Experts Call for Health Warning Labels on Caffeinated Energy Drinks

Caroline Cassels

September 26, 2008

September 26, 2008 — Experts are calling for health warning labels on so-called "energy drinks" that, due to their high caffeine content, may pose a significant consumer health risk, particularly in adolescents and young adults.

In a review paper published online September 20 in Drug and Alcohol Dependence, investigators at Johns Hopkins University School of Medicine, in Baltimore, point out that a single serving of some of these drinks can contain more than 500 mg of caffeine, an amount equivalent to 14 cans of Coca-Cola.

Despite this, the caffeine content of these products is frequently not indicated, and few brands include warnings about potential health risks, including caffeine intoxication.

"Many products don't label the amount of caffeine they contain, and the amount of caffeine across different brands is quite variable, so you can pick up something called a can of energy drink and it may contain as little as 50 mg of caffeine or it can contain 505 mg of caffeine," lead author Roland Griffiths, PhD, told Medscape Psychiatry.

Vulnerable Population

Furthermore, and even more disturbing, said Dr. Griffiths, is the aggressive marketing of these drinks to young people, who are frequently caffeine naive and therefore more susceptible to the negative physical effects of caffeine.

"A caffeine-naive population is going to be much more sensitive to caffeine, and we really run the risk of caffeine overdose. We don't really know what the prevalence of this is, but we know it occurs and this shouldn't surprise us.

"Caffeine intoxication is a well-recognized psychiatric diagnosis with well-described symptoms, and if you give high doses of caffeine to caffeine-naive people, some of them are going to get into trouble," said Dr. Griffiths.

He added that reports of caffeine abuse to US poison control centers showed negative reaction to energy drinks.

In a 2007 survey of 496 college students, 51% reported consuming at least 1 energy drink during the past month. Of these energy-drink users, 29% reported "weekly jolt-and-crash" episodes and 19% reported heart palpitations from consuming these beverages.

Gateway to Drug Abuse?

The same survey revealed that 27% of the survey respondents reported mixing energy drinks and alcohol at least once in the past month. "When you combine caffeine and alcohol, people are less likely to perceive the extent to which they are intoxicated and are at greater risk of alcohol-related injury," said Dr. Griffiths.

Further, there is a concern that the strong stimulant effect of energy drinks may increase the risk of nonmedical use of prescription stimulants such as amphetamines and methylphenidate. A 2008 study of 1253 college students showed energy-drink consumption significantly predicted subsequent nonmedical prescription stimulant use.

Potentially fueling this "transition" market, there are other energy drinks, such as the powdered energy drink Blow, which is sold in vials, and the energy drink Cocaine, that use language on their products suggesting illicit drugs.

Energy drinks first came on the market in 1987 with the launching of Red Bull in Australia. Since then, the industry has grown exponentially worldwide and stands at an estimated $5.4 billion in the United States and is expanding at a rate of 55% annually.

Given all these factors, Dr. Griffiths believes the US Food and Drug Administration (FDA) should move to require warning labels on these drinks. However, it does not appear likely this will occur in the foreseeable future.

FDA Responds

Medscape Psychiatry contacted the FDA for comment and was told in an e-mail communication that many so-called "energy drinks" are marketed as dietary supplements and therefore are not legally required to seek premarket approval.

For both dietary supplements and food products, the producer bears the onus of ensuring that it is bringing a safe product to market, the FDA writes. "In order to require a warning label, FDA must establish that the lack of such a warning creates a risk to consumers and that the warning label would effectively remediate that risk. At this time, FDA has not determined that these products are unsafe because they contain caffeine or that there is a consumer risk that would effectively be remediated by a warning label statement," the FDA writes.

Drug Alcohol Depend. Published online September 20, 2008. Abstract


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