Energy Beverages: Content and Safety

doi:10.4065/mcp.2010.0381

Mayo Clinic Proceedings

Volume 85, Issue 11, November 2010, Pages 1033-1041

https://doi.org/10.4065/mcp.2010.0381 Get rights and content

Exercise is making a resurgence in many countries, given its benefits for fitness as well as prevention of obesity. This trend has spawned many supplements that purport to aid performance, muscle growth, and recovery. Initially, sports drinks were developed to provide electrolyte and carbohydrate replacement. Subsequently, energy beverages (EBs) containing stimulants and additives have appeared in most gyms and grocery stores and are being used increasingly by “weekend warriors” and those seeking an edge in an endurance event. Long-term exposure to the various components of EBs may result in significant alterations in the cardiovascular system, and the safety of EBs has not been fully established. For this review, we searched the MEDLINE and EMBASE databases from 1976 through May 2010, using the following keywords: energy beverage, energy drink, power drink, exercise, caffeine, red bull, bitter orange, glucose, ginseng, guarana, and taurine. Evidence regarding the effects of EBs is summarized, and practical recommendations are made to help in answering the patient who asks, “Is it safe for me to drink an energy beverage when I exercise?”

Section snippets

METHODS

A search of the English-language scientific literature was performed primarily by searching the MEDLINE and EMBASE databases and using the Google Internet search engine for the period January 1976 through May 2010. For this search, we used keywords found in lead peer-reviewed articles and research outlining the current body of knowledge on EBs. Keywords used in the search are energy beverage, energy drink, power drink, exercise, caffeine, red bull, bitter orange, glucose, ginseng, guarana, and

INGREDIENTS OF EBs

The most common ingredient in EBs is caffeine, which is often combined with taurine, glucuronolactone, guarana, and B vitamins to form what manufacturers have called an “energy blend.”¹ When higher doses of caffeine are combined with these other substances currently blended in EBs, the subsequent effect cannot always be predicted; adverse effects have been reported, including cardiac arrest.11, 12 The components of the 4 best-selling EBs are given in Table 1, and the specific ingredients are

Research Issues

A number of factors relating to EB consumption may make good morbidity and mortality data difficult to ascertain. These include the following.

•
The target market for EBs is people between 15 and 30 years of age. This population is typically healthy and involved in activities and includes a higher proportion of sports enthusiasts and high-risk takers.
•
Because of the many ingredients in EBs, cause and effect is difficult to assign to one specific ingredient. Indeed, it may be the combination

RECOMMENDATIONS

On the basis of this review, we make the recommendations listed in Table 2.

In summary, one can of an EB during one session is safe for most healthy individuals. However, excess consumption and consumption with other caffeine-containing beverages or alcohol may lead to adverse effects and possibly death. Patients with clinically relevant underlying medical conditions, including heart disease and hypertension, should consult with their physician before drinking EBs.

CONCLUSION

Coaches and athletic departments should take the initiative in addressing the issue of EBs with student athletes and in educating them about the effects and risks. The main ingredients of energy/power drinks are caffeine, taurine, glucuronolactone, B vitamins, guarana, ginseng, ginkgo biloba, l-carnitine, sugars, antioxidants, and trace minerals. The negative effects of excess caffeine have been proven, but the positive effects of many of the other additives, such as taurine and

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Flying high?—Exploring the effect of red bull on blood pressure after microsurgical breast reconstruction in a randomized controlled trial
2024, Journal of Plastic, Reconstructive and Aesthetic Surgery
A sufficiently high blood pressure (BP) is essential for flap perfusion after microsurgical breast reconstruction. However, postoperative hypotension is common after these procedures. Perioperative volume overload may increase flap-related complications, and postoperative vasopressor use may be limited depending on institutions. Red Bull has been shown to increase BP in several studies. We aimed to evaluate the effect of Red Bull on perfusion-related variables after microsurgical breast reconstruction.
We conducted a multicenter, prospective, randomized controlled trial. Female patients undergoing unilateral microsurgical breast reconstruction from June 2020 to October 2022 were randomly assigned to the intervention or control groups. The intervention group received 250 ml of Red Bull 2 h after surgery and twice on postoperative day (POD) 1. The control group received 250 ml still water at the respective intervals. BP was measured using a 24-hour monitoring device. Vasopressor use, fluid balance, and flap outcomes were compared.
One hundred patients were included in the study. Both groups were comparable concerning age, body mass index, and caffeine consumption. Mean arterial and diastolic BP were significantly higher in the Red Bull group after the second drink in the morning of POD1 (p-value = 0.03 and 0.03, respectively). Vasopressor use was similar, with a tendency for less postoperative etilefrine in the Red Bull group (p-value = 0.08). No flap loss was observed.
We observed increased mean arterial and diastolic BP in the Red Bull group after the second drink. Red Bull may be a useful adjunct after microsurgical breast reconstruction.
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Binge-like administration of alcohol mixed to energy drinks to male adolescent rats severely impacts on mesocortical dopaminergic function in adulthood: A behavioral, neurochemical and electrophysiological study
2024, Neuropharmacology
A growing body of evidence indicates that the practice of consuming alcohol mixed with energy drinks (ED) (AMED) in a binge drinking pattern is significantly diffusing among the adolescent population. This behavior, aimed at increasing the intake of alcohol, raises serious concerns about its long-term effects. Epidemiological studies suggest that AMED consumption might increase vulnerability to alcohol abuse and have a gating effect on the use of illicit drugs.
The medial prefrontal cortex (mPFC) is involved in the modulation of the reinforcing effects of alcohol and of impulsive behavior and plays a key role in the development of addiction. In our study, we used a binge-like protocol of administration of alcohol, ED, or AMED in male adolescent rats, to mimic the binge-like intake behavior observed in humans, in order to evaluate whether these treatments could differentially affect the function of mesocortical dopaminergic neurons in adulthood. We did so by measuring: i) physiological sensorimotor gating; ii) voluntary alcohol consumption and dopamine transmission before, during, and after presentation of alcohol; iii) electrophysiological activity of VTA dopaminergic neurons and their sensitivity to a challenge with alcohol. Our results indicate that exposure to alcohol, ED, or AMED during adolescence induces differential adaptive changes in the function of mesocortical dopaminergic neurons and, in particular, that AMED exposure decreases their sensitivity to external stimuli, possibly laying the foundation for the altered behaviors observed in adulthood.
Caffeine warning labels may increase young adults' intention to purchase energy drinks
2023, Food Quality and Preference
Increasing consumption of energy drinks has raised public health concerns worldwide. The present study intended to contribute to the literature on policies to discourage consumption of these beverages by exploring the effect of front-of-package caffeine warning labels on the purchase intention of young Uruguayan adults. A mixed-methods approach was used to address the research objectives in an online survey with 225 participants aged between 18- and 30-years old. The quantitative component of the survey intended to evaluate the effect of caffeine warnings on purchase intention using choice-based conjoint analysis, whereas the qualitative component explored participants' perceived efficacy of the warnings using an open-ended question. The conjoint task involved a series of choice sets composed of two cans differing in three 2-level variables: octagonal caffeine warning featuring the expression 'Contains caffeine', octagonal sugar warning, and brand. Results from the conjoint analysis showed that caffeine warnings increased choice likelihood, as did the brand conveying energy-related associations. On the contrary, sugar warnings reduced choice likelihood. Responses to the open-ended question provided insights on the lack of efficacy of caffeine warnings and stressed the importance of raising awareness of the potential negative health consequences of energy drink consumption. Taken together results from the present work suggest the importance of designing effective front-of-package warning labels to discourage consumption of energy drinks among young adults.
Energy drink consumption in nurses: Is high-stress work relevant to the adoption of poor drinking habits?
2023, Maturitas
Single Dose of an Energy Dietary Supplement with a Small Amount of Caffeine Prevents an Increase of a Low Frequency Resting State EEG in Possible Mental Fatigue
2023, Neuroscience
Due to the increasing needs to enhance our cognitive performance, and decrease fatigue with increasing number of tasks in our everyday life, it’s interesting to study whether a small amount of active substance present in dietary supplements, is enough to impact cognition. We investigated an acute effect of an energy dietary supplement containing low amount of caffeine (55 mg) and other stimulatory ingredients by means of a resting state EEG in a double blind, placebo controlled study (N = 47, 27 women). The use of a nonparametric cluster-based permutation analysis allowed us to observed a significant group × block interaction effect after 90 minutes post-ingestion (P = 0.022 cluster corrected) in the ‘eyes closed’ condition, i.e. an increase in normalized rsEEG power in the placebo group, which was abolished in the study group. This difference corresponded to a broad spatio-spectral cluster between around 6.5 Hz and 10.5 Hz (i.e. high theta and low alpha band) maximal over centro-temporo-parieto-occipital scalp areas. Similar trend but without significant effect was found in the ‘eyes open’ condition. Our results suggest that low caffeine content dietary supplementation acts as a reversal of the fatigue-related brain activity in the neural networks active in the resting state. These findings not only may help to clarify previous nonconclusive findings, but more importantly, show that an ingestion of caffeinated stimulants before neurocognitive examinations, both in research and diagnostics, should be taken into account, as they may influence cognition, even in small doses and when the effects are absent in the behavioral measures.
Caffeine and sport
2023, Advances in Food and Nutrition Research
Caffeine is a trimethylxanthine found in coffee and several other foods and beverages. Its stimulatory effects make it an interesting strategy to boost performance for athletic populations. Scientific evidence supports its efficacy to improve high-intensity endurance exercise, explosive and high-intensity efforts, resistance exercise, team sports and combat sports, though individual variation in the ergogenic response to caffeine exists. Supplementation can be taken in many forms including dissolved in water, via capsules, coffee, energy drinks and caffeinated gum; ingestion via capsules, dissolved in water or in caffeinated gum appear to be most effective. Variability in the exercise response following caffeine supplementation may be explained by genetic factors or habitual caffeine consumption. Caffeine is an excellent supplement for athletes looking to improve their exercise performance, though some consideration of side-effects and impact on sleep are warranted.

View all citing articles on Scopus

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REVIEWEnergy Beverages: Content and Safety

Section snippets

METHODS

INGREDIENTS OF EBs

Research Issues

RECOMMENDATIONS

CONCLUSION

Drug Alcohol Depend

J Adolesc Health

Am J Med

Chem Biol Interact

Cell Calcium

Nutrition

Comp Biochem Physiol Physiol

J Nutr Biochem

Petition calls for FDA to regulate energy drinks

USA Today

Strategies to crack well-guarded markets

Harv Bus Rev

Effects of commercial energy drink consumption on athletic performance and body composition

Phys Sportsmed

Event-level analyses of energy drink consumption and alcohol intoxication in bar patrons

Addict Behav

Coingestion of protein with carbohydrate during recovery from endurance exercise stimulates skeletal muscle protein synthesis in humans

J Appl Physiol

Diuretic potential of energy drinks

Amino Acids

Thermogenic effect of meltdown RTD energy drink in young healthy women: a double blind, cross-over design study

Lipids Health Dis

Effects of ingesting 6% and 12% glucose/electrolyte beverages during prolonged intermittent cycling in the heat

Eur J Appl Physiol Occup Physiol

Cardiac arrest in a young man following excess consumption of caffeinated “energy drinks.”

Med J Aust

Caffeine and other sympathomimetic stimulants: modes of action and effects on sports performance

Essays Biochem

Safety issues associated with commercially available energy drinks

J Am Pharm Assoc

Adolescents living the 24/7 lifestyle: effects of caffeine and technology on sleep duration and daytime functioning

Pediatrics

Effect of caffeine on sport-specific endurance performance: a systematic review

J Strength Cond Res

Caffeine use in sports: considerations for the athlete

J Strength Cond Res

Nutrition for improved sports performance: current issues on ergogenic aids

Sports Med

The absolute bioavailability of caffeine in man

Eur J Clin Pharmacol

Effects of caffeine on muscle glycogen utilization and the neuroendocrine axis during exercise

J Clin Endocrinol Metab

Acute effect of caffeine on arterial stiffness and aortic pressure waveform

Hypertension

Coffee consumption and total body water homeostasis as measured by fluid balance and bioelectrical impedance analysis

Ann Nutr Metab

Caffeine ingestion and fluid balance: a review

J Hum Nutr Diet

Tolerance to the humoral and hemodynamic effects of caffeine in man

J Clin Invest

Influence of caffeine on exercise performance in habitual caffeine users

Int J Sports Med

Fluid, electrolyte, and renal indices of hydration during 11 days of controlled caffeine consumption

Int J Sport Nutr Exerc Metab

Taurine in pediatric nutrition: review and update

Pediatrics

Pharmacokinetics of oral taurine in healthy volunteers

J Amino Acids

REVIEW
Energy Beverages: Content and Safety