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My stimulant of choice is coffee. I started drinking it in first-year university, and never looked back. A tiny four-cup coffee maker became my reliable companion right through graduate school. But since I stopped needing to drink a pot at a time, an entirely new category of products has appeared — the energy drink. Targeting students, athletes, and others seeking a mental or physical boost, energy drinks are now an enormous industry: from the first U.S. product sale in 1997, the market size was $4.8 billion by 2008, and continues to grow.

My precious coffee effectively has a single therapeutic ingredient, caffeine. Its pharmacology is well documented, and the physiologic effects are understood. The safety data isn’t too shabby either: it’s probably not harmful and possibly is even beneficial. (I’m talking about oral consumption — no coffee enemas. Please.) In comparison, energy drinks are a bewildering category of products with an array of ingredients including caffeine, amino acids, vitamins, and other “natural” substances and assorted “nutraceuticals,” usually in a sugar-laden vehicle (though sugar-free versions exist). Given many products contain chemicals with pharmacologic effects, understanding the risks, signs of adverse events, and potential implications on drug therapy, are important.

So are energy drinks just candied caffeine delivery systems? Or are these syrupy supplements skirting drug regulations?

The message

The ads are seductive. Who doesn’t want more energy? Who doesn’t want their mind and body “vitalized”? And don’t we have time-starved lifestyles? Initially envisioned for athletes, energy drinks are now marketed mainly towards teens and young adults, where uptake has been dramatic. Cross-promotion with extreme sporting events, and creating names like “Full Throttle,” “Rockstar,” and even “Cocaine” burnish the “extreme” image. The market is now segmented further with products targeted at women, vegetarians, diabetics, celiacs, and more. However you identify yourself, there’s probably an energy drink developed with you in mind.

The ingredients

Evaluating claims of efficacy and safety are complicated by the multiple formulations and versions of the products. Most energy drinks contain these ingredients (analysis based largely on the Natural Medicines Comprehensive Database (subscription required):

Risks

Side effects related to energy drinks appear to be largely due to the caffeine content. Thresholds are difficult to predict, given that tolerances to caffeine can vary. In general, the amounts of taurine, guarana, and other components are felt to be below the level necessary to cause noticeable adverse effects. While there have been serious adverse events reported with energy drinks including seizures and sudden death, clear causation has not been established.

Probably the biggest concern related to energy drinks is their consumptions by youths and adolescents, where caffeine’s effects are less well understood. Sugar and caffeine consumption are probably best minimized in this population, yet it’s clear that this is the target consumer.

The combination of energy drinks with alcohol — they are popular mixers — has been linked to a suppression of the traditional intoxication effects. There’s controversy over the sale of the deliberate combinations of the two ingredients, and some regulators have taken action to stop the sales of some products.

Regulation

Regulation of energy drinks varies by country. From an international perspective, the United States has one of the least regulated marketplaces. Caffeine limits that apply to cola drinks do not apply to energy drinks. In Canada, some energy drinks are federally approved as natural health products. For example, the authorized recommended use for Red Bull is:

Developed for periods of increased mental and physical exertion, helps temporarily restore mental alertness or wakefulness when experiencing fatigue or drowsiness.

The product has a specific caution not to consume more than 500mL (2 cans) per day, and that it is not recommended for children, pregnant, or breastfeeding women.

Given their noveltly in the market, and their growing popularity, expect regulatory approaches to vary around the world. Products like Red Bull have been subject to regulatory restrictions and even bans in some European countries.

Conclusion: How about a cup of coffee?

Neither innocuous nor toxic, energy drinks seem safe for adults when consumed in moderation. There’s no convincing evidence to back up the cognitive or athletic performance enhancement claims attached to the category, or to specific products. Despite the impressive lists of ingredients and slick marketing, these products are essentially caffeine delivery vehicles, most of which come loaded with sugar. The incremental risk from the other ingredients isn’t well understood, but is probably small when consumed occasionally.

So go ahead and enjoy your Red Bull. But when that liquid candy stops appealing to you, I’ve got some shade-grown, bird-friendly, passive-organic, fair-trade, home-roasted coffee for you to try.