negative effects of energy drinks essay

The Impact of Energy Drinks on Health and Well-Being: What Does the Science Say?

African American male holding a basketball drinking an energy drink or electrolyte replacement

Written by: Rafael Guimarães, MS & Kristen DiFilippo, PhD, RDN

In recent years, the consumption of energy drinks has grown significantly in the United States. According to the Centers for Disease Control and Prevention (Greene et al. 2019), approximately 33.5% of adolescents aged 12 to 17 reported consuming energy drinks regularly, while 42% of adults aged 18 to 24 stated they frequently consumed these beverages. However, the stimulants in these drinks can have a detrimental effect on the nervous system (Greene et al. 2019). According to the Center for Behavioral Health Statistics and Quality, 1,499 adolescents aged 12 to 17 visited the emergency room for an energy drink-related emergency in 2011 ( The DAWN Report: Update on Emergency Department Visits Involving Energy Drinks: A Continuing Public Health Concern 2013). Therefore, energy drinks should be consumed with caution.

Marketed as quick solutions for fatigue and lack of energy, these products are widely consumed by individuals seeking to improve physical and mental performance. However, as consumption increases, so does the debate over the potential health risks.

Thus, let’s explore what science says about energy drinks and their effects on the body, both positive and negative.

What Are Energy Drinks?

According to the National Center for Complementary and Integrative Health, energy drinks are widely promoted as products that boost energy and enhance mental alertness and physical performance (National Center for Complementary and Integrative Health 2018). Their main ingredients include:

Caffeine : The primary stimulant found in energy drinks. A 250 ml can may contain up to 80 mg of caffeine, equivalent to a cup of coffee (Seifert et al. 2011). Caffeine acts on the central nervous system, increasing alertness (Graham 2001).
Sugars : Many energy drinks contain significant amounts of sugar, which quickly raises energy levels but can lead to a “crash” soon after (Seifert et al. 2011).
B Vitamins : Most brands include B vitamins, which help with energy metabolism (Scholey and Kennedy 2004).However, high doses of Niacin (Vitamin B3), commonly found in energy drinks, may pose a risk. Doses above 35 mg can cause Niacin flushing, leading to skin redness, itching, and tingling, especially when consumed in excess ( Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline 1998). Some energy drinks contain levels of Niacin that exceed these limits, increasing the risk of flushing and potentially liver damage over time (Haller et al. 2008).
Taurine and other amino acids : Substances that may contribute to cardiovascular and muscle function (Lourenço and Camilo 2002).

Short-Term Benefits

Some studies indicate that energy drinks can improve attention and physical performance in high-intensity tasks, especially due to the caffeine (Scholey and Kennedy 2004). This explains why many athletes and people with intense work or study routines turn to these drinks to boost productivity. Caffeine can also improve reaction time and the ability to concentrate on cognitive activities (Graham 2001).

Negative Effects and Health Risks

Despite the benefits, frequent consumption of energy drinks is associated with several adverse effects:

Caffeine overload : Excessive caffeine intake can cause insomnia, anxiety, increased heart rate, and in extreme cases, cardiac arrhythmias and seizures (Higgins, Tuttle, and Higgins 2010). It is estimated that excessive caffeine consumption, particularly through energy drinks, can result in sleep disturbances and irritability (Seifert et al. 2011).
Increased sugar intake : The high sugar content can contribute to weight gain, an increased risk of type 2 diabetes, and dental cavities (Breda et al. 2014). Regular intake can also lead to a sudden drop in energy levels after the initial effect (Seifert et al. 2011).
Dependence : Studies suggest that constant consumption of energy drinks may lead to caffeine dependence, resulting in withdrawal symptoms such as headaches, irritability, and fatigue (Juliano and Griffiths 2004).
Impact on cardiovascular health : Research shows that excessive consumption of energy drinks can increase blood pressure and lead to heart problems, especially in individuals predisposed to cardiovascular diseases (Higgins, Tuttle, and Higgins 2010).

Who Should Avoid Them?

People with heart problems, hypertension, or caffeine sensitivity should avoid energy drinks (Higgins, Tuttle, and Higgins 2010). Additionally, adolescents and young adults, who often overconsume these beverages, are particularly vulnerable to the negative effects of caffeine and sugar (Breda et al. 2014). Many health authorities recommend that consumption should be limited or avoided by this group (Seifert et al. 2011).

While energy drinks may offer a quick solution for fatigue, excessive consumption can pose significant health risks. Therefore, it is essential to use them in moderation and be aware of their effects on the body. Staying informed and making conscious choices are essential steps toward a healthier and more balanced life.

Breda, João Joaquim, Stephen Hugh Whiting, Ricardo Encarnação, Stina Norberg, Rebecca Jones, Marge Reinap, and Jo Jewell. 2014. “Energy Drink Consumption in Europe: A Review of the Risks, Adverse Health Effects, and Policy Options to Respond.” Frontiers in Public Health 2 (October): 134.

Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline . 1998. Washington, DC: National Academy Press.

Graham, Terry E. 2001. “Caffeine and Exercise.” Sports Medicine (Auckland, N.Z.) 31 (11): 785–807.

Greene, Sharon A., Jamal Ahmed, S. Deblina Datta, Cara C. Burns, Arshad Quddus, John F. Vertefeuille, and Steven G. F. Wassilak. 2019. “Progress toward Polio Eradication – Worldwide, January 2017-March 2019.” MMWR. Morbidity and Mortality Weekly Report 68 (20): 458–62.

Haller, Christine A., Minjing Duan, Peyton Jacob 3rd, and Neal Benowitz. 2008. “Human Pharmacology of a Performance-Enhancing Dietary Supplement under Resting and Exercise Conditions.” British Journal of Clinical Pharmacology 65 (6): 833–40.

Higgins, John P., Troy D. Tuttle, and Christopher L. Higgins. 2010. “Energy Beverages: Content and Safety.” Mayo Clinic Proceedings. Mayo Clinic 85 (11): 1033–41.

Juliano, Laura M., and Roland R. Griffiths. 2004. “A Critical Review of Caffeine Withdrawal: Empirical Validation of Symptoms and Signs, Incidence, Severity, and Associated Features.” Psychopharmacology 176 (1): 1–29.

Lourenço, R., and M. E. Camilo. 2002. “Taurine: A Conditionally Essential Amino Acid in Humans? An Overview in Health and Disease.” Nutricion Hospitalaria: Organo Oficial de La Sociedad Espanola de Nutricion Parenteral y Enteral 17 (6): 262–70.

National Center for Complementary and Integrative Health. 2018. “Energy Drinks.” NCCIH. 2018. https://www.nccih.nih.gov/health/energy-drinks.

Scholey, Andrew B., and David O. Kennedy. 2004. “Cognitive and Physiological Effects of an ‘Energy Drink’: An Evaluation of the Whole Drink and of Glucose, Caffeine and Herbal Flavouring Fractions.” Psychopharmacology 176 (3–4): 320–30.

Seifert, Sara M., Judith L. Schaechter, Eugene R. Hershorin, and Steven E. Lipshultz. 2011. “Health Effects of Energy Drinks on Children, Adolescents, and Young Adults.” Pediatrics 127 (3): 511–28.

The DAWN Report: Update on Emergency Department Visits Involving Energy Drinks: A Continuing Public Health Concern . 2013. Rockville, MD.

Photo credit: Ketut Subiyanto, via Pexels

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Home — Essay Samples — Nursing & Health — Energy Drink — Why Energy Drinks Should Be Banned

Why Energy Drinks Should Be Banned

Categories: Caffeine Energy Drink

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Words: 695 |

Published: Aug 31, 2023

Words: 695 | Pages: 2 | 4 min read

Health risks and negative effects, high caffeine content, targeting youth and adolescents, lack of regulation and labeling, emergency room visits and cases, alternatives to energy drinks, counterargument: personal choice and responsibility.

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Energy Drinks: Benefits and Disadvantages Essay

Introduction, research area, history of energy drinks, risks and health benefits, how long have energy drinks been available, works cited.

Energy drinks are a relatively new product; the number of sales has been growing since the end of the 20th century. These are beverages aimed at stimulating the central nervous system with an anti-sedative effect. Energy drinks contain tonic agents, most often caffeine, vitamins and sugars. The increase in their consumption has led to a public debate whether they should be banned or not. Medical institutions report a growing number of complaints related to harmful effects on consumers’ health. Therefore, it is critical to analyze where energy drinks came from, risks and health benefits, target population and marketing campaign, and states’ regulation.

The subject of energy drinks remains debatable as the data available on the effects is insufficient and contradictory. Higgins et al. claim that the current evidence remains unsystematic, leading to the impossibility of forming one position within the scientific field (65). According to Hammond et al., most of the data available shows short-term health impacts; most results are gained from the investigation of people with chronic conditions (20). The industry is also characterized by a significant amount of sponsored literature (Higgins et al. 65). Thus, the topic lacks unbiased studies, long-term research with samples of healthy people.

The main point of energy drinks opponents is the high concentration of caffeine. There are several common stimulants in energy drinks, such as taurine and guarana extracts (Hammond et al. 23). Each of them can be considered harmless, not causing adverse outcomes for the organism, but the interaction of both substances can increase the effect of caffeine and result in health risks (Hammond et al. 23). Regarding health concerns, most of the public’s questions focus on potential risks for youth as children and teenagers are more susceptible to stimulants than the older population (Hammond et al. 19). However, according to Hammond et al., the current position towards energy drinks is that these beverages’ effects exceed outcomes of other caffeinated drinks (Hammond et al. 23). Therefore, it has been recognized as novel exposure and should be investigated independently from previous caffeine research.

The first energy drink was invented in Asia, specifically in Japan. The use of amphetamines was widespread after the Second World War but limited due to restricting laws (Engber). As a result, in 1962, the Taisho company presented Lipovitan D; it was a legal, energizing drink sold in small bottles (Engber). The supply of extra-caffeinated and vitamin-fortified beverages increased; a large portion of drinks was bought by Japanese CEOs to maintain beneficial business performance by the end of the 20th century (Engber). They served as replenishing energy sources, containing caffeine, vitamins, and a significant amount of sugar.

The adverse outcomes for health are associated with caffeine consumption above the norm. Energy drinks affect the nervous and cardiovascular systems; the possible consequences are insomnia, fast heartbeat, headache, accompanied by vomiting, nausea or diarrhea; sometimes, it can cause chest pain (Hammond et al. 23). It can also provoke tachycardia and other cardiac problems; severe cases are seizures and death (Reid et al. 66). The overuse may lead to neurotic issues such as anxiety, agitation or jitteriness (Reid et al. 66). People that consumed energy drinks may report the intention of seeking medical help.

In small amounts, energy drinks are supposed to bring positive effects. For instance, they accelerate the reaction, increase aerobic and anaerobic endurance, prevent drowsiness while driving, improve the intensity of perception, mood and well-being (Hammond et al. 21). Nevertheless, the leading target group – youth – is more vulnerable to energy drinks due to smaller body size, lower levels of pharmacological tolerance to caffeine (Hammond et al. 22). These beverages may impact cognitive capabilities in adolescents faced with some behavior modifications (De Sanctis et al. 228). However, the long-term effects are unstudied in terms of chronic and excessive consumption.

Frequent consumption of energy drinks relates to athletes and secondary school students. According to Higgins et al., energy drinks continue to be marketed to children and adolescents (65). Market campaigns target teenagers through the Internet, social media platforms, posters, wall graffiti, and videos. The central theme of advertising campaigns is the involvement in sports activities. Consequently, several studies report the prevalence of energy drink consumption in youth intended to improve their strength and speed (Hammond et al. 23). For instance, up to 80% of college athletes drink them to enhance their sports performance (Higgins et al. 65). The industry aggressively advertises the product; hence due to bright packaging, these beverages have become popular, especially among young people.

Concerning the typical reasons, these are curiosity, taste and need for energy. According to Reid et al., in Canada, people want to stay awake for study, work or driving; similar intentions are reported in Europe (66). Moreover, the consumption behavior is impacted by social circumstances; for instance, children say, “my friends drink them” or “energy drinks are cool” (Reid et al. 66). Teenagers report that they drink it for “going out or partying” or “to mix with alcohol” (Reid et al. 66). Thus, energy drinks are consumed at home to be productive or at parties.

Energy drinks have been available in the market since the middle of the 20th century. In the United States, they were introduced in 1949; in Asia, the first campaign was performed in 1976 in Thailand, based on a Japanese drink (De Sanctis et al. 223). In Europe, it appeared in 1987 in Austria; overall, energy drinks became popular in the late 1990s (De Sanctis et al. 223). These days, they are available in almost all countries around the globe.

Energy drinks are considered legal mostly worldwide, being sold to all ages and groups of the population. The Food and Drug Administration (FDA) classifies these beverages as dietary supplements or foods. Both categories do not require adverse effect reporting; content might be strictly controlled depending on definition (Higgins et al. 66). This results in the ability of producers to control the caffeine level of their free choice. In most countries, energy drinks are sold freely; some states have forbidden their sale to adolescents. In France, Denmark and Norway, until 2009, energy drinks were banned for sale in grocery stores; they could be bought in pharmacies since they were considered medication. However, at present, almost all people can buy energy drinks regardless of age.

Personal Conclusion

To sum up, the current pace of living requires a person to be active. When energy resources are declining, some people consume energy drinks. It is an unfortunate tendency as energy drinks can be addictive. In my view, the necessity to outlaw energy drinks across the country should be acknowledged. However, until recently, the manufacturers of these beverages have found reasons and tools to influence the government, scientific community and target audience.

Energy drinks contain a concentrated dosage of caffeine and stimulants, including vitamins, taurine, herbal supplement and sugars. Side effects are possible, namely tachycardia, nervousness, anxiety and depression in case of an overdose. It is recommended to diminish consuming energy drinks by children and adolescents, people who have problems with the gastrointestinal tract, heart, blood vessels and pressure, and increased excitability, nervousness, sleep disorders and sensitivity to caffeine. Marketing campaigns are often youth-oriented, targeting children and teenagers; therefore, the government should accelerate the adoption of laws to limit sales and control their advertising aimed at minors.

De Sanctis, Vincenzo, et al. “Caffeinated energy drink consumption among adolescents and potential health consequences associated with their use: A significant public health hazard.” Acta Bio Medica: Atenei Parmensis , vol. 88, no. 2, 2017, pp. 222-231.

Engber, Daniel. “The Beauty of the Injured Book.” Medieval Fragments , 2013.

Hammond, David, et al. “Adverse effects of caffeinated energy drinks among youth and young adults in Canada: A web-based survey.” CMAJ Open, vol. 6, no. 1, 2018, pp. 19-25

Higgins, John, et al. “Energy drinks: A contemporary issues paper.” Current Sports Medicine Reports , vol. 17, no. 2, 2018, pp. 65-72.

Reid, Jessica L., et al. “Consumption of caffeinated energy drinks among youth and young adults in Canada.” Preventive Medicine Reports , no. 5, 2017, pp. 65-70.

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Energy drinks: Health downsides not worth the extra pep

Consuming energy drinks may increase the risks of a wide range of health problems, including poor mental health, substance abuse, diabetes , tooth decay, high blood pressure , and kidney damage, according to Harvard T.H. Chan School of Public Health researchers. They say that the risks are especially concerning because these drinks are aggressively marketed to young people, are often mixed with alcoholic drinks , and face little regulatory oversight.

Josiemer Mattei , assistant professor of nutrition and lead author of a review article published in August in Frontiers in Public Health that explored the science on energy drinks, told Men’s Health that “The wide range of conditions that energy drinks can negatively impact was quite astounding.”

In an interview published November 16, 2017, Mattei said that the high amounts of sugar and caffeine in these drinks likely play a role in their negative health effects. Other stimulants on the ingredient list, such as guarana, taurine, and ginseng, may also be contributing factors, but more research is needed.

Mattei said that the evidence is clear that the health risks associated with energy drinks outweigh any short-term pep they may provide. A better energy boosting choice, she said, is staying hydrated.

Read study: Health Effects and Public Health Concerns of Energy Drink Consumption in the United States: A Mini-Review

Read Men’s Health coverage: Here’s What Energy Drinks Actually Do to Your Body

Energy Drinks

Plain water is the best hydrating beverage for most people, but sports and energy drinks are advertised to appeal to those who exercise or need a boost of energy to get through the day.

Though sometimes confused with sports beverages , energy drinks are a different product entirely. They are marketed to increase alertness and energy levels, containing significant amounts of caffeine and as much or more sugar as in soda. Many energy drinks pack about 200 mg of caffeine, the amount in two cups of brewed coffee. Other substances purported to increase energy may be added, like B vitamins and herbs such as ginseng and guarana. Most concerning is a lack of regulation about the safety of these drinks, as well as aggressive marketing tactics geared toward adolescents. [1] The Centers for Disease Control and Prevention reported that in 2007, 1,145 adolescents ages 12 to 17 went to the emergency room for an energy drink-related emergency. In 2011 that number climbed to 1,499. [2]

After water, sugar is the main ingredient in energy drinks. A nutritional comparison shows that a 12-ounce cola drink contains about 39 grams of sugar, 41 grams of sugar in an energy drink. Research has found that consuming high-sugar drinks of any kind can lead to weight gain and an increased risk of type 2 diabetes, cardiovascular disease, and gout.

Because of the amount of sugar and stimulant ingredients, there is concern that these beverages may not be helpful, and even worse, harmful to adolescents and people with certain health conditions.

Energy Drinks and Health

Sipping a beverage that offers quick energy may appeal to people who feel fatigued or who believe the caffeine can provide an edge when exercising or playing competitive sports. Although statements on the websites of energy drinks warn that these beverages may not be suitable for children, youth are among their largest consumers. An energy drink may be used by adolescents or college students cramming for exams through the night, or by a young athlete before an important game. While it is true that some controlled trials have shown temporary improved alertness and reversal of fatigue after taking energy drinks, as well as enhanced physical performance in young athletes, the majority of studies show an association with negative health effects. These include increased stress, aggressive behaviors like fighting, alcohol/cigarette abuse, increased blood pressure, increased risk of obesity and type 2 diabetes, poor sleep quality, and stomach irritation. [1]

A typical energy drink may contain the following: carbonated water, around 40 grams of sugar (from sucrose and/or glucose), 160 mg or more of caffeine, artificial sweetener , and herbs/substances associated with mental alertness and performance but that lack scientific evidence with controlled trials (taurine, panax ginseng root extract, L-carnitine, L-tartarate, guarana seed extract, B vitamins).

Special concerns with energy drinks:

Amplified negative health effects in adolescents. Children and teens may experience heightened effects from the high amounts of caffeine, added sugars including high fructose corn syrup, low-calorie sweeteners , and herbal stimulants, partly due to their smaller body size. [3]
Marketing tactics towards youth. Estimates show more than a 240% increase in U.S. and worldwide sales of energy drinks. It is a $21 billion industry, with marketing campaigns targeting youth and being sold in places that are easily accessed by this age group. [1,4] Youth are exposed to energy drink advertising on children’s websites, computer games, television, supermarkets, and sporting events. [5] Research has shown that adolescents lack maturity in key areas of the brain and are more likely to engage in risk-taking behavior, making them vulnerable to risky behaviors sometimes portrayed in energy drink marketing. Youth are attracted to energy drinks due to effective marketing, influence from peers, and lack of knowledge about their potential harmful effects. [4]
Negative health outcomes. Emerging evidence has linked energy drink consumption with negative health consequences in youth like risk-seeking behaviors, poor mental health, adverse cardiovascular effects, and metabolic, renal, or dental problems. [1]
Excessive caffeine. Too much caffeine from any beverage, particularly when several are taken in one day in sensitive individuals, can lead to anxiety, insomnia, heart problems like irregular heartbeat and elevated blood pressure, and in rare cases seizures or cardiac arrest. Some energy drinks may contain as much as 500 mg per can (the amount in 14 cans of cola). [4.6]
High sugar content. Because of the excessive sugar content in some energy drinks, they carry the same health risks associated with other sugar-sweetened beverages. See Sugary Drinks .
Dangers with alcohol. A greater danger is introduced if energy drinks are combined with alcohol, a trend largely seen in underage drinkers and associated with binge drinking. Studies suggest that drinking this type of cocktail leads to a greater alcohol intake than if just drinking alcohol alone. This may be because energy drinks increase alertness that masks the signs of inebriation, leading one to believe they can consume even more alcohol. [1] In case reports, high consumption of energy drinks—especially when mixed with alcohol—has been linked to adverse cardiovascular, psychological, and neurologic events, including fatal events. [2]
Lack of regulation. The Food and Drug Administration (FDA) does not regulate energy drinks but enforces a caffeine limit of 71 mg per 12 ounces of soda; energy drinks typically contain about 120 mg per 12 ounces. However, energy drink manufacturers may choose to classify their product as a supplement to sidestep the caffeine limit. For companies that classify their energy drinks as beverages, the American Beverage Association published voluntary guidelines that advise accurate listings of caffeine content, restriction of marketing to children, and reporting of adverse events to the FDA. However, compliance to these guidelines has been found to be low. [1]
The International Society of Sports Nutrition (ISSN) issued a position statement on energy drinks after analyzing their safety and efficacy. (8) They concluded that consuming energy drinks 10-60 minutes before exercise can improve mental focus, alertness, anaerobic performance, and endurance in adults, largely through the effects of caffeine. However, other ingredients in these drinks require more study to demonstrate their safety and effects on performance. ISSN cautioned that higher-calorie energy drinks can lead to weight gain, and that their high glycemic load could negatively affect blood glucose and insulin levels. They discouraged use of energy drinks for children and adolescents unless under careful parental monitoring, and for people with diabetes or cardiovascular disease who could be negatively affected by the stimulant ingredients.
The American Academy of Pediatrics’ Committee on Nutrition and the Council on Sports Medicine and Fitness encourage pediatric health care providers to discourage the use of and discuss potential health risks of stimulant ingredients in energy drinks with youth and parents, and to limit or avoid sugar-sweetened beverages of any kind in youth due to risk of excessive calorie intake and weight gain, as well as dental erosion. [7]

Bottom Line

Water that is calorie-free and accessible without cost to most people is the beverage of choice taken with and between meals. Energy drinks are a source of caffeine that people may choose as an alternative to coffee or tea. However, they also contain high amounts of sugar, vitamins, and herbs that may not be necessary for the average person. Energy drinks can pose a health risk in vulnerable groups including children, teenagers, pregnant women, and those with medical conditions like diabetes and cardiovascular disease. Adults who choose to consume energy drinks should check the label for caffeine content and avoid high consumption (over 200 mg of caffeine per drink); consumption in combination with alcohol should be avoided. [9] Pediatricians should discuss the use of energy drinks with their young patients and parents to ensure that all are aware of the health risks, and if used, are monitored carefully. [7]

Sugary Drinks Sports Drinks

chemical formula for caffeine with three coffee beans on the side

Al-Shaar L, Vercammen K, Lu C, Richardson S, Tamez M, Mattei J. Health Effects and Public Health Concerns of Energy Drink Consumption in the United States: A Mini-Review. Front Public Health . 2017;5:225.
Ehlers A, Marakis G, Lampen A, Hirsch-Ernst KI. Risk assessment of energy drinks with focus on cardiovascular parameters and energy drink consumption in Europe. Food and Chemical Toxicology . 2019 Aug 1;130:109-21.
Centers for Disease Control and Prevention. The Buzz on Energy Drinks. https://www.cdc.gov/healthyschools/nutrition/energy.htm Accessed 8/21/19.
Pound CM, Blair B; Canadian Paediatric Society, Nutrition and Gastroenterology Committee, Ottawa, Ontario. Energy and sports drinks in children and adolescents. Paediatr Child Health . 2017 Oct;22(7):406-410.
De Sanctis V, Soliman N, Soliman AT, Elsedfy H, Di Maio S, El Kholy M, Fiscina B. Caffeinated energy drink consumption among adolescents and potential health consequences associated with their use: a significant public health hazard. Acta Biomed . 2017 Aug 23;88(2):222-231.
Wiggers D, Asbridge M, Baskerville NB, Reid JL, Hammond D. Exposure to Caffeinated Energy Drink Marketing and Educational Messages among Youth and Young Adults in Canada. Int J Environ Res Public Health . 2019 Feb 21;16(4).
Schneider MB, Benjamin HJ. Sports drinks and energy drinks for children and adolescents: Are they appropriate? Pediatrics . 2011;127(6):1182–9.
Campbell B, Wilborn C, La Bounty P, Taylor L, Nelson MT, Greenwood M, Ziegenfuss TN, Lopez HL, Hoffman JR, Stout JR, Schmitz S, Collins R, Kalman DS, Antonio J, Kreider RB. International Society of Sports Nutrition position stand: energy drinks. J Int Soc Sports Nutr . 2013 Jan 3;10(1):1.
van Dam RM, Hu FB, Willett WC. Coffee, Caffeine, and Health. NEJM . 2020 Jul 23; 383:369-378

Last reviewed July 2020

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How Dangerous Are Energy Drinks?

Verywell / Photo Illustration by Michela Buttignol / Getty Images

Key Takeaways

Energy drinks contain high levels of caffeine, sugar, and a variety of other legal stimulants.
Experts warn that energy drinks can increase blood pressure and cause irregular heart rhythms.
Combining alcohol and energy drinks may cause further health problems and increase the risk of binge drinking.

Energy drinks are one of the most popular dietary supplements in America—only second to multivitamins for some age groups. In fact, over 30% of teens aged 12–17 consume energy drinks on a regular basis.

Experts warn that these highly caffeinated, often sugary, drinks may be associated with increased blood pressure, weight gain, headaches, anxiety, dental problems, dehydration, and heart disease.

Despite the risks, energy drinks continue to grow in popularity. Celebrities promote these drinks on TikTok and global energy drink sales are expected to top $53 billion by the end of this year, with a 7.1% increase projected by 2027.

Why So Popular?

Since energy drinks are known to contain high levels of caffeine, they are associated with mental and physical boosts. They are often used by athletes to increase performance and by students to enhance study sessions.

How Much Caffeine Is Safe?

According to the Food and Drug Administration (FDA), 400 milligrams (mg) of caffeine per day is safe for most adults. That’s the amount you’d get from about 4 cups of coffee or around a dozen 12-ounce cans of Coca-Cola .

For young adults, the caffeine recommendations are much less.

“If an adolescent is in taking caffeine, the maximum that they should intake per day is 100 milligrams,” Priscilla Mpasi, MD, a pediatrician and region II chairperson with the National Medical Association, told Verywell.

Energy Drink Caffeine Content

Red Bull : An 8.4-ounce can contains 80 mg of caffeine
Monster: A 16-ounce can contains 160 mg of caffeine
Celsius Essential Energy : A 16-ounce can contains 200 mg of caffeine
Bang: A 16-ounce can contains 300 mg of caffeine

Many energy drinks contain well over 100 mg of caffeine, which is one reason why the American Academy of Pediatrics (AAP) advises against any child or adolescent consuming them.

According to the National Center for Complementary and Integrative Health (NCCIH), 16-oz energy drinks contain anywhere from 70 to 240 mg of caffeine on average. Bang, a fast-growing company that has blown up on TikTok , offers 300 mg of caffeine in its 16-oz energy drink. This product even comes with a warning label stating that it is “not recommended” for children under 18 and should not be consumed with any other caffeine-containing products.

Energy Drinks May Contribute to Heart Disease

Martha Gulati, MD, MS , a cardiologist at Cedars-Sinai Heart Institute, told Verywell that one of the biggest concerns with energy drinks are irregular heart rhythms, known as arrhythmias, that can occur due to “hyperstimulation of the heart.”

Arrhythmias can impact the amount of blood pumped throughout the body, making you feel faint. Over time, untreated arrhythmias could lead to more serious or fatal conditions.

“The other thing that I think people underestimate is the effect of energy drinks on blood pressure,” Gulati said.

A randomized control trial from 2019 found that energy drinks elevated blood pressure in otherwise healthy young adults. And another study published this year connected energy drinks with hypertension in children and teenagers.

Gulati said that energy drinks might pose an even greater risk for people who already have hypertension since these drinks can increase their blood pressure further on a regular basis. However, she said many people don’t realize they have hypertension, especially if they are young.

Long-term energy drink consumption could lead to heart failure or heart attacks, but experts say it is hard to test these associations with randomized control trials. This lack of evidence leads experts to broadly caution against energy drinks.

“I think that people should be careful with what they consume,” Gulati said.

Alcohol Makes Things Worse

In addition to the concerns about consuming energy drinks on their own, experts also caution against combining alcohol with energy drinks.

Mpasi told Verywell that alcohol acts as a depressant while energy drinks are a stimulant, which can confuse your body’s neurotransmitters.

“Your brain is going to be getting a lot of different signals—you don’t know how your brain and your body will respond to drinking alcohol and an energy drink together,” she said.

In 2010, the FDA cracked down on caffeinated alcoholic beverages, which led companies like Four Loko to reformulate their recipe and remove the caffeine, guarana, and taurine from their products.

However, Jägerbombs, Vodka Redbulls, and other energy drink cocktails are still sold in bars and mixed at home. The CDC reported in 2017 that almost 32% of adults aged 19–28 consumed an energy drink with alcohol in the previous year.

Gulati told Verywell that combining alcohol with caffeine means it will take longer for the caffeine to leave your body.

“That means you’re stimulated for an even longer time than maybe you would be if you took either of them separately,” she said.

Experts say this additional stimulation can lead to people consuming more alcohol than they might otherwise. The CDC reported that young adults who consumed alcohol and energy drinks together were more likely to binge drink than those who did not mix these substances.

It Can Be Difficult to Consume Energy Drinks Safely

While a single energy drink may contain less than the 400 mg of caffeine considered safe by the FDA, people who rely on these drinks might find themselves consuming more than one to feel the same effects.

A 2015 study of nursing students using energy drinks to stay awake while studying for exams found that some of the students consumed as many as 30 energy drinks in a week.

“The effects that they might feel early on when they take these energy drinks and feel more awake and feel more stimulated tend to wear off in time,” Gulati said.

Some athletes also use energy drinks for performance, but experts say it is important to discuss the pros and cons with a trusted healthcare provider first.

“Don’t assume food and drink manufacturers have your best interests at heart,” Gulati said. “They’re just trying to sell something to you.”

What This Means For You

In addition to caffeine and other stimulant additives, many energy drinks contain high levels of sugar. Experts say that the sugar content in energy drinks can contribute to weight gain and dental issues.

National Center for Complementary and Integrative Health. Energy drinks .

Al-Shaar L, Vercammen K, Lu C, Richardson S, Tamez M, Mattei J. Health effects and public health concerns of energy drink consumption in the united states: a mini-review . Front Public Health . 2017;5:225. doi:10.3389/fpubh.2017.00225

Food and Drug Administration. Spilling the beans: how much caffeine is too much?

Centers for Disease Control and Prevention. The buzz on energy drinks .

Beverage Industry . 2020 state of the beverage industry: energy drinks, mixes maintain steady growth .

National Heart, Lung and Blood Institute. What Is an arrhythmia?

Shah SA, Szeto AH, Farewell R, et al. Impact of high volume energy drink consumption on electrocardiographic and blood pressure parameters: a randomized trial . J Am Heart Assoc . 2019;8(11):e011318. doi:10.1161/JAHA.118.011318

Oberhoffer FS, Li P, Jakob A, Dalla-Pozza R, Haas NA, Mandilaras G. Energy drinks: effects on blood pressure and heart rate in children and teenagers. A randomized trial . Front Cardiovasc Med . 2022;9:862041. doi:10.3389/fcvm.2022.862041

Centers for Disease Control and Prevention. Alcohol and caffeine .

Kim IK, Kim KM. Energy drink consumption patterns and associated factors among nursing students: a descriptive survey study . J Addict Nurs . 2015;26(1):24-31. doi:10.1097/JAN.0000000000000061

By Stephanie Brown Brown is a nutrition writer who received her Didactic Program in Dietetics certification from the University of Tennessee at Knoxville. Previously, she worked as a nutrition educator and culinary instructor in New York City.

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Health Effects and Public Health Concerns of Energy Drink Consumption in the United States: A Mini-Review

Laila al-shaar, kelsey vercammen, scott richardson, martha tamez, josiemer mattei.

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Edited by: Shane Andrew Thomas, Shenzhen Health Authority, Australia

Reviewed by: Hemal Shroff, Tata Institute of Social Sciences, India; Mayura Shinde, Harvard Pilgrim Health Care, United States

*Correspondence: Josiemer Mattei, [email protected]

† These authors have contributed equally to this work.

Specialty section: This article was submitted to Public Health Education and Promotion, a section of the journal Frontiers in Public Health

Received 2017 Jun 9; Accepted 2017 Aug 11; Collection date 2017.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

As energy drink consumption continues to grow worldwide and within the United States, it is important to critically examine the nutritional content and effects on population health of these beverages. This mini-review summarizes the current scientific evidence on health consequences from energy drink consumption, presents relevant public health challenges, and proposes recommendations to mitigate these issues. Emerging evidence has linked energy drink consumption with a number of negative health consequences such as risk-seeking behaviors, poor mental health, adverse cardiovascular effects, and metabolic, renal, or dental conditions. Despite the consistency in evidence, most studies are of cross-sectional design or focus almost exclusively on the effect of caffeine and sugar, failing to address potentially harmful effects of other ingredients. The negative health effects associated with energy drinks (ED) are compounded by a lack of regulatory oversight and aggressive marketing by the industry toward adolescents. Moreover, the rising trend of mixing ED with alcohol presents a new challenge that researchers and public health practitioners must address further. To curb this growing public health issue, policy makers should consider creating a separate regulatory category for ED, setting an evidence-based upper limit on caffeine, restricting sales of ED, and regulating existing ED marketing strategies, especially among children and adolescents.

Keywords: energy drinks, beverages, review, health effects, food policy, regulation

Introduction

Energy drinks (ED) are non-alcoholic beverages marketed to improve energy, stamina, athletic performance, and concentration. Categorized as “functional beverages” alongside sports drinks and nutraceuticals, the ED industry has grown dramatically in the past 20 years, reaching over $9.7 billion in United States (U.S.) sales in 2015, with two brands accounting for nearly 85% of the market ( 1 ). The target consumer market for ED is adolescents and young adults ( 1 ), with one study finding that 51% of college students report consuming at least one ED each month ( 2 ). While annual sales of ED remain dwarfed by those of soft drinks and coffee, there are concerns that lax regulation of marketing and ingredient labeling is spurring a trend of increased consumption. Since their introduction to the U.S. market in 1997, there has been a significant increasing trend in ED consumption among children, adolescents, and adults, although the proportion of calories attributable to ED is still marginal compared to other sugar-sweetened beverages (SSBs) such as soda and fruit juice ( 3 , 4 ). The rising prevalence of ED consumption is particularly problematic given the emerging evidence of association with negative health consequences such as risk-seeking behaviors, adverse cardiovascular effects, and metabolic, renal, or dental conditions ( 5 , 6 ). Updating and integrating the findings of some previous reviews ( 7 , 8 ), this mini-review summarizes the current scientific evidence on ED health effects, presents relevant public health challenges, and proposes recommendations to amend these issues.

Constituents and Ingredients

Despite the vast array of ED available in the U.S., most ED contain similar ingredients including water, sugar, caffeine, non-nutritive stimulants (e.g., guarana, ginseng, yerba mate, taurine, l -carnitine, d -glucuronolactone, and inositol) and certain vitamins and minerals (e.g., B vitamins) ( 1 , 9 ). The caffeine content in ED ranges widely from 47 to 80 mg per 8 oz to as high as 207 mg per 2 oz and comes from a number of ingredient sources ( 10 ). While moderate caffeine intake (up to 400 mg/day) is generally considered safe and even beneficial for health among adults ( 11 ), there has not been extensive research conducted on children and adolescents to determine if any tolerable level exists ( 12 ). ED also contain large amounts of high fructose-corn syrup, sucrose, or artificial sweeteners. The amount of sugar contained in one can (500 mL or 16.9 oz) of an ED is typically about 54 g ( 13 ). Many institutions, including the World Health Organization, have recommended reducing sugar intake due to the strong evidence linking consumption of added sugar to poor health ( 14 ).

Reports on other constituents of ED are relatively limited. Guarana is a plant extract native to South America which contains a significant amount of caffeine, with 1 g of guarana equivalent to 40 mg of caffeine ( 15 ). Due to this particularly high caffeine content, guarana is often included as an ingredient in ED for its stimulatory effect ( 1 , 16 ). Ginseng is an herbal supplement that has been used for thousands of years in East Asia and has reported health benefits including vasorelaxation, antioxidation, anti-inflammation, and anticancer ( 17 , 18 ). Like guarana, yerba mate has a high caffeine concentration (78 mg caffeine per cup) ( 1 ) and is additionally thought to have benefits in the form of antioxidant capacity, weight management, and cancer prevention ( 19 ). Taurine has been reported to have anti-inflammatory actions and has been suggested in the treatment of epilepsy, heart failure, cystic fibrosis, and diabetes ( 20 ). B vitamins refer to a group of eight water soluble vitamins which generally play an important role in cell functioning, with vitamin B2 (riboflavin), B3 (niacin), B6 (pyridoxine, pyridoxal, and pyridoxamine), and B12 being the most common B vitamins added to ED ( 1 ). Despite the importance of B vitamins as coenzymes in various metabolic processes, most individuals in the U.S. already meet the recommended daily amount and hence the additional B vitamins added to ED are often excreted from the body with urine, failing to impart any additional health effect ( 1 ). The literature on the content and function of other additives such as l -carnitine, d -glucuronolactone, and inositol is limited, with a few studies suggesting moderate benefits ( 18 ).

Health Effects of ED

Improved cognitive and physical performance.

Some studies support the temporary health benefits of ED in improving mental and physical stamina among both adults and adolescents. Several randomized controlled trials among adults have shown an association between components of ED and improved subjective alertness ( 21 ), as well as restoration of fatigue ( 22 ). Due to its similar structure to adenosine, caffeine can inhibit sleep through its competitive binding to the adenosine receptor ( 23 ). Studies have also shown the effect of ED on improved physical activity performance in young-adult athletes ( 24 – 27 ). A recent meta-analysis of acute-effect studies conducted among adults found that ED consumption improved muscle strength and endurance, performance on endurance exercise tests, jumping, and sport-specific actions ( 28 ).

In contrast, the vast majority of evidence suggests negative health effects of both short- and long-term ED consumption (Table 1 ), with most literature proposing these health disadvantages are attributable to high levels of caffeine and sugar while highlighting that more research is needed on the effects of other ED constituents.

Summary of negative health effects of energy drinks (ED).

a The evidence for adverse metabolic and dental effects comes from studies on sugar-sweetened beverages in general; ED are often classified as such as they contain added sugar .

Risk-Seeking Behaviors and Mental Health Effects

Several studies report a consistent association between ED consumption and substance abuse, although the evidence base consists primarily of cross-sectional studies, which does not allow for establishing directionality of the association ( 29 – 34 ). For example, in a nationally representative sample of U.S. middle- and high-school students, significant associations were found between ED frequency and 30-day frequency of use of alcohol, cigarettes, marijuana, or amphetamines ( 32 ). This echoes cross-sectional results among adolescent regular consumers (>1 ED/week) in Europe who were more likely to smoke and drink alcohol compared to non-consumers ( 35 ). Some studies have additionally found evidence for an association between ED consumption and mental health, including stress, anxiety, depressive symptoms, and suicidal ideation, plan or attempt ( 33 , 36 , 37 ). For example, teenagers in Canada who reported ED consumption more than once a month were nearly three times more likely to report elevated depressive symptoms compared to those who did not report ED consumption ( 33 ). A review of ED consumption and mental health among adolescents and adults supported a positive association between chronic ED use and undesirable mental health effects, including stress, anxiety, and depression ( 37 ). The authors postulate that this association may be moderated by dysregulated sleep, such that consuming heavily caffeinated ED may result in sleep loss which in turn may contribute to poor functioning and mental health.

Adverse Cardiovascular Effects

Numerous studies have explored the short-term effects of ED on the cardiovascular system, primarily with respect to caffeine and sugar ( 38 – 40 ). For example, a recent randomized crossover study on healthy subjects found that consumption of 355 mL of an ED resulted in increased systolic and diastolic blood pressure, heart rate, and cardiac output ( 39 ). A 2016 meta-analysis of 15 studies similarly reported that acute ED consumption resulted in increased systolic and diastolic blood pressure across the pooled results ( 41 ). Although the meta-analysis did not find evidence for increased heart rate, the researchers noted the need for well-designed studies before any conclusions can be made.

Caffeine toxicity is believed to occur above 400 mg/day for adults, 100 mg/day for adolescents (12–18 years), and 2.5 mg/kg of body weight for children (<12 years), with serious symptoms often related to cardiovascular effects ( 42 ). In the 1-year period between October 2010 and September 2011, the U.S. National Poison Data System received 4,854 ED-related calls, including major adverse events such as seizure, dysrhythmia, and tachypnea ( 42 ). Data from Australian poisons centers confirm these major symptoms of recreational or accidental ED intake among children and adolescents, in addition to palpitations, agitation, and tremor ( 43 ). Given that these data relies on self-reported signs and symptoms and most consumers may not readily identify ED as a poison, it is likely that ED-related toxicity reports are underestimated. It is believed that the potential for caffeine toxicity from ED is greater than other caffeine sources such as coffee or tea due to inadequate labeling and greater volume of consumption driven by heavy advertising promoting “more is better,” especially among children and youth ( 5 ).

Adverse Metabolic, Dental, or Renal Effects

Sugar-sweetened beverages, which refer to beverages with added sugar such as soda, fruit juice, and many ED, are consistently associated with long-term negative health effects particularly among children and adolescents ( 44 – 46 ). Primarily, SSBs have been linked to overweight/obesity risk and metabolic conditions such as type 2 diabetes ( 44 , 47 – 49 ), potentially through the low satiety of SSBs and consumers not sufficiently reducing total energy intake to account for the additional calories of SSBs ( 50 ). In addition, consumption of SSBs increases blood glucose and insulin levels, contributing to a high glycemic load which is associated with glucose intolerance and insulin resistance ( 48 ). SSBs are also associated with a high prevalence of dental caries, wherein bacteria in the mouth utilize the sugars from SSBs and produce acid that decays the teeth ( 51 , 52 ). Finally, renal diseases, specifically renal microvascular damage ( 53 ) and accelerated progression of chronic kidney disease, have been shown to be induced by fructose in SSBs in animal-based models ( 54 , 55 ).

Other Health Effects

Energy drinks’ consumption is also associated with other commonly reported health problems such as sleep dissatisfaction, tiredness/fatigue, late bedtime, headaches, and stomachaches and irritation ( 35 , 56 – 59 ). It is likely that many of these general health complaints are attributable to caffeine or sugar content, but additional research needs to be conducted to confirm this, as well as to assess the potential effect of other constituents. In a cross-sectional study conducted in Finland, consumers of ED had a 4.6 (95% CI: 2.8, 7.7) times greater odds of headaches, 3.6 (95% CI: 2.2, 5.8) times greater odds of sleeping problems, and 4.1 (95% CI: 2.7, 6.1) times greater odds of having an irritable mood compared to non-consumers ( 57 ).

Limitations of the Existing Literature

The literature generally suggests that the negative health effects of ED outweigh the beneficial effects. However, there are considerable limitations to the existing literature. First, most studies on ED are cross-sectional, limiting the ability to establish temporal relationships and support causality. In addition, many articles used small homogenous populations, often consisting of healthy, young to middle-aged adults, thus limiting generalizability to the U.S. population. Finally, studies specifically examining the effects of other ED constituents are lacking and thus there is limited knowledge on the potential mechanisms beyond those of caffeine and sugar, for which most of the literature exist.

Relevant Public Health Challenges

Energy drink marketing.

Since 2004, aggressive advertising by ED companies has led to substantial market growth, with a more than 240% increase in sales in the U.S. and worldwide. ED are now available in more than 140 countries ( 8 ) and are on track to become a $21 billion industry in the U.S. by 2017 ( 60 ).

Energy drinks’ marketing strategies pose a significant public health threat in the U.S. due to the size of their target adolescent market and the marketing strategies they employ. ED face heavy competition for market share with SSB corporations that dwarf them in size, customer base, distribution capability, and ability to invest in advertising ( 61 ). To compete, ED companies target the approximately 33.5 million 12- to 19-year olds in the U.S. ( 62 ). The public health implications of targeting adolescents are not trivial: adolescents lack maturity in key areas of the brain, are biologically predisposed to have poor impulse control, and are more likely to engage in risk-taking behavior ( 63 ). This not only makes them more likely to consume the product on a regular basis but also makes them more vulnerable to identifying and potentially engaging in sexual and risk-taking behaviors depicted in ED marketing.

Adolescents’ vulnerability to the marketing tactics of ED companies is particularly serious given that ED are now omnipresent across multiple vending channels with price points widely affordable to all strata of the population. There are few signs that the scale and targeting of ED marketing will change in the near future. A 2014 study on ED marketing conducted by the offices of several U.S. Senators found that of the sixteen companies they approached, only four agreed to avoid marketing their products to children ( 64 ).

Lack of Regulation and Taxation

Overall, there is a significant lack of ED regulation in the U.S. ( 65 ). While the Food and Drug Administration (FDA) enforces a caffeine limit of 71 mg per 12 fluid ounces for soda, ED manufacturers can avoid this by classifying their product as a “supplement,” regulated under the 1994 Dietary Supplement and Education Act and not subject to any caffeine limits ( 1 , 8 ). That said, many ED companies are moving to marketing their products as beverages to address public concerns that their products are circumventing labeling requirements and also to enable ED to be available to participants of the Supplemental Nutrition Assistance Program, a U.S. nutrition assistance program providing low-income individuals with financial support to purchase food and beverages.

In 2014, the American Beverage Association published the “Guidance for the Responsible Labeling and Marketing of Energy Drinks,” which allowed ED companies to voluntarily commit to a number of industry goals ( 66 ). The companies committed to report total quantities of caffeine from all sources, restrict marketing to children, and voluntarily report adverse events to the FDA. However, an assessment report found that compliance to this commitment was staggeringly low ( 64 ), with 8 of 12 companies still marketing to children and 4 of 10 companies not willing to report adverse events voluntarily. Other countries facing similar challenge to the U.S. have implemented various approaches to regulate ED. For example, Australia and New Zealand created a unique regulatory category for ED called “formulated caffeine beverages,” and set the upper limit of caffeine from any source to be 320 mg/L ( 65 ).

In addition to regulation, some countries have implemented taxation policies as a deterrent to ED consumption. Mexico currently taxes all non-alcoholic beverages with added sugar, including ED, at one-peso-per-liter, with recent assessments reporting that purchases of taxed beverages have decreased by an average of 6% since implementation in January 2014 ( 67 ). Similarly successful initiatives have been emerging in some U.S. cities ( 68 ).

Alcohol and Energy Drink Mixing

In addition to being consumed alone, ED are frequently mixed with alcohol, with one study in the European Union finding that 71% of young adults report consuming ED with alcohol ( 69 ). This is problematic because individuals who drink alcohol-mixed ED consume more alcohol than if they were drinking alcohol alone ( 70 , 71 ). Researchers attribute this to the fact that consumption of ED masks the signs of alcohol inebriation, enabling an individual to believe they can still safely consume more alcohol, leading to “awake drunkenness” ( 72 ). As a result of this increased alcohol consumption, those who drink alcohol-mixed ED are more likely to experience severe dehydration and alcohol poisoning ( 73 ). This negative health trend is particularly concerning as it disproportionately affects underage individuals and has been linked to binge drinking, alcohol-dependence behaviors ( 70 ) and drunk driving ( 74 ).

Recommendations and Future Directions

Public health and policy action must be taken to mitigate the negative health effects and public health challenges associated with ED. First, the FDA should consider regulation of ED as a separate category, requiring clear labeling of total caffeine and sugar content in reference to daily recommended amounts, and enforcing an upper limit for caffeine based on current evidence. Additional consideration should be given to taxing ED and/or restricting the sale of ED to children and adolescents. Marketing strategies should be also regulated to minimize the promotion of ED among adolescent and young adults. Because marketing is largely aimed at this segment of the population, exposure to ED products could be reduced considerably. In parallel, further research should continue to improve the quality of the evidence on the health effects of ED with particular attention to observational studies with longer follow-up, more heterogeneous populations, and the effects of other ED constituents. Finally, adolescents and their parents should be educated on the adverse nutritional content and subsequent health effects of ED so that they can make informed decisions about consumption.

Despite some limited beneficial short-term effects, ED should be considered a significant public health problem that warrants attention. The growing evidence base demonstrating associations between ED consumption and negative health effects and public health challenges point to the need for close surveillance and assessment of this issue by researchers and policy makers.

Author Contributions

LA-S and KV conceptualized the topic, researched and analyzed the background literature, and wrote the manuscript, including interpretations. CL and SR researched and analyzed the background literature and wrote portions of the manuscript, including interpretations. MT and JM provided substantial scholarly guidance on the conception of the topic, manuscript draft and interpretation, and revised the manuscript critically for intellectual content. All the authors approved the final version of the manuscript, ensured the accuracy and integrity of the work, and agreed to be accountable for all aspects of the work.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer, MS, declared a shared affiliation, with no collaboration, with the authors to the handling editor.

Acknowledgments

The authors appreciate the comments from our colleagues from the 2016 Principles of Nutrition course at Harvard TH Chan School of Public Health.

Funding. SR was supported by the NIH-NHLBI (HHS/United States) CVD Epidemiology Training Program in Behavior, the Environment and Global Health (grant number T32 HL098048). MT was supported by the National Council of Science and Technology (CONACyT, Mexico). JM was supported by a NIH-NHLBI Mentored Career Development Award to Promote Faculty Diversity in Biomedical Research (grant number K01-HL120951).

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Energy drinks are killing young people. It’s time to stop that.

June 7, 2017

Co-authored by Wendi Gosliner, a project scientist at the Nutrition Policy Institute .

Last week, a 16-year-old tragically lost his life after consuming an energy drink, a soda and a latte — drinks routinely consumed by and often intensively marketed to youth — all within a few hours. According to the coroner, the boy’s heart simply couldn’t cope with the amount of caffeine in the beverages.

The teen wasn’t the first to pay a terrible price for drinking popular beverages that are commonly (but mistakenly) considered safe, but he must be the last. The government must take steps to reduce caffeine levels allowed in energy drinks; to clearly provide recommendations for the safe caffeine consumption for children and adolescents; to ban the marketing of energy drinks to youth of all ages; and to help educate the public on the health risks of high caffeine intake.

Making matters worse, consumers do not know the risks of the high levels of caffeine in an energy drink. Nutrition labels are not legally required to include information about caffeine content — a critical and potentially life-threatening omission. Many energy drink manufacturers have initiated voluntary labeling initiatives, but they are not consistently applied and they do not provide adequate information to ensure consumers appropriately interpret the level of risk presented by the beverage. Labels are a first step — necessary, but not sufficient.

Unlike coffee, energy drinks are widely marketed to adolescents, putting them at risk of extreme caffeine overload with potentially devastating cardiovascular and neurological consequences. From 2005 to 2011, energy drink-related emergency room visits increased from 1,128 to 20,783. This included high rates of unintentional exposure in children younger than 6 years old. In 2013, the American Medical Association adopted a policy supporting a ban on the marketing of energy drinks to youth under the age of 18 years, saying, “Energy drinks contain massive and excessive amounts of caffeine that may lead to a host of problems in young people including heart problems …”

In 2011, the American Academy of Pediatrics released a report on the appropriateness of sports and energy drinks for children and adolescents. They concluded that “…energy drinks pose potential health because of the stimulants they contain, and should never be consumed by children and adolescents.”

Still, energy drink consumption has skyrocketed in recent years, even as soda consumption has begun to decline. Given the danger energy drinks pose to children and youth with no potential benefit to their health or wellbeing, the marketing and advertising of these products to young people must stop.

Because manufacturers add caffeine to energy drinks, it is subject to regulation by the Food and Drug Administration as a food additive. In fact, the FDA has recognized the risks of high caffeine consumption and imposed a 71-milligram limit on the level of caffeine that may be added to a 12-ounce soda. However, no limits currently are imposed on the caffeine content of energy drinks, and containers easily can contain 200 to 300 milligrams or more. There is no justification for this regulatory distinction. Youth drinking energy drinks need as much protection as those drinking Coke or Pepsi.

Adolescents — the prime consumers of energy drinks — are entitled to information that can save their lives. The FDA’s limits on added caffeine in colas should also be applied to energy drinks, and the amount of caffeine added to an energy drink should always be listed on its nutrition label, including a distinct front-of-package warning for drinks with caffeine levels greater than those allowed in soda. Information based on scientific testing should also be made available on the effects of energy drink additives, such as guarana and taurine, that can increase the potency and increase the effects of caffeine.

As the sales of energy drinks rise every year, the need to act becomes even more critical. Steps to protect the health of our children are both feasible and necessary. The problem has been identified; now is the time to act.

Originally published in the Washington Post; this version has been updated.

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Article Contents

Introduction, energy drinks and marketing to youth, evidence for concern, evidence that teens can safely consume energy drinks, need for additional research, policy options.

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Energy drinks and adolescents: what’s the harm?

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Jennifer L. Harris, Christina R. Munsell, Energy drinks and adolescents: what’s the harm?, Nutrition Reviews , Volume 73, Issue 4, April 2015, Pages 247–257, https://doi.org/10.1093/nutrit/nuu061

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Concerns about potential dangers from energy drink consumption by youth have been raised by health experts, whereas energy drink manufacturers claim these products are safe and suitable for marketing to teens. This review summarizes the evidence used to support both sides of the debate. Unlike most beverage categories, sales of energy drinks and other highly caffeinated products continue to grow, and marketing is often targeted to youth under the age of 18 years. These products pose a risk of caffeine toxicity when consumed by some young people, and there is evidence of other troubling physiological and behavioral effects associated with their consumption by youth. The US Food and Drug Administration has indicated it will reexamine the safety of caffeine in the food supply; however, more research is needed to better understand youth consumption of energy drinks and caffeine in general, as well as the long-term effects on health. Meanwhile, policymakers and physician groups have called on energy drink manufacturers to take voluntary action to reduce the potential harm of their products, including placing restrictions on marketing to youth under the age of 18 years. Additional regulatory and legislative options are also being discussed.

In 2011, the American Academy of Pediatrics issued a report that raised significant concerns about the consumption of energy drinks by youth; it concluded that “rigorous review and analysis of the literature reveal that caffeine and other stimulant substances contained in energy drinks have no place in the diet of children and adolescents.” 1 Despite the potential health issues presented in the report, manufacturers of energy drinks continue to market energy drink products to children under the age of 18 years. 2 In 2013, the US Senate Committee on Commerce, Science, and Transportation held a hearing as part of an ongoing investigation of energy drink marketing to youth. 3 During that hearing, industry representatives pledged that they would not market their products to young children but refused to place limitations on marketing to children aged 12 years and older. Assertions such as the following were made by company executives: “Red Bull is safe for teenagers and adults to consume” 4 and “We believe our product [Monster Energy Drink] is safe for teenagers, and there is no reason why teenagers should not be part of being able to consume the brand.” 3

In this review, the emerging issue of energy drink consumption by youth is discussed and the evidence used to support both sides of the debate is summarized. It also identifies the need for additional research to better understand youth consumption of energy drinks and caffeine in general and to confirm medical experts’ concerns about the potential physiological and behavioral risks of energy drink consumption by children under 18 years of age. Until these effects are better understood, it is recommended that the public health community increase awareness among young people and their parents about the potential risks related to energy drink consumption and for energy drink companies to refrain from marketing their products directly to youth. Policy options to restrict energy drink sales and marketing to protect youth from harm that could result from consuming energy drinks and other highly caffeinated products are offered.

In this review, “energy drinks” is defined as the category of beverages that contain high levels of caffeine plus specialty ingredients not commonly found in sodas and juices. 5 These products typically have the word “energy” in their names and include both energy drinks and energy shots. Although the category comprises a wide variety of products, energy drinks typically contain carbonation and added sugar and come in nonresealable containers, most commonly sized to hold 16 oz. In contrast, energy shots are concentrated, typically contain artificial sweeteners but not added sugar, and are sold in 2 - to 2.5-oz containers. 6 Energy drinks differ from sports drinks, which are marketed primarily to provide hydration during physical activity and contain electrolytes and no caffeine.

Total caffeine in energy drink products ranges from 70 to 240 mg in a 16-oz energy drink and 113 to 200 mg in a 2-oz shot. 2 By comparison, most colas contain approximately 35 mg per 12-oz container. 6 Most energy drinks and shots also contain a proprietary “energy blend” that consists of stimulants and other specialty ingredients such as taurine, ginseng, and guarana. 7 Added sugar in energy drinks also poses a concern. The most common 16-oz size contains 54–62 g of sugar (up to 280 kcal). 6 In addition, carbonated energy drinks often come in larger-sized nonresealable containers intended to be consumed in one sitting. For example, a 32-oz can of Monster Energy contains 320 mg of caffeine and 108 g of sugar, totaling 400 kcal.

Despite the high levels of caffeine and incidence of novel ingredients in energy drinks, consumers have limited information about energy drink contents due to inconsistent and incomplete labeling requirements. 2 , 5 Energy shots typically follow labeling requirements for dietary supplements, while manufacturers may designate energy drinks as either supplements or beverages. 5 The US Food, Drug, and Cosmetic Act does not require companies to disclose the caffeine content of either beverages or supplements, and many companies do not disclose this information. 2 , 5 However, the American Beverage Association requires its member companies (which include Red Bull, Monster Energy, and Rockstar) to voluntarily disclose information regarding caffeine on the labels. 8 Novel ingredients such as taurine and guarana must be listed on nutrition and supplement facts panels, but the US Food and Drug Administration (FDA) does not require that the amounts of these ingredients be disclosed. 2 , 5 As a result, consumers do not know how much of these novel ingredients they are ingesting, and independent researchers cannot study the interactive effects of these ingredients in amounts found in the food supply.

Sales of energy drinks

Energy drinks are relatively new to the US market. Red Bull was first introduced in California in 1997 as a niche product targeted to college students and extreme sports enthusiasts. 9 Since then, new companies and products have entered the market, marketing efforts have expanded to reach additional segments of the population, and sales of energy drinks have grown rapidly. In 2010, US energy drink sales totaled $20 per capita, equal to approximately one-half the sales of sugar-sweetened sodas and surpassing sales of both sports drinks and fruit drinks. 6 In 2012, total sales of energy drinks reached $6.9 billion and sales of energy shots totaled $1.1 billion, reflecting increases of 19% and 9%, respectively, over the previous year. 10 While sales of most sugary drinks, including soda, declined from 2007 to 2012, gallon sales of energy drinks increased by 53%. 11

Currently, there are few restrictions on sales of energy drinks. Common retail practices make these products readily available to young people and encourage impulse purchases. For example, 79% of energy drinks are sold in convenience stores. 6 Typically, they are stocked in beverage coolers alongside other sugary drinks, implying that they are a suitable substitution for soda and other soft drinks, or next to alcoholic beverages, suggesting their consumption with alcohol. Energy shots frequently are featured in freestanding displays near the checkout counter in convenience and drug stores. 6

Marketing of energy drinks

Marketing expenditures for energy drinks also have increased in recent years and now surpass expenses for all other categories of sugary drinks except soda. 6 In 2012, energy drink brands spent $282 million on advertising in all media, 71% more than was spent 2 years earlier and 2.5 times 2008 spending. 12 Much of this advertising appears designed to reach youth under the age of 18 years, and youth-directed marketing has increased in the past 5 years. On average, in 2012, adolescents (aged 12–17 years) saw 165 television ads for energy drinks and shots, which is approximately double the number of ads seen in 2008. 12 In addition, energy drink brands placed many of their television advertisements on networks watched disproportionately more often by youth under the age of 18 years than by adults, such as Adult Swim, MTV, MTV2, and Comedy Central. 12 Two brands appeared to target their television advertising directly to youth, as evidenced by exposure numbers: adolescents saw 31% more TV ads for Red Bull energy drinks and 44% more ads for Street King energy shots compared with adults.

Energy drink brands also have increased youth-oriented advertising on the Internet. 12 From 2010 to 2012, the number of adolescents visiting RedBull.com, 5HourEnergy.com, and DrinkNOS.com per month increased. 12 Of note, adolescent visitors to DrinkNOS.com increased by 4.5 times during that time, and adolescents were 54% more likely to visit the site compared with adults. Energy drink brands also greatly expanded their marketing in social media that are popular with teens. In 2012, Facebook was the most common website to feature display advertising for energy drinks, totaling more than 30 million ads viewed per month, while more than 6 million energy drink ads were viewed on YouTube monthly. 12 As of February 2014, Red Bull and Monster ranked 5 and 16 in number of likes for any corporate brand on Facebook, at 43 million and 24 million, respectively. 13 In early 2013, energy drink brands posted to their Facebook pages on average 1.3 times per day and tweeted 2–68 times per day. 12 YouTube videos posted by Red Bull had been viewed almost 600 million times and Monster Energy videos had been viewed 54 million times.

Companies that belong to the American Beverage Association commit that they will not advertise to children under 12 years of age, 8 , 14 and energy drink companies deny marketing directly to children. 3 However, analysis of their specific statements indicates that companies primarily pledge to limit advertising during children’s television programming. 15 Young children still view large amounts of energy drink advertising during other types of programming. For example, children between the ages 2 and 11 years saw, on average, 66 ads on television for energy drinks or shots in 2012, which amounts to more than 1 ad per week. 12 In 2010, children saw more television ads for 5-Hour Energy than for any brand of children’s beverage, except Capri Sun. 6 In addition, many of the messages in energy drink marketing likely appeal to children, including sponsorships of young athletes. For example, Red Bull sponsored Enzo Lopes, a 12-year-old Motocross athlete who appeared on the cover of Red Bulletin magazine, and Monster Energy’s Monster Army Recon Tour included age categories for children as young as 7 years. 3 Energy drink companies also commonly provide product samples at sporting events, concerts, local parks, and community events, without age restrictions on who can receive a sample. 3

A final concern about marketing of energy drinks involves stated and implied claims of product benefits. Advertising claims by energy drink companies typically promise increased energy, but many also claim to enhance mental alertness and focus, hydration, physical performance, and health from antioxidants and vitamins. 2 Companies generally are not required to substantiate these claims with the FDA. 2 However, the US Federal Trade Commission has the authority to investigate energy drink claims that may be false and misleading, especially those conveyed in advertising to youth. 16 Medical researchers have already highlighted some problems associated with the advertising of energy drinks to youth, including high youth appeal and promises of improved attention and physical performance as described below. 18

Claims of enhanced physical performance from energy drink use while participating in sports raise particular concerns for young consumers. The National Federation of State High School Associations warns student athletes about the health and safety risks of consuming energy drinks, including dehydration and harm to the central nervous and gastrointestinal systems, especially when consumed before, during, and after strenuous exercise. 17 The American Beverage Association specifically advises members that advertising should not suggest that energy drinks are appropriate for use in connection with sports. 8 However, common marketing practices such as sponsorships of sporting events and high school athletics and sports celebrity endorsers appear to contradict this recommendation. 3 One American Beverage Association member (Monster Energy) has specifically stated that it does not follow this voluntary guideline. 3

Parents also are concerned about energy drinks. Three-quarters of parents with children under the age of 18 years agree that energy drinks should not be marketed or sold to children or adolescents, and 85% support caffeine disclosures and warning labels about potential adverse effects on energy drink packaging. 5 In addition, almost one-half of parents (48%) agree that youth under the age of 18 years should not be allowed to consume energy drinks. 5

Recent introduction of new “energy” products

The success of energy drinks in the market has spurred a proliferation of new energy drinks as well as other types of so-called “energy” products. For example, in 2012, SK Energy was founded with the mission to “Create an energy shot that is better for you and better for the world” by producing “a new breed of energy shot” that appears to be targeted to a youth audience. 15 Sports celebrities endorse the product with direct claims that it helps improve their performance. The company spent $6 million in advertising in 2012 and it maintains Facebook, Twitter, and YouTube pages. 12 The company's extra strength energy shots contain 280 mg of caffeine per 2.5-oz shot (higher than most other shots). 19 Also in 2012, Kraft Foods introduced Mio Energy “drops” as part of a line of drink mixes to be added to water or other beverages, 20 supported by $16 million in advertising. 12 Package instructions call for 1 “squirt” (containing 60 mg of caffeine) to be added to 8 oz of liquid. However, the entire package contains 18 squirts, totaling 1,080 mg of caffeine, raising concerns that consumers may purposely or inadvertently add more. Furthermore, the product is stocked in the supermarket aisle with other drink mixes – including Kool-Aid, lemonade, and iced tea mixes – leading to the risk of consumer confusion about the product’s potential risks, particularly with regard to the possibility of inadvertently high caffeine intake.

Companies also have begun to add caffeine to other types of foods and beverages. Examples of products marketed and sold in the United States in recent years include V8 Fusion+ Energy fruit drinks, 21 Jelly Belly Sport Energizing Beans, 22 and Cracker Jack’d Power Bites snacks. 23 One product, Wrigley’s Alert Energy Caffeine Gum, appears to have been discontinued following an FDA statement of intent to evaluate the regulatory framework for added caffeine in food and beverage products. 24 Given the rapid introduction of new highly caffeinated products, including energy drinks, the Institute of Medicine hosted a workshop in 2013 at the request of the FDA to reassess the safety of caffeine in the food supply. 25 In particular, the FDA and workshop participants cited concerns about potentially harmful effects of caffeine and energy drink consumption on vulnerable populations, including children and adolescents.

This rapid expansion of energy drink sales and marketing coincides with increased concerns within the medical community about youth consumption of these products. In 2008, 100 scientists and physicians wrote a letter to the FDA requesting additional regulation of energy drinks due to risks from caffeine intoxication and alcohol-related consumption by youth. 26 In 2011, the American Academy of Pediatrics published its recommendation that children and adolescents should not consume energy drinks, 1 and in 2013 the American Medical Association adopted a policy to support banning the marketing of energy drinks and shots to adolescents under the age of 18 years as “a common sense action that we can take to protect the health of American kids.” 27

Public health research has just begun to document youth consumption of energy drinks, although study results are inconsistent due to differences in methodology and sample populations. A survey of almost 3,000 US adolescents in 2010–2011 found that 15% reported consuming energy drinks at least once per week, with greater intake by boys than girls but no differences for middle school versus high school students. 28 A study of eighth-graders during the same year indicated that 35% had consumed an energy drink in the past year and that 18% consumed more than 1 on the days they did consume the drink. 29 A survey of US high school students found that 8.8% of sugar-sweetened beverage calories consumed overall were in the form of energy drinks and energy drinks represented 10% of beverage calories consumed by Hispanic students and males. 30 However, this study did not assess consumption of zero-calorie energy drinks such as energy shots. In 2013, the European Food Safety Authority commissioned a survey of 32,000 youths in the European Union and found that 68% of adolescents and 18% of children consumed energy drinks and the average amount consumed per month was 16 oz for children and 71 oz for adolescents. 31 This study also found that 12% of adolescents consumed energy drinks 4 times or more per week.

Physicians and other health experts have raised numerous concerns about youth consumption of energy drinks and caffeine more generally. Caffeine may be addictive, 32 , 33 and as noted in one review of the literature, “may be the only psychoactive drug legally available over-the-counter to children.” 34 Caffeine withdrawal symptoms, including headache, drowsiness, and irritability, have been documented in school children, 34 , 35 and withdrawal is associated with decreased reaction and attention for up to 1 week after caffeine use is discontinued. 35 Although the American Psychiatric Association did not include caffeine use disorder as a clinically significant substance-related or addictive disorder in Diagnostic and Statistical Manual of Mental Disorders (5th Edition), the committee did conclude that there is sufficient evidence to support caffeine use disorder as a condition and to encourage further research on its impact. 36 The dangers of combining energy drinks and alcohol have been highlighted as an important public health issue. 37 , 38 However, studies also have documented severe adverse reactions and other troubling outcomes associated with youth consumption of energy drinks alone. 34 This review summarizes the growing body of evidence indicating that consumption of energy drinks raises health concerns for children and youth, including caffeine toxicity and other physiological effects as well as longer-term emotional, social, and behavioral effects.

Caffeine toxicity and other physiological effects

Recommendations by the American Academy of Pediatrics 1 and medical experts 18 , 34 , 39 are based primarily on the fact that energy drinks provide no nutritional benefits but can cause potentially dangerous adverse reactions in some vulnerable populations. Reviews of the medical literature provide substantial evidence of the potential for caffeine toxicity and other adverse physiological effects from consuming energy drinks. For example, a 2009 review by Reissig et al. 18 documented the potential for dependence and withdrawal resulting from regular consumption of energy drinks. In a 2011 review of studies published in the scientific literature and government agency reports, Seifert et al. 34 describe potentially problematic physiological effects for children and young adults, including cardiovascular and abdominal effects, seizures, and agitation. In extreme cases, caffeine toxicity may cause death, 40 especially when consumed by individuals with an underlying heart condition and no history of caffeine consumption. Recent lawsuits brought against energy drink companies allege that energy drink ingestion was the primary contributing factor in the deaths of youth under the age of 18 years. 3 , 41

Although reviews of the literature on the effects of energy drinks when consumed by adults report mixed findings, 42 , 43 1 review concluded that there is insufficient evidence to conclude that energy drinks are safe for adults or to allow “definitive dietary recommendations to be made regarding safe levels of ED [energy drink] consumption.” 44 Substantiating the potential risk, an experiment conducted with healthy young adults showed that consumption of 1 Red Bull energy drink increased blood pressure and other measures of cardiac workload while cerebral blood flow velocity was decreased. 45 The authors conclude that energy drink consumption is potentially harmful and could aggravate preexisting health problems. As caffeine acts on the body tissues at a concentration level, measured by milligrams of caffeine to units of blood volume or kilograms of body weight, 38 these effects would likely be even more pronounced in the smaller bodies of children, young adolescents, and other individuals who have not developed tolerance to caffeine, which also suggests that youth should be cautioned against consuming these products.

Emergency room visits associated with energy drink consumption also indicate potential acute physiological responses from consuming these products. According to a 2013 Drug Abuse Warning Network report, produced by the Substance Abuse and Mental Health Services Administration, the number of emergency department visits by 12- to 17-year-olds attributable to energy drink consumption increased from 1,145 in 2007 to 1,499 in 2011. 46 Moreover, 58% of energy drink–related visits were attributed to energy drink intake alone, not a combination of energy drinks and other substances such as alcohol. Consistent with these findings, analyses of calls to local poison centers compiled by the US National Poison Data System documented 3,028 energy drink–related calls in 2013, 47 up from 672 in 2010; 32 61% were for children 18 years of age and younger. 47 Moderate to major adverse effects reported include seizures, delirium, tachycardia, and dysrhythmia, all events consistent with caffeine toxicity. Studies have documented similar adverse effects in several European countries 31 and Australia. 39 For example, the number of energy drink–related calls to the Australian Poison Control Centre increased 5-fold from 2004 to 2010; the median age of the callers was 17 years, and 54% of the callers reported consuming no other substances. 39 Severe reactions, including cardiac events, hallucinations, and seizures, were reported in 10% of cases. Furthermore, 9% of adolescent boys take stimulants such as Adderall for attention deficit hyperactivity disorder. 48 Potential drug interactions between energy drinks and prescription stimulants have not been studied; however, this combination could substantially increase risks from energy drink consumption. 32

In summary, the high concentration of caffeine in many energy drink products, together with evidence of frequent and growing energy drink consumption by young people who may not have yet developed a tolerance, appears to present substantial risks for caffeine toxicity among children and adolescents.

Potential behavioral effects

In addition to caffeine toxicity and other physiological effects of energy drink consumption by youth, there is growing evidence of a relationship between energy drink consumption (and caffeine consumption more generally) and other negative social, emotional, and behavioral health outcomes. Known side effects of caffeine consumption include sleep disturbances, anxiety, irritability, and restlessness. 32 Researchers in Iceland surveyed 7,400 adolescents (age 14 and 15 years) and found that the majority reported consuming caffeine on a typical day and that caffeine intake (primarily from soda and energy drinks) was related to daytime sleepiness and anger for both sexes. 49 A study of 13- to 17-year-olds admitted to urban US emergency rooms found that more than half reported consuming energy drinks in the past month, and those who had were also more likely to report that they had “gotten into trouble at home, school, or work” than those who consumed other types of caffeinated beverages. 50 In a 2013 study of 15- to 16-year-olds, self-reported caffeine intake was strongly correlated with self-reported violent behavior and conduct disorders. 51 In this study, 21% of participants consumed at least 1 energy drink per day.

Evidence of a possible link between energy drink consumption and abuse of alcohol and other illegal substances by young people raises further troubling concerns. 18 In one study, adolescents (age 14 and 15 years) who consumed caffeinated drinks were more likely to report both nicotine and alcohol use. 49 US studies also have shown associations between adolescent consumption of energy drinks and smoking, alcohol, and illicit drug use, 26 , 29 , 52 as well as other risky behaviors such as sexual risk-taking, fighting, and seat belt omission. 52 Messages in energy drink marketing may reinforce these associations with implicit comparisons between energy drinks and alcohol and drugs. 2 , 3 For example, energy drink companies encourage users to “chug down,” “throw it back,” and “pound it down” in social media. One Red Bull Instagram post suggested, “take a sleeping pill, wash down with Red Bull, and let the battle begin.” In testimony to the United States Senate Committee on Commerce, Science and Transportation, Suffolk County Legislator, Dr. William R. Spencer, raised a broader concern about energy drink marketing to youth, “the message to children, who are frequently overscheduled and under constant pressure to succeed, is to ignore the body’s signals of fatigue and hunger and use a stimulant instead.” 53

Representatives of energy drink manufacturers make 3 primary arguments for the safety of their products when consumed by teenagers aged 12–17 years: 1) caffeine consumption by children and adolescents is low and has not increased over time; 2) energy drinks contribute a small proportion of total caffeine intake, and the caffeine in these products is lower than in other caffeinated beverages; and 3) experts have determined that the caffeine and other ingredients in energy drinks are safe. 54–56

Consumption of energy drinks and other caffeinated products by teenagers

An FDA-commissioned report (referred to as the “Somogyi Report”) documented little change in caffeine consumption by children, teenagers, and adults from 2003 to 2008, with teenagers consuming an average of 100 mg of caffeine per day from all sources. 57 This report also showed that children and teens consume more caffeine from soft drinks, coffee, and tea than from energy drinks. Another study funded by the Caffeine Working Group (an industry trade group) found similar results, reporting that 13- to 17-year-olds consume an average of 6 mg caffeine per day from energy drinks and 83 mg from all sources. 58 Industry representatives also cite the caffeine content of premium coffeehouse coffees as evidence that caffeine levels in energy drinks are safe. 3 For example, a 16-oz can of Monster Energy contains approximately 160 mg of caffeine from all sources compared with 330 mg of caffeine in a 16-oz cup of Starbucks coffee. 55

A more recent analysis conducted by researchers at the US Centers for Disease Control and Prevention, which used 24-h dietary recall data, corroborates these general trends and sources of caffeine consumption by youth under 18 years of age. 59 From 1999 to 2010, mean caffeine intake did not increase for children or teens, and soda and tea contributed 56–78% of total caffeine consumed by youth under the age of 17 years. Coffee ranked third as a source of caffeine in diets of 12- to 16-year-olds, followed by energy drinks, which accounted for 3% of caffeine consumption. However, this study also found an increase in caffeine consumption from energy drinks and coffee by children and adolescents, while caffeine from soda consumption declined by 30% or more. The authors raise concerns about these trends due to higher concentrations of caffeine in energy drinks and coffee, and call for continued monitoring.

Safety of ingredients in energy drinks

According to energy drink manufacturers, another reason their products are safe for teenagers is because the caffeine and other ingredients in energy drinks are generally recognized as safe (GRAS). 4 , 55 , 56 Manufacturers also cite the small number of adverse event reports for energy drinks. 56 From 2002 to 2012, 145 adverse events were reported to the FDA’s Center for Food Safety and Applied Nutrition Adverse Event Reporting System by 3 energy drink companies (5-Hour Energy, Monster, and Rockstar). 60 However, the FDA cautions against making conclusions based on these reports for several reasons: 1) the reports rely on individuals’ self-report of the product that caused the event, 2) the FDA often does not have the required information to conclusively determine the cause of all events, and 3) these reports represent only a “small fraction” of adverse events associated with any product. 60 In addition, only energy drink manufacturers that designate their products as supplements (not beverages) are required to disclose adverse events associated with consumption of their products. Finally, manufacturers dispute conclusions drawn about the safety of energy drinks based on reports of poison center calls and emergency room visits (e.g., the 2013 Drug Abuse Warning Network report). 56 As evidence of their safety, one industry-commissioned report concluded that the number of emergency room visits reported to be associated with energy drink consumption is relatively low given the amount of energy drinks consumed. 56 According to the report, even if all emergency room visits were associated with energy drinks, they would represent just 1 emergency room visit per 168,400 energy drinks sold in 2011, or 1 visit per 336,800 drinks sold when the patient did not also admit alcohol or drug consumption.

Public health experts and the US Government Accountability Office have concluded, however, that current regulations are insufficient to ensure the safety of ingredients contained in many foods and beverages. 61 , 62 FDA regulations state that GRAS status must be reconsidered as new information becomes available; however, the FDA has limited information and resources to conduct these investigations. 62 Moreover, since 1997 the FDA has allowed manufacturers to self-determine GRAS status for ingredients that have not been approved as food additives by the FDA, provided there is “reasonable certainty in the minds of competent scientists that the substance is not harmful under the intended condition of use.” 63 Food and beverage manufacturers are not required to notify the FDA that they are using a new ingredient and have determined it to be GRAS nor to provide evidence of their determination. 2 , 62 Citizens may file a petition with the FDA to reevaluate the safety of GRAS substances. Eleven citizen petitions were filed from 2004 to 2008; however, as of December 2009, the FDA had decided on only 1 of these petitions, citing limited resources. 62

Notably, the FDA has not independently evaluated the GRAS status of caffeine since the 1970s. At that time, the Code of Federal Regulations described caffeine as GRAS in concentrations up to 71 mg/12 oz (0.02% concentration) in “cola-type beverages.” 2 At 80 mg of caffeine per 8-oz serving, 6 the standard energy drink on the market contains about 70% more caffeine than the 0.02% concentration proscribed as GRAS by the FDA. The safety of novel ingredients such as taurine, guarana, and ginseng, which are commonly part of the “energy blend” in most energy drinks, presents additional concerns. 5 , 7 According to energy drink manufacturers, these ingredients increase the effects of caffeine alone on physical or cognitive performance, 7 but these novel ingredients also may increase adverse effects versus caffeine intake alone. Such an interaction could help explain why the number of emergency room visits associated with energy drink consumption by young people appears to have increased, 39 , 46 , 56 even though total caffeine consumption by youths has not. 57–59 However, the FDA has not evaluated these other common energy drink ingredients for their current uses in the food supply. For example, the FDA has approved guarana as a flavor additive but not as a source of caffeine, and it has not approved taurine as a food additive nor confirmed its GRAS status. 2

FDA requirements for establishing the safety of ingredients used in dietary supplements (including energy shots and some energy drinks) differ somewhat from requirements for beverages. Supplement manufacturers may voluntarily notify the FDA in advance that they are using a new dietary ingredient but they are not required to do so, and the FDA monitors adverse event reports and other measures to identify safety concerns once products are in the market. 2 However, even for dietary supplements, the threshold for the FDA to remove a product from the market due to safety concerns is quite high. 2 Therefore, energy drink manufacturers have determined the GRAS status of the level of caffeine and other ingredients in energy drinks by hiring scientists who state that they are reasonably certain that these ingredients are safe. Although this practice complies with FDA requirements for all foods, beverages, and supplements, the objectivity of such designations has been questioned by public health experts and the US Government Accountability Office. 61 , 62

Clearly there are 2 distinct points of view regarding whether young people should be encouraged (e.g., through marketing), or even allowed, to consume energy drinks. In the absence of proof that energy drinks are not safe when consumed as intended, manufacturers argue that they should be allowed to continue to market and sell their products to teens and adults. However, The American Academy of Pediatrics, the American Medical Association, and other health experts argue that evidence of potential toxicity and other negative outcomes from consuming energy drinks, especially for vulnerable populations, justifies policies to restrict the sales and marketing of energy drinks to youth under the age of 18 years. 1 , 2 , 28 Although this debate may be largely philosophical, there are several in which additional research would provide valuable information to inform both sides. 64

Long-term, systematic assessment of energy drink and general caffeine intake at the population level, specifically intake by youth, should be a priority. It will be important to continue long-term dietary assessments (e.g., through National Health and Nutrition Examination Survey) 59 and other longitudinal studies to appropriately identify sources and amounts of caffeine consumption, as well as consumption of caffeine together with the other stimulants and novel ingredients typically contained in energy drinks. Due to the rapid introduction of caffeine into nontraditional foods and beverages as well as new energy drink products, it also will be important to update dietary assessment tools to account for changing sources of caffeine and novel ingredients in the food supply.

However, published studies of intake generally lag several years behind data collection. For example, a recent 2014 paper provides information on 2009–2010 intake. 59 As sales of energy drinks have increased by as much as 19% per year since 2010, 15 it would be beneficial to add energy drink consumption to ongoing youth health monitoring programs such as the Centers for Disease Control and Prevention’s Youth Risk Behavioral Risk Surveillance. 65 Furthermore, systematic collection of all adverse events, poison center data, and emergency room visits associated with energy drink consumption, together with more comprehensive evaluation of additional risk factors, are necessary to accurately determine the risks of toxicity for youth and other vulnerable individuals. Analyses should attempt to separate the contribution of the novel ingredients contained in energy drinks, as well as the ways that young people consume them (e.g., rapid intake, volume of intake, and intake together with other substances such as alcohol or drugs).

As discussed, the literature also suggests an association between energy drink and/or caffeine consumption and longer-term behavioral problems in youth, such as anger, violence, poor sleep, and alcohol and drug use. 66–68 However, these cross-sectional studies do not prove that these products caused these negative behavioral outcomes. Further research is necessary. In particular, longitudinal studies and randomized controlled trials (if they can be designed safely) are necessary to evaluate these troubling links. Given that some energy drink marketing also promotes other risky behaviors, including drug and alcohol use, it is important to examine whether exposure to these messages mediates the link between energy drink consumption and risk-taking behaviors.

In addition, the long-term consequences of caffeine addiction for young people are not well understood. With further understanding of caffeine use disorder and its potential clinical significance, 36 it will be important for researchers to investigate whether regular caffeine and/or energy drink usage during adolescence contributes to the severity of the disorder. It also will be critical to evaluate how caffeine consumption interacts with consumption of other stimulants (e.g., other ingredients in energy drinks, drugs to treat attention deficit hyperactivity disorder) and potentially addictive substances (e.g., sugar) that are commonly consumed by youth. Furthermore, a better understanding of the potential dangers from consuming energy drinks before, during, and after athletic activity will be essential to identify the potential dangers of direct and implied claims of enhanced athletic performance, which is common in energy drink marketing.

Finally, it will be important for independent evaluations to confirm the findings of energy drink manufacturers' studies and conclude the GRAS status of today’s higher levels of caffeine in the food supply, as well as the additional stimulants and other novel ingredients contained in energy drinks and their interactions. In 2013, the FDA reported that it would reevaluate the GRAS status of caffeine. 69 At the Institute of Medicine workshop that was convened in preparation for this effort, speakers highlighted the critical need for further research and monitoring. 25 The summary report stated that “a wealth of unanswered questions remain about exposure to caffeine in food and dietary supplements, and the health consequences of that exposure, especially in certain potentially vulnerable populations.” In particular, it noted that evaluation of the safety of caffeine levels and other stimulants in energy drinks when consumed by lower-weight individuals (e.g., children and young teens) and by those who have not developed caffeine tolerance will be essential.

Although further research is needed to evaluate energy drink and caffeine consumption by youth and its effects, as well as to reevaluate the GRAS status of caffeine and other common energy drink ingredients, public health experts propose immediate actions to protect children and adolescents from the potential dangers of energy drink consumption. In 2013, Senators Markey, Durbin, and Blumenthal began an ongoing investigation of the energy drink industry and its marketing practices. 2 In the report of their findings, 2 the senators called on energy drink manufacturers to voluntarily “take steps to improve transparency and representation of its products and ensure that children and teens are adequately protected from deceptive advertising practices.” The following steps were recommended: 1) clearly label the caffeine content on product packaging, including caffeine in the entire container (in effect 1 serving) for nonresealable containers; 2) include the following warning label on all products that contain caffeine in concentrations greater than the level affirmed as GRAS by the FDA (i.e., 71 mg/12 fl oz), “This product is not intended for individuals under 18 years of age, pregnant or nursing women or for those sensitive to caffeine. Consult with your doctor before use if you are taking medication and/or have a medical condition”; 3) stop marketing energy drinks to youth under 18 years of age, including in traditional and social media, sponsorships, and other activities with a primarily youth audience; and 4) report all serious adverse events to the FDA, including for products labeled as beverages.

During the Senate hearing on energy drinks in July 2013, representatives from Red Bull, Monster Energy, and Rockstar agreed to voluntarily stop promoting rapid or excessive consumption of energy drinks and consumption of energy drinks with alcohol or other drugs, including in social media, and to not sell or market their products in K – 12 schools. 3 In addition, Red Bull submitted a letter agreeing to further restrict its marketing to children and adolescents by not selling in other institutions responsible for children under the age of 18 years, by not providing free samples in the vicinity of K – 12 schools or youth-targeted institutions, and by limiting the caffeine content of its products to 80 mg/8.4 fl oz (i.e., 61% higher than current FDA-affirmed GRAS limits). 54 Of note, the company also agreed to report serious adverse events to the FDA and to not sell products in containers larger than 12 fl oz, but only if producers of other beverages that contain sugar or caffeine do the same. As of May 2014, the company has not made any further public statements about the implementation of its pledge.

Following the hearing, Senators Markey, Rockefeller, Durbin, and Blumenthal sent letters to 17 manufacturers of energy drinks and shots calling on them to voluntarily commit to take these actions, as well as asking them to not market or sell their products in K-12 schools, to place access restrictions on social media sites for youth under the age of 18 years, to restrict purchases of advertising in media that has an audience share of 35% or more in the under-18-year category, and to not advertise energy drinks as sports drinks. 70 It is not clear how many energy drink manufacturers will voluntarily commit to change the sales, marketing, and/or packaging of their products in accordance with this request.

However, voluntary action on the part of industry is not the only solution. The FDA has the authority over the safety, labeling, and ingredients in energy drinks. The agency could restrict the inclusion and/or concentration of caffeine and novel ingredients in these products and require caffeine disclosure and/or warning labels. 5 The US Federal Trade Commission and states’ attorneys general could bring consumer protection action against energy drink manufacturers for labeling and ingredient violations as well as for unfair and deceptive marketing practices. 5 For example, both the New York State attorney general and the San Francisco city attorney are investigating whether companies have misled consumers about the ingredients in energy drinks and their potential health risks. 41 , 71 In addition, state and local governments have the authority to enact regulations of retail sales, including establishing age limits for purchase of energy drinks, placing restrictions on where these products may be sold, prohibiting sales of the most problematic products (e.g., containers larger than 12 fl oz or those with the highest caffeine content), and establishing excise taxes on high-sugar and/or high-caffeine products. 5 In 2013, Suffolk County New York was the first community to regulate marketing of energy drinks, prohibiting distribution of coupons and free samples to minors and sales in county parks and beaches. 72

Registered dietitians, healthcare providers, educators, and parents also can play an important role in reducing the potential harm of energy drink consumption by children and adolescents. Given the growing evidence of potential short-term and long-term negative effects from consumption of energy drinks and other highly caffeinated products by youth, pediatricians should assess their patients’ intake of energy drinks and advise parents about the American Academy of Pediatrics position that these products should never be consumed by children under the age of 18 years. 1 , 34 School officials could prohibit energy drinks on school grounds and ensure that coaches educate young players about the danger of consuming these products before, during, and after athletics. Parents should monitor their children’s caffeine intake, be aware of signs of excessive caffeine intake (e.g., poor sleep, anxiety), and discourage their children from consuming energy drinks and other highly caffeinated products.

Although additional research is needed, there is growing evidence that energy drinks can have adverse physiological effects when consumed by some individuals, particularly children and youth. Additional evidence of potential harmful effects of energy drinks on young people’s long-term health raises further concerns. Given these risks, it is recommended that energy drink manufacturers refrain from marketing their products directly to adolescents unless and until independent research confirms the companies’ claims that their products are safe for teenagers. Policymakers and physicians’ groups have called on energy drink manufacturers to voluntarily take steps to reduce the potential harm of their products on young people’s health. However, regulatory and legislative options also are available to limit the marketing and sales of these products to children and adolescents under the age of 18 years.

Funding. This research is funded by a grant from the Robert Wood Johnson Foundation.

Declaration of interest . The authors have no relevant interests to declare.

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Published: 04 June 2022

Is the consumption of energy drink beneficial or detrimental to health: a comprehensive review?

Hani’ Ariffin 1 ,
Xiu Qing Chong 1 ,
Pei Nee Chong 2 &
Patrick Nwabueze Okechukwu ORCID: orcid.org/0000-0002-3855-2666 1

Bulletin of the National Research Centre volume 46 , Article number: 163 ( 2022 ) Cite this article

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Energy drinks (EDs) are a type of beverage that mostly contains caffeine and other dietary supplements (if present) and does not contain any alcohol in the ingredients. The products in this category include Red Bull, Redline, Monster, Full Throttle, and others. They are claimed to help in boosting energy, stamina, sports performance, and concentration among individuals. This article focused on the review of the benefits and disadvantages of consumption of energy drinks to health and well-being. ED provides health benefits effects such as improved physical performance, mood and attitude, cognition, and weight loss. Some adverse negative health challenges have been linked to consumption of ED. Therefore, this review is a wholistic appraisal of benefits or detriments of consumption of energy drink to our health and suggestions to curtail the excesses of ED consumption.

Energy drink has been around since 1950, and it is marketed as energy booster and comes in different types, energy shots, fruit-based, non-fruit-based (regular), sugar-free, and plant-based. These products are marketed as a low-calorie “instant” energy drink that can be consumed in a single sip, or bottle to boost energy or to boost the nutritional value of conventional products. Many of them contain different ingredients such as caffeine, guarana, ginseng, yerba mate, acai berry, ginkgo biloba, methylxanthines, sugar, glucuronolactone, taurine, maltodextrin, B vitamins. Vitamin B2 (riboflavin), B3 (niacin), B6 (pyridoxine, pyridoxal, and pyridoxamine), Inositol B8 and B12, vitamin C and vitamin D; calcium, Iron, chromium, zinc, manganese, molybdenum; artificial sweeteners, aspartame, and sucralose. Health benefits such as improved physical performance, improved mood and attitude, improved concentration, and memory, good source of vitamin B and weight loss have been reported. Negative impact on health such as adverse cardiovascular effect, headaches, epileptic seizures, ischemic stroke, hallucinations, muscular twitching, restlessness, sleeplessness, anxiety, depression, gastrointestinal effect, renal effects, dental effects, obesity and type II diabetes, cancer, and caffeine toxicity has been reported.

Conclusions

Most of the health detriments caused because of consumption of energy drink is mostly due to the presence of excess quantity of caffeine and sugar. If the quantities of caffeine and sugar content in energy drink are kept at FDA- and WHO-recommended daily consumption amount, then it will not be present any problem to health. Consumption of energy drink that contains natural ingredients such as yerba mate, acai berry, ginkgo biloba, methylxanthines, amino acid, guarana, and ginseng with moderate FDA- and WHO-approved daily consumption of caffeine and sugar is not detrimental to health.

Energy drinks (EDs) are a type of liquid beverage that contains caffeine and may or may not contain other dietary supplements (Alsunni 2015 ). They are non-alcoholic drinks that claim to boost energy, stamina, sports performance, and concentration (Al-Shaar et al. 2017 ). Energy drinks use a combination of stimulants and energy boosters to give the consumer an “energy boost.” Caffeine is the main ingredient in most energy drinks. They typically have 80–150 mg of caffeine per 8 oz, which is about the same as 5 oz of coffee or two 12-oz cans of caffeinated soda (Alsunni 2011 ). Most brands on the market are high in glucose, while some do provide artificially sweetened variants. The common ingredients used in ED are being classified into 4 different categories: natural extracts (ginseng, guarana, yerba mate, acai, caffeine, and ginkgo biloba), macronutrients (carbohydrates and protein), micronutrients (vitamins and minerals), and artificial sweeteners (aspartame and sucralose).

Manufacturers recently have shifted their consumer focus from athletes to young people. Energy drinks are aggressively marketed in places popular with teens and young adults. The capability of EDs to control mood, increase alertness, reduce fatigue, improve athletic performance (Giles et al. 2012 ), and lower high levels of perceived stress has been promoted aggressively among college students (Pettit and DeBarr 2011 ).

Currently, there are major concerns about the safety of these products. There have been several reports linking energy drinks to negative health effects. Despite this, energy drink manufacturers believe that their products are safe and appropriate for customers. Scientists are conflicted on whether energy drinks have negative health impacts. There are only a few extensive reviews of the literature evaluations that show the acceptability and safety of energy drink intake, especially among young individuals.

Article was obtained through online database search from Mendeley, Science direct, Scopus, PubMed, Google Scholar. Search was limited between 2001 and 2021.

Brief introduction of ED

Japan was the first country to invent the energy drink. Amphetamines were immensely popular in the postwar period until legislation was implemented in the 1950s to restrict their usage. Then, in 1962, Taisho released Lipovitan D shown in Fig. 1 A, a legal, stimulating tonic packaged in minibar-size bottles. By the 1980s, Japanese businessmen tried to push the frequent consumption of fortified vitamins and extra-caffeinated drinks (Engber 2013 ). The first energy drink appeared in the USA in 1949 and was marketed as “Dr. Enuf.” They were originally introduced in Europe in 1987, and the market quickly spread across the globe with the introduction of Red Bull in 1997 (Zucconi et al. 2013 ). Since then, the energy drink market has grown rapidly, with several new brands hitting the markets across the world. In 2013, energy drinks were consumed in more than 160 countries for a total of 5.8 billion liters (Bailey et al. 2014 ). In 2017, energy drinks accounted for 30% of all packaged beverages sold in convenience stores in the USA in terms of dollar sales. According to energy drink sales data, the global market for energy drinks was worth $53 billion in 2019 (Edgson 2021 ).

A Energy shots, B variety of fruit-flavored energy drinks, C non-fruit-based (regular) energy drink, D sugar-free energy drink, E plant-based energy drink

Types of ED

Energy shots.

There are two types of energy drinks on the market. One is marketed in bottles the same size as regular soft drinks, such as a 16-oz bottle. The other type, known as “energy shots,” comes in little bottles that hold 2 to 212 oz of concentrated drink (NCCIH 2021 ). Energy shots can contain the same total amount of caffeine, vitamins, or other functional ingredients as their larger versions and may be considered concentrated forms of energy drinks. Energy shots are typically marketed as a low-calorie “instant” energy drink that can be consumed in a single sip (or “shot”), as opposed to energy drinks that encourage users to drink a full can, which can have 250 cal or more (We-energy 2015 ). An example of energy shots of ED (Lipovitan D brand) is shown in Fig. 1 A.

Fruit-based

The development of blended drinks is a successful way to boost the nutritional value of conventional products or to overcome the problems associated with current products (Márquez Cardozo et al. 2017 ). Several researchers have created alternatives to energy drinks based on fruits. For example, Márquez Cardozo et al. ( 2017 ) formulated mango energy drinks containing caffeine at a concentration of 30 mg/100 mL, though Nowak and Goslinski ( 2020 ) evaluated various fruit energy drinks containing pineapple, apple, strawberry, raspberry, carrot, and pomegranate juice. An example of a variety of fruit-based energy drinks is shown in Fig. 1 B.

Non-fruit-based (regular)

Regular or non-fruit-based EDs are beverages that contain large doses of caffeine, sugar, and a variety of other stimulants and substances such as guarana, taurine, or vitamins (Higgins et al. 2010 ). Examples include ED brands such as Red Bull, Rockstar, Monster, Full Throttle ED, and NOS. Figure 1 C shows the non-fruit-based (regular) ED of Red Bull brand (Table 1 ).

In recent years, consumption of sugar-free energy drinks has increased possibly because of the low-calorie, refined sugar content. The main active ingredient in sugar-free energy drinks such as Red Bull is caffeine. Caffeine is one of the most widely used ergogenic aids, with acute caffeine ingestion increasing aerobic exercise endurance and reducing fatigue. Although they are claimed as sugar-free, artificial sweeteners are heavily used as the ingredients such as Aspartame (Null Chiropractic LLC n.d.). It is also known as non-nutritive sweeteners which are high-intensity sweeteners that are used in small amounts to reduce the caloric and sugar content of food and beverages (Choudhary and Pretorius 2014 ). An example of a sugar-free energy drink is shown in Fig. 1 D.

Plant-based

Most energy drinks incorporate additional artificial mood enhancers, synthetic caffeine, and a huge amount of sugar. Plant-based energy drinks, on the other hand, contain only natural caffeine, electrolytes, vitamins, and antioxidants, as well as a blend of natural caffeine, electrolytes, vitamins, and antioxidants. An example of plant-based energy drinks is shown in Fig. 1 E.

Major ingredients and constituents of ED

Natural extracts.

Natural ED may get a boost from the antioxidants, vitamin, minerals, and naturally occurring caffeine derived from the fruits, herbs, and plants. The natural extracts found in various types of ED are summarized in Table 2 .

Caffeine concentration in ED varies significantly, ranging from 47 to 80 mg per 8 oz to 207 mg per 2 oz, and comes from a variety of sources (Generali 2013 ), while moderate caffeine consumption (up to 400 mg per day) is usually regarded as safe and even beneficial to adults' well-being (McLellan et al. 2016 ). Caffeine is a stimulant that antagonizes adenosine receptors and stimulates dopamine neurotransmission in the central and peripheral nervous systems. Interactions with various receptors result in a variety of outcomes. O’Mathúna ( 2021 ) stated that moderate acute dosages (200–350 mg) reduce heart rate and raise blood pressure in adults, while also enhancing emotions of well-being, focus, and arousal.

Reports on other constituents of ED are relatively limited. Guarana is a plant extract native to South America which contains a significant amount of caffeine, with 1 g of guarana equivalent to 40 mg of caffeine (Al-Shaar et al. 2017 ). Guarana is frequently added as an ingredient in ED for its stimulatory impact due to its high caffeine content (Heckman et al. 2010 ). The effects of guarana are currently unknown. It is uncertain whether it has an additional or synergistic impact when coupled with caffeine. However, it has been found that guarana can act as an antioxidant, traditional medicinal, and an effective stimulant. It can also treat fatigue and depression related to cancer treatment (Moustakas et al. 2015 ). The amount of guarana in a 16-oz energy drink can range from 1.4 to 300 mg. Although there are no standard quantities, the FDA considers guarana to be safe. It is also unclear how much guarana is in each drink because many manufacturers do not specify the milligram value. As a result, it is safe to believe that the amount of caffeine in the products is higher than the amount listed, especially if guarana is present (Schimpl et al. 2013 ).

Ginseng has been used as a medicinal herb for ages and is claimed to boost energy, reduce fatigue, relieve stress, and improve memory. It is also claimed to activate the hypothalamus and pituitary glands, which subsequently release an anti-inflammatory hormone called adrenal corticotropic hormone. Normal ginseng-incorporated energy drink appears to have a regular amount of 200 mg per day, although most people can safely take up to 2700 mg through supplementation (Caffeineinformer n.d). However, there are several adverse effects caused by ginseng abuse which include maniac episodes, uterine bleeding, gynecomastia, long QT syndrome, atrial fibrillation with bradycardia, hypertensive crisis, and acute lobular hepatitis (Ratan et al. 2021 ).

Yerba mate is derived from the Ilex paraguariensis plant, which is native to South America and is mostly used to make yerba mate tea. Yerba mate tea has historically been a popular beverage in South American countries; however, its global appeal is growing due to its high concentration of bioactive components such as polyphenols, xanthines, flavonoids, saponins, amino acids, minerals, and vitamins (Valenca et al. 2013 ). Yerba mate has anti-inflammatory and anti-diabetic effects, as well as functioning as an oxidative stress regulator. Furthermore, yerba mate has demonstrated in vitro cytotoxicity to cancer cells as well as inhibition of Topoisomerase II, which is involved in cell division and hence inhibits cancer cell proliferation; however, further in research is needed (Heckman et al. 2010 ). Both in vivo and in vitro yerba mate has a beneficial effect on the management of obesity. In both normolipidemic and dyslipidemic people, yerba mate consumption improved blood lipid markers considerably. Additionally, yerba mate assisted in the decrease in LDL cholesterol levels in people who were taking statins (Yunusa and Ahmed 2011 ).

Acai berry is an ingredient that is increasingly appearing in energy drinks. The acai berry is produced by the Acai Palm tree, which is native to South America. Antioxidants are abundant in the berries, but not as much as in a concord grape or blueberry (Yunusa and Ahmed 2011 ). Most acai berry advantages are unproven and linked to marketing hype. It contains a high number of oxidants, nutrient dense, has anticancer properties, and helps to lower cholesterol levels (Arakelyan 2020 ).

Ginkgo Biloba

The ingredient ginkgo biloba is named after the unique tree from which it derives. It is associated with improvement of memory retention, focus, and circulation, as well as acting as an antidepressant and showing indications of aiding persons with Alzheimer's disease. It is recognized by the German government as a treatment for memory loss, attention problems, and depression. A normal supplemental dose is 60 mg. Most energy drinks, on the other hand, do not contain enough ginkgo to be beneficial. Blood thinning, nausea, vomiting, diarrhea, headaches, dizziness, heart palpitations, and restlessness are some of the other side effects of ginkgo (Yunusa and Ahmed 2011 ).

Methylxanthines

Methylated xanthines (methylxanthines) are produced by many different plant species.

They are commonly found in regular diet, as well as in a variety of incredibly common beverages and meals. Caffeine, theophylline, and theobromine are the most common methylxanthines found in nature. Methylxanthines have a long history of usage as therapeutic agents in a diverse variety of medical applications. Methylxanthines have been/were utilized in medicine as CNS stimulants, bronchodilators, coronary dilators, diuretics, and anticancer adjuvant therapies. Aside from these uses, methylxanthines have been linked to several other health benefits, including neurodegenerative disorders, cardio protection, diabetes, and fertility (Monteiro et al. 2019 ). However, methylxanthines have a limited therapeutic spectrum and, as a result, a high rate of side effects. When concentrations of methylxanthines are below 20 mcg/ml, milder side effects such as nausea, vomiting, increased stomach acid secretion (and subsequent gastroesophageal reflux), polyuria, sleeplessness, palpitations, headaches, and tremors are more common (Gottwalt and Tadi 2021 ).

Macronutrients

Breakdown of macronutrients such as carbohydrates and proteins will contribute to the major sources of energy. Different classes of macronutrients are summarized in Table 3 .

Carbohydrates

Simple sugars (such as sucrose, fructose, or beet sugar) are a fast-acting source of energy and are used in energy drinks to boost cognitive performance. Sugar content in drinks is normally around 27 g per 8 oz. Energy drinks with a higher volume surpass the daily sugar limit of 32 g (Rath 2012 ). The amount of sugar in one can of ED (500 mL or 16.9 oz) is usually around 54 g (Higgins et al. 2010 ). Due to the strong significant evidence linking added sugar consumption to poor health, many institutions, including the World Health Organization, have advised limiting sugar intake (WHO 2015 ).

Glucuronolactone

The human body produces glucuronolactone (DGL) when glucose is broken down by the liver.

This component is found in all connective tissue. DGL is believed to help with detoxification, the release of hormones and other compounds, and vitamin C production. It is included in energy drinks because it claimed to help with glycogen depletion by preventing other compounds from depleting muscle glycogen stores. (Yunusa and Ahmed 2011 ).

A semi-essential amino acid that is not involved in protein synthesis and is abundant in mammalian tissues is known as taurine (2-aminoethanesulfonic acid). It is naturally found in human bodies, mostly in the brain, eyes, heart, and muscles (Beyranvand et al. 2014 ). Taurine is also naturally found in protein sources such as milk, meat, and fish. It is a common ingredient in sports supplements, energy drinks, dietary supplements, and non-caffeinated energy drinks. It has also been proved to help athletes perform better. Taurine is normally included in levels of 1–2 g per serving in products that specify the amount of taurine contained (Childs 2014 ). Taurine has been recommended as a treatment for epilepsy, heart failure, cystic fibrosis, and diabetes due to its anti-inflammatory properties (Caine and Geracioti 2016 ). Taurine may help to manage blood sugar levels and fight diabetes. Without any modifications in food or exercise, long-term supplementation reduced fasting blood sugar levels in diabetic rats used in research labs (Chauhan and Piracha 2021 ). According to some animal studies, increasing taurine intake can help prevent type 2 diabetes by lowering blood sugar levels and insulin resistance (Ito et al. 2012 ). However, additional research is required before any conclusions can be drawn.

Maltodextrin

Maltodextrins (C 6 H 10 O 5 ) n·H 2 O are saccharide polymers composed mostly of glucose units linked by -1,4 glucosidic boundaries. Maltodextrins are produced by enzymatic hydrolysis with or without acid, although only to a lesser amount than starch syrups (Klinjapo and Krasaekoopt 2018 ). Commercially accessible, typically white powders with excellent purity and microbiological safety are utilized in a wide range of food and beverage products, including baked goods and sports drinks (Hofman et al. 2016 ). Maltodextrins are known for their relatively high molecular weights and limited reducing power. Maltodextrin solutions have low osmotic pressures, high viscosities, and little or no sweetness due to their high molecular weights (Featherstone 2018 ). Maltodextrins, like any other carbohydrate, were found to reduce net glycogen breakdown during long-duration exercise while maintaining a high whole-body glucose oxidation rate (Hofman et al. 2016 ).

Micronutrients

Many EDs are fortified with various types of vitamins and minerals. The purpose of the micronutrients (vitamins and minerals) improves person’s emotion and increases the alertness and focus. The health benefits and side effects of the micronutrients in different types of ED are summarized in Tables 4 and 5 .

A group of eight water-soluble vitamins that play a significant role in cell function is referred to as B vitamins. Vitamin B 2 (riboflavin), B 3 (niacin), B 6 (pyridoxine, pyridoxal, and pyridoxamine), inositol B 8 and B 12 are the most common B vitamins added to ED (Heckman et al. 2010 ). Considering the significance of B vitamins as coenzymes in many metabolic processes, most people in the USA already consume the necessary daily quantity, and thus, any additional B vitamins added to ED are often lost in the urine, with no further health benefits (Heckman et al. 2010 ). Other additives including l-carnitine, d-glucuronolactone, and inositol have less research on their composition and function, with just a few studies showing minimal advantages (Yunusa and Ahmed 2011 ).

Riboflavin (B 2 )

Riboflavin, often known as crucial vitamin B2, is a heat-stable water-soluble vitamin. The flavoenzymes of the respiratory chain require riboflavin (B2), which facilitates energy metabolism involving lipids, carbs, and proteins (Yunusa and Ahmed 2011 ). It is also an important vitamin for a variety of physiological functions in the body, such as lowering migraines and boosting the immune system (Suwannasom et al. 2020 ). Riboflavin levels taken orally in a diet or from most multivitamin supplements rarely give side effects or toxicity (Pinto and Zempleni 2016 ).

Niacin (B 3 )

Niacin is used to make the reduced form of nicotinamide adenine dinucleotide (NADH) (vitamin B3). This coenzyme is necessary for supplying protons for oxidative phosphorylation and is important for cell energy production. It also raises the production of l-dopa, dopamine, serotonin, and norepinephrine, among other neurotransmitters (Yunusa and Ahmed 2011 ). Niacin dosage, either alone or in addition with statins and/or bile acid sequestrants, was reported to significantly improve markers of atherosclerosis, such as carotid intima-media thickening and stenosis incidence and balance out the ratio of HDL/LDL cholesterol in patients with dyslipidemia (Meyer-Ficca et al. 2016 ). The characteristics including skin flushing and itching were reported in clinical trials, as well as more significant disorders such as gastrointestinal and musculoskeletal issues, heart failure, diabetic complications, and new-onset diabetes (Meyer-Ficca and Kirkland 2016).

Pyridoxine (B 6 )

Vitamin B6 (pyridoxine hydrochloride) is a coenzyme that plays a role in amino acid and homocysteine metabolism, glucose and lipid metabolism, neurotransmitter generation, and DNA and RNA synthesis. Pyridoxine hydrochloride is involved in protein and red blood cell metabolism, as well as immune system function and the conversion of tryptophan to niacin (Yunusa and Ahmed 2011 ). It also works to utilize a protection reaction against chronic diseases including cardiovascular diseases (CVD) and diabetes by inhibiting inflammation, inflammasomes, oxidative stress, and carbonyl stress (Thanutchaporn et al. 2020 ). However, vitamin B6 can be toxic if its concentration inside the body is too high, resulting in sensory neuropathy with no apparent cause. Degeneration of peripheral nerve sensory fibers and myelin, as well as the dorsal columns of the spinal cord, results in bilateral loss of peripheral sensation or hyperesthesia, as well as limb pain, ataxia, and loss of balance (Abosamak and Gupta 2021 ).

Inositol (B 8 )

Inositol (previously vitamin B8, but no longer considered a vitamin because it is produced by the human body) comes in nine different stereoisomers, the most common of which being myoinositol. It is a component of cell membranes, aids in the digestion of fats by the liver, and aids muscle and nerve function (Higgins et al. 2010 ). The consumption of inositol may also help in preventing the development of chronic diseases—including obesity, diabetes, polycystic ovary syndrome (PCOS), metabolic syndrome, cardiovascular diseases, and cancer (Dinicola et al. 2017 ).

Cyanocobalamin B 12

Cyanocobalamin is a vitamin B12 synthetic compound used to treat vitamin B12 deficiency. It is involved in several methylation reactions in the human body. In the body, it functions as a cofactor in the conversion of homocysteine to methionine as methylcobalamin, and as adenosylcobalamin in the conversion of methylmalonyl-CoA to succinyl-CoA as adenosylcobalamin. Cell division and expansion rely on both responses (Vasavada and Sanghavi 2020). This vitamin also aids nerve cell function, is required for DNA creation, and is necessary for red blood cell formation.

Vitamin C is required for the body's basic physiological activities. It aids in tyrosine, folic acid, and tryptophan synthesis and metabolism, as well as the hydroxylation of glycine, proline, lysine, carnitine, and catecholamine. It promotes cholesterol conversion to bile acids easier, decreasing blood cholesterol levels. Vitamin C also improves iron absorption in the intestines by converting ferric to ferrous. It protects the body from the harmful effects of free radicals, pollution, and poisons as an antioxidant (Chambial et al. 2013 ). Although large doses of vitamin C are safe, there have been reports that they can induce hemolytic anemia in individuals who have glucose-6-phosphate dehydrogenase deficiency (Unlu et al. 2016 ).

Vitamin D is exceptional that it can be produced in the skin because of sun exposure (Nair and Maseeh 2012 ). Vitamin D is both a vitamin and a hormone produced by our bodies. It is a fat-soluble vitamin that has long been recognized to aid in the absorption and retention of calcium and phosphorus, both of which are essential for bone formation. Vitamin D may help prevent cancer, heart disease, fractures and falls, autoimmune illnesses, influenza, type 2 diabetes, and depression, according to recent studies (Nair and Maseeh 2012 ). However, a higher possibility of exogenous hypervitaminosis D with symptoms of hypercalcemia also known as vitamin D toxicity (VDT) is caused by excess intake or overdose of vitamin D (Marcinowska-Suchowierska et al. 2018 ).

Calcium (Ca)

Calcium is most typically associated with the development and metabolism of bone as a nutrient. Calcium hydroxyapatite (Ca 10 [PO 4 ] 6 [OH] 2 ) makes up almost 99% of total body calcium and is found in bones and teeth, where it gives hard tissue its strength. Calcium is required for vascular contraction and vasodilation, muscular function, neuronal transmission, intracellular interaction, and hormone production in the circulatory system, extracellular fluid, muscle, and other tissues. Through the process of bone remodeling, bone tissue serves as a calcium storage and supplier for these key metabolic demands (Ross et al. 2011 ). The prevention of hypertensive disorders of pregnancy and blood pressure reduction not only been linked to a sufficient of dietary calcium consumption but also with low-density lipoprotein (LDL) cholesterol levels and prevention of osteoporosis and colorectal adenomas (Cormick and Belizan 2019 ). However, excess consumption of calcium might lead to increase in the incidence of constipation, severe diarrhea, and abdominal pain (Li et al. 2018a , b ).

Iron is a vital element for practically all living creatures since it is involved in a range of metabolic activities such as oxygen transport, DNA synthesis, and electron transport (Abbaspour et al. 2014 ). The most important health benefits that this nutrient provides are to prevent iron deficiency anemia especially to pregnant mothers and women during menstruation. As for its adverse effects associated with oral iron intake, it is frequently reported to be gastrointestinal side effects which include nausea, flatulence, abdominal pain, diarrhea, constipation, and black or tarry stools (Tolkien et al. 2015 ).

Chromium (Cr)

Chromium is a trace mineral that can help with insulin sensitivity as well as protein, carbohydrate, and lipid metabolism. The exact mechanism by which chromium improves the body is unknown, and human insufficiency reports are uncommon. A deficit could be linked to a variety of health issues. Impaired glucose tolerance leads to poor blood sugar management in persons with type 2 diabetes, and ineffective cholesterol control, which increases the risk of atherosclerosis and heart disease. However, there is insufficient evidence to back up either the advantages of chromium or the risks associated with a deficiency (Wilson and Ware 2021 ).

Zinc is an essential nutrient, which means that your body cannot make or store it. It is an essential trace mineral for maintaining good health and is only second to iron in terms of body content among the trace minerals. It is present in every cell of the body, and it is required for the normal functioning of the body's defensive (immune) system. Zinc can be present in a wide range of foods, both plant and animal. Breakfast cereals, snack bars, and baking flour are typically fortified with synthetic forms of zinc because they do not naturally contain the mineral. Cell division, cell development, wound healing, and glucose digestion are all facilitated by this protein. The senses of smell and taste require zinc as well. The body requires zinc to grow and develop normally during pregnancy, infancy, and childhood. Zinc also helps insulin perform better (MedlinePlus n.d.). There are several adverse effects for excessive intake of zinc which includes immediate symptoms such as abdominal pain, nausea, and vomiting (Plum et al. 2010 ).

Manganese (Mn)

Manganese (Mn) is a mineral that is mostly derived from food and water in the human body. Mn is absorbed by the gastrointestinal system and subsequently delivered to mitochondria-rich tissues (the liver, pancreas, and pituitary, in particular), where it is rapidly concentrated. Mn is also involved in the synthesis and activation of many enzymes (e.g., oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases); glucose and lipid metabolism; protein, vitamin C, and vitamin B synthesis; hematopoiesis catalysis; endocrine regulation; and immune function improvement (Li and Yang 2018 ). The health benefits for the consumption of manganese in our diet include regulation of cellular energy, bone and growth of connective tissue, blood clotting and improve brain development. However, there are also adverse effects in Mn which includes the increase in oxidative stress, a well-established molecular mechanism of Mn-induced toxicity (Avila et al. 2013 ).

Molybdenum (Mo)

Molybdenum is a crucial trace element for microorganisms, plants, and mammals. It can be found in large amounts in legumes, grains, and organ meats. It helps break down toxic sulfites and prevents toxins from building up in the body by activating enzymes. Mo is required in extremely small amounts by the human body (usually 100 mg per day1), as opposed to macronutrients such as nitrogen, phosphorus, salt, calcium, magnesium, potassium, chlorine, and others, which are required in larger amounts (Sabatino et al. 2018 ).

Artificial sweeteners

The role of artificial sweeteners is to provide sweetness to ED without adding extra calories and glucose. They may also aid in controlling blood glucose level and thus reduce the risk of obesity and diabetes. The health benefits and side effects of the artificial sweeteners in different types of ED are summarized in Table 6 .

Aspartame (E951) is a dipeptide-based synthetic sweetener that is nearly 180–200 times sweeter than sucrose while having a low calorific value. The consumption of regular sugar is restricted in diabetics who have trouble controlling their blood sugar levels. This is caused by diabetics' insufficient amounts of insulin, a hormone that regulates sugar absorption in the bloodstream. Aspartame helps to restrict sucrose intake by acting as a sugar substitute and release a very small amount of energy. Since it is digested more slowly than sucrose, blood sugar levels stay steadier over time. After swiftly absorbing glucose into the bloodstream, people with reactive hypoglycemia produce an excess of insulin (Zafar et al. 2017 ). Aspartame metabolites may also be a primary cause for adverse effects, such as headache, compromised memory, mood changes, and depression and others which are not being identified yet (Lindseth et al. 2014 ). Aspartame's metabolic metabolites (aspartic acid, phenylalanine, and methanol) have been determined to be more toxic to the body than the original chemical. After ingesting aspartame, both normal persons and phenylketonurics saw a significant increase in plasma phenylalanine levels (Stegink et al 1977 ; Koch et al 1976 ). Many studies have linked aspartame consumption to health implications. There could be a link between aspartame consumption and the development of diabetes mellitus (DM) and type 2 diabetes (T2D), as well as effects on obesity levels, glucose and insulin intolerance, and alterations in the microbiota of rats' offspring. In humans, there have been reports of premature birth, allergic reactions, and weight gain in newborns, increased risk of early first menstruation (11 years), mood disorders, mental stress, and depression, autism development in children, neurodegeneration, modification of neuronal cell functions, disruption of homeostasis, learning, and memory. Aspartame, whose metabolite is phenylalanine, is a common food additive that is particularly toxic to those with phenylketonuria. Aspartame releases 50% of its mass as phenylalanine after digestion, resulting in an increase in phenylalanine levels in the blood. Although the genotoxicity of aspartame is unknown, it has been shown to promote proliferation and slow apoptosis in test cells, suggesting that it may have carcinogenic qualities. Increases in the markers Ki 67, PCNA, and bcl-2 were also seen. The markers c-myc, Ha-ras, and the p53 suppressor gene have all increased significantly. Females who are exposed to aspartame from a young age are more likely to develop lymphomas and leukemias. P27 and H-ras expression has also been found to be higher in studies. There is no evidence of a link between aspartame and pancreatic, gastric, or endometrial cancer. Aspartame's consumption has been linked to free radical generation and decrease in antioxidant enzyme activity (Mohammad et al. 2017 ; Ab Qayoom et al. 2018 ; Zafar et al. 2017 ; Czarnecka et al. 1957 ; Iman 2011 ). Table 7 shows effects of aspartame in various diseases.

Sucralose is a modified version of ordinary sugar (sucrose) with the E number E955 attached to it. It is typically available in granular, liquid, or mini-tablet form under the brand name “Splenda,” or as individual Canderel yellow packets (no other versions of Canderel as they contain different sweeteners). Sucralose has no calories, but because it is so sweet (about 600 times sweeter than sugar), it is frequently blended with other sweetening substances like maltodextrin in granulated form. This adds volume and texture while diluting the strong sweetness. These, on the other hand, are not calorie-free, and a teaspoon has roughly 2–4 cal in it. This is roughly 20% of the sugar calories that the granulated product is supposed to (British Dietetic Association 2018 ). The health benefits for sucralose as a beverage sweetener include improvement in weight loss, as well as prevention of tooth decay, diabetes, and reactive hypoglycemia. Safety concerns regarding sucralose were mostly related to the fact that it comes from a class of chemicals called organic chlorides, some types of which are known as toxic or carcinogenic; however, the chlorine presence in an organic compound does not guarantee its toxicity (Lindseth et al. 2014 ). Thus, there is lack of evidence or study regarding the toxicity and carcinogenic effect of sucralose consumption.

Health benefits of ED

Improved physical performance.

Walsh et al. ( 2010 ) investigated the effects of energy drinks on treadmill exercise time to exhaustion. During a moderate-intensity endurance run, they noticed a significant increase in time to exhaustion, as well as improvements in perceived feelings of focus, energy, and tiredness (Walsh et al. 2010 ). Another research examined how caffeinated energy drinks affected acceleration tolerance and strength when subjected to a “G” load. Energy drinks improved relaxed G tolerance and increased strength but did not influence acceleration tolerance duration, according to the findings (Walker et al. 2010 ). According to the findings of a recent study, caffeinated energy drinks containing around 3 mg/kg of caffeine greatly increased the physical performance of female volleyball players (Perez-Lopez et al. 2015 ).

Improves mood and attitude

Taurine is found in ED ingredients and plays a role in metabolic processes. Amino acids are often added to energy drinks and supplements because they are the building blocks of proteins and precursors of neurotransmitters. The assumption is that enhanced amino acid availability will improve protein synthesis and neurotransmitter reserve, influencing consumer mood (Childs 2014 ). Another research found that 50 mg of guarana in EDs given twice daily for 21 days improved fatigue and tiredness ratings without affecting anxiety or depression in people receiving systemic chemotherapy. Prolonged treatment sessions did not create any noticeable mood effects in healthy participants (e.g., 360 mg 3 times daily for 3 days) or in people undergoing radiation therapy (75 mg daily for 28 days) (Silvestrini et al. 2013 ).

A range of automated memory and attention tests were used to examine cognitive performance, while the mood was assessed using a variety of questionnaires such as the Profile of Mood States (POMS), Bond–Lader, and Chalder Fatigue Scales. Both cognitive function and mood were dramatically enhanced in partially sleep-deprived persons who drank energy drinks, according to the findings. They were able to maintain their initial levels of attention for six hours, but the placebo group was unable to do so (Wesnes et al. 2013 ).

Improved concentration and memory

Only a few randomized controlled trials (RCTs) on energy drinks have been reported. 5-way crossover research with 20 college students (mean age 21 years) was conducted in one of the studies. They drank 250 mL of either flavorants (not expected to have physiological effects), the energetic drink (glucose, caffeine, ginseng, and gingko), or a placebo consisting of the medium used for the other drinks. The energy drink considerably increased “secondary memory” ( P = 0.007) and “speed of attention” ( P = 0.044) when compared to the placebo (O’Mathúna 2021 ).

Other studies involving Red Bull energy drink and sports performance have also been documented, in which participants were given either Red Bull or a placebo drink to drink. The Red Bull groups improved their aerobic endurance by 9% ( P < 0.05), as well as their anaerobic performance by up to 24% ( P < 0.05). Significant improvements also occurred in mental performance, including choice reaction time, concentration, and memory (O’Mathúna 2021 ).

Good source of vitamin B

Energy drinks frequently include significant amounts of B-group vitamins, often at higher doses than the daily recommended requirement for healthy people. High dietary folate and vitamin B6 intakes have been related to a lower risk of death from stroke, coronary heart disease, and heart failure, according to studies (Cui et al. 2010 ). B vitamins have also been proven to lower homocysteine levels, which have been associated with a variety of comorbidities, including pregnancy problems, cognitive impairment and mental illnesses, and cardiovascular risks. Although B vitamin supplementation lowered homocysteine levels and has a significant protective impact against stroke, there was no advantage in reducing cardiovascular disease, myocardial infarction, coronary artery disease, cardiovascular death, or all-cause mortality, according to a meta-analysis (Huang et al. 2012 ).

Weight loss

Energy drinks have been shown to be relatively useful in stimulating metabolic alterations in various studies (Jeffers et al. 2014 ). Caffeine in energy drinks may accelerate metabolism by fewer than 100 cal per day, which might burn around 1 pound of fat in a month. Caffeine's weight loss effect is dose-dependent, according to Tabrizi et al. 2019 . Repeated energy drinks in a day, on the other hand, can have major health and well-being effects. Nevertheless, there is a lack of evidence and study investigating the effects of energy drinks on weight loss endeavors (Jeffers et al. 2014 ).

Health disadvantages of ED

Adverse cardiovascular effect.

Several researchers have examined the short-term effects of ED on the cardiovascular system, focusing on caffeine and sugar (38–40). Consuming 355 mL of ED raised systolic and diastolic blood pressure, heart rate, and cardiac output according to a recent randomized crossover study on healthy adults (Grasser et al. 2014 ). A meta-analysis of 15 studies published in 2016 found that acute ED consumption led to higher systolic and diastolic blood pressure across the pooled results (Shah et al. 2016 ). Aspartame administration (54.87.3 mg kgG1 b.wt. day) resulted in elevated blood pressure, increased body weight, and a short-term increase in blood pressure, plasma glucose and triglyceride values, as well as a transitory reduction in plasma urea, all of which could affect cardiovascular risk factors (Martinez-Morales et al 2015 ). When compared to a control group, aspartame (40 mg kgG1 b.wt.) causes a rise in blood glucose, cholesterol, and triglycerides (Prokic et al 2014 ).

Caffeine toxicity is assumed to cause at doses higher than 400 mg per day for adults, 100 mg per day for adolescents (12–18 years), and 2.5 mg per kilogram of body weight for children (< 12 years), with serious symptoms often linked to cardiovascular consequences (Seifert et al. 2013 ). The US National Poison Data System received 4,854 ED-related calls between October 2010 and September 2011, including significant adverse events like seizure, dysrhythmia, and tachypnea (Seifert et al. 2013 ). In addition to palpitations, agitation, and tremor, data from Australian poison control centers indicate these primary symptoms of recreational or accidental ED consumption among children and adolescents (Gunja and Brown 2012 ). Considering that these data are based on self-reported signs and symptoms, and most consumers may not recognize ED as a toxin, ED-related toxicity concerns are likely to be underestimated.

Neurological effect

Caffeine causes a pro-nociceptive condition of cortical hyperexcitability, which is connected to acute and recurrent daily headaches (Espinosa and Sobrino 2017 ). Using a statistical model, Mostofsky et al. 2019 determined that drinking one or two caffeinated beverages did not alter the likelihood of getting a migraine headache on the same day. The probabilities were much higher when the volunteers took three or more caffeinated drinks. There was a nonlinear relationship between caffeinated beverage consumption and the likelihood of a migraine headache on that day in this study. This shows that excessive consumption of caffeinated beverages on that day may be a migraine trigger (Mostofsky et al. 2019 ).

Epileptic seizures

Caffeine has been shown to cause seizures in people who are sensitive to it, especially when they are sleep-deprived. There has been no conclusive evidence of a relationship between seizures and energy drinks. Nonetheless, after drinking a lot of energy drinks, some people started having new adult-onset seizures without any signs of intracranial abnormalities or electroencephalography (Dikici et al. 2013 ). In kainic acid-induced seizure models in rats, long-term administration of taurine in drinking water increases seizure susceptibility and reduces clonic seizure latency. Caffeine is also a natural stimulant that can be found in coffee and tea. Caffeine overdose has been linked to seizures in humans (Dikici et al. 2013 ).

Ischemic stroke

In young- and middle-aged adults, alcohol misuse is also an independent risk factor for ischemic stroke. Rapid absorption and the resulting increase in the CNS may cause more negative effects when high-volume energy drinks are consumed with vodka on an empty stomach (Dikici et al. 2013 ). According to Steinke et al., after consuming 500 mL of energy drink on a weekly basis, heart rate increased 5 to 7 beats per minute, and maximum mean systolic blood pressure increased 10 mm Hg. On an empty stomach, drinking a high-energy drink with vodka may contribute to ischemic stroke by raising blood pressure and heart rate. In addition, the patient has hemorrhoid-related iron deficiency anemia. Anemia due to iron deficiency may play a role in ischemic stroke (Dikici et al. 2013 ). In Syrian weanling hamsters, aspartame increased appetite and weight gain and caused histological alterations in brain and liver cells, while aspartame metabolites, aspartic acid, phenylalanine, and diketopiperazine are responsible for neuron and astrocyte degeneration (Hassan 2016 ; Rycerz and Jaworska-Adamu 2013 ).

Hallucinations

Hallucinations may occur in people who consume more than 300 mg of caffeine per day. High levels of cortisol can be caused by caffeine consumption, which could explain the above. Cortisol amplifies the physiological effects of stress, increasing the risk of hallucinations (Crowe et al. 2011 ).

Physiological effect

Muscular twitching.

Caffeine overdose can result in muscle twitching, which can be caused by minor muscle contractions or uncontrollable twitching in muscle groups controlled by motor nerve fibers. Dietary deficiencies, medication side effects, and strenuous exercise are all possible causes.

Muscle twitching can be caused by stress or anxiety, or it can indicate a nervous system disorder (MedlinePlus 2021 ).

Restlessness

Energy drinks significantly increased the odds of insomnia and jitteriness/activity when compared to the control group (P 0.05), according to a meta-analysis. Caffeine intoxication, a clinical syndrome described in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, is linked to many of the negative effects of energy drinks. Caffeine intoxications are typically indicated by restlessness. (Nadeem et al. 2021 ).

Sleeplessness

There is currently inadequate research evaluating how these substances function alone or in combination to produce mental health issues. It is possible that caffeinated and sugary EDs influence sleep behavior (i.e., the sleep–wake cycle) by stimulating the adrenergic system, which could contribute to poor psychological distress management and mental health issues (Kaur et al. 2020 ).

Psychological effect

According to report from Hofmeister et al. ( 2010 ), in two samples of students, anxiety levels were found to be higher in energy drink consumers compared to non-consumers. Nevertheless, in one of the two groups, anxiety was only higher among regular users compared to nonregular users, making it difficult to say whether the association was dosage-dependent or not. In addition, another study found that energy drink use was associated with anxiety in a large sample ( N = 4957) of Turkish 10th grade students; anxiety scores were higher in those who had used the products once in their lifetime, once to three times a month, once to five times a week, and every day, compared to nonusers in the previous year. However, at the multivariate level, the impacts were no longer significant (Evren and Evren 2015 ).

Over a two-year period, this study discovered strong positive relationships between ED use and depression, anxiety, and stress symptoms in young adult males (but not females). Males who switched from non-ED to ED use experienced greater depression and stress symptoms over time. The findings backed up previous research that found a link between ED use and sadness and stress symptoms. Males are more likely than females to have these relationships, according to cross-sectional studies (Kaur et al. 2020 ). Consumption of aspartame has been linked to mood problems, mental stress, and sadness. Long-term aspartame usage affects the cerebral and cerebellar cortex, causing neurodegeneration, altering neuronal cell activities, and disrupting homeostasis, learning, and memory (Czarnecka et al. 1957 ).

Gastrointestinal effect

A case with a woman that presented with jaundice, abdominal pain, and highly increased liver enzymes was reported following energy drink overconsumption (Vivekanandarajah et al. 2011 ). The same result was reported by Huang et al. in a 36-year-old man (Huang et al. 2014 ). More research is needed to determine which people are particularly vulnerable and the mechanism by which energy drinks cause hepatic injury.

Renal effects

EDs are not the same as “sports drinks,” which provide hydration and electrolyte replenishment. EDs are rich in carbohydrates, which influence fluid absorption and cause gastrointestinal distress, as well as caffeine, which tends to cause diuresis, which results in greater urinary output and natriuresis rather than hydration (Higgins et al. 2010 ). Excessive Red Bull consumption has been linked to a variety of effects, including acute renal failure, greater systolic and diastolic blood pressure, heart rate, and even decreased blood supply to the brain (Greene et al. 2014 ). According to Schöffl et al. ( 2011 ), after consuming 750 mL of energy drink, this patient developed acute kidney failure with tubular necrosis and rhabdomyolysis. Due to its potential to change renal blood flow and regulate osmolarity in the renal medulla, the authors speculated that excessive intake of taurine may be implicated in the development of kidney injury; however, this role has yet to be proven (Chesney et al. 2010 ). Nephrotoxicity is caused by the ingestion of aspartame (Martins et al 2007 ; Bahr and Zaki 2014 ).

Dental effects

There is growing evidence that the intake of possibly erosive beverages is on the rise. Also, there has been a significant correlation discovered between the consumption of energy drinks and the deterioration of teeth (Hasselkvist et al. 2010 ). The consumption of ED was linked to a 2.4-fold rise in tooth deterioration. This has been related to energy drinks' low pH and high sugar content (Li et al. 2012 ). The sugars in drinks are metabolized by plaque microorganisms to generate organic acids that bring about demineralization (Li et al. 2012 ). Pinto et al. have discovered that drinking energy drinks can cause cervical dentin hypersensitivity by eliminating the smear layer of the teeth (Pinto et al. 2013 ).

Obesity and type II diabetes

Energy drinks often have high sugar content, ranging from 21 to 34 g per ounce. Sucrose, glucose, and high-fructose corn syrup are the main sources of sugar. As a result, excessive consumption of high-energy drinks may raise the risk of obesity and type 2 diabetes (Bedi et al. 2014 ). Furthermore, the amount of sugar in energy drinks may decrease intestinal bacteria activity, variety, and gene expression, increasing the risk of obesity and metabolic syndrome (Greenblum et al. 2012 ). Acute caffeine consumption reduces insulin sensitivity, which may justify the spike in blood glucose levels observed in some studies after energy drink consumption (Ragsdale et al. 2010 ). Caffeine intake lowers insulin sensitivity in a dose-dependent approach, with a 5.8% increase in insulin for each mg/kg increase in caffeine (Beaudoin et al. 2012 ). There may be a link between aspartame consumption and the development of diabetes mellitus (DM) and type 2 diabetes (T2D), and it was found to be dangerous to mice in terms of behavior and biochemical analysis parameters when used as a food additive (Czarnecka et al. 1957 ; Abu-Taweel 2016 ; Zafar et al. 2017 ; Collison et al. 2012 ). When C57BL/6J mice are exposed to chronic aspartame treatment beginning in utero, it causes changes in blood glucose levels, spatial learning, and memory, as well as weight growth (Collison et al 2013 ).

The link between sugary drinks and cancer risk has received far less attention. Nevertheless, because of its mechanical plausibility, this potential relationship raises growing concern. Sugary drinks are, in fact, strongly linked to the development of obesity, which is now identified as a major risk factor for several cancers. Besides obesity and adiposity, insulin resistance induced by high glycemic index or glycemic load, which has been linked to breast cancer, hepatocellular cancer, and diabetes-related carcinomas, could be a mechanism behind a link between sugary drinks and cancer. Chemical compounds in sugary drinks, such as 4-methylimidazole in drinks containing caramel colorings (described as possibly carcinogenic to humans by the International Agency for Research on Cancer, IARC), pesticides in fruit juices, and artificial sweeteners like aspartame, could all play a role in cancer development (Chazelas et al. 2019 ). Another study revealed that a combination of caffeine, taurine, and guarana may stimulate and increase apoptosis by lowering superoxide dismutase and catalase activity in human neuronal SH-SY5Y cells in vitro (Zeidán-Chuliá et al. 2013 ). In both male and female rodents, aspartame ingestion has been shown to be a carcinogenic and angiogenic agent. The markers Ki 67, PCNA, and bcl-2 all showed an increase. According to rat studies, 200 mg/kg body weight caused a considerable surge in the markers c-myc, Ha-ras, and the p53 suppressor gene in rats. Females who are exposed to aspartame from a young age are more likely to develop lymphomas and leukemias. P27 and H-ras expression has also been found to be higher in studies (Czarnecka et al. 1957 ; Soffritti et al 2010 ; Alleva et al 2011 ; Gombos et al 2007 ; Martins et al 2007 ).

Caffeine toxicity

Caffeine is a stimulant that has been used for ages around the world because of its ability to increase mental alertness. Caffeine lethal dosages have been reported at blood concentrations of 80 to 100 µg/ml, which can be achieved with a dose of 10 g or more. Caffeine overdoses in adults are uncommon, but when they do occur, they are frequently triggered by an intentional overdose of medications (Murray and Traylor 2020 ). Four caffeine-induced psychiatric disorders have been classified by the Diagnostic and Statistical Manual of Mental Disorders. Caffeine intoxication, anxiety, sleep disturbance and other related disorders are all examples of caffeine related disorders (Juliano et al. 2012 ). Caffeine intoxication symptoms are most common in individuals who consume 200 mg or more of the stimulant. Anxiety, insomnia, gastrointestinal problems, muscle twitching, restlessness, and spells of exhaustion are just a few of the symptoms (Bedi et al. 2014 ).

Combined effects of alcohol

Underage and younger consumers enjoy alcohol combined with energy drinks, and the beverage industry has benefited on this dynamic trend by aggressively marketing to teenagers and young adults. Nonetheless, there have recently been concerns about the combination's potential public health implications. Consequently, the FDA issued warning letter to manufacturers, effectively banning the manufacture and sale of pre-mixed caffeinated alcoholic beverages (CABs); however, consumers continue to combine energy drinks with alcohol by hand (e.g., Red Bull and vodka, Jaeger Bomb) (Heinz et al. 2013 ). CAB use is linked to problematic alcohol use and harmful alcohol-related effects. In a large multi-site survey, college students who consumed alcohol mixed with energy drinks reported more alcohol-related risk behaviors (e.g., riding in a car with a drunk driver, being hurt or injured, sexually exploiting another student, being taken advantage of sexually) than students who consumed alcohol alone. Furthermore, students who drink caffeine–alcohol combination drink more alcohol and engage in riskier drinking behaviors (e.g., binge drinking) than students who solely consume alcohol (Heinz et al. 2013 ).

Reduction of antioxidant enzyme activity

Aspartame use lowers hepatic tissue superoxide dismutase (SOD), superoxide dismutase SOD and catalase CAT activity in renal tissue, and glutathione (GSH) levels while increasing glutathione S-transferase (GST) activity in liver tissue. This could be due to the creation of methanol or other metabolites, as aspartame is metabolized into aspartic acid, phenylalanine, and methanol in the ratio of 50:40:10, as well as a little quantity of aspartyl phenylalanine diketopiperazine, especially when heated (Abhilash et al 2011 ; Iman 2011 ; Prokic et al 2014 ; Choudhary and Devi 2014 ; Alwaleedi 2016 ; Adaramoye and Akanni 2016 ; Iyyaswamy and Rathinasamy 2012 ).

Inflammation

Aspartame caused neurotoxicity, oxidative stress, and inflammation in rat brain tissue, as well as a large increase in protein carbonyl content and a significant drop in reduced glutathione concentration. Also, a significant increase in brain interleukin-1 (IL-1) and tumor necrosis factor- “(TNF-)” production was accompanied by a significant reduction in brain-derived neurotropic factor (BDNF), serotonin, and acetylcholine esterase (AchE) activity, as well as a substantial increase in acetylcholine (Ach) accumulation in brain homogenates (Lindseth et al 2014 ; Kamel 2015 ).

Preterm birth and maternity problem in women

Intake of artificially sweetened drinks containing aspartame as one of the ingredients has been associated with an increased risk of premature birth in both normal-weight and overweight women, indicating that aspartame intake and use, particularly during pregnancy, may have detrimental consequences (Halldorsson et al 2010 ; Czarnecka et al. 1957 ; Martins et al 2007 ; Czarnecka et al. 1957 ). There have been instances of allergic reactions, and weight growth in babies in humans. Aspartame has been proven to enhance the probability of an early first menstruation (11 years) in females aged 9–10. Aspartame absorption by mothers during pregnancy is linked to autism in children. Maternal absorption of aspartame during pregnancy correlates with autism in children (Halldorsson et al 2010 ; Czarnecka et al. 1957 ; Martins et al 2007 ).

This review has given a lot of insight into the benefits and detriments of the consumption of energy drink to human health. The author’s view is that the ingredient type and the amount contained in the energy drink determine to a major extent the effect on health. The presence of caffeine in ED is not a threat to health; rather a moderate acute dose ranging from 200–350 mg reduces heart rate and raise blood pressure in adults, while also enhancing emotions of well-being, focus, and arousal. Moderate caffeine consumption of up to 400 mg per day is usually regarded as safe and even beneficial to adults' well-being. Guarana has been reported to possess antioxidant, effective stimulant and may be effective in treatment of fatigue and depression related to cancer treatment. A 16-oz energy drink can range from 1.4 mg to 300 mg and is considered safe by Food and Drug Administration (FDA). Ginseng is useful in boosting energy, reducing fatigue, relieving stress, and improving memory and anti-inflammatory activity through activation of corticotropic hormone release from hypothalamus and pituitary glands, and consumption of regular amount of 200 mg per day is considered safe. However, the consumption of more than 2700 mg per day may pose a threat to health such as maniac episodes, uterine bleeding, gynecomastia, long QT syndrome, atrial fibrillation with bradycardia, hypertensive crisis, and acute lobular hepatitis.

Yerba mate and acai berry possess useful pharmacological such as anti-inflammatory, anti-diabetic, antioxidant, in vitro anticancer, inhibition of topoisomerase II, anti-obesity and reduces LDL cholesterol levels. Ginkgo biloba has good health benefits, a normal supplemental dose of 60 mg per day present biological effect such as improvement of memory retention, focus, enhanced blood circulation, and antidepressant. However, consumption of ginkgo biloba maybe poses health discomfort of blood thinning, nausea, vomiting, diarrhea, headaches, dizziness, heart palpitations, and restlessness. Methylxanthines act as CNS stimulants, bronchodilators, coronary dilators, diuretics, and anticancer adjuvant therapies, aside from treatment of neurodegenerative disorders, cardio protection, diabetes, and fertility. Consumption of methylxanthines at lower dose may pose milder side effects such as nausea, vomiting, increased stomach acid secretion, polyuria, sleeplessness, palpitations, headaches, and tremors which are more common.

Energy drink that contains sugar concentration of 500 mL or 16.9 oz usually around 54 g maybe detrimental to health, strong evidence has associated sugar consumption to poor health, and many institutions, including the World Health Organization, have advised limiting sugar intake. This is because the consumption of regular sugar for diabetics who have trouble controlling their blood sugar levels causes insufficient amounts of insulin that regulates sugar absorption in the bloodstream. Consumption of ED that the sugar content is above the daily sugar limit of 32 g for sure will be detrimental to health and Rath 2012 reported that energy drinks with a higher volume usually surpass the daily sugar limit of 32 g. Glucuronolactone is useful in detoxification, the release of hormones and vitamin C production, and protection of muscle glycogen stores. Taurine is associated with treatment of epilepsy, heart failure, cystic fibrosis, and diabetes; however, additional research is required before any conclusions can be drawn. Carnitine acts as antioxidant and anti-inflammatory compound and may reduce the exercise-induced muscle damage. Maltodextrins reduce net glycogen breakdown during long-duration exercise while maintaining a high whole-body glucose oxidation rate. Artificial sweeteners such as aspartame and sucralose are added in energy drink to replace sugar and restrict absorption of sugar. Aspartame helps to restrict sucrose intake by acting as a sugar substitute and releases a very small amount of energy. Aspartame metabolites may also be a primary cause for adverse effects, such as headache, compromised memory, mood changes, and depression and others which are not being identified yet.

The presence of vitamins such as vitamin B, riboflavin (B2), niacin (B3), pyridoxine (B6), inositol (B8), cyanocobalamin B12, vitamin C and vitamin D in energy drink has various health benefits. B vitamins as coenzymes in many metabolic processes facilitate energy metabolism involving lipids, carbs, and proteins, boast immune system, oxidative phosphorylation, and cell energy production; amino acid and homocysteine metabolism, glucose and lipid metabolism, neurotransmitter generation, and DNA and RNA synthesis. The consumption of inositol (former B8) is reported to assist in preventing the development of chronic diseases, including obesity, diabetes, polycystic ovary syndrome (PCOS), metabolic syndrome, cardiovascular diseases, and cancer. Incorporation of mineral such as calcium, iron, chromium, zinc, manganese, and molybdenum is very useful to health. Most of the minerals are useful for vascular contraction and vasodilation, muscular function, neuronal transmission, intracellular interaction, and hormone production in the circulatory system, extracellular fluid, muscle, and other tissues. Oxygen transport, DNA synthesis, and electron transport prevent iron deficiency anemia, protein, carbohydrate, and lipid metabolism. They help in glucose and lipid metabolism; protein, vitamin C, and vitamin B synthesis, hematopoiesis catalysis, endocrine regulation, regulation of cellular energy, bone and growth of connective tissue, blood clotting, improvement of brain development, and immune function improvement (Li and Yang 2018 ); consumption of aspartame and the development of diabetes mellitus (DM) and type 2 diabetes (T2D), obesity, changes in the microbiota of the offspring of rats. In humans, there has been evidence of premature birth, allergic reactions, weight gain in the newborns, increase in the risk of an early first menstruation, mood disorders, mental stress, and depression, development of autism in children, neurodegeneration, modification of the functions of neuronal cells, interruption of homeostasis, learning and memory, harmful people with phenylketonuria, free radical generation, impairment of antioxidant enzymes and carcinogenic.

Consumers should be aware of the potential side effects of aspartame, notwithstanding the lack of solid clinical data on those side effects. The author concludes that the oral treatment with a high dose of aspartame used in those animal trials was rare in humans. Future epidemiological studies and clinical trials are needed to look at the long-term effects of aspartame use at the recommended daily amount. The position of aspartame has remained controversial due to the lack of scientific data supporting and opposing its use. The negative side effects of aspartame ingestion, on the other hand, are extensively documented in human and animal studies. Investigations in similar fresh avenues are strongly urged to cover existing research gaps and put an end to the debate regarding aspartame use. The critical assessment of the literature supporting aspartame use appears to be affected in part by interest groups. The authors propose that bias-free comprehensive trials be used to investigate the safety of aspartame in a variety of groups with varying clinical circumstances. As a result, authorities such as the US Food and Drug Administration (FDA), the European Food Safety Authority (EFSA), the Agence Française de Sécurité Sanitaire des Aliments (AFSSA), the FSSAI (Food Safety and Standard Authority of India), and the Joint FAO/WHO Expert Committee on Food Additives (JECFA) should reconsider the acceptable daily intake (ADI) of aspartame among the public.

In the food and pharmaceutical industries, aspartame is a common sweetener; therefore, it is critical to understand the benefits and drawbacks of aspartame to determine the danger of negative health effects. Based on current knowledge, the benefits of using aspartame outweigh the risks of adverse effects, and thus, this artificial sweetener will continue to be a common ingredient in products. Given the widespread use of aspartame as an artificial sweetener, it appears reasonable to continue study into its safety. Nonetheless, whether aspartame is the direct cause of sickness is unknown.

Most of the health detriments caused because of consumption of energy drink is mostly due to the presence of excess quantity of caffeine and sugar, and presence of aspartame. Scientific reports from in vitro and in vivo have linked aspartame to many detrimental health issues. The presence of aspartame in the energy drink may pose a health risk to consumers. However, if the quantities of caffeine and sugar content in energy drink are kept at FDA- and WHO-recommended daily consumption amount, and no aspartame content, then it may not present any problem to health. Consumption of energy drink that contains natural ingredients such as yerba mate, acai berry, ginkgo biloba, methylxanthines, amino acid, guarana, and ginseng with moderate FDA- and WHO-approved daily consumption of caffeine and sugar is not detrimental to health.

Availability of data and materials

Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

Abbreviations

Energy drinks

Cyanocobalamin

Ascorbic acid

Cholecalciferol

Ergocalciferol

World Health Organization

Maltodextrins

Cardiovascular diseases

Low-density lipoprotein

Randomized controlled trials

International Agency for Research on Cancer

Caffeinated alcoholic beverages

Food and Drug Administration

Polycystic ovary syndrome

Ribonucleic acid

Central nervous system

Deoxyribonucleic acid

Superoxide dismutase

Glutathione

Glutathione S -transferase

Diabetes mellitus

Type 2 diabetes

Marker of proliferation Ki-67

B-cell lymphoma 2

C-myelocytomatosis

Tumor suppressor protein

Cyclin-dependent kinase inhibitors

European Food Safety Authority

Agence Française de Sécurité Sanitaire des Aliments

Food Safety and Standard Authority of India

Joint FAO/WHO Expert Committee on Food Additives

Acceptable daily intake

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Acknowledgements

We thank UCSI University for supporting and providing facility for this project.

Research fund was fully supported by UCSI University CERVIE REIG grant number REIG-FAS-2020-031.

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Hani’ Ariffin, Xiu Qing Chong & Patrick Nwabueze Okechukwu

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PNO conceptualized the project and reviewed and supervised the writing of the manuscript, and CPN assisted with review and supervised the writing of the manuscript project. HA searched for materials and wrote the manuscript, assisted by XQC. All authors read and approved the final manuscript.

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Correspondence to Patrick Nwabueze Okechukwu .

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We, the authors (Hani’ Ariffin, Xiu Qing, Dr. Chong, Chong Pei Nee, and Dr. Patrick Nwabueze Okechukwu), declare that we do not have any conflict of interest with any one with respect to our manuscript entitled “Is the Consumption of Energy Drink Beneficial or Detrimental to Health: A Comprehensive Review?”.

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Ariffin, H., Chong, X.Q., Chong, P.N. et al. Is the consumption of energy drink beneficial or detrimental to health: a comprehensive review?. Bull Natl Res Cent 46 , 163 (2022). https://doi.org/10.1186/s42269-022-00829-6

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DOI : https://doi.org/10.1186/s42269-022-00829-6

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Micro/macronutrients
Natural ingredients
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Frontiers | Science News

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Featured news

Health risks associated with energy drinks can outweigh short-term benefits.

To curb this growing public health issue, policy makers should regulate sales and marketing towards children and adolescents and set upper limits on caffeine. Image: Shutterstock

— By Tania Fitzgeorge-Balfour

A review of current scientific knowledge on energy drinks finds their advertised short-term benefits can be outweighed by serious health risks — which include risk-seeking behavior, mental health problems, increased blood pressure, obesity and kidney damage. The study, published in Frontiers in Public Health , also highlights the worrying trend of mixing energy drinks with alcohol. The authors recommend restricted sales to children and adolescents and setting evidence-based caffeine limits.

As energy drink consumption continues to grow worldwide, there is a need to thoroughly examine their advertised benefits, nutritional content and any negative effects on public health.

“We summarize the consequences of energy drink consumption, which include heart, kidney, and dental problems, as well as risk-seeking behavior and poor mental health,” says Dr. Josiemer Mattei , Assistant Professor of Nutrition based at the Harvard T.H. Chan School of Public Health, Boston, USA, who published this study along with a team of graduate researchers.

“The evidence suggests they are harmful to health and should be limited through more stringent regulation by restricting their sales to children and adolescents, as well as setting an evidence-based upper limit on the amount of caffeine.”

Most energy drinks consist of similar ingredients — water, sugar, caffeine, certain vitamins, minerals and non-nutritive stimulants such as guarana, taurine and ginseng. Some can contain up to 100 mg caffeine per fluid ounce, eight times more than a regular coffee at 12 mg. A moderate daily caffeine intake of up to 400 mg is recommended for adults, but little research exists on tolerable levels for adolescents and children.

“The energy drink industry has grown dramatically in the past 20 years, culminating in a nearly $10 billion per year industry in the United States. They are often marketed as a healthy beverage that people can adopt to improve their energy, stamina, athletic performance and concentration, but our review shows there are important health consequences, and little is known about many of their non-nutritive stimulants such as guarana and taurine,” says Dr. Mattei.

The health risks associated with energy drinks are mostly attributed to their high sugar and caffeine levels. They range from risk-seeking behavior, such as substance misuse and aggression, mental health problems in the form of anxiety and stress, to increased blood pressure, obesity, kidney damage, fatigue, stomachaches and irritation.

The review also highlights another worrying trend of mixing energy drinks with alcohol. Individuals who do this consume more alcohol than if they were drinking alcohol alone. It is thought energy drinks can mask the signs of alcohol inebriation, enabling an individual to consume more, increasing the likelihood of dehydration and alcohol poisoning.

Dr. Mattei and her colleagues hope that by highlighting our current knowledge about the health consequences of energy drinks, policy and interventions can be put in place to reduce negative effects on public health. In addition, the review can be used to target research to fill the gaps in our knowledge.

“Our review is limited because there are a small number of studies in this area and they primarily focus on healthy young adults, assessed at one point in time. Future research should explore the effects of the energy drink constituents we know less about, such as taurine, and consider long-term assessments across a broader range of the population to examine the effects of energy drink consumption over time,” she explains.

“However, we conclude that there is currently enough evidence to suggest that the negative health consequences of drinking energy drinks outweigh any potential short-term benefits.”

Original research article: Health Effects and Public Health Concerns of Energy Drink Consumption in the United States: A Mini-Review

Corresponding author: Josiemer Mattei

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The Positive and Negative Effects of Energy Drinks

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The Impact of Energy Drinks on Health and Well-Being: What Does the Science Say?

What Are Energy Drinks?

Short-Term Benefits

Negative Effects and Health Risks

Who Should Avoid Them?

Bethany Daugherty

Be a Powerful Provider.

Why Energy Drinks Should Be Banned

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Energy Drinks

Energy Drinks and Health

Special concerns with energy drinks:

Bottom Line

Terms of Use

How Dangerous Are Energy Drinks?

Key Takeaways

Why So Popular?

How Much Caffeine Is Safe?

Energy Drink Caffeine Content

Other Ingredients Are Problematic, Too

Energy Drinks May Contribute to Heart Disease

Alcohol Makes Things Worse

It Can Be Difficult to Consume Energy Drinks Safely

What This Means For You

Health Effects and Public Health Concerns of Energy Drink Consumption in the United States: A Mini-Review

Introduction

Constituents and Ingredients

Health Effects of ED

Risk-Seeking Behaviors and Mental Health Effects

Adverse Cardiovascular Effects

Adverse Metabolic, Dental, or Renal Effects

Other Health Effects

Limitations of the Existing Literature

Relevant Public Health Challenges

Lack of Regulation and Taxation

Alcohol and Energy Drink Mixing

Recommendations and Future Directions

Author Contributions

Conflict of Interest Statement

Acknowledgments

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Energy drinks are killing young people. It’s time to stop that.

Article Contents

Energy drinks and adolescents: what’s the harm?

Sales of energy drinks

Marketing of energy drinks

Recent introduction of new “energy” products

Caffeine toxicity and other physiological effects

Potential behavioral effects

Consumption of energy drinks and other caffeinated products by teenagers

Safety of ingredients in energy drinks

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Is the consumption of energy drink beneficial or detrimental to health: a comprehensive review?

Conclusions

Brief introduction of ED

Types of ED

Fruit-based

Non-fruit-based (regular)

Plant-based

Major ingredients and constituents of ED

Ginkgo Biloba

Methylxanthines

Macronutrients

Carbohydrates

Maltodextrin

Micronutrients

Riboflavin (B 2 )

Niacin (B 3 )