Energy Drinks: Giving you Wings or Withdrawal?

by Marissa Camilon, MD 2011 |

It’s the problem we all share. As you walk into your doctor’s office in the wee hours of the morning to squeeze in an appointment before work, chances are your doctor has the same drink in hand: a cup of coffee.  Let’s face it: America’s capitalistic, workaholic attitude thrives on caffeine so its no wonder that it’s the first thing we reach for in the morning…and at 2 o’clock in the afternoon…and after dinner.  Now, since we’re American, we have to do everything bigger and better bringing us to the Energy Drink. Heavily advertised as a beverage that will literally “energize you” with every sip, it’s not hard to imagine why this new segment of the beverage market has grown so rapidly (200 new brands were introduced to the US market in a one year period).  What exactly is behind these “magic potions?” Do the new “natural” ingredients really make an energy drink better than a cup of coffee?

What are you actually drinking?

This one is actually hard to tell (thanks to all the new “herbs” from the Amazon jungle they claim the contain) but we do know that caffeine is a huge part of energy drinks.  A significant number of energy drink producers call the caffeine added to their beverage a “dietary supplement” thus allowing them to dodge the maximum caffeine limit enforced on soft drinks.  Some companies choose to not have labels showing the amount of caffeine in their products. For those that do, many show the amount of caffeine in an 8 oz serving size when their products are often sold in 16 and 24 oz sizes.  The range of caffeine content can be anywhere from 50 mg to 505 mg per bottle or can, compared to an average 77 to 150 mg of caffeine in 6 ounces of coffee.

Other than sugar, energy drinks also boast natural ingredients including ginseng, taurine, bitter orange and guarana.  Ginseng is used therapeutically to increases concentration and memory and is alleged to improve physical stamina and enhance one’s overall well being. Taurine plays a role in fat absorption and is needed in infants and adults who are sick and cannot make it on their own.  Bitter orange is a compound that has made its way into many products after the banning of ephedra.  As a stimulant, it can be used to treat chronic fatigue syndrome, nasal congestion, bruises, inflammation and bedsores.  Guarana is another stimulant whose active ingredient is (surpsise!) caffeine.

The Truth Behind the Wings

Good news first: Studies have shown a number of benefits to caffeine ingestion with regards to cognitive performance, mood and sports endurance.  The bad news is that the levels of caffeine shown to have these benefits are lower than what is often ingested with energy drinks.  A study that surveyed college students (the main target population for energy drinks) showed that 30-50% of students drink 2 or more energy drinks when trying to study or after a sleepless night.  This is an extremely high amount of caffeine consumption for a single day. We have seen a significant increase in the number of cases of caffeine toxicity (symptoms of which include anxiety, restlessness, stomach irritation, tremors, an increased heart rate, and in rare cases, death) since the creation of energy drinks.

More bad news: As many of us know, caffeine drinkers can develop dependence and withdrawal.  Most people notice the withdrawal in the form of a headache after they skip their regular trip to Starbucks (Note: headache is the most common symptom of caffeine withdrawal). Other symptoms include fatigue, drowsiness, difficulty concentrating, depression, nausea and vomiting.  The high caffeine content of energy drinks can worsen both dependence and withdrawal. This is especially true now as younger individuals start to drink energy drinks and start the addiction at a younger age.  Nothing worse than a 10 year old hooked on caffeine.

Energy drinks have also been shown to be closely related to alcohol ingestion.  Drinking alcohol and energy drinks to “party harder” has become extremely popular, occurring in 70% of energy drink users.  Additionally, a large percentage of those drinking energy drinks with alcohol will drink three or more energy drinks in a night.  Studies have shown that while individuals who drink energy drinks may not feel the effect of alcohol as much, it does not in any way prevent their motor and cognitive decline secondary to alcohol.  Yes, were saying exactly what you’re thinking.  You could be very drunk but you won’t feel very drunk…that’s a dangerous situation in our book.  Students who drink alcohol with energy drinks have been shown to have more alcohol-related consequences, including being taken advantage of sexually or being injured while intoxicated.

As medical professionals, we should also address one of the main enemies of our healthcare system: obesity.  Like any other sugar-rich beverage, increased calorie intake, especially liquid calories, can cause weight gain in individuals who are do not subsequently increase their calorie expenditure (i.e. exercise) as well.

What about those promising “natural” energy-enhancing ingredients?

It turns out that the amount of those ingredients, specifically the ginseng, in energy drinks is lower than needed to see a clinical benefit. They aren’t putting enough of all that good stuff in the can to make a difference.  The ingredients themselves also come with their own set of side effects. Of note, bitter orange, when combined with other stimulants like caffeine and sugar, can become addictive and subsequently cause side effects from withdrawal.  These side effects include higher blood pressures, fainting or even strokes.  In addition, Guarana’s active ingredient is caffeine meaning that your can of voovoo juice contains more caffeine than you thought.

The Take Home Message: Caffeine, like everything else, is good in moderation. The occasional energy drink (or half an energy drink) when you feel that you must have caffeine is totally fine. At the same time, we don’t need to start putting energy drinks “in the water.”  It is your responsibility to make sure that they are drinking safe amounts of caffeine, especially when there is a lack of proper labeling.

What You Should Do: Make sure to take a look at your can (or do a little research online) and see just how much caffeine you are about to drink to avoid caffeine addiction and withdrawal.  The absolute maximum amount of caffeine you can consume is 1600mg in 24 hours…and remember this is the upper limit that your body can physically handle.  No need to push the envelope, Mad Max.

Questions? E-mail the Author:


  1. Clauson, K, et al. “Safety issues associated with commercially available energy drinks.” Journal of the American Pharmacists Association, 2008. 48(3): e55-64.
  2. Duchan, E, et al. “Energy Drinks: A Review of Use and Safety for Athletes.” The Physician and Sportsmedicine.” 2010 38(2): 171-9.
  3. Melinauskas, BM, et al. “A survey of energy drink consumption patterns among college students.” Nutrition Journal, 2007. 6(35): 1-7.
  4. Reissig, C, et al. “Caffeinated energy drinks – a growing problem.” Drug and Alcohol Dependence, 2009. 99: 1-10.


10 2010

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