In the Energy Drink Market, Advertising and Science Collide

Energy drinks are wildly popular among teens, despite being loaded with stimulants. How did that happen, and is it a concern?

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 Deitelbaum told state legislators. “Even though this is true, most energy drink companies continue to market these drinks specifically toward teens.”

“Countries such as the United Kingdom and Norway have considered banning sales to young people, while Lithuania and Latvia have active bans in place.”

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.


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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 fine 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.

According to sports cardiologist John Higgins, a professor at McGovern Medical School at UTHealth in Houston, there is also another factor: “very, very intelligent advertising.”

  • “Most energy drink companies continue to market these drinks specifically toward teens,” argued 7th-grader Luke Deitelbaum in testimony before Connecticut state legislators. See the full testimony here.


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.

“If caffeine had not been accepted as a flavor enhancer, but had been regarded as a psychoactive ingredient, soft drinks might have been regulated by the FDA as drugs.”

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-ounce 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. an [over-the-counter] stimulant medication containing 100 mg of caffeine per tablet (e.g. NoDoz) 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.”

(As it happens, a few months before the senate hearing, Monster Beverage Corporation and Rockstar Inc. announced their intention to follow in the footsteps of Red Bull by declaring their products to be foods, rather than dietary supplements.)

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.

Democratic Senator Richard Durbin of Illinois holds up a can of Monster energy drink as he testifies during a 2013 hearing on concerns about marketing energy drinks to youth.

Visual: Alex Wong/Getty Images

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. (According to guidelines put forth by the American Beverage Association, a trade group, energy drinks should not be marketed to children under 12, and other leading brands such as Red Bull and Rockstar carry similar labels recommending against consumption by children.)

Further, Sacks and representatives from Rockstar, Inc. and Red Bull North America denied that their companies advertise to young teenagers. Doing this, said Sacks, “would undermine the credibility of the brand image in the eyes of young adults,” — nominally their target consumer demographic.

Not everyone buys this. A 2017 study published in the journal Public Health Nutrition, for example, tested whether young consumers perceived energy drink advertising as being targeted at people their age and younger. Researchers at the University of Waterloo randomly assigned over 2,000 Canadians aged 12 to 24 to view one of four online ads for Red Bull. Among the youngest subjects — those aged 12 to 14 — nearly 72 percent of participants who viewed an advertisement featuring the company’s sponsorship of the X Games, an extreme sports event, perceived the ad to be targeted to people their age and younger.

Across all age groups, 71 percent of those who were shown a Red Bull ad with a sports theme thought the ad they viewed promoted the use of energy drinks during sports.

The University of Waterloo researchers compare energy drink marketing practices with those of 20th-century cigarette companies. “While tobacco advertising was ostensibly targeted only at adults,” they write, “it nevertheless achieved very high levels of reach and appeal among young people.”

Further, and perhaps not surprisingly, across all age groups, 71 percent of those who were shown a Red Bull ad with a sports theme — the X games, for example, or an image of an airborne snowboarder with accompanying text reading “RED BULL GIVES YOU WIIINGS” — thought the ad they viewed promoted the use of energy drinks during sports.

This is a problem, says Matt Fedoruk, chief science officer at the U.S. Anti-Doping Agency (USADA). Though his organization is perhaps best known for its role in testing Olympic athletes for banned substances, it also promotes a positive youth sports culture. Fedoruk says they field questions about energy drinks from athletes of all ages.

“Caffeine is the most studied ergogenic aid on the planet,” says Fedoruk, and its use is widespread among elite athletes. Research has even produced recommended guidelines for ingestion prior to exercise. But these guidelines were developed for adults. Young people who try to follow them could quickly surpass the American Academy of Pediatrics’ guidelines for adolescents: no more than 100 mg of caffeine per day, or roughly the amount in a typical cup of coffee. Further, because energy drinks are manufactured in adult serving sizes, says Fedoruk, it’s easy for a child to get too much. “Depending on the product you choose, you could definitely be dosing your young child or youth athlete in doses that far exceed what may be safe for their body weight and size.”

When it comes to youth athletes, “our experts recommend both water and sports drinks as the best options for hydration,” writes Danielle Eurich, a USADA spokesperson. Athletes exercising less than an hour probably don’t even need sports drinks, she adds. “Water would be best.”

A 2013 advertisement for Red Bull makes clear connections between the drink and various sporting activities.


Last year, John Higgins, the sports cardiologist, ran a small study in which healthy medical students downed a 24-ounce can of Monster Energy. Ninety minutes later, the students’ arteries were measured to test their ability to bounce back — or dilate — after being compressed by a blood pressure cuff. Dilation helps control blood flow, increasing circulation when necessary, including during exercise. In this study, the medical students’ blood flow was “significantly and adversely affected,” says Higgins.

Higgins suspects that the combination of ingredients — the caffeine and other stimulants such as guarana, taurine, L-carnitine, along with added vitamins and minerals — interferes with the endothelium, a thin layer of cells that control dilation. But he can’t say for certain because there hasn’t been enough research. Higgins’ own study was preliminary and lacked a control group. Further, a recent review by a group of Harvard researchers noted considerable limitations to the existing energy drink literature. Most studies, the authors found, used small sample sizes or employed a cross-sectional design, which isn’t able to determine causation. Large longitudinal studies, meanwhile, require time and money.

Higgins says the main reason there is no evidence of safety is that energy drinks are not classified by most countries as drugs. “They are classified as supplements, additives, or whatever.” Until more data are available, Higgins’ opinion is that energy drinks should be avoided before, during, and after exercise. Anyone under 18 should avoid them entirely, he says. This recommendation has been endorsed by the American College of Sports Medicine.

Yet at the Connecticut hearing, Red Bull’s Joseph Luppino insisted that there is ample evidence of safety. He referenced the European Food Safety Authority, which conducts food-chain risk assessments for the European Union: “They have unequivocally concluded there are no synergistic effects between the various ingredients that are contained in energy drinks.”


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When asked for a comment, the European agency pointed to its 2015 report, and a spokesperson explained the findings: In general, the combination of substances typically found in energy drinks “would not affect the safety of single doses of caffeine up to 200 mg.” Individuals who might drink a 16-oz can of Rockstar, or a 24-oz can of Monster containing 240 mg of caffeine plus other stimulants were not considered by the analysis. The E.U. agency spokesperson also issued a caveat: There wasn’t enough data to determine whether other common energy drink ingredients like guarana and taurine influence the acute effects of caffeine on blood pressure.

“I’m not trying to get rid of energy drinks,” Watts said. “I know a lot of people use them. But I do think that the age is a concern that everybody needs to be really serious about.”

Monster and Rockstar did not respond to repeated requests for comment. When asked about the discrepancy between Luppino’s characterization of the European report and the agency’s own characterization of its findings, Erin Mand, a spokesperson for Red Bull, pointed to particular passages in the report that suggest the safety of particular ingredient combinations up to 200 mg of caffeine. She additionally noted that “its single-serving products fall under 200 mg of caffeine.”

The American Beverage Association also did not respond to specific interview questions, but did provide this statement: “Energy drinks have been enjoyed by millions of people around the world for more than 30 years, and are recognized by government health agencies worldwide as safe for consumption. The amount of caffeine in energy drinks is typically half the amount found in a coffeehouse coffee and is no different from the caffeine found in other foods and beverages. Further, America’s mainstream energy drink companies have taken voluntary steps to ensure their products are not marketed to children.” 


In the spring of 2017, Gary Watts, the coroner for South Carolina’s Richland County, released the autopsy results for Davis Cripe, the teenager whose death spurred the South Carolina bill to ban sales of energy drinks to minors. The cause of death: a caffeine-induced cardiac event causing a probable arrythmia. “Typically you don’t see the results of an arrythmia in an actual autopsy because there’s no real damage to the heart,” Watts said.

After Cripe collapsed at school, a staff member who had previously worked as a nurse in a cardiac unit diagnosed a cardiac arrythmia.

“Who’s to say that this hasn’t happened before?” says Watts, whose office has performed autopsies on other young adults who died of sudden death. “It probably has — it’s just that we’ve not been able to document [the cause] with someone on the scene at the time who says, ‘Okay, this is an arrythmia.’” Watts believes there are too many uncertainties about energy drinks to say that they are safe for adolescents. “I’m not trying to get rid of energy drinks,” he said. “I know a lot of people use them. But I do think that the age is a concern that everybody needs to be really serious about.”

As for the Connecticut bill, it has not moved out of committee, but in mid-May, the City Hill Middle School students and their teacher returned to the state capital to lobby lawmakers. They shared informational brochures created by the students, as well as informal results from a survey of students and parents, indicating widespread support for their bill among the latter. In the meantime, the students say, their siblings and peers continue to consume energy drinks — on soccer fields, in dugouts, in front of video game consoles.

“It’s so interesting,” City Hill student Emily Fine said of energy drink makers and their products, “how they still put them on the market.”


Sara Talpos is a freelance writer whose recent work has been published in Science, Mosaic, and the Kenyon Review’s special issue on science writing. Sara has an MFA in creative writing (poetry) and is interested in the connections between science and literature. She taught writing classes at the University of Michigan for 10 years.

Top visual: Matthew Horwood/Getty Images
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9 comments / Join the Discussion

    I got a text from Mr Bradley he want to issue me a check to put a decal on my car to advertise Hype Enery Drink. I got a check for 2600 issued in my name from Kevin J Domina. Is this real?

    Reply

    Thank you for writing this article and bringing awareness to an industry that needs to be disrupted. We are (teaRIOT) trying to do just that with the first plant based energy drink our to Venice CA – no added sugar, no process ingredients simply the naturally occurring power of tea. Unlike our competitors we would welcome to comment.

    Reply

    I wish that this article went further into detail about which ingredients were found to be harmful. Was it just the caffeine? Are the sugar free variants any more or less dangerous?

    Reply

    You did not do your research. Taurine is not a stimulant. L-carnatine is not a stimulant. Guarana could be described as a stimulant only because it contains caffeine. You keep referring to “other stimulants” in energy drinks, but there aren’t any: It’s just caffeine.

    If you can’t get the most basic information right – i.e. what the active ingredients in energy drinks are – I’m personally gonna write off the whole article as fear-mongering trash.

    Reply

    That “lack of evidence” is by design. There is no way to track how many Emergency room visits or psychiatric episodes. There is no check box on any intake form for caffeine or energy drink consumption. There may even be a correlation with acts of aggression, and crippling anxiety. The industry would have made it difficult to track the adverse events.

    Parents believed this stuff was harmless because it is marketed everywhere. At every point of sale there are the ubiquitous energy drinks, advertising concentration and vitality. They cross over into the wellness category, meaning since they are assumed to be harmless, there is no research. These drinks are more expensive than the usual soft drinks and some take up less shelf space, making them more likely to be promoted. The big box stores sell them in bulk, and many consumers buy them that way. That leads to more consumption, which includes multiple servings a day.

    The marketing, is targeted at teens, and young adults. In much the same way they peddled vaping on social media, these drinks were marketed as wellness products. Many include vitamins, herbal products, and amino acids, giving the drinks the false veneer of a health product. In some cases these drinks are ingested along with stimulant medications, or in place of them. There is an uptake in the abuse of stimulants, including crystal meth, and ADHD medications.

    It is really clear that our youth are under a lot of stress to perform, athletically and academically. The drinks have been marketed as status indicators, compelling more kids to consume them. With the advent of social media, and the continuing targeting of marketing at children, it is really clear that the regulatory agencies are no longer functioning. Since caffeine is assumed to be harmless and not a drug, these soft drink marketers found a loop hole and exploited it fully.

    Our regulatory agencies, and health industry regulators are no longer functioning. At the same time the media claims there is over regulation, to protect these industries. The FDA and FTC are no longer tracking the extensive marketing, product placement, and content marketing. There used to be laws about marketing products with health claims, in the US. Now it is the wild west, any ridiculous claim can be made in media content. The industry funds and designs academic research, designed to make it’s product appear harmless.

    Unfortunately our elected representatives and policy makers turn to the corporations for insight on marketing to children. We have seen years of regulatory capture, where industry insiders sit on the regulatory boards, fact based science is ignored, and half truths are promoted as facts. The soft drink industry spends millions to protect its market share. It is clear that Diabetes is the result of sugar consumption, but the same tactics they used to market sugary drinks are used to market these highly caffeinated beverages.

    In post fact America, we are all going to pay for the greed of these corporations. They turned millions of kids not mindless consumers of beverages, fast food, and social media. Whenever anyone questions any of it, they have industry front group create a counter narrative. Young people are having strokes, dealing with obesity, and the suicide and mental health rates are rising. These drinks were marketed alongside computer games and social media, and their consumption became almost automatic. Young socially isolated people, in the glare of a computer screen, gulped down quarts of this stuff, daily. There has been no research on how this has affected a lot of them. It is clear that no good came of it. There was no research done on how many of them will never function in any normal capacity. That kind of research was not funded, the industry decided it could be inconvenient, and unprofitable.

    Our of my own curiosity, since no actual research was done, I started asking people who consume these beverages, and have mental health disorders, if their therapists or psychologists or psychiatrists have ever told them to lay off these beverages. The answer is always no, and a quizzical response. As a layperson, I can see a correlation between anxiety, depression, and confusion, and the consumption of these beverages. The fact that no mental health therapist would question the excessive use of these beverages is telling. The industry made sure no one would track this.

    Reply

    It boggles my mind that people are so concerned about energy drinks when the FDA is just fine with putting kids on a dose of ritalin or adderall meant to last all day before they’re 10. As a college student, I see people using energy drinks frequently, but the lengths that some people will go to get a hold of Rx stimulants like that is far more scary. Not to mention the folks that have been on it their whole academic career feel absolutely worthless when forced to go without and completely lose confidence in their ability to preform any kind of work.

    Reply

    I had a manager of mine when I worked for a pizza delivery place some years ago who had to have a pace maker put in before her 21st birthday. One major contributing factor was that she was a heavy energy drink consumer. She would drink , on average, between 3 to 5 a day. She was not ever weight. She was short. She was attractive, but she would drink energy drinks more often than practically any other type of drink. I worked with her for almost a year.

    Reply

    All the heavy dudes (300lbs+) I know ended up going to the hospital after drinking 200mg of caffiene. The two of them learned a lesson and don’t touch the stuff. They are Engineers and both play piano. I love the dudes and I am glad they are taking care of themselves the past couple of years. The skinny runners drink that and nothing happens. Regardless of our shape or condition, anything 300mg or more of caffiene and we all have some problems appear. Like a Grande Starbucks Americano or mocha, or any general coffee greater than 28oz. Whether it is a wild heart rate, high blood pressure and spots in our vision, or nausea – something unpleasant and undesireable occurs. It is caffiene. Guarana and yerba mate is garbage poison too. Above 200mg of caffiene within an hour is plain stupid.

    People drinking energy drinks repeatedly typically have an addiction to caffiene and other drugs. Like 3 cans a day. Mental or emontional issues for sure – depression or habitual/addiction issues. I used to work physically for 10-12 hours a day hand digging trenches under active railroad tracks. I was tired and had a 90-120 minute commute home. It was coffee in the morning (10-16oz), cold brew in the afternoon, and a can of something while driving home. Water all day long. I would saturate a sweatshirt and my pants with sweat from non stop physical labor when it was 25F outside. If I didn’t sleep enough, that can of energy drink would only make me fall asleep faster and I would be stuck at a rest stop knocked out for 2-3 hours. After ending that job I went to one cup of coffee a day only. Sleep is key. Once in a while I buy a Monster original or Red Bull Pear (12oz) because of an urge. It makes me talk a lot and have high blood pressure for two hours, then heart burn appears. I think the “natural” flavors and high sodium content along with taurine rips a hole in my throat and stomach. Oh yeah – they ALL have a pH between 2.8 to 3.6, which is the same as stomach acid. Actually, so does Gatorade and any crap “iced tea” on the shelves. No longer enjoyable. Anyone else drinking multiple cans is probably a step away from being a useless cocaine or heroin addict. Or they do not like coffee. Or is too lazy to make coffee.

    My biggest concern is these new energy drinks appearing within the past year or two. Look at BANG or the newest 7-11 energy drink. They START at 250mg per can. Bang has a few with close to 400mg per can. Just stupid. You cannot reseal the cans either (obviously). I used to get the giant Monster with the cap on top and drink it over three days (or less). If I could handle sugar better than buying Vitamin Water Energy (yellow) is a safe choice. Less than 60mg per smaller bottle, but the caffiene is based off of green tea and will make you pee like crazy. Watch out for anything with more than 200mg of caffiene. Don’t care if it is a huge bottle of cola, big old coffee, energy drink or whatnot. It is all bad for you. Watch out for almost any prepackaged drink out there too. The pH of most are stomach acid matching and will screw your teeth and digestive tract eventually. Errosive. I always thought cola was bad because of the acid
    The acid only softens your tooth’s enamel. Low pH erodes it. Blessings all.

    Reply

    Coffee contains the same amount of caffeine as energy drinks. It’s just the energy drinks have with them a fast delivery system so your body absorbes them faster. Now I use energy drinks occasionally. Once a week on average. But I also drink coffee and tea. I have also used performance stimulants for workouts. I will tell you that nothing comes close to the metabolism boosters. No energy drinks. What I suspect is any kid that has gone to the er for this has underlying issues. Heart trouble, obesity, high blood pressure, use of other drugs or stimulates. I will let my healthy 15 year old have a NOS before my lazy overweight 17 year old. You can see the effects on my elder son(red face, high pulse) because his body is already struggling with his overweight.

    Reply
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