Energy Drinks: Buyer Beware


Slickly marketed and heavily consumed, caffeine-laced energy drinks lately have generated a buzz of concern within the medical community, and understandably so.

Cardiac events, seizures and even deaths have been associated with consumption of these beverages, which tout such sexy names as Red Bull and Rockstar and are widely available in supermarkets, convenience stores and drug stores. Yet they remain largely unregulated by the FDA and are especially popular with youths—the very population potentially most at risk. According to a recent survey cited in an information sheet published by UC Davis’ Department of Nutrition, energy drinks were consumed by some 42 percent of 11- to 18-year-olds.

“More and more, when we see kids for their checkups, it comes up that they are drinking these beverages,” says pediatrician Meghna Kant, D.O., of Mercy Medical Group. Mostly, she says, it’s the teens: “A lot of teens feel like they always have to be on the go, juggling school, family life and extracurricular activities.” When they need a little boost, she says, they often turn to energy drinks.


That was true for Celia Boutiette. A junior at the University of the Pacific in Stockton, Boutiette, 21, still enjoys a Red Bull now and then. But she drank them regularly, she says, during her years at Granite Bay High School.

“I was really stuck on them as a sophomore in high school,” says Boutiette, who carried a heavy academic load along with marching band, choir and other extracurriculars. “I would usually use them either when I was going to class and I was super tired, or if I was studying late and needed to stay up.” She had no serious ill effects, she says, though they would sometimes make her “a little jittery. To me, energy drinks give you more of a jittery awake than a focused awake, like you get from coffee.”

As a healthy youngster whose intake was moderate—“maybe three or four a week,” she recalls—Boutiette was probably not in danger’s way. But experts warn that energy drinks are not recommended for children or adolescents for one simple reason: They are loaded with caffeine. While safety data regarding this population is limited, amounts of caffeine greater than 100 milligrams have been linked to increased blood pressure and jitteriness in children and adolescents, suggesting they should limit their intake accordingly. Increased heart rate, brain function and motor function also are associated with high levels of caffeine, which may pose particular dangers for those with cardiovascular issues or mood disorders, such as bipolar. While an 8 ounce energy drink may have less caffeine than the same amount of coffee, they are often sold in 12, 16 and even 24 ounce-size containers, doubling and even tripling the caffeine content. Many also contain additional stimulants, such as guarana and ginseng.

These are just a few of the things that worry people such as Sheri Zidenberg-Cherr, Ph.D., a UC Cooperative Extension Nutrition Specialist and scientist at UC Davis’ Department of Nutrition.

“If individuals choose to have an energy drink, they should be aware of the servings in one container,” warns Zidenberg-Cherr. “The combination of these stimulants may also be a concern.” Plus, as she points out, energy drinks don’t always exist in a vacuum. When combined with chocolate, coffee, soft drinks or other caffeine-containing products, the day’s cumulative intake can creep up even further.

High levels of caffeine aren’t necessarily good for adults, either. But on the young body, it can mean double trouble. “These energy drinks are so easily accessible and so appealing to the younger generation, some whose bodies are not even developed,” notes Michele Canny Gilles, a registered dietitian and director of nutrition services for Wenmat Fitness. “When I taught nutrition at AR (American River College), about half the kids came to class with energy drinks.”



The often-strange mix of ingredients in energy drinks also has raised a red flag. In addition to caffeine and other stimulants, other frequently used additives include B vitamins, ginkgo biloba, taurine and glucuronolactone, some of whose effects, especially long term, remain unknown. How these ingredients interact also is unknown. “People need to know that we don’t have any real clear evidence of how these ingredients work together,” says Canny Gilles. “We know what caffeine does, but we don’t know what these ingredients do when they are combined.” In addition, individual reactions can and do differ. “One person may be fine; another may have stomach upset, insomnia or irritability,” notes Canny Gilles.

Far more frightening outcomes have been reported for sports enthusiasts who guzzled energy drinks to get an edge in an endurance event. In a report recently published in Mayo Clinic Proceedings, researchers from the University of Texas in Houston and the University of Queensland in Australia cite cases of an otherwise healthy 28-year-old man who ingested energy drinks, spent the day motocross racing and then suffered cardiac arrest; more alarmingly, an 18-year-old man, also healthy, died playing basketball after drinking two cans of Red Bull. While such dire outcomes may be rare, experts warn against consuming energy drinks prior to exercise, partly because they raise blood pressure and partly because the high caffeine and sugar levels may result in dehydration. A typical energy drink, the researchers note, contains a whopping 13 teaspoons of sugar.

Such staggering levels of sugar not only add to dehydration dangers for athletes and other exercisers, but raise an additional concern: They’re full of empty calories.

“It’s not just the caffeine that concerns me, but the sugar they contain, which contributes to the obesity epidemic,” says Kant. “There are two things going on.” But she’s not wild about the sugar-free versions, either. “I think the diet versions—diet Rockstar, Red Bull, whatever—falsely give people the idea they’re healthy,” she says.



Possibly the most dangerous practice of all, however, is this troubling trend: mixing energy drinks with alcohol. As the UCD fact sheet points out, caffeine and alcohol act as diuretics, increasing the likelihood of dehydration and adverse cardiovascular effects. In addition, people under the influence of both substances may be so buoyed by the stimulants in the energy drink that they don’t realize how inebriated they are, with potentially disastrous consequences.

“Caffeine makes you feel alert, so you can overlook the feelings of intoxication,” says Canny Gilles. “One’s a stimulant (caffeine) and one’s a depressant (alcohol).” In that state of mind, she says, “you’re more apt to go out there and drive and harm not only yourself, but someone else.”

The well-publicized story of NFL wide receiver Donte Stallworth serves as a sobering example. In 2009, Stallworth struck and killed a pedestrian with his car after swilling multiple tequila shots and a can of Red Bull. He told police he did not feel drunk at the time of the accident.

While researchers in the Mayo Clinic report point to white men and intramural athletes—aka “toxic jocks”—as the primary consumers who mix alcohol and energy drinks, its use has been witnessed on college campuses, too. She doesn’t indulge in “Jager Bombs” (Jagermeister + Red Bull) or other energy drink-based cocktails popular among her peers, says UOP’s Boutiette, but she does note that it’s awfully easy to get energy drinks on campus—often for free.

At basketball games and other campus events, Boutiette says, she’s often collected a Red Bull, Monster or other energy drink on the house. “Usually there’ll be buff guys or pretty, dolled up girls handing them out, to make it more attractive,” she says. “I don’t think I’ve ever paid for Red Bulls on campus.”



The marketing machine behind energy drinks—and the easy access factor—is a sore subject for many health experts, including Canny Gilles. “The marketing is phenomenal,” she says. “They have a wonderful appeal to the eye, ear, everything. But it’s a big problem because they’re attracting everybody— educated, uneducated, everybody. And some of these people have no idea what they’re drinking.”

For those who do indulge, what is the payoff? Not much, apparently.

While there is limited evidence that energy drinks can improve physical and mental performance and decrease mental fatigue during periods of concentration, the effects are short-term, says Canny Gilles. “I always tell my athletes that it really does not enhance their long-term performance,” she says. “Even though these drinks are labeled ‘energy,’ the only way to give your body energy is through food.”

Mercy’s Kant couldn’t agree more. “Basically, I don’t think there’s any place in the diet for energy drinks—no place at all,” she says. With her young patients, she says, she preaches the value of getting back to the basics: a balanced diet, sleep, exercise and, instead of energy drinks, “good, old-fashioned water.”



They may sit side by side on a convenience store shelf, but there’s a big difference between energy drinks and sports drinks. While sports drinks provide electrolyte and carbohydrate replacement, energy drinks contain caffeine and other stimulants that have a host of potentially adverse effects, including dehydration, elevated blood pressure and increased heart rate.