This is a story of a young ambitious medical student who after a stressful and overburdened day started taking energy drinks in evening after duty. It gave instant high, helped him to be awake. He took two or three of these that evening. He immediately noticed being uncomfortable and awareness of racing heart. Being a medical student, he immediately did an electrocardiogram (ECG) which is a test that depicts electrical activity of heart on a piece of paper and it shows abnormal heart beats. He was put on continuous heart rhythm monitoring which revealed runs of ventricular tachycardia.
Figure 1: Runs of ventricular tachycardia in Holter recording of the patient (abnormal heart rhythm originating from lower chambers of heart).
Ventricular tachycardia is an abnormal fast heart rhythm originating from lower chamber of heart and is known to be associated with sudden cardiac death. He was immediately started on medicines to suppress these abnormal heart rhythms and fortunately responded to it. Other tests like echocardiogram, cardiac MRI were normal ruling out any other structural cause of these rhythm abnormalities.
In this article we will like to educate readers about Energy drinks & dangers of legalized or unregulated addictive substances? European countries like Norway, Denmark have banned these energy drinks but they are able to make their way to India & other countries.
What are these high caffeinated energy drinks?
A beverage that typically contains large amount of caffeine, added sugars, other additives & legal stimulants such as guarana, taurine & L-carnitine. These legal stimulants can increase alertness, attention, energy as well as increase in blood pressure, heart rate & breathing.
They have billion-dollar market globally. Energy drinks are frequently marketed towards active young adults & adolescent populations, which also represent the majority of consumer base (aged 20-39 years). But are they a healthy choice? – Definitely NO as we describe risk with these drinks.
What is caffeine?
Caffeine is a stimulant present in coffee, tea, energy drinks. The FDA considers up to 400 mg of caffeine per day as an acceptable amount for healthy adults. Caffeine with sugar has great addictive potential comparable to banned drugs like opioids.
What is the risk?
Energy drinks are designed to give an “energy boost” to the drinker by a combination of stimulants and energy boosters.
The major constituent in most energy drinks is caffeine. They usually contain 80-150 mg of caffeine per 8 ounces, which is equivalent to 5 ounces of coffee or two 12 ounces can of caffeinated soda. Most of the brands on the market contain large amount of glucose while some brands offer artificially sweetened versions, other commonly used constituents are taurine, methylxanthines, vitamin B, ginseng, guarana, yerba mate, acai, maltodextrin.
The problem with energy drink consumption is that these beverages often contain high amount of labelled & even masked caffeine, as well other substances such as guarana, ginseng & taurine in variable quantities which may generate uncertain interactions.
Guarana is a Brazilian plant containing “guaranine” which is nothing more than caffeine, in about twice the concentration of caffeine found in coffee beans (about 2-4 % caffeine in guarana seeds compared with 1-2 % in coffee beans).
Ginseng exerts its stimulating effects through a mixture of ginsenosides, polysaccharide peptides, polyethylenic alcohols and fatty acids.
The major active component of ginseng are ginsenosides which act on several different tissue & cells & produce a kaleidoscope of biological effects. Taurine is an amino acid that exerts a number of physiological functions, including cell volume regulation & inhibitory neuromodulation.
When considering body size previous research recommends keeping caffeine intake within 3-6 mg/Kg as this is the level of intake that is ergogenic & found to be well tolerated regardless of size & age. Given this, it is important to also consider the total amount of caffeine from all sources of beverages and food (e.g., coffee, tea, chocolate, etc.) within an individual tolerance limit, to make sure excessive amount are not consumed.
Possible drug interaction between Panax ginseng & warfarin phenelzine & alcohol have also been reported (NOT FOR THOSE ON BLOOD THINNING AGENTS -WARFARIN).
Caffeine undergoes placental transfer which is the reason for limiting dietary intake during pregnancy (UNSAFE IN PREGNANCY).
How much caffeine in different brands of these energy drinks?
Energy drinks are prepacked & ready to drink functional beverages while energy shots are a similar more concentrated ready to drink beverage sold in 2-5 fl oz volumes.
The caffeine content of different energy drinks is as under:
- 12 oz Red Bull: 111 mg
- 16 oz Rockstar: 165 mg
- 16 oz Monster: 172 mg (1 can is considered 2 serving, each serving listed as 86 mg)
- Monster 24 fluid ounce (682 ml) – 240 mg caffeine
- 2 oz 5-hour energy shot – 215 mg
- 2 oz 5-hour extra strength – 245 mg
- 4 oz cocaine energy drink – 280 mg
- Sting energy drink – 200 mg caffeine
- Monster Ultra Blue & Ultra Red – 140 mg/can,
- Monster Ultra Black’s – 155 mg/can
- Monster ultra-watermelon, ultra-gold and ultra-peachy can – 150 mg/can
- Monster vibrant ultraviolet weighing – 140 mg/can.
- 8 oz brewed black coffee: 65 to 195 mg depending on the strength of brew.
- Red Bull 8.4 oz packs 80 mg of caffeine.
- Monster Energy 16-ounce vessel- impressive 160 mg of caffeine.
Monster towers over coke with a whopping 160 mg of caffeine per can, equivalent to 2-3 invigorating cups of coffee. Coke lags behind with a mere 35 mg. But there’s more – Monster 16 ounce can pack 27 gm of sugar a sugar rush with 7 teaspoons and to top it off a dash of artificial sweetener sucralose for an extra kick.
In addition to caffeine these drinks also contain other substances like sugars, artificial sweeteners, Guarana (which is derived from South American plants which also contain caffeine).
Dr Rohit Walia
MBBS, MD , DNB, DM : Cardiology – SGPGI Lucknow
Post Doctoral Fellowship : Electrophysiology & Devices
Post Doctoral Fellowship : Advanced Electrophysiology ( Taiwan , USA , Germany )
Certificate of Advanced Studies : Mitral & Tricuspid Interventions : Zurich University Switzerland
Fellowship Intervention Cardiology & structural heart disease ( Europe , USA)
Post Graduate Diploma in Hospital Management
Post Graduate Diploma in Health Economics , Finance & health policy
Associate Professor
Department of Cardiology
Christian Medical College , Ludhiana , Punjab .
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