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Energy drinks implicated in multiple deaths

Robin Wulffson MD's picture
energy drinks, caffeine, deaths, emergency department visits, alcohol

Energy drinks are coming under increased scrutiny because evidence is increasing that the high caffeine content of these beverages is implicated in multiple deaths and thousands of emergency department (ED) visits. Two US senators, Illinois Sen. Dick Durbin and Connecticut Sen. Richard Blumenthalare, are urging the Food and Drug Administration (FDA) to restrict caffeine levels in certain energy drinks, which have been associated to deaths.

In addition, a New York attorney general and the city attorney of San Francisco are asking the manufacturers of energy drinks to provide additional information when marketing their products.

The drinks in question include NOS, Full Throttle, Red Bull, Amp and 5-hour Energy drink. On November 15, the FDA announced it was looking into claims that 5-hour Energy was linked to 13 deaths over a four-year period. According to a report by the Substance Abuse and Mental Health Services Administration (SAMHSA), the number of emergency room visits due to energy drinks increased tenfold in four years, from 1,128 in 2005 to 13,114 in 2009. Approximately half of the energy drink-related ED visits (52%) made by patients aged 18 to 25 involved combinations of energy drinks with alcohol or other drugs. The majority of the ED visits were made by males (males: 64%; females: 36%); furthermore, visits by males were more likely than visits by females to involve energy drinks in combination with alcohol (20% vs. 10%) or illicit drugs (12% vs. 5%). However, ED visits made by females were more likely to involve energy drinks in combination with pharmaceuticals than visits by males (35% vs. 23%t). When examined regarding the reason for the ED visit, more than two thirds (67%) of visits involving energy drinks were classified as adverse reactions.

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Energy drinks are flavored beverages, which contain high amounts of caffeine and typically other additives, such as vitamins, taurine, herbal supplements, creatine, sugars, and guarana, a plant product containing concentrated caffeine. These drinks are sold in cans and bottles and are readily available in grocery stores, vending machines, convenience stores, as well as bars and other venues where alcohol is sold. These beverages provide high doses of caffeine that act as a stimulant to the central nervous system and the cardiovascular system. The total amount of caffeine in a can or bottle of an energy drink varies from about 80 to more than 500 mg of caffeine, compared with about 100 mg in a 5-ounce cup of coffee or 50 mg in a 12-ounce cola.

SAMHSA notes that research suggests that certain additives may compound the stimulant effects of caffeine. In addition, some types of energy drinks may also contain alcohol, producing a hazardous combination. Although consumed by a range of age groups, energy drinks are marketed to appeal to youth and are consumed by 30-50% of children, adolescents, and young adults. Marketing for energy drinks often targets young people, suggesting benefits such as increased energy and stamina, weight loss, and enhanced physical and/or mental performance. SAMSHA notes that consumption of energy drinks is a rising public health problem because medical and behavioral consequences can result from excessive caffeine intake. A growing body of scientific evidence documents harmful effects, particularly for children, adolescents, and young adults. Among college students, associations have been established between energy drink consumption and problematic behaviors such as marijuana use, sexual risk taking, fighting, smoking, drinking, and prescription drug abused. In one study, bar patrons who consumed alcohol mixed with energy drinks were three times more likely to leave a bar highly intoxicated and were four times more likely to intend to drive while intoxicated than those who did not consume alcohol mixed with energy drinks. This latter finding may be because the high levels of caffeine found in energy drinks can mask the symptoms associated with being intoxicated (i.e., feeling sleepy or lethargic). Individuals, especially youthful drinkers, may incorrectly believe that consumption of caffeine can “undo” the effects of alcohol intake and make it safe to drive after drinking.

In the letters to the FDA, senators Durbin and Blumenthal urged the agency to classify energy drinks in the same category as soft drinks. The FDA limits caffeine levels in beverages to approximately 70 mg per 12-ounce soda. However, energy drinks fall into another category: food supplements; thus, they are not subject to the same regulations. The senators argue that energy drinks are sold alongside sodas in very similar packaging and should be considered beverages, not supplements. In a letter responding to the senators, the FDA said it is in the process of re-writing guidelines for the industry on this issue. Furthermore FDA spokesperson Shelly Burgess noted that the “FDA is considering several citizen petitions requesting limits on caffeine in foods and requiring that labels state these limits.” She added that many soft drinks have much higher levels than 70 milligrams per 12 ounces, or the amount is misrepresented. She also noted that energy drinks are particularly dangerous for adolescents and children, who obviously have smaller capacities for caffeine.

Substance Abuse and Mental Health Services Administration

See also:
Inaccurate caffeine labeling of energy drinks may have serious health consequences
Sambazon refutes Consumer Reports review of its energy drinks