Whether sports and energy drinks live up to their healthy, helpful image is a popular news topic and a concern for medical professionals and parents alike. The following special report offers insight about how and when these drinks may be helpful – or if they should be avoided altogether – along with recommendations from Dr. Bill Shaw for safely staying hydrated before, during and after exercise.The usage of sports drinks has been popular ever since the introduction of Gatorade in the mid ‘60s. Consuming these drinks, which contain large amounts of sugar and salts, was thought to delay fatigue and help prevent muscle cramps. A greater concern today, however, is dehydration and heat exhaustion/stroke. To combat dehydration during exercise, athletes of all ages need to drink fluids before, during and after exercise. Reminding young athletes of this is important as they may lack thirst awareness and the experience or motivation to take in appropriate amounts of fluid.Pre-exerciseIt has been noted that water is better absorbed from the stomach when it has added salt and sugars. This has led to a recommendation of sports drinks for pre-exercise hydration. However, using sports drinks prior to exercise may not be necessary if the overall water, diet and salt intake of the athlete are adequate, particularly when timed properly. In the United States, the average person takes in much more salt than daily recommended, which can provide a buffer to the salt losses that occur during exercise. An exception to this can be seen in football players, particularly during the summertime, when salt losses can range from 3 to 8 grams a day. They would likely benefit from added salt available through sports drinks before, during and after exercise, along with eating salty foods before and after exercise.During ExerciseRecent guidelines recommend the usage of sports drinks during exercise for athletes exercising more than an hour at a time, with water recommended for hydration during exercise when exercising less than an hour. Taking in carbohydrates (sugars) during exercise delays muscle fatigue by slowing depletion of the body’s sugar stores.Got Milk? Certain athletes lack an appetite after exercising and may benefit from a drink with added sugars and protein. If there is an option, should the athlete select a sports drink or chocolate-flavored skim milk? To help answer this question, consider the impact on teeth:Sports drinks have an acid level (pH) of 3 to 4, which is not very different from many soft drinks and juices. Exposure to a pH less than 5 is associated with enamel erosion and tooth decay. Thus, there is a risk of dental harm with regular usage of sports drinks, particularly during exercise when there may not be as much saliva produced to clear the product from the teeth. On the other hand, milk products are less acidic (they have a pH in the 6-7 range) and the proteins in milk are known to reduce dental erosion and help strengthen bones and refuel muscles.Energy DrinksIt has been noted that “energy drinks have no therapeutic benefit, and many ingredients are understudied and not regulated.” These drinks typically have large quantities of caffeine or guarana. High doses of caffeine can be associated with seizures, stroke and sudden death. Guarana is an herbal stimulant that contains caffeine along with two similar substances, and thus can be harmful in a similar manner.Since energy drinks are considered dietary supplements and not food beverages, there is no exact caffeine quantity that needs to be reported on the product’s label, and they are not regulated by the U.S. Food and Drug Administration (FDA). In addition, due to the higher percentage of carbohydrates in these energy drinks, there is an increased risk of an upset stomach during exercise if they are consumed close to the start of exercise.As of December 2012, both the FDA and U.S. Congress are investigating the safety of energy drinks. Energy drinks are not recommended for the pediatric population and even adults should use extreme caution when ingesting these since the side effects will be unpredictable as the content of the ingredients may not be exact.Dr. Shaw is a pediatrician with a special interest in sports medicine. He sees patients for both general pediatrics and sports medicine at Children’s Hospital of Richmond at VCU’s Children’s Pavilion and was recently ranked a “Top Doc” in Sports Medicine by Richmond Magazine.