Since the early 2000s, energy drinks have rocketed in popularity. By 2020, sales of energy drinks and shots such as Red Bull, Monster, Rockstar and 5-Hour Energy had reached $57.4 billion, according to investing website Investopedia. The industry is expected to grow another 7% between 2020 and 2025.
It’s easy to see why: From working moms to doctors on the night shift, Americans’ supply of good old-fashioned energy seems to be wearing thin.
But concerns about the drinks — which have been linked to heart and neurological problems, as well as poor mental health and substance use among teens — are rampant, too. Emergency room visits, hospitalizations and deaths have all been attributed to the drinks.
But what are these energy drinks, and are they really that bad?
What Are in Energy Drinks?
“Any drink that contains a stimulant compound” can be considered an energy drink, says Dr. Larry Nolan, a primary care sports medicine physician at the Ohio State University Wexner Medical Center in Columbus.
There are dozens of brands on the market, and each varies in the ingredients they contain. But most have some combination of:
— Carbonated water.
— Sugar or other sweeteners, including glucose, which is a type of rapidly absorbed sugar.
— B vitamins.
— Added colorings and flavorings.
— Supplements associated with energy, such as taurine, ginseng, guarana, glucuronolactone, yohimbe, carnitine or bitter orange.
Are Energy Drinks Safe?
Taken together, these ingredients add up to a daily fix for some people who aren’t getting enough sleep or otherwise need a daily jolt to keep up with modern life. But there can be a darker side to these beverages, particularly for kids and adolescents who may be more susceptible to the effects of certain stimulating compounds contained in the beverages.
Wroe says that in her opinion energy drink products aren’t safe, but adds, “this is based on context. If someone has one of these drinks on a very rare occasion, that singular act will likely not do much, if any, damage. But over time, there are lots of potential complications.”
There are several reasons to be cautious when downing energy drinks:
— Labeling confusion.
— Caffeine concerns.
— Sugar content.
— How they’re used.
One of the major critiques of energy drinks is that not all are well-regulated by the U.S. Food and Drug Administration. That means energy drink companies can market their products as dietary supplements and forgo a nutrition facts label, leaving consumers to wonder whether what they see is what they get, says Ruth Litchfield, an associate professor in the department of food science and human nutrition at Iowa State University in Ames.
“When a product has a supplements facts label, it has not gone through the FDA approval process to be on the market as a food item,” she says. “Whereas a nutrition facts panel goes through the FDA process of proving safety and efficacy before it goes on the market as a food product.”
Even FDA-approved energy drinks aren’t required to disclose how much caffeine and other stimulants they contain, Litchfield adds. “That’s the biggest problem I see: It’s not required on the label, and in most cases, they are not disclosing the total stimulant dose in the product for people to make an educated decision.”
Quite simply: The contents may not be exactly what the consumer expects, Nolan says.
Another issue, Wroe says, is the caffeine content. “Caffeine addiction and its relation to cardiac issues for some people is a concern.”
While experts believe it’s safe for most healthy adults to consume up to 400 milligrams of caffeine a day — about the equivalent of four 8-ounce cups of coffee or 10 cans of cola — downing multiple energy drinks daily could quickly put someone over that limit, increasing their risk for headaches, as well as boosting blood pressure and heart rate, Litchfield says.
A 2019 study in the Journal of the American Heart Association confirmed that consumption of these drinks altered heart rate and blood pressure.
The caffeine content of energy drinks can range from 80 milligrams in an 8-ounce Red Bull to 300 milligrams in 16 ounces of the no-calorie energy drink Bang, according to the nonprofit consumer advocacy organization Center for Science in the Public Interest. But for some drinks, their advertised caffeine counts could be underestimates, since they may not take into account caffeine from ingredients like guarana.
Most energy drinks contain between 80 and 120 milligrams of caffeine per serving, “but many people drink more than one per day or may have one in addition to several cups of coffee,” Wroe points out.
Determining how much caffeine is too much is an individual calculation, Wroe adds. “I work with people who are extremely caffeine sensitive and get jittery after only a small cup of green tea,” she explains. “Some people also don’t realize they’re sensitive because they’re used to the side effects. But once they ditch caffeine, they suddenly realize that they actually were consuming too much for their own unique body, even though it may still have been less than 400 milligrams.”
Overconsuming caffeine can lead to:
— Increased heart rate.
— Jitters, tremors and anxiety.
— Nausea or digestive issues.
Nolan adds that while generally speaking, 400 milligrams of caffeine can be tolerated by most healthy adults, some people need to consume far less, including:
— Children and young adults.
— Pregnant or breastfeeding people.
— People with high blood pressure or other cardiovascular conditions.
— People with diabetes.
In addition, these drinks also usually contain large amounts of sugar — often as much as or more than a can of soda. “The neurological and metabolic effects of excessive liquid sugar and artificial sweeteners is my main concern with these products,” Wroe says.
High consumer demand for lower-carb or sugar-free alternatives has led “many of the most popular brands to carry low- or no-sugar versions of their drinks as well,” she notes. To make them sweet, the manufacturers use a variety of artificial sweeteners, including acesulfame K (or acesulfame potassium), aspartame and sucralose.
Using artificial sweeteners certainly removes calories, but it may not improve the overall health profile of the beverage, because all of these compounds have “been correlated with neurological side effects and insulin resistance,” Wroe adds.
[See: Foods That Age You.]
How They’re Used
There’s also a major concern regarding “how people are drinking these products,” Wroe says.
For example, if you’re mixing them with alcohol, you might want to rethink that. Research compiled by the Centers for Disease Control and Prevention suggests that caffeine can mask some of alcohol’s effects and raise drinkers’ chances of binge drinking. A study in the journal Alcoholism: Clinical and Experimental Research found that participants who drank a cocktail with Red Bull and vodka had a greater urge to keep drinking than those whose drinks included a soda water-based fruit drink instead of Red Bull.
Alcohol is a depressant, but when combined with caffeine or other stimulants, you may not feel as intoxicated as you actually are. That can bring about a whole host of other issues, such as encouraging binge drinking, drunk driving, unwanted or unprotected sex or alcohol-related accidents and injuries. The National Center for Complementary and Integrative Health reports that about 25% of college students consume alcohol with energy drinks, leading to significantly more binge-drinking than is found among students who don’t mix them.
In addition, Wroe says that if you’re replacing meals with these drinks, that can also lead to trouble. At the other end of the spectrum, if you’re consuming energy drinks alongside a diet that’s heavy in processed foods, that can also be problematic. All of these factors can compound the effects of these drinks and potentially set you up for health concerns.
A Sometimes Drink
Bottom line, Wroe says, is that as with any food, moderation is key. “Basically, asking if energy drinks are safe is like asking if donuts or soda or deep-fried Twinkies are safe. If you have one, you’ll be OK, but anything more than perhaps a couple times per year poses health risks.”
Nolan adds that while “moderate consumption in otherwise healthy adults is likely OK, unfortunately the majority of consumption of energy drinks takes place in a younger population.” In fact, the NCCIH reports that drinks that claim to increase energy and enhance mental alertness and physical performance are the most popular dietary supplements (after multivitamins) consumed by American teens and young adults.
The American Academy of Pediatrics recommends that teens and adolescents avoid these beverages, as kids’ brains are more susceptible to the effects of caffeine. Caffeine can also interfere with bone growth and development, and at excessive levels it can be toxic for kids and young adults.
Kicking the Habit
It’s easy to fall into a pattern of reaching for an energy drink whenever you feel sluggish. That habitual act can lead to much higher consumption of these products than you might mean to or than is considered healthy.
If you’ve developed an energy drink habit, Nolan recommends “talking with your primary care provider to help establish safe amounts and strategies to help find healthy alternatives.” For example, substituting an 8-ounce cup of black tea, which has about 47 milligrams of caffeine, can lower your caffeine consumption in short order. Plus, if you don’t doctor it with sugar, that will also eliminate a source of excess calories from your diet.
Getting off caffeine isn’t always easy, though, and Nolan warns that “withdrawal from caffeine can lead to headaches, increased fatigue, drowsiness and difficulty concentrating.”
Wroe notes that weaning yourself off of energy drinks slowly often works better than going cold turkey. “I would recommend a slow weaning off to prevent the headaches or jitters. Look at how many drinks you’re having now and cut back slowly.”
For example, if you’re currently consuming two drinks per day, lower that to one per day for a while. After a week or two, see if you can skip a day in between those days that you do have a drink.
“You could also try switching over to coffee as a replacement to wean off the energy drink itself,” Wroe adds.
If you’re looking to scale back on consumption of caffeine, Nolan offers some additional advice:
— Read labels carefully and do your research. Know what you’re consuming and keep tabs on how much caffeine, sugar and other stimulants you may be ingesting.
— Remember, it’s not just energy drinks that can be problematic. Keep in mind other sources of caffeine or other stimulants, such as chocolate or other soft drinks and sodas.
— It’s not just about the caffeine, either. The added effects of the other ingredients are important as well, such as sugar, taurine and guarana.
— Talk to your doctor. If you find that you’re always wanting an energy drink or have become dependent on caffeine, talk with your doctor about what’s contributing to this need. You may not be sleeping well or might have an underlying condition such as depression that’s contributing to your feeling sluggish and fatigued.
“When we look at the causes of fatigue, the best ways to solve this are better sleep and stress management along with healthier eating,” Wroe says. “Even during times when someone may be excessively tired — like during finals or after a night shift — bonus energy could be obtained with a cup of coffee or a small cup of orange juice with some protein. With other options available, I don’t recommend energy drinks at all, or only on a super rare occasion.”
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Update 07/02/21: This story was previously published at an earlier date and has been updated with new information.