Energy drinks have been around for some time but their popularity did not take off until the introduction of Red Bull in 1987. Since then the energy drink market has grown extensively, with hundreds of different brands of varying strength now available. Global energy drinks consumption climbed by 14% in 2011, according to the latest report from food and drink consultancy Zenith International reaching 4.8 billion litres. North America was the leading region, with 36% of global volume in 2011, followed by Asia Pacific with 22% and West Europe with 17%.
According to marketing speak, energy drinks are supposed to provide mental and physical stimulation, and who can object to that kind of kick. They may or may not be carbonated, and generally contain large amounts of caffeine and other stimulants, as well as sugar or other sweeteners, herbal extracts and amino acids. While ordinary soft drinks typically contain around 100 mg caffeine/L, energy drinks often contain three times this amount or more than 300 mg/L.
Energy shots are a specialised kind of energy drink usually sold in small bottles of around 60 ml. They contain the same amount of caffeine as a 250 ml energy drink bottle or more than 1,300 mg/L. Energy shots are the fastest-growing part of the energy drink category. Energy drinks are targeting young people. Approximately 66% of its drinkers are between the ages of 13 and 35 years old, with males making up approximately 65% of the market.
And this is the problem
Although healthy people can tolerate caffeine in moderation, heavy caffeine consumption, through drinking energy drinks, has been associated with serious consequences such as seizures, mania, stroke, and sudden death. It has been suggested that both the known and unknown pharmacology of various ingredients in energy drinks, combined with reports of toxicity, may put some children at risk for serious adverse health effects.
A German survey of high energy drink consumers in discos and at music and sports events found that some people down as much as five litres of the caffeine-loaded drinks in the space of 24 hours. On average, the clubbers and disco dancers said they consumed a litre of energy drinks in combination with alcohol with most drinkers at such events ignoring health warnings. The highest exposure levels were found among gatherings of computer geeks and video gamers, with non-stop sessions lasting up to 48 hours.
Dangerous adverse health effects
Excessive amounts of caffeine can cause very unpleasant and even life-threatening adverse effects. Although it is possible to die by consuming too much caffeine, it is difficult. The lethal dose has been estimated to be between 3-8 g, which is roughly equivalent to 30 to 80 cups of coffee in a day, but such doses are more likely to be the result of excessive intake of caffeine-containing stay-awake pills or very high volumes of energy drink consumption. Death results from convulsion and respiratory collapse.
The American Association of Poison Control Centers received reports of around 46,000 cases of caffeine poisoning between 2006 and 2008 of which 45 had life threatening symptoms. The number of emergency department visits involving energy drinks among patients 12 years of age or older increased from 10,068 in 2007 to 20,783 in 2011. The Adverse Event Reporting System run by the U.S. Food and Drug Administration collects reports about adverse health events and product complaints including for energy drinks classified as dietary supplements. A summary of adverse effects for energy drinks under the labels 5-Hour Energy and Monster between 2004 and 2012 lists thirteen deaths linked to 5-Hour Energy consumption and five deaths linked to Monster drink consumption.
In 2008 energy drinks were granted marketing authorisation in France. In 2009 this was accompanied by a national nutritional surveillance scheme which required national health agencies and regional centres to send information on spontaneously reported adverse events to the French agency for food safety. During the 2009 to 2011 period 257 cases were reported to the agency, of which 212 provided sufficient information for food and drug safety evaluation. The experts found that 95 of the reported adverse events had cardiovascular symptoms, 74 psychiatric, and 57 neurological, sometimes overlapping. Cardiac arrests and sudden or unexplained deaths occurred in at least eight cases, while 46 people had heart rhythm disorders, thirteen had angina and three had hypertension.
Time for action?
Harmful health effects from energy drinks are especially likely when people drink large quantities of them mixed with alcohol, combined with a lack of sleep and physical exertion. Warnings seem to be useless. Maybe it is time to take some further regulatory action?