Dermatologic Effects of Energy and High Protein Drinks

In recent decades, the consumption of energy drinks and protein shakes has surged among college and medical students, athletes, and professionals seeking to enhance their energy and performance.¹ In 2010, the annual weighted prevalence of energy drink use was 36.5% in the second and third years of college.² More recently, in 2022, a cross- sectional study examined the energy drink consumption of 256 medical students and found that 74.88% used these beverages.³ "It wakes me up in the morning; I don't think I could live without it," and "it gives me my caffeine kick right before the gym" are some of the common responses that lead many to consume energy drinks and protein shakes in high amounts. For each of these products — whether energy drinks or protein shakes — the FDA has a recommended daily allowance for the nutritional ingredients. The FDA considers 400 mg of caffeine, 50 g of sugar, and roughly 50 g of protein (based on a 2000-calorie diet) to be safe daily limits; many commercial products approach or exceed these thresholds with 2 servings.^4-7 Given the popularity of these products among patients in their teens and 20s, it is important to consider their impact on common dermatologic conditions such as acne.

Dietary factors have long been suspected to contribute to the pathogenesis of acne.⁸ A review published in 2022 noted that diets with a high glycemic index and the consumption of milk-based proteins may elevate insulin and IGF-1 activity, thereby promoting sebaceous gland enlargement and increased sebum secretion.⁸ Elevated dietary glycemic load leads to rapid spikes in blood glucose and insulin, which activate the mammalian target of rapamycin complex 1 (mTORC1) pathway—driving keratinocyte proliferation and inflammation.^9,10 Similarly, whey and casein proteins increase circulating IGF-1, amplifying androgenic stimulation of sebaceous glands.¹¹

Energy Drinks

In energy drinks, there are many products that are known culprits of acne and acne flares; these products include high amounts of sugar, high doses of B vitamins, caffeine, and other stimulants.¹² High caffeine intake has been shown to reduce insulin sensitivity and elevate stress hormones, potentially worsening glycemic control. Energy drinks and protein shakes contain high amounts of sugar and sweeteners. High amounts of sugar increase insulin secretion. Insulin affects the function of sebaceous glands by inducing an increase in the size and number of sebocytes.¹³ This spike in insulin also disrupts hormone signaling, which can affect acne. In response to high sugar consumption, manufacturers began producing "zero sugar" or sugar-free energy drinks. However, data suggest that consumption of both standard and “sugar-free” energy drinks is associated with metabolic syndrome, particularly insulin resistance. This indicates that both standard and sugar-free energy drinks can be harmful.⁸ A recent meta-analysis and systematic review of 13 studies supported that patients who had acne also had significantly higher insulin resistance.¹⁴ Although the study did not directly assess sugar intake, the association supports that products with a high amount of sugar, or that cause insulin spikes, could exacerbate acne. It is challenging to precisely quantify the amount of sugar that leads to abnormal sebum production, as each patient has their own individualized diet, lifestyle, and genetic makeup, all of which play a vital role in sebum production.¹⁵ 

Protein Shakes

Protein shakes contain mostly whey or soy protein, with some containing added B vitamins, sugar, and other additives that can increase the insulin/ insulin growth factor- 1 (IGF) and glycemic index of consumers.¹⁶ In 2012, a study by Silverberg et al showed an association between severe acne flares and whey protein. The study analyzed 5 young males, between the ages of 14 and 18 years, who were drinking or taking whey protein supplements for either weight gain or muscle strength enhancement. All 5 patients received oral antibiotics, topical retinoids, and benzoyl peroxide for acne treatment; however, they all had a poor response to this mode of treatment.¹⁷ Notably, 4 of the patients who chose to discontinue whey protein supplementation fully cleared their acne.¹⁸ Studies have shown that since 1998, more people are engaging in aerobic activity and muscle-strengthening exercises.¹⁹ As a result of more people going to the gym to either start or end their day, more people are consuming energy drinks for an energy boost or protein shakes for extra muscular gains.²⁰ Consumers are not the only ones, though. Many gyms, medical schools, and places of business have incorporated energy drinks, protein bars, and protein shakes in their vending machines, ultimately making these beverages readily available.

Dermatology clinicians can help educate patients on their dietary contributions to acne. For energy and alertness, patients should be encouraged to hydrate throughout the day. To make it more engaging, patients can even be challenged to create their own electrolyte-crafted water - adding a small amount of salt, a teaspoon of lemon, and one to 2 tablespoons of honey for taste. For protein, patients can create their own protein shakes that include egg white, unflavored pea, or rice protein isolate. Unsweetened oat or almond milk can be used instead of cow milk. Patients with acne can be screened for protein and caffeine intake. Dermatology clinicians and PCPs can also educate patients on label literacy to notice caffeine, sugar, and whey protein. In summary, the use of energy drinks and protein shakes among athletes, students, and professionals constitutes an overlooked but modifiable risk factor for common dermatologic conditions. Routinely asking about these products during history taking, educating patients on label literacy, and advising the use of skin-friendly alternatives. Uncovering this hidden contributor will ultimately lead to more effective, holistic treatment. Overall, this process empowers patients to make informed decisions that enhance their performance and skin goals.

Kevin Crumpton, Jr, is a third-year medical student at Meharry Medical College, School of Medicine in Nashville, Tennessee.

References

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