When Energy Drinks Turn Deadly

The US Food and Drug Administration (FDA) is investigating a series of deaths reportedly linked to the consumption of energy drinks and shots. The investigation comes amid a growing number of reports of various adverse events related to energy drink consumption.

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Energy drink consumption has grown exponentially over the past five to ten years. The main active ingredients of such drinks, which include Red Bull and Mother, are a combination of varying amounts of caffeine, guarana extract, taurine and ginseng. Other additives include carbohydrates, amino acids and vitamins.

The intended purpose of these drinks, according to the manufacturers, is to sustain alertness, so their target markets are athletes, students, and people in professions that require prolonged alertness. Energy drinks are also commonly consumed at nightclubs and dance parties, where they are often combined with alcohol, and recreational drugs, such as ecstasy.

MORE: Energy Drink Overdoses On The Rise

The adverse effects of these energy drinks, either alone or in combination, are being increasingly reported worldwide, and recently in Australia.

Caffeine and other additives

The main component of energy drinks is caffeine and it has been associated with many adverse health outcomes in susceptible individuals. In terms of heart health, there are three main effects – increased heart rate, increased blood pressure, and evidence of increasing blood viscosity that can lead to clots forming in the heart and beyond.

Three independent cases where consumption of energy drinks led to catastrophic consequences, including cardiac rhythm disturbances and cardiac arrest, have recently been described in medical literature.

To be clear, these are life-threatening cardiac rhythm disturbances that can lead to sudden death, particularly in young people. And these effects have been observed with the consumption of as little as one can of energy drink.

Energy drink consumption has also been linked to anxiety, insomnia, vomiting, nervousness, addictive behaviours, and panic attacks. In pregnant women, caffeine consumption is associated with risk of late miscarriage, stillbirth, and small-for-gestational-age infants.

MORE: What Caffeine Actually Does To Your Brain

The other additives in energy drinks exacerbate many of these effects. And the manner in which these drinks are marketed – to be drunk fast and in high concentrations for a quick energy boost – magnifies their adverse effects. Indeed, the introduction of "energy shots", the small volume, high-concentration shots of caffeine, guarana and taurine, available at petrol stations and the like, support this marketing strategy.

What to do?

The major challenges for both health professionals and the general community is the vast array of energy drinks on the market, the differences in their content, and that overall, the industry is largely unregulated. And the fact that the target of these types of energy drinks clearly includes children, adolescents and young adults is cause for great concern.

It's likely that people will be unaware of the variations in the chemical composition and caffeine dosage in energy drinks. And with minimal and poorly stated warnings on energy drink cans, the potential for adverse effects, overdose, poisoning, and potentially death all remain distinct possibilities.

In Australia, energy drinks are regulated under Standard 2.6.4 of the Code by the Food Standards Australia New Zealand (FSANZ), and the maximum amount of caffeine allowed is 320 milligrams per litre. But because many energy drinks are sold in small volumes, their numerous additional additives exceed this limit.

A typical can of energy drink contains up to 300 milligrams of caffeine, from added caffeine and natural sources such as guarana, but importantly, in volumes far less than a litre – usually 200 millilitres or less. This includes "energy shots", which clearly also don't meet the requirements of Standard 2.6.4. Many energy drinks are also marketed as "dietary supplements" or "conventional foods" in an attempt to circumvent standard requirements of both the FDA and FSANZ.

Given the potentially catastrophic consequences of energy drink consumption in susceptible young people, we clearly need greater community education and awareness. This may require somewhat drastic measures, such as clear, graphic warnings on energy drink cans to warn people of their potential dangers (much like the highly successful packaging of cigarette cartons which include images of the consequences of smoking, such as cancer).

Another initiative may be to restrict the sales of energy drinks to children and adolescents, who are often the target of energy drink advertising and who face significant peer influence. The collective goal of such measures is to protect the young by raising community awareness of the potential detrimental effects of energy drinks.

Needless to say, the outcome of the current FDA investigation into the 13 reported deaths will be followed in Australia with great interest.

Chris Semsarian is Professor of Medicine at the University of Sydney

The Conversation This article was originally published at The Conversation. Read the original article.


Comments

    Such a massive issue, since children and adolescents can buy and drink such substances. Soft drinks are worse enough, energy drinks are insanely unhealthy.

    If people are drinking more than the recommended amount per day then they've only got themselves to blames.

      To be clear, these are life-threatening cardiac rhythm disturbances that can lead to sudden death, particularly in young people. And these effects have been observed with the consumption of as little as one can of energy drink.

      I think one can is well within the recommended amount.

        I agree these drinks do need age restrictions and more warnings. One small can of V is enough to make my heart beat irregularly, as I have learnt the hard way.

      Yeah as the recommended amount of that crap to drink is zero.

        where's the gun to your head forcing you to drink it?

          I don't drink it, not sure that your reply is relevant. you said not to exceed the recommended amount I said it's not recommended that you drink it at all, there's no RDI for poison.

          Last edited 27/11/12 5:34 pm

    And here come the laws to save us from ourselves yet again.

    My first instinct is to equate energy drinks with a hammer, in the sense that used properly there's nothing very dangerous about a hammer, but used recklessly it can easily become a problem.

    However the trouble with food safety is that our knowledge of how different foods affect our bodies is far from complete - and this changes every week with a new flavour, preservative, colour or "nutrient". By contrast, we have a pretty good handle on how blunt-force impact affects our bodies.

    I don't think we need laws to protect us from ourselves. Rather I think people could be a lot less trusting that "if it's in a food aisle, it's OK to eat/drink"

      Unfortunately there are those that are not smart enough to think for themselves, and are only quick to blame and sue the state when something goes wrong.

      It's because of this that the hammer wants to go all nanny, and not because they want to be all nanny.

        In terms of energy drinks, I agree. No need be be nannying. People tend to expand that same argument to things like drink driving, speeding, and gun ownership though... in those cases the nannying argument doesn't apply since the problem there is harm to others, not one's self.

    Keeping in mind that in the US you can pickup an energy drink with 500mg of caffeine, plus the taurine and plus the guarana, for a staggeringly higher amount of caffeine than available here in AUS. and that is just a standard energy drink. Some in the US have ridiculous amounts of all of that and its perfectly legal.

      This would be the same US where you can buy assault rifiles for home defence?
      Providing an example of something worse doesn't make this better.

      ... although at least in Murica I'm fairly sure that i can pistol-whip someone* for exposing bystanders to the nauseating stench of their cough-syrup/cordial/nodoze/bulldust cocktail on the train and then having the audacity to breath.

      (* disclaimer - this might not be true)

      Most of guarana's stimulant effect is from the high caffeine content it has (though there are some other mild stimulants in there). To my knowledge it's always included in the reported caffeine content.

      Taurine isn't a stimulant and is already produced by your body. It's safe to have in pretty large doses. If you want to know what's causing your heart palpitations, the most likely culprit is caffeine.

      And of course, if you want a dangerous dose it's hard to go past good old coffee. One of these babies puts 230mg of caffeine in 185ml and sets you back a whole $2: http://www.bickfords.net/products/cafecino.html

    Didn't I read somewhere that coffee has between 100-150 mg of caffeine per cup (http://www.lifehacker.com.au/2011/04/coffee-vs-tea-infographic-lays-out-health-benefits-and-risks/)? I'm all for fixing up loopholes that allow energy drinks to be sold as dietary supplements, but be reasonable. The FDA is only just starting the process of investigating claims - lets wait for their results, measure them against our own regulations, look for any inadequacies and then decide on what actions to take.

    I remember traveling to the states for the 8 years ago and first t noticed they had 500ml energy drinks as standard (which we have adopted only recently). And as with any product selling in a competitive market , the need to be bigger and better than the next one has created a potentially dangerous and slow to regulate market. And as previously said kids/students get hooked on these drinks and larger sizes which is detrimental to their health.

    Coles is selling 1.2L bottles of V, http://t.co/QNWjt8dt, ... and it has this pathetic 'warning' on the side; http://t.co/NMPCM7kB

    So I shouldn't be taking anywhere up to 4 200mg caffeine caps everyday...?
    No joke...
    I work anywhere from 10-14 hours 6 days a week! If I don't have a large amount of caffeine everyday I actually cannot function.

    I don't like the taste of Coffee or most energy drinks, so I don't drink many of those either. Maybe the occasional Sugar Free Red Bull (Yes I know the fake Sugar is bad) that's about all.

    I'm quite healthy and go to the gym 3-4 times a week and run anywhere from 20-30kms.

    Long story short, I consume way more than the recommended amount of caffeine, and yes I definitely think I am addicted to it. But besides problems with my liver and kidneys in 10-20 years I am functioning fine...

      "If I don't have a large amount of caffeine everyday I actually cannot function."

      This is true for any drug addict, you could function for 10-14 hours a day without it, but first you'd have to break the addiction and let your body go through an adjustment period.

        Yeah, I'm actually thinking of slowly reducing the amount of caffeine I'm taking over the christmas / new years period.

        I get really bad headaches if I don't take it haha my body has definitely addicted to it.

          Dude - even if RB is not as dangerous as the article paints it to be - its probably a good idea to start detoxing yourself before you get dangerously dependant on it. If anything because its such a PITA/hassle to continue living like that.

    Well I myself have seen how energy drinks change people in literally minutes. Horrifying stuff.

    1 can of energy drink = 300mg caffeine
    2 cups of coffee = 300mg caffeine

    I don't see the difference. Unless we start banning coffee. How come one caffeinated beverage is 'horrifying stuff' and the other is totally legitimate?

    Horrible things, nasty taste and bad for you. However I don't understand the point about the amount of caffeine allowed per litre. How does a smaller container affect that? Surely if the max is 320mg/l then the max is 60mg for 200ml? Have I misunderstood?

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