Over the years, Global Advisory Services has consulted not only in wellness and integrative medicine, but also for supplement product development including Zip Fizz, which is still carried at Costco. I am the managing director of Global, and at one point our consulting team was engaged by a publicly traded Japanese firm that wanted to identify 10 "hit products" from the United States as it set out to build a 7-Eleven-type chain.
Notwithstanding intense industry competition that generates a plethora of fancy labels and attractive advertising, there are seven key supplement product areas: energy and mental clarity, relaxation, workout and weight loss, mood support, immune boosters, sexual performance and anti-aging.
Consumer demand is greatest for more energy. In previous generations the norm was coffee and then, increasingly, Coke. Largely stimulated by traditional Japanese energy drinks, the field has now exploded. Red Bull held 42 percent of market share and sold $2.9 billion of energy drink products in 2012, while Monster held 37 percent of the market last year and sold $2.6 billion of its products, according to Energy Fiend, a website that provides information about caffeine and energy drink products.
Despite a huge range of ingredients, the boost typically comes from caffeine, guarana (which is mostly caffeine), theophylline (found in tea), ginseng and amino acids, principally taurine and L-carnitine. In low doses, for most people, these ingredients are not harmful. But in higher doses they can be dangerous. That limit depends on the drink, the person’s weight and any existing health conditions.
The reasons for consuming energy drinks are many: to wake up in the morning, to treat a hangover or compensation for poor sleep, as a pick-me-up in the afternoon or later to get through the day. Some consume energy drinks to help their workout. Others drink them for mental focus and concentration, which can unknowingly be an attempt at self-medication for attention deficit hyperactivity disorder (ADHD).
ADHD is a medical condition characterized by poor concentration, distractibility and difficulty staying on task.
"More children in the U.S. are being diagnosed with ADHD than even before," according to the Huffington Post.
There was a 66 percent increase in diagnoses annually among children between 2000 and 2010, and the number now is greater than 10 million per year for children alone. The condition is typically treated with stimulants such as Ritalin, Adderall and Modafinil.
These medications, while helpful in some cases, are also subject to abuse. Increasingly, pharmaceutical stimulants are sought out by graduate students, academicians, attorneys and software developers simply to achieve higher levels of productivity when processing information.
Because of such demand, as is the case with opiates, some patients feign complaints of ADHD to their physicians to get prescriptions for sale on the street. At Manakai o Malama we treat prescriptions for ADHD the same way we manage chronic pain medications. Patients are required to sign contracts agreeing to confirm the diagnosis with one of our psychologists, undergo routine drug testing and refrain from obtaining controlled prescriptions from any other facility.
On Thursday a longtime patient came for a refill of medication for ADHD and, when asked to submit to a urine test, admitted that he had recently done some cocaine. Medication for ADHD plus cocaine can be a lethal combination.
Whether consuming energy drinks or pharmaceutical stimulants for ADHD, extreme caution is warranted.
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Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.
