Earlier this year, a half-dozen students from City Hill Middle School, in Naugatuck, Connecticut, traveled with their science teacher Katrina Spina to the state capital to testify in support of a bill that would ban sales of energy drinks to children under the age of 16. Having devoted three months to a chemistry unit studying the ingredients in and potential health impacts of common energy drinks with brand names like Red Bull, Monster Energy, and Rockstar the students came to a sobering conclusion: “Energy drinks can be fatal to everyone, but especially to adolescents,” 7th-grader Luke Deite album told state legislators. “Even though this is true, most energy drink companies continue to market these drinks specifically toward teens.”
A 2018 report found that more than 40 percent of American teens in a survey had consumed an energy drink within the past three months. Another survey found that 28 percent of adolescents in the European Union had consumed these sorts of beverages in the past three days.
This popularity is in marked contrast to the recommendations of groups like the American Academy of Pediatrics and the American College of Sports Medicine, who say youth should forgo these products entirely. These recommendations are based on concerns about health problems that, although rare, can occur after consumption, including seizures, delirium, rapid heart rate, stroke, and even sudden death. A U.S. government report found that from 2007 to 2011, the number of emergency department visits involving energy drinks more than doubled, to nearly 21,000.
Of these, approximately 1,500 were children aged 12 to 17, although the number of visits from this age group increased only slightly over the four years.
For their part, energy drink manufacturers argue that they are being unfairly targeted. At the Connecticut hearing, the head of public affairs for Red Bull North America, Joseph Luppino, maintained that there is no scientific justification to regulate energy drinks differently than other caffeine-containing beverages such as soda, coffee, and tea particularly when some coffeehouses serve coffee with a caffeine content exceeding that of a can of Red Bull. “Age-gating is an incredibly powerful tool,” Luppino said and should be reserved for “inherently dangerous products” like nicotine.
The showdown in Connecticut, which pitted the City Hill students against a growing $55 billion a year global industry, was the latest in an ongoing debate about the safety and regulation of energy drinks. In recent years, countries such as the United Kingdom and Norway have considered banning sales to young people, while Lithuania and Latvia have active bans in place. In the U.S., along with Connecticut, state legislators in Maryland, Illinois, and Indiana have introduced bills, though none have been signed into law. A South Carolina bill to ban sales to kids under 18 and to find those caught selling them to minors advanced through the legislature in April, and is now pending before the state’s full medical affairs committee. It is supported by the parents of a 16-year-old who died from a caffeine-induced cardiac event after consuming a coffee, a soda, and an energy drink within a period of two hours.
As the regulatory status of energy drinks continues to be debated, a growing number of consumers and public health advocates are asking why and how a product loaded with caffeine and other stimulants became so popular among young people. The reasons are a mix of lax regulation, the use of caffeine as a sports performance enhancer among adults, and a bit of scientific uncertainty.
Historically, government agencies such as the U.S. Food and Drug Administration have struggled to regulate beverages with added caffeine. Though it offers some guidance, the FDA allows manufacturers of liquid products to decide on their own whether to market their products as dietary supplements or as conventional foods and beverages, which carry differing regulatory requirements. All three major energy drink makers now have most of their products regulated as foods, rather than dietary supplements though that wasn’t always the case.
Researchers from the Johns Hopkins School of Medicine, in a review published in the journal Drug and Alcohol Dependence, note that lack of consistency is partly due to our long love affair with drinks in which caffeine is naturally occurring, including coffee and tea. In 1980, citing health concerns, the FDA proposed to eliminate caffeine from soft drinks, which are regulated as foods. The manufacturers, however, claimed the caffeine was a flavor enhancer. The FDA approved caffeine but limited the maximum content of cola-type soft drinks to .02 percent or roughly 71 milligrams per 12 ounces serving.
“If caffeine had not been accepted as a flavor enhancer, but had been regarded as a psychoactive ingredient,” write the Johns Hopkins researchers, “soft drinks might have been regulated by the FDA as drugs” which are subject to additional regulations.
When energy drinks first appeared on the American market in the late 1990s and early 2000s, some manufacturers claimed the products were neither drugs nor conventional foods, but dietary supplements. Drugs with caffeine require warning labels, but dietary supplements don’t. “It is a striking inconsistency that, in the U.S. a [over-the-counter] stimulant medication containing 100 mg of caffeine per tablet must include [a series of] warnings,” write the Johns Hopkins researchers, “whereas a 500 mg energy drink can be marketed with no such warnings and no information on caffeine dose amount in the product.”
As early as 2009, sports and medical organizations began issuing position statements discouraging energy drink consumption by young people. In 2011, the American Academy of Pediatrics concluded that energy drinks “are not appropriate for children and adolescents, and should never be consumed.” Further, the group warned that adolescents might mistakenly use energy drinks, rather than sports drinks like Gatorade, for rehydration during physical activity. “Advertisements that target young people are contributing to the confusion,” wrote the authors.
Two years later, in 2013, questions about safety and marketing came to a head in the halls of Congress. Three Democratic senators launched an investigation into the marketing practices of energy drink companies. They found that adolescents between the ages of 13 and 17 are frequent targets of energy drink marketing, and stated in a written report that “this population is also at risk for the detrimental impacts of energy drink consumption.” The report also noted a range of claims not evaluated or substantiated by the FDA. For example, the makers of AMP Energy marketed the drinks as helping to “energize and hydrate the body,” while advertisements for Red Bull promised “increased concentration and reaction speed.”
Among those providing testimony at a committee hearing was Jennifer L. Harris, a researcher at the Rudd Center for Food Policy and Obesity, currently housed at the University of Connecticut. She and her team had conducted an earlier study of how sugary beverages are marketed to children. “What we learned about energy drinks stunned us,” she said at the hearing.
Energy drink companies had been pioneers in using social media to market their products, said Harris. At the time of her study, Red Bull and Monster Energy were the fifth and twelfth most popular brands on Facebook a platform that was, at the time, particularly popular among college students and adolescents. Further, said Harris, “energy drink brands often promote teen athletes and musicians and sponsor local events, where they provide free samples, including to minors.” The marketing is effective, she noted. Sales of most other beverage categories were declining, but energy drink sales had increased by 19 percent the previous year, reaching $8 billion in 2012.
The energy beverage industry vigorously defended its products and marketing practices. In his congressional statement, Rodney Sacks, CEO of Monster Beverage Corporation, noted that a 16-ounce can of Monster Energy contains 160 mg of caffeine. In contrast, the equivalent amount of Starbucks coffee contains 330 mg more than twice as much. Further, Monster cans include a label recommending against consumption by children.