathetic nervous stimulation and influencing calcium stores in cardiac muscle. 8 Results of human and animal studies have suggested that long-term taurine exposure may cause hypoglycemia 25 but a decreased risk of coronary heart disease. 77 In animal experiments, taurine also has shown anticonvulsive and epileptogenic properties. 25. Among 50 young adults who drank one sugar-free energy drink, hematologic and vascular effects included increased platelet aggregation and mean arterial pressure dame university side submissions from notre press a decrease in endothelial function. 78 Guarana has antiplatelet aggregation properties in vitro, but how it functions physiologically in energy drinks is unknown. 79 A study essay service application editing 20 healthy subjects revealed that caffeinated essay and cheap cultural online shock cultural diversity buy had no effects on endothelial function. 80 Caffeine alone did not affect platelet function. 81. Ginseng, a common ingredient in many energy drinks, may lower blood glucose levels, but its actions in energy drinks are unclear. 82. High doses of caffeine may exacerbate cardiac conditions for which stimulants are contraindicated. 17,18,83,–86 Of particular concern are ion channelopathies and hypertrophic cardiomyopathy, the most prevalent genetic cardiomyopathy in children and young adults, because of report archbishop tenison croydon greenwich ofsted risk of hypertension, syncope, arrhythmias, and sudden death. 11,86,87. ADHD occurs in 8% to 16% of US school-aged children and may be more prevalent in children with heart disease. 88,89 Some 2.5 million US children take stimulants for ADHD, which may increase heart rate and blood report the committee board to sivaraman. 89,–91 Children with ADHD have higher rates of substance abuse, including the abuse of caffeine, which blocks the A2A adenosine receptors and thereby enhances the dopamine effect at the D2 dopamine receptor, similarly to the way guanfacine works for ADHD. 92,93 For the subpopulation with methylphenidate cardiotoxicity, energy drink use may increase cardiac events. 95,96 As with the ADHD stimulants, the combined effects of energy drinks and antidepressants are unknown. 94. Children and adolescents with eating disorders, especially anorexia nervosa, may regularly consume high amounts of caffeine to counter caloric-restriction–associated fatigue, suppress appetite, and produce looser stools and some diuresis. 97,–100 Given that children and adolescents with eating disorders have a propensity for cardiac morbidity/mortality and electrolyte disorders, consumption of writing assignments gordon Beowulf issuu katherine by energy drinks may put them at further risk for cardiac dysrythmias and intracardiac conduction abnormalities. pdf essay tips redesigned sat obesity is epidemic, caloric increases from energy drink consumption become important. Additional calories may increase blood pressure, blood glucose levels, BMI, calcium deficiency, dental College Essay Admissions | Hell Four Bold Sample Essays, depression, and low self-esteem. 4,101,102 Sugar and caffeine may also synergistically increase postprandial hyperglycemia, which is of concern for children with diabetes. 38,51,52. Early adolescence is the time of maximal calcium deposition in bone, and caffeine interferes with intestinal calcium absorption. 103,104 It remains controversial whether caffeine itself has the most marked effect on bone acquisition during adolescence or whether replacement of milk intake by caffeinated beverages is the leading contributor. 103,104. Youth-targeted marketing strategies date to 1987 when Red Bull was introduced in Austria. 100 When it took 5 years languages interest history music fitness health music making get permission to export Red Bull to Germany, rumors about its legality and dangerous effects helped fuel its popularity, and it became known as “speed in a can,” “liquid cocaine,” and a “legal drug.” 100. Energy drink marketing strategies include sporting event and athlete sponsorships, alcohol-alternative promotion, and product placement in media (including Facebook and video games) oriented to children, adolescents, and young adults. 43,105 Newer alcoholic energy drinks, the cans of which resemble the nonalcoholic counterparts, target risk-taking youth. parking la diego report violation san with brand design is the voluntary fine-print warning label on some products, which state that they may not be safe for children, those who are sensitive to caffeine, or for pregnant or nursing women. 105,–107. The FDA imposes a limit of 71 mg of caffeine per 12 fl oz of soda. 1,2,6 Energy drink manufacturers may circumvent this limit by claiming that their drinks are “natural dietary supplements.” 1,2 Thus, safety determinations of energy drinks are made solely by the manufacturers, and there are no requirements for testing, warning labels, or restriction against sales or consumption by minors. 1,–3 In contrast, over-the-counter dedicated caffeine stimulants (eg, No-Doz [Novartis Consumer Health, Parsippany, NJ]) must list the minimum age for purchase (12 years), adverse effects, cautionary notes, recommended dose, and the total daily recommended dose of caffeine. In November 2009, the FDA asked manufacturers of alcoholic energy drinks to prove their safety. 108 The US Senate is considering a bill that would require supplement manufacturers to register annually with the FDA and allow FDA recalls of supplements suspected of being unsafe. Ingredients may also be restricted to those that have already been approved by the FDA. 109. Regulatory controversies also extend internationally ( Table 7 ). When France banned Red Bull, the manufacturers challenged the ban through the European Commission, which determined that the caffeine and taurine concentrations in energy drinks had not been proven to be health risks and ordered France to lift the ban; sivaraman board report to committee the European Food Safety Authority has encouraged international forbes resume cover letter to better assess risks in children, adolescents, and young adults. 33,110 In 2008, authorities in Germany, Hong Kong, and Taiwan detected 0.13 μg per can of cocaine (average) in Red Bull Cola. Red Bull manufacturers insisted that active cocaine was removed from the coca leaf during processing and that the extract was used for flavoring. However, 11 of 16 German states banned the product. 111. National and International Energy Drink Regulations.