The Real Buzz About Energy Drinks
June 18, 2014
By Gizele Rubeiz, Penn Law’16
Many college students, including those at Penn, often feel overwhelmed by the amount of items on their to-do lists. Between balancing a combination of school work, extracurricular activities, and part-time employment, students often reach for a caffeine boost to keep them energized throughout the day. However, the source of that boost has increasingly been from energy drinks, instead of more traditional sources of caffeine, like coffee, tea and soda. But what if students and teenagers realized that their late-night “pick me up” is potentially dangerous? What if, next to the “Red Bull” or “Monster” label, there was a label warning of the possibility of “sudden cardiac arrhythmia” or “caffeine toxicity?”
Energy drinks are highly caffeinated beverages that contain greater concentrations of caffeine (as much as 505 milligrams of caffeine per container) than other caffeinated beverages (e.g., a 12-ounce cola, containing 34 to 54 milligrams of caffeine per serving, and a 6-ounce coffee, which can range from 77 to 150 milligrams of caffeine per serving).1 The main active ingredient in energy drinks is caffeine. In contrast to coffee (which, as a hot beverage, is sipped slowly),2 energy drinks are consumed cold and often quickly “chugged,” similarly to soda.
Energy drinks are sold next to sodas in grocery stores, vending machines, and convenience stores, and consumers purchase them in the same way they do sodas.3 However, because energy drinks are not considered a “cola-type beverage” under current federal law, they are not subject to the same regulations on caffeine that are imposed on sodas or other “colas,” which limits the amount of caffeine in sodas to .02%, or 71 milligrams per 12 ounces.4 As a result, “the caffeine concentration of the energy products surveyed is much higher than that of sodas for which the Food and Drug Administration (FDA) has generally recognized as safe… in contrast, popular energy drinks, such as NOS and Rockstar contain between 240 and 260 milligrams of caffeine per 16 ounce can.”5Recent surveys show that consumers—including teens, parents and coaches—are unclear about the differences between energy drinks and sports drinks, finding that adolescents do not differentiate between sports and energy drinks.6
Because of this lack of regulation, energy drinks have been linked with serious consequences, including death. Anais Fournier, a 14-year-old girl, died from a cardiac arrhythmia due to caffeine toxicity7 after consuming a Monster energy drink while she was at the mall with her friends. In addition, a 19-year-old in California, Alex Morries, died after consuming Monster beverages and in Oklahoma 16-year-old, Jason Hamric, suffered brain damage after drinking a Monster beverage. Government records also show that two 15-year-old males and an 18-year-old male died after drinking either Monster or Red Bull beverages in Canada. But, the dangers are not limited to teenagers—a case report indicates that a 28-year-old man drank 3 cans of an energy drink 5 hours before playing basketball, and after playing in the game for 30 minutes, lost consciousness and was hospitalized. Three days later, he died after sudden cardiac arrest.8
The FDA has received reports of deaths linked to energy drinks through its Adverse Event Reporting (AER) System, a database that collects information on harms resulting from the consumption of medications, foods and beverages, among other things.9 The AERs indicate that the FDA received 142 reports of adverse events involving energy drinks between January 1, 2004, and March 10, 2014, 34 of which involved death, often as a result of heart failure. Among the other reports, 42 involved life-threatening injuries, 82 involved injuries that were characterized as “serious,” and 115 incidents resulted in hospitalization. Of the fatalities, 23 were linked to 5-Hour Energy, 11 to Monster and one to Rockstar brand beverages.
However, despite these harms, energy drink manufacturers engage in marketing efforts that target teenagers and adolescents. These marketing practices have been effective at increasing energy drink consumption at a rapid rate, demonstrated by a 240% increase in sales from 2004 to 2009.10 In 2011, energy drinks were the fastest growing beverage market in the United States11and sales reached a record-high 9 billion dollars that year, a 16% increase from the previous year.12Sales of energy drinks to teens and young adults constitute the largest percentage, accounting for nearly $2.3 billion in sales.13
Approximately 30-50% of children, adolescents and young adults self-report consuming more than one energy drink per month.14A Senate report published last year found that despite the insistence of energy drink manufacturers that they do not target marketing to children, “the use of unconventional market practices combined with product design and placement on store shelves assists in creating product images that appeal to children and teens.”15 Testimony in a recent Maryland legislative hearing from beverage industry representatives indicated that the companies define “minors” as people less than 12 years of age, in defiance of state laws that define minors as those below 18 years of age.16 A lawsuit by the San Francisco City Attorney against the Monster Beverage Company documents online participants in viral marketing on Facebook and other venues who are as young as six years old.17As this reflects, energy drink companies stage an aggressive presence on social media and other online outlets and actively sponsor high school athletic events, concerts, and other areas in which teens (and college students) gather.18
The most significant step the FDA can take in order to reduce the number of fatalities linked with energy drinks is to require that energy drinks comply with the same regulations that limit caffeine in “cola-type beverages,” (.02%, or 71 milligrams per 12 ounces).19Further, energy drink manufactures should be prohibited from marketing to minors and should define “minors” as those under 18 years of age, in contrast to their current practice, which defies state law and defines minors merely as those under 12 years of age. These actions will help protect the public health from the threat of energy drinks, and ensure college students likely be far better informed about their harms, long before they arrive on campus.
1 Amelia M. Arria and Mary Claire O’Brien. “The ‘High’ Risk of Energy Drinks,”Journal of the American Medical Association 305, No. 6 (2011).
2 Arria and O’Brien, 2011.
3 Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (January 10, 2013). The DAWN Report: Update on Emergency Department Visits Involving Energy Drinks: A Continuing Public Health Concern. Rockville, MD.
4 See 21 C.F.R. § 182.1180
5 Congressman Markey, with Senators Durbin and Blumenthal. “What’s all the Buzz About? A survey of Popular Energy Drinks Finds Inconsistent Labeling, Questionable Ingredients, and Targeted Marketing to Adolescents.” April 10, 2013.
6 Committee on Nutrition and the Council on Sports Medicine and Fitness. “Clinical Report—Sports Drinks and Energy Drinks for Children and Adolescents: Are They Appropriate?” Pediatrics 127, No. 6 (2011).
7 Autopsy Report of Anais Fournier, Age 14, Hagerstown Maryland Resident Who Died After Consuming Monster Energy Drink.
8 Sema Avci, M.D., Ridvan Sarikaya, M.D., and Faith Buyukcam, M.D. “Death of a Young Man after Overuse of Energy Drink,” American Journal of Emergency Medicine 31 (2013).
9 Food and Drug Administration. “CAERS Reports Allegedly Related to Multiple Energy Drinks.” Obtained by CSPI through multiple Freedom of Information Act (FOIA) requests.
10 Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (November 22, 2011). The DAWN Report: Emergency Department Visits Involving Energy Drinks. Rockville, MD.
11 Seifert, et al., 2011.
12 Meier, Barry. (2012, October 23). More Than a Case of the Jitters. New York Times, p. B1. Retrieved from http://www.nytimes.com/2012/10/24/business/safety-becomes-a-concern-with-energy-drinks.html
13 Rath, 2012.
14 Seifert, et al. “An analysis of energy-drink toxicity in the National Poison Data System,” Clinical Toxicology 51, 566-574 (2013).
15 Congressman Markey, with Senators Durbin and Blumenthal. “What’s all the Buzz About? A survey of Popular Energy Drinks Finds Inconsistent Labeling, Questionable Ingredients, and Targeted Marketing to Adolescents.” April 10, 2013.
16 Stuart M. Pape, on Behalf of the American Beverage Association. Testimony in Opposition to House Bill 1273, Maryland House of Delegates, Economic Matters Committee. March 7, 2014.
17 Dorsey, Matt. “Herrera blasts Monster Energy’s lawsuit over unlawful marketing to youth, product safety,” City Attorney Dennis Herrera Statement. April 30, 2013.
18 Kwabena L. Blankson, Amy M. Thompson, Dale M. Ahrendt, & Vijayalakshmy Patrick. “Energy Drinks: What Teenagers (and Their Doctors) Should Know,”Pediatrics in Review 34, No. 2 (2013).
19 See 21 C.F.R. § 182.1180
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