Energy drinks charged into the U.S. market in 1997 with Red Bull and its claim: "Improves performance ... increased concentration ... stimulates the metabolism."
At 66.7 milligrams of caffeine per 8.3-ounce can, that would be a mere blip in the bold new world of energy drinks. A cup of coffee, by contrast, has 107.5 milligrams.
Today, provocative handles like Cocaine (since changed to No Name, owing to a 2007 Food and Drug Administration ruling against naming a product after an illegal drug), Blow, Bawls, Monster, Rockstar, Pimp Juice, Dopamine, SoBe No Fear and Spike Shooter abound. Caffeine counts of 350 milligrams -- the equivalent of 10 cans of Coke -- are common. The slogans scream: "Feel the freak." "Get spiked!" "Party like a rockstar."
The $2-per-can drinks buzzed $4.7 billion in sales in 2007, up from $3.5 billion in 2006, according to market research firm ACNielsen. The drinks, with their high caffeine content, have caused concern among health professionals -- especially when kids consume them. Studies have linked excessive caffeine in children to elevated heart rates, hypertension, anxiety, headaches and interrupted sleep patterns.
Last month, four students at Falcon Cove Middle School in Weston, Fla., were taken to the emergency room of Memorial Hospital West/Joe DiMaggio Children's Hospital with racing hearts and body sweats. They said they shared a can of Redline.
"We have been seeing lots of kids coming in with anxiety attacks -- it has gone up in the last year and a half," says Dr. Deanna Soloway, assistant medical director of the pediatric emergency room at Hollywood, Fla.'s Joe DiMaggio Children's Hospital.
"One of the routine questions we ask them is about their intake of energy drinks. Many kids are using them. I believe there is some connection between the use of energy drinks and hypertension, elevated heart rate, jitters. We had to monitor these four kids for several hours and put them on hydration."
The Florida Poison Control Center at the University of Miami/Jackson reports that 39 people ages 2 to 20 had symptoms of caffeine overexposure between January 2007 and last month. The signs were serious enough that it led to the center's tracking of this data. Statewide, the number was 125 during this period.
"It's grown because of the popularity of these products," said Dr. Richard Weisman, the center's director.
In addition to caffeine, the berry-flavored Redline contains yohimbine, used in treating erectile dysfunction, and vinpocetine, used in Europe in the treatment of Alzheimer's, according to David Schardt, senior nutritionist for the Center for Science in the Public Interest, a health advocacy group.
Redline's bottle contains a warning that it's not for use by individuals younger than 18, those pregnant or nursing, or if there's a family history of heart disease, high blood pressure, depression, caffeine sensitivity, glaucoma and other ailments. Monster, Rockstar, Spike Shooter and SoBe No Fear contain similar printed warnings. The Food and Drug Administration regulates the caffeine content in soft drinks but not in energy drinks. For colas, the FDA has set the maximum concentration of caffeine at 32.4 milligrams per 6-ounce bottle or 65 milligrams per 12 ounces.
"The FDA could challenge such products, but we have generally refrained to do so if amounts to be consumed were not higher than the levels consumed from coffee," FDA press officer Stephanie Kwisnek says. An 8-ounce coffee, in general, contains about 100 milligrams of caffeine.
"If there is a public health risk with energy drinks or with any other beverage, FDA will take the appropriate action deemed necessary to protect the public's health," she adds.
The attention surrounding the Weston incident -- the students recovered -- prompted Broward, Fla., school board members to consider banning energy drinks from school campuses. This potential move was welcomed by Davie, Fla.-based Redline CEO Jack Owoc, who has offered the district $25,000 toward enacting a ban. Owoc feels that minors should not be taking these drinks.
"There is no real therapeutic benefits associated with these energy drinks," said Dr. Steven Lipshultz, chairman of the Department of Pediatrics at the University of Miami Miller School of Medicine. "If you're a 200-pound adult, an 8-ounce bottle of something that contains 250 milligrams of caffeine may not be a big deal, but if you weigh 60 pounds and are getting the same dose" it's a problem.
The University of Florida's Department of Pathology, Immunology and Laboratory Medicine conducted a study analyzing the caffeine content in energy drinks and other beverages. Publishing their work in the March 2006 edition of the Journal of Analytical Toxicology, researchers concluded that "there are important health concerns that cannot be ignored with regards to the amount of caffeine contained in these drinks. Children should be considered vulnerable to excess caffeine."
The study found that children and adolescents consuming caffeine in high concentrations suffered from caffeine-induced headaches and interrupted sleep patterns. Warning labels "would be prudent."
Elevated caffeine poses particular risks for those in warmer climates. "Every couple of years, in the humid heat of summer, you hear of high school athletes having adverse effects," Lipshultz says. "The heat is up, your heart rate is up. Caffeine is a diuretic. It increases the kidney's disposal of fluid from the body. If you take a bottle of this stuff, thinking you are getting hydrated, you're getting dehydrated."
"The issue with these energy drinks is that they are the 'sexy' beverages of the 2000s, the 'cool' beverage for today's generation," says Dr. Bruce Goldberger, a co-author of the University of Florida study. "In my 25 years of experience, I've only seen two or three overdoses on caffeine. ...
"But there are certain at-risk populations of people that should avoid caffeine. Those would include people with cardiovascular problems, people who are anxious or have a mental disorder, people with hypertension or a propensity for cardiac arrhythmia. I see no place in school for these types of beverages."