HAVING flooded the Nigerian market with the promise to improve energy, rehydration, stamina, athletic performance and concentration, and address weight loss, if taken in moderation, many had rushed to the "heal quick" energy drinks. But how many are aware of their components and effects?
Now prone to abuse, they have been linked to deaths due to heart attack or suicide, miscarriage, convulsions, deafness, hemorrhage, stroke, irregular heartbeat, severe diarrhea, migraine, psychotic disorder, and vomiting. These concerns have led to a call for the ban of energy drinks in Nigeria by a member of the House of Representatives.
Nevertheless, some experts have called for caution and want a thorough national scientific probe of the health effects of energy drinks, which results will inform the final decision. Energy drinks are beverages that contain caffeine, taurine, vitamins, herbal supplements and sugar or sweeteners, and are marketed to improve energy, weight loss, stamina, athletic performance and concentration.
They are available in over 140 countries and are fast taking over the Nigerian beverage market with over 30 brands registered by the National Agency for Food, Drug Administration and Control (NAFDAC). Until now, several reports had indicated that though healthy people could tolerate caffeine in moderation, heavy caffeine consumption, through energy drinks, has been associated with serious consequences such as seizures, mania, stroke and sudden death.
A recent study published in Pediatrics has shown that children and adults, especially those with cardiovascular, renal or liver disease, seizures, diabetes, mood and behavioural disorders or hyperthyroidism, or those who take certain medications, may be at higher risk for adverse events from energy drink consumption.
The Guardian investigations revealed that the energy drinks market in Nigeria is large and unregulated, and research into their use and effects is sparse. It was gathered that Nigerians, especially those between ages 14 and 45, take several cans of energy drinks at a sitting and most often mixed with alcoholic drinks.
However, the controversy surrounding the health benefits and adverse effects of energy drinks has led to a call for the ban of the product by a member of the House of Representatives, Mr. Yacoob Bush-Alebiosu. Bush-Alebiosu has sponsored a bill in the National Assembly that might result in the ban of energy drinks throughout the nation.
According to him, "energy drinks contain high levels of ingredients and stimulants that pose dangerous health risks such as kidney damage, seizures and stroke, and life threatening effects on blood pressure, heart and brain function."
He expressed concern that the heart diseases caused by the consumption of these drinks, especially among the young people, were alarming and threatening the health condition of the younger generation.
Interestingly, the Minister of Health, Prof. Onyebuchi Chukwu, told The Guardian that before energy drinks could be banned, they have to be re-analysed for evidence-based report, explaining: "We have to be careful here. You cannot just come out and say you want to ban a product.
"Anything that we have to do has to be evidence-based. I have to talk to NAFDAC D-G. They have to coordinate fresh analysis of energy drinks and once their findings show there is need, why not?"
For the Chief Medical Director of Lagos State University Teaching Hospital (LASUTH), Dr. Wale Oke, "there should be a trial to determine the potential hazardous effects of energy drinks before a decision is made."
However, the Director General of NAFDAC, Dr. Paul Orhii, told The Guardian that the problem with energy drinks is that most Nigerians abuse it.
"The problem we have had is that of abuse. Most Nigerians believe that it is a status symbol. People abuse it and there should be education," he explained. "What I can assure you, and what NAFDAC assures Nigerians, is that we make sure that those components, if taken in moderation, are good for health.
"Some people are mixing energy drinks with alcoholic beverages but that should not be. Energy drinks are taken by people who are weak and those who are recuperating after an illness and need boosters. People should not just sit down and consume cans after cans of energy drinks and accumulate toxins in their bodies."
On the proposed ban on energy drinks by the House of Representatives, Orhii said: "I am aware of the plan. If they want to ban it, they have the right. I do not market energy drinks. I only approve them. If the National Assembly bans it, it becomes a law."
Though energy drinks are approved and registered by NAFDAC, he noted: "Our test is to make sure that they meet the standards set by the Standards Organisation of Nigeria (SON). Once we prove that they meet the standards, we register. You have to understand that energy drinks are not marketed only in Nigeria, they are marketed all over the world."
A fellow of the Nigerian Institute of Food Science and Technology (NIFST), Mr. Morayo A. T. Giwa, said an outright ban on energy drinks is not the solution, but regulations on the contents of the drinks, especially the percentage content of caffeine in the drink.
Giwa explained: "As at today in the soft drink industry, there is no clear differentiation and clear-cut segregation of functional beverages and drinks from the generic carbonated canned and bottled soft drinks that are highly sugar-based.
"Also, a blanket ban on energy drinks without clear differentiation between them would have direct adverse effect on other categories of the functional beverages and drinks in which caffeine is not part of the ingredients.
"It is time for NAFDAC officials to advise the Federal Government and educate the public through sponsored programme or a joint press conference with NIFST and Customs officials on the difference and category of functional beverages and drinks and those that are supporting the health-being of the populace."
Executive Director of the Nigerian Heart Foundation (NHF), Dr. Kingsley Kola Akinroye, noted that energy drinks contain substances that are recognised as heart stimulants, such as caffeine and many other ingredients that are understudied but not regulated. According to him, some energy drinks contain high levels of glucose that may increase risk factors for cardiovascular disease, and excessive caffeine is known to cause rapid heart rate and increased blood pressure, both of which are risk factors for Cardiovascular Disease (CVD).
The cardiologist said there was need to promote awareness in the population and educate on the effects of consumption of energy drinks, noting: "Regulation of energy drinks consumption should be based on appropriate scientific research.
"More scientific evidence and appropriate research are needed before regulation of all drinks that are considered for legislation. Also, NAFDAC should be supported to promote labelling of drinks that are heart-friendly."
In agreement with this view is the adjunct professor at the University of Illinois, Chicago, United States, and medical director of Medical Art Centre (MART), Maryland, Lagos, Dr. Oladapo Ashiru, who said: "We cannot ban food, we should only caution people about its use. It's like saying you want to ban coffee or sugar. They also have similar side effects when used in excess."
Ashiru explained: "The health hazards of the energy drinks have become apparent for over five years. The frequent utilisation has been associated with increased admission at the emergency clinics in a number of countries. The health hazards derive from the caffeine content of the energy drinks as well as the sugar content.
"Problems such as insomnia, headache, anxiety and fast heartbeat are some of the known consequences of overuse of the energy drinks. In severe cases, it can cause seizures and even heart attack. Really, there is no basis for its use, especially for those who combine it with alcohol, as this can have severe consequences.
"The benefit gained from the initial energy boost can equally be obtained from just one boiled without the dangerous side effects that come with the energy boost. There are other dangerous long-term effects that caffeine can have on the liver and the nervous system, these include liver failure."
But for the consultant endocrinologist and physician to Lagos University Teaching Hospital (LUTH), Idi-Araba, and Associate Professor of Medicine, Dr. Olufemi Fasanmade, the use of energy drinks should be restricted, regulated or banned. Fasanmade explained: "Energy drinks pose dangers to health if taken in large quantity in short period or taken in moderate quantity over long periods, or in conjunction with alcohol, drugs or other stimulants.
"Side effects may include tremors, palpitations and insomnia, and some may raise blood pressure, increase heart rate, raise blood sugar or lead to anxiety and agitation."
The Medical Director of Optimal Specialist Hospital, Dr. Ugochukwu Chukwunenye, noted that energy drinks appear beneficial to the health of a vast majority of the consumers, therefore, a total ban might not be good. He canvassed regulated sales of the drinks as likely a better policy.
"It should not be sold to those under 18 and above 70 years, except on doctor's recommendation," he said. "The sales outlets should be restricted, quantity sold to each individual should be limited based on the concentration of caffeine in it, and it should only be sold in certain hours of the evening,"
He also noted that caffeine is generally found in many beverages like coffee, tea, coca-cola, kola nuts, bitter kola, and energy drinks. Chukwunenye further explained: "Many people consume them because of their benefits, which include better performance, improved concentration, increased zest and libido, among others.
"The drawback is that it induces palpitations in some people, which may prove lethal, especially in the elderly and among school-age children."
Furthermore, a consultant public health physician and lecturer at the College of Medicine, the University of Lagos (CMUL), Dr Fela Oridota, stated: "We know that some side effects have been reported; we know what caffeine and excessive sugar can do to the body. I will advise the public to be cautious because energy drinks act on the central nervous system and can carry health risks both in the short and long run."
Astonishingly, however, a study published in Pediatrics entitled, "Health Effects of Energy Drinks on Children, Adolescents and Young Adults" concluded: "Energy drinks have no therapeutic benefit, and many ingredients are understudied and not regulated. The known and unknown pharmacology of agents included in such drinks, combined with reports of toxicity, raise concern for potentially serious adverse effects in association with energy drink use."
It further recommended: "In the short-term, pediatricians need to be aware of the possible effects of energy drinks in vulnerable populations and screen for consumption to educate families. Long-term research should aim to understand the effects in at-risk populations. Toxicity surveillance should be improved, and regulations of energy drinks sales and consumption should be based on appropriate research."
In line with the foregoing, the health warning on a can of Power Horse energy drink seems necessary. It reads: "Consumption of more than two cans in a day may be harmful to your health. Not to be used for pregnant women, breast feeders, children under the age of 16, people with heart disease, high blood pressure, diabetes, allergy to caffeine, and athletes during exercise."
Fresh global concerns
The United States Food and Drug Administration (FDA) last November linked 92 illnesses and 13 deaths to a brand of energy drink. The body said the adverse-event reports (AERs) were filed by patients, families, or doctors. FDA warned that the products might have harmed someone but they do not prove that the product caused harm.
The FDA can remove a product from the market only when investigation shows that the product causes harm when used according to its label. Moreover, the reports do not offer details on any underlying medical conditions that may have led to product-related illnesses.
The FDA reports detail the events suffered by users of two different brands of energy drinks, including deaths due to heart attack or suicide, a miscarriage, convulsion, life-threatening fear, deafness and hemorrhage, deaths due to heart attack or loss of consciousness, hospitalisation due to irregular heartbeat, severe diarrhea, migraine, psychotic disorder, heart attack, and/or vomiting, disability from irregular heartbeat or stroke, and hospitalisation due to psychotic disorder, increased heart rate, or loss of consciousness.
A recent report by the United States Government documented a sharp spike in the number of people who need emergency medical care after consuming energy drinks. Also, health officials in Germany, Austria and Hong Kong had confirmed that they had found trace levels of cocaine in test samples of popular energy drinks. But health authorities said the findings hovered near the lowest detectable levels, and do not pose a health risk.
However, officials said the company found no traces of cocaine in its independent tests, maintaining that the product in question, 'X' Cola, is "harmless." Also, an energy drink ingredient, taurine, is banned in several countries. Taurine is raising concern, which has caused several countries to ban the drink.
There are concerns of taurine's cardiovascular effects in particular combinations with caffeine. However, experts have called for detailed investigations and in the meantime recommended moderation when consuming any energy drink, just as people would with coffee.
However, a study published in Experimental Clinical Cardiology entitled, "The potential health benefits of taurine in cardiovascular disease" concluded: "The potential health benefits of taurine in cardiovascular disease are rapidly emerging. Though more research needs to be performed, numerous experimental and several clinical studies demonstrated that taurine helps the cardiovascular system through a variety of mechanisms.
"While no severe side effects were reported with taurine-supplemented beverages or commercially available multivitamin and mineral formulations, some caution should be used when consuming these preparations.
"Pregnant women should be particularly careful, because it has been reported that maternal taurine supplementation during pregnancy causes insulin resistance and obesity in rat offspring."
Benefits of energy drinks
A variety of physiological and psychological effects have been attributed to energy drinks and their ingredients. Two studies reported significant improvements in mental and cognitive performances as well as increased subjective alertness. Excess consumption of energy drinks may induce mild to moderate euphoria primarily caused by stimulant properties of caffeine, and may also induce agitation, anxiety, irritability and insomnia.
During repeated cycling tests in young healthy adults, an energy drink significantly increased upper body muscle endurance. It has been suggested that reversal of caffeine withdrawal is a major component of the effects of caffeine on mood and performance.
Restorative properties were shown by a combination of caffeine and the sugar glucose in an energy drink, and some degree of synergy between the cognition-modulating effects of glucose and caffeine was also suggested.
In one experiment, a glucose-based energy drink (containing caffeine, taurine and glucuronolactone) was given to 11 tired participants being tested in a driving simulator. Lane drifting and reaction times were measured for two hours post-treatment and showed significant improvement.
Two articles concluded that the improved information processing and other effects could not be explained in terms of the restoration of plasma caffeine levels to normal following caffeine withdrawal.
Consumption of a single energy drink will not lead to excessive caffeine intake, but consumption of two or more drinks in a single day can. Other stimulants such as ginseng are often added to energy drinks and may enhance the effects of caffeine, and ingredients such as guarana themselves contain caffeine.
Adverse effects of energy drinks
Reported adverse effects associated with caffeine consumption in amounts greater than 400mg include nervousness, irritability, sleeplessness, increased urination, abnormal heart rhythms (arrhythmia), and dyspepsia.
Consumption also has been known to cause pupil dilation when taken with certain anti-depressants or selective serotonin reuptake inhibitors (SSRIs)/a type of medicine used to treat mental health conditions. It has been shown that most mainstream energy drinks do not provide electrolytes, and have a higher likelihood of an energy "crash-and-burn" effect.
Caffeine in energy drinks can cause the excretion of water from the body to dilute high concentrations of sugar entering the blood stream, leading to dehydration. If the body is dehydrated by one per cent, performance is decreased by up to 10 per cent.
In the U.S., energy drinks have been linked with reports of nausea, abnormal heart rhythms and emergency room visits. The drinks may cause seizures due to the "crash" following the energy high that occurs after consumption.
In November 2010, the University of Texas Medical School at Houston reported that energy drinks contain more caffeine than a strong cup of coffee, and that the caffeine combined with other ingredients (sometimes not reported correctly on labels) such as guarana, taurine, other herbs, vitamins and minerals may interact.
Energy drinks and alcohol
Energy drinks consumed with alcohol may affect heart rates, blood pressure and even mental states. The caffeine content of energy drinks range from 80 to 300mg per cup serving, whereas a cup of coffee can contain 70 to 200mg.
Health experts say that caffeine prevents sleepiness and delays the feeling of drunkenness normally experienced when drinking alcohol, causing some people to continue drinking after they normally would have stopped. Both caffeine and alcohol are diuretics, so mixing energy drinks with alcohol can cause severe dehydration, possibly leading to vomiting, nausea and other health problems in the long term.
Best practices
The United Kingdom has investigated the drink but only issued a warning against its consumption by children and pregnant women.
In November 2012, President Ramzan Kadyrov of Chechnya (Russian Federation) ordered his government to develop a bill banning the sale of energy drinks, arguing that as a form of "intoxicating drug", such drinks were "unacceptable in a Muslim society." Kadyrov cited reports of one death and 530 hospital admissions in 2012 due to "poisoning" from the consumption of such drinks.
In 2009, a school in Hove, England, requested that local shops refrain from selling energy drinks to students. Head teacher Malvina Sanders added: "This was a preventative measure, as all research shows that consuming high-energy drinks can have detrimental impact on the ability of young people to concentrate in class."
The school negotiated for the local branch of the Tesco supermarket to display posters asking students not to purchase the products. Similar measures were taken by a school in Oxted, England, which banned students from consuming drinks, and sent letters to parents.
Some countries have certain restrictions on the sale and/or manufacture of energy drinks. For example, in Australia and New Zealand, energy drinks are regulated under the Australia New Zealand Food Standards Code, limiting the caffeine content of "formulated caffeinated beverages" (energy drinks) at 320mg/L and soft drinks at 145mg/L.
Mandatory caffeine labelling is issued for all food products containing guarana. On June 7, 2012, the parliament of Latvia approved changes in the legislation of sale of consumable goods to prohibit sale of energy drinks to persons under the age of 18.
The Guardian
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