The US Food and Drug Administration (FDA) defines energy drinks (EDs) as “a class of products in liquid form that typically contains caffeine, with or without other added ingredients.” Most of these beverages claim to contain “natural” ingredients, classifying them as dietary supplements rather than medications, and, as such, monitoring of these products and manufacturers by the FDA is not required. The FDA has no specific classification for energy drinks, which are sometimes considered nutritional supplements and other times beverages. Despite the FDA classification, the medical literature still has questions as to whether these beverages are dietary supplements or actual drugs.
The primary ingredient in these drinks is caffeine, which we’ve talked about in these pages before. Energy drinks have led to an estimated 70% increase in caffeine consumption nationwide. Caffeine is considered both a food additive and a drug by FDA standards and caffeine intake does have FDA recommendations due to cardiac and neurological side effects. The amount of caffeine in these beverages ranges from 80 to about 400 mg per serving, compared with about 60 mg in your morning cup of brewed coffee. That’s kind of like chugging 7 cups of coffee to start off your day and exceeds the FDA limit of 71 mg of caffeine per 12 fluid oz. In addition, many of these energy drinks contain an enhanced form of caffeine that’s typically a synthetic alkaloid rather than a naturally occurring constituent of plant-based beverages like in that morning cup of tea or coffee. Just to give them that added kick, they contain other stimulating ingredients in addition to caffeine that are also totally unregulated by the FDA like taurine, yerba mat, and guarana, which contains theophylline (a powerful smooth muscle relaxant and cardiac stimulant)—all of these add more energy boost. Some energy drinks also have significant amounts of carbohydrates (usually glucose), niacin, pyridoxine, vitamin B12, riboflavin (B2), ginseng extract, glucuronolactone (a glucose metabolite), inositol, ephedra (another potentially dangerous stimulant), Yohimbine, ginkgo, and kola nut extract. The effects and safety of these additives have been called into question in recent medical reviews, and there are real concerns of health hazards from the combined effects of caffeine with all of these additional unregulated ingredients in energy beverages. With this ingredient list it’s no surprise that this stuff can have some serious side effects.
Most people can tolerate these beverages with no problems—at least in moderation—and get the benefit of a little boost to their day, but not everyone, as some people are very sensitive to the ingredients. The most likely group of patients most susceptible to side effects are those under 18 years of age, caffeine-naïve or caffeine-sensitive people, pregnant or breastfeeding women, anyone taking stimulants or other caffeine-based medications, and those with cardiovascular or other medical conditions. Reports from the NIH point out that energy drinks can have a seriously negative impact on a whole lot of bodily systems like anxiety, gastrointestinal disturbances, dehydration, nervousness, and tachycardia, along with more severe outcomes like muscle cell death (rhabdomyolysis), acute kidney injury (AKI), seizures, acute mania, hypertension, and stroke. The most serious potential risk from these drinks is sudden cardiac death (SCD).
There have been a lot of headlines about young, fit athletes who have suffered sudden cardiac arrest. Fortunately some were witnessed, resuscitated, and survived but tragically others haven’t. The most recent attention has gone to football players on the national stage, but basketball players actually have the highest rate of SCD and there is even a report of a recent badminton player who died while competing. The causes of these incidents vary but there have been a few interesting reviews that found some important similarities. Of 145 survivors of SCD, the study found that 7 (5%) of the patients, who had an average age of 29, drank one of the popular energy drinks within a few minutes prior to their cardiac arrest. Another review cites 80 cases of cardiac and neurological events—including fatalities—in all age groups associated with energy drink consumption. These studies show that some users who suffered SCD had an underlying arrhythmia brought out with near-fatal complications, but not all patients had an unknown or previous illness.
The takeaway from all of these events is that most people can enjoy an energy beverage and get all the advertised benefits of a nice boost to their day. The risk is small but it’s real, and drinking a couple of cans of your favorite energy supplement and then getting into your airplane and flying off into the clouds is a really dangerous time to find out you are having a bad reaction. So just like you’re very careful about the fuel you put into your wing tanks, be careful about what you put into your own tank too. As always, fly safe!
