Caffeinated: The Buzz Surrounding Energy Drinks

In 2020, energy drink sales reached $57 billion globally. Energy drinks are now the second most popular dietary supplement among US teens and young adults behind multivitamins. But are these drinks safe? What should consumers know?

Read on as Phelps Health Internal Medicine Physician John Armstrong, DO, answers frequently asked questions on these fizzy favorites.

What are energy drinks?

According to the Centers for Disease Control and Prevention (CDC), energy drinks are beverages that typically contain large amounts of caffeine, added sugars, other additives and legal stimulants such as guarana, taurine and L-carnitine. (Caffeine is a natural stimulant found in coffee, tea and certain other plants.) While these legal stimulants can increase alertness, attention and energy, they also can increase blood pressure, heart rate and breathing.

Are energy drinks more harmful than coffee? In addition to caffeine, what additives are typically found in energy drinks?

The contents of energy drinks can vary greatly, making it difficult to generalize whether or not they are more harmful than coffee. Typically, energy drinks contain a large amount of caffeine, sugar and other potential additives, whereas coffee typically has a lower caffeine content. Caloric content is entirely dependent on the drink’s added ingredients. Coffee, on its own, is a naturally occurring substance containing some antioxidants and micronutrients. Simply put, not all energy drinks are bad, and not all coffee is good. Consumers have to look at the particular product they choose, and what they may or may not add to it (cream, sugar, etc.).

Do energy drinks typically have a higher caffeine concentration than coffee?

Energy drinks don’t necessarily have more caffeine than coffee. Caffeine levels can widely vary, depending on the specific drink. Each year, it seems, that a bolder energy drink, with even more caffeine, hits the market. Case in point: Panera Bread recently came out with a charged lemonade beverage containing roughly 390 milligrams (mg) of caffeine in a large 30-ounce drink, just shy of the FDA’s maximum recommended daily allotment of 400 milligrams.

Some energy drinks, though not higher in caffeine than a large coffee, deliver a quick, intense caffeine boost due to their rapid consumption. For instance, a medium coffee from Dunkin' Donuts has 210 milligrams of caffeine, while a Red Bull energy drink has 111 milligrams of caffeine in a 12-ounce can. Can you imagine which one you can drink faster?

Are there certain people who should avoid energy drinks, like those with heart-related conditions? Can energy drinks affect the electrical activity of the heart?

Individuals with, or at risk for, heart arrhythmias should avoid energy drinks and large amounts of coffee, as caffeine has the potential to provoke the condition. A heart arrhythmia is an irregular heartbeat, that occurs when the electrical signals that tell the heart to beat don't work properly. Some heart arrhythmias are harmless, while others may cause life-threatening symptoms.

What are the potential dangers of energy drinks?

According to the CDC, some of the dangers that have been associated with energy drinks include the following:

• Dehydration (not enough water in your body)
• Heart complications (such as irregular heartbeat and heart failure)
• Anxiety (may worsen existing anxiety issues)
• Insomnia (unable to sleep)

While consuming a reasonable amount of caffeine is generally safe, some evidence suggests that chronic caffeine consumption can contribute to a slight elevation in blood pressure. Individuals who are particularly sensitive to the side effects of caffeine should avoid excess caffeine use. If you have a condition that may be affected by caffeine, talk with your healthcare provider before consuming the stimulant.

Is it ever OK for children to consume energy drinks?

According to the American Academy of Child and Adolescent Psychiatry (AACAP), there is no proven safe dose of caffeine for children. The AACAP recommends that children under the age of 12 shouldn’t consume caffeinated beverages, while adolescents between the ages of 12 and 18 should limit their intake to less than 100 milligrams per day. (A 12-ounce can of Coke has 34 milligrams, for perspective.)

With increasing stories of caffeine overdose and abuse in the news today, parents and children need to recognize the dangers of excessive caffeine use. Another alarming case study: In July 2023, the FDA was asked to investigate Logan Paul’s energy drink, PRIME, which contains the caffeine equivalent of six cans of Coke.

For a healthy adult with no underlying health conditions, what is a safe amount of caffeine to consume daily? And for someone who is pregnant or breastfeeding?

Studies show that for the majority of healthy adults, consuming up to 400 milligrams of caffeine daily appears to be safe. Even so, everybody has different sensitivities to caffeine. One individual may be able to consume 400 milligrams of caffeine in a day, but other individuals may feel unwell if they have that much. Remember that caffeine also is found in tea, chocolate and soft drinks.

According to the American College of Obstetricians and Gynecologists, pregnant and breastfeeding women are advised to limit their caffeine consumption to less than 200 milligrams per day (the amount in one 12-ounce cup of coffee). These are general guidelines, however. If you are pregnant or breastfeeding, ask your OB/GYN (obstetrician/gynecologist) for their specific recommendations before consuming caffeine.

Does caffeine, in moderation, offer any positive health benefits?

• Caffeine consumption can increase alertness, mental energy and the ability to concentrate. Some studies have shown that caffeine also can increase a person’s reaction time and improve test performance.
• Feeling down? Caffeine can elevate an individual’s mood. According to the American Medical Association, caffeine stimulates dopamine, the chemical in your brain that plays a role in pleasure, motivation and learning.
• Coffee is rich in antioxidants, including vitamins B2 and B3, and magnesium. Antioxidants are substances that keep your body's cells safe from damage.
• Some studies suggest that coffee has anti-inflammatory properties and may reduce the risk of Parkinson's disease, Alzheimer's disease, dementia, heart disease and diabetes. For women, drinking at least one cup of coffee a day also is associated with lowered stroke risk. Learn more about coffee’s benefits. Note: Many of these studies are fairly small, and more data collection is needed to prove some of these claims.
• Have a headache? Consuming caffeine with over-the-counter headache medication has been proven to help cure headaches.

Is it dangerous to mix an energy drink with alcohol? If so, why?

Using caffeine while consuming alcohol can be particularly dangerous, as caffeine can mask the depressant effects of alcohol. In other words, caffeine can make it difficult for an individual to realize how intoxicated they actually are. Because of these safety risks, the US Food and Drug Administration (FDA) has discontinued caffeinated alcoholic beverages from the US market. However, people are still combining the two substances; the “Vodka Red Bull” cocktail is one popular example. Learn more about why caffeine and alcohol are a dangerous mix.

Furthermore, the belief that caffeine causes you to metabolize (break down) alcohol faster by the liver is a myth. According to the CDC, caffeine doesn’t reduce blood alcohol concentrations (it does not “sober you up”) or reduce impairment due to alcohol consumption.

Energy drinks are typically high in sugar. Why is this problematic?

Energy drinks often contain large amounts of sugars. Routinely consuming sweetened beverages can take a negative toll on one’s health, potentially leading to diabetes and heart disease. Many popular coffee drinks also contain large amounts of sugar, as well as saturated fats, landing them in the unhealthy category, as well.

If you’re going to reach for an energy or coffee drink, I recommend drinking one that is low in calories and uses an artificial sweetener like sucralose, that has been well researched and is generally regarded as safe. Learn more about approved artificial sweeteners here. Skip the saturated fats by opting for an alternative to heavy creamers, like skim, coconut or almond milk.

Are energy drinks addictive? Why do you think they are so popular today?

All drugs with some perceived benefit have an addictive potential, caffeine included. Caffeine use, however, does not meet the full criteria for dependence or abuse, according to the current medical definition. People often say they can’t function in the morning without their cup of coffee or Monster. In other words, they’re dependent upon caffeine to function normally.

In some people, withdrawal from chronic caffeine use can result in headaches, fatigue, depression, concentration difficulties, irritability and drowsiness. Individuals with a significant history of caffeine use also may experience flulike symptoms and muscle pain from withdrawal.

Some energy drinks contain vitamins, minerals, amino acids and herbal supplements. Does this mean they are healthy?

Many of these additives are compounds that we already regularly consume, and are generally regarded as safe. These additives are believed to have health benefits and to improve stamina and energy capacity.

Common additives in energy drinks include the following:

• Taurine is an amino acid that is commonly added to energy drinks, said to help with exercise capacity and performance.
• Guarana is a compound often found in energy drinks, thought to help with awareness and energy.
• Ginseng is an herbal supplement added to energy drinks, believed to increase energy and concentration.

While these additives sound good in theory, most energy drinks have much lower amounts than what's believed to be beneficial for your health. The bottom line: Many of the supposed benefits of these additives are used for marketing purposes and lack reliable evidence.

Are energy drink-related emergencies and health conditions on the rise?

Although energy drink-related emergencies are fairly rare, they are becoming more common, as in this case. This increase is likely due to the prevalence of energy drinks, along with their increasing caffeine content. (While the American Academy of Pediatrics recommends that adolescents don’t consume energy drinks, between 30% to 50% of young adults have reported consuming these drinks, and over 11% of high school districts sell them.)

In addition, people are under the assumption that because caffeine is found in food and beverages not marketed as drugs or medication, that it must be harmless and can’t be abused. The difference between a drug and poison is the dose. Like any other drug, you can overdose on caffeine.

Any advice on kicking the energy drink habit? A healthier alternative?

While drinking coffee or an energy drink is not necessarily unhealthy, consumers should make smart choices when selecting a product. Avoid overly caffeinated products, drinks that contain a large number of calories and drinks that use saturated fats for creamers.

If you struggle with self-control (like me), opt for a smaller beverage. To kick the coffee/caffeine habit altogether, I recommend substituting your coffee for a hot, decaf drink in the morning, like an herbal tea. That first cup of coffee in the morning seems to be the most difficult for people to give up. However, people may find that simply drinking a hot beverage in the morning (even without caffeine) can still provide a boost of energy. Many people also rely on coffee to stimulate a bowel movement in the morning, but other hot beverages can do the same. Good alternatives include water, prune juice and decaffeinated teas.