High-caffeine drinks are providing an energy jolt for Canadians young and old, but some products are delivering enough of the drug to potentially cause intoxication, Canada’s top medical journal is charging.
"Caffeine-loaded energy drinks have now crossed the line from beverages to drugs delivered as tasty syrups," the Canadian Medical Association Journal says in an editorial to be published Tuesday that calls for prominent labels listing total caffeine content and an end to advertising targeting children.
"These super-loaded syrups typically contain 80 to 140 mg of caffeine per 250 mL – the equivalent caffeine in one cup of coffee or two cans of cola," according to the journal, but some companies are offering formulations containing the caffeine equivalent of 10 cans of cola in a 500 ml serving.
Editor Dr. Paul Hebert says energy drinks are aggressively marketed to youth, especially teenage boys, through advertising and sports sponsorship.
"What are the health concerns of caffeine? With acute intoxication you can get nausea, vomiting, heart palpitations," says Hebert, a critical care physician. "You get GI (gastrointestinal) upset, potentially heart arrhythmia, feelings of anxiety and nervousness. You do get hyper-energized to the point sometimes where your thoughts race and you get quite anxious."
Health Canada has received 59 reports of adverse reactions involving energy drinks, according to data provided to Postmedia News. Symptoms included nausea, vomiting and heart irregularities. The reports are being investigated to determine what led to the reaction.
"In light of this, Health Canada is examining its current approach to energy drinks to determine whether or not changes may be required to address potential risks," the department said in an email to Postmedia News.
In Canada, 18 energy drinks – including products from Red Bull, Full Throttle, Sobe No Fear, A-Rush and Thai Rage – have been authorized for sale as natural health products. The labels of licensed energy drinks warn the products contain caffeine, should not be mixed with alcohol, are not recommended for children, pregnant or breastfeeding women and that their consumption should be restricted.
But many energy drinks are still considered foods that only list ingredients, the CMAJ says. "Neither natural health products nor foods list total caffeine content or easily understood equivalents in terms of cups of coffee because caffeine-containing herbal extracts are listed separately."
Health Canada recommends no more than 400 mg of caffeine per day for adults, the equivalent of about three eight-ounce (237 mL) cups of brewed coffee. For children under 12, the agency recommends a maximum daily caffeine intake of no more than 2.5 milligrams per kilogram of body weight. That means a daily caffeine intake of no more than 62.5 mg for children aged seven to nine, and 85 mg for children aged 10 to 12 – the equivalent to about one to two 12-oz (355 mL) cans of cola a day.
For teens 13 and older, Health Canada suggests limiting daily caffeine intake to no more than 2.5 mg per kg of body weight.
Hebert says the combined use of energy drinks and alcohol is also a worry. When mixed with booze, people feel less intoxicated. "It blunts the perception of being drunk. You’re still drunk, you just don’t feel it."
The journal says that, given the potential for harm, "It’s time for the federal minister of health to be awakened and alerted to concerns about energy drinks sold to children. Strict regulations are required if business practices and consumer trends are not curbed."
"Parents need to take a much stronger stance and role here," Hebert added. "These are stimulants."
Daniel Evatt, a research fellow at Johns Hopkins University School of Medicine in Baltimore, who has just completed a caffeine treatment study for people addicted to caffeine, says caffeine intoxication can cause insomnia, nervousness and, in rarer reported cases, "bizarre sensory experiences and hallucinations."
"We have a drug that we know people can become dependent on, and have negative effects from, and it’s being marketed very heavily to young adolescent boys in the form of a drink that can vary a lot in how much caffeine they’re getting," Evatt said.
Teens are less likely to have experience with caffeine – meaning they’re less tolerant to its effects. "You have this drug that an adolescent might not have a lot of experience with, its advertised to them to ‘slam’ it and use it for energy. So they do that, they use a lot at once and they have an adverse effect."
Evatt said all energy drinks should be properly labelled "so that people can make an educated decision about what, and how much of something, they want to put in their body."
In an email, Justin Sherwood, president of Refreshments Canada, an industry association, said that energy drinks have been "the subject of extensive review and analysis by regulatory authorities worldwide, including the European Food Safety Authority and Australia. Without exception these examinations have confirmed the safety of these products in markets around the world."
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