Energy Drinks: Performance Effects and Safety Concerns

IronPlayground

http://www.nsca.com/ContentTemplates/PublicationArticleDetail.aspx?id=2147486468

TL;DR: There is no evidence to support that energy drinks increase aerobic or anaerobic performance. Also, there is no evidence to support energy drinks being harmful when consumed in moderation.

Energy drinks are becoming a larger, more controversial topic in the world of athletics. This article summarizes studies that look at the effects of energy drinks on performance.
Introduction

Energy drinks have become very controversial because of their alleged capacity to enhance performance and because of their potential health risks. Is the controversy about either their benefits or dangers valid? Do they help both aerobic (endurance) and anaerobic (speed, power, or weightlifting) performance? Are they helpful enough to justify their use despite potential harm? This short paper will attempt to answer these questions.
Background

Ergogenic (from the Greek “ergon,” meaning “work”) aids are ingested to enhance energy utilization in athletes and have been used for hundreds, possibly even thousands, of years. Energy drinks are a relatively new entry into the ergogenic marketplace and are heavily marketed. They arrived on the scene about 9 years ago, and the demand among an ever-broader demographic has continued to increase dramatically.

Energy drink sales figures for the 2005 calendar year showed Red Bull at the top with around $262 million in sales. Monster sold about $81 million, Rockstar $67million, and Full Throttle $40 million (2). According to Report Buyer, in 2002 the energy drink market was about $1.2 billion and progressed to an estimated $6.6 billion in 2007 (1).

It does not appear likely that the market will slow down any time soon, which makes answering these questions regarding their risks and benefits even more important.

Energy drinks are typically composed of a carbohydrate source (glucose, maltodextrin), B vitamins, caffeine, and possibly other minor ingredients, such as the amino acids taurine and L-carnitine and some herbs. Despite the great deal of data on caffeine and the use of carbohydrates to enhance aerobic exercise performance, (3, 9-11, 18, 29, 30) there is little data on the effects of energy drinks on exercise performance, especially from randomized controlled trial formats.
Effects of Energy Drinks on Aerobic Exercise Performance

Candow and colleagues investigated the effects of a sugar-free Red Bull energy drink on high-intensity run time to exhaustion in young adults(4). Physically active university students (9 men, 8 women, aged 21 ±4 years) participated in a double-blind, crossover, repeated-measures study.

Each subject was randomized to the supplement group (sugar-free Red Bull at 2 mg/kg body mass of caffeine) and a non-caffeinated, sugar-free placebo (tonic water with lime juice) with 7 days between tests. A run time to exhaustion test at 80% VO2 max was performed while rating of perceived exertion (RPE) was assessed immediately after exercise. They found no differences in run time to exhaustion (Red Bull: 12.6 ±3.8 minutes, placebo: 1.8 ±3.4 minutes), or perceived exertion on a Borg scale (Red Bull: 17.1 ±2.0, placebo: 16.6 ±1.8) between groups.

Ivy and company investigated the effects of a commercially available energy drink ingested before exercise on endurance performance (17). This study also used a double-blind, randomized, crossover design. Subjects (6 male and 6 female) were trained cyclists (mean age 27.3 ±1.7 years, mass 68.9 ±3.2 kg, and VO2 peak 54.9 ±2.3 ml/kg/min) and arrived to the lab after an overnight (12-hour) fast.

They consumed 500 ml of either a flavored placebo or Red Bull Energy Drink (160 mg caffeine with 54 g carbohydrate). Performance was measured as time to complete a standardized amount of work equal to 1 hour of cycling at 70% wVO2 max. Performance improved with the energy drink compared with placebo (3,690 ±64 s vs. 3,874 ±93 s, p < .01), although there was no difference in ratings of perceived exertion (RPE).

Respiratory exchange ratio (RER) was also evaluated to investigate substrate (fat or carbohydrate) utilization by open-circuit spirometry and did not differ between treatments.

The conflicting results of these two studies from Candow and Ivy may be related to the different study designs and the mode of exercise. For example, Candow (4) used a run to exhaustion yet Ivy (17) used a cycling time trial. Furthermore, it remains difficult to pinpoint the potential ergogenic ingredient(s) in energy drinks, such as carbohydrates and caffeine.

Carbohydrates and fluids have been repeatedly shown to be ergogenic when given before and during endurance exercise (18, 19, 22, 24, 27-30). There is substantial information that shows caffeine can improve endurance performance (9, 10), but the combination of ingredients in energy drinks may inhibit this improvement in performance.
Effects of Energy Drinks on Anaerobic Exercise Performance

Not all athletes engage in aerobic-based sports, as some sports are anaerobic in nature. With that said, perhaps there is an ergogenic effect of an energy drink taken pre-exercise in anaerobic-based performance? Forbes and company studied the effects of Red Bull at 2 mg/kg body mass caffeine as compared to those of a placebo (noncaffeinated Mountain Dew with lemon juice) (8).

Sixteen healthy, physically active subjects (12 men, 4 women, aged 24 ±6 years) volunteered for the study. After a familiarization trial, subjects were randomized to groups and accordingly ingested either the supplement or a placebo 60 minutes before exercise.

Muscle strength and endurance was measured by 1-rep max (1RM) bench press test where subjects performed 3 sets of reps to volitional fatigue at 70% of their 1RM. Anaerobic power was assessed by repeated 30-second Wingate cycle ergometer tests with resistance set at 7.5% of their body mass.

The Red Bull group was found to increase the total bench press reps vs. that of the placebo group (34 ± 9 reps vs. 32 ± 8 reps, p<0.05), but had no effect on peak anaerobic power (701 ± 124 W vs. 700 ± 132 W) or average power (479 ±74 W vs. 471 ±74 W) for the Red Bull vs. placebo, respectively. From this study, Red Bull improved bench press rep performance but not anaerobic power.
Conclusion

Despite the great deal of data on the main active ingredients in energy drinks (caffeine and carbohydrates), there is limited data to show that they enhance aerobic or anaerobic exercise performance.
Safety

The albeit brief history of energy drinks contains many case reports of acute short-term effects, but substantial data to determine the validity of any and all claims regarding short- or long-term effects is yet to come (5-7, 25). More safety data is always a good thing, but that argument could be made for any supplement or even some common food items. Energy drinks are no different in this regard.

The main active stimulant in most energy drinks is caffeine since it is cheap and effective. Recently, Canada passed new rules limiting caffeine levels at 180 mg per drink (12). For comparison, the average cup of coffee contains between 40 and 150 mg caffeine, although specialty coffees may contain much higher doses (20).

"The dose makes the poison" – Paracelsus

A substance can produce the harmful effect once it reaches a high enough dose. Caffeine is one of the most studied substances in the food supply and has a long history with overwhelming scientific evidence supporting its safety when consumed in moderation (13).

Fatal caffeine overdoses in adults are relatively rare and require ingestion of a large amount of the drug, typically in excess of 5 g or 5,000 mg (20). At 120 mg caffeine per average cup of coffee, that amounts to about 41 cups of coffee. While there are a handful of case reports of caffeine overdosing in the literature (16, 20, 26), they are very rare especially considering the broad accessibility of caffeine.

The effective dose where an ergogenic effect is seen is about 2-6 mg caffeine/kg body mass; so a 220-pound athlete would need about 200 to 600 mg or 1.5 to 5 averaged-sized cups of coffee to potentially enhance performance (9). Too much caffeine, on the other hand, can potentially be ergolytic (detrimental to performance) (9). For athletes monitoring performance, an increased dose of caffeine will show a performance drop-off well before they approach the amount close to acute caffeine toxicity.

Based on the data reviewed by Nawrot and colleagues in 2003(23), up to 400 mg of caffeine daily was not associated with any adverse effects in healthy adults. The study did state that children should limit their consumption to less than 2.5 mg/kg bodyweight/day. Higdon and company (14) presented data (also in children), that no adverse effects were seen with doses under 3 mg/ kg bodyweight/day; however, the exact amount of caffeine will vary from person to person based on genetics, body mass, and sensitivity.

For reference, a youth athlete weighing 120 lb (54.4 kg) at 3 mg/kg body mass caffeine calculates out to 163 mg of caffeine per day, or about 2 servings of an average energy drink (average caffeine per serving of Red Bull is 81 mg).
Recommendations

While clear-cut recommendations for athletes do not exist, some groups such as the Mayo Clinic do not recommend energy drinks for athletes participating in exercise lasting less than 1 hour (15), but also admit there is a lack of long-term data to support this conclusion.

Even when consumption of an energy drink results in a statistical increase in performance, this translates into a very small real-world change; it will not transform anyone into the next Olympic athlete overnight. The main ergogenic ingredient (caffeine) has a great safety record when used in moderation.

The longest-term data available in the literature on one type of energy drink (Celsius) taken once a day for 10 weeks did not show any change in clinical markers for hepatic, renal, cardiovascular, or immune function, and revealed no adverse effects in response to its consumption (21).

Unfortunately there are not any other data investigating other types of energy drinks for a similar length of time, especially accounting for a higher total dose and frequency. Based on current data, it appears that an occasional energy drink with regard to acute health risks is safe; but long-term studies have not yet been conducted.
References

Energy Drinks in the US. Report Buyer. 2007: p. 147.
The year's top energy drinks - Slashfood [Internet] [cited 2008 2/29/2008]. Available from: http://www.slashfood.com/2006/12/20/the-years-top-energy-drinks/.
Campbell C, D Prince, M Braun, E Applegate, GA Casazza. Carbohydrate-supplement form and exercise performance. Int J Sport Nutr Exerc Metab. 2008; 18(2):179-90.
Candow DG, AK Kleisinger, S Grenier, KD Dorsch. Effect of sugar-free Red Bull energy drink on high-intensity run time-to-exhaustion in young adults. J Strength Cond Res. 2009; 23(4):1271-5.
Clauson KA, KM Shields, CE McQueen, N Persad. Safety issues associated with commercially available energy drinks. J Am Pharm Assoc (2003). 2008; 48(3):e55,63; quiz e64-7.
Duchan E, ND Patel, C Feucht. Energy drinks: a review of use and safety for athletes. Phys Sportsmed. 2010; 38(2):171-9.
Duchan E, ND Patel, C Feucht. Energy drinks: a review of use and safety for athletes. Phys Sportsmed. 2010; 38(2):171-9.
Forbes SC, DG Candow, JP Little, C Magnus, PD Chilibeck. Effect of Red Bull energy drink on repeated Wingate cycle performance and bench-press muscle endurance. Int J Sport Nutr Exerc Metab. 2007; 17(5):433-44.
Graham TE. Caffeine and exercise: metabolism, endurance and performance. Sports Med. 2001; 31(11):785-807.
Graham TE, JW Rush, MH van Soeren. Caffeine and exercise: metabolism and performance. Can J Appl Physiol. 1994; 19(2):111-38.
Greer F, D Friars, TE Graham. Comparison of caffeine and theophylline ingestion: exercise metabolism and endurance. J Appl Physiol. 2000; 89(5):1837-44.
Ottawa caps caffeine in energy drinks, but won't label them dangerous drugs [Internet]. Canada: The Canadian Press [cited 2011 October 10]. Available from: http://ca.news.yahoo.com/ottawa-caps-caffeine-energy-drinks-wont-label-them-162627637.html.
Heckman MA, J Weil, E Gonzalez de Mejia. Caffeine (1, 3, 7-trimethylxanthine) in foods: a comprehensive review on consumption, functionality, safety, and regulatory matters. J Food Sci. 2010; 75(3):R77-87.
Higdon JV, B Frei. Coffee and health: a review of recent human research. Crit Rev Food Sci Nutr. 2006; 46(2):101-23.
Higgins JP, TD Tuttle, CL Higgins. Energy beverages: content and safety. Mayo Clin Proc. 2010; 85(11):1033-41.
Holmgren P, L Norden-Pettersson, J Ahlner. Caffeine fatalities--four case reports. Forensic Sci Int. 2004; 139(1):71-3.
Ivy JL, L Kammer, Z Ding, et al. Improved cycling time-trial performance after ingestion of a caffeine energy drink. Int J Sport NutrExercMetab. 2009; 19(1):61-78.
Jeukendrup AE. Carbohydrate intake during exercise and performance. Nutrition. 2004; 20(7-8):669-77.
Kang J, RJ Robertson, FL Goss, et al. Effect of carbohydrate substrate availability on ratings of perceived exertion during prolonged exercise of moderate intensity. Percept Mot Skills. 1996; 82(2):495-506.
Kerrigan S, T Lindsey. Fatal caffeine overdose: two case reports. Forensic Sci Int. 2005; 153(1):67-9.
Lockwood CM, JR Moon, AE Smith, et al. Low-calorie energy drink improves physiological response to exercise in previously sedentary men: a placebo-controlled efficacy and safety study. J Strength Cond Res. 2010; 24(8):2227-38.
Nassis GP, C Williams, P Chisnall. Effect of a carbohydrate-electrolyte drink on endurance capacity during prolonged intermittent high intensity running. Br J Sports Med. 1998; 32(3):248-52.
Nawrot P, S Jordan, J Eastwood, J Rotstein, AHugenholtz, M Feeley. Effects of caffeine on human health. Food Addit Contam. 2003; 20(1):1-30.
Noakes TD, EV Lambert, MI Lambert, PS McArthur, KH Myburgh, AJ Benade. Carbohydrate ingestion and muscle glycogen depletion during marathon and ultramarathon racing. Eur J Appl Physiol Occup Physiol. 1988; 57(4):482-9.
Pennington N, M Johnson, E Delaney, MB Blankenship. Energy drinks: a new health hazard for adolescents. J Sch Nurs. 2010; 26(5):352-9.
Rudolph T, K Knudsen. A case of fatal caffeine poisoning. Acta Anaesthesiol Scand. 2010; 54(4):521-3.
Sugiura K, K Kobayashi. Effect of carbohydrate ingestion on sprint performance following continuous and intermittent exercise. Med Sci Sports Exerc. 1998; 30(11):1624-30.
Tsintzas K, C Williams. Human muscle glycogen metabolism during exercise. Effect of carbohydrate supplementation. Sports Med. 1998; 25(1):7-23.
Utter A, J Kang, D Nieman, B Warren. Effect of carbohydrate substrate availability on ratings of perceived exertion during prolonged running. Int J Sport Nutr. 1997; 7(4):274-85.
Utter AC, J Kang, DC Nieman, et al. Effect of carbohydrate ingestion and hormonal responses on ratings of perceived exertion during prolonged cycling and running. Eur J Appl Physiol Occup Physiol. 1999; 80(2):92-9.

magerum

There is evidence that Monster Ultra Zero is absolutely delicious though.

MizTerry

One of my old martial arts instructors was totally against them. He said they were a heart attack waiting to happen.

I wouldn't let my kids have them at all.

auddii

Interesting, one of the references jumped out at me because it's a researcher at our institution who's currently doing a study on energy drinks (and one time consumption in fact). Study hasn't started yet, but I have a feeling more research is coming. There have been deaths associated with excessive use, but I just don't know if there's enough definitive proof of what moderate use of energy drinks does to the body.

IronPlayground

There is evidence that Monster Ultra Zero is absolutely delicious though.

I have no first hand knowledge of this, but can attest to Monster Rehab Tea+Lemonade being very tasty.

Gordo1981

While I appreciate the article and what it is saying It should be stressed the dangers are not seen in moderate use. We need to classify what is moderate use.

I only have anecdotal evidence:
As I pharmacist I have seen multiple (3-4)soldiers from a nearby base admitted to the cardiac care unit after drinking red bulls mixed with alcohol. They were admitted with arrhythmia. Working with the nursing and physician staff we ruled out other causes and as a result submitted adverse effect reports to Health Canada.

My wife, who is a teacher, found it amazing that her high school kids were showing up with 4-6 Red bulls, monsters or others. When asked about it they said somethingto the effect of " I didn't get to sleep last night I was so jittery, so I woke up so tired this morning, that's why I need [energy drink] today just to stay awake"

I think that there is abuse of energy drinks (an sugar and heroin, and perscription drugs) so people should be mindful about how they are consuming them.

IronPlayground

While I appreciate the article and what it is saying It should be stressed the dangers are not seen in moderate use. We need to classify what is moderate use.

I only have anecdotal evidence:
As I pharmacist I have seen multiple (3-4)soldiers from a nearby base admitted to the cardiac care unit after drinking red bulls mixed with alcohol. They were admitted with arrhythmia. Working with the nursing and physician staff we ruled out other causes and as a result submitted adverse effect reports to Health Canada.

My wife, who is a teacher, found it amazing that her high school kids were showing up with 4-6 Red bulls, monsters or others. When asked about it they said somethingto the effect of " I didn't get to sleep last night I was so jittery, so I woke up so tired this morning, that's why I need [energy drink] today just to stay awake"

I think that there is abuse of energy drinks (an sugar and heroin, and perscription drugs) so people should be mindful about how they are consuming them.

Yes, I would classify 3-4 as excessive. Also, when mixed with alcohol, people tend to over consume red bull.

Charles4Jesus

There is evidence that Monster Ultra Zero is absolutely delicious though.

I have no first hand knowledge of this, but can attest to Monster Rehab Tea+Lemonade being very tasty.

Agreed! on both accounts. I have first hand knowledge of both.

Monster Rehab Orangeade+Tea is very good as well.
On another note, I think I had some Gall bladder issues and was told by a friend in the medical field Energy drinks could attribute to that. Therefore, I have stopped drinking completely because the "attack" I had scared the crap out of me. I was walking in the house and doubled over with pain. Everyone I talked to said Gall Bladder. I dunno. It was close enough to my heart to scare me though.

DatMurse

inb4 someone mentions the teenager who died from drinking 2 monsters.
















but they fail to mention her heart condition

gwhizeh

In b4 my next rockstar.

Think the key is moderation. Imagine that. Its key with French fries too.

AlleganyMiss

Drinking a Rockstar Energy+Recovery Orange right now. I had to have a colonoscopy and endoscopy here about a year ago and when sitting with the Gastrointerologist I asked him straight out what all the hype was about them. He told me that aside from having a heart condition (no one with heart conditions should be consuming caffeine he said) the biggest problem is 1. over consumption and 2. Not drinking enough water when consuming them. Large amounts of caffeine depleats calcium and potassium from the body and if you are not consuming calcium and potassium in other forms that becomes an issue. He also mentioned that not drinking water when drinking these is leading to an increase in colon problems. He also stated that most people who drink soda all day (and not water or milk or juice) are consuming more caffeine than one can of an energy drink.

NOW.....on to drink my Rockstar before going on my walk!!!