Dr. L. Lee Coyne
Nutrition Consulting
Dr. Lee, the Healthy Professor

Energy Drinks

Should you be drinking this stuff?

The news media and the research literature have been raising issues and concerns over Energy Drinks over the past year.  I don’t like to sound like an alarmist, but this is something worth more attention and investigation.  It is also something that doesn’t surprise me as you will see in the final link of this article. 

One if my long standing concerns has been the inclusion of energy drinks under the regulatory umbrella of “Dietary Supplements”.  I don’t consider them to be dietary, nor are they a supplement.  They are “stimulants” – nothing more, nothing less. They have nothing to do with diet in the strictest terms.

This is the recent chronology of the reports I refer to, from both media and science sources.

The American Heart Association journal Circulation published a review report by Tracy Hampton Ph.D. titled “Energy Drinks Pose Worrisome Risks to Adolescents’ Cardiovascular Health”.  It started with the obvious comment that the research on energy drinks is in its very early stages, so there is a lot we don’t know about their effects, but what we do know is disturbing, especially when they are consumed by youth. The concern lies in the fact that Energy drinks contain high amounts of caffeine, sugar, and other stimulants, and ingredients such as taurine, guarana, ginseng, carnitine, inositol, B vitamins, and glucuronolactone.

Industry research always reports that these beverages are safe but independent research studies have linked them with severe short-term events including emergency department visits, poison control calls, and even death. The later is usually when combined with alcohol.  The other symptoms occur with “heavy” use defined as more than 2 drinks / day, particularly when applying to children and teenagers.  Even with caffeine, teenagers have yet to develop caffeine tolerance.

High consumption has been associated with elevated blood pressure, increased frequency of palpitations and arrhythmias (worse when consumed with alcohol or other illicit drugs. Dr. Hampton referred to previous investigations having demonstrated increases platelet aggregation, alters electrolytes, triggers endothelial dysfunction, and promotes atherosclerosis. There is also evidence of cardiovascular abnormalities in cardiac function, meaning that it increases heart rate, stroke volume, cardiac output, and contractility, and it also increases blood glucose concentration and reduces cerebral blood flow velocity.

Long term effects are unknown but there have been indication of addiction/ dependence issues and behaviour alterations of an aggressive nature.

Already the NCCA bans high levels of caffeine because it considers the effects performance enhancing, and there is concern for long term health.

The American Academy of Pediatrics has also stated that energy drinks should never be consumed by youth under 8 years of age because of potential adverse consequences on neurological and cardiovascular development. This warning is also shared by the American Medical Association.

Some countries have banned the sale of Energy drinks to minors and others are trying to do so but there have been court challenges.

The American Heart Association has urged rigorous study of the issue.

Circulation - Oct 2016

Time magazine followed the above publication with a report in Nov. 2016 by Alexandra Sifferlin entitled “The Case Against Energy Drinks Is Getting Stronger”. The article opened with a survey report published in Pediatric Emergency Care, which found that at two emergency departments from June 2011 to June 2013 surveyed adolescents between ages 12 and 18. Of the 612 young people who responded, 33% said they frequently drank energy drinks. Among those teens, 76% said they experienced a headache in the last six months, 47% said they experienced anger and 22% reported difficulty breathing.  The CDC found in a survey of 1,000 students, 51% consumed Energy drinks and 72% of those in combination with alcohol.

Center for Science in the Public Interest have joined  with American Academy of Pediatrics researchers, calling  on the U.S. FDA to add safety warnings to energy drinks, and have argued the stimulants in energy drinks have "no place in the diet of children and adolescents."

Time -  Nov 2016   

In April 2017,  Emily A. Fletcher et. Al. published “Randomized Controlled Trial of High‐Volume Energy Drink Versus Caffeine Consumption on ECG and Hemodynamic Parameters” in the Journal of the American Heart Association.

They evaluated the ECG and blood pressure (BP) effects of high‐volume energy drink consumption compared with caffeine alone.  Following high volume energy drink consumption (either 946 mL (32 ounces) of energy drink or caffeinated control drink, both of which contained 320 mg of caffeine = approximately 4 cups of regular coffee. ECG changes and Blood Pressure elevations were significantly more pronounced than in the caffeine only group.  Naturally there was a call for more and larger studies.

Journal of the American Heart Association - April 2017

In the following month, the CBC (Canadian Broadcasting Corporation) filed a report entitled “Energy drinks' non-caffeine ingredients may affect heart” and subtitled  “Why the multiple ingredients in energy drinks may need more scrutiny when consumed in high volumes”.  It referred to the American Heart Association article above and to a Canadian Institutes for Health Research (CIHR) funded survey (http://www.sciencedirect.com/science/article/pii/S2211335516301450) reported 76 per cent of Canadians aged 12 to 24 reported consuming energy drinks, and 16 per cent said that they'd had more than two energy drinks a day, the maximum recommended by Health Canada.

Health Canada has received 86 reports of adverse reactions to energy drinks, at a time when U.S. regulators are investigating 13 deaths possibly related to energy "shots" in that country.

The U.S. Food and Drug Administration has received 92 reports that cite illnesses, hospitalizations and deaths after people consumed 5-Hour Energy.

CBC - May 2017 

On May 26th, the Toronto Star reported confirmation from a South Carolina coroner that “Teen dies after drinking latte, Mountain Dew and energy drink in two-hour span”. It was determined that after drinking 3 heavily caffeinated drinks within the two hour span, the teenager suffered from a cardiac arrhythmia which stopped his heart.

Toronto Star   May 2017   also report by CNN

Finally, reported in June 2017 by the London Daily Mail, “Three deaths linked to energy drink”. The drinks were Red Bull and the deaths occurred in Sweden. The incidents are still under investigation.  However, a study at Dublin's St James Hospital last April found that only two cans of the drink caused some arteries to dilate so that blood pressure fell, while others stiffened and led to higher blood pressure. While the two effects may cancel each other out, the addition of alcohol could create unpredictable results.

London Daily Mail - June 2017

Now, why am I not surprised?  In 2000 I wrote about this subject for a local news paper and a local magazine.  My concerns met with some skepticism and a little scoff.  So I regard this series of recent reports as a little vindication.  Energy drinks need to be scrutinized and regulated and I don’t see them as necessary nor valuable, particularly for young growing individuals.  You can read my article from 2000 here : Energy Drinks - May 2000

Further Reading

Sports Drinks Review - Top 10 Things to look for in a Sports Drink, 16 Sports Drinks Reviewed.
Is Coconut Water a Sports Drink? - Although coconut water is high in potassium, a valuable electrolyte, it is sorrowfully deficient in sodium
Sports Drink Science - The science and chemistry behind Sports Drinks.
Daily Water Requirements - How much water should you drink per day?
Hyponatremia - Over Hydration - Water Intoxication.
Energy Drinks - A critical review.

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Dr. L. Lee Coyne

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