Growth of Energy Drinks Speeds Debate on Their Dangers

WASHINGTON -- Veteran infielder Adam Kennedy broke down why boxes of caffeine-laced energy drinks have become as commonplace in clubhouses as signs that warn against everything from gambling to the use of performance-enhancing drugs.

"It's a long season," says Kennedy, a second baseman on the Washington Nationals in his 12th major league season. "You get bored. You get tired. With the combination of those two things, guys are always looking for an edge or something to be able to perform better -- legally."

Kennedy says his go-to drink of late has been 5-Hour Energy, a two-ounce shot that -- like most every other energy drink in an ever-growing market -- includes a proprietary blend of caffeine and other ingredients. It's not one of the three energy drinks -- including industry leader Red Bull -- certified by Major League Baseball, but Kennedy says he's not worried about any ill effects from using the drink a couple times a day.

Medical experts, however, have their concerns about younger athletes who have turned to energy drinks --- and most recently the more concentrated energy shots --- in increasing numbers.

"I don't see how young people in any way can benefit from these kinds of drinks," says Bruce Goldberger, a professor at the University of Florida College of Medicine who has studied energy drinks for several years. "The risks are much greater than any benefit that can be derived from their use."

In large amounts, caffeine can cause heart palpitations, anxiety and can leave users more prone to dehydration. Those effects can be even more pronounced to teenagers, says Jeanna M. Marraffa, a clinical toxicologist at the Upstate New York Poison Center.

"They don't know the limitations of their bodies," Marraffa says. "If you're a young football player doing two-a-days, you may not know how to maintain good hydration and that's my biggest concern (with energy drinks). They don't know the difference between Gatorade and Red Bull or products like that. Fundamentally, they are very different."

That's the point Powered by Me! and other organizations that typically warn children about the ills of steroid use have tried to pass along to young athletes and their parents.

"These are not as safe and harmless as they want you to believe," says Mike Gimbel, director of Maryland-based Powered by Me! "We are going to create a generation of kids on speed. They are not even thinking about it and they are downing this stuff like crazy. To me, I don't think these products pose any less danger to young athletes as tobacco and alcohol."

Small Bottle, Big Punch

The energy shot is a relative newcomer to the $5 billion energy drink market already populated by Red Bull, Monster and other products sold in cans that usually range from eight to 24 ounces. A 2008 study by Johns Hopkins University studied four shots, including one (AMMO Energy) that had a caffeine concentration of 171 milligrams per ounce.

By comparison, Red Bull, Monster and Rockstar had caffeine concentrations of 10 milligrams per ounce or less.

"These shots deliver caffeine in large doses," Goldberger says. "These are of much greater concern for young people because an overdose can occur much more easily."

Living Essentials, the Michigan-based company behind 5-hour Energy, doesn't disclose the caffeine content for 5-Hour. Its ubiquitous television ads claim that each shot has "as much caffeine as a cup of premium coffee." According to the Mayo Clinic, eight ounces of brewed coffee can contain as much as 200 milligrams of caffeine.

Carl Sperber, a spokesperson for Living Essentials, said his company's products are made up of ingredients that have shown to be safe over many years. As far as the exact caffeine content of 5-Hour Energy, Sperber says that will remain a company secret.

"There is a lot of competition out there," Sperber says. "There are others who want to copy our formula. We are going to do whatever we can to defend our trademark and our specific energy blend."

Like all the major players in the energy drink space, 5-Hour has had its share of professional athlete endorsers since the product's launch in 2004. New York Giants lineman Osi Umenyiora has served as a pitchman for 5-Hour and the company is currently the title sponsor for Rusty Wallace Racing's NASCAR Nationwide Series team.

Pepsi's Amp line of products sponsors Dale Earnhardt Jr.'s car in the NASCAR Sprint Cup Series and has its hand in mixed martial arts. Hansen Natural Corporation's Monster Energy backs several extreme-sport athletes. Austria-based Red Bull has its name on everything from a NASCAR team to a Major League Soccer franchise to air races. Coca-Cola's Full Throttle is the title sponsor of the National Hot Rod Association's top national series.

Along with having multi-million dollar ad budgets in common, each brand also has its own energy shot on the market.

Dangers Beyond Caffeine Crash

Michael Lee, a cardiologist and assistant professor at the UCLA David Geffen School of Medicine, says most people are able to tolerate high doses of caffeine, although it's hardly recommended that somebody ingest these drinks before a strenuous activity.

"They can increase somebody's heart rate to the point it turns into an arrhythmia and that sometimes can be fatal," Lee says. "If somebody has an undetected heart abnormality, these beverages can be dangerous."

"They can increase somebody's heart rate to the point it turns into an arrhythmia and that sometimes can be fatal. If somebody has an undetected heart abnormality, these beverages can be dangerous."
-- Dr. Michael Lee That's what the wife of a 27-year-old Tennessee man alleges. In a lawsuit filed at U.S. District Court in Memphis earlier this month, Monica Hassell claims her husband, Antonio Hassell, suffered a sudden heart attack while playing basketball and doctors linked his death to 5-Hour Energy.

Monica Hassell's lawyers are seeking $165 million in economic and punitive damages. The lawsuit alleges Living Essentials failed to disclose the risks of using its product, "especially in cases of exercise." It also claims Living Essentials failed to conduct testing and research into the safety of 5-Hour Energy, did not warn consumers of side effects and "was otherwise careless and negligent."

While Living Essentials didn't talk specifically about the lawsuit, a statement by the company said 5-Hour Energy "fully complies with the Dietary Supplement Health and Education Act (DSHEA) regulations for labeling and manufacturing practices."

That may have not always been the case.

Innovation Ventures, the parent company of Living Essentials, filed a lawsuit against Custom Nutrition Labs in 2007 alleging employees of the Texas-based facility "stole and pilfered its packaging for the use of illegally selling the 5-Hour Energy drink that may not meet the strict and confidential quality control specifications."

The federal lawsuit, which was thrown out by a judge as the sides battled it out in separate lawsuits filed in Texas, also claimed Living Essentials "discovered gross deviations in product quality." The two sides settled the Texas lawsuit -- which revolved around which outfit had intellectual rights to 5-Hour Energy -- last summer with the the help of mediator, according to Custom Nutrition Labs' attorney Baxter W. Banowsky.

Little FDA Oversight

Unlike soft drinks, energy drinks are not regulated as a food product by the Food and Drug Administration. Instead, they are considered dietary supplements and fall under the Dietary Supplement Health and Education Act of 1994 -- legislation that left the supplement industry lightly regulated by the FDA.

Soft drinks can't contain more than 71 milligrams of caffeine per 12 ounces of fluid, but there are no such limitations on energy drinks. Manufacturers of energy drinks are also not required to list how much caffeine is in their products, although Goldberger says about half do disclose the concentration on their labels.

Daniel Fabricant, spokesperson for the Natural Products Association, says caffeine disclosure falls into a "gray area" of FDA regulation, but adds that manufacturers of energy drinks are delivering as much caffeine as one could get at any Starbucks. Despite some products not displaying the exact amount of caffeine, Fabricant says the products do give the consumer a list of ingredients contained inside.

"I think to some degree these are easy targets," Fabricant says. "Coke doesn't list how much caffeine it contains. You go to Burger King and don't know how much caffeine is in a cup of coffee. Is it really that different?"

Supplement manufacturers have been subject to mandatory adverse event reports since 2008, forcing manufacturers to pass along any serious negative reactions to the FDA. Consumers and physicians are also allowed to report any such events directly to the FDA.

FanHouse obtained several adverse event reports, many detailing reactions to energy drinks. Names of those who reported or alleged injury as result of using the products were redacted.

In one report dated April 2008, a parent reported their son suffered suffered from nosebleeds in each of the three occasions he used 5-Hour Energy. In another from September 2008, a user reported hallucinations after consuming 5-Hour Energy.

AdvoCare Slam -- an energy shot endorsed by Drew Brees, the New Orleans Saints quarterback and MVP of Super Bowl XLIV -- allegedly led to bladder problems for one of its users. The use of Iovate Health's Extreme Energy 6-Hour Shot led to dizziness, difficulty breathing and swelling that required hospitalization before the symptoms subsided. Another user of the 6-Hour Shot claimed to break out in hives 10 minutes after consuming the product.

The FDA says that adverse event reporting system is one of many tools the agency uses to review a product. The agency, however, adds "there is no certainty that the reported event was actually due to the product."

Recalls of energy drinks have been rare. The Hydroxycut Liquid Shot was part of voluntary recall last year after the FDA received 23 reports of serious liver injuries due to Hydroxycut products. The Hardcore Energize Bullet was also recalled in 2009 after a utility knife was found inside one of its products. The FDA also forced the recall of Redux Beverages' Cocaine energy drink since the company was illegally marketing the product as alternative to the street drug in 2007.

"FDA does not currently have any official guidance on energy drinks," FDA spokesman Ira Allen says in an e-mail. "Under current law, the manufacturer of a food is responsible for ensuring that the food is safe and lawful."

The FDA did write last December in draft guidance -- basically a document that spells out how the agency feels about a topic -- that energy drinks could be more tightly regulated down the road.

Caffeine as Performance-Enhancer

Experts have debated whether caffeine found in these energy drinks provide a performance advantage.

Conrad Woolsey, an assistant professor at Oklahoma State University, wrote in an article released this week in an American College of Sports Medicine publication that any gains from energy drinks were typically one-dimensional, like in reaction time.

"Performers perceived they were doing better, but actually made significantly more errors," Woosley writes. "Technical skills rely on timing and coordination, and (energy drinks) can and often do reduce performance."

The World Anti-Doping Agency, the independent organization in charge of setting rules of Olympic-bound athletes, hasn't included caffeine on its banned list since 2004. In fact, the NCAA is the only major sports body to currently ban the substance.

"The concern about caffeine consumption is a real one," NCAA spokeswoman Jennifer Royer says in an e-mail. "The NCAA bans caffeine because it is found to be a performance enhancer and because of concern about the effects of stimulant use during intense exercise."

Royer says only one athlete has tested positive for excess levels of caffeine over the prior two years, although the NCAA only tests for stimulants like caffeine during NCAA championships. The threshold set at 15 micrograms per milliliter of urine "is designed to eliminate individuals from testing positive for caffeine because of the 'normal' amounts consumed from average dietary intake," Royer says.

Back in the professional ranks, Florida Marlins manager Edwin Rodriguez doesn't see energy drinks giving his players much of an advantage --- at least physically.

"I think it's more mental than anything else," Rodriguez says.