ENERGY DRINKS

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ENERGY DRINKS

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All text tables, copyright Health Equalities Group 2017

Primary authors:

Michael Viggars, MA

Health Equalities Group151 Dale StreetLiverpoolL2 2JHUnited Kingdom

www.giveuplovingpop.org.uk@gulpNOW

CONTENTS

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Foreword

Introduction

Contents of Energy Drinks

Consumption Levels

Information on consumer groups

Risks associated with ED consumption

Marketing of Energy Drinks

Examples of marketing and promotions

Recommendations

References

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FOREWORD

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An energy drink is a type of beverage containing high levels of sugar and caffeine andwhich is marketed as providing mental and physical stimulation. This is cause for concernas not unlike other soft drinks, the high sugar content in energy drinks is directlycontributing to rising levels of obesity, CVD, type 2 diabetes and dental erosion.

The addition of caffeine to these drinks presents another problem, as it is an addictivestimulant. Adverse effects associated with caffeine consumption in large amounts includenervousness, irritability, sleeplessness and even arrhythmia (abnormal heart beat).

Knowingly or not, the marketing strategies of energy drinks companies mimic thecampaigns of big tobacco, combining celebrity and an addictive substance to targetchildren and adolescents and establishing brand loyalty early in life.

However, energy drinks go one step further. By associating energy drinks with extremesports with an implicit sense of danger, these products are positioned directly in front ofyoung males; which in part explains why sales of energy drinks continue to increaseagainst the general decline of soft drink consumption.

This document puts forward some recommendations in terms of policy, regulation andconsumption to curb the adverse effects associated with regular consumption of energydrinks, in addition to dispelling some of the myths surrounding these drinks.

Michael Viggars

Drinking energy drinks can cause the following

DROWSINESSHEADACHES

NAUSEAPALPITATIONSDEPENDENCE

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ENERGY DRINKS

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Introduction

Despite the general decline in sugar-sweetened beverages (SSBs), energy drinks(EDs) continue to grow in popularity in theUK, rising from 475 million litres sold in 2012to 500 million litres in 2013, an increase ofover 5% in 12 months [1].

They can be found in supermarkets but alsoin leisure centres, hospitals and bars and arereadily available wherever you can find avending machine.

In food labelling law, there is no legaldefinition of an drink as use of theterm would imply a nutrition /health claim.

Energy drinks are commonly understood tobe non-alcoholic and can contain caffeine,taurine, vitamins and occasionally acombination of other ingredients (usuallyherbal supplements) marketed for their

perceived or actual benefits as a stimulant,for improving performance and forincreasing energy.

Carbohydrates (in the form of sugar) areoften found in large quantities though theliterature does not specifically state this.

Standard soft drinks such as Coca-Cola andlemonade are not considered energy drinksas, in comparison to the high-caffeinateddrinks such as Red Bull, Monster andRelentless, the volume of caffeine present ismuch lower.

Furthermore, energy drinks (e.g. Red Bull)should not be confused with isotonicbeverages or (e.g.Lucozade). Whilst both claim to be

there are severalsignificant differences between them, bothin terms of ingredients but also theirbranding and marketing.

Retailers regularly display the two in closeproximity, potentially misleading customersinto thinking that they are similar products.Even online grocery shopping, that has thefacility to categorise products, often fails todistinguish between the two.

Contents of energy drinks

Energy drinks contain a range of ingredientswhich may include caffeine, taurine,carbohydrate (in the form of sugar), artificialsweeteners, vitamins and a variety of herbalingredients which add to the marketability ofthe product [2].

Energy drinks have been with us for nearly20 years and come in a variety of shapes,sizes and concentrations. Different brands ofenergy drink can contain anywhere from 016g of sugar per 100ml and 50 550mg ofcaffeine per can or bottle, offering little or nonutritional value and are potentially harmfulto health.

Whereas sports drinks can provide hydrationand may replenish electrolytes; high levelsof caffeine in energy drinks can causedehydration, particularly as a first-time user.

Both categories of drink tend to supply an

amount of carbohydrate (in the form ofsugar) far beyond that recommended forphysically active people, a problemcompounded by sedentary lifestyles. Someretailers are beginning to substitute sugar insoft drinks with artificial sweeteners, asevidenced by diet and zero labelledproducts and the same is true with energydrinks.

Caffeine

Caffeine is a powerful stimulant derived fromcoffee beans, but it can also be synthesisedin a laboratory. Caffeine acts by inhibitingadenosine (which is associated withsedation and relaxation) causing increasedalertness and wakefulness.

Habitual caffeine use can lead to tolerance,diminishing its effects often to the extentthat consumers experience disrupted sleeppatterns and daytime sleepiness.

Drink Type Mg Caffeine

Can of cola (330ml) 40mg

Small can of energy drink (250ml) 80mg

Large can of energy drink (500ml) 160mg

Mug of instant coffee ~100mg*

Mug of filter coffee ~140mg*

Mug of tea ~75mg*

Above: Chemical structure of caffeine

Amount of caffeine found in common food and drink (*depending on how they are made).

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The European Food Safety Authority (EFSA) state that:

doses of caffeine up to 200mgand daily intake of up to 400mg do notraise safety concerns for adults inEurope.

However, it has been found that caffeine, atconcentrations commonly found in regularsugary drinks, increases consumption [3].

Furthermore, although guidelines exist foradults there are currently norecommendations for caffeine consumptionlevels for children or adolescents a lack ofdata to derive a sage level of caffeine intake.

Taurine

Taurine is an organic acid found in highconcentrations in your muscles, brain, heartand bloodstream. It helps to stabilise cellmembranes and performs several anti-oxidant functions.

Taurine has also shown anti-anxiety effectsfollowing oral ingestion which may boostconfidence and improve alertness.

Sugar

Sugars are simple carbohydrates and comein a variety of different forms. Fructose andGlucose are monosaccharides. Glucose isused as the primary energy source andenters cells with help of the hormone insulin.

Parents concern about added sugar indrinks was relatively low (40%)compared with their concern aboutother ingredients such as caffeine,artificial sweeteners and high-fructosecorn syrup [4].

Long-term excess sugar consumption hasbeen linked with weight gain, cardiovasculardisease, the development of type 2diabetes and dental decay with children andyoung adults being at particular risk, as they

consume more than any other age group onaverage.

Vitamins and Herbal Ingredients

Since energy drinks contain large amountsof sugar, B-Vitamins are touted as necessaryingredients to metabolise these simplesugars and produce energy [5].

The presence of sugar-free options nowcontradicts this justification.

Exotic herbal ingredients such as guarana,ginseng and ginkgo biloba are oftenemphasised in the marketing of energydrinks without merit.

The amount of herbal ingredientsfound in energy drinks is far below thatexpected to produce benefits or causeadverse effects and appear to be amarketing ploy.

This poses a significant problem bothbecause consumers should be informedabout what they are putting into their bodiesand because guarana and others oftencontain caffeine, making it difficult toascertain whether the products demonstratea true caffeine content.

Consumption Levels

EFSA commissioned a report in 2011 togather data on consumption of energydrinks in the 16 countries in the EuropeanUnion [6].

In adolescents, prevalence of consumptionwas 68%, ahead of adults (30%) andchildren (18%).

The following page will describeconsumption behaviour for:

• adults aged 19-65;

• adolescents aged 10-18; and

• children aged 3-10 years old

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Adults

• Over a quarter (28%) of UK adults consume energy drinks (ED) citing the need for energy(40%), the need to stay awake (18%) and their taste (16%) as the main reasons forconsumption.

• Consumption falls with increasing age and this could be attributed to generationaldifferences and marketing aimed specifically at younger people.

• In total, 21% of UK adult ED consumers have 4-5 cans or more per week and over halfconsume EDs with alcohol.

• Some 12% of UK adult consumers will drink in excess of 1L at once exceeding therecommended daily amount of caffeine and sugar in one sitting.

• 88% of UK adult ED consumers practice sport citing endurance (40%), vitality (21%) andconcentration as the main reasons for doing so.

Adolescents

• 69% of UK adolescents consume energy drinks citing taste (40%), energy (21%) and stayingawake (17%) as the main reasons for consumption.

• Consumption is more common in males than in females, with consumption increasing withage.

• 19% of UK adolescent ED drinkers consume an energy drink 4-5 days per week or more.

• 35% of adolescents drink EDs and alcohol with consumption increasing with age.

• 65% drink EDs in relation to sports citing the need for endurance time at the maximumintensity (43%), power (21%) and vitality (12%) as the main reasons for doing so.

• 13% of UK adolescent ED consumers will drink in excess of 1L in one sitting.

Children

• 24% of UK children consume energy drinks citing taste (60%) and energy (31%) as the mainreasons for consumption.

• More boys drink energy drinks than girls with consumption in both increasing with age.

• Consumption occurred at home (35%), during physical exercise (27%) and at parties (26%)most frequently.

• 55% of children understood that energy drinks and other SSBs such as Coca-Cola andlemonade are very different products; 19% thought they were the same thing; and 23%

know.

• No data was available on the relationship between understanding and frequency ofconsumption.

Data taken from EFSA (2013). Gathering data on specific consumer groups of energydrinks [6].

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Risks associated with ED consumption

The health risks associated with energy drinkconsumption are primarily related to theircaffeine content although the volume ofsugar present in some needs seriousdiscussion. Overconsumption of caffeinecan cause palpitations, hypertension,nausea and vomiting; and long-termconsumption can lead to type 2 diabetesdue to decreased sensitivity to insulin.

Children and Adolescents

Early research on energy drinksconsumption in adolescents presents causefor concern [7]. Long-term structural andfunctional changes have been observed inthe brain of adolescents for other neuro-active substances, including nicotine andalcohol, suggesting caffeine may alsoinfluence brain development.

Adolescent brains are more susceptible topsychoactive substances and thesubsequent activation of reward centres,creating dependence. Signs of this includehigh intake despite being aware it may be aproblem, persistent desire or unsuccessfulattempts to cut down.

Symptoms of caffeine overconsumptioninclude reduction in the length of sleep andsleep quality, which can be linked to poorperformance at school; and withdrawalsymptoms if consumption ceases.

Ironically, withdrawal creates some of thevery symptoms energy drinks are purportedto alleviate including concentration issuesand fatigue.

Regular energy drink consumption wasassociated with higher levels of media use,video game use and cigarette smoking.There was also a significant associationbetween energy drinks consumption andhigher daily intake of SSBs [8].

A lower frequency of breakfast was found ingirls who regularly consumed energy drinks,suggesting they are either monitoring theircalorie consumption or simply feel anenergy drink is enough to sustain them untillunch.

Shift Workers

Anecdotal evidence suggests that energydrink consumption is high in shift workers asa means for staying awake, remaining alertand reducing the likelihood of injury.

Whilst past research indicates that energydrinks are effective in counteractingsleepiness, active ingredients such ascaffeine and the high sugar content maynegatively impact sleep and may thereforebe counter-productive.

Consumption of energy drinks in asimulated night shift reduced average sleeptime by nearly 30 minutes, however next-day performance was unaffected. Thisindicates that one-time consumption ofenergy drinks may be effective for a singlenight-shift but it remains unclear what thelong-term consequences may be.

Shift workers are at higher risk of developingcardiovascular disease, obesity and variouscancers due to disrupted circadian rhythms.An example of a circadian rhythm is yourbody clock. When we have been awake fora long period, the need for sleepaccumulates and we begin to feel tired anddrowsy.

Overconsumption of high-sugar, high-caffeine energy drinks are likely toexacerbate problems related to sleep andwork-time sleepiness in the long-term.

Alcohol

Even though energy drinks are a relativelynew type of soft drink, both soft drinkcompanies and individual bars and clubs

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have quickly established them as an integralpart of nightlife, particularly amongst youngpeople who often mix energy drinks withalcohol.

This has coincided with longer licensedserving hours in the UK, with many bars andclubs open until 4am.

Drinkers therefore need more tokeep drinking, stay awake longer andsubdue the effects of alcohol creating anunprecedented demand for energy drinks.

Marketing of EDs

Big tobacco has historically used celebrity toendorse their products and the nicotinepresent in cigarettes to create dependence,transforming teenage usage into a lifelonghabit.

There are blatant similarities betweenbig tobacco and the strategiesemployed by energy drinks companieswith young athletes offering celebrityand caffeine delivering thedependence.

This combination provides a long-termcommercial interest for establishing brandloyalty early in life in other words marketingaimed at children and adolescents.

The British Soft Drinks (BSDA)voluntary code of practice states that energydrinks may not be promoted or marketed topersons under the age of 16 [10]. However,this has been especially difficult to police.

Red Bull has been extremely proficient inmanifesting its brand. The tagline, Bullgives you in conjunction withattractive visuals and clever audio, is veryaspirational in tone, vowing to increaseenergy and subsequently successsomething that young students are underincreasing pressure to achieve.

Furthermore, Red Bull is intimately linked

with extreme sports from Formula 1 to cliffdiving and Air Races to BMXing, adding toits . Red Bull have also penetratedestablished sporting markets, havingrecently set up New York Red Bulls footballclub and owning FC Red Bull Salzburg.

Parental Influence

In the EFSA report on energy drinksconsumption, around one third of childrenindicated that they consumed energy drinksat home, so it is important to consider therole parents play in consumption.

Munsell et al. [11] found that nearly allparents provided SSBs for their child and thenumber increased with age. Despite this,most parents understand that the productsare not healthy, however beliefsabout how healthy energy drinks and sportsdrinks are does not correspond with publichealth recommendations. A plausibleexplanation for these purchases despitepublic health warnings is the aggressivemarketing.

Whilst energy drink sales grew 5.1% in 2013the value of the market increased by 2%suggesting that price competition continuesto be fierce, forcing premium brands torespond with promotions and price cutsfurther enhancing their appeal as a cheaptreat.

Labelling Rules

The Foods Standards Agency in line with EUregulation [10], states that drinks containingmore than 150mg of caffeine per litre (mg/l)must be labelled with:

High caffeine content: notrecommended for children or pregnantor breast-feeding women in closeproximity to the name of the product whichmust be accompanied by the amount ofcaffeine per 100ml.

Click the boxes above to see first-hand how energy drink companies market theirproducts to children and adolescents.

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The British Soft Drinks Association (BSDA)published a voluntary Code of Practice thatsuggests that the term

(or similar words) should beincluded on the label and that suchproducts should not be promoted ormarketed to those under 16 years of age.

Sales / Restrictions

There are no legal restrictions on the sale ofenergy drinks to children in the UK. InFebruary 2015, Morrisons ended a trial banon the sale of energy drinks to childrenunder the age of 16 despite receiving a lot ofsupport from schools and teachers.

Morrisons refused to comment on theimpact of the ban claiming that someadolescents over the age of 16 had hadtrouble purchasing energy drinks as they donot routinely carry proof of age.

Recommendations

Immediate measures should be put in placeto ensure that the risks associated withenergy drinks are well known to the publicboth in terms of caffeine and sugaroverconsumption.

The marketing and communications ofenergy drinks and associated collateral mustbe more heavily regulated to adequatelyprotect children and adolescents [11 & 12].

The following pages will set out policyrecommendations in terms of the definitionand reference intakes (RI) of energy drinksand their constituents; education andawareness; and marketing / age restrictedsales / labelling best practices.

Recommendations on consumption willfollow in addition to viable alternatives forenergy drinks.

Definitions and Reference Intakes (RI)

• To ensure clarity and informed consumerchoice the Food Standards Agency (FSA)

should define what constitutes an energydrink, an isotonic beverage or

and other beverages.

• Moderate caffeine consumption isconsidered by the FSA to be around300mg per day. Currently only pregnantwomen are advised to limit their caffeineconsumption to around 200mg per day,or two cups of coffee.

• Daily caffeine consumption limits forchildren and adolescents are required inaddition to adults and pregnant women.

• An evidence-based, upper limit for theamount of caffeine allowed per 100mlmust be introduced and restrictions onthe maximum size of an energy drinkwould help to discourageoverconsumption.

Education and Awareness

• Health practitioners should be aware ofthe potentially dangerous consequencesof excess caffeine consumption.

• They should be able to identifysymptomatic caffeine overconsumptionand educate families on the riskassociated with overconsumption.

Marketing / Age Restricted Sales /Labelling Best Practices

• Industry-wide standards must beimplemented for responsible marketingof energy drinks.

• All energy drinks manufacturers shouldcease marketing of their products tochildren and adolescents under the ageof 16 and closely monitor contentdistributed via social media.

• Restriction of sales to under 16s shouldbe considered and retailers encouragedto do so voluntarily due to the potentiallyharmful adverse and developmentaleffects of caffeine on children.

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• Caffeine content should be displayed perserving and per 100ml on each individualcan or bottle.

• Assurance that energy drinks do not fallunder the school definition of

.

• All reporting of adverse events associatedwith energy drink consumption shouldcommit to providing details both to theenergy drinks manufacturer, the FSA andthe Department of Health to improve ourunderstanding of the consumption andhealth effects associated with energydrinks.

Consumption Recommendations

The volume of caffeine and sugar present inmany energy drinks far exceeds what isrequired nutritionally to the point that it maybe detrimental to health.

The Scientific Advisory Committee onNutrition (SACN) have proposed newrecommendations that sugars added tofood by the manufacturer, or sugars which

are naturally present in syrups andunsweetened fruit juices should account forno more than 5% of our energy intake, halfthat of current recommendation [14].

• Children should be encouraged to drinkwater and low fat milk to stay hydrated.

• We can also take on water throughconsumption of fresh fruit andvegetables.

• In regards to sports, both children andadults should start each session wellhydrated and drink water in response tothirst.

• During high intensity exercise, adults canlose up to 1L of water per hour and it isimportant to replace these fluids onceexercise is completed.

Please refer the gulp resource on sportsdrinks for further information.

REFERENCES

1. BSDA (2014). Creating New Choices (accessed 28/07/2015 fromhttp://www.britishsoftdrinks.com/write/mediauploads/bsda_annual_report_2014.pdf)

2. Higgins, J. P. et al. (2010). Energy Beverages: Content and Safety. Mayo Clin Proc, 85 (10), 1033-1041.

3. Keast, R. S. J., et al. (2014). Caffeine increases sugar-sweetened beverages consumption in a free-livingpopulation: a randomised controlled trial. British Journal of Nutrition.

4. Marks, R. (2015). Energy Drinks: A Potentially Overlooked Obesity Correlate. Advances in Obesity, WeightManagement & Control, 2 (3).

5. Red Bull B-group vitamins. (Accessed 13/10/2015 from: http://energydrink-uk.redbull.com/red-bull-b-vitamins).

6. EFSA (2013). Gathering consumption data on specific consumer groups of energy drinks.

7. Ishak, W. W. et al. (2012). Energy Drinks: Psychological Effects and Impact on Well-being and Quality of LifeA Literature Review. Innovations in Clinical Neuroscience, 9 (1), 25-34.

8. Larson, N., et al. (2014). Adolescent Consumption of Sports and Energy Drinks: Linkages to Higher PhysicalActivity, Unhealthy Beverage Patterns, Cigarette Smoking, and Screen Media Use. Journal of Nutrition,Education and Behaviour, 46 (3), 181-187.

9. Jay, S. M., et al. (2006). The suitability of a caffeinated energy drink for night-shift workers. Physiology &Behavior, 87, 925-931.

10. FSA. High caffeine energy drinks and other foods containing caffeine. (Accessed 28/07/2015 from:https://www.food.gov.uk/science/additives/energydrinks).

11. Munsell, C. R. et al. (2015). beliefs about the healthfulness of sugary drink options: opportunities toaddress misperceptions. Public Health Nutrition.

12. Buzz Kill. A Survey of Popular Energy Drinks Finds Majority of the Market Unwilling to Make Commitments toProtect Adolescents.

13. Breda, J., et al. (2014). Energy drink consumption in Europe: a review of the risks, adverse health effects, andpolicy options to respond. Frontiers in Public Health, 2 (134), 1-5.

14. SACN (2015). Carbohydrates and Health.

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All text tables, copyright Health Equalities Group 2017

Primary authors:

Michael Viggars, MA

Health Equalities Group151 Dale StreetLiverpoolL2 2JHUnited Kingdom

www.giveuplovingpop.org.uk@gulpNOW