ABSTRACT

Consumption of energy drinks have been increasing dramatically in the last two decades,
particularly among adolescent and young adults. Energy drinks are aggressively marketed with
the claim that these products give an energy boost to improve physical and cognitive
performance. However, studies supporting these claims are limited. In fact, several adverse
health effects have been related to energy drinks, this has raised the question of whether these
beverages are safe. This review was carried out to identify and discuss the published articles that
examined the beneficial and adverse health effects related to energy drink. It is concluded that
although energy drinks may have beneficial effects on physical performance, these products also
have possible detrimental health consequences. Marketing of energy drinks should be limited or
forbidden untill independent research confirms their safety , particularly among adolescents.

1.0 INTRODUCTION.

1.1 BACKGROUND OF THE STUDY.

Energy drinks belongs to a class of products in liquid form that typically contains caffeine, with
or without other added dietary supplements. The first energy drink appeared in the U.S in 1949
and was marketed as "Dr. Enuf" (Reissig et al 2009). In Europe, they were launched for the first
time in 1987; then the market expanded throughout the world, becoming very popular after the
launch of red bull 1997. (Zucconi et al 2013). Since then, the energy drink market has grown
dramatically, with various brands released worldwide. The annual consumption of energy drinks
in 2013 exceeded 5.8billion litres in around 160 countries.(Bailey et al 2014). The estimated total
U.S retail market value for energy drinks was around 12.5billion USD in 2012 and the market
value increased 56% from 2006 to 2012.

Manufacturers recently have moved their consumers focus athletes to young people.
Energy drinks are aggressively marketed in places popular with teens and young adults.
Approximately, two thirds of energy drinks consumers are 13-35 years old, and boys are two
third of the market. (Mintel Energy Drink Report. 2012). The popularity of energy drinks in the
kingdom of Saudi Arabia does not seem to differ from other parts of the world. Around half of
the Saudi university students who participated in a survey admitted to regular consumption of
energy drinks. (Alsunni & Badar; 2011). Energy drinks are designed to give an energy boost to
the drinker by a combination of stimulants and energy boosters. The major constituents in most
energy drinks is caffeine. They usually contain 80-150mg of caffeine per 8 ounces, which is

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equivalent to 5 ounces of coffee or two 12 ounces cans of caffeinated soda.(Alsunni Energy
Drinks; 2011). Most of the brands in the market contains large amount of glucose while some
brands offer artificially sweetened versions. Other commonly used constituents are taurine,
methylxanthines, vitamin B, ginseng, guarana, yerba mate, acai, maltodextrin, inositol, carnitine,
creatine, glucuronolactone and gingko biloba.

Currently, significant concerns have been raised about the safety of these products, there have
been several reports that showed adverse health effects associated with energy drink. Despite
this, manufacturers of energy drinks claim these products are suitable for consumers and that
they are safe. In fact, the adverse health effects associated with energy drinks remains
controversial among scientists. There are limited comprehensive literature reviews that illustrates
in detail the suitability and safety related to energy drink consumption, particularly among young
adults.

1.2 ACTIVE INGREDIENTS OF ENERGY DRINKS

1.2.1. CAFFEINE

Caffeine has a similar chemical structure to that of adenosine allowing caffeine to attach to the
adenosine receptors. The main mechanism of action of caffeine in concentrations typically
achieved after the consumption of a caffeinated beverage is to act as an adenosine receptor
blocker in the brain.(Pettenuzzo et al, 2008).

1.2.2. TAURINE

Taurine (2 aminoethyl sulfonic acid) is sulfur containing amino acid that is the most abundant
amino acid found naturally in our bodies, primarily in the retina and skeletal and cardiac muscle
tissues. (Imagawa et al, 2009). Taurine is derived from the metabolism of methionine and
cysteine. (Stipanuk, 2004).

1.2.3. GUARANA

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This comes from the "Paulina Cupana" plant, indigenous to South America. It originated in the
Amazon basin in Brazil, where it has had a long history of use (Angelo et al., 2008). It is
commonly known for its small berry like fruit it produces, which contains 1 to 3 dark seeds
which accounts for the only edible part of the guarana plant. (Scholey and Haskel, 2008).

1.2.4. GINSENG

Ginseng is a herb that has been used for over 2,000 years by people in East Asian countries
including China, Japan, and Korea as a remedy for various diseases and for promoting longevity.
(Nam et al, 2005). Panax ginseng is the primary commercial species and is often referred to as
Korean or Asian ginseng.

1.2.5 B VITAMINS

B VITAMINS are a group of 8 individual water soluble vitamins, usually referred to as the B-
complex when grouped together, and all play essential roles in cellular processes. B VITAMINS
are incorporated into many of the mainstream energy drinks. A typical can of 250ml may contain
360% B12 and 120% of B3. Hence, the container size varies among brands and it may hold
multiple servings. (Wardlaw and Smith, 2009).

1.3 OBJECTIVES OF THE STUDY

The objectives of the study are

 To illustrate the benefits of energy drink consumption

 To enlighten the public or people about the adverse/negative effects of energy drink
consumption.

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2.0. BENEFITS OF ENERGY DRINK CONSUMPTION.

2.1 INCREASED FOCUS AND BRAIN FUNCTION.

An important benefits of energy drinks consumption is increased focus and brain function.
Multiple studies have shown that energy drinks can improve your memory, concentration
reaction time and also reduce mental fatigue. (Kavita et al, 2008). When selecting your energy
drink for consumption, also look for drinks that contains the amino acid L-theanine. L-theanine
helps to boost your focus and concentration when used in collaboration with caffeine. It also
helps to balance out the negative side effects of caffeine, such as the jitters and crash.

2.2. INCREASED ENERGY.

The obvious benefits of energy drink is ENERGY! This energy usually comes from caffeine and
sugar. Caffeine stimulates the brain cells and stops them from detecting the chemical adenosine,
which induces sleep. Adenosine builds up in the brain throughout the day which ultimately tells
our brain when we are tired. By consuming caffeine, you end up feeling less sleepy. (Energy
fiend, 2009). The other key contributor of energy is sugar which is food for the mitochondria of
your cells. Basically think of sugar as the power unit or engine. Organic, natural caffeine breaks
down slower than synthetic caffeine to provide longer lasting energy. (Kavita et al, 2008).

2.3. INCREASED PRODUCTIVITY.

Increased productivity is a direct result of boosted energy, focus and brain function. When an
individual consumes energy drink, that person possesses more energy and focus, that locked in
feeling is almost certainly going to make you more productive. (De Morais et al, 2009).

3.0 ADVERSE HEALTH EFFECTS OF ENERGY DRINK CONSUMPTION

3.1 CARDIOVASCULAR EFFECT

Several studies have shown an increase in heart rate and arterial blood pressure after energy
drink consumption. These findings were attributed to the ergogenic effects of the caffeine
content of the energy drink. In addition, cardiac manifestations such as ventricular arrhythmias
have been documented following energy drink consumption.(Goldfarb and Teller, 2014).

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Consumption of energy drinks reduces endothelial function and stimulates platelet activity
through acid induced platelet.(Gonzalez and Alvarado, 2014).

3.2. NEUROLOGICAL AND PSYCHOLOGICAL EFFECTS

Individuals usually develop symptoms of caffeine intoxication in doses equal to or above 200mg.
Symptoms include anxiety, insomnia, gastrointestinal upset, muscle twitching, restlessness, and
periods of inexhaustibility. (Bedi and Dewan, 2014).

In addition, High caffeine intake is associated with acute and chronic daily headaches by
stimulating a state of hyperexcitability.( Espina 2015). Caffeine combination with taurine and
guarana may promote and enhance apoptosis(Cell death) by reducing both superoxide dismutase
and catalase activities on human neuronal cells. (Juliano et al, 2012).

3.3. GASTROINTESTINAL AND METABOLIC EFFECTS

Energy drinks usually contain large amounts of sugar ranging from 21 g to 34 g per oz. The
sugar content is mainly in the form of sucrose, glucose or high fructose corn syrup. Therefore,
high energy drink intake may increase the risk of obesity and type 2 diabetes. (Goldfarb and
Tellier, 2014 ). In addition, the high sugar content in energy drinks may reduce the activity,
diversity and gene expression of intestinal bacteria resulting in increased risk of obesity and the
metabolic syndrome. (Greenblum And Boreinsten, 2012). Deep caffeine intake contained in
energy drinks decreases insulin sensitivity which could explain the rise of in blood glucose
levels. (Lee et al, 2005)

3.4. RENAL EFFECTS

The caffeine in energy drinks has been shown to enhance diuresis. Therefore, energy drinks
should be avoided during prolonged exercise in a hot environment because of the potential for
dehydration. Studies have reported that dehydration at a level of 1.5% during prolonged exercise
may result in an increase in body temperature, heart rate and perceived rate of exertion.
(Montain, 2019). Caffeine also promotes sodium loses in urine which affects the plasma volume
and results in significant alteration of cardiovascular performance while exercising. (Mora,
2014).

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3.5. DENTAL EFFECTS

There is a strong relationship between energy drinks and dental erosion. It has been found that
the acid in energy drinks is so significant that it could gradually destroy your tooth enamel. As
energy drinks can erode your enamel, your teeth can become susceptible to decay and cavities.
The enamel cannot be regrown after it is damaged, so the decaying effects can be quite severe.
Energy drinks are mostly bad for the teeth and contains high levels of sugar and acid. Therefore,
it is advised to dilute the acid by drinking plenty of water. (Oral health foundation, 2018).

4.0. ALCOHOL AND ENERGY DRINK MIXING

In addition to being consumed alone, energy drinks are frequently mixed with alcohol, it has
been observed that 71% of young adults report consuming energy drink with alcohol.(Zucconi et
al, 2013). This is problematic because individuals who drinks alcohol mixed energy drink
consume more alcohol than if they were drinking alcohol alone due to the fact that consumption
of energy drink masks the signs of alcohol drunkenness, enabling an individual to believe they
can still safely consume more alcohol, leading to "awake drunkenness". (Weldy D.L, 2010). As a
result of this increased alcohol consumption, those who drink alcohol mixed energy drink are
more likely to experience severe dehydration and alcohol poisoning. This negative health effects
trend is particularly concerning as it disproportionately affects underage individuals and has been
linked to bringe drinking, alcohol dependence behaviours and drunk driving.(Aria et al, 2016).

5.0. CONCLUSION AND RECOMMENDATION

5.1. CONCLUSION

Energy drinks may show positive beneficial effects on exercise performance in various sport
activities. However, while energy drinks might benefit performance, possible detrimental health
problems have been documented, particularly amongst children and adolescents. Various parts of
the body are negatively affected by energy drink consumption. Considering this fact and the
increasing popularity of these drinks, caution should be exercised while consuming energy
drinks. Overambitious marketing and non-scientific claims should be regulated by governments
until independent studies confirm that these products are safe.

5.2. RECOMMENDATION

Public health and policy action must be taken to mitigate the negative health effects and public
health challenges associated with energy drink. First, concerned agencies like NAFDAC, SON
and so on should consider regulation of energy drink as a separate category, requiring clear

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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 energy drink and/or restricting the sale of energy drink to children and
adolescents.

Marketing strategies should be also regulated to minimize the promotion of energy drink among
adolescent and young adults. Because marketing is largely aimed at this segment of the
population, exposure to energy drink products could be reduced considerably. In parallel, further
research should continue to improve the quality of the evidence on the health effects of energy
drink with particular attention to observational studies with longer follow up.

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