The Effect of the High Consumption of Energy Drinks in Teenagers and Young Adults

Abrar Baabbad

Nouf AlBasseet

Sara Jomar

CHS 439

Dr. Sadaa M. AlOrf

Objectives

The study is determined to evaluate the frequency of energy drinks consumption among teenagers and young adults in Riyadh city in Saudi Arabia from both sexes and to investigate the association between the consumption and the related side effects.

Energy drinks

It is a drinks containing high amount of caffeine in addition to other ingredients such as amino acids, vitamins, minerals, and herbs.

The producers of these products claims that these drinks increase alertness and enhance the mental or the physical performance

Motivations of Consuming Energy Drinks

Provide the consumer  with more energy1 .

Enhance their performance, mentally or physically1.

Improve cognitive performance and mood2.

Increased alertness2.

Increased upper body muscle endurance3.1. Ragsdale, FR et al. The Effect of Red Bull energy drink on cardiovascular and renal function. Amino Acids.2009 August2.  Malinauskas, BM et al. A survey of energy drink consumption patterns among college students. Nutrition Journal 20073.Forbes, SC et al. Effect of Red Bull energy drink on repeated Wingate cycle performance and bench-press muscle endurance. International journal of sport nutrition and exercise metabolism. 2007 Oct

Ingredients of Energy Drinks and Their Effects

Caffeine

Definition

It is a stimulant that affect the central nervous system  and promoting activation of the sympathetic adrenal-medullar system4.

4- Lane JD. Caffeine and cardiovascular responses to stress. Psychosom Med. 1983

Caffeine Cont.

 Amount:

• In 100 ml of energy drinks , there is 24-32 mg of caffeine 5,6,7.

  Benefit:

• Provides energy, improve cognitive performance and mood, increase alertness and it acts as a stimulant2.

5. POWER HORSE Energy Drinks GmbH [Internet]. 6. Ingredients. Red Bull GmbH [Internet]. Ingredients.7. Abuljadayel Beverages Inc. [Internet]. Ingredients and nutrition facts of Bison.2. Malinauskas,BM. et al. A survey of energy drink consumption patterns among college students. Nutrition Journal 2007.

Caffeine Cont.

Side effect:

• nervousness, irritability, anxiety, tremulousness, muscle twitching (hyperreflexia), insomnia, headaches, respiratory alkalosis, and heart palpitations8.

• Peptic ulcers, erosive esophagitis, and gastroesophageal reflux disease GERD9.

8.Leson, CL; McGuigan, MA; Bryson, SM. Caffeine overdose in an adolescent male. Journal of toxicology. Clinical toxicology.19889.Cedars-Sinai Hospital[Internet]. Gastroesophageal Reflux Disease (GERD). 2008 April

Caffeine Cont.A study was done to address the side effects of caffeine on the QT interval shown in the electrocardiography and the results were:

19 Males + 21 Females

caffeinated coffee

1 hour after consumption

systolic and diastolic blood

pressure

30 minutes after

consumptionHeart rate

decaffeinated coffee

30 minutes after

consumption

increase of the QT

duration

10.Buscemi, S. Acute effects of coffee on QT interval in healthy subjects. Nutrition Journal. 2011 Feb.

Ingredient and its effect Cont.

Sugar

Definition:

• The primary  source of energy  in the body11.

Amount:

• Often, energy drinks contain high fructose corn syrup (HFCS) or sucrose. It is found that 500 ml contains about 54 gm of sugar which is equal to 13 teaspoons11.

11.Higgins JP., Tuttle TD., and Higgins CL., Energy Beverages: Content and safety. Mayo Clinic Proceedings;2010 Nov

Sugar Cont.

Benefits:

• The benefit of consuming sugars during sport is that the administration of glucose or other carbohydrate before, during, and after prolonged exercise (>1hour) has been shown to postpone fatigue, conserve muscle glycogen, and improve performance11.

11.Higgins JP., Tuttle TD., and Higgins CL., Energy Beverages: Content and safety. Mayo Clinic Proceedings;2010 Nov

Sugar Cont.

Side effects:

• Obesity, Insulin resistance, Diabetes mellitus, hypertriglyceridemia and Non-alcoholic fatty liver disease has been associated with the high consumption of high fructose corn syrup12.

12.Gaby AR. Alternative Medicine Review: Adverse Effects of Dietary Fructose. Thorne Research, Inc. 2005 Dec.

Ingredient and its effect Cont.

B vitamins

Definition

• A water soluble vitamins, consist of 8 vitamins: thiamin (vitamin B1), vitamin B2 , niacin (vitamin B3) , biotin, pantothenic acid, vitamin B6, folate, vitamin B12.

• They function as a coenzymes ,help releasing the energy from carbohydrates, fat, and protein13.

13.Rolfes, S., Pinna, K. and Whitney, E. The water soluble vitamins: B vitamins and vitamin C. Understanding Normal and Clinical Nutrition. Wadsworth, Cengage learning 2008

B Vitamins Cont.Amount

Redbull14 (100ml)

Power Horse5

(100ml)

Bison 7

(100ml)

Niacin 8 mg 8 mg 6 mg

Pantothenic acid

2 mg 2.2 mg 2.5 mg

Vitamin B6 2 mg 2 mg 0.6 mg

Vitamin B12

0.002 mg 0.002 mg --

Vitamin B2 -- 0.06 mg --

Folate -- -- 0.053 mg14.Red Bull GmbH [Internet]. Products and company: FAQ's. 5. POWER HORSE Energy Drinks GmbH [Internet]. Ingredients.7. Abuljadayel Beverages Inc. [Internet]. Ingredients and nutrition facts of Bison

B Vitamins Cont.

Benefit

• The role of the B Vitamins  in energy drinks appears to be converting the added sugars into energy11.

• They improve all the energy provided by the simple sugars in energy drinks and this is the extra energy that the energy drinks companies claim their product can provide11.

11. Higgins JP., Tuttle TD., and Higgins CL., Energy Beverages: Content and safety. Mayo Clinic Proceedings;2010 Nov

Ingredient and its effect Cont.

Taurine

 Definition

• Sulfur-containing amino acid , present in the plasma and cells of the mammalian with high concentrations, the most abundant intracellular amino acid and occurs naturally in food especially in meat and seafood17.

15. Gaull GE. Taurine in pediatric nutrition: review and update. American Academy of Pediatrics.1989 Mar

Taurine Cont.

 Amount:

• Amount of taurine found in 100 ml of power horse or red bull is 400 mg, while in bison the amount is 30 mg per 100 ml5,14,7.

5. POWER HORSE Energy Drinks GmbH [Internet]. Ingredieants.14.Red Bull GmbH [Internet]. Products and company: FAQ's7.Abuljadayel Beverages Inc. [Internet]. Ingredients and nutrition facts of Bison.

Taurine Cont.Benefit:

It plays an effective role in several essential biological processes such as:

development of the central nervous system (CNS) and the retina,

Antioxidant.

calcium modulation.

involved in bile salt formation.

Antiarrhythmic and antihypertensive effects . 16. Kontny, E., et al. The mechanism of taurine chloramine inhibition of cytokine (interleukin-6, interleukin-8) production by rheumatoid arthritis ￠ broblast-like synoviocytes. Arthritis & Rheumatism. 2000 Oct

17. Huxtable, RJ. Physiological actions of taurine. Physiological Reviews.1992 Jan

Taurine Cont.

 Side effect

• It’s found that taurine either alone or in combination with caffeine, was responsible for the increase in stroke volume

18. Baum M, and Weiss M. The influence of taurine containing drink on cardiac parameters before and after exercise measured by echocardiograph. Amino Acid. 2001

Ingredient and its effect Cont.Ginseng

Definition

Ginseng is a common herbal supplement around the world. It has been used as a tonic and restorative for 5000 years 19.

Amount :Most of the energy drinks contains about 80 mg of ginseng per 100 ml 20,21,22.

21ROCKSTAR, Inc [Internet]. The original Rockstar: Ingredients.20. Monster Beverage Company [Internet]. Products: Monster Energy Ingredient.

22.Blue Sky Beverage Company[Internet]. Product Info: Energy.

19. Chong SK. and Oberholzer VG. Ginseng--is there a use in clinical medicine? Postgraduate Medical Journal. 1988 Nov

Ginseng Cont.

Benefit:

Ginseng has an ability to increase the resistance of the body to stress, fatigue and anxiety and the ability to improve the memory9.

Side effect

Insomnia, mastalgia, vaginal bleeding, amenorrhea, tachycardia, palpitations, hypertension, edema, headache, vertigo, euphoria, mania 23.

9.Higgins JP., Tuttle TD., and Higgins CL., Energy Beverages: Content and safety. Mayo Clinic Proceedings; 2010 Nov.23. Clauson K., et al. Safety issues associated with commercially available energy drinks. Pharmacy Today;2008 May.

Regulation of energy drinks by governments and organizations

In Europe, a labeling must be provided to give the consumer a clear information about the content of caffeine24.

Also the Gulf Cooperation Council Standardization organization (GSO)  require a complete information about the ingredients to be written on the labels25.  

24. Commission Directive 2002/67/EC on the Labelling of Foodstuffs Containing Quinine, and of Foodstuffs  Containing Caffeine. Official Journal of the European Communities. 2002 Jul 18.25. Recommendations of handling energy drinks. Gulf Cooperation Council Standardization Organization (GSO).  2009 May.

Regulation of energy drinks by governments and organizations

France and Denmark banned the sale of Red Bull because it has been linked to several deaths and it contains a high level of caffeine26.

In Norway the sale of Red Bull limited to pharmacies also because it contains a high level of caffeine27.

26. Nordqvist,C. French ban on Red Bull (drink) upheld by European Court. Medical News Today [Internet]. 2004 Feb27. Kapner D., Ephedra and Energy Drinks on College Campuses. The U.S. Department of Education: The Higher Education Center for Alcohol and Other Drug Abuse and Violence Prevention[Internet]. 2008 Aug

Regulation of energy drinks by governments and organizations

The FDA does not has a strong rule in regulating the caffeine content of energy drinks28.

GSO require from the producers of these products  to write a warning labels on the cans25.

Also they require to write the safe limit of the consumption of these products by an individual in one day on the cans25.

28.Reissig C. ,Strain E. ,and Griffithsb R. , Caffeinated Energy Drinks A Growing Problem. Drug Alcohol Depend. 2009 January.25.Recommendations of handling energy drinks. Gulf Cooperation Council Standardization Organization (GSO).  2009 May.

Conclusion

It is concluded from the literature review that :

• Consuming a large amounts of energy drinks may cause a variety of side effects mostly upon the nervous system  due to the different ingredients they contain.

• Most affected people are teenagers and young adults as they tend to be the most susceptible to get influenced by the commercials which promote for those drinks.

Conclusion Cont.

• Peers influence and the environment surrounding the consumer has a clear impact too.

• Most of the Energy drinks consumers are not aware of the content and the effect of those drinks generally on the over all health and specifically on the body’s organs.

Recommendations

1. More attention must be paid to educate the consumers and the public about the side effects of consuming those energy drinks.

2. More further  research should be done to study the side effects of consuming energy drinks.

3. Advertisements, places of Selling, legal age to buy energy drinks , manufacturing, and warning phrases   should be regulated by Saudi Food and Drug Authority.

References1. Ragsdale FR, Gronli TD ,Batool N ,Haight N, Mehaffey A, McMahon EC, Nalli TW ,Mannello CM ,Sell CJ, McCann PJ , Kastello GM,  Hooks T, Wilson T. Effect of Red Bull energy drink on cardiovascular and renal function. Amino Acids.2009 August 4; 38:1193–1200

2.  Malinauskas BM, Aeby VG, Overton RF, Aeby TC  and Heidal KB. A survey of energy drink consumption patterns among college students. Nutrition Journal 2007, 6:35

3.Forbes, SC; Candow, DG; Little, JP; Magnus, C; Chilibeck, PD. Effect of Red Bull energy drink on repeated Wingate cycle performance and bench-press muscle endurance. International journal of sport nutrition and exercise metabolism. 2007 Oct; 17(5):433–444.

4.Lane JD. Caffeine and cardiovascular responses to stress. Psychosom Med. 1983; 45(5):447–451.

5. POWER HORSE Energy Drinks GmbH [Internet]. Austria.  Ingredients. Available from: http://www.power-horse.com/energydrinkfacts/ingredients/lang1/

6. Red Bull GmbH [Internet]. Austria;c2011. Products: Ingredients.  Available from:http://www.redbull.com/cs/Satellite/en_INT/red-bull-energy-drink/001242937921959?pcs_c=PCS_Product&pcs_cid=1242937842064&pcs_pvt=ingredients

7.Abuljadayel Beverages Inc. [Internet]. Saudi Arabia;c2010. Ingredients and nutrition facts of Bison. Available from: http://www.bison.com.sa/energy/drink.html

References Cont.

8.Leson, CL; McGuigan, MA; Bryson, SM. Caffeine overdose in an adolescent male. Journal of toxicology. Clinical toxicology.1988; 26(5–6):407–415.

9.Cedars-Sinai Hospital[Internet]. Gastroesophageal Reflux Disease (GERD). 2008 April. Avaliable from: http://web.archive.org/web/20080423214804/http://www.csmc.edu/pf_5543.html

10.Buscemi, S., Mattina, A., Tranchina, M. and Verga, S.,  Acute effects of coffee on QT interval in healthy subjects. Nutrition Journal. 2011 Feb 2; 10:15

11. Higgins JP., Tuttle TD., and Higgins CL., Energy Beverages: Content and safety. Mayo Clinic Proceedings;2010 Nov; 85(11);1033-1041.

12.Gaby AR. Alternative Medicine Review: Adverse Effects of Dietary Fructose. Thorne Research, Inc. 2005 Dec; 10(4);294-306.

13.Rolfes, S., Pinna, K. and Whitney, E. The water soluble vitamins: B vitamins and vitamin C. Understanding Normal and Clinical Nutrition 8th Edition. Belmont, CA: Wadsworth, Cengage learning ;2008.P.323-359.

14.Red Bull GmbH [Internet]. Austria;c2011. Products and company: FAQ's. Available from:http://www.redbull.com/cs/Satellite/en_INT/red-bull-energy-drink/001242937921959?pcs_c=PCS_Product&pcs_cid=1242937842064&pcs_pvt=faqs

References Cont.

15.Gaull GE. Taurine in pediatric nutrition: review and update. American Academy of Pediatrics.1989 Mar; 83:433-442

16.Kontny, E., Szczepanska, K., Kowalczewski, J., Kurowska, M., Janicka,I., Marcinkiewicz, J. and Maslinski, W. The mechanism of taurine chloramine inhibition of cytokine (interleukin-6, interleukin-8) production by rheumatoid arthritis ￠ broblast-like synoviocytes. Arthritis & Rheumatism. 2000 Oct; 43(10):2169-2177

17. Huxtable, RJ. Physiological actions of taurine. Physiological Reviews.1992 Jan; 72(1):101–163

18. Baum M, Weiss M. The influence of taurine containing drink on cardiac parameters before and after exercise measured by echocardiograph. Amino Acid. 2001; 20(11):75-82.

19. Chong SK. and Oberholzer VG. Ginseng--is there a use in clinical medicine? Postgraduate Medical Journal. 1988 Nov; 64(757):841–846.

20. Monster Beverage Company [Internet]. Corona CA, USA; c2011. Products: Monster Energy Ingredient. Available from: http://www.monsterenergy.com/us/en/products/monster-energy/

21.ROCKSTAR, Inc [Internet]. Las Vegas;c2007. The original Rockstar: Ingrediant. Available from: http://www.rockstar69.com/productIngredients.php?pdt=1

22.Blue Sky Beverage Company[Internet]. Corona CA, USA;c2009. Product Info: Energy. Available from:http://www.blueskysoda.com/#/products/energy

References Cont.

23.Clauson K., Shields K. , McQueen C. , and Persad N. Safety issues associated with commercially available energy drinks. Pharmacy Today;2008 May;14(5):52–64

24. EUROPA Summaries of EU legislation [Internet]. Commission Directive 2002/67/EC on the Labelling of Foodstuffs Containing Quinine, and of Foodstuffs  Containing Caffeine. Official Journal of the European Communities. 2002 Jul 18. Avaliable from:http://europa.eu/legislation_summaries/consumers/product_labelling_and_packaging/l21140_en.htm

25. Sector of Foods and Agricultural Products' Standards. Recommendations of handling energy drinks. Gulf Cooperation Council Standardization Organization (GSO).  2009 May.

26. Nordqvist,C. French ban on Red Bull (drink) upheld by European Court. Medical News Today [Internet]. 2004 Feb. Available from: http://www.medicalnewstoday.com/releases/5753.php

27. Kapner D., Ephedra and Energy Drinks on College Campuses. The U.S. Department of Education: The Higher Education Center for Alcohol and Other Drug Abuse and Violence Prevention[Internet]. 2008 Aug. Available from: http://www.higheredcenter.org/services/publications/ephedra-and-energy-drinks-college-campuses

28. . Reissig C. ,Strain E. ,and Griffithsb R. , Caffeinated Energy Drinks A Growing Problem. Drug Alcohol Depend. 2009 January 1; 99(1-3):1–10.