Jairred Killeem, 10, and sister Mikinna, 12, got permission from their dad before trying a can of Monster energy drink, at Monster Energy Motocross Nationals at Sand Del Lee track in Richmond, Ont., Aug. 6, 2011. Health Canada has spent the last 20 months wrestling with whether to try to rein in the fastest-growing category in the beverage industry, according to thousands of pages of internal records released under access to information legislation. Photograph by: David Kawai , Postmedia News

Brandon Stephenson and Shane Stephens blend in perfectly at the Sand Del Lee race track, their summer stomping ground as amateur motocross riders. On this special August weekend, the motocross park on the outskirts of town is teeming with teenage boys who, like these kids, are sporting gear that carries the logo of their favourite energy drink as they watch a round in the Monster Energy Motocross Nationals. "When you're racing, an energy drink gives you the extra boost to get you to the front of the line. Pop is good, but there's something they put in Monster," Brandon, 15, says of his habit of downing a can or two during his weekend practice runs. "It's not like a drug, but it's good," chimes in his cousin Shane, 13. Back in 2004, when Health Canada approved the sale of another energy drink, Red Bull, as a natural health product for adults — the first in Canada — the regulator may not have anticipated this scene. Red Bull's elevated levels of caffeine meant the Austrian company could make a health claim that its drink provides an energy boost or, in the words of its tagline: "gives you wings." Applications from other energy drink makers, such as the Monster Beverage Company, started flooding Health Canada's natural health products directorate. Each sought approval to sell its own therapeutic drink, relying on high-caffeine content to make the same claim: The product temporarily restores mental alertness and wakefulness if you're feeling tired or drowsy. By 2005, Health Canada had acknowledged the growing popularity of energy drinks, and explained it was trying to figure out if the department needed to revisit how it regulated the drinks, given the product's attraction for teenagers and children. Today, six years later, Health Canada is struggling to sort out what to do about energy drinks, now dubbed internally as one of the department's "hot issues." After approving the sale of nine energy drinks and allowing another 157 products such as Rip It Energy Fuel, Monster Nitrous Killer-B and N.O-Xplode Igniter Shot on the marketplace, Health Canada has spent the past 20 months wrestling with whether to rein in the fastest-growing category in the beverage industry. Caffeine, a main active ingredient in energy drinks, isn't illegal. But it is a stimulant that, in high doses, can have serious side effects, such as seizures, heart problems and changes in mood and behaviours. Children and teens with underlying health problems, or those taking certain kinds of medications, can be especially susceptible to high amounts of caffeine. Health Canada won't talk about its plans for dealing with the issue of energy drinks and children and teens, or discuss the recommendations of an expert panel convened last year by Health Minister Leona Aglukkaq. But thousands of pages of internal records released under access to information legislation offer a glimpse at the conundrum in which the federal regulator finds itself. Are energy drinks simply getting a bad rap based on public pressure rather than science, as the beverage industry says? Or are there enough signs of health risks for young people to warrant new warning labels on the cans and perhaps even more drastic restrictions considered by Health Canada?

The stakes are high. Even though carbonated soft drinks continue to dwindle in overall sales, pop still thumps energy drinks in terms of market share. For every case of energy drinks sold, an estimated 36 cases of carbonated pop are sold, according to the U.S. trade publication Beverage-Digest. But editor and publisher John Sicher said the value of energy drinks comes in profit margins, not in the number of cases sold. "Energy drinks are important because they are premium priced. They are very profitable for the beverage companies and for the retailers," Sicher told Postmedia News. Young people form an important segment of the energy-drink market, even though the industry says the beverages are formulated and recommended for adults only. Canadian data are unavailable, but according to U.S. research, children under the age of 12, teenagers and young adults ages 19 to 25 make up half of the energy-drink market. Health professionals have become increasingly vocal about energy drinks, with a particular focus on how young people are drawn to them. The drinks are sold in flashy cans as big as 550 ml loaded up with 235 mg of caffeine. For comparison purposes, a regular 355 ml can of cola contains 44.94 mg of caffeine. A tall cup of brewed coffee at Starbucks contains 260 mg of caffeine. Marketing slogans such as "Amp Up," "Unleash the Beast, and "Bigger. Better. Faster" are complemented by energy-drink companies' high-profile sponsorship of motocross, skateboarding, and wakeboarding competitions — always big hits with younger people. "They're where the kids are," says Dwayne Killeen, who attended the August motocross championship sponsored by Monster with his three children, ages 12, 10 and six. Last year, the Canadian Medical Association Journal published an editorial, saying "caffeine-loaded energy drinks have now crossed the line from beverages to drugs delivered as tasty syrups." The editorial called for more prominent labels listing total caffeine content and an end to advertising targeting children. The American Academy of Pediatrics went farther in June, when it published a clinical report, saying energy drinks pose potential health risks because of the stimulants they contain. The products should never be consumed by kids and teens, the report concluded. "We wouldn't tell kids, 'Why don't you just drink two large cups of coffee because you have a test today and you need energy, or have a couple of cups of coffee so you can play better at soccer,'" said Dr. Holly Benjamin, co-author of the U.S. academy's report and professor of pediatrics at the University of Chicago, in an interview. "The bottom line is it's a stimulant drug. It's addictive and it can have serious side effects." It's unknown whether Health Canada finds these arguments persuasive because the department has declined multiple Postmedia News requests to interview departmental experts about energy drinks. What is clear from internal records is the file is very active and senior departmental officials have been fully engaged in it, including the minister's office. The records also indicate significant measures have been on the table, including product recalls, but Health Canada has so far stopped short of implementing any of them as it considers feedback from the beverage industry and weighs the recommendations of its own expert panel.

For example, in February 2010, senior officials met to discuss the "potential for recall, stop sale vs. sending of Section 16 notices," according to a senior adviser to an assistant deputy minister in health. Section 16 of the natural health products regulations, which has only been used nine times and never for an energy drink, is a tool used when the health minister "has reasonable grounds to believe that a natural health product may no longer be safe when used under the recommended conditions of use." Once notices are issued, manufacturers are required to provide any adverse reaction and consumption data within 15 days to illustrate the products "are indeed safe" when used properly. Aglukkaq agreed to issue Section 16 letters in June 2010 on the recommendation of departmental staff, but Health Canada opted instead to make the request on a voluntary basis, a measure with which companies complied. Justin Sherwood, president of the Canadian Beverage Association, said the request yielded very few reports, emphasizing this is an indication of the product's strong safety record. Health Canada had also planned to announcenew cautionary labelling rules by March 2010, requiring energy-drink makers to add a risk statement on cans about how "irregular heart rate or rhythm have been known to occur, in which case discontinue use and consult a health care practitioner." (Companies are already required to state on cans sold in Canada that the drink is not recommended for children, pregnant nor breastfeeding women, nor caffeine sensitive persons, and that it is not to be mixed with alcohol.) The labelling proposal, considered alternately as "high priority" and "extremely high priority" in internal correspondence, is now stalled after the industry group questioned the scientific basis for the cardiac statement. The association provided two reports commissioned by independent experts challenging Health Canada's analysis of 59 adverse reactions reported to the department. The list includes 32 incidents classified by the department as "serious," of which 15 involved the cardiac system. Seven of these cardiac-related incidents involved teens ages 13 to 18, all within the recommended use. But Health Canada's own assessment could only make a "probable" link to the energy drink in one of these cases, the records show. And in the two most serious cases — involving the deaths of teen boys in 2006 and 2008 — Health Canada classified the cause as "unclassifiable" — meaning the information was insufficient or contradictory, and could not be supplemented or verified. "The levels of caffeine in energy drinks are generally equal to or less than the amount found in a typical serving of coffee. There is no effort being made by the federal government (or anyone else) to regulate the labelling of coffee- and tea-based beverages, or other sources of caffeine. Energy drinks should be addressed in a non-discriminatory manner," the industry association wrote to Health Canada in March 2010. Raising the spectre of a likely challenge at the World Trade Organization, the association also accused Health Canada of being "completely out of step with the way these products are labelling in rest of world, and will result in total lack of harmonization with other major regulatory jurisdictions that are also Canada's major trading partners."

Labels aside, the industry could have bigger problems coming down the pike, even though it says energy drinks are already more tightly regulated in Canada than in any other country. The energy-drink sector is fretting about what Health Canada's expert panel report recommended to Aglukkaq in November. Health Canada is mum on both the panel's membership and its recommendations, but the group tackled the idea of placing strict parameters on how energy drinks can be displayed and sold at convenience stores. Companies say they only market their products to adults, but kids such as Brandon and Shane have certainly taken note of the marketing campaigns for energy drinks, often placed next to soft drinks, juices and sports drinks at corner stores. "It's a pretty cool-looking design and it's got a nice taste to it," Brandon, sporting his Monster T-shirt, says of the Monster brand at the Monster motocross competition. For Jim Shepherd, he just wants to see some progress on the energy-drink file at Health Canada. Shepherd's 15-year old son, Brian, died in January 2008 after competing in daylong paintball tournament at which a Red Bull representative came and handed out samples of energy drinks. Witnesses reported seeing Brian drink one of the samples during the company's noon-hour visit. Around 7:20 p.m., while waiting for the awards ceremony, Brian collapsed and later died in hospital. The coroner ascribed Brian's death clinically to Sudden Arrhythmic Death Syndrome (SADS), but offered no plausible explanation for the cause of that arrhythmia, given he had no genetic markers demonstrating a pre-disposition to an arrhythmic event. Health Canada reviewed Shepherd's adverse reaction case, but concluded it was "unclassifiable" because "the time and amount of Red Bull ingested could not be confirmed." "We didn't know what an energy drink was. We had conversation with the kids about alcohol, cigarettes and sex. But we never had a conversation about energy drinks, and that's just as important," Shepherd told Postmedia News. He's equally adamant that Health Canada step up and do its job to protect families. In addition to his concerns about marketing and labelling, Shepherd said energy drinks should not be regulated as natural health products. "Truly, if you look at the definition of a natural health product, it's to mitigate disease, it's to improve a condition. I don't think you'd find any doctor that would take the recommended dosage of this product over the years and expect to be healthier." At the Monster Energy national motocross competition, Brandon offers his own words of wisdom. "Everything in moderation. There's a limit to everything," says Brandon, who has his own energy-drink rule during his weekend riding day. "Usually one, but if two is needed, two or three." sschmidt@postmedia.com Twitter.com/sarah_schmidt_

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