Many people get caffeine from energy drinks. A study conducted by the European Food and Safety Authority revealed that 30% of adults, 68% of teens, and 18% of children under the age of 10 drink energy drinks (1,2). In 2006, nearly 500 new energy drink products entered the market (1). According to a 2013 article in BloombergBusinessweek, energy drink sales have reached $9.7 billion dollars (3).
What are energy drinks? What ingredients are commonly found in energy drinks? Are energy drinks safe? This is the focus of my blog this week.
What are energy drinks?
The United States Food and Drug Administration (FDA) has not established a legal definition for "energy drink." Energy drinks are treated like dietary supplements and not as food (Dietary supplement label, black cohosh, Nutrition Tuesday). They are subject to labeling requirements and regulations that govern other dietary supplements as opposed to the laws and regulations that govern other beverages like soda and juice.
An energy shot is generally defined as those beverages marketed and sold in small volume (less than 50 ml) and energy drinks are those beverages greater than 50 ml. The difference between energy drinks and energy shots is the volume per serving. I tend to use the terms interchangeably.
Energy drinks and shots are:
- Non-alcoholic
- Marketed as products that will "boost energy," "increase physical performance," and/or "increase mental performance"
- Ingredients you may find in an energy drink or shot include:
- caffeine
- vitamins (usually B vitamins)
- taurine
- L-carnitine
- ginseng
- methylxanthines
- caffeine, theobromine, theophyline are all methylxanthines
- guarana
- includes caffeine, theobromine, and theophyline
- theobromine - Royal Society of Chemistry
- theophyline
The following label is an example of a Nutrition Facts panel taken from a Monster Energy drink. This label is similar to what all energy drink panels look like.
Energy drinks may have a "Nutrition Facts" panel on them (added 10/25/2014).
Do you notice anything missing?
http://www.cbsnews.com/news/monster-to-label-caffeine-content-on-energy-drinks/
"Monster Energy drink supplement facts" by Monster Energy - http://ctuckk.files.wordpress.com/2011/04/monster1.png. Licensed under Public domain via Wikimedia Commons
References
1. Frontiers. (2014, October 14). Energy drinks may pose danger to public health, researchers warn. ScienceDaily. Retrieved October 20, 2014 from www.sciencedaily.com/releases/2014/10/141014170727.htm
2. Breda JJ, Whiting SH, Encarnação R, et al. Energy drink consumption in Europe: a review of the risks, adverse health effects, and policy options to respond. Frontiers in Public Health, 2014; 2 DOI: 10.3389/fpubh.2014.00134
3. Wong V. Overcaffeination concerns haven't dented energy drinks. (2013, June 6). BloombergBusiness Week. Retrieved October 19, 2014 from http://www.businessweek.com/articles/2013-06-06/overcaffeination-concerns-havent-dented-energy-drinks.
Caffeine, Guarana and Ginseng
Caffeine
One of the greatest challenges faced when trying to figure out how much caffeine is in an energy drink is that it is not always listed on the supplement facts panel. When caffeine is included as part of the "energy blend," it does not have to be listed separately on the label. If you look at the label above, that is exactly what you see - a label for an energy drink that does not tell us anything about the caffeine content of the product. Also, caffeine can come as caffeine, guarana, methylxanthines, theobromine, theophyline, etc. You have to know what to look for to be able to find all the caffeine in your product, and even then you may not know how much is actually in the drink you want. This is not common knowledge and yet the FDA acts as if it is.
Caffeine provides flavor and is used as a food additive. Chocolate has caffeine (theobromine). Caffeine (often as theophyline) is used in drug formulations and is part of some medications. Sometimes caffeine itself is used in drug formulations. We get caffeine from sources we know about and sources we don't. On top of that, we may not know who much caffeine we get when we know we want it.
Moderate consumption of caffeine is 300 mg/day. This is the equivalent of about three 8 oz cups of coffee a day, depending on the roast and brand of coffee. Lightly roasted coffees contain more caffeine than medium or dark roasted coffee. Starbucks commercial coffee, for example, consistently has higher caffeine content than other brands.
Caffeine itself (not as part of an energy drink) may have health and performance benefits. Small amounts of caffeine, 3-9 mg of caffeine (1-2 cups of coffee) per kg of body weight, taken 1 hour before activity has been shown to increase endurance and performance. (1)
The Linus Pauling Institute (Coffee) has a thorough and accessible review about what is and is not yet known about coffee, health and disease. (link accessed 10/19/14)
Reference
1. Spriet LL and Graham TE. Caffeine and Exercise Performance. American College of Sports Medicine Current Comment. Retrieved on 10/19/2014 from http://www.acsm.org/docs/current-comments/caffeineandexercise.pdf.
Guarana
Guarana is a South American plant that contains caffeine as well as other related stimulants like theobromine and theophyline. Guarana is added to energy drinks for the same reasons caffeine is; to facilitate the sense of alertness, clarity, and to possibly enhance performance. Whenever you see "guarana" on a label, keep in mind that this is a source of caffeine; it may be in place of caffeine or in addition to caffeine.
Ginseng
Ginseng is an herb that has been used for centuries in Asian cultures. Among numerous other qualities, ginseng has been viewed as an herb that can support the central nervous system, improve cognitive function, and enhance physical performance. It is the historical use of ginseng that has lead to its addition in energy drinks. Research is ongoing to determine if and how ginseng impacts mental and physical performance. "Panax quinquefolius". Licensed under Public domain via Wikimedia Commons
L-Carnitine and Taurine
L-Carnitine is an amino acid. The human body makes all of the L-carnitine that it needs. In addition to that, L-carnitine is present in the foods we eat; we get it from beef (which contains a lot of L-carnitine), chicken, diary, whole-wheat bread, and asparagus as well as other foods. Taurine is also an amino acid produced by the body. It is present in foods such as fish, meat, and is present in breast milk. The amount of taurine in plants depends on the environment in which the plant grows.
Why are L-carnitine and tuarine included in energy drinks?
- L-carnitine is involved in the production of energy. Specifically, it is involved in the oxidation ("burning") of long chain fatty acids to make energy. Because of this, L-carnitine has become a popular dietary supplement. There is no research that supports supplementing the diet with L-carnitine.
- Taurine also plays a role in maintaining the water and mineral balance in the blood and is involved in neurological development. Research about the ability of taurine to promote physical and mental (cognitive) performance is inconclusive. At this time, 3000 mg (3 grams) of taurine per day is considered safe for adults. It is noteworthy that not a lot is known about what happens to the body when it is exposed to tuarine supplements for long periods of time.
Only people with a genetic or medically diagnosed carnitine deficiency are encouraged to take carnitine (L-carnitine) supplements. Genetic deficiencies manifest within the first five years of life. Medical conditions that can contribute to an L-carnitine deficiency include things like kidney disease.
If you decide to take a L-carnitine supplement without a medical or genetic need, be aware 3000 mg (3 grams) per day of L-carnitine is the upper level of tolerable and safe consumption. Doses higher than that can cause unpleasant side effects such as nausea, vomiting, abdominal cramping, diarrhea, muscle weakness, and in severe instances seizures have occurred. Some people develop a "fishy" odor when they take too much L-carnitine (more than 3 grams/day).
Resources:
Office of Dietary Supplements. Carnitine Fact Sheet. Retrieved October 16, 2015 from http://ods.od.nih.gov/factsheets/Carnitine-HealthProfessional/.
Zeratsky K. Taurine is listed as an ingredient in many energy drinks. What is taurine? Is it safe? Retrieved on October 16, 2014 from http://www.mayoclinic.org/healthy-living/nutrition-and-healthy-eating/expert-answers/taurine/faq-20058177#/.
Carbohydrates: Glucose and Maltodextrin
Glucose is a sugar and that provides energy. The body, particularly the brain and muscles, uses the energy from glucose to fuel metabolic reactions. Malotdextrin is a large, sweet sugar called a polysaccharide. It can be made from corn starch, rice starch, potato starch or wheat starch. In the U.S., it is common for maltodextrin to come from corn starch. It is an additive used in a lot of food and beverages. It adds sweetness and is low in calories.
Eight ounces of the energy drink represented by the supplement label shown above provides 27 grams of sugar. That is the equivalent of 6.75 teaspoons of sugar (4 grams of sugar equals 1 teaspoon). The entire 16 oz container, which is what most people will drink, provides 13.5 teaspoons of sugar. That is a lot of energy without even considering the caffeine and guarana.
B Vitamins
Vitamins themselves have no energy. The most likely reason that B vitamins like riboflavin, niacin, and B6 are included in energy drinks is because these vitamins are co-factors that enzymes need to catalyze the release of energy from carbohydrates, fats, or proteins. Adequate folate and B12 are needed in order to properly synthesize RNA, DNA, and to make healthy and functional red blood cells. The theory behind including B vitamins in energy drinks is that these vitamins will facilitate energy metabolism, and over time, improve red blood cell function. This is not supported by research.
- B vitamins are widely available in our food supply. It is not necessary to supplement the diet with them unless there is an actual vitamin deficiency. For example, too much folate (folic acid) obtained through supplements (which energy drinks are) can hide a vitamin B12 deficiency.
- Regardless of where they come from, and whether or not they are accompanied by a mixture of B vitamins, excess calories get stored by the body. We store them mostly as fat.
- Malnutrition means "bad" nutrition. We generally think of undernourishment and malnutrition, but overnourishment is also a form of malnutrition. Consuming the entire 16 oz container of the drink above will result in consuming 200% of the daily value of the B vitamins contained in the product.
Are energy drinks safe?
In 2013, United States poison control centers received over 3000 calls about energy drinks. According to the American Association of Poison Control Centers (accessed 10/17/2014), just over 60% of those calls were about people 18 years of age and younger.
Too much caffeine, sometimes called caffeine intoxication, happens after drinking too much caffeine (too many energy drinks), or drinking one or more caffeine/stimulant drinks too quickly. Symptoms include:
- nausea, vomiting, diarrhea, dehydration
- nervousness, insomnia, restlessness
- headache, tremors, seizure, delirium
- sweating, chest pains, rapid heart rate or irregular heart beat
- increased blood pressure, kidney problems
Public Perception of Energy Drinks
On January 9, 2014, the Institute of Food Technologies (IFT) issued a press release about energy drinks and marketing growth in the U.S. Within this press release was a summary of results from a survey gauging public perception of energy drinks. I do not know the details of the survey structure, questions, or participants. The results as reported in the press release indicated the following:
- 39% of the people said that they were concerned that energy drinks were bad for their health;
- 35% of people said they had heard something negative about energy drinks and health;
- 35% of people said energy drinks were too expensive and that would be a reason to use them less;
- 79% of women 18-34 years of age and 71% of men in this age group reported a desire to see some kind of information about safe limits of consumption;
- 62% of women and 51% of men 35 and older said they had concerns about safety and the use of energy drinks.
Resource:
IFT Energy Drink Market Continues Growth (accessed 10/16/2014)
Energy drinks and alcohol
I will never forget the moment in September of 2007 when I was confronted with how long it had been since I last gone out to the bar. I was sitting in a restaurant/bar with two friends that I'd known for decades and had not seen in years. They ordered a round of Jägerbombs. I assumed this meant shots of Jägermeister and mugs of beer. Imagine my surprise when shots of Jäger with Red Bull arrived at the table.
Mixing alcohol with energy drinks is a now a regular part of the drinking culture. Estimates suggest that more than 70% of 18-29 year old adults who drink energy drinks (beverages and shots) also mix them with alcohol. Mixing energy drinks with alcohol is associated with riskier behaviors that include increased intoxication and greater frequency of binge drinking. Because people mixing energy drinks with alcohol are less likely to recognize when they are getting drunk, they tend to get more intoxicated and to engage in more binge drinking (1).
People describe a variety of reasons for mixing alcohol and energy drinks ranging from being tired and wanting to go out to getting older and wanting to keep up with the younger crowd to finding the combination helpful in overcoming social discomfort to not becoming a "sloppy" drunk (1). It is this last reason, the sloppy drunk clause, that may be the most misleading and potentially harmful.
Mixing energy drinks of any kind and alcohol really is a problem no matter how old you are (2).
- The caffeine and other stimulants only hide the effect of alcohol - you get every bit as drunk on just as much as alcohol but you are less aware of it. That is a dangerous mix.
- The stimulants (caffeine, guarana, etc.) may mask the appearance of drunkenness, but the body's ability to metabolize alcohol is exactly the same as it would be without energy drinks.
- Because you don't feel drunk, you drink more alcohol. Your body does not metabolize the alcohol any faster and instead your blood alcohol level continues to rise. Because you feel less drunk, you are more likely to drink more than you otherwise would. This increases the risk of drinking in excess and the risk of alcohol poisoning.
- This increases the risk of making poor decisions and increases the risk of alcohol poisoning.
- People who mix energy drinks with alcohol are three times more likely to binge drink than those who don't mix alcohol and energy drinks (2,3).
- People who mix alcohol and energy drinks are twice as likely to (2,4):
- Become a victim of a sexual assault
- Sexually assault another person
- Ride in a car with a drunk driver
References
1. Pennay A and Lubman DI. Alcohol and energy drinks: aa pilot study exploring patterns of consumption, social contexts, benefits and harms BMC Research Notes 2012. (Accessed 10/17/2014)
2. CDC facts about caffeine and alcohol (Accessed 10/17/2014)
3. Thombs DL, O’Mara RJ, Tsukamoto M, Rossheim Me, Weiler RM, Merves ML, Goldberger BA. Event-level analyses of energy drink consumption and alcohol intoxication in bar patrons. Addictive Behaviors. 2010;35;325-330.
4. O’Brien MC, McCoy TP, Rhode SD, Wagoner A, Wolfson M. Caffeinated cocktails; energy drink consumption, high-risk drinking, and alcohol-related consequences among college students. Acad Emerg Med. 2008;15(5):453-460.
Jerry Springer Final Thought
Energy drinks are still relatively new. The research to date is limited. Because they are treated like supplements by the FDA, the FDA only gets involved after there have been many significant health complaints reported. And because this a Jerry Springer final thought, always remember never to pay your prostitute with a personal check (Time content - Jerry Springer, US News - Politicians and Prostitutes).
