Reviews
Safety issues associated with commercially available energy drinks

https://doi.org/10.1331/JAPhA.2008.07055Get rights and content

Abstract

Objective

To describe benefits and adverse effects associated with the consumption of energy drinks.

Data sources

Searches were conducted using Medline, IPA (International Pharmaceutical Abstracts), EMBASE, and MANTIS; databases such as Natural Medicines Comprehensive Database, Natural Standard, ALTMEDEX, and AltHealthWatch; and Google (range 1980 to September 2007). Search terms included energy drink, Red Bull, caffeine, glucose, ginseng, guarana, taurine, and bitter orange.

Data synthesis

Most energy drinks contain natural products such as guarana, ginseng, and taurine. As much as 80 to 300 mg of caffeine and 35 grams of processed sugar per 8-ounce serving are commonly present in energy drinks such as Cocaine, Pimp Juice, Red Bull, and Spike Shooter. No reports were identified of negative effects associated with taurine, ginseng, and guarana used in the amounts found in most energy drinks. Commonly reported adverse effects seen with caffeine in the quantities present in most energy drinks are insomnia, nervousness, headache, and tachycardia. Four documented case reports of caffeine-associated deaths were found, as well as four separate cases of seizures associated with the consumption of energy drinks.

Conclusion

The amounts of guarana, taurine, and ginseng found in popular energy drinks are far below the amounts expected to deliver either therapeutic benefits or adverse events. However, caffeine and sugar are present in amounts known to cause a variety of adverse health effects.

Section snippets

Objective

The purpose of this review is to identify the potential for any benefits or adverse effects (AEs) associated with the consumption of energy drinks.

Methods

Searches were conducted using the terms energy drink, sports drink, Red Bull, caffeine, glucose, ginseng, guarana, taurine, bitterorange, ephedra, alcohol, efficacy, and safety using databases such as Medline, IPA (International Pharmaceutical Abstracts), EMBASE, and MANTIS (range 1980 to September 2007), as well as Natural Medicines Comprehensive Database, Natural Standard, ALTMEDEX, and AltHealthWatch. Internet search engines such as Google were also used to locate relevant information. In

Overview of ingredients

Ginseng, taurine, bitter orange, guarana/caffeine, and glucose are among the most common ingredients used in energy drinks. They are used in combination for their real or supposed synergistic effects of increased stimulation. Each of these popular components is discussed in detail in the following sections.

Ginseng

Many varieties of ginseng exist. The most commonly studied variety is Panax ginseng, also known as Korean or Asian ginseng, which is found principally in Korea, Japan, and China.6 Other names

Additional health issues

Energy drinks have been implicated in a number of health-related concerns in recent years. Their effects range from being a contributing factor in obesity to exacerbating symptoms in manic phases in patients with bipolar disorder to causing new-onset seizures. Effective identification of and intervention in at-risk patients by pharmacists is essential. Examples of the potential negative impact of energy drinks and their components on health are provided below.

Discussion

Although all of the natural products contained in energy drinks are touted for their use in various diseases and conditions, with several demonstrating some efficacy at improving either energy or cognitive function, recognizing that energy drinks generally do not contain the therapeutic doses of “natural” dietary supplements necessary to achieve these effects is important. Manufacturers would like consumers to believe that consuming energy drinks has beneficial health effects as opposed to

Conclusion

Little evidence exists in the literature to support beneficial effects of energy drinks. Mechanistically, purported benefits are equally unlikely because the amounts of guarana, taurine, and ginseng found in popular energy drinks are far below the amounts expected to deliver therapeutic benefits. Similarly, the potential for serious AEs is improbable because of the small amounts of those natural products added to the drinks. However, energy drinks can present a safety concern. In particular,

References (55)

  • S.J. Iyadurai et al.

    New-onset seizures in adults: possible association with consumption of popular energy drinks

    Epilepsy Behav.

    (2007)
  • N. Ogawa et al.

    Secondary mania caused by caffeine

    Gen Hosp Psychiatry.

    (2003)
  • G.A. Bray et al.

    Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity

    Am J Clin Nutr.

    (2004)
  • J.A. Von Fraunhofer et al.

    Effects of sports drinks and other beverages on dental enamel

    Gen Dent.

    (2005)
  • D. Bauerlein

    Students ride a wave of caffeine to study hall

    (29 August 2007)
  • K.A. Dolan

    Billionaires: the soda with buzz. Accessed at

    (29 August 2007)
  • A.E. Cruse

    FDA warning letter regarding Cocaine

    (29 August 2007)
  • Redux beverages parties bi-continental style.

    (29 August 2007)
  • D. Kiefer et al.

    Panax ginseng

    Am Fam Phys

    (2003)
  • Natural Medicines Comprehensive Database

    (29 August 2007)
  • Natural Standard: the authority on integrative medicine

    (29 August 2007)
  • M.S. Bahrke et al.

    Evaluation of the ergogenic properties of ginseng: an update

    Sports Med.

    (2000)
  • H.-J. Engels et al.

    Effects of ginseng on secretory IgA, performance, and recovery from interval exercise

    Med Sci Sports Exer.

    (2003)
  • R.R. McCusker et al.

    Caffeine content of energy drinks, carbonated sodas, and other beverages

    J Anal Toxicol.

    (2006)
  • BEVNET. Beverage reviews

    (29 August 2007)
  • M. Sowry

    The ultimate energy drink: Cocaine? ABC News

    (29 August 2007)
  • R. Seidl et al.

    Ataurine and caffeine-containing drink stimulates cognitive performance and well-being

    Amino Acids.

    (2000)
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    Continuing education credits: See learning objectives below and assessment questions at the end of this article, which is ACPE universal program number 202-000-08-142-H01-P in APhA's educational programs. The CE examination form is located at the end of this article. To take the CE test for this article online, go to www.pharmacist.com/education and follow the links to the APhA CE center.

    Disclosure: The authors declare no conflicts of interest or financial interests in any product or service mentioned in this article, including grants, employment, gifts, stock holdings, or honoraria.

    Acknowledgments: To the following students for assisting with manuscript preparation: Princess Dorvilien-Scutt, Franky Jean, and Carrie Starkey.

    Published concurrently in Pharmacy Today and the Journal of the American Pharmacists Association.

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