Story URL: http://news.medill.northwestern.edu/chicago/news.aspx?id=224338
Story Retrieval Date: 9/23/2014 5:23:47 PM CST
Two decades ago, energy drinks were relatively unknown products in the U.S. Today, the popular caffeine-infused beverages sit as ubiquitously on convenience store shelves as soda and juice, waiting for bleary-eyed consumers to reach for them for a quick pick-me-up.
But for the parents of young consumers, the drinks have raised alarms as more incidents have been reported of cardiac deaths following their consumption. The latest lawsuit filed in June was over the death of Alex Morris, a 19-year-old who had consumed two cans of Monster.
The case is the sixth adverse event since 2009 reported to the Food and Drug Administration that cites Monster Energy beverages as contributing to a consumer’s death, prompting the FDA to investigate.
“I am concerned about the unregulated aspect and marketing [of energy beverages] as if they were innocuous drinks,” said David Gozal, professor, pediatrician and sleep disorder expert at the University of Chicago.
Three major health risks associated with caffeine consumption, Gozal said, are addiction, compromised performance and toxicity and he urges consumers instead to focus on getting adequate sleep in lieu of turning to energy drinks.
Despite growing criticism and calls for action, the energy drink industry continues to thrive. For the year ended June 16, Americans spent a total of $8.3 billion on energy drinks, up 16.6 percent from the same period in 2011, according to Euromonitor data.
Red Bull, Monster and Rockstar manufacturers are, if anything, becoming more aggressive at muscling their way to their goal of market dominance over coffee and soda.
“Over the last decade or so, they have been growing by a double-digit rate annually,” John Sicher, editor of trade publication Beverage Digest, said of energy drinks.
Annual revenue of Corona, Calif.-based Monster Energy has grown almost fivefold since 2005 to $2.06 billion last year. Revenue of Red Bull, based in Austria, increased almost 16 percent in 2012 alone to about $6.53 billion.
Meanwhile soda sales have been sluggish. According to Beverage Digest’s “Companies Ranked by Carbonated Soda Drinks Volume 2012” list, which measures volume in cases of beverages sold, Coca-Cola Co. and Pepsico lost 1 percent and 2.5 percent volume, respectively, while Monster Beverage Co., Red Bull and Rockstar volumes jumped 19.1 percent, 17 percent and 8 percent, respectively.
The FDA launched an investigation of energy drinks in July in light of the large number of adverse events reports received within the past year, though the total number of adverse events relating to energy drinks has not been established, said an FDA spokesperson.
“I’m sure it’s in the hundreds, but one reason why it’s not possible to just come up with a figure is that reports were not always submitted electronically like they are now,” said FDA press officer Tamara Ward.
Ward said the ongoing investigation is examining energy drink products across the board but with a focus on “the big three”— Monster, Rockstar and 5-Hour Energy.
“We are realizing that the amount of caffeine put in food has increased,” Ward said of the investigation, adding that the organization is unsure how long the investigation will take.
The FDA’s only explicit regulation for caffeine dates from the 1950s and applies only to soda.
Its current guidelines discourage adolescents from consumption of highly caffeinated beverages, but the guidelines have no teeth, as they do not explicitly prohibit adolescents from purchasing such beverages.
One of the most outspoken critics of energy drink sales to adolescents has been Ill. Sen. Dick Durbin, who says manufacturers market aggressively to children under the age of 18 by focusing on sports and other high-energy activities.
“Across the board, makers of energy drinks say they do not market their products to children,” Durbin said at a July 31 hearing of the Senate Commerce Committee on labeling and classification of energy drinks. “But then you hear about samples of energy drinks being distributed at places where teens hang out – like sports events, concerts, local parks and SAT prep courses.”
A group of senators led by Durbin introduced the Dietary Supplement Labeling Act, which would require more information on product labels and discourage manufacturers from labeling their products as “dietary supplements,” which he said enables them to skirt many FDA regulations.
Sen. Durbin was also a driver of the adverse event reporting campaign that requires manufacturers to report consumption-related problems to the FDA. The agency’s medical reviewers are examining such reports now as they relate to energy drinks to determine health effects.
Among the cases being reviewed is the Morris death. The 19-year-old's mother alleges he consumed Monster Energy regularly for the three years leading up to his July 1, 2012 death, and two 16-ounce cans of the beverage the day of his death before suffering cardiac arrest.
A spokesperson for Sen. Durbin said he wants the FDA to clarify what qualifies as a food and what qualifies as a beverage following moves by Monster and Rockstar in the spring to market their energy drinks as beverages, which has allowed them to be purchased with food stamps for the first time.
The move concerns many health care professionals, especially as lower-income consumers often lack knowledge of the side effects of caffeine, specifically on adolescents. Around two million Illinois residents were enrolled in the food stamp program as of May 2013.
The beverage industry says the level of caffeine in energy and other drinks is harmless. In its Aug. 8 earnings call, Monster Beverage Corp. CEO Rodney Sacks noted that a 16-ounce can of Monster contains approximately 160 mg of caffeine, while a Starbucks coffee of the same size contains about 330 mg.
“It is important to keep in mind that caffeine has been a part of the American diet for centuries,” said Maureen Beach, director of communications at the American Beverage Association. “The vast body of available and reliable science supports the safety of caffeine, including levels found in mainstream energy drinks, which have been consumed in the U.S. for more than 15 years.”
Beach noted that recent studies from the FDA and the International Life Science Institute-North America show that American caffeine consumption has remained stable in the past decade.
“What the data seems to say is that the increase in caffeine over the past 10 years is not much,” Executive Director of ILSI-North America Eric Hentges said of the Institute's study of beverage caffeine consumption. “It looks like people are substituting, not adding on, since we are not seeing a huge increase in caffeine consumption.”
According to the study, energy drink consumption accounted for just 4.3 percent of reported caffeine usage, while flavored carbonated sodas, coffee and tea dominated, accounting for 63 percent, 55 percent and 53 percent of caffeine consumption, respectively.
But Gozal is skeptical about the energy drink business and said consumers, oftentimes college students, use energy drinks as a "band-aid" for a lack of adequate sleep.
“I view this as a marketing ploy to sell many more drinks that are cheap to a sleep-deprived society,” Gozal said, adding that there is no scientific evidence to support the notion that higher caffeine consumption leads to better performance.
“This society prefers to use any type of approach to enable them to function in an environment when they sacrifice sleep over anything else,” Gozal said.
Gozal compared the recent surge in popularity of energy drinks with that of sodas, such as Coke, in an earlier generation.
“I would say that 30 years ago, a 5-year-old would never drink Coke,” he said. “It’s not unusual for us to see kindergarteners drinking caffeinated beverages and parents unaware that these are fraught with health risks.”
While scientific evidence about the specific health risks to children is yet to be determined, Gozal pointed out that people with greater body masses metabolize differently from smaller people like children.