Hooked on Energy Drinks? Experts Warn of Serious Risks

By Hugh C. McBride

If a growing number of experts and advocates get their way, it may become a bit more difficult for American teenagers to party like a "Rockstar."

In the aftermath of a Johns Hopkins University study that questions the safety of caffeine-rich energy drinks such Rockstar, Red Bull, and Monster, 99 drug abuse and addiction experts have signed a letter to the U.S. Food and Drug Administration requesting mandatory warning labels and restrictions on the manner in which these products are marketed.

The study was published on the ScienceDirect website and in the September 2008 edition of the journal Drug and Alcohol Dependence. Both the letter and the study were authored by Roland R. Griffiths, Ph.D., a professor of behavioral science and neuroscience at Johns Hopkins School of Medicine.

Too Much Caffeine
Energy drinks have been the subject of considerable concern as their popularity has soared in recent years, particularly in regard to their widespread consumption by adolescents and teenagers. Griffiths and the 98 other experts who signed the FDA letter are especially concerned about the amount of caffeine contained in these drinks, and the effect that that drug may be having on young consumers.

"The caffeine content of energy drinks varies over a 10-fold range, with some containing the equivalent of 14 cans of Coca-Cola," Griffiths said in a release that announced the publication of his study. "Yet the caffeine amounts are often unlabeled, and few include warnings about the potential health risks of caffeine intoxication."

Griffiths and co-authors Chad Reissig and Eric Strain directly addressed this issue in the abstract that introduced their study:

There are increasing reports of caffeine intoxication from energy drinks, and it seems likely that problems with caffeine dependence and withdrawal will also increase.

In children and adolescents who are not habitual caffeine users, vulnerability to caffeine intoxication may be markedly increased due to an absence of pharmacological tolerance. Genetic factors may also contribute to an individual's vulnerability to caffeine-related disorders including caffeine intoxication, dependence, and withdrawal.

The caffeine content of soft drinks is regulated by the FDA, and is limited to no more than 71 milligrams of caffeine per 12-ounce serving. According to Kathleen Doheny's Sept. 24 article on the WebMD website, the average 12-ounce can of Coke contains 34.5 milligrams of caffeine; Pepsi contains 38 milligrams of caffeine per 12 ounces; and Mountain Dew has 54 ounces in a 12-ounce serving.

Because energy drinks are classified as "dietary supplements," though, no FDA review or approval is required before these products hit store shelves. The Johns Hopkins researchers, Doheny reported, found that many of the most popular energy drinks contain considerably more caffeine than is found in the average soda:

Red Bull: 80 milligrams of caffeine per 8.3 oz. serving
Tab Energy: 95 milligrams of caffeine per 10.5 oz. serving
Monster and Rockstar: 160 milligrams of caffeine per 16 oz. serving
No Fear: 174 milligrams of caffeine per 16 oz. serving
Wired X505: 505 milligrams of caffeine per 24 oz. serving

Depending upon an individual's body weight and tolerance, ingesting 300 milligrams or more of caffeine can lead to symptoms that are similar to overdoses of other stimulants. Signs of caffeine intoxication can include restlessness, insomnia, excitement, irritability, and increased urination. Significantly larger overdoses can cause mania, depression, delusions, and disorientation. In severe cases, caffeine overdose can even be deadly.

In an Oct. 9 post on the Washington Post's "The Checkup" blog, writer Rob Stein noted that poison control centers reported at least 41 cases of energy drink-associated caffeine intoxication between 2002 and 2004. "And that's probably just the tip of the iceberg," Stein wrote.

Exacerbating the risk, Griffiths said in a Sept. 25 article on the ScienceDaily website, is that there is currently no requirement for manufacturers to list the caffeine content on energy drink cans. "It's like drinking a serving of an alcoholic beverage and not knowing if it's beer or scotch," the researcher said.

A Gateway To Alcohol Abuse?
In addition to risks that are directly associated with caffeine ingestion, energy drinks also pose dangers due to the manner in which they are often ingested. In the abstract section of their study, Griffiths, Reissig, and Strain noted that the prevalence of mixing energy drinks with alcohol may lead young consumers into other unhealthy behaviors:

The combined use of caffeine and alcohol is increasing sharply, and studies suggest that such combined use may increase the rate of alcohol-related injury. Several studies suggest that energy drinks may serve as a gateway to other forms of drug dependence.

At first glance, concerns about energy drinks serving as a "gateway" to more dangerous drug use may appear to contain a Reefer Madness-like sense of hyperbole - but as science writer Jill U. Adams noted in her Oct. 13 article in the Los Angeles Times, research supports this association between energy drinks and the misuse of other substances:

A survey of 795 college students found that respondents who drank at least six energy drinks a month were three times more likely to have smoked cigarettes, abused prescription drugs, and been in serious physical fights than were students who consumed fewer energy drinks. The members of the high-consumption group were also twice as likely to have smoked marijuana and had alcohol-related problems (including hangovers or blackouts). This study was published in the March/April 2008 edition Journal of American College Health.
A web-based survey of more than 4,000 college students found that almost one-fourth of those who had consumed any type of alcohol had mixed it with an energy drink, and students who drank the alcohol-energy drink cocktail reported more drinking-related consequences, such as unsafe sex, injury, or driving while intoxicated. The study was published in the May 2008 edition of the journal Academic Emergency Medicine.

Though the manufacturers don't directly advise their underage consumers to mix their drinks with alcohol, industry critics note that marketing slogans such as Rockstar's "Party Like a Rockstar," Monster's "Unleash the Beast," and Full Throttle's "Go Full Throttle or Go Home" implicitly endorse an "extreme" lifestyle and encourage reckless behaviors.

Calls For Regulation
The letter that Griffiths wrote to the FDA is the latest in a series of efforts to control the sale of energy drinks.

Until recent changes in their nation's laws, Finland, France, Iceland, and Switzerland had banned energy drinks that contained taurine (a popular ingredient) or elevated levels of caffeine. Bans on these drinks remain in place in Denmark, Norway, and Uruguay.

Closer to the United States, an article in the Sept. 22 edition of Canada's National Post newspaper reported that schools in three Canadian provinces had sent warning letters to parents about the risks associated with energy drinks, and that the health minister of Nova Scotia had halted plans by Red Bull distributors to hand out free cans of the drink outside a high school in that province.

"We are getting kids coming into school unable to put in any kind of work effort because they are so high on these drinks," Dr. Lamont Sweet, Prince Edward Island's deputy chief health officer told Post writer Tom Blackwell. "They are causing hyperactivity, excitement, agitation, [and] inability to concentrate."

To date, the FDA has not issued any public warnings related to the consumption of energy drinks, nor has the agency responded to calls for additional oversight of the manufacture and sale of these products.

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