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Energy Drinks – Marketing Fad or Silent Killer?

One of the biggest biggest marketing success stories of the last decade and a half is energy drinks. Whilst energy drinks have been around for a significant amount of time, there has been a substantial push by companies to grab a large share in the soft drink market. Although these drinks are freely available and can be bought by anyone, there is a growing concern that some of the ingredients in these drinks may be posing serious health risks to the consumer, or may even be potentially deadly. Currently there have been several deaths which have been linked to these drinks, however there is no direct proof to prove so. This article will look at the background of energy drinks, the different types that are available on the market, health warnings and the deaths that have been linked to the product.

Background

Humans consuming drinks in order to feel refreshed, revitalised or a pick me up is not a new concept by any means. It can be argued that it has been occurring for hundreds of years in the form of caffeinated drinks such as tea and coffee. The first known for of the energy drink as we know it today was introduced in Thailand in 1976 and marketed under the name 'Krating Deang', and is also known as Thai Red Bull. This original drink contained sugar, caffeine, taurine, inositol and B-12 vitamins 1). The Red Bull that we know today was the first energy drink to be mass marketed in the western world, with the first sales occurring in Austria in 1987 and after a successful launch leading the drink to be marketed worldwide.

Today an equivalent of 40 billion cans of energy drink is consumed worldwide, with the majority in economically developed area such as the United States, Europe, Australia and parts of South-East Asia. In 2010 a staggering 9 billion dollars was spent on energy drinks alone in the United States 2). Whilst the sales of soft and sugary drinks are falling around the world, there is a marked increase in the sales of energy drinks. Interestingly the amount of caffeine that is being consumed by younger adults iand adolescents is also increasing inline with the increase in energy drinks, prompting many warnings from health experts 3)

coffee.jpg

Coffee 4)

Types of Energy Drink

The Red Bull brand is by far the highest selling form of energy drink worldwide. The brands Monster and Rockstar are the next two highest sellers in the United States, with a sprinkling of other brands with small market share. There are also other significant brands which are sold worldwide, including Mother and V. The pie chart below shows a break down of sales percentage in the United States for the year 2011:

energy_drink_sales.jpg

Sales in The United States, 2011 5)

Whilst the ingredients of the major brands of energy drink are similar, there are subtle differences in the amounts of ingredients, with the companies also trying to use different flavours in order to increase market share. Please see the breakdown of ingredients for the five previously mentioned major brands below:

Red Bull

red_bull.jpg

Red Bull Energy Drink 6)

Standard size: 250ml Can (8.3 fl. oz)

Main Ingredients (per 100ml):

Caffeine: 32mg

Sugars: 11mg

Taurine: 400mg

Glucuronolactone: 240mg

B-12 Vitamins: Unspecified

Source: http://energydrink.redbull.com/

Monster

monster.jpg

Monster Energy Drink 7)

Standard size: 240ml (8 fl. oz.)

Ingredients (per 100 ml):

Sugars: 11.25g Taurine: 416mg

Ginseng: 83mg

'Energy Blend' (combination of Camitine, Glucose, Caffeine, Guarana, Inositol, Maltodextrin, Glucuronolactone): 1000mg

Source: http://www.monsterenergy.com

Rockstar

Standard size: 250ml (8.3 fl. oz.)

Ingredients (per 100ml):

Taurine: 1250mg

Glucuronolactone: 625mg

Caffeine: 32mg

Ginseng and Guarana: 10mg

Sugars: 0mg (artificially sweetened)

Source: http://www.caffeineinformer.com/caffeine-content/rockstar

Mother

Standard size: 250ml (8.3 fl. oz.)

Ingredients (per 100ml):

Caffeine: 32mg

Sugars: 12.7g

Taurine: 800mg

Glucuronolactone: 240mg

Inositol: 25mg

Source: http://www.pcauthority.com.au/Gallery/173686,mother-extra-energy-big-shot-energy-drink.aspx/3

V

Standard size: 250ml (8.3 fl. oz.)

Ingredients (per 100ml):

Caffeine: 31mg

Sugars: 11.2g

Glucuronolactone: 25mg

Inositol: 20mg

Guarana Extract: 120mg

Source: http://v-energy.com.au/products/v-green/

What Are These Ingredients?

Whilst caffeine and sugar are self explanatory, you may not be familiar with some of these key ingredients in energy drinks. Please see below for some brief explanations about each one:

Taurine

Essentially speaking Taurine is an amino acid which is found within the human body. It helps the body regulate water and mineral salt levels in the blood, and is also known as an antioxidant. Some studies have indicated a correlation between Taurine supplementation and an increase in both mental stimulation and physical performance. It is recommended that the daily supplementation of this acid should not exceed 3,000mg. Currently there is no research on the long term effects of Taurine supplementation 8).

Glucuronolactone

Glucuronolactone is a metabolite which is generated by the liver in the human body as a by product of glucose. It is thought to help increase fitness and reduce recovery times after exercising. Currently there has been no research into the effects of long term Glucuronolactone supplementation, although most scientists recommend that 350mg a day should be the maximum amount to be ingested by a human per day 9).

Inositol

Inositol is a water soluble vitamin which helps the body repair and create new cell membranes. It is very similar to glucose in structure and assists in the transport and metabolism of fats in the blood stream. Inositol is found in many foods and studies have shown that ingesting large amounts can inhibit the absorption of zinc in the gastric system, possibly leading to a zinc deficiency. There have been no cases of Inotisol deficiency, and there is no research into the effects of long term supplementation 10).

Guarana

Guarana is a plant species that is native to South America. The plant has a fleshy fruit which surrounds a seed which is the source of the Guarana extract. The seeds are around the size of a coffee been but contain twice as much caffeine, thus giving the consumer similar effects as caffeine. The seeds also contain theophylline and theobromine which are also similar in structure and function as caffeine. Excessive consumption of Guarana can cause serious problems such as insomnia, nervousness, increase in blood pressure and heart rate, which are all similar to the side effects of caffeine 11).

Ginseng

Ginseng is a herb which is native to South-East Asia and parts of Northern America. It is one of the most popular and used herbal supplements and has been used in Chinese medicine for thousands of years. It is thought that Ginseng has many medicinal benefits, including the reduction of blood pressure, increased mental function, increased physical performance and is also known to reduce cholesterol and also work as an antibacterial agent. There has been little evidence of any side effects to come from Ginseng, with minor cases of headaches and insomnia 12).

ginseng.jpg

Ginseng Plant 13)

Performance Benefits and Weight Loss

One of main marketing strategies employed by energy drink companies is that the drinks will increase physical performance and capability. Caffeine has long been used as a performance enhancing product by athletes and the high consumption of caffeine is now banned in most performance sports. Whilst there are no direct studies or evidence that high level athletes use these drinks for performance increases, there has been a study conducted on college athletes which was released by the National Collegiate Athletic Association (NCAA) in 2012 in which the athletes were asked whether they consumed energy drinks. A total of 20,474 students from across 23 different sports were asked and a staggering 44.5% of the replies were in the affirmative 14). In an online survey conducted by Hoyte et al, data was collected from 1960 college student, and of those who participated in sport, 80% of respondents stated that they drank energy drinks in order to boost performance 15).

In the past caffeine has been demonstrated to contribute to weight loss. Caffeine can help fat oxidation and the reduction of glycogen breakdown. When combined with other elements such as Ephedra, studies have shown that it can increase metabolic rate and contribute to weight loss. Some energy drinks have also been marketed as a weight loss agent despite the high levels of sugar which are found in these drinks. In 2007 Hoffman et al conducted a study into the weight loss effects of various energy drinks and concluded that there were some short term benefits for weight loss, especially in those with low or no sugar content. This however required concentrated amounts of the drink, and a serious potential for side effects were present 16).

Health Warnings

As seen in the ingredients list above, energy drinks contain high levels of caffeine and it is the possible effects of the caffeine that has prompted the biggest warnings from health experts worldwide. Most experts suggest that children should not consume any caffeine at all, adolescents no more than 100mg per day and adults 500mg per day. Despite this, between 30% and 50% of children have admitted to drinking energy drinks, and visits to emergency departments in the United States due to excessive intake of energy drinks rose nearly doubled between the years 2007 and 2011 17).

In a study which was published in the Journal of the American Medical Association, it was found that the consumption of energy drinks posed serious health implications for users, including an increase in heart rate, heart palpitations and irregular beat, increase in blood pressure, insomnia and other sleep disturbance, an increase in urine production leading to dehydration and hyperglycaemia which is an increase in blood sugar levels 18).

The Medical Journal of Australia also published results of a study that was conducted on energy drinks and energy drink consumption. Several of the major brands were studied over a period of 7 years, using data received from the Australian Poisons Centre. In the year 2004 only 12 cases were reported to the poisons centre relating to energy drinks. By the year 2010 this number had significantly increased to 297 in 2010. Whilst the increase in numbers are a worrying factor, perhaps the most worrying statistic is that the median age of the subjects that were exposed was only 17. The report concluded that in addition to the side effects listed by the Journal of the American Medical Association, consumers of energy drinks also suffered from agitation and restlessness, upsetting of the gastrointestinal tract, chest pain, dizziness, respiratory difficulty and headaches 19).

In a study headed by doctors from the University of Bonn, Germany, studied the effects of energy drink consumption and heart function. There were 18 people involved in the study, 15 males and 3 females, all of whom had no medical issues and a median age of 27.5 years. Each subject had a Magnetic Resonance Imaging (MRI) scan before consuming an energy drink which had 400mg of Taurine and 32mg of caffeine. Another MRI scan one hour after drinking the energy drink showed a significant increase in the peak strain and the peak systolic strain on the left ventricle of the heart, which receives oxygenated blood from vessels. Similar studies have also shown that major blood vessels and arteries have a slower recovery rate after compression after consuming energy drinks 20).

Linked Deaths

One of the most controversial discussions about energy drinks have been the many deaths worldwide that have been linked to the product. Please note that the events here are from articles and studies that have been conducted, and the author is not implying or insinuating that the mentioned energy drinks were the main cause in these deaths. Please find below a brief list of some of the linked cases:

In 2012, the Food and Drug Administration (FDA) in the United States handed down the report which was the culmination of an 8 year study. The study examined 13 deaths from a certain brand of energy drink, with also 5 deaths related to a secondary drink. The deaths mainly occurred due to heart attacks and heart failure, with the hospitalisations ranging from heart related illnesses to psychotic episodes. The complaints were filed by either doctors, patients or families. The report did not mention any previous underlying medical problems from the affected people thus the results may not be an accurate in this regard. Due to this fact, the FDA was unable to instigate any banning or forced withdrawal of these products and the investigation is currently ongoing 21).

In Sweden officials are investigating three deaths which have been linked to the consumption of energy drinks. It is believed that two of the people died after mixing the drink with alcohol and the third person died from massive kidney failure after drinking several cans of the drink after a workout 22).

In Australia, energy drinks were in the spotlight in 2012 following the death of a 16 year old schoolgirl in Melbourne. The girl reportedly drank three cans of an alcoholic energy drink in a short period of time. Whilst the coroners report listed the cause of death as undetermined, medical experts believe that the drinks contributed to her death 23). Another incident occurred in Australia after a man's heart stopped after consuming 8 cans of energy drink, or 640mg of caffeine. Luckily quick acting by paramedics were able to revive the man by the use of a defibrillator 24).

The sale of energy drinks has been regulated in different ways by various countries worldwide. In France, Greece, Norway and Denmark, energy drinks can only be sold in pharmacies. Energy drinks with alcohol have been banned by some states in the United States and Australia. Many health experts are calling for stronger regulation or just outright banning of energy drinks, whilst others are calling for more warnings on the cans themselves.

Conclusion

Energy drinks have proven to be a most successful and well marketed product over the last 15 years. The marketing strategies have been second to none, with the sponsoring of such events as motor racing and other extreme sports, along with labelling on clothing and other merchandise. The most critical aspect of the ingredients of energy drinks seems to be caffeine, and this is the major concern of health officials and the cause of many of the adverse effects. The other ingredients that are found in the drinks are all relatively small in dose and should not be harmful given responsible use of the product. The studies into the linked deaths and other health effects of these drinks appears to be due to the misuse by consumers, and not directly linked to the companies that are producing the product. Most energy drink labels have warning regarding their use and daily limits, and perhaps such warnings should be more prominent on the cans, and regulating authorities should try to educate people about the dangers of overconsumption of caffeine and the angers of energy drinks mixed with alcohol. Whilst it is extremely unfortunate that people may have died or suffered adverse health effects due to these drinks, it appears that responsible users of the products will most likely have no negative health effects.

Health

1) Higgins, J.P., Tuttle, T.D & Higgins, C.L, 2010, 'Energy Beverage: Content and Safety', Mayo Clinic Proceedings, vol.85, no.11, pp. 1033-1041
2) Joelving, F., 2011, 'As sales soar, experts warn about energy drinks', Reuters Online, Available: http://www.reuters.com/article/2011/02/14/us-energy-drinks-idUSTRE71D1K520110214
3) Sifferlin, A., 2014, 'Among Kids, Soda Is Out, Energy and Coffee Drinks Are All the Buzz', Time.com, Available: http://time.com/6496/kids-are-drinking-more-energy-drinks/
4) Cafe con leche by Jeremy Keith, licence CC 2.0, Available: http://commons.wikimedia.org/wiki/File:Cafeconleche.jpg
6) Red Bull Can by mediaphoto.org, licence CC 3.0, Available: http://commons.wikimedia.org/wiki/File:Red_Bull_can.jpg
7) Monster M-80 by The Master Shake Signal, licence CC 2.0, Available: http://commons.wikimedia.org/wiki/File:Monster_M-80.jpg
8) Zetarsky, K., 2014, 'Taurine is listed as an ingredient in many energy drinks. What is taurine? Is it safe?', Available: http://www.mayoclinic.org/healthy-living/nutrition-and-healthy-eating/expert-answers/taurine/faq-20058177
9) Hoffman, J.R., Ratamess, N.A., Ross, R., Shanklin, M., Kang, J & Faigenbaum, A.D 2008, 'Effect of a pre-exercise energy supplement on the acute hormonal response to resistance exercise', Journal of Strength Conditioning, vol.22, no.3, pp.874-882
10) Belmaker, R. H., 1994,' Inositol', European Neuropsychopharmacology, vol.4, no.3, pp.165-166
11) Schimpl, F. C., da Silva, J. F., Gonçalves, J. F. d. C., & Mazzafera, P., 2013, 'Guarana: Revisiting a highly caffeinated plant from the amazon', Journal of Ethnopharmacology, vol.150, no.1, p.14
12) Barton, D., 2011, 'Ginseng', Oncology, vol.25, no.4, p.42
13) Ginseng by Katharina Lohrie, licence CC 3.0, Available: http://commons.wikimedia.org/wiki/File:Ginsengpflanze.jpg
14) , 15) Rosenbloom, C., 2014, 'Energy Drinks, Caffeine, and Athletes', Nutrition Today, vol.49, no.2, pp.49-54
16) Hoffman, J.R., 2010, 'Caffeine and Energy Drinks', Strength and Conditioning Journal, vol.32, no.1, pg.15
17) Substance Abuse and Mental Health Screening Association, The DAWN Report, 2013,'Update on emergency department visits involving energy drinks:a continuing public health concern' Available: http://www.samhsa.gov/data/2k13/DAWN126/sr126-energy-drinks-use.pdf
18) Torpy, J.M. & Livingston, E.H 2012, 'Energy Drinks', Journal of the American Medical Association, vol.309, no.3, p.297
19) Gunja, M. & Brown, J.A. 2012, 'Energy Drinks: Health Risks and Toxicity', Medical Journal of Australia, vol.196, no.1, pp. 46-49
20) Ellis, M., 2013, 'Energy drinks alter heart function, study shows', Medical News Today, Available: http://www.medicalnewstoday.com/articles/269569
22) ABC News, 2013, 'Red Bull Drink Raises Red Flag', Available: http://abcnews.go.com/WNT/story?id=130751
23) Kamenev, M., 2012, 'Schoolgirl death sparks call for alcoholic energy drink ban', Australian Medical Observer, Available: http://www.medicalobserver.com.au/news/schoolgirl-death-sparks-call-for-alcoholic-energy-drink-ban
24) SMH, 2007, 'Man's heart stops after Red Bull overdose', Available: http://www.smh.com.au/articles/2007/08/18/1186857834956.html

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