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Caffeine Levels in Energy Drinks Not Always Accurate, Study Says

Caffeine Levels in Energy Drinks Not Always Accurate, Study Says

Yikes: energy drinks may contain more caffeine than what the labels say

Now there's another good reason to put down the energy drinks: After a flurry of bad news surrounding Monster Energy Drinks and death reports linked back to the drinks, a new study shows that energy drinks' labels, which show the amount of caffeine, are often inaccurate.

Reuters reports that more often than not, the amount of caffeine isn't on the energy drink label. And when it is, there's usually more caffeine in the energy drink than is advertised on the label. The study by Consumer Reports examined 27 energy drinks; 11 of the 27 did not have the amount of caffeine on the label. And of the 16 that did advertise the caffeine amount, five of them contained more caffeine than listed — about 20 percent more caffeine. Those drinks: the Arizona Energy, Clif Shot Turbo Energy Gel, Sambazon Organic Amazon Energy, Venom Energy, and Nestlé Jamba.

However, the makers of energy drinks aren't required to put the amount of caffeine in the drink on the label — and many say it's not good business sense to do so. A Monster Beverage official told Consumer Reports that it did not advertise the amount of caffeine because there is no legal or commercial business requirement to put that number on the label, and "because our products are completely safe, and the actual numbers are not meaningful to most consumers."

Update: Sambazon responded in regards to the Consumer Reports study, and said: "The caffeine in our beverages is derived from organic botanical sources that include guarana, yerba mate and green tea extract. The Consumer Reports study stated that our product was found to have 81 mg of caffeine per 8 ounces, but the correct amount is 53mg of organic caffeine per 8 ounces." Sambazon also noted that is a food and beverage product and has the appropriate nutrition label; the company has reached out to Consumer Reports for a correction.


Handmade Pictures/istock

Energy drinks are a popular way to boost energy and sharpen focus, but overconsumption can lead to adverse health effects, research has shown.

Energy drinks have become the beverage of choice for the sleep-deprived and many people looking for an extra performance edge, including athletes.

They're marketed as a way to boost alertness and, of course, heighten energy levels. And it's worked. The energy drink industry was valued at $61 billion last year and is projected to nearly hit $100 billion by 2027.

According to the National Institutes of Health , 34% percent of adults ages 18-24 regularly consume energy drinks. But nutritional experts warn that chronic use is linked to serious adverse health effects.

Though energy drinks are sometimes confused as sports beverages, they are a completely different type of product. Many energy drinks contain almost 200mg of caffeine — about two cups of coffee — and as much or more sugar as soda, according to Harvard Health.

"A lot of people are not aware of the possible dangers and keep drinking them all day," Dr. Amy Lee, chief medical officer of Lindora Clinic in Southern California and an expert in weight control, obesity and nutrition, told PhillyVoice. "It is critical to always read labels and to understand what could happen if you overdose on certain herbs or other ingredients."

Breaking down the energy drink

The U.S. Food and Drug Administration allows energy drink manufacturers to classify their products as beverages or dietary supplements based on several variables, including packaging, serving size and recommended conditions of use.

The ingredients in beverages must be pre-approved by the FDA, but dietary supplements face less scrutiny. So, it isn't necessarily easy to know the exact health effects of energy drinks. Most research has focused on the caffeine and sugar in them.

"Caffeine can affect quality of sleep," Lee said. "Consuming too much of it can lead to difficulties falling asleep and staying asleep. Lack of sleep then affects your cognitive abilities which may lead you to eat more bad foods in an effort to boost your energy and focus."

Caffeine and other stimulants also can have an adverse effect on the heart and blood pressure, research has shown.

Overdosing on caffeine can cause vomiting, palpitations, high blood pressure and, in severe cases, seizures and death. Children and teenagers are particularly vulnerable because they may not understand how much caffeine energy drinks contain.

In 2017, a 16-year-old boy died of a caffeine overdose after drinking soda, coffee and an energy drink. The caffeine caused a heart arrhythmia.

It isn't totally clear how overconsumption affects a person's health b ecause there is little research on the other ingredients in energy drinks . For example, some energy drinks contain B vitamins, which can cause skin conditions, liver toxicity, blurred vision and nerve damage when consumed in excess.

And because these drinks are sugar-laden, chronic use can cause dental issues, including cavities, and increase the risk of developing obesity and type 2 diabetes.

However, caffeine and sugar are not the only potentially unhealthy ingredients included in energy drinks. A Texas A&M University study found that theophylline, adenine and azelate caused the most adverse effect on the heart.

Theophylline, a chemical similar to caffeine, relaxes the muscle around the lungs' airways. Adenine is a small molecule that is used for nutritional supplementation. When combined with ribose, it is known to cause heart blockage in people suffering from supraventricular tachycardia — a condition where the heart beats faster. Azelate is the salt of azelaic acid, an acid known to reduce inflammation.

The Texas A&M researchers tested the effect that 17 brands of energy drinks had on the heart's function using lab-grown human heart cells. They found they caused improper heartbeat cardiomyopathy, increased blood pressure and other heart conditions.

"Even legal stimulants, when chronically used, can overstimulate the sympathetic nervous system — our fight or flight response — which causes blood pressure and heart beat to rise, leading to dangerous health effects," Dr. Rand McClain, chief medical officer of LCR Health and a longevity and restorative health specialist who treats professional athletes, told PhillyVoice.

This overstimulation can cause negative effects to the heart's rhythm and to cellular function, he said. The sympathetic nervous system is designed for short flight or fight. Chronic release of these hormones, like through the regular use of the stimulants in energy drinks, increases inflammation and can cause organ damage.

Though the Texas A&M study improves the understanding of the way ingredients in energy drinks affect health, McClain, who was not involved in it, stressed that more research is needed.

Other possible adverse health effects include increased stress, aggressive behaviors, alcohol and cigarette abuse, increased risk of obesity and type 2 diabetes, according to Harvard Health.

Yet, health experts are most concerned about the lack of regulation around energy drinks and the aggressive marketing to teens. Their nervous systems are still developing, putting them at greater risk of damage.

"Most younger kids didn't grow up with a cup of coffee in hand, but it is so accessible to buy energy drinks," Lee said. "They don't understand the possible bad effects."

The American Academy of Pediatrics says children and adolescents shouldn't be consuming the amount of caffeine and other stimulants found in energy drinks at all.

Nearly 1,500 adolescents ages 12-17 visited to the emergency room for an energy drink related emergency in 2011, according to the Centers for Disease Control and Prevention.

Also, combining alcohol and energy drinks has been a growing dangerous trend. Over 30% of adults ages 18-28 reported mixing the two substances at least once in the last year, a University of Michigan study found.

Natural energy boosts are better

So what should you do if you need a little energy boost before a workout or a big presentation?

McClain offered the same advice his grandmom used to give him: it's most important to get an appropriate amount of sleep each night.

"We are the only animal on the planet who goes without sleep on purpose," he said. "The importance of getting a good night's sleep on a regular basis isn't hard to comprehend, but it can be hard to do."

A healthy diet, which includes plenty of water for proper hydration, is also critical. If you need a little boost, he suggests drinking an espresso or a green tea instead.

"Energy drinks should only be used for break-the-glass-in-case-of-emergency use," he said.


Introduction

Energy drinks are a group of beverages used by consumers to provide an extra boost in energy, promote wakefulness, maintain alertness, and provide cognitive and mood enhancement. Although they seem like a new fad, these drinks have been available to the general public for some time. For instance, Red Bull (currently one of the most popular energy drinks) was introduced in Austria in 1987 and to the United States in 1997. Historically, cola soft drinks have been available in their current caffeine-containing form since 1904, and in their original coca leaf (from which cocaine is derived) and kola nut (from which the caffeine is derived) form since 1886, with similar effects as energy drinks as they contain approximately 34mg of caffeine per 12oz can. These beverages have stimulant effects on the central nervous system (CNS) and their consumption is accompanied by an expectation of improving user’s performance physically and mentally. 1

Energy drinks mostly contain caffeine, taurine, l-carnitine, carbohydrates, glucuronolactone, vitamins, and other herbal supplements like ginseng and guarana among others. Additives such as guarana, yerba mate, cocoa, and kola nut may increase the caffeine content of energy drinks unbeknownst to consumers, as manufacturers of these products are not required to include the caffeine content of these herbal supplements in the nutritional information. 2 Different brands of energy drinks contain caffeine ranging from 50mg to 550mg per can or bottle. 3

Caffeine is one of the most commonly consumed alkaloids worldwide in the form of coffee, tea, or soft drinks, and in high doses may cause abnormal stimulation of the nervous system 4 as well as adverse effects in the cardiovascular, hematologic, and gastrointestinal systems. 2 With energy drinks becoming a worldwide phenomenon, the short- and long-term effects of these beverages must be evaluated more closely in order to fully comprehend the psychological impact of these products.

The market and degree of consumption of energy drinks is increasing every year, 5 , 6 and while only few have detailed knowledge of their potential harmful physiological and psychological effects, the number of publications that have documented the potential adverse risks associated with the use of these beverages remains small. 7 Whereas most studies to date have examined the physiological effects of energy drinks, this article reviews and compiles the body of knowledge of this increasingly important topic by examining the psychological effects of energy drinks on cognitive functions, mood, sleep, decision making, and overall impact on well-being and quality of life (QOL). A list of the top selling energy drinks and contents appears in Table 1 .

TABLE 1

Top selling energy drinks and contents *

CONTENTS PER SERVINGRED BULLMONSTERROCKSTARFULL THROTTLESOBE NO FEAR
Caffeine80mg80mg80mg141mg32mg
TaurineND1000mg1000mgNDND
GuaranaNDND25mgNDND
Sugar27g27g31g57g27g
Sodium200mg180mg40mg160mg15mg
Vitamin B65mg2mg2mg4mgND

Energy drinks could cause public health problems, says WHO study

Energy drinks will become a significant public health problem if their use among young people is not addressed through a cap on caffeine levels and restrictions on their sale and marketing, United Nations researchers have warned.

The World Health Organisation (WHO) study said the primary risk was from high caffeine levels, which can cause problems such as palpitations, hypertension, vomiting, convulsions and in extreme cases heart failure leading to death. The paper, published in Frontiers in Public Health on Tuesday, will add to concerns about the harmful effects of excessive energy-drink consumption.

João Breda, from WHO’s Regional Office for Europe, and colleaguesThe researchers wrote that caffeine has a proven negative effect on children.

They said: “The full impact of the rise in popularity of energy drinks has not yet been quantified, but the aggressive marketing of energy drinks targeted at young people, combined with limited and varied regulation have created an environment where energy drinks could pose a significant threat to public health.”

Global sales of energy drinks surged from £2.4bn in 1999 to £17.3bn in 2013, according to Euromonitor. Red Bull is the UK’s third bestselling soft drink. Although some coffees have comparable levels of caffeine, energy drinks can be drunk cold and therefore more quickly.

The WHO study, a review of the literature, said there was also a proliferation of new products containing “extreme” caffeine levels, far higher than mainstream brands. Energy drinks also include other ingredients such as guarana, taurine and B vitamins, which the WHO researchers say require further investigation, including into their interaction with caffeine.

The paper, which does not represent WHO policy, said there was growing evidence of harm due to consumption of energy drinks with alcohol. A European Food Safety Authority study found that over 70% of 18- to 29-year olds who drink energy drinks mix them with alcohol.

The study authors said research has shown this is more risky than drinking alcohol alone, possibly because energy drinks make it harder for people to notice when they are getting drunk even though there is no reduction in intoxication.

They said energy drinks had also been linked to dangers when combined with physical activity – despite often being marketed as boosting sports performance – and to obesity and dental cavities.

The authors did not quantify what cap should be imposed on caffeine levels but stated that it should be evidence based. Other recommendations included making health practitioners aware of the potential dangers of excess caffeine consumption, screening patients with a history of diet problems and substance abuse for heavy consumption of energy drinks, educating the public about the risks of mixing them with alcohol and better labelling.

In the UK, the Food Standards Agency requires high-caffeine energy drinks to be labelled as such and from December they must contain a warning stating: “Not recommended for children or pregnant or breastfeeding women.” A spokesman said: “The FSA advises that people who are sensitive to caffeine should only consume high caffeine drinks . in moderation.” It is not planning further legislation at present.

Gavin Partington, director general of the British Soft Drinks Association (BSDA), said the review had failed to take into account the conclusions of other scientific articles, adding: “Several of the policy recommendations it makes are already well established through the BSDA’s voluntary code and EU regulation.” An industry code of practice restricts marketing energy drinks to children.


Kids at Risk

As concerned as many doctors and nutritionists are about how energy drinks might impact anyone who uses them, children and teens are considered to be especially vulnerable. Yet manufacturers continue to advertise on websites, social media, and TV channels that cater to children and adolescents. They also advertise at sports and other events that are popular with youths.

"Caffeine has effects on a growing body, from head to toe," says Benjamin. The amount of caffeine found in energy drinks can affect a child's brain, heart, muscles, and bone development.

Studies in the U.S. and in Sweden have also linked energy drink consumption to dental erosion in children, probably thanks to the high sugar content.

In the meantime, the AAP is very concerned that children are sometimes choosing these drinks because they're confusing them with electrolyte-containing sports beverages (like Gatorade) or because they're misled by the word "energy."

"Energy is good when it comes from natural, essential energy sources like carbohydrates found in fruits and vegetables." Benjamin says.

Sources

International Journal of Health Sciences: “Energy Drink Consumption: Beneficial and Adverse Health Effects.”

American Beverage Association: "Energy Drinks and Their Ingredients."

American College of Sports Medicine: "ACSM Announces New Recommendations and Warnings Regarding Safety of Energy Drinks."

American Journal of Preventive Medicine: "Trends in Energy Drink Consumption Among U.S. Adolescents and Adults, 2003–2016."

Associated Press: "Proposed CT Energy Drink Ban for Kids Would Be First in Nation."

Jen Bruning, registered dietitian nutritionist and nutrition strategist spokesperson, Academy of Nutrition and Dietetics.

Nutrients: “Caffeine-Related Deaths: Manner of Deaths and Categories at Risk.”

Center for Science in the Public Interest: "Caffeine Chart."

FamilyDoctor.org (American Academy of Family Physicians): "The Truth About Energy Drinks."

Grandview Research: "U.S. Energy Drinks Market Size, Share & Trends Analysis Report By Product (Organic, Non-Organic, Natural), By Target Consumer, By Distribution Channel (Off-Trade, On-Trade), And Segment Forecasts, 2019 - 2025."

Holly J. Benjamin, MD, professor of orthopedic surgery, rehabilitation medicine, and pediatrics and director of primary care sports medicine, University of Chicago co-author, American Academy of Pediatrics statement on sports drinks and energy drinks.

Mordor Intelligence: "Energy Drinks Market -- Growth, Trends, and Forecast (2019-2014)."

Murray A., Traylor, J. Caffeine Toxicity, StatPearls, 2019.

NIH National Center for Complementary and Integrative Medicine: "Energy Drinks."

Robert Segal, MD, board-certified cardiologist founder, Manhattan Cardiology

Pediatrics: “Sports drinks and energy drinks for children and adolescents: are they appropriate?”

Journal of the American Heart Association: “Impact of High Volume Energy Drink Consumption on Electrocardiographic and Blood Pressure Parameters: A Randomized Trial.”

South Carolina Legislature: "Bill H. 4352."

Texas Medical Center: "Energy Drinks: Health Risks Behind the Boost."

WTOC: "SC Family Advocating for Bill That Would Ban the Sale of Energy Drinks to Minors."


Energy Drinks’ Effects on Student-Athletes and Implications for Athletic Departments

Worldwide, the market for so-called energy drinks has grown exponentially in the last decade. The primary targets of the industry’s marketing campaigns are young adults, and college athletes are frequent consumers of the products. Campaigns promote consumption of energy drinks to enhance performance and suggest their addition to cocktails. Studies have shown college athletes to engage regularly in binge drinking they are also, clearly, individuals eager to maximize performance. In this article, the ingredients of energy drinks are discussed and the dangers of combining those ingredients with alcohol are explored. In addition, recent research about energy drinks and athletic performance is reviewed. Specific implications for college athletic departments are discussed.

Energy Drinks’ Effects on Student-Athletes and Implications for Athletic Departments

The worldwide market for so-called energy drink has grown exponentially in the last decade. The primary targets of the industry’s marketing campaigns are young adults. As a result, university and college athletes are frequent consumers of the products. The effects of these beverages can be quite significant. Therefore, their use by student-athletes requires analysis, results of which administrators and coaches need to be aware of so that they can share this knowledge with student-athletes in need of direction. They should also track the current trends among student-athletes concerning energy drinks.

Caffeine is the main “energy” ingredient in energy drinks. Its ability to enhance performance, under certain conditions, has been well documented. Yet consuming too much caffeine often has negative effects on overall wellness. Elite athletes continually strive for enhanced performance, trying a variety of strategies to reach that goal. Incorporating energy drinks within a training regime may be one such strategy. Many of the marketing campaigns explicitly state that an energy drink improves functioning, implying that it can boost athletic performance.

Binge drinking, too, has a negative effect on wellness, and research findings indicate that student-athletes—to a greater extent than other students—display a propensity to engage in it. On college campuses today, students commonly use energy drinks as an ingredient in alcoholic cocktails. When they consume alcohol and large amounts of caffeine in combination, many students find themselves drinking more and becoming more intoxicated, which can lead to serious health and other consequences.

History of the Energy Drink

Energy drinks entered the North American beverage market with exotic names, catchy slogans, and expensive marketing campaigns and now occupy a significant portion of the industry. They have become available everywhere, offered alongside soft drinks in vending machines, convenience stores, and grocery stores. Their manufacturers say that, in addition to providing a boost in energy, the drinks promote wellness through medicinal properties (they usually contain vitamins and/or ingredients like ginseng, guarana, and taurine). In 2005 such claims prompted Health Canada (the department of Canada’s federal government responsible for helping Canadians maintain and improve their health) to state, “Energy drinks are meant to supply mental and physical stimulation for a short period of time” (Safe Use of Energy Drinks, n.d., Background section, ¶ 2). Whatever their intended use and purported benefits, consumers today consume energy drinks for a variety of reasons: to boost energy, quench thirst, mix cocktails. Moreover, consumers are constantly pioneering new uses, such as flavoring smoothies with popular energy drinks.

The term energy drink suggests activity, and the uninformed consumer may assume that such a drink would support physical exercise. Locating energy drinks on store shelves adjacent to traditional sports drinks like Gatorade and Powerade reinforces such an assumption of a positive relationship between their use and exercise. Caffeine, the main stimulant ingredient in most energy drinks, has been shown by research to offer questionable potential (at best) as a performance enhancer, in light of the broad variation in individuals’ tolerance of it and also in light of an accompanying range of possible adverse effects (Caffeine—Performance, n.d.).

Drinks providing high doses of caffeine are not a new concept. Jolt cola, a precursor to today’s energy drink phenomenon, was first distributed in the 1980s (Retelny, 2007). Jolt was not marketed as a medicinal health product as, to an extent, energy drinks are. But like energy drinks, it was and is laden with caffeine. The Red Bull energy drink, introduced in the United States in 1997, was the forerunner of the modern energy drink and remains the most recognizable brand in the industry (Retelny, 2007). However, it has considerable competition in today’s marketplace: 500 new varieties of energy drink were introduced to the worldwide market in 2006 (Fornicola, 2007). According to Cohen (2008), the marketing research firm A. C. Nielsen indicated that worldwide sales of the drinks rose from $3.5 billion in 2006 to $4.7 billion in 2007. This speaks volumes for the drinks’ profitability and potential new markets, chiefly within the young teen to young adult demographic. Many companies continue to introduce new drinks, hoping to capture a share of a growing consumer base. Responding to the influx of new products with which they must compete, manufacturers push the boundaries, producing drinks with increasingly complex combinations of medicinal ingredients, with ever higher levels of caffeine, served in larger sizes (Fornicola, 2007).

Ingredients of the Energy Drink

Content labeling has always been inconsistent across North America, and the steady stream of new products developed for the energy drink market further complicates the picture. Energy drinks’ proliferation and popularity clearly caught regulatory agencies such as Health Canada off guard by all accounts, agencies were ill equipped to respond to initial claims made by the drinks’ various manufacturers. In Canada, most energy drinks have been approved since 2004 as “natural health products.” Approval was a controversial decision, resulting in the establishment of Health Canada’s Natural Health Products Directorate (Raging Bull, 2005). Dr. Eric Marsden of the Ontario Association of Naturopathic Doctors considers Red Bull to be like “sin in a tin” (Raging Bull, 2005, p. 2, All In a Label section, ¶ 8), making a mockery of proper natural health products. On the other hand, energy drinks’ designation as natural health products means that, in Canada, they must be labeled with detailed information about amounts of medicinal and nonmedicinal ingredients and about recommended uses and doses, including cautionary statements.

In the United States, in contrast, the Food and Drug Administration (FDA), while it regulates caffeine content in soft drinks, does not regulate caffeine contained in energy drinks (Cohen, 2008, Anxiety Attacks section, ¶ 9). The FDA is authorized to move to regulate caffeine in energy drinks but tends not to do so unless a given product provides more caffeine than is found in the average cup of coffee (Cohen, 2008, Anxiety Attacks section, ¶ 10). In the United States, it is not required that manufacturers list the ingredients of energy drinks therefore, it is difficult for consumers to appreciate how much caffeine they ingest with an energy drink. While the information often is available on the manufacturer’s website, it is unlikely typical consumers are concerned about product ingredients to the point of visiting a website. Most take it for granted that a product is safe simply because it is found on the shelves of food stores. And yet, studies have suggested that people with high blood pressure or heart disease should avoid energy drinks. The American Heart Association issued an alert in November 2007 concerning dangers energy drinks pose to those with known cardiovascular issues (Lofshult, 2008).

The variety of energy drinks available makes a complete review of their contents a daunting task. Sugar (whether in the form of glucose, sucrose, fructose, or other compound) is found in most, and sugar’s effects are well known. Sugar-free varieties of energy drinks are now being consumed in significant numbers, as well. In their study, Malinauskas, Aeby, Overton, Carpenter-Aeby, and Barber-Heidal (2007) found that 26% of college students who use energy drinks chose sugar-free versions significantly more females than males opted for the low-calorie version. Sugar and sweeteners are household ingredients, but the various brands of energy drinks also contain many exotic components, as well. Four in particular seem central in the majority of the marketed products: caffeine, taurine, glucuronolactone, and vitamins.

The primary exotic ingredient of energy drinks is the stimulant drug caffeine. According to the website of the Sports Medicine Council of Manitoba (Caffeine—Performance, n.d.), there is scientific evidence that caffeine raises both heart rate and blood pressure, which can increase alertness and enhance performance of some tasks if small doses only are consumed. Caffeine’s effects are such that it is included in the World Anti-Doping Agency’s monitoring program, although the agency removed caffeine from its list of restricted substances in 2004 (Desbrow & Leveritt, 2007). The decision by the World Anti-Doping Agency implies that the performance-enhancing capacity of caffeine is limited most research confirms that. Although caffeine in limited quantities improves mood and cognitive performance (Scholey & Kennedy, 2004), consuming more than limited quantities can generate many negative effects. As a result, any beneficial effect on athletic performance proposed for caffeine is not universally accepted.

The Sports Medicine Council of Manitoba (Caffeine—Performance, n.d., p. 2) indicated that a 250-ml can of Red Bull contains 80 mg of caffeine, while in caffeinated soft drinks the concentration ranges from 29 mg to 55 mg per 355-ml serving. Coffee’s caffeine content varies, but it typically contains 100 mg per 250-ml serving (Fornicola, 2007). Popular energy drinks including Monster, Full Throttle, and Rockstar contain about the same amount of caffeine as Red Bull. Some manufacturers, however, in attempting to create a unique product, have added significantly more caffeine to certain niche energy drinks. An article in the McLatchy–Tribune Business News (Energy Drinks’ Buzz, 2008) identified three drinks with extremely high caffeine levels: Boo-Koo Energy, with 360 mg of caffeine in 24 oz Wired X344, with 344 mg in 16 oz and Fixx, with 500 mg in 20 oz (Energy Drinks section).

When used in moderation, caffeine rarely produces visible effects, despite the fact that many negative effects have been identified in research. The acceptance and use of caffeine in contemporary society is commonplace, most caffeine being consumed without ill effect in morning coffee, to improve alertness and mood. Since coffee is generally served hot, it is generally drunk slowly. But energy drinks’ good taste and chilled state mean they can be consumed quickly (Fornicola, 2007), allowing a high dose of caffeine to enter the body fairly quickly. Even moderate amounts of caffeine can lead to severe negative effects in people who are caffeine sensitive, as well as in children, with their relatively low body weight. High doses of caffeine can negatively affect concentration, attention, and behavior and can produce irregular heartbeat, nausea, restlessness, headache, and dehydration (Griffith, 2008). Even when dehydration is not a problem, choosing an energy drink over drinks like juice, milk, and water can deprive children of nutrients (and can deplete a parent’s budget). Their students’ increasing access to energy drinks is for good reason causing concern among school officials.

The most widely used medicinal ingredient in energy drinks after caffeine is also, perhaps, the least understood: the amino acid taurine. The human body on its own replenishes its supply of taurine (Lidz, 2003, With Taurine section, ¶ 3), which is involved in several metabolic processes and may also have antioxidant properties (Raging Bull, 2005, p. 4, Medicinal Ingredients chart, ¶ 1). A typical person’s intake of taurine is about 60 mg per day (Laquale, 2007), but a single serving of Red Bull (and of most other energy drinks) contains 1,000 mg of taurine. That amount is doubled in the 473-ml serving of Monster and nearly doubled (1,894 mg) in the same size container of Rock Star. Manufacturers imply that a special synergy exists among energy drink ingredients, and certainly taurine would be key to it. Laquale (2007) challenges the synergy notion, suggesting that taurine’s benefits were declared on the basis of testing on house cats in the 1970s.

The taurine in Red Bull has been promoted as the drink’s secret and controversial ingredient. Research on the effects of taurine is limited and inconclusive. But taurine is the reason Red Bull’s acceptance has been delayed in many countries until recently it was actually illegal to sell Red Bull in Canada (Raging Bull, 2005). According to Lidz, Red Bull’s manufacturer “admits that taurine’s main function [in its product] is simply that of flavor enhancer” (2003, With Taurine section, ¶ 3). The German Institute for the Protection of Consumer Health suggests that claims of taurine’s value are “misleading” (Lidz, 2003, With Taurine section, ¶ 3). Alford et al.’s study (as cited in Laquale, 2007) indicated that Red Bull improved aerobic endurance and anaerobic performance, but whether that resulted from caffeine or taurine (or the combination of the two) was not determined. Griffiths’ research (also cited in Laquale, 2007) furthermore showed that consumers were being misled and that energy drinks’ effects depended on how much caffeine they contained. At this point, not enough research has been done to substantiate any positive effect of taurine, much less to investigate long-term effects of consuming taurine in the amounts present in energy drinks.

Glucuronolactone is a carbohydrate that occurs naturally in the body and, like taurine, is suspected of helping “detoxify the body” (Raging Bull, 2005, p. 4, Medicinal Ingredients chart, ¶ 2). Red Bull includes glucuronolactone to increase energy and feelings of well-being (Laquale, 2007). Not surprisingly, the hundreds of energy drink brands joining the market following Red Bull’s introduction also contain glucuronolactone. Laquale notes that glucuronolactone has been made known by undocumented reports that it was given to American soldiers during the Vietnam War to increase energy but was eventually linked to deadly brain tumors and banned. Glucuronolactone research to date has focused on animals, making its effects in humans difficult to assess (Raging Bull, 2005, p. 4, Medicinal Ingredients chart, ¶ 2).

An assortment of B vitamins (B2, riboflavin B3, niacin B6 and B12) are the final ingredient common to the majority of energy drinks. While these vitamins’ importance to healthy living is undeniable, it may be more appropriate to ingest them in the form of a balanced diet than in the form of an energy drink supplement.

Although U.S. products may not be labeled as to their ingredients, they may include some type of warning label with recommendations for use of the product.

The long-term effects of energy drink consumption are unknown. Many studies have analyzed extended use of caffeine, generating mixed findings—although moderate use of caffeine is commonly accepted to pose little health risk. Fornicola (2007) found that on average, adults consumed 200 mg of caffeine per day, the amount in about two cups of coffee. While caffeine is undoubtedly the greatest contributor to the effect produced by energy drinks, the fact remains there is no research into possible problems associated with long-term ingestion of high concentrations of taurine and glucuronolactone.

Red Bull states that short-term positive effects of the drink—of its particular combination of ingredients—are proven by publicly available academic studies (FAQ, n.d., What proof is there that Red Bull energy drink does what it says it does? section). But the Red Bull website does not provide links or directions for accessing those studies. The majority of the extant research clearly disputes the claims, essentially attributing to caffeine the quantifiable short-term effect of increased energy (Malinauskas et al., 2007). Caffeine is also a diuretic, however, and the manufacturer of Red Bull recommends that users of its product drink ample amounts of water when they exercise (FAQ, n.d., Is Red Bull Energy Drink Suitable As Fluid Replacement? section).

There remains considerable concern regarding the negative effects of energy drinks. Emergency room visits arising from energy drink consumption are becoming commonplace. For example, Child Health Alert reported a 23-year-old was hospitalized with a dangerously high heart rate after consuming the energy drink GNC Speed Shot followed by a Mountain Dew soft drink, also containing caffeine (Caffeine: Watch Out, 2008). The report noted that the GNC Speed Shot website does warn against using the product together with others that contain caffeine. There are countries, France, Denmark, and Norway among them, that continue to ban the sale of Red Bull. Several highly publicized deaths linked to energy drinks have fueled ongoing suspicion. In one such tragedy, a healthy 18-year-old Irish basketball player experienced cardiac arrest after consuming four cans of Red Bull prior to a game (Laquale, 2007).

Malinauskas et al. (2007) stated that energy drinks are intended for young adults but that little formal research is available accurately describing the multibillion-dollar energy drink industry’s actual clientele. Studying energy drink consumption by college students, Malinauskas et al. found that 51% used energy drinks, defined as consuming more than one energy drink monthly during the academic semester in which they were surveyed. In Canada, energy drinks labeled as natural health products must provide cautions complying with requirements of Health Canada’s Natural Health Products Directorate. For example, the beverages are not recommended for nursing or pregnant women, caffeine-sensitive persons, or children. Product labeling also establishes a maximum daily dose and advises against mixing the beverages with alcohol. An analysis of the labels on three popular energy drinks found that all delivered the same messages except when offering a maximum daily dose. Red Bull and Rock Star advise consumers not to exceed 500 ml of the product per day, while Monster recommends no more than 1,000 ml per day.

It is not clear how many adults consume energy drinks, but it is certain that, despite manufacturers’ warnings, many children are regular consumers. The Florida Poison Control Center started to track cases of caffeine overexposure after 39 people ages 2 to 20 years developed symptoms between January 2007 and March 2008 (Cohen, 2008, Anxiety Attacks section, ¶ 3). A school nurse in California sent three students to hospital by ambulance in the past year because they had irregular heart rates brought on by consumption of energy drinks (Dorsey, 2008). Energy drinks are not recommended for children or adolescents nor are they marketed directly to them. But surprisingly, there is currently no restriction on children’s purchase of energy drinks, even though caffeine’s effects are more pronounced in children than adults, due to body size and tolerance. It is furthermore clear that children and adolescents contribute significantly to the total market. Some schools have banned energy drinks from school property, and many jurisdictions are considering attempting to restrict energy drink sales to children.

Energy drinks are marketed with colorful descriptions and provocative names that make them sound fun and exciting. Rockstar, Monster, Full Throttle, Throw Down, and Sobe No Fear are just a sampling of the inviting products that fill store shelves. Marketing slogans are developed to stimulate interest in a product and distinguish it from its competition: “Get spiked,” “Party like a rockstar,” and “Feel the freak” are slogans representing the marketing strategies of energy drink companies. The language and images of such advertising are not directed at mature adults. If anything, the marketing of energy drinks removes all ambiguity about whom these products are meant to appeal to: teens and young adults.

With 40% of the market share, Red Bull remains the leader in energy drink sales (Agriculture and Agri-Food Canada, 2008, Background section, ¶ 2). Not surprisingly, the “Red Bull gives you wiiings” slogan is widely recognized. Red Bull has developed its image over the past decade by sponsoring extreme sports and targeting college students (Lidz, 2003, Red Bull’s Effects Have Been Recognized by World-Class Athletes section, ¶ 3-4). More than other brand’s marketing, Red Bull’s marketing has created a connection between the product and sports and fitness, with the implication that greater performance in athletics is achieved by those who consume Red Bull. Currently, Red Bull containers feature the phrase “Vitalizes body and mind.” Lidz (2003) identified other slogans from Red Bull that have made a connection to sports: “increases concentration,” “improves reaction speed,” “stimulates metabolism,” and “Red Bull’s effects have been recognized by world-class athletes.” Miller (2008) suggested that other manufacturers have copied Red Bull’s strategy, since “energy drink advertising consistently emphasizes a physically active lifestyle featuring a range of extreme sports” (p. 481). Miller further suggested that, in their appeal to the young, energy drink marketing strategies are similar to those of the tobacco and alcohol industry (p. 488). Such an affinity between a “healthy natural product” and smoking and drinking is incongruous.

Consumption Among Student-Athletes

Malinauskas et al. (2007) found that 51% of college students consume energy drinks, so logic would dictate that student-athletes in colleges and universities consume the product at a similar or perhaps higher rate, given the marketing-constructed connection between energy drinks and sports. Promotional statements for Red Bull suggest consuming the product prior to a demanding athletic contest like a race or game (FAQ, n.d., When Should Red Bull Energy Drink Be Consumed? section). Also suggesting student-athletes’ susceptibility to energy drink marketing is Miller’s confirmation (2008) of the phenomenon called toxic jock identity. Miller defined toxic jock identity as the state of having “a sport-related identity predicated on risk taking and hyper masculinity” (p. 481). Toxic jock identity may increase risky behaviors, and consuming energy drinks may be a predictor of the phenomenon (Miller, 2008). The drive to improve athletic performance and exhibit one’s athletic identity could influence student-athletes to consume energy drinks at a relatively high level compared to that of the general student body.

Consumption to Boost Athletic Performance

Does ingestion of an energy drink really boost athletic performance? Caffeine is the only ingredient in energy drinks that has been studied in depth and that shows proven effects short- and long-term effects of high doses of taurine and glucuronolactone require additional study. Athletes have long used caffeine prior to training sessions and competitions, but most nevertheless do not well understand how the drug works, for example that, as a diuretic, caffeine is capable of aggravating the dehydration athletes may experience during competition. The scientific literature itself provides mixed messages about caffeine’s performance-enhancing capability and its value prior to exercise. Fornicola (2007) stated that no real need exists to use energy drinks for performance advantage and that that quick caffeine fix is not a very intelligent strategy. In contrast, the website of the Sports Medicine Council of Manitoba reports that endurance athletes might gain some advantage by exploiting caffeine to derive energy from fat early in a competition, thereby leaving more muscle glycogen available to provide energy later on (Caffeine—Performance, n.d., p. 1). However, the website also advises athletes that “4% dehydration equals 20% of performance lost” (p. 1). Caffeine promotes dehydration, so the amount of it to be ingested for athletic advantage would have to be determined very precisely. Desbrow and Leveritt (2007) demonstrated that the majority of elite triathletes use caffeine to improve physical performance and concentration. However, these athletes’ knowledge of which products contain caffeine (and how much they contain) was limited (Desbrow & Leveritt, 2007). Umaña-Alvarado and Moncada-Jiménez (2005) studied the effects of energy drinks on male athletes’ aerobic activity, finding no performance improvement from energy drink consumption prior to testing. However, their results did demonstrate that those participants who consumed energy drinks reported lower levels of perceived exertion.

Studies show student-athletes are more prone to binge drinking than other students. Grossman, Wechsler, Davenport, and Dowdall (1997) found college athletes engaged in binge drinking and used chewing tobacco at higher rates than nonathletes, although they were less likely to smoke cigarettes or marijuana. Other research indicates that team sports participants are especially likely to consume alcohol in a high-risk manner (Brenner & Swanik, 2007). Such findings, particularly when considered in light of something like toxic jock identity, suggest that the newly popular practice of mixing energy drinks into alcoholic cocktails may place student-athletes at an elevated risk. Consuming energy drinks along with alcohol lessens the subjective sense of intoxication (O’Brien, McCoy, Rhodes, Wagoner, & Wolfson, 2008). This means one can consume more alcohol than usual because one doesn’t feel intoxicated. In addition, the alcohol-induced fatigue that normally tends to limit further alcohol consumption may be masked by the caffeine in the energy drink (Dunlap, 2008).

Although energy drink companies may caution consumers against mixing the products with alcohol, young people, especially, do so. According to Miller (2008), the website Drinknation.com contained 201 Red Bull–based alcoholic beverage recipes. And despite the Red Bull label’s warning about mixing the product with alcohol, the manufacturer’s website tells visitors that Red Bull can be used for more than nonstop partying (Benefits, n.d., Red Bull—More Than Just a Myth section, ¶ 3).

Combining a depressant (alcohol) with a stimulant (energy drink containing caffeine) clearly could exacerbate the typical risks of alcohol consumption. The practice, combined with the tendency of student-athletes to binge on alcohol, should raise concern. O’Brien et al. (2008) indicated that “students who reported consuming alcohol mixed with energy drinks had significantly higher prevalence of alcohol–related consequences, including being taken advantage of sexually, taking advantage of another sexually, riding with an intoxicated driver, being physically hurt or injured, and requiring medical treatment” (p. 453). Further, the U.S. Surgeon General has reported that in the United States, close to 5,000 people under age 21 die each year of alcohol-related injuries (Dunlap, 2008).

Consumption in Conjunction With Studying

Long before the introduction of energy drinks, students used caffeine to stay up late at night studying. Today student-athletes who do not like the taste of coffee can choose an energy drink instead. In moderation, use of energy drinks to sustain a study session would appear to be harmless. Nevertheless, coaches and athletic department staff should make sure student-athletes are familiar with caffeine’s potential negative effects (when it is consumed to excess), in order to help them make informed and responsible choices, whatever the circumstance.

Consumption Representing Casual Use

Casual consumption of energy drinks accounts most significantly for the rapid rise in their popularity. Now available everywhere, energy drinks strike many consumers as a choice akin to a soft drink or coffee. The market seems poised for continued expansion, supported by aggressive marketing. The consumption of energy drinks is likely to become even more common and socially acceptable. Student-athletes are likely to be part of the trend, increasing their consumption, especially if they lack complete information about energy drinks, their ingredients, and their actual effects on athletic performance and health.

Given the proliferation of energy drinks and their growing popularity despite possible negative effects, coaches and athletic department administrators should take the initiative in educating student-athletes about the products. Energy drinks are aggressively marketed to college students with messages touting the performance and other benefits of consuming the beverages. Students are urged be energy drink consumers, and for the uninformed student-athlete, the trend’s influence may produce negative consequences.

While the purported benefits of the taurine and glucuronolactone in energy drinks are unproven, potential positive and negative effects of another common ingredient, caffeine, are well documented. The choice to use caffeine prior to training or competition should belong to the individual, based on adequate knowledge of pros and cons and on past experiences with caffeine. Student-athletes who choose to use caffeine should be encouraged to do so in moderation. They should also be provided information about levels of caffeine contained in various foods and beverages, in order to monitor their intake. Most energy drinks in fact have not contained more caffeine than a cup of coffee, but there is a noticeable trend toward selling the beverages in larger containers—meaning larger servings and more caffeine. If consuming an energy drink before a competition improves mood and concentration, it would be difficult to suggest that it poses significant danger. Assuming a consumer is not caffeine-sensitive, caffeine’s negative effects are unlikely to become evident unless intake becomes excessive. Although deaths associated with energy drink consumption and sport have been reported, they seem to be isolated cases involving multiple servings with high levels of caffeine.

While it is important to provide student-athletes with accurate information on energy drinks and caffeine as these affect athletic performance, of greater concern to athletic departments should be the growing trend of combining energy drinks and alcohol. Take the not uncommon pattern of student-athletes, dehydrated by the effort of playing a game, gathering after that game to consume alcohol. If the alcohol is mixed with caffeinated energy drinks, the student-athletes are subjected to a double diuretic effect, since alcohol, like caffeine, has diuretic properties. Thus they further compromise hydration.

Moreover, energy drinks’ capacity to mask intoxicated feelings allows increased alcohol consumption, which in turn increases the likelihood that a young drinker will make the kind of choices that have negative, if not disastrous, results. Evidence suggests that energy drink consumption with and without alcohol remains on the increase, so educating student-athletes on all aspects of energy drink consumption needs to become an athletic department priority, to ensure both wellness and safety.

Agriculture and Agri-Food Canada. (2008). Agri-Food Trade Service: The Energy Drink Segment in North America, January 2008. Retrieved July 10, 2008, from http://www.ats.agr.gc.ca/us/4387_e.htm

Benefits (n.d.). Retrieved July 10, 2008, from the Red Bull website: http://www.redbullusa.com/#page=ProductPage.Benefits

Brenner, J., & Swanik, K. (2007). High-risk drinking characteristics in collegiate athletes. Journal of American College Health, 56(3), 267-272.

Caffeine—Performance enhancement or hindrance? (n.d.). Retrieved June 30, 2008, from the Sports Medicine Council of Manitoba website: http://www.sportmed.mb.ca/uploads/pdfs/Caffeine%20good%20and%20bad.pdf

Caffeine: Watch out for “energy drinks.” (2008, May). Child Health Alert, 26, 2-3.

Cohen, H. (2008, April 2). Kids + energy drinks = dangerous mix. The Miami Herald. Retrieved June 5, 2008, from http://seattletimes.nwsource.com/html/health/2004322357_zhea02energy.html

Desbrow, B., & Leveritt, M. (2007). Well-trained endurance athletes’ knowledge, insight, and experience of caffine use. International Journal of Sport Nutrition and Exercise Metabolism, 17(4), 328-339.

Dunlap, L. (2008). Wake up to the facts: Energy drinks and alcohol don’t mix. The Journal of the Air Mobility Command’s Magazine, 17(2), 20-21.

Energy drinks’ buzz may pose some risk. (2008, January 30). McClatchy–Tribune Business News. Retrieved June 5, 2008, from the ProQuest database.

FAQ (n.d.). Retrieved July 10, 2008, from the Red Bull website: http://www.redbullusa.com/#page=ProductPage.FAQS

Fornicola, F. (2007). Energy drinks: What’s all the “buzz” about? Coach and Athletic Director, 76(10), 38-43.

Griffith, D. (2008, May 11). Energy drinks make caffeine the drug of choice among California youth. Sacramento Bee. Retrieved June 5, 2008, from http://search.ebscohost.com/login.aspx?direct=true&db=nfh&AN=2W62W6639513775&site=ehost-live

Grossman, S. J., Wechsler, H., Davenport, A. E., & Dowdall, G. W. (1997). Binge drinking, tobacco, and illicit drug use and involvement in college athletics: A survey of students at 140 American colleges. Journal of American College Health, 45(5), 195-200.

Laquale, K. (2007). Red Bull: The other energy drink and its effect on performance. Athletic Therapy Today, 12(2), 43-45. Retrieved October 5, 2008, from the SportDiscus database.

Lidz, F. (2003). The fuel of extremists (or, taurine in your tank). Sports Illustrated, 99(4), 8-16.

Lofshult, D. (2008). Energy drinks may present danger. Idea Fitness Journal, 5(4), 58.

Malinauskas, B. M., Aeby, V. G., Overton, R. F., Carpenter-Aeby, T., & Barber-Heidal, K. (2007). A survey of energy drink consumption patterns among college students. Nutrition Journal, 6(1), 35.

Miller, K. E. (2008). Wired: Energy drinks, jock identity, masculine norms, and risk taking. Journal of American College Health, 56(5), 481-490.

O’Brien, M. C., McCoy, T. P., Rhodes, S. C., Wagoner, A., & Wolfson, M. (2008). Caffeinated cocktails: Energy drink consumption, high-risk drinking, and alcohol-related consequences among college students. Academic Emergency Medicine, 15(5), 453-460.

Raging bull: Health warnings over popular energy drink being brushed off? (2005, February 6). Retrieved July, 10, 2008, from the Canadian Broadcasting Corporation (CBC) website: http://www.cbc.ca/consumers/market/files/health/redbull/

Retelny, V. S. (2007). Energy drinks. Obesity Management, 3(3), 139-142.

Safe use of energy drinks. (n.d.). Retrieved June 20, 2008, from the Health Canada website: http://www.hc-sc.gc.ca/hl-vs/iyh-vsv/prod/energy-energie-eng.php

Scholey, A. B., & Kennedy, D. O. (2004). Cognitive and physiological effects of an “energy drink”: An evaluation of the whole drink and of glucose, caffeine and herbal flavouring fractions. Psychopharmacology, 176(3-4), 320-330.

Umaña-Alvarado, M., & Moncada-Jiménez, J. (2005). Consumption of an “energy drink” does not improve aerobic performance in male athletes. International Journal of Applied Sport Sciences, 17(2), 26-34.


Caffeine Levels in Energy Drinks Not Always Accurate, Study Says - Recipes

April 2018 Issue

Safety and Efficacy of Energy Drinks
By Densie Webb, PhD, RD
Today's Dietitian
Vol. 20, No. 4, P. 30

Consumer demand for these beverages is huge, but their safety continues to be questionable.

Energy drinks, not to be confused with sports drinks, are defined as beverages that typically contain large amounts of caffeine, added sugars, and legal stimulants, such as guarana, taurine, and L-carnitine, plus any number of vitamins, minerals, and herbs, which together can increase alertness, attention, and energy, while also raising blood pressure, heart rate, and breathing. Energy drinks were introduced to the United States in 1997. Today there are more than 500 energy drinks on the market, and consumption is on the rise.1 The global energy drink market is forecast to exceed $61 billion by the year 2021.2

These drinks generally are sold in cans or bottles in grocery stores, vending machines, convenience stores, and bars, and other places where alcohol is sold. They're promoted as a way to boost energy, decrease fatigue, and enhance concentration.3 The biggest misconception about energy drinks, says Kelly Pritchett, PhD, RDN, CSSD, an assistant professor of health science at Central Washington University and national media spokesperson for the Academy of Nutrition and Dietetics, is that "they will keep you energized throughout the day or give you a boost. In reality, energy drinks are unpredictable you will likely feel good for a brief period of time, then you'll crash."

Past and present energy drinks are associated with provocative slogans: "Drink it in seconds, feel it in minutes, lasts for hours." "Drinks like a soda, kicks like an energy drink." One deemed itself "the legal alternative" to illegal narcotics. And possibly the most easily recognized slogan, "gives you wiiings." Some lesser-known brands even claim to "burn body fat." Such tag lines are incredibly appealing, especially to young consumers.

Labeling of Energy Drinks
While the American Beverage Association (ABA) recommends energy drinks be labeled as conventional foods and beverages, not as dietary supplements, not all products follow those guidelines. The ABA also requires that the total amount of caffeine in the container (not just per serving) be displayed on the Nutrition Facts label. However, the FDA doesn't require manufacturers to provide the caffeine content or label the amounts of other ingredients, such as taurine and guarana. The ABA states that members, which represent 95% of the energy drinks sold in the United States, must comply with its recommendations and voluntarily provide caffeine content on the label.4 But it turns out that labeling may not always accurately reflect caffeine content. A small sampling of seven energy drinks found that six had less caffeine (<1% to almost 12% less) than declared on the label, and one had 11% more than was listed on the label.5 While it's true that most energy drinks are labeled as beverages and do carry a Nutrition Facts label, a regulatory twist leaves the decision of whether to label their products as beverages or supplements up to manufacturers, and some smaller companies label their products as supplements, which have less stringent labeling regulations. In fact, Monster Energy drinks, one of the most popular brands, were originally labeled as supplements and, in compliance with ABA guidelines, were reclassified as beverages and product labeling was revamped accordingly.6

What's Inside Energy Drinks?
Energy drinks can contain several ingredients from caffeine to herbal stimulants to vitamins and minerals to amino acids.

Caffeine
As the world's most commonly consumed central nervous system stimulant, caffeine isn't a new ingredient in beverages. Most consumers have long gotten caffeine from coffee, tea, and soda. Caffeine also is naturally present in dark chocolate and in some ingredients found in energy drinks, including guarana. Energy drinks typically contain anywhere from 17 to 242 mg caffeine per serving (not always per container). In small quantities, caffeine may boost energy, alertness, and even athletic performance. For healthy adults, the FDA has determined that up to 400 mg per day is safe—that's about four or five small cups of coffee—an amount not generally associated with dangerous, negative effects.7 The safe limit is set at only 100 mg per day for adolescents (aged 12 to 18), the amount of caffeine in one cup of coffee.8 A single serving of many energy drinks exceeds that amount.9

Canada has set a legal limit of 180 mg caffeine per serving of energy drinks, but a container may provide more than a single serving.10 While the FDA doesn't require products to list caffeine content on product labels, leading brands provide the information voluntarily. Energy drinks that are labeled as supplements, rather than beverages, aren't subject to the FDA's enforced limit of 71 mg caffeine per 12 oz for soda.11

"While the safe limit of caffeine is set at 400 mg per day for 'most' adults, I've had some patients that have negative effects, such as heart palpitations, insomnia, and nervousness from caffeine after just 100 mg," says Angela Lemond, RDN, CSP, LD, owner of Lemond Nutrition in Plano, Texas, and a national spokesperson for the Academy of Nutrition and Dietetics. "Just like any other drug, it affects each body system differently."

To put caffeine content into perspective, a 16 oz (Grande) medium roast coffee at Starbucks contains 310 mg caffeine, more than is found in 16 oz of the Java Monster Mean Bean variety (188 mg), one of the more highly caffeinated energy drinks (see table).

Sugar and Calories
While most energy drinks provide as much sugar as a soft drink or a fruit drink,12 some have historically contained as much as 27 teaspoons of sugar in a 32-oz container. Typically, one 20-oz can contains between 220 and 280 kcal and 54 to 62 g carbohydrate, nearly all of which are from added sugars (about 14 to 16 teaspoons of sugar). There's some suggestion that sweetened energy drinks may affect weight management. A small study of young women found that energy drink consumption slowed lipolysis, and the researchers suggested that this could contribute to obesity.13 Other energy drinks are sugar-free and are sweetened with the artificial sweeteners aspartame and acesulfame K, which would appear to be in opposition to the promise of quick energy.

Sodium
Most energy drinks contain moderate amounts of sodium, less than sports drinks, but more than soft drinks. However, at least one variety of one brand contains 340 mg sodium per 8-oz serving, about 15% of the maximum recommended daily intake. Sodium content is provided on most labels of energy drinks.

B Vitamins
B vitamins are, of course, essential for good health, but too much can be harmful. Some energy drinks contain extremely high levels of B3 (niacin), B6, and B12, which in excess can cause skin conditions, gastrointestinal problems, liver toxicity, blurred vision, headaches, and nerve damage. Some energy drinks contain several hundred times the DV for some of the B vitamins Bonnie Taub-Dix, MA, RDN, CDN, nutrition consultant and author of Read It Before You Eat It, says, "They are the equivalent of taking a mega, mega vitamin, something that needs to be reconsidered, especially if you're already taking supplements."

Other Ingredients
Other common ingredients found in energy drinks include taurine, Gingko biloba, ginseng, tyrosine, ginger, green tea, calcium, and beta-alanine in varying amounts not often listed on the nutrition label.

While most conventional extra ingredients are Generally Recognized as Safe by the FDA—a designation that a chemical or substance added to food is considered safe by experts—and so is exempted from the food additive requirements, it isn't known what the combined effects might be.

Safety Concerns
"Another misconception of energy drinks," Lemond says, "is that there is benefit without risk." While some studies have found an association between the ingredients in energy drinks and improved alertness, reduced fatigue, and improved physical activity performance and strength, the vast majority of the available evidence suggests there are both short-term and long-term negative health effects.11 The World Health Organization and the American Academy of Pediatrics have warned of the dangers of energy drinks.14,15 The American Academy of Pediatrics has taken it further and stated that "Rigorous review and analysis of the literature reveal that caffeine and other stimulant substances contained in energy drinks have no place in the diet of children and adolescents."9

Some countries have banned the sale of energy drinks to children under the age of either 16 or 18. The ABA's 2014 guidelines for the marketing of energy drinks state, "Energy drink manufacturers will not market their energy drink products to children under 12 years of age … [and they] will not sell or market in K–12 schools."4 While there may not be direct marketing to a young demographic, the energy drink companies are regular sponsors of events such as skateboarding, surfing, BMX riders, Formula 1 racing, gaming, and concerts, all of which attract young audiences.

Between 2007 and 2011, the overall number of energy-drink related visits to emergency departments (EDs) doubled. While the drinks have wide appeal among youth, the most significant increase (279%) of ED visits was among people aged 40 and older.

A growing trend among young adults and teens is mixing energy drinks with alcohol. About 25% of college students consume alcohol with energy drinks, and they binge drink significantly more often than students who don't mix them. In 2011, 42% of all energy drink-related ED visits involved combining these beverages with alcohol or drugs, including marijuana and central nervous system stimulants like Ritalin or Adderall.16

Energy drinks are sometimes drunk along with alcohol in the hope of being able to drink more while feeling less drunk. However, studies have shown that while the energy drink may reduce sensations of intoxication, motor coordination and visual reactions as well as breath alcohol concentrations are unchanged.17 The combination can be dangerous, Lemond says. "The feeling of being 'buzzed' is an indication to slow down to prevent alcohol intoxication. You may not get the warnings of intoxication when drinking a beverage that contains both alcohol and caffeine."

Large amounts of caffeine can cause serious problems such as heart rhythm disturbances and increases in heart rate and blood pressure. Caffeine also can harm children's still-developing cardiovascular and nervous systems and may be associated with palpitations, anxiety, sleep problems, digestive problems, elevated blood pressure, and dehydration. Excessive energy drink consumption may disrupt teens' sleep patterns and may fuel risk-taking behavior. Guarana, commonly added to energy drinks, contains caffeine. Therefore, the addition of guarana increases the drink's total caffeine content.

A study out of Finland found that consumers of energy drinks had a 4.6 times greater risk of headaches, 3.6 times greater odds of sleeping problems, and 4.1 times greater chance of having an irritable mood compared with nonconsumers.18 Individual ingredients in energy drinks have the ability to affect the heart's electrophysiological properties, but their effects when consumed together in energy drinks is unknown.1

A recent study published in the Journal of the American Heart Association found that 32 oz of an energy drink with 320 mg caffeine raised blood pressure and increased the risk of a higher cardiac QT interval, which is associated with sudden death.1 More serious problems occur when two, three, or four drinks are consumed over a short period of time. A published case study found that drinking six energy drinks per day resulted in cardiopulmonary arrest in a man aged 27.

Recommendations for Practice
Consuming one can of an energy drink likely is safe for most healthy individuals who aren't sensitive to caffeine. The World Health Organization recommended in 2014 that an upper limit for the amount of caffeine allowed in a single serving of these types of drinks be established along with regulations to enforce labeling restrictions and the sale of energy drinks to children and adolescents.14 However, this hasn't happened. Until then, educate clients on the difference between energy drinks and sports drinks and the potential dangers of consuming highly caffeinated beverages, especially in quantity and in combination with alcohol.

— Densie Webb, PhD, RD, is a freelance writer, editor, and industry consultant based in Austin, Texas.


References
1. Fletcher EA, Lacey CS, Aaron M, Kolasa M, Occiano A, Shah SA. Randomized controlled trial of high-volume energy drink versus caffeine consumption on ECG and hemodynamic parameters. J Am Heart Assoc. 20176(5).

2. Global energy drinks market 2015-2021: insights, market size, share, growth, trends analysis and forecasts for the $61 billion industry. Cision PR Newswire website. https://www.prnewswire.com/news-releases/global-energy-drinks-market-2015-2021-insights-market-size-share-growth-trends-analysis-and-forecasts-for-the-61-billion-industry-300137637.html. Published September 3, 2015. Accessed February 6, 2018.

3. Watson E. The evolution of energy drinks: what next for Monster, Red Bull and 5-Hour Energy? Beveragedaily.com website. https://www.beveragedaily.com/Article/2013/02/04/The-evolution-of-energy-drinks-What-next-for-Monster-and-Red-Bull. Updated February 4, 2013. Accessed February 6, 2018.

4. American Beverage Association. ABA guidance for the responsible labeling and marketing of energy drinks. http://www.ameribev.org/files/resources/2014-energy-drinks-guidance-approved-by-bod-43020c.pdf. Accessed February 6, 2018.

5. Attipoe S, Leggit J, Deuster PA. Caffeine content in popular energy drinks and energy shots. Mil Med. 2016181(9):1016-1020.

6. McNamara B. Monster Energy switches from supplement to beverage. New Hope Network website. http://www.newhope.com/beverages/monster-energy-switches-supplement-beverage. Published February 13, 2013. Accessed February 6, 2018.

7. Caffeine and kids: FDA takes a closer look. US Food and Drug Administration website. https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm350570.htm. Updated January 4, 2018. Accessed February 6, 2018.

8. Seifert SM, Schaechter JL, Hershorin ER, Lipshultz SE. Health effects of energy drinks on children, adolescents, and young adults. Pediatrics. 2011127(3):511-528.

9. Committee on Nutrition and the Council on Sports Medicine and Fitness. Sports drinks and energy drinks for children and adolescents: are they appropriate? Pediatrics. 2011127(6):1182-1189.

10. Pound CM, Blair B Canadian Paediatric Society, Nutrition and Gastroenterology Committee, Ottawa, Ontario. Energy and sports drinks in children and adolescents. Paediatr Child Health. 201722(7):406-410.

11. Al-Shaar L, Vercammen K, Lu C, Richardson S, Tamez M, Mattei J. Health effects and public health concerns of energy drink consumption in the United States: a mini-review. Front Public Health. 20175:225.

12. Bowers J. How much sugar is in popular drinks? TheDiabetesCouncil.com website. https://www.thediabetescouncil.com/how-much-sugar-is-in-popular-drinks. Updated January 15, 2018.

13. Rush E, Schulz S, Obolonkin V, Simmons D, Plank L. Are energy drinks contributing to the obesity epidemic? Asia Pac J Clin Nutr. 200615(2):242-244.

14. Energy drinks cause concern for health of young people. World Health Organization website. http://www.euro.who.int/en/health-topics/disease-prevention/nutrition/news/news/2014/10/energy-drinks-cause-concern-for-health-of-young-people. Published October 14, 2014. Accessed February 7, 2018.

15. Kids should not consume energy drinks, and rarely need sports drinks, says AAP. American Academy of Pediatrics website. https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/kids-should-not-consume-energy-drinks,-and-rarely-need-sports-drinks,-says-aap.aspx. Updated May 30, 2011. Accessed February 2018.

16. Energy drinks. National Center for Complementary and Integrative Health website. https://nccih.nih.gov/health/energy-drinks. Updated October 4, 2017.

17. Ferreira SE, de Mello MT, Pompéia S, de Souza-Formigoni ML. Effects of energy drink ingestion on alcohol intoxication. Alcohol Clin Exp Res. 200630(4):598-605.

18. Koivusilta L, Kuoppamäki H, Rimpelä A. Energy drink consumption, health complaints and late bedtime among young adolescents. Int J Public Health. 201661(3):299-306.


The Mild Effect of Caffeine in Green Tea

If green tea has a relatively small amount of caffeine, how does it deliver a mild, gentle buzz?

While green tea contains a lower caffeine content than coffee, it has enough to produce an effect, according to Lisa Young, PhD, RDN. "It also contains the amino acid L-theanine, which has a calming effect, and can also work together with the tea's caffeine content to improve brain function," Young explains.

When taken together, L-theanine and caffeine can improve attention and focus, according to an August 2020 study in ​Scientific Reports​. The researchers suggest a potential for the combination to improve cognitive focus while controlling compulsive behaviors in people with ADHD.

The combination of caffeine with L-theanine may help explain why the energizing effects from green tea are much milder and more stabilizing than that of coffee and energy drinks.


11 Health Benefits Of Ashwagandha (Backed By Science)

BioHacker, competitive athlete, researcher in many fields including health and fitness, science, philosophy, metaphysics, religion. Read full profile

I&rsquove been taking ashwagandha for about three years now, starting with liquid ashwagandha and more recently, consuming the supplement in pill form. I&rsquove cycled through different brands over the years to determine which brand I prefer and which form to consume the supplement in. Moreover, I&rsquove made a couple of videos on my YouTube channel discussing the benefits of ashwagandha and other similar supplements.


Warning: Are You Aware That Energy Drinks Can Trigger Strokes?

Energy drinks line the never-ending wall of coolers at rest stops, drugstores and supermarkets. You may not think twice about grabbing one to stay awake on the road, to study or to work a long shift. After all, you drink coffee. What harm could a little extra caffeine do?

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“Energy drinks have megadoses of caffeine and sometimes other stimulants. We find that some people who use them come into the hospital with strokes or severe brain hemorrhages,” warns rheumatologist Rula Hajj-Ali, MD.

“These are typically young, otherwise healthy people in their 30s and 40s.”

What is it that causes a stroke?

The condition that can trigger a stroke after downing an energy drink is reversible cerebral vasoconstriction syndrome, or RCVS. This sudden spasm of the brain’s blood vessels can either restrict its blood supply or cause a hemorrhage.

Although RCVS is reversible, it is not a benign disease. Dr. Hajj-Ali says some people have a stroke and never recover, and in in very rare cases, RCVS can cause death.

What are the symptoms of RCVS?

“The most important symptom of RCVS is a severe thunderclap headache — the worst headache you’ve ever felt in your life,” notes Dr. Hajj-Ali. “It comes on very intensely, within minutes.”

Other symptoms can include tingling and numbness in different parts of the body, as well as seizures.

Dr. Hajj-Ali, an expert in central nervous system (CNS) vasculitis — a rare inflammatory disease affecting the brain’s arteries — says RCVS often mimics CNS vasculitis. Both share similar symptoms and trigger strokes early in life. However, “the treatments are totally different,” she adds.

Why do energy drinks cause RCVS?

Experts aren’t sure why energy drinks trigger RCVS. “Some people who have been drinking energy drinks for some time become more sensitive to them as time goes on. Others are very sensitive to begin with, and can develop RCVS the first time they consume one,” says Dr. Hajj-Ali.

Unfortunately, there is no way to test for who will develop RCVS and who will not.

The agonizing headache sends most patients to the hospital, where they get a CT scan of the brain. The initial scan can look normal, however, so RCVS may be overlooked at first, she says.

Patients are sent home until the persistent headache brings them back to the ER. That’s when the stroke or hemorrhage shows up on a CT or MRI scan.

Because patients are too young to have developed the usual risk factors for stroke — like high blood pressure or high cholesterol — doctors must look for another cause.

The statistics are shocking about the use of energy drinks at younger ages. One study found that 43% of 13-to-15-year-olds had tried them.

Doctors typically do a spinal tap to check for an infection or inflammation in the brain. They may also order a magnetic resonance angiogram (MRA) or an angiogram (catheterization) of the brain’s blood vessels.

“When the brain’s blood vessels look abnormal, we ask, ‘Is this CNS vasculitis or something else?’” she says. “Most often, it is RCVS, and I feel so bad for these young people, since this could have been prevented.”

Can other substances trigger RCVS?

Besides energy drinks, medications that constrict the blood vessels can trigger RCVS. The biggest culprit is nasal decongestants.

Less common causes of RCVS include high doses of antidepressants from the SSRI (selective serotonin-reuptake inhibitor) class, migraine medicines, nicotine patches and ginseng.

RCVS is also among the many problems that illegal drug and marijuana use can cause.

“Also, woman who have delivered a baby can develop RCVS postpartum,” says Dr. Hajj-Ali. “Often, we see it in people who are on combinations of medications.”

How risky are energy drinks for adolescents?

“The statistics are shocking about the use of energy drinks at younger ages,” notes Dr. Hajj-Ali. “One study found that 43 percent of 13-to-15-year-olds had tried them.”

Energy drinks can cause anxiety, high blood pressure, heart palpitations, and caffeine intoxication and withdrawal, in young people.

And while adolescents may use energy drinks to study, long-term mega-doses of caffeine aren’t good for the brain, she says.

Energy drinks may enhance arousal but do not improve other cognitive tasks. And contrary to popular belief, they do not help kids with attention-deficit disorder.

Dr. Hajj-Ali does her best to educate young patients about the risks of energy drinks.

“Unfortunately, energy drinks are marketed mainly to adolescents, especially on social media,” she says. “We have to better educate kids and schools about their dangers.”

What is the alternative?

Dr. Hajj-Ali says that, in our society, we try to burn the candle at both ends. “So often, when we are fatigued and tired, we think we need more caffeine. But what we really need is sleep,” she says.

So the next time you’re prowling the coolers for a beverage, forget about grabbing an energy drink — look for an alternative, she says, and get some rest.

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