Should Kids Use "Energy Drinks?" Should Anyone?
It's Thursday night at a local gay club, and the comedy is underway. On a video monitor, a drag queen is holding a can of 180, a caffeinated "energy drink" from Anheuser-Busch.
"Liquid crack!" the drag queen announces. "It's what you need!"
The crowd laughs and cringes at the same time. Some of them hold cans of 180.
During the past year, "energy drinks," also known in the business as "functional beverages," have become part of the scenery at bars and convenience stores nationwide. The names of these drinks are usually aggressive: Whoopass, Venom, Piranha, Amp. The most successful, Red Bull, has already passed into pop-cult status, regularly used in TV shows and magazines as shorthand for getting legally jacked.
The buzz these drinks provide comes mainly from caffeine and sugar -- in some cases, as many as five teaspoons of sugar in a thin little can -- with a variety of extras thrown in. Some drinks load up on herbs like ma huang, ginseng, green tea or guarana, and market themselves as "natural" alternatives, despite the fact that ma huang is just a form of ephedrine. Others dispense with the froufrou stuff and sell themselves to bodybuilders, like Speed Stack, Adrenaline Rush or Extreme Ripped Force. Still others, like Red Bull, toss in chemicals like the nonessential amino acid taurine and make claims of increased endurance. Many drinks create a stew of all those things, plus a few more.
The marketing hype is as aggressive as the product names. Ads promise to "give you wings," "make you fire on all cylinders" and "thunder through your workouts" with "radical energy in liquid form."
The spread of these edgy products across the United States has drawn a lot of attention since Red Bull introduced them in 1997. A similar wave spread across Europe after the drinks were imported from Asia in the late 1980s. While energy drinks now constitute only about 1 percent of the U.S. soft-drink market, they're one of the fastest-growing segments of the industry. Big players like Pepsi, Coca-Cola, Anheuser-Busch and Snapple have all introduced their own versions in thin 8.4-ounce cans. Dozens of smaller companies like Jones Soda and Hansen's Beverage are also in the game.
"The energy-drink market is a tiny, tiny dot in the overall soft-drink business," says John Sicher, editor of Beverage Digest, an industry trade magazine. "At this point in time, its staying power is unclear. Will it grow into a small category, or is it a fad? We don't know."
Not surprisingly, Red Bull North America spokeswoman Emmy Cortes is optimistic. Her good spirits may have something to do with the fact that the company she works for controls about 65 percent of U.S. energy-drink sales.
"The growth has been spectacular, but we've done it slowly to build a loyal audience," she says. "It took us five years to get in all 50 states. But we sold over one billion cans around the world last year alone. It's not a fad."
Catching the Eye of Jittery Kids
Specific data on the age breakdown of energy-drink consumers is difficult to obtain because companies consider it proprietary information. But one thing is clear: The industry's advertising aims squarely at young, active consumers. When Pepsi announced the creation of Amp, a drink based on Mountain Dew, Beverage Digest editor Sicher noted that "Mountain Dew as a platform for energy drinks makes perfect sense" because of the caffeinated soda's youthful consumer base. Companies also routinely create new extreme-sports events, such as Red Bull's kite-boarding and free-ride snowboarding competitions, to attract a youthful demographic.
Red Bull's Cortes acknowledges the attraction of young people to the drink but is quick to point out that truck drivers, businessmen, college students and those who are "youthful without age limits" are also customers.
"You have to remember that all active people aren't young," she says.
That's certainly true. But when Drug Store News wrote last summer that "the juiced-up fizzy drink segment... appeals mainly to the sneaker- and-jeans demographic," it probably wasn't referring to middle-aged businessmen who need a lift to get through the workday.
Still, one local convenience-store worker notes that at $2 a can, energy drinks tend to be out of the price range of the average kid. That position is echoed by an industry analyst, who told Brandweek that energy drinks "move at prices which are mind-blowing," adding, "Obviously we're not talking about the price-sensitive consumer."
But a worker at another local convenience store doesn't hesitate when asked if high school-aged teens bought energy drinks.
"Oh, yes. They buy a lot of those," he says, "a whole lot. And they buy these, too." He points to a display of packets of tiny ephedrine pills.
Suitable for Minors?
Most manufacturers insist their drinks are safe and effective when used properly by adolescents. The Red Bull Web site answers the question, "Is Red Bull suitable for young people?" with a confident "Yes! For young people who drink coffee, Red Bull is harmless."
That characterization makes at least one drug scientist laugh.
"I'm not sure that coffee is harmless for young people," says Dr. Wilkie Wilson, a professor of pharmacology at Duke University Medical Center and a career research scientist at the Department of Veterans Affairs. "At a minimum, we know it causes anxiety and disrupts sleep. It's a powerful stimulant. Do you think it's appropriate for kids to be anxious and sleepless? If so, then give them caffeine."
In addition to his academic work, Wilson is a co-author of three mass- market books about drugs. One of them, Buzzed: The Straight Facts About the Most Used and Abused Drugs from Alcohol to Ecstasy, earned praise from Trainspotting author Irvine Welsh for its depth and readability. Wilson cautions that there is "very little research" about the health effects of caffeine, ephedrine and similar stimulants on young people.
"I have a lot of concerns because the brain is still growing," he says. "The human brain is wiring itself up to around age 21. Anything like this can affect a growing brain, but we don't know how."
"When I was young, we always heard that caffeine was an adult drink and would stunt our growth," says Cynthia Sass, spokeswoman for the American Dietetic Association and a registered dietitian. "Now, I've seen children drinking lattes. It seems to be a real change from five or 10 years ago."
A similar shift is apparent to Dr. Roland Griffiths, a professor in psychiatry and neuroscience at Johns Hopkins University and one of the world's leading caffeine researchers.
"Caffeine has not really been a subject of study in children," Griffiths says. "It's only in recent years that kids have been targets. We're now seeing very aggressive marketing of caffeine products to kids. A lot of parents are unaware that caffeine is a drug and it needs to be accorded respect as a drug."
When asked if he thinks society should set an age limit for caffeine consumption, Griffiths replies: "How do you propose to enforce an age limit on caffeine? Given its penetration in our society, it's impossible to keep caffeine away from kids. It's just so ubiquitous in our culture."
The Center for Science in the Public Interest estimates that consumption of soft drinks, including those with caffeine, has doubled among children in the last 25 years. Many of those, like Mountain Dew, have higher levels of caffeine and come in bigger sizes than the soft drinks of the past. Companies like Starbucks have also recently created sugary, bottled coffee drinks that have strong appeal to kids.
Consumer watchdogs and groups like the American Medical Association worry about this sharp rise in child and adolescent caffeine use -- a rise encouraged by a society that treats the drug very casually. In 1997 CSPI petitioned the Food and Drug Administration to require warning labels that clearly state how much caffeine a given product contains. The agency has taken no action on the petition.
CSPI considers products like Sunkist Orange Drink, which contains as much caffeine as Pepsi, troubling. High caffeine consumption has been linked to pregnancy problems, osteoporosis, insomnia and other ailments, but it's difficult for consumers to know just how much of the drug they're getting.
"Caffeine is regulated as a drug when it's in a form like No Doz," says Irene Ringel, senior staff attorney. "They're required to carry a warning like ëThis product contains as much caffeine as X cups of coffee.' We think any caffeinated food or drink should list ëX milligrams of caffeine' along with the vitamins and minerals."
Some energy drinks use their high caffeine content as a marketing angle. Speed Stack boasts openly of its 200 milligrams, equivalent to two No Doz pills or a 12-ounce cup of Starbucks' deliberately strong coffee. Red Bull notes that its 80 milligrams of caffeine are equal to the amount found in "a strong cup of black coffee," but it may be more useful to imagine squeezing the caffeine dose of 24 ounces of Pepsi into an 8.4-ounce can.
The lack of good information about the effects on teens and adolescents of concentrated doses of caffeine -- not to mention the possible effects of the herbal "energy" found in drinks like Amp, Venom and Whoopass -- is obvious in the scientific literature.
"To date, few studies have explored caffeine's physical effects on children, and even less attention has been paid to the drug's psychological consequences," stated an article in the American Psychological Association's Monitor on Psychology last summer. It added that "researchers are now beginning to delve into the field."
So how is it possible for a company like Red Bull to assert that its product is safe for kids?
"That sure seems like an oversimplification, doesn't it?" asks caffeine researcher Griffiths.
The Attention Deficit Connection
Some scientists see a link between our jittery children's culture -- aggressively dense computer games, rapid-fire ads, loud TV shows and violent movies, among other regular offerings -- and the recent rise of diagnoses of attention deficit hyperactivity disorder among young people. Does a daily schedule packed with 50-minute classes, lots of exciting distractions and frequent gulps of caffeine play a role in sparking or exacerbating attention difficulties?
Complicating the picture is evidence that some stimulants actually calm children with ADHD. In fact, one of the most commonly prescribed medicines used to treat ADHD is amphetamine. At least one study cited in the Monitor of Psychology found caffeine to be somewhat beneficial in reducing ADHD symptoms as reported by parents and teachers. Could it be possible that a stimulant-heavy culture may actually be helping some kids?
Relatively few children actually have ADHD. The same study that found caffeine beneficial for those children found increased anxiety and restlessness among non-ADHD children. Other research into the connection between caffeine and ADHD suggests that the drug's effect on sleep patterns may be strong enough to cause attention problems and "potentially could be ADHD."
"The consequences of escalating caffeine use have to be studied," one ADHD researcher told the Monitor. "I wouldn't give it a clean bill of health just yet."
Also yet to be studied are the possible interactions between prescription ADHD medications and natural speedy substances like the ephedrine and guarana increasingly found in bottled fruit drinks and sodas. In fact, the growing presence of these chemicals in everything from iced tea to candy bars has become something that doctors now must take into account when dealing with patients.
"We absolutely ask if they're taking supplements or supplement drinks," says Tausha Robertson, head of the Center for Healthy Student Behaviors at UNC-Chapel Hill. "You have to ask that question directly. Taking large doses of stimulants could be a cause of their symptoms. You could also prescribe them something that wouldn't interact well with something they're taking. And you can't just ask them if they're taking any drugs, because most people don't consider supplements to be drugs."
Healthy Drink or Deadly Drug?
Possible links to ADHD may be the least of the energy-drink industry's problems. It seems that young, apparently healthy consumers of energy drinks sometimes die suddenly on the dance floor or at the gym. Compared to the size of the market, the phenomenon is extremely rare, but many see a link between the drinks and the deaths. Last July the Swedish government began an investigation into the deaths of three young people who'd recently consumed Red Bull (two of them with vodka, a common cocktail). Deaths linked to energy-drink cocktails have also been reported in Asia. Other deaths have occurred after strenuous exercise coupled with large doses of energy drinks. A Burbank, Calif., high school banned energy drinks two years ago when two athletes fainted at practice after consuming products with ephedrine.
Sweden warned its citizens not to drink Red Bull after a heavy workout or with alcohol. "It's just a suspicion, and we don't really know why," said a government representative.
Red Bull spokeswoman Cortes adamantly denies any harmful association.
"There is no clear link between those deaths and Red Bull," she says. "It's nothing but speculation. We are aware that people use it as a mixer, but we don't recommend that and don't market it that way."
So why does the company sell so much of the drink in bars and clubs?
"Red Bull is the perfect alternative to alcohol," Cortes says. "People go out to be social, to have a good time, and they like our drink to help them do that. It's also a wonderful drink for the designated driver. Red Bull does not market itself as a mixer."
"Of course Red Bull is being promoted as a mixer," counters George Hacker, director of the Alcohol Policies Project at CSPI. "I've been in liquor stores where Red Bull and vodka are sitting right next to each other. Even if it's not Red Bull that's putting it there, they certainly should know it's going on. If they wanted to stop it, they could."
Hacker says the main problem is that Red Bull helps mask the degree to which a person is actually inebriated. That encourages them to drink more or drive when they shouldn't. In short, a highly caffeinated drunk is still a drunk.
"People should be aware that the edge one gets does not reduce the potential for intoxication," he says.
Proving a direct connection between energy-drink cocktails and club deaths may be difficult from a legal standpoint, but many observers believe large amounts of alcohol combined with caffeine or ephedrine is an accident waiting to happen. Unlike Gatorade and other sports drinks that replenish minerals and water lost due to exercise, energy drinks with caffeine, guarana and/or ephedrine actually work to dehydrate you. The combination of dehydration and exercise can itself be dangerous; add alcohol to the mix, and you have the potential for serious trouble.
"Any stimulant is a diuretic," says UNC-Chapel Hill's Robertson. "If someone mixes it with alcohol, the more they drink, the more dehydrated they become. You've got a double whammy."
Industry boosters adamantly defend their products, pointing out that nobody gets upset at the thought of rum and Coke, which also contains caffeine. A marketing executive for Colorado-based EAS Inc., which makes the ephedrine-laced Piranha, drew the connection for USA Today: "When it's all said and done, most energy drinks are caffeine and sugar, as are most soda pops."
Which raises an interesting question: If energy drinks are like soda pop, why aren't they subject to the same regulations as soda pop?
Falling Through the Regulatory Cracks
The "functional beverage" industry is part of a larger trend known as "nutraceutical foods," which has exploded in part because it occupies a gray area between foods and dietary supplements. Congress, prompted by lobbying from herbal-supplement companies, exempted substances like guarana, kava kava and ma huang from strict regulation by the FDA in 1994. This was despite evidence linking misuse of ma huang to serious medical problems, including heart attacks and death.
"If you have a dietary supplement, like a pill in a bottle, there's no real regulation," says CSPI's Ringel. "But when you put that same supplement in food, it's now considered a food additive and GRAS [generally recognized as safe] standards are supposed to take over. But all these energy drinks on the market now are not GRAS. I've even seen potato chips with kava kava."
Exaggerated claims of health benefits by energy-drink and other herbal food manufacturers became so common last year that the FDA issued a letter to the entire industry reminding companies they were expected to follow "longstanding legal requirements" governing food products. Red Bull itself avoids the problem by staying away from ephedrine and guarana, and sticking to caffeine and taurine, ingredients with FDA approval. Still, the drink is treated as a medicine, not a food, in Denmark and Norway. It's also currently banned in Canada, although the regulation is under review.
Other energy drinks with non-GRAS ingredients have to be only a little more careful.
The folks who make Speed Stack, for example, load it with ephedrine, guarana and a full day's complement of caffeine, and then boast about the fact that it's nothing but nutrient-free legal speed, easily available to anyone regardless of age. It's designed, they say, to provide dedicated athletes "better mental focus," but check out this warning on their Web site:
"First of all, keep out of reach of children. This drink is for healthy adults only!... Do not exceed recommended use. Taking more than the recommended dosage of one bottle will not be more effective and may increase the risk of side effects, which can include headaches, heart attacks, stroke, seizure and death. In other words, do not take more than one bottle. Do not use if you are pregnant or nursing, or if you have high blood pressure, heart disease, diabetes, difficulty in urination due to prostate enlargement, or if taking a MAO inhibitor or any other prescription drug. Reduce or discontinue use if nervousness, tremor, sleeplessness, loss of appetite or nausea occurs."
That's quite a mouthful for something not regulated as a drug. Drinks like Speed Stack may be the first to disappear from the market if young American suburbanites begin to have heart palpitations in gyms and on dance floors.
It's tempting to compare the speedy world of energy drinks with another recent liquid drug craze, gamma hydroxyl butyrate. GHB was a completely legal muscle-building supplement, popular -- like many of the ephedrine-soaked drinks now on the market -- with both the gym crowd and dance-club aficionados, who got off on its pleasant body buzz. GHB acts as a central nervous system depressant; it's potentially deadly when consumed with even small amounts of alcohol. As bouncers in big cities got tired of hauling unconscious patrons into ambulances, bars began to post warnings about mixing the two drinks. Then GHB use spread to -- surprise -- young people. When a few of those young people started keeling over, the party was over for legal GHB.
Will anyone be surprised if the fast-growing, speed-driven world of energy drinks follows a similar path?
Todd Morman writes for Spectator Magazine, the alternative weekly of Raleigh, North Carolina.