Wednesday, November 12, 2014

Energy drinks and health risks… what’s all the buzz about?

The popularity of energy drinks has grown tremendously in the past decade. In the U.S. alone, sales of energy drinks have increased 10% every year between 2008 and 2012, with US sales estimated to be over $12.5 billion in 2012 (about $40 per person). Additionally, nearly 500 new brands hit the market worldwide in 2006 alone. There are certain segments of the population that are more likely to drink energy drinks; It is estimated that 30% of adults, 68% of adolescents and 18% of children below the age of 10 consume energy drinks. 

With this dramatic increase in caffeine consumption worldwide, attention has been drawn to how these high levels of caffeine can affect public health. International health authorities from the World Health Organization (WHO) have completed a review of research to see if energy drink consumption should be a concern. 

Risks associated with energy drink consumption

According to the WHO paper published in the journal Frontiers in Public Health, they warn that caffeine intoxication (an actual diagnosis, according to the DSM-V) can lead to irregular heartbeat, Type 2 diabetes, high blood pressure, nausea/vomiting, convulsions, psychosis, miscarriages and even death. Specifically, caffeine consumption in children and adolescents has been proven to negatively affect the cardiovascular and neurological systems and may lead to physical dependence and addiction. In adolescence, energy drink consumption is associated with greater risk for depression, sensation seeking, tobacco, binge drinking, and use of other harmful substances. Energy drinks are also commonly mixed with alcohol (over 70% of young adults who consume them, mix them with alcohol). The act of mixing alcohol and energy drinks is risky in itself, due to the combination of a suppressant and stimulant on the nervous system. It is also positively associated with other high-risk behaviors, such as marijuana use, sexual risk taking, illicit drug use, etc. 

Energy drinks vs. coffee/tea

You may be asking yourself, “why are health authorities concerned now? People have been drinking caffeine in coffee and tea for hundreds of years… what is the big deal with energy drinks?” There are several reasons why energy drinks pose a greater health risk than coffee or tea. First, the caffeine found in coffee and tea is self-limiting in nature; one or two cups of coffee gives you a pleasant caffeine high, however, drink five cups and you will feel sick to your stomach. Because of this self-limiting factor, it is very hard to get severe caffeine intoxication from naturally-occurring caffeine sources. Energy drinks, on the other hand, can be quickly consumed in large amounts and may not upset your stomach if you drink too much. Secondly, energy drinks may contain vastly more caffeine than coffee per serving; 1 oz of coffee contains approximately 20 mg caffeine, whereas some energy drinks contain more than 434 mg/oz (Energy Catalyst)… that’s over 20X more caffeine than coffee! Another reason energy drinks are of concern is due to lack of research examining the acute and long-term effects of the other ingredients contained in these drinks, such as guarana, glucuronolactone, B-vitamins, ginseng and taurine. Further research is still needed to determine additional health consequences of heavy and long-term energy drink consumption. 

WHO Policy Recommendations

In response to their findings, the World Health Organization outlined specific policy recommendations that would limit the harmful effects of energy drink consumption.

  1. Establish an Upper Limit (UL) for the amount of caffeine allowed in a single serving of any drink
  2. Restrict sales of energy drinks to children and adolescents due to potentially harmful adverse and developmental effects of caffeine on children
  3. Regulatory agencies (FDA) should enforce industry-wide standards for responsible marketing of energy drinks and ensure that the risks associated with energy drink consumption are well known

Bottom Line

If the U.S. is proactive on this issue, there will likely be an established UL for caffeine and there may even be age restrictions for purchasing energy drinks. For those of you who are coffee drinkers, you need not fear; while it is important to be aware of the negative health consequences of drinking too much caffeine, it’s also good to recognize that a moderate intake of caffeine can be healthy. Studies show that up to 400 mg (3-4 cups of coffee) of caffeine per day appears to be safe for most adults. And some studies show that a healthy level of caffeine may even provide additional health benefits, such as protecting against Parkinson's disease, type 2 diabetes and liver disease, including liver cancer. It also appears to improve cognitive function and decrease the risk of depression. So, as always, moderation is key!

- Ashley Hamm, MS, RD, LD/N


Breda JJ, Whiting SH, Encarnação R, Norberg S, Jones R, Reinap M and Jewell J (2014) Energy drink consumption in Europe: a review of the risks, adverse health effects, and policy options to respond. Front. Public Health 2:134. doi: 10.3389/fpubh.2014.00134

Caffeine Content of Drinks. Caffeine Informer Website. Accessed November 7, 2014. Available at:

Hensrud, D. Is coffee good or bad for me? Mayo Clinic Website. March 13, 2014. Accessed November 7, 2014. Available at: