KAREN CARPENTER – PALUMBO COMMISSIONER STEVEN KIPNIS MD, FACP, FASAM PATRICIA TALABA, CPP ROBERT KILLAR, CASAC Energy and Alcohol/Energy Drinks: Ingredients, Dangers, Reviews, & Comparisons Since the early 1990’s, energy drinks and alcohol pop drinks (alcopops) have proliferated and become a permanent fixture in our culture. An energy drink is any beverage that contains some form of legal stimulant and/or vitamins which have been added to give the consumer a short term boost in energy. These drinks tend to contain significant amounts of sugar and caffeine. An example of a popular energy drink on the market is Red Bull. An alcopop is a term used to describe a bottled alcoholic beverage that resembles soft drinks or lemonade. The alcohol beverage industry classifies these drinks as RTD’s (“Ready to Drink”) due to the fact that they are pre-mixed, FAB’s (“Flavored Alcoholic Beverages”), FMB’s (“Flavored Malt Beverages”) or PPS’s (“Pre-Packaged Spirits”). An alcohol energy drink is either premixed by the manufacturer or mixed by the consumer. Tilt and Sparks are manufactured examples of this type of beverage. As stated, the energy drink or energy component of the mixed drink contains many different ingredients that are vitamins or stimulants, all with the purpose of increasing ones energy. Ingredients that may be found in these beverages include: Caffeine – a mild stimulant found in cola, tea, coffee, and chocolate. Most energy drinks have 70 – 200 mg of caffeine. Caffeine is known medically as trimethylxanthine. Medically, caffeine is useful as a cardiac stimulant and also as a mild diuretic (it increases urine production). Recreationally, it is used to provide a "boost of energy" or a feeling of heightened alertness. Caffeine is an addictive drug and it operates using the same mechanisms that amphetamines and cocaine use to stimulate the brain, though caffeine's effects are more mild than amphetamines and cocaine. (see appendix for caffeine content of various beverages) Guarana is a climbing plant, native to Brazil, that contains caffeine. Each fruit contains about one seed, which contains approximately three times more caffeine than coffee beans. (It also contains modest amounts of related compounds, one is theophylline a substance that dilates the bronchi in the lung and is used to treat various respiratory diseases such as asthma.). Guarana has also been found to promote weight loss, again through its stimulant properties (increasing the metabolic rate). Taurine is an amino acid which is just now being researched. It is a possible inhibitory neurotransmitter and a cardiac stimulant and it is not known yet what influences it has on the body. One theory is that taurine enhances the effect of caffeine. Ginseng is actually three different herbs commonly grouped together and called ginseng: Asian or Korean ginseng (Panax ginseng), American ginseng (Panax quinquefolius), and Siberian "ginseng" (Eleutherococcus senticosus). The latter herb is actually not ginseng at all, but the Russian scientists responsible for promoting it believe that it functions identically. Asian ginseng is said to stimulate and relax the nervous system, encourage the secretion of hormones, improve stamina, lower blood sugar and cholesterol levels and increase resistance to disease. It is used internally in the treatment of debility associated with old age or illness, lack of appetite, insomnia, stress, shock and chronic illness. There are known adverse effects to the use of excess ginseng and these include: headaches, restlessness, and raised blood pressure, especially if it is taken with caffeine and/or alcohol. Inositol is any one of nine isomeric alcohols. One of these is found in plant and animal tissue and is classified as a member of the vitamin B complex, though it is not considered a vitamin per se, since the human body can synthesize it. Inositol, unofficially referred to as "vitamin B8," is present in all animal tissues, with the highest levels in the heart and brain. Inositol may also be involved in depression. People who are depressed may have lower than normal levels of inositol in their spinal fluid. In addition, inositol participates in the action of serotonin, a neurotransmitter known to be a factor in depression. Inositol also is said to boost the body’s natural cellular defenses by increasing the levels of inositol phosphates in the cells; as a result, it dramatically increases natural killer cell activity, which plays a key role in strengthening the body's immune system. Choline, a dietary component of many foods, is part of several major phospholipids (including phosphatidylcholine - also called lecithin) that are critical for normal membrane structure and function. Due to its effects on brain acetylcholine levels, choline supplementation can enhance memory capacity in healthy humans and rats. Furthermore, choline, in conjunction with supplements that prolong the effects of acetylcholine at the neuromuscular junction, may improve neuromuscular transmission. Large oral doses of choline or phosphatidylcholine may be associated with hypotension, sweating, salivation and diarrhea. Sugar (glucose) is the major carbohydrate used as fuel in our body to supply energy. Glucose is the preferred fuel of brain cells, and also muscle cells in early exercise. Carbohydrates (which sugar is) provide most of the energy needed in our daily lives, both for normal body functions such as heartbeat, breathing and digestion and for exercise such as cycling, walking and running. Carnitine, an amino acid, creatine, ginko, milk thistle and many vitamins (especially the B vitamins – riboflavin, niacin, etc) have also been ingredients in these drinks. ALCOPOPS, are beverages that are sweet, are served in 12 fl oz cans or bottles and contain 4 – 7% alcohol by volume (8 – 14 proof). In Europe and Canada, alcopops tend to be pre-mixed spirits such as Smirnoff Ice or Bacardi Breezer. In the United States, they are generally beers with added sugar, coloring and flavorings. One advantage to the manufacturer is that if legally classified as beers, they can be sold in outlets that do not carry spirit based drinks. The alcopops hit the US in the mid -90’s with the successful marketing plan of “malternative beverages”. Later, other beverages came onto the US scene, including Mike’s Hard Lemonade and Smirnoff Ice. There has been significant concern that these beverages might appeal to children due to their names, sweetness and colors. A list of alcopop beverages can be found in the appendix. What happens when energy drinks are combined with alcohol? This combination carries a number of dangers: Since energy drinks are stimulants and alcohol is a depressant, the combination of effects may be dangerous. The stimulant effects can mask how intoxicated you are and prevent you from realizing how much alcohol you have consumed. Fatigue is one of the ways the body normally tells someone that they've had enough to drink. The stimulant effect can give the person the impression they aren't impaired. No matter how alert you feel, your blood alcohol concentration (BAC) is the same as it would be without the energy drink. Once the stimulant effect wears off, the depressant effects of the alcohol will remain and could cause vomiting in your sleep or respiratory depression. Both energy drinks and alcohol are very dehydrating (the caffeine in energy drinks is a diuretic). Dehydration can hinder your body's ability to metabolize alcohol and will increase the toxicity, and therefore the hangover, the next day. What do the experts think? The California-based Marin Institute, an alcohol industry watchdog group, has just released the most comprehensive report yet on alcoholic energy drinks. “The available research suggests that alcoholic energy drinks create a dangerous mix,” the report states. “Yet the alcohol industry markets the beverages with messages that fail to alert users to the potential for misjudging one’s intoxication. Indeed, these messages irresponsibly suggest the beverages will enhance alertness and energy.” The companies market these products as ways to “party all night.” On the Tilt and Bud Extra websites, they say “Move from party to after-party,” “Get your second wind,” and “Who’s up for staying out all night.” California's recently changed (August 2007) policy that will tax Alcopops at the distilled spirits rate per gallon ($3.30), rather than the per gallon beer rate ($.20). The policy change is based on the alcohol content of the product. Based on a Marin Institute Study California’s expected benefits include: 1 - a reduction in underage alcopop consumption in the state by 35 percent, resulting in a cost savings of $437 million. 2 - The proposed tax could increase the average price of alcopops by an estimated 25% and generate over $40 million for the state treasury. The Marin Institute reported that recently, 29 attorneys general (including New York State’s) took a powerful stand against alcoholic energy drinks. In their letter to the Alcohol and Tobacco Tax and Trade Bureau, the AGs expressed grave concern about how the products are targeting youth, and called upon the agency to enforce federal law that says companies cannot market these beverages as “energy-enhancing”. APPENDIX Sports/energy drinks Brand (12 ounces) 7-Up A&W Creme Soda AMP Energy Drink, 8.4 ounces (oz.) Full Throttle, 16 oz. KMX Orange, 8.4 oz. Red Bull, 8.5 oz. (250 milliliters) SoBe Adrenaline Rush, 8.3 oz. SoBe No Fear, 16 oz. Barq's Root Beer Cherry Coca-Cola, Diet Cherry Coca-Cola Coca-Cola Classic Code Red Mountain Dew Diet Barq's Root Beer Diet Coke Dr Pepper Diet Pepsi-Cola Diet Wild Cherry Pepsi Fanta Caffeine (milligrams) 0 29 75 144 75 80 79 158 22 34 34 55 0 45 41 36 36 0 Coffee Type Caffeine (milligrams) 135 Plain, brewed, 8 ounces (oz.) Instant, 8 oz. Espresso, 1 fluid oz. Flavored, 8 oz. Decaffeinated, brewed, 8 oz. Decaffeinated, instant, 8 oz. Starbucks' Coffee Grande, 16 oz. 95 30-50 25-100 5 3 259 Sources: American Dietetic Association, 2005; Center for Science in the Public Interest, 1997; International Food Information Council, 1998; Sources: American Beverage Association, 2005; SoBe Beverages, 2005; Red Bull, 2005 ALCOPOPS Black Douglas Bundaberg Rum Hooper's Hooch Jack Daniels Jewel Isle Rum Punch Jim Beam Johnnie Walker Creator Black Douglas Bundaberg Rum United States Beverage Jack Daniels Jewel Isle Productions Jim Beam Johnnie Walker Base Scotch Whisky Rum Beer Sold mixed with Ginger Sold in Cola Lemonade Citrus Milk Ale America Yes Yes No Yes Yes No Yes No Yes Yes No No Yes Yes No No No No No No No No No Yes No No No No Yes No No No Bourbon Yes Whiskey Rum No Yes No No No No No Bourbon Yes Whiskey Scotch Yes whisky Beer No Mike's Hard Mike's Hard Lemonade Lemonade Co Pulse Red Square Independent Liquor No Yes Yes No Yes Vodka No No Yes No No No Rum, Halewood Schnapps, No No Yes Yes No Yes International Vodka, Independent No Yes No No Vodka Cruisers Vodka No No Liquor Independent No No Yes No Vodka Mudshakes Vodka No No Liquor Global No Yes No No Vodka Kick Vodka No No Brands Stroh White Mountain Coolers Brewery Beer No No No Yes No Yes Company Coors Zima XXX Beer No No No Yes No Yes Brewing Company Federal Trade Commission. Alcohol Marketing and Advertising: A Report to Congress. Washington, DC: Federal Trade Commission, 2003.