Unleashing a Beast
February 27, 2020 | Christie Baker: Love Oak Pharmacist Intern
Energy Drinks Made Simple
America runs on caffeine. Isn’t that the saying? Close enough. I bet that you’ve had caffeine within the last 24 hours. In many cases, I would be right. The average adult in the United States takes in around 9mg of caffeine for every 1 pound of body weight with most of this coming from coffee.1 With everyone expected to do more, push harder and run themselves ragged, that makes sense! Caffeine is advertised as enhancing your mood, increasing alertness and attention and overall helping you stay awake. Because of this, energy drinks have become increasingly popular.
What is an energy drink?
Energy drinks are generally any beverage that has caffeine in combination with any number of ingredients that are supposed to increase your energy.2 You can find them in pharmacies, gas stations, bars, and in the checkout line of various stores. Majority of consumers are college-aged or young adults aged 18 – 34 years old.2 This population are the ones pulling all-nighters for an exam or putting in long hours to advance in their workplace or new parents trying to juggle everything. With labels boasting energy, mental alertness and physical performance enhancement, why wouldn’t you grab a boost?
What is in each can?
Not all energy drinks are created equal and the ingredients vary between manufacturers. According to various labels, sodium, sugar, caffeine, taurine and B vitamins are the most commonly shared ingredients (Table 1).
Table 1. Common ingredients of popular energy drinks
*16 ounce sizes
**Sugar-free options available
Caffeine in beverages is generally considered safe (GRAS) by the FDA.1 Too much caffeine can cause serious problems like faster heart rate, anxiety, high blood pressure and in some cases, death.3 Just because something is sold in the cooler at Best Buy, doesn’t mean it is completely harmless. Taking in less than 400 mg of caffeine daily is considered safe for most people (Figure 1). Pregnant women should have less than 300 mg and children should have less than 5.5 mg per pound of body weight. It is important to note that people with high blood pressure are more sensitive to caffeine and their medications may not be able to control it. Also, someone that generally doesn’t drink caffeine shouldn’t take in up to 400 mg and expect no problems. Those people tend to be a little more sensitive too. Now, this is not to scare you! Knowing what you are consuming means you can have a little more control of your health!
Figure 1. (400mg caffeine equivalents):
Taurine was originally prepared from ox bile, but this is not the case anymore!5 Your body contains about 2 grams of taurine per pound with the highest concentrations being places like the heart and brain. You get most of it from eating meats. Taurine’s claim to fame is an energy booster, antioxidant and anti-inflammatory. Like caffeine, taurine should be limited but the data behind this is limited. Most of the studies are related to taurine in combination with other ingredients (like energy drinks) but should still be limited to less than 3 grams per day. Something to keep in mind is taurine can interact with medications and alcohol.
3. Vitamin B3
Also known as niacin, vitamin B3 is important in converting food to energy, making fatty acids and is an antioxidant.6 The recommended daily intake is 16 mg for men and 14 mg for women but we consume roughly twice that much on average. This is because we get it from many animal-based food and fortified foods. Side effects like flushing usually don’t start until you consume closer to 35 mg and insulin resistance/ blood sugar control can be harder after 1.5g.7 People with diabetes should be careful with this vitamin. This ingredient also has a few drug interactions. Alcohol can cause more toxic side effects from vitamin B3 whereas vitamin B3 can cause more problems with statins.
4. Vitamin B6
Also known as pyridoxine, vitamin B6 also helps with food breakdown and releasing sugar stores in your body.8 The recommended daily intake is 1.3 mg and can easily be achieved by eating chickpeas, fish and beef liver.9 This one is pretty safe and can cause you to be more tired if you take in too much. It’s possible if you’ve been through morning sickness, you were told to take this since it is recommended for pregnancy-related nausea.8 Although vitamin B6 isn’t toxic, in amounts over 80 mg it can make barbiturates, phenytoin and levodopa less effective.
5. Vitamin B12
When you think of energy supplements, you probably think of vitamin B12. That is its claim to fame! If you’re constantly low on energy, the doctor may even prescribe you the weekly injection. Vitamin B12 is not only helpful for energy, it is also very important for your blood cells.10 The recommended daily intake is 2.4 mcg and is accomplished by animal products and fortified foods.11 Because our bodies can’t make this, we are dependent on our foods. This is why vegans are at risk for being too low on vitamin B12. Out of all these vitamins, B12 deficiency is most common and is called macrocytic anemia. It is more harmful to be low in vitamin B12 than high because extra B12 doesn’t stay in the body.
Why should you care?
Energy drink are everywhere and easily bought. Because of this, many people may not be aware of the problems they can cause. The number of energy drink-related emergency room visits are on the rise and 10% lead to hospitalization.12 Consistently over 1000 poison control calls are made annually in regards to energy drinks, majority involving children.13-16 There have been studies that have shown that energy drinks, not even including exercise, can cause changes in the way your heart beats.17-19 That doesn’t even touch the many studies on the combination of energy drinks and alcohol or what happens when you exercise after an energy drink. This blog post isn’t meant to scare you. Am I saying never drink an energy drink again? Nope. Even I had one while writing this. I’m saying be smart. Don’t consume more than the recommended amounts listed on the can. Be careful if you have heart conditions or are already sensitive to caffeine. Be mindful that your medications can interact with other natural supplements. Most importantly, listen to your body. If you have concerns, talk to your healthcare providers. We are here to help!
Heckman MA, Weil J, Gonzalez de Mejia E. Caffeine (1, 3, 7-trimethylxanthine) in foods: a comprehensive review on consumption, functionality, safety, and regulatory matters. J Food Sci. 2010;75(3):R77–R87. doi:10.1111/j.1750-3841.2010.01561.x
Heckman MA, Sherry K, Gonzalez de Mejia E. Energy drinks: an assessment of their market size, consumer demographics, ingredient profile, functionality, and regulations in the United States. Compr Rev Food Sci Food Saf. 2010;9(3):303-317. https://doi.org/10.1111/j.1541-4337.2010.00111.x
Cappelletti S, Piacentino D, Fineschi V, et al. Caffeine-Related Deaths: Manner of Deaths and Categories at Risk. Nutrients. 2018;10(5):611. doi:10.3390/nu10050611
Kallmyer T. Caffeine Safe Limits: Calculate Your Safe Daily Dose. https://www.caffeineinformer.com/caffeine-safe-limits. Published November 13, 2019. Accessed January 14, 2020.
Caine JJ, Geracioti TD. Taurine, energy drinks, and neuroendocrine effects. Cleve Clin J Med. 2016;83(12):895–904. doi:10.3949/ccjm.83a.15050
Niacin fact sheet for health professionals. National Institutes of Health Office of Dietary Supplements website. https://ods.od.nih.gov/factsheets/Niacin-HealthProfessional/. Updated July 9, 2019. Accessed February 5, 2020.
Niacin. ln: Lexi-Drugs [database online]. Hudson, Ohio: Wolters Kluwer Health. Updated January 24, 2020. Accessed January 26, 2020.
Pyridoxine. ln: Lexi-Drugs [database online]. Hudson, Ohio: Wolters Kluwer Health. Updated December 20, 2019. Accessed January 26, 2020.
Vitamin B6 fact sheet for health professionals. National Institutes of Health Office of Dietary Supplements website. https://ods.od.nih.gov/factsheets/VitaminB6-HealthProfessional/. Updated September 19, 2019. Accessed February 5, 2020.
Cyanocobalamin. ln: Lexi-Drugs [database online]. Hudson, Ohio: Wolters Kluwer Health. Updated November 29, 2019. Accessed January 26, 2020.
Vitamin B12 fact sheet for health professionals. National Institutes of Health Office of Dietary Supplements website. https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/. Updated July 9, 2019. Accessed February 5, 2020.
Energy Drinks. National Center for Complementary and Integrative Health. https://nccih.nih.gov/health/energy-drinks. Updated July 26, 2018. Accessed January 13, 2020.
Gummin DD, Mowry JB, Spyker DA, et al. 2018 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 36th Annual Report. Clin Toxicol (Phila). 2019 Dec;57(12):1220-1413.
Gummin DD, Mowry JB, Spyker DA, et al. 2017 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 35th Annual Report. Clin Toxicol (Phila). 2018 Dec 21;:1-203.
Gummin DD, Mowry JB, Spyker DA, et al. 2016 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 34th Annual Report. Clin Toxicol (Phila). 2017 Dec;55(10):1072-1252.
Mowry JB, Spyker DA, Brooks DE, Zimmerman A, Schauben JL. 2015 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 33rd Annual Report. Clin Toxicol (Phila). 2016 Dec;54(10):924-1109.
Svatikova A, Covassin N, Somers KR, et al. A randomized trial of cardiovascular responses to energy drink consumption in healthy adults. JAMA. 2015;314:2079–82.
Fletcher EA, Lacey CS, Aaron M, et al. Randomized Controlled Trial of High-Volume Energy Drink Versus Caffeine Consumption on ECG and Hemodynamic Parameters. J Am Heart Assoc. 2017;6(5):e004448. doi:10.1161/JAHA.116.004448
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