Energy Drinks Under Investigation: Are They Healthy or Dangerous?

The Wall Street Journal reported this week that New York's attorney general is investigating whether the booming multibillion-dollar energy-drink industry is deceiving consumers with misstatements about the ingredients and health value of its products.

The energy drink market is fast growing, and these drinks -- promising boosts of energy -- have become ubiquitous. It's estimated that 30 percent of college students consume energy drinks regularly.

Are there real benefits in these drinks and are they safe? Health advocates have long been raising concerns about these drinks, especially when consumed alongside alcohol.

What's in an energy drink?

Caffeine is the main active ingredient in energy drinks - they usually contain 70 to 80 milligrams of caffeine per 8-oz. serving, more than triple many cola drinks. Additional caffeine can come from energy drink's other ingredients: guarna, kola nut, yerba mate and cocoa.

Energy drinks may also contain taurine (an amino acid), vitamins, herbal supplements such as yohimbine and ginseng and sweeteners.

Are energy drinks safe for kids?

A recent article in Pediatrics reviewed the literature and looked at 121 scientific studies, government reports and media sources on energy drinks. The authors raised some serious concerns and warned that energy drinks are under studied, overused and can be dangerous for vulnerable kids and teens.

The review found evidence that caffeine may increase kids' blood pressure and disturb sleep. Caffeine causes dependence, and can lead to symptoms such asheadaches and inattention when caffeine is withdrawn. Caffeine also affects food and beverage choices, making kids prefer caffeinated sodas. Caffeine interferes with calcium absorption in early adolescence, and whether because of this trait, or because it replaces milk, caffeinated drinks are associated with lower bone mass. And let's not forget that most of these drinks contain empty calories from sugar, contributing to obesity and dental problems.

But most worrisome is caffeine's effect on kids with underlying medical conditions. Kids and teens with heart disease take the risk of heart rhythm abnormalities and even sudden death when exposed to high doses of caffeine. Kids with seizures, diabetes, mood and behavior disorders, hyperthyroidism, kidney and liver diseases may also be especially sensitive to the effects of caffeine.

Marketing to the young

Energy drinks advertising campaigns, brand design and sponsorship strategies are geared towards teens, students and young adults and include sponsoring extreme-sport competitions, athlete sponsorship and product placement in programming and social media that targets a young audience.

Energy drink regulation

The FDA's upper limit of caffeine in soda is 71mg per 12 fl oz. This upper limit is easily circumvented by labeling energy drinks as dietary supplements.

Dietary supplements require no testing, warning labels or restrictions. This leads to the absurd reality in which soda, with a moderate caffeine content, has to list caffeine content, over-the-counter caffeine medications such as No-Doz must carry warnings, adverse effects label and have a minimum age for purchase (12 years), yet energy drinks with as much as 400 mg of caffeine per container aren't regulated at all. The FDA announced recently that caffeine is an unsafe food additive to alcoholic beverages and that it will prohibit the sale of premixed alcoholic energy drinks (such as Four Loko).

The Pediatrics article includes a chart listing energy drink regulation around the world. In Denmark energy drinks are prohibited entirely. The European Food Safety Authority requires energy drinks with high caffeine to be labeled "high caffeine content", and the exact content be listed. In Norway energy drinks can only be sold in pharmacies.

The authors, led by Sara Seifert, conclude that energy drinks have no therapeutic benefit, that these drinks may put some children at risk for serious adverse health effects and that labeling of energy drinks as nutritional supplements shields manufacturers from safety testing and labeling required by food and pharmaceuticals makers.

Renewable energy

Should kids be running on caffeine? Don't get me wrong: I love my morning coffee, look forward to it, and have to admit it makes loose words in my brain connect into somewhat coherent sentences. Research on coffee's effect on heath has shown that coffee in moderation probably poses no threat to healthy adults, and has even shown to have benefits in some studies (coffee lovers rejoice every time such a study is published and add it to their collection). But most coffee drinks contain only moderate amounts of caffeine, and since coffee is hot, it is usually consumed slowly.

That doesn't mean that caffeine is safe for kids, that it's safe in high doses, or that it can safely be combined with dietary supplements. It definitely shouldn't be combined with alcohol!

The notion that energy comes from a can introduces kids to the false idea that our bodies function on surges of energy in the way a rocket needs super-fuel to lift off.

Nothing can be further from the truth. Our body regulates its energy in very complex and efficient ways, and healthy people enjoy good, steady levels of energy throughout the day with no need for boosts from stimulants -- and an energy drink should really be called a stimulant drink.

The two major sources of energy in energy drinks are caffeine and sugar. Neither source supplies sustained energy -- quite the opposite. Drinking refined sugar and stimulants, such as caffeine, results quite often in highs and lows in energy levels and overall exhaustion. The best recipe for good stamina is to eat well, get enough sleep and be physically active.

Red bull claims to vitalize the body and the mind, increase performance, increase concentration and reaction speed, improve vigilance, improve emotional status and stimulate metabolism. Scientists cannot find good evidence for any of these claims, warn of risks, encourage regulation of these energy drinks and suggest parents and pediatricians discuss energy drinks with kids.

I think it's high time energy drinks get some scrutiny.

Dr. Ayala

Full disclosure: I'm vice president of product development for Herbal Water, where we make organic herb-infused waters that have zero calories and no sugar or artificial ingredients. I'm also a pediatrician and have been promoting good nutrition and healthy lifestyle for many years.