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JAMA commentary questions energy drinks

A new commentary published online by the Journal of the American Medical Association asserts that caffeinated, nonalcoholic energy drinks and shots may pose a risk to consumers’ health.


Caffeinated alcoholic beverages were pulled from the shelves in the United States late last year.  But a new commentary published online by the Journal of the American Medical Association asserted that the caffeinated, nonalcoholic energy drinks and shots that remain on the market may pose just as great a risk to consumers’ health.

The article by Amelia M. Arria, Ph.D. and Mary Claire O’Brien, MD said that energy drinks pose health risks for three reasons: caffeine’s pharmacological effects themselves pose health risks for susceptible people such as children and pregnant women; energy shots are frequently mixed with alcohol; and habitual caffeine usage may confer an increased risk of dependence on alcohol or other drugs.   

The authors focused on the concentrations of caffeine in the array of energy drinks. This value varies with product and format. Many 8 oz. drinks have caffeine concentrations similar to that of a cup of coffee, while smaller shots have higher concentrations.  The article asserted that one key difference, though, is that coffee is usually consumed hot and therefore slowly, whereas shots are intended to be consumed in one go.

Anthony Almada, CEO of Fein Innovations, said it’s unfair that the authors focused solely on energy beverages, if caffeine is the boogeyman. “It’s caffeinated beverages, period.  Colas, coffee, energy drinks, energy shots. Don’t focus on a certain category when the drug in discussion is caffeine, irrespective of where it comes from.”

Almada noted a 16 oz. cup of coffee – the standard serving size these days at most coffee shops – contains significantly more caffeine that a standard energy drink. But, Almada said, coffee gets a pass because “it’s a historical beverage that is protected because it is  a ‘food.’“

Almada’s company makes a powdered caffeine product called Fein that, according the label directions, is meant to be mixed with 4 oz. of liquid in a shot format. The label says the resulting beverage provides “about as much caffeine as the leading 8.3 oz. energy drink.”

Energy shots lead category growth

For 2010, Nutrition Business Journal estimates that U.S. consumer sales of sports and energy drinks and shots reached $13.1 billion on nearly 12 percent growth. This consists of sports drink sales of $5.4 billion (8 percent growth), energy drink sales of $6.3 billion  (11 percent growth) and energy shot sales of $1.3 billion (38 percent growth).

Sales of energy shots have grown tremendously from $590 million in 2008 to $970 million in 2009 (65 percent growth). 2009 was tough for drinks. Sports drinks declined 7 percent from $5.4 billion in 2008 to $5.0 billion in 2009. Energy drinks went down nearly 2 percent from $5.8 billion to $5.7 billion.

Arria and O’Brien’s article noted that data on energy drinks is lacking. “More research is needed in particular to guide the decision making of regulatory agencies related to placing a scientifically validated upper limit on the amount of caffeine a manufacturer can include in a single serving of any beverage,” they stated.

The risks of alcohol consumption are well known. Alcoholic beverages carry warning labels and ads for alcoholic beverages contain statements urging consumers to drink responsibly.  

Acknowledged risks of caffeine/alcohol pairing

The risks of caffeinated beverages premixed with alcohol are now also a matter of public record.  In November 2010 Dr. Joshua Sharfstein, then U.S. Food and Drug Administration principal deputy commissioner, said,  “FDA does not find support for the claim that the addition of caffeine to these alcoholic beverages is ‘generally recognized as safe,’ which is the legal standard.  To the contrary, there is evidence that the combinations of caffeine and alcohol in these products pose a public health concern.”

The worry among experts was that caffeine can mask some of the sensory cues individuals might normally rely on to determine their level of intoxication.  The FDA press release that contained Sharfstein’s statement said that, “peer-reviewed studies suggest that the consumption of beverages containing added caffeine and alcohol is associated with risky behaviors that may lead to hazardous and life-threatening situations.”

That concern about the caffeine alcohol link now extends to drinks like rum and coke as well. A 2010 study that collected data from 328  bar patrons in a college bar district compared intoxication levels among an alcohol mixed with energy drinks group (AmED), a cola-caffeinated alcoholic drinks group and other drinkers. The results showed that the cola and AmED groups got about equally intoxicated and both left the bars more drunk on average than general drinkers.

The advertizing for energy products is less clear cut than for straight alcoholic beverages.   The package language for Fein, for example, says, among other things, “turn any drink into an energy drink.” It also has the statement: “Stay up later than your friends.”  There is no language cautioning against using Fein in conjunction with alcohol.  But, Almada noted, his company’s marketing is not focused on the bar/nightclub setting as some other energy products are. 

“We don’t put our product out in nightclubs.  We don’t do bar promo events.  We don’t market that same way.”

Health risks debated

Not everyone agrees with Arria and O’Brien on the risks that caffeine used in isolation poses. Dr. Wayne Heidenreich, a Milwaukee-based internist who consults within the health insurance industry, said he has not seen a broad health risk connected to caffeine use. It’s not a question asked when deciding how big an underwriting risk a prospective client poses, for example.

But he was a little more inclined to the notion that caffeine use could lead to other things.

 “It makes sense to me that people who would use the high potency drinks to basically enhance their mental functioning would find themselves predisposed to use other stuff to treat their mental alertness,” he said, “especially knowing how many people naturally need their venti coffee to feel awake and ready to go. There’s a psychological dependence.  Some of it’s habit, some of it’s ritual.”

And to further muddy the issue on caffeine, a study published on Jan. 22 and conducted among an ethnic Chinese population in Singapore concluded that coffee and caffeine consumption may reduce the risk of developing liver cancer.

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