Energy drinks can threaten the health of consumers, especially the younger ones. Their habitual and/or massive consumption is in fact associated with damage to the cardiovascular system.
The market survey on 16 energy drinks available in Italy also reveals the presence of undesirable colorants and chemical additives, as well as caffeine and sugar in quantity.
1) Red Bull, Monster and other energy drinks
The basic recipe of energy drinks consists of a high caffeine content, combined with taurine, sucrose (or synthetic sweeteners, in sugar-free versions), B vitamins, ginseng and other herbal extracts.
Caffeine, in all the products examined, has a concentration always higher than 150 mg/L. And it is therefore mandatory to report on the label of such drinks, pursuant to the Food Information Regulation (EU) 1169/11, the warning:
‘High caffeine content. Not suitable for children or pregnant or breastfeeding women’.
2) Caffeine, crazy concentrations and doses
Concentration of caffeine, in the 16 products examined, varies from 240 to 320 mg/L. That is, from 160% to 213% compared to the dose that the European legislator classifies as ‘high’.
The amount of caffeine moreover increases in proportion to the size of the can, up to exceeding 160 mg of caffeine in a can of Monster. An objectively excessive dose.
3) Caffeine, ‘health claims’ not allowed and food safety
The characteristic ingredient of energy drinks – caffeine, sourced as natural in Coop’s drink alone-can stimulate the central nervous system and increase mental alertness, reducing drowsiness. However, the relevant ‘health claims’ have not been approved, under the Nutrition and Health Claims Regulation (EC) 1924/06, and their suggestion even by implication is therefore prohibited.
The food safety of beverages containing caffeine was evaluated by EFSA (European Food Safety Authority), in 2015. According to the Authority, they are of no concern in a healthy 70-kg adult
– single doses of up to 200 mg of caffeine and
– up to 400 mg total of the substance throughout the day. (1)
4) Children and teenagers, just one drink is enough to go over the limit
For children and teenagers, instead, ‘the available information is insufficient to derive a safe caffeine intake’, declares the Authority. The criterion established for healthy adults is therefore extended to this population group (vulnerable by definition).
The daily dose not to be exceeded is therefore set at 3 mg per kg of body weight. That is to say, for example
- 150 mg per day for a body weight of 50 kg, typical for an adolescent
- 120 mg for a pre-adolescent (13 years) weighing 40 kg
- 75 mg for a 10-year-old child weighing 25 kg.
The math is quickly done. For the younger ones, just one can of energy drink is enough to exceed the safety threshold. Not to mention the additional consumption of caffeine contained in other food sources such as tea, chocolate and other drinks (such as Coca-Cola, which contains over 106 mg/L).
5) Excess caffeine, what are the effects?
The adults have almost certainly experienced at least once the unpleasant effects of an excess of caffeine, even just because of one too many coffees. Effects that ‘energy drinks’ can amplify, due to the dosage and the combination with sugar and other ingredients (see the next paragraph).
Agitation, palpitations, insomnia and other sleep disorders are the most known side effects. But they are not the only ones. The cardiovascular system is also affected.
A study (Kurt et al., 2022) emphasizes that the consumption of energy drinks has been repeatedly associated with damage to the cardiovascular system, such as atrial and ventricular arrhythmias, myocardial infarctions, cardiomyopathies and sudden cardiac death. The authors define their consumption as ‘a growing public health problem in recent decades’. (2)
6) Caffeine mixed with other stimulants
Each ingredient of energy drinks may contribute to these harmful effects.
Caffeine acts on the cardiovascular system through various mechanisms – such as blocking vasodilation of vascular beds, increasing sympathetic tone and positive inotropic action on the myocardium – which result in acute increase in heart rate and blood pressure.
The other characteristic ingredients of energy drinks – such as taurine, sugars and B vitamins – in turn ‘may contribute to these outcomes by increasing heart rate, blood pressure (BP), and cardiac contractility, as well as prolonging the QTc (the interval measured by ECG, ed.)’.
7) Simple sugars, cardiovascular disease and diabetes
Simple sugars, namely, sucrose, glucose or high-fructose corn syrup, are also responsible for the cardiovascular risks described in the study under review. In the products we examined, sugars range from 7,4 to 15%. Up to a dose of 55 g – equivalent to 11 teaspoons of sugar in a single serving – in a can of Monster.
‘It has been noted that sugar and caffeine have synergistic effects which cause a significantly high increase in blood sugar and insulin after their consumption.’ This means that in the long term, the consumption of these drinks leads to obesity and insulin resistance. ‘And diabetes is a major risk factor and one of the most common causes of cardiovascular disease.’
8) Other ‘active’ ingredients
B vitamins are almost always present in energy drinks. Known as a beneficial supplement, these can also probably enhance the stimulatory effects of the other ingredients present in these drinks, the authors of the study hypothesize.
Guarana and yerba mate, two plants often present in energy drinks, are themselves rich in caffeine. ‘These ingredients may also increase the adverse effects of caffeine on the cardiovascular system’, the researchers note.
Ginkgo biloba and ginseng, which are also often present in energy drinks, are listed by researchers (Kaur et al., 2022) as potentially harmful:
– some clinical cases describe serious haemorrhagic events due to ginkgo biloba extracts, probably due to its antagonism effect on platelet activating factor;
– prolonged use of ginseng is associated with cardiovascular side effects, such as increased blood pressure, long QT syndrome or atrial fibrillation.
9) Salt/sodium
Despite their sweetened flavors, energy drinks also contain significant amounts of salt.
The highest content, 0,24%, is found in the Eurospin drink which thus provides 60 mg of salt per serving. On the other hand, the highest dose of salt per can is found in Monster, 0,96 g.
10) Additives and colorants
Additives, flavourings and colourings complete the recipe of ‘energising’ drinks.
Physik, Burn, Monster, Lemonsoda, Crazy Tiger and Eurospin contain the preservative sodium benzoate (E 211) or benzoic acid (E 210), the diffusion of which in beverages suggests that it is easy to exceed the tolerable daily dose for children. Both additives are associated with hypersensitivity and allergy reactions (asthma, itching, redness) and are suspected of promoting hyperactivity in children, alone or in combination with some azo dyes.
Lemonsoda, on the other hand, contains sodium phosphates, which have been linked to an increase in cardiovascular risk and worsening of intestinal inflammation. (3)
Many ‘classic’ energy drinks also contain colorants which are strongly discouraged:
– Burn and Lidl add ammonia caramel (E 150d), which may contain a compound suspected of being carcinogenic (group 2b) by IARC and should be avoided in case of sulphite intolerance.
– Eurospin and Lidl zero instead employ ammonia-based E150c caramel, which may contain an immunotoxic substance (THI) and one suspected by Iarc to be carcinogenic (class 2b). Psychik, on the other hand, contains caramel 150b, which should be avoided in case of sulfite intolerance.
Finally, San Benedetto, adds a Southampton colorant, E129 red, which, as the mandatory warning on the label states ‘May adversely affect children’s activity and attention.’
11) Sugar free, out of the frying pan into the fire
The search for sugar free products is a consolidated and growing trend, as the Osservatorio Immagino has been pointing out for some years. (4) Even among energy drinks the offer is prospering. But what is sugar replaced with?
In the sample, the sugar free version is always based on synthetic sweeteners: aspartame, acesulfame K and sucralose. In Eurospin and San Benedetto products we also find cyclamates. All these substances are discouraged by WHO because they are useless for weight loss and expose to diseases such as type 2 diabetes, cardiovascular diseases and mortality. (5)
Aspartame and acesulfame K, moreover, in a recent cohort study conducted on 102,865 French adults (Debras et al., 2022) are also associated with an increased risk of cancer, particularly breast cancer, and obesity-related tumors. (6)
The ‘no added sugar’ versions sometimes contain gum arabic and xanthan gum, the abuse of which causes intestinal disorders.
12) Flavours and colourings in the fruit flavour version
With or without sugar, fruit-flavored energy drinks are multiplying. A subgroup that is not better from the nutritional quality point of view.
The basic recipe is essentially identical to that of ‘classic’ energy drinks. Same amount of sugars or same synthetic sweeteners, caffeine, taurine etc.
The various flavours are obtained with synthetic aromas (generically defined as ‘flavours’), as in Red Bull, or natural aromas (in Monster) that recall the flavour of the fruit mentioned on the label.
As for the colorants, in addition to the presence of caramels mentioned above, mention should be made of Monster Energy Ultra Strawberry Dreams, which in its beverage with 160 mg of caffeine per serving also includes E129 and E110 reported to cause ADHD and therefore accompanied by the warning on the label, ‘May adversely affect children’s activity and attention’.
13) Use, abuse and warnings
In any shape and taste, it is a fact that energy drinks are understood by certain segments of the population as a stimulant useful for getting ‘high’.
Swallowing several cans of drinks or combining them with spirits (which mitigates the alcohol-induced drowsiness but not the stunning effects) is dangerous, however, and manufacturers-who are aware of this-try to limit their liability with label warnings such as:
‘Do not mix with alcohol. Consume responsibly’, Monster.
‘Consume responsibly’, Burn.
‘Consume in moderation’, Red Bull and Lemonsoda.
‘Not suitable for diabetics and people sensitive to caffeine. Do not consume with alcohol or during intense sporting activity’, Lidl.
14) Unbridled marketing
It’s difficult to reconcile warnings of caution with the encouragement to consumption conveyed by marketing and sponsorships with sports events and personalities considered a model to emulate. Some examples.
Drinking a can of Burn ‘will fuel the fire that is in you. Artists, Musicians, Stylists and Enthusiasts all know what we are talking about. Open a can of Burn Energy and you will find out too!’.
The creatives – or aspiring ones – are in the crosshairs of marketing. ‘Musicians, revolutionaries, students, road warriors, metalheads, geeks, hipsters and bikers love it… you will too!’, Monster guarantees.
15) Temporary and permanent damage
Energy drink consumption, despite marketing, is associated with temporary suffering and very serious reactions. The authors of the study in question (Kaur et al., 2022) summarize them as follows:
‘Acute side effects associated with EDs (energy drinks, ed) are headache, discomfort, irritability, excitability, malaise, dehydration, nervousness, insomnia, nausea/vomiting, abdominal pain, and xerostomia (dry mouth, ed).
Some other more serious and even fatal consequences that have been reported from ED consumption include seizures, intracerebral hemorrhage, acute hepatitis, rhabdomyolysis, acute renal failure, and psychosis’.
All that in addition to the cardiovascular damage already mentioned, which ‘include supraventricular and ventricular arrhythmias, coronary vasospasms, myocardial ischemia/infarction, and sudden cardiac death in otherwise healthy patients. Presenting symptoms in these patients were often chest pain, palpitations, nausea, and vomiting’.
A recent Italian study (Constantine et al., 2023) offers a comprehensive review of the confirmed effects of acute or chronic abuse of energy drinks on human health. An impressive collection of data accompanied by a disturbing consideration:
‘This review highlights the need for greater rigor in the assessment of sudden cardiac death, especially in young people, as legal substances such as energy drinks may be involved’, write the authors of the study. (7)
16) Restrictions on the sale of energy drinks
The researchers call for the regulation of these drinks and more studies on the interaction of the various ingredients contained in them. Energy drinks, on the other hand, continue to be available without restrictions, even in vending machines.
Only in some countries restrictions on sales to minors are foreseen. In Poland, Lithuania, Latvia and Turkey, sales are only permitted to those over 18 years of age. The Czech government has voted on a similar measure and the United Kingdom is discussing it. (8)
Marta Strinati
Footnotes
(1) EFSA Panel on Dietetic Products, Nutrition and Allergies. Scientific Opinion on the safety of caffeine. EFSA Journal. 27.5.15 https://doi.org/10.2903/j.efsa.2015.4102
(2) Amandeep Kaur, Hamza Yousuf, Devyani Ramgobin-Marshall, Rahul Jain, Rohit Jain. Energy drink consumption: a rising public health issue. Rev. Cardiovasc. Med. 2022, 23(3), 83. https://doi.org/10.31083/j.rcm2303083
(3) Marta Strinati. Ginseng coffee, be careful of additives. 20 products compared. GIFT (Great Italian Food Trade).
(4) Marta Strinati. Food consumption in Italy in the XVI edition of the Osservatorio Imagine. FT (FoodTimes).
(5) Marta Strinati. ‘Sugar free’? Synthetic sweeteners are useless and harmful, WHO warns. GIFT (Great Italian Food Trade).
(6) Marta Strinati. Aspartame and health risks, brief scientific review. FT (FoodTimes).
(7) The Italian study. Costantino A, Maiese A, Lazzari J, Casula C, Turillazzi E, Frati P, Fineschi V. The Dark Side of Energy Drinks: A Comprehensive Review of Their Impact on the Human Body. Nutrients. 2023 Sep 9;15(18):3922. doi: 10.3390/nu15183922. PMID: 37764707; PMCID: PMC10535526.
(8) Energy Drinks: Europe Calls for Bans for Children, but EFSA Does Not Set Limits for Young People. Beverfood. 29.11.24
Professional journalist since January 1995, he has worked for newspapers (Il Messaggero, Paese Sera, La Stampa) and periodicals (NumeroUno, Il Salvagente). She is the author of journalistic surveys on food, she has published the book "Reading labels to know what we eat".
