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ARTICLE International Food Risk Analysis Journal

Energy Drinks: An Assessment of the Potential Health Risks in the Canadian Context

Regular Paper

Joel Rotstein1, Jennifer Barber1, Carl Strowbridge1, Stephen Hayward1, Rong Huang1 and Samuel Benrejeb Godefroy1,*

1 Food Directorate, Health Products and Food Branch, Health Canada, Canada * Corresponding author E-mail: [email protected] ȱ Received 12 February 2013; Accepted 3 June 2013

DOI: 10.5772/56723

© 2013 Rotstein et al.; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstractȱ Theȱ purposeȱ ofȱ thisȱ documentȱ isȱ toȱ developȱ aȱ caffeine.ȱInȱaddition,ȱtheȱhealthȱeffectsȱofȱexcessiveȱintakeȱ healthȱriskȱassessmentȱonȱenergyȱdrinks,ȱbasedȱonȱhealthȱ ofȱ taurineȱ andȱ glucuronolactoneȱ areȱ alsoȱ unknown.ȱ Theȱ hazardȱ andȱ exposureȱ assessmentsȱ whenȱ consumedȱ asȱ aȱ healthȱhazardȱassessmentȱconcludedȱthatȱtheȱgeneralȱadultȱ foodȱinȱCanada.ȱInȱthisȱdocument,ȱaȱtypicalȱenergyȱdrinkȱ populationȱ couldȱ safelyȱ consumeȱ 2ȱ servingsȱ ofȱ aȱ typicalȱ isȱ exemplifiedȱ byȱ theȱ productȱ knownȱ asȱ Redȱ Bull•,ȱ energyȱ drinkȱ perȱ day,ȱ withȱ noȱ healthȱ consequences.ȱ Thisȱ whereȱ aȱ singleȱ canȱ servingȱ ofȱ 250ȱ mlȱ containsȱ 80ȱ mgȱ ofȱ conclusionȱ wasȱ basedȱ onȱ theȱ safetyȱ ofȱ theȱ nonȬcaffeineȱ caffeine,ȱ1000ȱmgȱofȱtaurine,ȱ600ȱmgȱofȱglucuronolactoneȱ ingredientsȱofȱenergyȱdrinksȱatȱthisȱlevelȱofȱconsumption,ȱ andȱseveralȱBȱvitamins.ȱȱ andȱ theȱ factȱ thatȱ caffeineȱ fromȱ otherȱ dietaryȱ sourcesȱ inȱ Healthȱ hazardȱ dataȱ onȱ energyȱ drinksȱ wereȱ foundȱ toȱ beȱ additionȱtoȱthatȱinȱ2ȱservingsȱofȱenergyȱdrinksȱwouldȱnotȱ limitedȱandȱthereforeȱtheȱhazardȱassessmentȱwasȱbasedȱonȱ poseȱaȱhealthȱhazardȱtoȱtheȱgeneralȱadultȱpopulation.ȱTheȱ individualȱ ingredients.ȱ Caffeineȱ wasȱ identifiedȱ asȱ theȱ consumptionȱofȱenergyȱdrinksȱbyȱsubpopulations,ȱsuchȱasȱ ingredientȱ withȱ theȱ greatestȱ potentialȱ forȱ intakesȱ ofȱ children,ȱ adolescents,ȱ andȱ pregnantȱ women,ȱ shouldȱ beȱ possibleȱ healthȱ concern.ȱ Onȱ thisȱ basis,ȱ excessȱ limitedȱ toȱ theirȱ respectiveȱ recommendedȱ maximumȱ dailyȱ consumptionȱ ofȱ energyȱ drinksȱ wouldȱ beȱ expectedȱ toȱ intakesȱofȱcaffeine,ȱasȱrecommendedȱbyȱHealthȱCanada.ȱȱ resultȱinȱhealthȱconsequencesȱsimilarȱtoȱthoseȱfromȱexcessȱ Usingȱexposureȱmodelling,ȱtheȱpotentialȱhealthȱriskȱposedȱ exposureȱtoȱcaffeine.ȱTheȱmoreȱmildȱandȱtransientȱhealthȱ byȱ energyȱ drinkȱ consumptionȱ wasȱ examined.ȱ However,ȱ consequencesȱ couldȱ includeȱ anxiety,ȱ headacheȱ andȱ noȱCanadianȱintakeȱdataȱforȱenergyȱdrinksȱwereȱavailable.ȱ insomniaȱ andȱ theseȱ healthȱ consequencesȱ canȱ becomeȱ Therefore,ȱ forȱ theȱ purposeȱ ofȱ modellingȱ intake,ȱ itȱ wasȱ chronicȱconditions.ȱMoreȱsevereȱhealthȱconsequencesȱmayȱ assumedȱ thatȱ energyȱ drinksȱ areȱ consumedȱ inȱ aȱ mannerȱ includeȱ irregularȱ heartbeat,ȱ heartȱ attackȱ and,ȱ veryȱ rarely,ȱ similarȱtoȱthatȱofȱcaffeinatedȱcarbonatedȱsoftȱdrinks.ȱInȱtheȱ death.ȱ Currently,ȱ theȱ potentialȱ forȱ taurineȱ andȱ worstȱ caseȱ modellingȱ exposureȱ scenario,ȱ energyȱ drinksȱ glucuronolactoneȱtoȱinteractȱwithȱcaffeineȱisȱunknownȱandȱ wereȱsubstitutedȱforȱcaffeinatedȱcarbonatedȱsoftȱdrinksȱonȱ thereforeȱ theyȱ mayȱ orȱ mayȱ notȱ exacerbateȱ theȱ effectsȱ ofȱ aȱvolumeȱbasis.ȱ www.intechopen.com Joel Rotstein, Jennifer Barber, Carl Strowbridge, Stephen Hayward, RongInt. Huang food risk and anal. Samuel j., 2013, Benrejeb Vol. Godefroy:3, 4:2013 1 Energy Drinks: An Assessment of the Potential Health Risks in the Canadian Context !

Theȱ energyȱ drinkȱ caffeineȱ concentrationȱ wasȱ setȱ toȱ 320ȱ Disclaimer:ȱȱ ppmȱ (80ȱ mgȱ ofȱ caffeine/250ȱ mlȱ serving)ȱ forȱ modellingȱ ȱ purposes.ȱInȱtheȱmostȱconservativeȱscenario,ȱallȱcaffeinatedȱ Thisȱ documentȱ wasȱ developedȱ asȱ aȱ reviewȱ ofȱ theȱ carbonatedȱ softȱ drinksȱ wereȱ replacedȱ byȱ aȱ typicalȱ energyȱ scientificȱinformationȱavailableȱpertainingȱtoȱtheȱsafetyȱofȱ drinkȱ forȱ consumersȱ whoȱ drinkȱ theseȱ beveragesȱ (eatersȱ ingredientsȱ thatȱ mayȱ beȱ partȱ ofȱ theȱ compositionȱ ofȱ theȱ only).ȱTheȱresultsȱofȱthisȱconservativeȱestimateȱshowedȱthatȱ beveragesȱ knownȱ asȱ Caffeinatedȱ Energyȱ Drinksȱ (Energyȱ slightlyȱlessȱthanȱ30%ȱofȱmaleȱandȱfemaleȱadults,ȱaboutȱ15%ȱ Drinks).ȱ Theȱ documentȱ wasȱ developedȱ duringȱ aȱ periodȱ ofȱpregnantȱwomanȱandȱmoreȱthanȱ50%ȱofȱtheȱchildrenȱandȱ spanningȱfromȱ2010ȱtoȱlateȱ2011.ȱAȱnumberȱofȱreferencesȱ adolescents,ȱ amongstȱ consumersȱ whoȱ drankȱ caffeinatedȱ andȱnewȱstudiesȱhaveȱbeenȱmadeȱavailableȱsinceȱthenȱandȱ carbonatedȱ softȱ drinks,ȱ wereȱ aboveȱ Healthȱ Canada’sȱ areȱnotȱreferencedȱinȱtheȱpresentȱdocument.ȱAnȱupdateȱofȱ recommendedȱmaximumȱdailyȱcaffeineȱintake.ȱȱ theȱpresentȱHealthȱRiskȱAssessmentȱisȱenvisagedȱinȱ2014Ȭ Thisȱ extremeȱ scenarioȱ onlyȱ appliesȱ toȱ thatȱ subsetȱ ofȱ theȱ 15,ȱuponȱreviewȱofȱinformationȱcurrentlyȱbeingȱcollectedȱ populationȱ thatȱ consumesȱ caffeinatedȱ carbonatedȱ softȱ byȱHealthȱCanada’sȱFoodȱDirectorateȱsinceȱtheȱregulatoryȱ drinks,ȱwhichȱdoesȱnotȱexceedȱ8%ȱofȱyoungȱchildrenȱ(1Ȭ8ȱ decisionȱmadeȱinȱOctoberȱ2011,ȱtoȱregulateȱEnergyȱDrinksȱ yearsȱold),ȱ22%ȱofȱolderȱchildrenȱ(9Ȭ14ȱyearsȱold),ȱ32%ȱofȱ asȱ beveragesȱ (i.e.ȱ food)ȱ asȱ opposedȱ toȱ theirȱ formerȱ adolescents,ȱ 20%ȱ ofȱ theȱ adultȱ populationȱ andȱ 13%ȱ ofȱ classificationȱasȱNaturalȱHealthȱProducts.ȱȱ pregnantȱfemales.ȱ ȱ Inȱ criticallyȱ reviewingȱ theȱ outcomesȱ ofȱ thisȱ exposureȱ 1.ȱIntroductionȱ modelling,ȱ itȱ appearedȱ thatȱ theȱ correspondingȱ healthȱ concernsȱ forȱ childrenȱ andȱ adultsȱ wouldȱ beȱ limitedȱ toȱ 1.1ȱȱ Purposeȱ remote,ȱ basedȱ onȱ thisȱ scenario,ȱ inȱ viewȱ ofȱ theȱ parentalȱ Theȱpurposeȱofȱthisȱdocumentȱisȱtoȱprovideȱaȱhealthȱriskȱ controlȱthatȱshouldȱexistȱandȱwouldȱlimitȱaccessȱofȱtheseȱ assessmentȱ ofȱ energyȱ drinkȱ productsȱ basedȱ onȱ theirȱ productsȱtoȱchildren,ȱasȱwellȱasȱtheȱabilityȱofȱadultsȱandȱ consumptionȱ asȱ beveragesȱ inȱ Canada.ȱ Theȱ documentȱ pregnantȱwomenȱtoȱmonitorȱtheirȱownȱcaffeineȱintake.ȱ attemptsȱ toȱ provideȱ aȱ scientificȱ analysisȱ basedȱ onȱ theȱ Thisȱhypotheticalȱscenarioȱandȱitsȱoutcomesȱcouldȱnotȱbeȱasȱ informationȱavailableȱ toȱdate,ȱ whichȱcouldȱ thenȱ beȱ usedȱ easilyȱ excludedȱ forȱ adolescents,ȱ givenȱ thatȱ energyȱ drinksȱ toȱsupportȱtheȱdevelopmentȱofȱsuitableȱriskȱmanagementȱ tendȱtoȱbeȱmarketedȱtoȱthisȱsubsetȱofȱtheȱpopulation,ȱwhichȱ measuresȱforȱtheseȱproductsȱwhenȱconsumedȱasȱfoods.ȱȱ isȱ lessȱ likelyȱ toȱ adhereȱ toȱ consumptionȱ recommendationsȱ thanȱadults.ȱTheȱexistenceȱofȱlargerȱvolumeȱcontainersȱ(e.g.,ȱ 2.ȱDefiningȱaȱtypicalȱenergyȱdrinkȱȱ 710ȱ ml)ȱ increasesȱ theȱ likelihoodȱ ofȱ exceedingȱ caffeineȱ recommendedȱintakesȱinȱoneȱconsumptionȱsetting.ȱ 2.1ȱDefiningȱproductsȱknownȱasȱenergyȱdrinksȱ Specificȱriskȱmanagementȱmeasuresȱtoȱaddressȱpotentiallyȱ highȱ caffeineȱ levelsȱ inȱ largerȱ volumeȱ energyȱ drinkȱ Forȱtheȱpurposeȱofȱthisȱdocument,ȱaȱtypicalȱenergyȱdrinkȱ productsȱwouldȱthereforeȱbeȱdesirable.ȱ isȱ characterisedȱ byȱ theȱ ingredientsȱ andȱ ingredientȱ levelsȱ Itȱisȱacknowledgedȱthatȱvariousȱdataȱgapsȱwouldȱneedȱtoȱ shownȱ inȱ Tableȱ 1.ȱ Ingredientsȱ includeȱ caffeine,ȱ taurine,ȱ beȱaddressedȱtoȱimproveȱtheȱexposureȱassessmentȱandȱtheȱ glucuronolactone,ȱ inositolȱ andȱ aȱ varietyȱ ofȱ Bȱ vitamins.ȱ overallȱriskȱcharacterization.ȱInȱparticular,ȱdataȱrelatedȱtoȱ Theȱ basisȱ forȱ thisȱ characterisationȱ isȱ theȱ formulationȱ ofȱ theȱ evolvingȱ consumptionȱ patternsȱ ofȱ theseȱ productsȱ byȱ theȱ mostȱ commonlyȱ soldȱ productsȱ ofȱ thisȱ categoryȱ ofȱ theȱvariousȱsubsetsȱofȱtheȱpopulation,ȱinȱCanada,ȱneedsȱtoȱ beverages,ȱ suchȱ asȱ theȱ productȱ knownȱ asȱ Redȱ Bull•,ȱ beȱgathered.ȱ whichȱwasȱtheȱfirstȱenergyȱdrinkȱapprovedȱforȱtheȱmarketȱ Healthȱ Canada’sȱ proposedȱ riskȱ managementȱ approachȱ forȱ inȱ Canada.ȱ Basedȱ onȱ 2009ȱ marketȱ dataȱ ofȱ theȱ globalȱ energyȱdrinks,ȱannouncedȱinȱOctoberȱ2011ȱandȱupdatedȱinȱ marketingȱ researchȱ firmȱ ACNielsen,ȱ Redȱ Bull•ȱ 2012,ȱlimitsȱtheȱconcentrationȱandȱtotalȱamountȱofȱcaffeineȱinȱ comprisedȱ approximatelyȱ 37%ȱ ofȱ theȱ salesȱ ofȱ energyȱ theseȱ productsȱ andȱ requiresȱ thatȱ caffeineȱ andȱ nutritionȱ drinksȱ inȱ Canadaȱ and,ȱ asȱ such,ȱ hadȱ theȱ largestȱ marketȱ informationȱbeȱdisplayedȱonȱproductȱlabels.ȱTheseȱmeasuresȱ share.ȱThisȱisȱconsistentȱwithȱaȱmoreȱrecentȱreportȱ(AAFC,ȱ supportȱtheȱmitigationȱofȱrisksȱrelatedȱtoȱoverconsumptionȱ 2011)ȱ thatȱ statesȱ thatȱ Redȱ Bull•ȱ constitutesȱ 43%ȱ ofȱ theȱ ofȱ caffeineȱ fromȱ thisȱ typeȱ ofȱ productȱ thatȱ areȱ withinȱ theȱ salesȱofȱenergyȱdrinksȱinȱNorthȱAmerica.ȱ possibleȱ areasȱ ofȱ interventionȱ availableȱ toȱ aȱ federalȱ foodȱ ȱ regulator.ȱ Aȱ moreȱ concertedȱ approachȱ (e.g.,ȱ education,ȱ Althoughȱ Healthȱ Canadaȱ doesȱ notȱ haveȱ aȱ definitionȱ orȱ awarenessȱ andȱ regulation)ȱ andȱ moreȱ researchȱ wouldȱ beȱ standardȱ forȱ productsȱ knownȱ asȱ energyȱ drinks,ȱ otherȱ neededȱtoȱascertainȱtheȱeffectivenessȱofȱtheȱvariousȱmeasuresȱ foodȱregulatorsȱhaveȱreachedȱaȱdecisionȱonȱthisȱaspectȱofȱ takenȱbyȱregulatorsȱandȱotherȱstakeholders.ȱ theseȱproducts.ȱForȱexample,ȱAustraliaȱandȱNewȱZealandȱ ȱ categorizesȱ energyȱ drinksȱ asȱ ‘formulatedȱ caffeinatedȱ Keywordsȱ Energyȱ drink,ȱ Caffeine,ȱ Taurine,ȱ beverages’ȱ whichȱ areȱ definedȱ underȱ theȱ Australiaȱ Newȱ Glucuronolactone,ȱInositol,ȱBȱvitaminȱ Zealandȱ Foodȱ Standardsȱ Codeȱ asȱ “aȱ nonȬalcoholicȱ waterȬ basedȱ flavouredȱ beverageȱ whichȱ containsȱ caffeineȱ andȱ ȱ

2 Int. food risk anal. j., 2013, Vol. 3, 4:2013 www.intechopen.com ȱ !

mayȱ containȱ carbohydrates,ȱ aminoȱ acids,ȱ vitaminsȱ andȱ Ofȱ theȱ energyȱ drinkȱ productsȱ thatȱ wereȱ inȱ theȱ NHPȱ otherȱ substances,ȱ includingȱ otherȱ foods,ȱ forȱ theȱ purposeȱ submissionȱ queue,ȱ approximatelyȱ 13%ȱ fellȱ withinȱ theȱ ofȱenhancingȱmentalȱperformance”.ȱȱ ‘typicalȱ description’ȱ forȱ energyȱ drinks.ȱ Basedȱ onȱ marketȱ ȱ shareȱdataȱfromȱACNielsenȱ(2009),ȱRedȱBull•ȱwasȱrankedȱ Inȱ Europe,ȱ theȱ Irelandȱ Foodȱ Safetyȱ Promotionȱ Boardȱ theȱhighest,ȱcomprisingȱapproximatelyȱ37%ȱofȱtheȱmarket.ȱ (FSPB)ȱ establishedȱ aȱ committeeȱ consistingȱ ofȱ externalȱ Energyȱ drinksȱ suchȱ asȱ Monster•ȱ andȱ Rockstar•,ȱ whichȱ expertsȱtoȱresearchȱtheȱhealthȱeffectsȱofȱ‘stimulantȱdrinks’ȱ containȱ levelsȱ ofȱ ingredientsȱ higherȱ thanȱ theȱ standardȱ (energyȱ drinks).ȱ Theȱ committeeȱ notedȱ inȱ itsȱ finalȱ reportȱ and/orȱ containȱ otherȱ ingredientsȱ thatȱ areȱ notȱ partȱ ofȱ theȱ thatȱ thereȱ isȱ noȱ agreedȱ definitionȱ inȱ theȱ regulatoryȱ standard,ȱ wereȱ rankedȱ nextȱ butȱ wellȱ belowȱ Redȱ Bull•ȱ frameworkȱ forȱ productsȱ referredȱ toȱ asȱ energyȱ drinksȱ orȱ withȱ5.5%ȱandȱ4.4%ȱofȱtheȱmarketȱrespectively.ȱThisȱmarketȱ ‘stimulantȱ drinks’.ȱ Forȱ theȱ purposesȱ ofȱ theȱ report,ȱ theȱ shareȱdataȱhasȱbeenȱevolvingȱoverȱtheȱyearsȱandȱmayȱnotȱ termȱ ’stimulantȱ drinks’ȱ wasȱ adopted.ȱ Theȱ committeeȱ beȱreflectiveȱofȱtheȱcurrentȱmarketȱsituation.ȱȱ definedȱ stimulantȱ drinksȱ asȱ “beverages,ȱ whichȱ typicallyȱ ȱ containȱcaffeine,ȱtaurineȱandȱvitamin(s),ȱandȱmayȱcontainȱ Aȱ wideȱ rangeȱ ofȱ energyȱ drinkȱ productsȱ isȱ availableȱ anȱ energyȱ sourceȱ (e.g.ȱ carbohydrate),ȱ and/orȱ otherȱ internationallyȱ andȱ inȱ theȱ Canadianȱ marketplace.ȱ substance(s),ȱ marketedȱ forȱ theȱ specificȱ purposeȱ ofȱ Ingredientsȱ andȱ ingredientȱ levelsȱ varyȱ fromȱ productȱ toȱ providingȱ realȱ orȱ perceivedȱ enhancedȱ physiologicalȱ product.ȱ Whileȱ theȱ majorȱ ingredientsȱ typicallyȱ foundȱ inȱ and/orȱperformanceȱeffects”ȱ(FSPB,ȱ2003).ȱ energyȱdrinksȱinȱCanadaȱareȱlistedȱinȱTableȱ1,ȱmanyȱotherȱ ingredientsȱ canȱ beȱ foundȱ inȱ theseȱ products,ȱ particularlyȱ 2.2ȱȱ Majorȱcomponentsȱofȱenergyȱdrinkȱproductsȱȱ variousȱherbsȱandȱextractsȱsuchȱasȱginseng,ȱginkgoȱbilobaȱ andȱgreenȱteaȱextract.ȱȱ Duringȱ theȱ preparationȱ ofȱ thisȱ manuscript,ȱ energyȱ drinksȱ wereȱ marketedȱ inȱ Canadaȱ underȱ theȱ Naturalȱ Healthȱ 2.3ȱȱ EnergyȱdrinkȱmarketȱgrowthȱinȱCanadaȱ Productsȱ(NHP)ȱRegulations.ȱAtȱtheȱtime,ȱitȱwasȱestimatedȱ thatȱ overȱ 300ȱ energyȱ drinkȱ productȱ submissionsȱ wereȱ Accordingȱtoȱaȱ2008ȱreportȱonȱtheȱCanadianȱenergyȱdrinkȱ beforeȱ Healthȱ Canadaȱ forȱ considerationȱ asȱ NHPs.ȱ Onlyȱ marketȱ publishedȱ byȱ Agricultureȱ andȱ AgriȬFoodȱ Canadaȱ twelveȱ wereȱ assessedȱ andȱ receivedȱ aȱ license.ȱ (AAFC),ȱ inȱ 2006ȱ theȱ “functionalȱ beverageȱ category”ȱ wasȱ Approximatelyȱ halfȱ ofȱ theȱ 300ȱ productȱ submissionsȱ wereȱ valuedȱatȱ7%ȱofȱtheȱtotalȱsoftȱdrinkȱmarket.ȱEnergyȱdrinksȱ eitherȱrefusedȱaȱlicenseȱorȱwithdrawnȱbyȱtheȱpetitioner.ȱAȱ areȱ includedȱ inȱ theȱ functionalȱ beverageȱ categoryȱ alongȱ numberȱ ofȱ productsȱ wereȱ alsoȱ onȱ theȱ Canadianȱ marketȱ withȱ sportȱ andȱ nutraceuticalȱ drinks.ȱ Energyȱ drinksȱ underȱtheȱprovisionsȱofȱtheȱUnprocessedȱProductȱLicensingȱ accountedȱ forȱ 65%ȱ ofȱ theȱ functionalȱ beverageȱ sectorȱ andȱ Regulations.ȱTableȱ1ȱbelowȱlistsȱtheȱmajorȱingredientsȱandȱ 4.6%ȱofȱtheȱvalueȱofȱtheȱsoftȱdrinkȱmarket.ȱInȱaȱmoreȱrecentȱ levelsȱ typicallyȱ foundȱ inȱ theȱ productsȱ thatȱ wereȱ inȱ theȱ reportȱ byȱ AAFCȱ (2011),ȱ itȱ wasȱ notedȱ thatȱ thereȱ areȱ moreȱ queueȱ forȱ considerationȱ toȱ beȱ licensedȱ asȱ anȱ NHP.ȱ Forȱ thanȱ210ȱdifferentȱenergyȱdrinkȱbrandsȱinȱNorthȱAmerica.ȱ comparisonȱ purposes,ȱ Tableȱ 1ȱ alsoȱ providesȱ theȱ levelsȱ ofȱ Itȱalsoȱreportedȱthatȱtheȱenergyȱdrinkȱ marketȱgrewȱ60.2%ȱ majorȱ ingredientsȱ thatȱ areȱ typicallyȱ foundȱ inȱ aȱ standardȱ fromȱ2007ȱtoȱ2010ȱandȱ5.1%ȱfromȱ2009ȱtoȱ2010.ȱ energyȱdrinkȱproduct.ȱȱȱ ȱ 3.ȱHealthȱEffectsȱofȱEnergyȱDrinksȱ Substanceȱ Formulationȱofȱproductsȱknownȱ Typicalȱ 3.1ȱȱ Introductionȱ asȱEnergyȱDrinksȱthatȱhaveȱ energyȱ beenȱeitherȱlicensedȱorȱinȱqueueȱ drinkȱȱ Theȱresearchȱonȱenergyȱdrinksȱisȱlargelyȱlimitedȱtoȱaȱsmallȱ withȱHealthȱCanadaȱforȱ ȱ(mgȱperȱ numberȱ ofȱ clinicalȱ studiesȱ (aboutȱ 12ȱ studies)ȱ andȱ caseȱ considerationȱasȱNHPs.ȱ(mgȱperȱ 250ȱmlȱ serving*)ȱ serving)ȱ reports.ȱTheȱclinicalȱstudiesȱtendedȱtoȱhaveȱsmallȱnumbersȱ Caffeineȱ 50ȱ–ȱ200ȱ 80ȱ ofȱparticipantsȱ(lessȱthanȱ100ȱsubjects)ȱandȱfocusedȱonȱveryȱ Taurineȱ 10ȱ–ȱ2000ȱ 1000ȱ specificȱhealthȱ effects.ȱTheseȱstudiesȱ mostlyȱexaminedȱtheȱ Glucuronolactoneȱ 600ȱ–ȱ1200ȱ 600ȱ effectȱ ofȱ energyȱ drinkȱ consumptionȱ onȱ behaviourȱ andȱ niacinȱȱ 10ȱ–ȱ40ȱ 18aȱ physicalȱactivity;ȱtherefore,ȱtheȱparametersȱexaminedȱwereȱ vitaminȱB6ȱȱ 5ȱ–ȱ10ȱ 2ȱ limitedȱ andȱ notȱ necessarilyȱ significantȱ fromȱ aȱ healthȱ andȱ vitaminȱB12ȱȱ 0.002ȱȬȱ0.2ȱȱȱȱ 0.001ȱ safetyȱperspective.ȱOtherȱstudiesȱassessedȱtheȱconsequencesȱ pantothenicȱacidȱȱ 5ȱ–ȱ10ȱ 6ȱ ofȱconsumingȱtheȱcombinationȱofȱenergyȱdrinksȱandȱalcohol.ȱȱ thiamineȱȱ 0.5ȱȬȱ5ȱȱȱȱȱ 2ȱ riboflavinȱȱ 0.5ȱȬȱ5ȱȱȱ 1.65ȱ 3.2ȱHealthȱeffectsȱofȱenergyȱdrinksȱȱ Inositolȱ 50Ȭ200ȱ 50ȱ *ȱServingȱsizeȱisȱtypicallyȱ250Ȭ473ȱml.ȱ 3.2.1ȱAcuteȱphysiologicalȱeffectsȱofȱenergyȱdrinksȱ aȱEnergyȱ drinksȱ containȱ niacinȱ eitherȱ inȱ theȱ formȱ ofȱ nicotinamideȱ orȱ nicotinicȱacid.ȱRedȱBull•ȱcontainsȱnicotinamide.ȱ Thereȱ isȱ concernȱ thatȱ someȱ individuals,ȱ whoȱ mayȱ haveȱ Tableȱ1.ȱAmountsȱofȱmajorȱingredientsȱinȱenergyȱdrinksȱ increasedȱsensitivityȱtoȱtheȱingredientsȱinȱenergyȱdrinks,ȱ www.intechopen.com Joel Rotstein, Jennifer Barber, Carl Strowbridge, Stephen Hayward, Rong Huang and Samuel Benrejeb Godefroy: 3 ȱ Energy Drinks: An Assessment of the Potential Health Risks in the Canadian Context !

mayȱhaveȱanȱacuteȱphysiologicalȱresponse,ȱspecificallyȱanȱ constitutesȱtheȱvastȱmajorityȱofȱcaloriesȱinȱtheseȱproducts.ȱ increaseȱ inȱ heartȱ rateȱ andȱ bloodȱ pressure.ȱ Tableȱ 2ȱ Aȱ 250ȱ mlȱ servingȱ ofȱ aȱ typicalȱ energyȱ drinkȱ containsȱ 110ȱ summarizesȱtheȱlimitedȱstudiesȱonȱtheȱacuteȱphysiologicalȱ calories,ȱwhichȱisȱsimilarȱtoȱtheȱ86Ȭ130ȱcaloriesȱinȱtheȱsameȱ effectsȱ ofȱ energyȱ drinks.ȱ Rashtiȱ etȱ al.ȱ (2009)ȱ investigatedȱ volumeȱ ofȱ aȱ carbonatedȱ caffeinatedȱ softȱ drinkȱ (USDAȱ 10ȱhealthyȱwomen,ȱmeanȱageȱ20ȱyears.ȱSubjectsȱconsumedȱ NutrientȱDatabase,ȱ2011).ȱȱ 140ȱmlȱofȱanȱenergyȱdrinkȱorȱaȱplacebo.ȱAverageȱsystolicȱ 3.3ȱȱ HealthȱEffectsȱofȱEnergyȱDrinksȱandȱSportsȱActivityȱ bloodȱ pressure1ȱ wasȱ significantlyȱ higherȱ forȱ theȱ energyȱ drinkȱ groupȱ comparedȱ toȱ placebo.ȱ Noȱ differencesȱ wereȱ Energyȱ drinksȱ areȱ frequentlyȱ marketedȱ toȱ individualsȱ seenȱ inȱ heartȱ rate,ȱ diastolicȱ bloodȱ pressureȱ orȱ profileȱ ofȱ interestedȱ inȱ athleticsȱ andȱ anȱ activeȱ lifestyle.ȱ Theȱ mainȱ moodȱ statesȱ atȱ anyȱ timeȱ point.ȱ Americanȱ Heartȱ ingredientsȱinȱenergyȱdrinksȱpurportedȱtoȱenhanceȱsportȱ Associationȱ (2007)ȱ reportedȱ onȱ aȱ studyȱ concerningȱ theȱ performanceȱ areȱ caffeineȱ andȱ carbohydrates.ȱ Theȱ termȱ cardiovascularȱeffectsȱofȱenergyȱdrinks.ȱFifteenȱsubjectsȱ(8ȱ “energyȱdrink”ȱitselfȱimpliesȱthatȱitsȱconsumptionȱmightȱ women,ȱ7ȱmen,ȱmeanȱageȱ26ȱyears)ȱwereȱgivenȱ500ȱmlȱofȱ enhanceȱphysicalȱactivity.ȱ anȱ energyȱ drink.ȱ Theȱ researchersȱ notedȱ anȱ increaseȱ inȱ ȱ systolicȱbloodȱpressureȱandȱanȱincreaseȱinȱheartȱrateȱinȱtheȱ Energyȱ drinksȱ shouldȱ notȱ beȱ confusedȱ withȱ ’sportsȱ fourȱ hoursȱ afterȱ consumptionȱ ofȱ theȱ beverageȱ (citedȱ inȱ drinks’.ȱ Sportsȱ drinksȱ areȱ typicallyȱ aȱ mixtureȱ ofȱ BfRȱ 2008).ȱ However,ȱacrossȱtheȱ variousȱ studies,ȱchangesȱ carbohydratesȱ andȱ electrolytesȱ formulatedȱ toȱ enhanceȱ inȱbloodȱpressureȱdidȱnotȱreachȱhypertensiveȱlevelsȱwithȱ athleticȱ performanceȱ andȱ preventȱ dehydration,ȱ and,ȱ theȱ consumptionȱ ofȱ energyȱ drinks.ȱ Theseȱ effectsȱ wereȱ unlikeȱ energyȱ drinks,ȱ theyȱ doȱ notȱ containȱ caffeine.ȱ similarȱ toȱ theȱ effectsȱ onȱ bloodȱ pressureȱ demonstratedȱ Conversely,ȱ energyȱ drinksȱ containȱ caffeineȱ whichȱ isȱ aȱ withȱtheȱconsumptionȱofȱcoffeeȱ(Riksenȱetȱal.ȱ2009).ȱȱ stimulantȱandȱthereforeȱ theyȱ areȱ notȱ consideredȱsuitableȱ 3.2.2ȱBehavioural/performanceȱeffectsȱofȱenergyȱdrinksȱ toȱ reȬestablishȱ normalȱ bodyȱ functionȱ afterȱ exerciseȱ (e.g.ȱ normalȱheartȱrate).ȱȱ Aȱ limitedȱ numberȱ ofȱ studiesȱ haveȱ assessedȱ theȱ ȱ behaviouralȱ effectsȱ followingȱ consumptionȱ ofȱ energyȱ Theȱ effectsȱ ofȱ energyȱ drinksȱ onȱ exerciseȱ haveȱ beenȱ drinksȱ containingȱ bothȱ glucoseȱ andȱ caffeine,ȱ alongȱ withȱ investigatedȱ inȱ aȱ smallȱ numberȱ ofȱ studiesȱ (seeȱ Tableȱ 4ȱ otherȱpotentiallyȱactiveȱagentsȱ(seeȱTableȱ3ȱbelow).ȱTheseȱ below).ȱ Studiesȱ investigatingȱ theȱ useȱ ofȱ energyȱ drinksȱ studiesȱhaveȱidentifiedȱimprovementsȱinȱperformanceȱofȱ haveȱ generallyȱ foundȱ anȱ improvementȱ inȱ enduranceȱ attentionȱ and/orȱ reactionȱ timeȱ tasksȱ andȱ variousȱ indicesȱ performance.ȱIvyȱetȱal.ȱ(2009)ȱfoundȱthatȱtheȱconsumptionȱ ofȱ alertness.ȱ Forȱ example,ȱ Alfordȱ etȱ al.ȱ (2001)ȱ examinedȱ ofȱ500ȱmlȱofȱaȱRedȱBullȱenergyȱdrinkȱ40ȱminutesȱbeforeȱaȱ theȱeffectsȱofȱRedȱBullȱEnergyȱDrinkȱoverȱ3ȱstudiesȱinȱ36ȱ simulatedȱ cyclingȱ timeȱ trialȱ inȱ 12ȱ trainedȱ cyclistsȱ volunteers.ȱ Significantȱ improvementsȱ inȱ mentalȱ significantlyȱimprovedȱenduranceȱperformanceȱcomparedȱ performanceȱ includingȱ choiceȱ reactionȱ time,ȱ toȱ aȱ nonȬcaffeinated,ȱ sugarȬfreeȱ placebo.ȱ Forbesȱ etȱ al.ȱ concentrationȱandȱmemoryȱwereȱobservedȱwithȱRedȱBullȱ (2007)ȱ foundȱ thatȱ theȱ consumptionȱ ofȱ Redȱ Bullȱ energyȱ comparedȱ toȱ theȱ controlȱ drinks.ȱ Scholeyȱ andȱ Kennedyȱ drinkȱ significantlyȱ increasedȱ upperȱ bodyȱ muscleȱ (2004)ȱ investigatedȱ theȱ effectsȱ ofȱ glucoseȱ alone,ȱ caffeineȱ enduranceȱbutȱhadȱnoȱeffectȱonȱanaerobicȱpeakȱorȱaverageȱ alone,ȱginsengȱandȱginkgoȱatȱflavouringȱlevels,ȱanȱenergyȱ powerȱ duringȱ repeatedȱ Wingateȱ cyclingȱ testsȱ inȱ healthyȱ drinkȱorȱaȱplaceboȱinȱ20ȱstudents.ȱComparedȱtoȱplacebo,ȱ youngȱ adults,ȱ whenȱ comparedȱ toȱ aȱ nonȬcaffeinated,ȱ theȱ energyȱ drinkȱ resultedȱ inȱ significantlyȱ improvedȱ isoenergetic,ȱ controlȱ beverage.ȱ Lockwoodȱ etȱ al.ȱ (2009)ȱ performanceȱ onȱ secondaryȱ memoryȱ andȱ speedȱ ofȱ foundȱ thatȱ preȬworkoutȱ energyȱ drinkȱ consumption,ȱ attentionȱ factors.ȱ Someȱ ofȱ theȱ studiesȱ attributedȱ theȱ significantlyȱimprovedȱsomeȱphysiologicalȱadaptationsȱtoȱ demonstratedȱeffectsȱtoȱtheȱcombinationȱofȱingredientsȱinȱ combinedȱ aerobicȱ andȱ resistanceȱ training,ȱ whenȱ energyȱ drinks,ȱ ratherȱ thanȱ caffeineȱ onlyȱ (Alfordȱ etȱ al.ȱ comparedȱ toȱ aȱ nonȬcaffeinated,ȱ sugarȬfreeȱ controlȱ drink.ȱ 2001;ȱReynerȱ&ȱHorneȱ2002;ȱScholeyȱ&ȱKennedyȱ2004).ȱ Lastly,ȱ aȱ studyȱ investigatingȱ theȱ useȱ ofȱ aȱ sugarȬfreeȱ energyȱ drinkȱȱ(Redȱ Bull)ȱ foundȱ thatȱ thereȱ wasȱ noȱ 3.2.3ȱCaloriesȱ differenceȱinȱrunȱtimeȬtoȬexhaustionȱorȱperceivedȱexertionȱ Exceptȱ forȱ sugarȬfreeȱ versions,ȱenergyȱdrinks,ȱlikeȱ manyȱ inȱ youngȱ adultsȱ whenȱ comparedȱ toȱ nonȬcaffeinatedȱ beverages,ȱcontainȱsugarsȱinȱtheȱformȱofȱsucrose,ȱglucose,ȱ sugarȬfreeȱ placeboȱ (Candowȱ etȱ al.ȱ 2009).ȱ Overallȱ theȱ and/orȱhighȬfructoseȱcornȱsyrup.ȱTheȱsugarȱcontentȱvariesȱ studies’ȱ resultȱ suggestȱ thatȱ theȱ consumptionȱ ofȱ energyȱ amongȱenergyȱdrinksȱbutȱrangesȱfromȱ21ȱtoȱ34ȱgramsȱperȱ drinksȱ mayȱ enhanceȱ physicalȱ abilityȱ butȱ itȱ isȱ notȱ clearȱ 237ȱ mlȱ canȱ (Clausonȱ etȱ al.ȱ 2008).ȱ Thisȱ sugarȱ contentȱ isȱ whetherȱtheȱeffectȱisȱdueȱtoȱtheȱpresenceȱofȱcaffeine,ȱsugarȱ similarȱ toȱ thatȱ ofȱ carbonatedȱ caffeinatedȱ softȱ drinks.ȱ Itȱ orȱbothȱofȱtheseȱconstituentsȱinȱtheȱenergyȱdrink.ȱ ȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ 1ȱDuringȱ eachȱ heartbeat,ȱ bloodȱ pressureȱ variesȱ betweenȱ aȱ maximumȱ(systolic)ȱandȱaȱminimumȱ(diastolic)ȱpressure.ȱ

4 Int. food risk anal. j., 2013, Vol. 3, 4:2013 www.intechopen.com ȱ !

StudyȱDesignȱ TestȱMaterialȱ Methods Resultsȱ Reference (composition)ȱ1ȱ DoubleȬblind,ȱ RedȱBullȱEnergyȱDrinkȱ Studyȱ1:ȱ69ȱsubjectsȱ Studyȱ1:ȱNoȱchangesȱnotedȱ Ragsdaleȱetȱal.ȱ placeboȬcontrolledȱ (32ȱmg/dLȱcaffeine,ȱ240ȱmg/dLȱ (48ȱwomen,ȱ21ȱ inȱoverallȱcardiovascularȱ 2010ȱ glucuronolactone,ȱ400ȱmg/dlȱtaurine)ȱ males,ȱmeanȱageȱ20ȱ functionȱorȱbloodȱglucoseȱ ȱ y)ȱconsumedȱ250ȱmlȱ overȱ2ȱhourȱtestȱperiod.ȱ LowȱCalorieȱRedȱBullȱEnergyȱDrinkȱ(32ȱ RedȱBull•,ȱLowȱ ȱ mg/dLȱcaffeine,ȱ240ȱmg/dLȱ CalorieȱRedȱBull•,ȱ ȱ glucuronolactone,ȱ400ȱmg/dlȱtaurine)ȱ highȱcalorieȱ Studyȱ2:ȱAȱsignificantȱ ȱ placebo,ȱorȱlowȱ increaseȱinȱdiastolicȱbloodȱ HighȱCalorieȱPlaceboȱ(carbonatedȱwater,ȱ calorieȱplacebo.ȱ pressureȱinȱtheȱmalesȱ tapȱwaterȱandȱdextrose)ȱ ȱ immediatelyȱafterȱ ȱ Studyȱ2:ȱ21ȱsubjectsȱ submersionȱofȱtheȱhandȱinȱ LowȱCalorieȱPlaceboȱ(carbonatedȱwater,ȱ (9ȱmen,ȱ12ȱwomen,ȱ coldȱwaterȱ(5oȱC).ȱNoȱ tapȱwaterȱandȱdextrose)ȱ meanȱageȱ22ȱy)ȱ significantȱchangeȱnotedȱinȱ ȱ consumedȱ250ȱmlȱ females.ȱ NB:ȱBananaȱflavouringȱandȱgreenȱ RedȱBull•ȱpreȱandȱ colouringȱwereȱaddedȱtoȱallȱtestȱmaterials postȱcoldȱpressorȱ test.ȱ Randomized,ȱ MeltdownȱRTDȱ 10ȱsubjectsȱ(meanȱ Meanȱsystolicȱbloodȱ Rashtiȱetȱal.ȱ doubleȬblind,ȱ crossȬ (140ȱmlȱcontains:ȱ230ȱmgȱcaffeine,ȱ ageȱ20ȱy)ȱreceivedȱ pressureȱwasȱsignificantlyȱ 2009ȱ over,ȱ placeboȬ unknownȱamountsȱofȱ 140ȱmlȱofȱMeltdownȱ higherȱforȱtheȱenergyȱdrinkȱ controlledȱ methyltetradecythioaceticȱacid,ȱyerbaȱ RTDȱenergyȱdrinkȱ groupȱcomparedȱtoȱplacebo.ȱ mateȱextract,ȱmethylȬsynephrine,ȱ orȱaȱplacebo.ȱ Noȱdifferencesȱnotedȱinȱ methylphenylethylene,ȱ11Ȭhydroxyȱȱ heartȱrate,ȱdiastolicȱbloodȱ yohimbine,ȱyohimbineȱHCL,ȱalphaȬ pressure,ȱorȱprofileȱofȱmoodȱ yohimbiine,ȱandȱmethylȬhordenineȱHCl)ȱ states.ȱ ȱ Placeboȱ (describedȱasȱsimilarȱinȱappearanceȱandȱ tasteȱtoȱMeltdownȱRTDȱbutȱonlyȱ containedȱinertȱsubstances)ȱ Prospectiveȱ Unspecifiedȱenergyȱdrinkȱ(250ȱmlȱ 15ȱsubjectsȱ(7ȱmen,ȱ8ȱ Withinȱ4ȱhoursȱofȱenergyȱ Steinkeȱetȱal.ȱ contains:ȱ1000ȱmgȱtaurine,ȱ100ȱmgȱ women,ȱmeanȱageȱ drinkȱconsumption,ȱmeanȱ 2009ȱ caffeine,ȱunstatedȱamountsȱofȱvitaminsȱB5,ȱ 26ȱy)ȱconsumedȱ500ȱ systolicȱbloodȱpressureȱandȱ B6,ȱB12,ȱglucuronolactone,ȱniacinamide)ȱ mlȱ(2ȱcans)ȱofȱanȱ heartȱrateȱsignificantlyȱ energyȱdrinkȱdailyȱ increased.ȱDiastolicȱbloodȱ forȱtheȱnextȱ5ȱdays. pressureȱsignificantlyȱ increasedȱwithinȱ2ȱhoursȱofȱ energyȱdrinkȱconsumption.ȱ PlaceboȬcontrolledȱ Unspecifiedȱenergyȱdrinkȱ(250ȱmlȱ 50ȱsubjectsȱ(34ȱmen,ȱ Comparedȱwithȱbaselineȱ Worthleyȱetȱal.ȱ contains:ȱ1000ȱmgȱtaurine,ȱ80ȱmgȱcaffeine,ȱ 16ȱwomen,ȱmeanȱ values,ȱthereȱwasȱaȱ 2010ȱ 600ȱmgȱglucuronolcatone,ȱunstatedȱ ageȱ22ȱy)ȱconsumedȱ significantȱincreaseȱinȱ amountsȱofȱȱvitaminsȱB2,ȱB5,ȱB6ȱandȱB12,ȱ eitherȱaȱ250ȱmlȱ plateletȱaggregationȱ sugarȬfreeȱsweetenerȱandȱthickeners)ȱ sugarȬfreeȱenergyȱ followingȱenergyȱdrinkȱ ȱ drinkȱorȱ250ȱmlȱofȱ consumption;ȱnoȱchangeȱ Placeboȱ carbonatedȱwaterȱ wasȱobservedȱwithȱcontrol.ȱ (carbonatedȱwater)ȱ (control)ȱ Meanȱarterialȱpressureȱ significantlyȱincreasedȱ followingȱenergyȱdrinkȱ consumptionȱcomparedȱwithȱ control.ȱ 1ȱTestȱmaterialȱcompositionȱisȱlistedȱasȱitȱisȱdescribedȱinȱtheȱpublishedȱreport.ȱ Tableȱ2.ȱStudiesȱinvestigatingȱtheȱacuteȱphysiologicalȱeffectsȱofȱenergyȱdrinksȱ

ȱ ȱ ȱ ȱ ȱ ȱ ȱ

www.intechopen.com Joel Rotstein, Jennifer Barber, Carl Strowbridge, Stephen Hayward, Rong Huang and Samuel Benrejeb Godefroy: 5 ȱ Energy Drinks: An Assessment of the Potential Health Risks in the Canadian Context !

StudyȱDesignȱ Testȱmaterialȱ Methods Resultsȱ Reference (composition)1ȱ Randomized,ȱ RedȱBullȱEnergyȱDrinkȱ 36ȱsubjectsȱ(19ȱmen,ȱ17ȱ Comparedȱtoȱcontrolȱ Alfordȱetȱal.ȱ doubleȬblindȱ (250ȱmlȱcontains:ȱcarbonatedȱwater,ȱ women,ȱageȱrangeȱ18Ȭ30ȱy)ȱinȱ drinks,ȱRedȱBullȱenergyȱ 2001ȱ 21.5ȱgȱsucrose,ȱ5.25ȱglucose,ȱ1000ȱmgȱ 3ȱstudiesȱreceivedȱnoȱdrink,ȱ drinkȱsignificantlyȱ taurine,ȱ600ȱmgȱglucuronolactone,ȱ 250ȱmlȱofȱcarbonatedȱwater,ȱ improvedȱmentalȱ 80ȱmgȱcaffeine,ȱ50ȱmgȱinositiol,ȱ RedȱBullȱenergyȱȱdrink,ȱorȱ performanceȱincludingȱ unstatedȱamountsȱofȱniacin,ȱ “dummy”ȱenergyȱdrink.ȱ choiceȱreactionȱtime,ȱ panthenol,ȱB6,ȱB12,ȱȱriboflavin,ȱ concentration,ȱandȱ flavours,ȱcolours)ȱ memory.ȱ ȱ Carbonatedȱwaterȱ ȱ Dummyȱenergyȱdrinkȱ(unstatedȱ amountsȱofȱlowȱcalorieȱquinineȱ flavouredȱcarbonatedȱwaterȱwithȱ lime,ȱappleȱandȱblackcurrantȱ concentrates)ȱ ȱ DoubleȬblindȱ RedȱBullȱEnergyȱDrinkȱ(250ȱmlȱ 11ȱsubjectsȱ(maleȱandȱfemale,ȱ Theȱenergyȱdrinkȱ Horneȱ&ȱ contains:ȱ21ȱgȱsucrose,ȱ5ȱgȱglucose,ȱ1ȱ meanȱageȱ24ȱy)ȱreceivedȱ500ȱ significantlyȱreducedȱ Reynerȱ2001ȱ gȱtaurine,ȱ600ȱmgȱglucuronolactone,ȱ mlȱofȱanȱenergyȱdrinkȱorȱaȱ laneȱdriftingȱandȱ 80ȱmgȱcaffeine,ȱ50ȱmgȱinositol,ȱandȱ controlȱdrinkȱpriorȱtoȱcarȱ improvedȱreactionȱ unstatedȱamountsȱofȱvitaminȱBȱ simulatorȱtest.ȱControlȱdrinkȱ time,ȱparticularlyȱforȱ complex)ȱ consistedȱofȱidenticalȱdrinkȱ theȱ1stȱhour.ȱ ȱ minusȱtheȱcaffeine,ȱtaurineȱ Placeboȱ(250ȱmlȱcontains:ȱ21ȱgȱ andȱglucuronolactone.ȱ sucrose,ȱ5ȱgȱglucose,ȱȱ50ȱmgȱinositol,ȱ andȱunstatedȱamountsȱofȱvitaminȱBȱ complex)ȱ DoubleȬblindȱ RedȱBullȱEnergyȱDrinkȱ(250ȱmlȱ 12ȱsubjectsȱ(7ȱmen,ȱ5ȱwomen,ȱ Comparedȱwithȱtheȱ Reynerȱ&ȱ contains:ȱ21ȱgȱsucrose,ȱ5ȱgȱglucose,ȱ1ȱ meanȱageȱ24ȱy)ȱreceivedȱ250ȱ control,ȱtheȱenergyȱ Horneȱ2002ȱ gȱtaurine,ȱ600ȱmgȱglucuronolactone,ȱ mlȱofȱRedȱBullȱenergyȱdrinkȱorȱ drinkȱsignificantlyȱ 80ȱmgȱcaffeine,ȱ50ȱmgȱinositol,ȱandȱ aȱcontrolȱdrinkȱpriorȱtoȱcarȱ reducedȱsleepȬrelatedȱ unstatedȱamountsȱofȱvitaminȱBȱ simulatorȱtest.ȱControlȱdrinkȱ drivingȱincidentsȱandȱ complex)ȱ consistedȱofȱidenticalȱdrinkȱ subjectiveȱsleepinessȱ ȱ minusȱtheȱcaffeine,ȱtaurineȱ forȱtheȱ1stȱ90ȱminutesȱofȱ Placeboȱ(250ȱmlȱcontains:ȱ21ȱgȱ andȱglucuronolactone.ȱ theȱdrive.ȱ sucrose,ȱ5ȱgȱglucose,ȱȱ50ȱmgȱinositol,ȱ andȱunstatedȱamountsȱofȱvitaminȱBȱ complex)ȱ ȱ Randomized,ȱ Placeboȱ(250ȱmlȱcontains:ȱwaterȱwithȱ 20ȱsubjectsȱ(14ȱwomen,ȱ6ȱmen,ȱ Comparedȱwithȱ Scholeyȱ&ȱ doubleȬblind,ȱ5ȱwayȱ flavourȱandȱsweeteners),ȱ meanȱageȱ21ȱy)ȱreceivedȱ1ȱofȱ5ȱ placebo,ȱtheȱenergyȱ Kennedyȱ2004ȱ crossȬover,ȱ placeboȬ ȱ drinks:ȱplacebo,ȱdrinkȱ1,ȱdrinkȱ drinkȱresultedȱinȱ controlledȱ Drinkȱ1ȱ(250ȱmlȱcontains:ȱwaterȱwithȱ 2,ȱdrinkȱ3ȱorȱanȱenergyȱdrinkȱ significantlyȱimprovedȱ flavour,ȱsweetenersȱandȱ75ȱmgȱ forȱaȱtotalȱofȱ6ȱstudyȱdays,ȱ performanceȱonȱ caffeineȱ eachȱ7ȱdaysȱapart.ȱ secondaryȱmemoryȱandȱ ȱ speedȱofȱattentionȱ Drinkȱ2ȱ(250ȱml:ȱwaterȱwithȱflavour,ȱ factors.ȱ sweetenersȱandȱ37.5ȱgȱglucose)ȱ ȱ Drinkȱ3ȱ(250ȱmlȱcontains:ȱwaterȱwithȱ flavour,ȱsweeteners,ȱ12.5ȱmgȱginsengȱ extract,ȱ2ȱmgȱginkgoȱbilobaȱextract) ȱ Unspecifiedȱenergyȱdrinkȱ(250ȱmlȱ contains:ȱwaterȱwithȱflavour,ȱ sweeteners,ȱ75ȱmgȱcaffeine,ȱ37.5ȱgȱ glucose,ȱ12.5ȱmgȱginsengȱextract,ȱ2ȱ mgȱginkgoȱbilobaȱextract)ȱ ȱ ȱ

6 Int. food risk anal. j., 2013, Vol. 3, 4:2013 www.intechopen.com ȱ !

DoubleȬblind,ȱ2ȱwayȱ Unspecifiedȱenergyȱdrinkȱ(250ȱmlȱ 42ȱsubjectsȱ(ageȱ18Ȭ24ȱy)ȱ Theȱenergyȱdrinkȱ Warburtonȱetȱ crossȬover,ȱ placeboȬ contains:ȱ80ȱmgȱcaffeine,ȱ1000ȱmgȱ consumedȱ250ȱmlȱofȱanȱenergyȱ improvedȱattentionȱandȱ al.ȱ2001ȱ controlledȱ taurine,ȱ600ȱmgȱglucuronolactone,ȱ drinkȱorȱaȱplacebo,ȱeitherȱaȱ verbalȱreasoningȱ 5.25ȱmgȱglucose,ȱ21.ȱ5ȱmgȱsucrose,ȱ50ȱ sugarȬfreeȱplaceboȱorȱaȱ comparedȱtoȱtheȱsugarȬ mgȱinositol,ȱ20ȱmgȱniacin,ȱ5ȱmgȱ placeboȱwithȱadditionalȱ freeȱandȱtheȱadditionalȱ vitaminȱB6,ȱ5ȱmgȱvitaminȱB5,ȱ1.5ȱmgȱ glucose.ȱ sugarȬcontainingȱ vitaminȱB2,ȱandȱ0.005ȱmgȱvitaminȱ placebos.ȱ B12)ȱ ȱ SugarȬfreeȱplaceboȱ(250ȱmlȱcontains:ȱ 1000ȱmgȱtaurine,ȱ600ȱmgȱ glucuronolactone,5.25ȱmgȱglucoseȱ50ȱ mgȱinositol,ȱ20ȱmgȱniacin,ȱ5ȱmgȱ vitaminȱB6,ȱ5ȱmgȱvitaminȱB5,ȱ1.5ȱmgȱ vitaminȱB2,ȱandȱ0.005ȱmgȱvitaminȱ B12)ȱ ȱ Placeboȱ(250ȱmlȱcontains:ȱ22.5ȱmgȱ caffeine,ȱ1000ȱmgȱtaurine,ȱ600ȱmgȱ glucuronolactone,ȱ6.5ȱmgȱglucose,ȱ 21.5ȱmgȱsucrose,ȱ50ȱmgȱinositol,ȱ20ȱ mgȱniacin,ȱ5ȱmgȱvitaminȱB6,ȱ5ȱmgȱ vitaminȱB5,ȱ1.5ȱmgȱvitaminȱB2,ȱandȱ 0.005ȱmgȱvitaminȱB12)ȱ 1ȱTestȱmaterialȱcompositionȱisȱlistedȱasȱitȱisȱdescribedȱinȱtheȱpublishedȱreport.ȱ Tableȱ3.ȱStudiesȱinvestigatingȱbehavioural/performanceȱeffectsȱofȱenergyȱdrinksȱȱ

StudyȱDesignȱ Testȱmaterialȱ Methods Resultsȱ Reference (composition)ȱ1ȱ Randomized,ȱ SugarȬfreeȱRedȱ 17ȱsubjectsȱȱ(9ȱmen,ȱ8ȱwomen,ȱ Noȱsignificantȱ Candowȱetȱal.ȱ doubleȬblind,ȱ crossȬ BullȱEnergyȱDrinkȱ(2ȱmg/kgȱcaffeine;ȱ meanȱageȱ21ȱy)ȱreceivedȱ differenceȱinȱrunȱtimeȬ 2009ȱ over,ȱ placeboȬ ~146ȱmgȱcaffeine)ȱ eitherȱsugarȬfreeȱRedȱBullȱ toȬexhaustion,ȱ controlledȱ ȱ energyȱdrinkȱorȱ perceivedȱexertionȱorȱ Placeboȱ(decaffeinated,ȱsugarȬfree,ȱ decaffeinated,ȱsugarȬfreeȱ calciumȱlactateȱbetweenȱ lemonȬlimeȱflavouredȱsoftȱdrink,ȱ placeboȱonȱ3ȱdaysȱofȱtesting,ȱ groups.ȱ tonicȱwater,ȱandȱlimeȱjuice)ȱ duringȱwhichȱtheyȱ performedȱphysicalȱactivity. ȱ Randomized,ȱ RedȱBullȱEnergyȱDrinkȱ(2ȱmg/kgȱ 15ȱsubjectsȱ(11ȱmen,ȱ4ȱ RedȱBullȱEnergyȱDrinkȱ Forbesȱetȱal.ȱ doubleȬblind,ȱ crossȬ caffeine;ȱ~146ȱmgȱcaffeine)ȱ women,ȱmeanȱageȱ21ȱy)ȱ significantlyȱincreasedȱ 2007ȱ over,ȱ placeboȬ ȱ receivedȱRedȱBullȱEnergyȱ upperȱbodyȱmuscleȱ controlledȱ Placeboȱ(isoenergetic,ȱisovolumetric,ȱ Drinkȱ(2ȱmg/kgȱcaffeine)ȱorȱ enduranceȱbutȱhadȱnoȱ nonȱcaffeinated)ȱ nonȬcaffeinatedȱplaceboȱ effectȱonȱanaerobicȱ ȱ separatedȱbyȱ7ȱdays.ȱMuscleȱ peakȱorȱaverageȱpower.ȱ ȱ enduranceȱassessedȱbyȱtheȱ ȱ maximumȱnumberȱofȱ repetitionsȱoverȱ3ȱsets.ȱThreeȱ Wingateȱcyclingȱtestsȱwereȱ usedȱtoȱassessȱpeakȱandȱ averageȱpowerȱoutput.ȱ ȱ ȱ Randomized,ȱ RedȱBullȱEnergyȱDrinkȱ(500ȱmlȱ 12ȱtrainedȱcyclistsȱ(6ȱmen,ȱ6ȱ Performanceȱ Ivyȱetȱal.ȱ2009ȱ doubleȬblind,ȱ crossȬ contains:ȱ2ȱgȱtaurine,ȱ1.2ȱgȱ women,ȱmeanȱageȱ27ȱy)ȱ significantlyȱimprovedȱ over,ȱ placeboȱ glucuronolactone,ȱ160ȱmgȱcaffeine,ȱ54ȱ consumedȱ500ȱmlȱofȱeitherȱ withȱenergyȱdrinkȱ controlledȱ gȱcarbohydrate,ȱ40ȱmgȱniacin,ȱ10ȱmgȱ placeboȱorȱRedȱBullȱEnergyȱ comparedȱtoȱplaceboȱ pantothenicȱacid,ȱ10ȱmgȱvitaminȱB6,ȱ Drinkȱ40ȱminutesȱbeforeȱ butȱnoȱdifferenceȱinȱ 10ȱugȱvitaminȱB12)ȱ simulatedȱcyclingȱtimeȱtrial.ȱ ratingȱofȱperceivedȱ ȱ exertionȱbetweenȱ Placeboȱ(500ȱmlȱcontains:ȱflavouredȱ treatments.ȱ drink)ȱ ȱ ȱ

www.intechopen.com Joel Rotstein, Jennifer Barber, Carl Strowbridge, Stephen Hayward, Rong Huang and Samuel Benrejeb Godefroy: 7 ȱ Energy Drinks: An Assessment of the Potential Health Risks in the Canadian Context !

Randomized,ȱ Unspecifiedȱenergyȱdrinkȱ(12ȱflȱozȱ 38ȱsubjectsȱ(male,ȱ18ȱȬ45ȱ Significantlyȱgreaterȱ Lockwoodȱetȱ doubleȬblind,ȱ contains:ȱcarbonatedȱwater,ȱcitricȱ yearsȱold)ȱreceivedȱenergyȱ decreasesȱinȱfatȱmassȱ al.ȱ2009ȱ placeboȬcontrolledȱ acid,ȱnaturalȱflavoursȱ(lemonȬlime),ȱ drinkȱ+ȱexercise,ȱenergyȱ andȱpercentageȱbodyȱ sucralose,ȱ60ȱmgȱvitaminȱC,ȱ1.7ȱmgȱ drink,ȱplacebo,ȱorȱplaceboȱ+ȱ fat,ȱasȱwellȱasȱpowerȱ riboflavin,ȱ20ȱmgȱniacin,ȱ2ȱmgȱ exerciseȱforȱ10ȱweeksȱ(1ȱdrinkȱ outputȱatȱventilatoryȱ vitaminȱB6,ȱ6ȱugȱvitaminȱB12,ȱ300ȱugȱ perȱday)ȱ thresholdȱwereȱ biotin,ȱ10ȱmgȱpantothenicȱacid,ȱ50ȱmgȱ observedȱinȱenergyȱ calcium,ȱ50ȱugȱchromium,ȱ6ȱmgȱ drinkȱ+ȱexerciseȱ sodium,ȱ1810ȱmgȱcombinedȱtaurine,ȱ comparedȱtoȱplaceboȱ+ȱ guaranaȱextract,ȱgreenteaȱleafȱextract,ȱ exercise.ȱ caffeine,ȱglucuronolactone,ȱgingerȱ extractȱ(totalȱ200ȱmgȱcaffeine))ȱ ȱ Placeboȱ(12ȱflȱozȱcontains:ȱcarbonatedȱ water,ȱcitricȱacid,ȱnaturalȱflavoursȱ (lemonȬlime),ȱsucralose)ȱ 1ȱTestȱmaterialȱcompositionȱisȱlistedȱasȱitȱisȱdescribedȱinȱtheȱpublishedȱreport.ȱ Tableȱ4.ȱStudiesȱinvestigatingȱenergyȱdrinksȱandȱexercise

3.4ȱȱ EnergyȱDrinksȱandȱAlcoholȱȱ AmericanȱcollegeȱstudentsȱbyȱO’Brienȱetȱal.ȱ(2008)ȱfoundȱ thatȱinȱcomparisonȱtoȱthoseȱwhoȱconsumedȱalcoholȱalone,ȱ Dueȱ toȱ concernsȱ withȱ theȱ combinationȱ ofȱ energyȱ drinksȱ studentsȱ whoȱ consumedȱ alcoholȱ mixedȱ withȱ energyȱ andȱalcohol,ȱHealthȱCanadaȱhasȱrecommendedȱsinceȱ2004,ȱ drinksȱ hadȱ aȱ significantlyȱ higherȱ prevalenceȱ ofȱ alcoholȬ theȱdateȱofȱlicensingȱofȱtheȱfirstȱEnergyȱDrinksȱasȱNHPs,ȱ relatedȱ consequences,ȱ including:ȱ beingȱ takenȱ advantageȱ thatȱ theseȱ productsȱȱshouldȱ notȱ beȱ mixedȱ withȱ alcoholȱ of,ȱ orȱ takingȱ advantageȱ ofȱ anotherȱ studentȱ sexually,ȱ (HealthȱCanada:ȱIt’sȱYourȱHealthȱ2010).ȱNonetheless,ȱtheȱ ridingȱinȱanȱautomobileȱwithȱaȱdriverȱunderȱtheȱinfluenceȱ ingestionȱ ofȱ energyȱ drinksȱ withȱ alcoholȱ hasȱ becomeȱ ofȱ alcohol,ȱ orȱ beingȱ hurtȱ orȱ injured.ȱ Inȱ addition,ȱ mixingȱ increasinglyȱ popularȱ (Healthȱ Canada:ȱ It’sȱ Yourȱ Healthȱ energyȱdrinksȱwithȱalcoholȱwasȱassociatedȱwithȱincreasedȱ 2010).ȱ Aȱ surveyȱ ofȱ 496ȱ Americanȱ collegeȱ studentsȱ heavyȱ episodicȱ drinkingȱ andȱ episodesȱ ofȱ weeklyȱ examinedȱ theȱ frequencyȱ ofȱ energyȱ drinkȱ useȱ forȱ sixȱ drunkenness.ȱ Thombsȱ etȱ al.ȱ (2010)ȱ conductedȱ aȱ fieldȱ “situations”:ȱ insufficientȱ sleep,ȱ toȱ increaseȱ energy,ȱ whileȱ studyȱ inȱ aȱ U.S.ȱ barȱ district,ȱ interviewingȱ 802ȱ randomlyȱ studying,ȱ drivingȱ longȱ periodsȱ ofȱ time,ȱ drinkingȱ withȱ selectedȱ andȱ selfȬselectedȱ participantsȱ andȱ foundȱ thatȱ alcohol,ȱ andȱ toȱ treatȱ hangover.ȱ Theȱ majorityȱ ofȱ usersȱ thoseȱwhoȱmixedȱenergyȱdrinksȱwithȱalcoholȱwereȱatȱaȱ3Ȭ consumedȱ oneȱ energyȱ drinkȱ toȱ treatȱ mostȱ situationsȱ foldȱriskȱofȱleavingȱaȱbarȱhighlyȱintoxicatedȱasȱwellȱasȱaȱ4Ȭ (namely,ȱ hangover,ȱ insufficientȱ sleep,ȱ increaseȱ energy,ȱ foldȱ riskȱ ofȱ intendingȱ toȱ driveȱ uponȱ leavingȱ theȱ barȱ drivingȱ aȱ carȱ forȱ aȱ longȱ periodȱ ofȱ time)ȱ althoughȱ usingȱ district,ȱcomparedȱtoȱthoseȱwhoȱdidȱnotȱmixȱalcoholȱwithȱ threeȱorȱmoreȱtoȱdrinkȱwithȱalcoholȱwhileȱpartyingȱwasȱaȱ energyȱdrinks.ȱ commonȱ practiceȱ (49%)ȱ (Malinauskasȱ etȱ al.ȱ 2007).ȱ Inȱ aȱ ȱ surveyȱ ofȱ 4271ȱ Americanȱ collegeȱ students,ȱ 24%ȱ (697ȱ students)ȱreportedȱconsumingȱenergyȱdrinksȱwithȱalcoholȱ Inȱ Germany,ȱ theȱ Federalȱ Instituteȱ forȱ Riskȱ Assessmentȱ (O’Brienȱetȱal.ȱ2008).ȱAȱsummaryȱofȱstudiesȱinvestigatingȱ (BfR)ȱ recommendsȱ thatȱ “adverseȱ effectsȱ cannotȱ beȱ ruledȱ theȱ useȱ ofȱ energyȱ drinksȱ andȱ alcoholȱ canȱ beȱ foundȱ inȱ outȱ whenȱ largerȱ amountsȱ ofȱ theseȱ beveragesȱ areȱ Tableȱ5ȱbelow.ȱ consumedȱinȱconjunctionȱwithȱintensiveȱphysicalȱactivityȱ ȱ orȱwithȱtheȱintakeȱofȱalcoholȱbeverages”.ȱTheȱBfRȱlookedȱ Basicȱ physiologyȱ suggestsȱ thatȱ theȱ carbonationȱ ofȱ theȱ atȱcaseȱreportsȱfromȱtheirȱSwedishȱregulatoryȱcounterpart,ȱ energyȱ drinkȱ permitsȱ aȱ quickerȱ absorptionȱ ofȱ alcoholȱ theȱNationalȱFoodȱAdministration.ȱInformationȱobtainedȱ whileȱ theȱ caffeineȱ ofȱ theȱ energyȱ drinkȱ mayȱ maskȱ theȱ fromȱtheȱSwedishȱliteratureȱsearchȱisȱdescribedȱinȱTableȱ6ȱ drowsinessȱ associatedȱ withȱ alcoholȱ intake.ȱ Althoughȱ below.ȱ thereȱ isȱlittleȱ directȱevidenceȱforȱit,ȱwhenȱ mixingȱ energyȱ ȱ drinksȱ andȱ alcohol,ȱ usersȱ mayȱ notȱ feelȱ theȱ symptomsȱ ofȱ alcoholȱintoxicationȱwhichȱmayȱincreaseȱtheȱpotentialȱforȱ alcoholȬrelatedȱinjuryȱ(Ferreiraȱetȱal.,ȱ2006)2.ȱAȱsurveyȱofȱ

ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ 2ȱWhileȱ thisȱ manuscriptȱ wasȱ inȱ preparation,ȱ aȱ studyȱ wasȱ publishedȱwhichȱsuggestedȱthatȱenergyȱdrinksȱdidȱnotȱmaskȱtheȱ effectȱ ofȱ alcoholȱ (Alfordȱ etȱ al.,ȱ 2012).ȱ Asȱ well,ȱ aȱ statementȱ wasȱ publishedȱ byȱ theȱ Committeeȱ onȱ Toxicity(UK)ȱ 2012,ȱ whichȱ concludedȱthatȱtheȱlimitedȱcurrentlyȱavailableȱevidenceȱdoesȱnotȱ supportȱaȱharmfulȱinteractionȱbetweenȱalcoholȱandȱcaffeine.ȱ

8 Int. food risk anal. j., 2013, Vol. 3, 4:2013 www.intechopen.com ȱ !

ȱ StudyȱDesignȱ Testȱmaterialȱ1ȱ Methods Results Study Randomized,ȱ GreenȱMonsterȱ(16ȱozȱ27ȱfemaleȱsubjectsȱ(meanȱ Energyȱdrinkȱplusȱalcoholȱsignificantlyȱloweredȱ Curryȱandȱ doubleȬblind,ȱ contains:ȱ160ȱmgȱ age:ȱ22ȱyears)ȱconsumedȱ postȬtestȱperformanceȱonȱaȱglobalȱscoreȱofȱ Stasioȱ2009ȱ placeboȬ caffeine,ȱ52ȱgȱsugar,ȱ GreenȱMonsterȱenergyȱ neuropsychologicalȱstatus,ȱspecificallyȱ controlledȱ 2000ȱmgȱtaurine,ȱ400ȱ drinkȱaloneȱ(1ȱdrink),ȱ visuospatial/ȱconstructionalȱandȱlanguageȱ mgȱginseng,ȱunstatedȱ withȱalcohol,ȱorȱaȱnonȬ performanceȱscores.ȱ amountȱofȱguarana)ȱ alcoholic,ȱnonȬ ȱ caffeinatedȱcontrol.ȱ Alcoholic,ȱ caffeinatedȱȱbeverageȱ (16ȱozȱcontainsȱ:ȱȱ6%ȱ alcohol,ȱ87ȱmgȱ caffeine,ȱ47ȱgȱsugar,ȱ unstatedȱamountsȱofȱ taurine,ȱginsengȱandȱ guarana)ȱ ȱ NonȬalcoholic,ȱnonȬ caffeinatedȱbeverageȱ (16ȱozȱcontainsȱ:ȱ5ȱgȱ sugar)ȱ Randomized,ȱ RedȱBullȱenergyȱ 26ȱmaleȱsubjectsȱ(meanȱ Whenȱcomparedȱtoȱtheȱingestionȱofȱalcoholȱalone,ȱ Ferreiraȱetȱal.ȱ doubleȬblindȱ drinkȱ(250ȱml/can)ȱ ageȱ23ȱy)ȱreceivedȱRedȱ theȱingestionȱofȱalcoholȱ+ȱenergyȱdrinkȱsignificantlyȱ 2006ȱ BullȱEnergyȱdrinkȱ(1ȱ reducedȱsubjects’ȱperceptionȱofȱheadache,ȱ can)ȱplusȱvodkaȱ(0.6ȱ weakness,ȱdryȱmouth,ȱandȱimpairmentȱofȱmotorȱ g/kgȱorȱ1ȱg/kg)ȱorȱ coordination.ȱ alcoholȱaloneȱorȱenergyȱ drinkȱalone.ȱ Unspecifiedȱenergyȱ 496ȱUSȱcollegeȱstudentsȱ Theȱmajorityȱofȱusersȱreportedȱconsumingȱenergyȱ Malinauskasȱ Surveyȱandȱfieldȱ drinksȱ completedȱ drinksȱforȱinsufficientȱsleepȱ(67%),ȱtoȱincreaseȱ etȱal.ȱ2007ȱ testȱ questionnairesȱ energyȱ(65%),ȱandȱtoȱdrinkȱalcoholȱwhileȱpartyingȱ (54%).ȱCommonȱpracticeȱtoȱdrinkȱ3ȱorȱmoreȱenergyȱ drinksȱwithȱalcoholȱ(49%).ȱWeeklyȱjoltȱandȱcrashȱ episodesȱwereȱexperiencedȱbyȱ29%ȱofȱtheȱusers,ȱ 22%ȱreportedȱeverȱhavingȱheadaches,ȱandȱ19%ȱ heartȱpalpitationsȱfromȱconsumingȱenergyȱdrinks.ȱ WebȬbasedȱ Unspecifiedȱenergyȱ Surveyȱwasȱconductedȱ 697ȱstudentsȱ(24%)ȱreportedȱconsumingȱalcoholȱ O’Brienȱetȱal.ȱ randomȱ sampleȱ drinksȱ inȱ4271ȱcollegeȱstudentsȱ withȱenergyȱdrinks.ȱStudentsȱwhoȱwereȱmale,ȱ 2008ȱ surveyȱ fromȱ10ȱuniversitiesȱinȱ white,ȱintramuralȱathletes,ȱfraternityȱorȱsororityȱ NorthȱCarolinaȱ membersȱorȱpledges,ȱandȱyoungerȱwereȱ significantlyȱmoreȱlikelyȱtoȱconsumeȱalcoholȱwithȱ energyȱdrinks.ȱConsumptionȱofȱenergyȱdrinksȱwithȱ alcoholȱwasȱassociatedȱwithȱsignificantlyȱincreasedȱ heavyȱepisodicȱdrinking,ȱandȱtwiceȱasȱmanyȱ episodesȱofȱweeklyȱdrunkenness.ȱStudentsȱ consumingȱalcoholȱwithȱenergyȱdrinksȱalsoȱhadȱ significantlyȱhigherȱprevalenceȱofȱalcoholȬrelatedȱ consequences.ȱ Unspecifiedȱenergyȱ 450ȱcollegeȱstudentsȱ 56.9%ȱstudentsȱdeclaredȱusingȱenergyȱdrinks.ȱ Oteriȱetȱal.ȱ Questionnaireȱ drinksȱ filledȱoutȱtheȱ 48.4%ȱofȱusersȱfrequentlyȱassociatedȱenergyȱdrinksȱ 2007ȱ questionnaireȱ withȱalcohol.ȱ Randomized,ȱ Unspecifiedȱenergyȱ 802ȱpatronsȱfromȱ7ȱbarsȱ 3Ȭfoldȱincreasedȱriskȱofȱleavingȱaȱbarȱhighlyȱ Thombsȱetȱal.ȱ fieldȱinterviewȱ drinksȱ overȱ4ȱconsecutiveȱ intoxicatedȱandȱ4Ȭfoldȱincreasedȱriskȱofȱintendingȱ 2010ȱ nights.ȱEveryȱ3rdȱpatronȱ toȱdriveȱuponȱleavingȱtheȱbarȱdistrict,ȱcomparedȱtoȱ exitingȱbarȱwasȱ patronsȱwhoȱdidȱnotȱmixȱenergyȱdrinksȱwithȱ approached.ȱ alcohol.ȱ 1ȱTestȱmaterialȱcompositionȱisȱlistedȱasȱitȱisȱdescribedȱinȱtheȱpublishedȱreport.ȱ Tableȱ5.ȱStudiesȱinvestigatingȱtheȱenergyȱdrinksȱconsumedȱwithȱalcoholȱ

ȱ ȱ

www.intechopen.com Joel Rotstein, Jennifer Barber, Carl Strowbridge, Stephen Hayward, Rong Huang and Samuel Benrejeb Godefroy: 9 ȱ Energy Drinks: An Assessment of the Potential Health Risks in the Canadian Context !

Subjectȱ Productȱ Effectsȱ Outcome 20,ȱ 2010ȱandȱ foundȱ 61ȱadverseȱ reactionsȱassociatedȱwithȱ 6ȱdrinksȱ 5 Death;ȱclearȱ theȱ consumptionȱ ofȱ energyȱ drinks. ȱ ThirtyȬtwoȱ ofȱ theseȱ Femaleȱ madeȱfromȱ Hemorrhagicȱ causeȱnotȱ reactionsȱareȱconsideredȱ“serious”,ȱ15ȱofȱwhichȱinvolvedȱ 19ȱyȱ RedȱBullȱandȱ pulmonaryȱedemaȱ establishedȱ theȱ cardiacȱ systemȱ (arrhythmia,ȱ increasedȱ heartȱ rate,ȱ vodkaȱ palpitationsȱandȱchestȱpain).ȱSixȱofȱtheseȱ15ȱcardiacȱeventsȱ DrankȱRedȱ Lossȱofȱresponsiveness,ȱ Death;ȱclearȱ Femaleȱ occurredȱinȱindividualsȱagedȱ13Ȭ17ȱyears.ȱBasedȱonȱtheseȱ Bullȱplusȱ collapse,ȱventricularȱ causeȱnotȱ 31ȱyȱ vodkaȱ fibrillationȱ establishedȱ reports,ȱ analysisȱ ofȱ availableȱ scientificȱ literature,ȱ MHPDȱ 6 Acuteȱseizures,ȱ detectedȱ aȱ safetyȱ signal ȱ indicatingȱ anȱ associationȱ DrankȱRedȱ Unknown,ȱ Maleȱȱ20ȱ epilepsyȱasȱchildȱbutȱ betweenȱ adverseȱ cardiacȱ eventsȱ andȱtheȱ consumptionȱofȱ Bullȱplusȱ clearȱcauseȱnotȱ yȱ noȱfurtherȱattacksȱsinceȱ energyȱ drinks.ȱ Almostȱ allȱ ofȱ theȱ reportsȱ areȱ inȱ healthyȱ vodkaȱ establishedȱ 8ȱyȱ youngȱ individualsȱ withoutȱ concurrentȱ diseaseȱ orȱ Tableȱ6.ȱSwedishȱcaseȱreportsȱinvestigatingȱenergyȱdrinksȱmixedȱ medications.ȱ Therefore,ȱ alternativeȱ causesȱ suchȱ asȱ withȱalcoholicȱbeveragesȱ underlyingȱdiseaseȱorȱdrugȱinteractionȱwereȱnotȱapparent.ȱ Fourȱ(4)ȱadverseȱcardiacȱreactionsȱwereȱassessedȱtoȱbeȱofȱ Inȱadditionȱtoȱalcoholȱconsumption,ȱenergyȱdrinksȱmayȱbeȱ probableȱcausalityȱandȱ8ȱwereȱassessedȱtoȱbeȱofȱpossibleȱ usedȱ alongȱ withȱ prescriptionȱ medicationȱ andȱ recreationalȱ causality,ȱ usingȱ theȱ WHOȱ causalityȱ assessmentȱ drugs.ȱ Diamondȱ etȱ al.ȱ (2000)ȱ demonstratedȱ thatȱ caffeineȱ algorithm6.ȱ Threeȱ adverseȱ reactions,ȱ includingȱ theȱ 2ȱ canȱ enhanceȱ theȱ effectȱ ofȱ certainȱ analgesics,ȱ includingȱ deathsȱthatȱwereȱassociatedȱwithȱenergyȱdrinks,ȱcouldȱnotȱ ibuprofen.ȱ Staibȱ etȱ al.ȱ (1987)ȱ advisedȱ thatȱ caffeineȱ intakeȱ beȱassessedȱbecauseȱofȱlackȱofȱinformation.ȱTheȱincidenceȱ shouldȱ beȱ reducedȱ inȱ individualsȱ prescribedȱ certainȱ ofȱcardiacȱeventsȱinȱtheȱhealthyȱyoungȱpopulationȱisȱrareȱ antibioticsȱ asȱ theyȱ mayȱ inhibitȱ theȱ eliminationȱ ofȱ caffeineȱ andȱ notȱ wellȱ characterizedȱ inȱ theȱ scientificȱ literature.ȱ Inȱ fromȱ theȱ body.ȱ Studiesȱ conductedȱ inȱ humansȱ showȱ thatȱ addition,ȱ theȱ absenceȱ ofȱ observationalȱ andȱ clinicalȱ trialȱ caffeineȱ producesȱ subjectiveȱ andȱ behaviouralȱ effectsȱ thatȱ dataȱonȱenergyȱdrinkȱuseȱpreventsȱaȱcomparisonȱbetweenȱ areȱsimilarȱtoȱthoseȱofȱtypicalȱpsychomotorȱstimulantȱdrugsȱ reactionsȱ associatedȱ withȱ theseȱ productsȱ andȱ theȱ thatȱ areȱ knownȱ toȱ beȱ dopaminergicallyȱ mediatedȱ (e.g.,ȱ backgroundȱincidenceȱofȱcardiacȱevents.ȱȱ amphetamines,ȱ cocaine).ȱ Caffeine,ȱ likeȱ amphetamineȱ andȱ ȱ cocaine,ȱ enhancesȱ feelingsȱ ofȱ wellȬbeing,ȱ motivationȱ forȱ Reportedȱadverseȱreactionsȱratesȱareȱknownȱtoȱbeȱunderȱ work,ȱ energy,ȱ andȱ concentration,ȱ delaysȱ sleep,ȱ andȱ ȱ enhancesȱ vigilanceȱ performanceȱ onȱ psychomotorȱ tasksȱ reported,ȱ particularlyȱ forȱ NHPs. ȱ Bothȱ consumersȱ andȱ (Garrettȱ&ȱGriffithsȱ1997).ȱȱ healthcareȱ practitioners,ȱ generallyȱ regardȱ NHPsȱ asȱ safeȱ ȱ andȱareȱusuallyȱunawareȱthatȱadverseȱreactionsȱcanȱoccurȱ Overall,ȱ theȱ evidenceȱ doesȱ notȱ conclusivelyȱ indicateȱ aȱ withȱ theseȱ productsȱ andȱ thatȱ theyȱ canȱ beȱ reportedȱ toȱ harmfulȱ toxicologicalȱ interactionȱ betweenȱ energyȱ drinksȱ Healthȱ Canada.ȱ Evenȱ thoughȱ energyȱ drinksȱ haveȱ beenȱ andȱ alcohol.ȱ However,ȱ theȱ dataȱ areȱ limitedȱ andȱ thereȱ isȱ regulatedȱasȱNHPsȱ(thereforeȱhealthȱproducts,ȱsubjectȱtoȱ substantialȱuncertainty.ȱItȱwasȱnotedȱthatȱadverseȱeventsȱ adverseȱreactionȱreporting)ȱfromȱ2004ȱtoȱ2011;ȱtheyȱmayȱ associatedȱwithȱenergyȱdrinkȱandȱalcoholȱcoȬconsumptionȱ notȱ haveȱ beenȱ recognizedȱ asȱ such,ȱ givenȱ theȱ wayȱ theyȱ happenedȱ mostȱ frequentlyȱ withȱ youngȱ adults.ȱ Thisȱ haveȱ beenȱ madeȱ availableȱ (groceryȱ storesȱ nextȱ toȱ otherȱ affectedȱ subpopulationȱ isȱ relativelyȱ inexperiencedȱ asȱ beverages,ȱ convenienceȱ stores,ȱ gasȱ stations).ȱ Beingȱ alcoholȱ consumersȱ andȱ relativelyȱ susceptibleȱ toȱ peerȱ perceivedȱ asȱ beveragesȱ (i.e.ȱ food)ȱ didȱ notȱ supportȱ pressure.ȱ Theȱ adviceȱ toȱ recommendȱ notȱ toȱ mixȱ energyȱ consistentȱ adverseȱ reactionȱ reportingȱ associatedȱ withȱ drinksȱ andȱ alcoholȱ couldȱ thereforeȱ beȱ arguedȱ toȱ beȱ aȱ theseȱproducts.ȱȱ prudentȱsafetyȱmeasure.3ȱ ȱ 3.5ȱȱ Canadianȱadverseȱreactionȱreportsȱ Whileȱtheseȱadverseȱreactionsȱareȱimportantȱtoȱnote,ȱtheyȱareȱ toȱ beȱ putȱ intoȱ perspective,ȱ consideringȱ theȱ comparativelyȱ Healthȱ Canada’sȱ Marketedȱ Healthȱ Productsȱ Directorateȱ smallȱ numberȱofȱ reportedȱadverseȱ reactionsȱinȱviewȱ ofȱ theȱ (MHPD)ȱ conductedȱ aȱ searchȱ ofȱ theȱ Canadaȱ Vigilanceȱ numberȱ ofȱ productȱ unitsȱ soldȱ (aroundȱ 91ȱ millionȱ unitsȱ inȱ AdverseȱReactionȱDatabase4ȱfromȱJanuaryȱ01,ȱ1965ȱtoȱJulyȱ Canadaȱ perȱ year,ȱ accordingȱ toȱ 2009ȱ ACNielsenȱ data).ȱ Thisȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ comparisonȱisȱanȱoverȬsimplification.ȱItȱwouldȱbeȱbetterȱtoȱ 3 ȱWhileȱthisȱmanuscriptȱwasȱinȱpreparation,ȱtheȱUKȱCommitteeȱ compareȱ theȱ numberȱ ofȱ adverseȱ effectsȱ toȱ theȱ numberȱ ofȱ onȱ Toxicityȱ ofȱ Chemicalsȱ inȱ Food,ȱ Consumerȱ Productsȱ andȱ theȱ Environmentȱpublishedȱaȱstatementȱonȱtheȱinteractionȱofȱcaffeineȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ andȱ alcoholȱ (2012).ȱ Theȱ Committeeȱ concludedȱ thatȱ theȱ overallȱ product,ȱasȱneitherȱtheȱtotalȱnumberȱofȱreactionsȱoccurring,ȱnorȱtheȱ currentȱevidenceȱdoesȱnotȱsupportȱaȱharmfulȱinteractionȱbetweenȱ numberȱofȱpatientsȱexposedȱtoȱtheȱhealthȱproduct,ȱisȱknown.ȱ caffeineȱandȱalcohol.ȱHowever,ȱitȱstatesȱthatȱthereȱisȱsubstantialȱ 5ȱTheȱfirstȱauthorizedȱenergyȱdrinkȱwasȱRedȱBullȱinȱ2004.ȱ uncertaintyȱinȱthisȱconclusion.ȱ 6ȱ Aȱ signalȱ isȱ reportedȱ informationȱ onȱ aȱ possibleȱ causalȱ 4ȱTheȱnumberȱofȱadverseȱreportsȱinȱtheȱCanadaȱVigilanceȱAdverseȱ relationshipȱ betweenȱ anȱ adverseȱ eventȱ andȱ aȱ drug,ȱ theȱ ReactionȱDatabaseȱshouldȱnotȱbeȱusedȱasȱaȱbasisȱforȱdeterminingȱ relationshipȱ beingȱ unknownȱ orȱ incompletelyȱ documentedȱ theȱ incidenceȱ ofȱ aȱ reactionȱ orȱ forȱ estimatingȱ riskȱ ofȱ aȱ particularȱ previouslyȱ(WorldȱHealthȱOrganizationȱ1991).ȱ

10 Int. food risk anal. j., 2013, Vol. 3, 4:2013 www.intechopen.com ȱ !

consumersȱ ofȱ energyȱ drinks,ȱ butȱ atȱ thisȱ time,ȱ Canadianȱ products.ȱThisȱapproachȱwasȱtakenȱbecauseȱtheȱpublishedȱ consumptionȱdataȱareȱnotȱavailable.ȱNonetheless,ȱitȱcanȱbeȱ literatureȱ onȱ energyȱ drinksȱ wasȱ limitedȱ toȱ aȱ fewȱ clinicalȱ saidȱ thatȱ theȱ numberȱ ofȱ adverseȱ reactionsȱ reportedȱ toȱ studiesȱandȱcaseȱreports.ȱNoȱrelevantȱpreclinicalȱ(animal)ȱ Healthȱ Canadaȱ isȱ relativelyȱ smallȱ comparedȱ toȱ generalȱ studiesȱ haveȱ beenȱ conducted.ȱ Oneȱ studyȱ didȱ administerȱ anȱenergyȱdrinkȱtoȱmiceȱforȱupȱtoȱ13ȱweeksȱbutȱtheȱworkȱ consumption.ȱȱ wasȱnotȱconsideredȱtoȱbeȱusefulȱinȱtheȱsafetyȱassessment,ȱ sinceȱ theȱ amountȱ consumedȱ didȱ notȱ constituteȱ aȱ veryȱ 3.6ȱȱ Summaryȱȱ highȱ doseȱ ofȱ theȱ energyȱ drinkȱ (citedȱ inȱ EFSAȱ 2009).ȱ Inȱ contrast,ȱ thereȱ isȱ aȱ goodȱ biologicalȱ understandingȱ andȱ aȱ Energyȱ drinks,ȱ likeȱ otherȱ beveragesȱ containingȱ addedȱ broadȱ toxicologicalȱ databaseȱ forȱ manyȱ ofȱ theȱ individualȱ sugars,ȱ areȱ oftenȱ associatedȱ withȱ aȱ highȱ caloricȱ intake.ȱ ingredientsȱthatȱconstituteȱenergyȱdrinks.ȱTherefore,ȱthisȱ Theseȱ drinksȱ areȱ notȱ toȱ beȱ consideredȱ “sportsȱ drinks”ȱ asȱ approachȱwasȱalsoȱusedȱinȱthisȱhazardȱcharacterization.ȱȱ theyȱ containȱ atȱ leastȱ oneȱ ingredientȱ thatȱ isȱ aȱ stimulantȱ ȱ (caffeine).ȱ Despiteȱ someȱ studyȱ resultsȱ suggestingȱ thatȱ Energyȱ drinksȱ canȱ beȱ generallyȱ characterisedȱ asȱ energyȱ drinkȱ consumptionȱ priorȱ toȱ exerciseȱ mayȱ haveȱ containingȱ theȱ followingȱ ingredients:ȱ caffeine,ȱ taurine,ȱ someȱperformanceȱbenefits,ȱthereȱareȱconcerns,ȱasȱcaffeineȱ glucuronolactone,ȱ inositolȱ andȱ aȱ varietyȱ ofȱ Bȱ vitamins,ȱ mayȱdelayȱtheȱreturnȱtoȱaȱrestingȱheartȱrate.ȱLimitedȱstudyȱ includingȱ thiamine,ȱ niacin,ȱ vitaminȱ B6,ȱ vitaminȱ B12,ȱ resultsȱhaveȱshownȱincreasesȱinȱsystolicȱbloodȱpressureȱandȱ pantothenicȱacidȱandȱriboflavinȱ(asȱmentionedȱinȱTableȱ1).ȱ heartȱ rateȱ associatedȱ withȱ moderateȱ intakesȱ ofȱ energyȱ Theȱ dietaryȱ sources,ȱ nutritionalȱ aspectsȱ andȱ toxicityȱ ofȱ drinksȱ (2ȱ servings).ȱ However,ȱ acrossȱ theȱ variousȱ studies,ȱ theseȱingredientsȱareȱreviewedȱbelow.ȱȱ transitoryȱ changesȱ inȱ bloodȱ pressureȱ didȱ notȱ reachȱ 4.2ȱȱ Caffeineȱ hypersensitiveȱ levelsȱ withȱ consumptionȱ ofȱ energyȱ drinks.ȱ Theseȱ effectsȱ wereȱ deemedȱ toȱ beȱ similarȱ toȱ theȱ effectsȱ onȱ Caffeineȱ isȱ consumedȱ asȱ aȱ naturalȱ constituentȱ ofȱ coffee,ȱ bloodȱpressureȱdemonstratedȱinȱconjunctionȱwithȱcaffeineȱ tea,ȱchocolateȱandȱotherȱnaturalȱsources,ȱsuchȱasȱguaranaȱ intakeȱ(Riksenȱetȱal.,ȱ2009).ȱȱ andȱyerbaȱmate.ȱItȱisȱalsoȱusedȱasȱaȱfoodȱadditiveȱandȱisȱ ȱ presentȱinȱcertainȱcarbonatedȱsoftȱdrinks.ȱItȱisȱalsoȱpresentȱ Surveysȱalsoȱsuggestȱthatȱinȱsocialȱsettingsȱ(e.g.,ȱbars,ȱparties)ȱ inȱsomeȱtherapeuticȱproducts,ȱsuchȱasȱcoldȱremediesȱandȱ moderateȱ orȱ highȱ consumptionȱ ofȱ energyȱ drinksȱ withȱ allergyȱ medicines.ȱ Inȱ Canada,ȱ itȱ isȱ estimatedȱ thatȱ maleȱ alcoholȱisȱnotȱuncommon,ȱandȱcouldȱleadȱtoȱriskyȱbehaviourȱ andȱ femaleȱ adultsȱ haveȱ aȱ respectiveȱ meanȱ intakeȱ ofȱ 281ȱ sinceȱenergyȱdrinksȱmayȱmaskȱtheȱeffectsȱofȱalcohol.ȱThereȱ andȱ 230ȱ mgȱ ofȱ caffeineȱ perȱ dayȱ (Canadianȱ Communityȱ haveȱ beenȱ adverseȱ reactionsȱ associatedȱ withȱ theȱ Healthȱ Survey,ȱ 2004).ȱ Theseȱ amountsȱ areȱ aboutȱ threeȱ timesȱ theȱ 80ȱ mgȱ ofȱ caffeineȱ presentȱ inȱ aȱ singleȱ 250ȱ mlȱ consumptionȱ ofȱ energyȱ drinks,ȱ whetherȱ aloneȱ orȱ inȱ servingȱofȱaȱtypicalȱenergyȱdrink.ȱȱ combinationȱwithȱotherȱphysiologicallyȱactiveȱsubstances,ȱinȱ ȱ Canada.ȱOnlyȱ4ȱofȱtheȱ15ȱreportedȱcardiacȱadverseȱreactionsȱ Whenȱ aȱ singleȱ servingȱ ofȱ aȱ caffeinatedȱ beverageȱ wereȱ assessedȱ asȱ havingȱ aȱ probableȱ causality.ȱ Theȱ containingȱ 40Ȭ120ȱ mgȱ ofȱ caffeine7ȱ isȱ consumedȱ theȱ mainȱ significanceȱ ofȱ theseȱ reportedȱ adverseȱ reactionsȱ isȱ toȱ beȱ biologicalȱ effectȱ ofȱ caffeineȱ isȱ thatȱ itȱ actsȱ asȱ aȱ stimulantȱ discussedȱinȱtheȱcontextȱofȱtheirȱlimitedȱnumberȱversusȱtheȱ andȱpromotesȱalertness,ȱenhancesȱcognitiveȱperformance,ȱ numberȱofȱenergyȱdrinkȱunitsȱconsumedȱandȱtheȱabsenceȱofȱ relievesȱ fatigueȱ andȱ promotesȱ physicalȱ enduranceȱ observationalȱ andȱ clinicalȱ trialȱ data,ȱ whichȱ preventsȱ aȱ (DohertyȱandȱSmith,ȱ2004;ȱLoristȱandȱTops,ȱ2003;ȱAstorinoȱ comparisonȱ betweenȱ reactionsȱ associatedȱ withȱ theseȱ andȱ Robertson,ȱ 2010)ȱ Aȱ singleȱ servingȱ canȱ alsoȱ causeȱ productsȱandȱtheȱ“background”ȱincidenceȱofȱcardiacȱevents.ȱȱ transientȱ adverseȱ effects,ȱ suchȱ asȱ insomnia,ȱ headachesȱ ȱ andȱ nervousnessȱ inȱ caffeineȬsensitiveȱ individualsȱ Thereȱwereȱinsufficientȱtoxicologicalȱdataȱtoȱcharacterizeȱtheȱ (Nawrotȱetȱal.ȱ2003;ȱHigdonȱandȱFrei,ȱ2006).ȱȱ healthȱ hazardȱ associatedȱ withȱ energyȱ drinksȱ asȱ aȱ singleȱ ȱ product.ȱAsȱaȱconsequence,ȱtheȱmajorȱindividualȱingredientsȱ Inȱ anȱ extensiveȱ reviewȱ ofȱ theȱ literature,ȱ Healthȱ Canadaȱ wereȱ assessedȱ forȱ hazardȱ identificationȱ andȱ hazardȱ assessedȱmoreȱthanȱ300ȱstudiesȱthatȱexaminedȱtheȱpotentialȱ healthȱ effectsȱ ofȱ caffeineȱ (Nawrotȱ etȱ al.ȱ 2003).ȱ Itȱ wasȱ characterization,ȱ andȱ thisȱ wasȱ consideredȱ aȱ meansȱ toȱ gainȱ concludedȱthatȱaȱhealthyȱadultȱcouldȱtolerateȱaȱmaximumȱ insightȱintoȱtheȱhazardȱcharacterizationȱofȱenergyȱdrinks.ȱȱ intakeȱofȱ400ȱmgȱofȱcaffeineȱperȱdayȱ(equivalentȱtoȱ6ȱmg/kgȱ bw/dayȱforȱaȱ65ȱkgȱadult).ȱThisȱamountȱofȱcaffeineȱwasȱnotȱ 4.ȱAssessmentȱofȱIndividualȱIngredientsȱofȱEnergyȱDrinksȱ associatedȱ withȱ adverseȱ effectsȱ suchȱ asȱ generalȱ toxicity,ȱ 4.1ȱȱ Introductionȱ cardiovascularȱ effects,ȱ effectsȱ onȱ boneȱ status,ȱ changesȱ inȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ Inȱotherȱjurisdictions,ȱtheȱapproachȱusedȱforȱassessmentsȱ 7ȱGenerally,ȱaȱservingȱofȱteaȱorȱcolaȱcanȱcontainȱaroundȱ40ȱmgȱofȱ onȱ energyȱ drinksȱ consideredȱ theȱ nutritionalȱ andȱ caffeineȱ whileȱ coffee,ȱ dependingȱ onȱ theȱ typeȱ andȱ brewingȱ toxicologicalȱaspectsȱofȱtheȱindividualȱingredientsȱinȱtheseȱ method,ȱcanȱcontainȱaroundȱ120ȱmgȱcaffeineȱandȱhigher.ȱ www.intechopen.com Joel Rotstein, Jennifer Barber, Carl Strowbridge, Stephen Hayward, Rong Huang and Samuel Benrejeb Godefroy: 11 ȱ Energy Drinks: An Assessment of the Potential Health Risks in the Canadian Context !

behaviour,ȱ effectsȱ onȱ maleȱ fertilityȱ orȱ increasedȱ incidenceȱ levelsȱ ofȱ taurineȱ areȱ relativelyȱ lowȱ comparedȱ withȱ theȱ ofȱcancerȱdevelopment.ȱ 1000ȱmgȱofȱtaurineȱpresentȱinȱaȱsingleȱservingȱofȱaȱtypicalȱ ȱ energyȱdrink.ȱȱ Further,ȱ theȱ assessmentȱ concludedȱ thatȱ reproductiveȬ ȱ agedȱ womenȱ couldȱ tolerateȱ aȱ maximumȱ intakeȱ ofȱ upȱ toȱ Taurineȱ isȱ alsoȱ synthesizedȱ inȱ theȱ liverȱ fromȱ theȱ aminoȱ 300ȱmgȱcaffeineȱperȱdayȱ(equivalentȱtoȱ4.6ȱmg/kgȱbw/dayȱ acidȱcysteine,ȱasȱwellȱasȱfromȱotherȱsulphurȱcompounds.ȱ forȱaȱ65ȱkgȱadult),ȱbasedȱonȱreproductiveȱconsiderationsȱ Itȱhasȱaȱroleȱinȱseveralȱbiologicalȱprocesses,ȱincludingȱtheȱ (spontaneousȱ abortion,ȱ retardedȱ fetalȱ growth).ȱ Finallyȱ formationȱ ofȱ bileȱ salt,ȱ cellȱ membraneȱ stability,ȱ theȱ children,ȱagedȱ4ȱtoȱ12ȱyears,ȱwereȱconsideredȱtoȱtolerateȱaȱ modulationȱ ofȱ calciumȱ flowȱ andȱ neuronalȱ excitabilityȱ maximumȱofȱ45ȱtoȱ85ȱmgȱofȱcaffeineȱperȱdayȱ(equivalentȱ (FSPBȱ 2002).ȱ Taurineȱ isȱ consideredȱ essentialȱ forȱ theȱ toȱ 2.5ȱ mg/kgȱ bw/dayȱ forȱ aȱ childȱ weighingȱ 18ȱ toȱ 34ȱ kg),ȱ normalȱ developmentȱ ofȱ infantsȱ andȱ consequentlyȱ itȱ isȱ aȱ basedȱonȱtransientȱmildȱbehaviourȱchanges.ȱȱ standardȱ ingredientȱ inȱ infantȱ formula,ȱ suchȱ thatȱ ȱ newbornsȱingestȱaboutȱ280ȱmgȱdailyȱ(equivalentȱtoȱaȱdoseȱ Thereȱ wereȱ insufficientȱ dataȱ toȱ recommendȱ aȱ dailyȱ ofȱ17ȱmg/kgȱbw/day).ȱȱ maximumȱintakeȱofȱcaffeineȱforȱadolescents,ȱagedȱ13ȱtoȱ18ȱ ȱ years.ȱ However,ȱ theȱ adultȱ recommendationȱ couldȱ beȱ Taurineȱ isȱ oneȱ ofȱ theȱ mostȱ abundantȱ aminoȱ acidsȱ inȱ theȱ consideredȱ inappropriateȱ sinceȱ manyȱ adolescentsȱ mayȱ humanȱ body.ȱ Itȱ isȱ presentȱ inȱ relativelyȱ highȱ amountsȱ inȱ haveȱaȱlighterȱbodyȱweightȱthanȱtheȱaverageȱadult.ȱMoreȱ skeletalȱ andȱ cardiacȱ muscleȱ (Timbrellȱ etȱ al.,ȱ 1995)ȱ andȱ importantly,ȱ adolescentsȱ areȱ lessȱ developedȱ thanȱ adultsȱ evidenceȱ inȱ experimentalȱ animalsȱ suggestsȱ thatȱ itȱ isȱ andȱ theirȱ growingȱ bodiesȱ mayȱ beȱ moreȱ susceptibleȱ toȱ essentialȱ toȱ normalȱ muscleȱ maintenanceȱ andȱ functionȱ adverseȱeffectsȱofȱcaffeine.ȱOneȱauthorȱhasȱsuggestedȱthatȱ (Warskulatȱetȱal.,ȱ2007).ȱLimitedȱliteratureȱhasȱsuggestedȱ caffeineȱ mayȱ adverselyȱ affectȱ theȱ growingȱ adolescentȱ thatȱtaurineȱsupplementsȱmayȱhaveȱaȱbeneficialȱeffectȱinȱ brainȱ (Templeȱ 2009).ȱ Alternatively,ȱ adolescentsȱ mayȱ beȱ personsȱ withȱ congestiveȱ heartȱ failure,ȱ hypertension,ȱ lessȱhabituatedȱtoȱconsumingȱcaffeineȱandȱthereforeȱmayȱ diabetesȱandȱskeletalȱmuscleȱdisordersȱ(referencesȱcitedȱinȱ beȱ moreȱ susceptible.ȱ Inȱ anyȱ case,ȱ thereȱ isȱ substantialȱ Bouknoogheȱetȱal.,ȱ2006;ȱShaoȱandȱHathcock,ȱ2008).ȱȱ uncertaintyȱ asȱ toȱ whetherȱ theȱ adultȱ recommendationȱ ȱ shouldȱbeȱapplied.ȱAsȱaȱprecaution,ȱitȱwouldȱbeȱprudentȱ Humanȱ studiesȱ suggestȱ thatȱ taurineȱ isȱ readilyȱ absorbedȱ toȱȱrecommendȱthatȱanȱadolescentȱhaveȱaȱdailyȱintakeȱofȱ fromȱ consumedȱ foodȱ andȱ thatȱ plasmaȱ levelȱ ofȱ taurineȱ caffeineȱ noȱ greaterȱ thanȱ theȱ amountȱ calculatedȱ fromȱ theȱ peakȱ withinȱ anȱ hourȱ afterȱ ingestionȱ (SCFȱ 2003).ȱ Thisȱ doseȱ usedȱ toȱ determineȱ theȱ recommendedȱ maximalȱ observationȱ isȱ consistentȱ withȱ theȱ findingsȱ ofȱ aȱ studyȱ intakeȱforȱchildrenȱ(2.5ȱmg/kgȱbw/day)ȱandȱtheȱindividualȱ whereȱ ratsȱ receivedȱ taurineȱ asȱ aȱ singleȱ oralȱ doseȱ ofȱ 300ȱ adolescentȱ bodyȱ weightȱ (estimatedȱ rangeȱ ofȱ adolescentȱ mg/kgȱbw.ȱItȱwasȱobservedȱthatȱtheȱexogenousȱtaurineȱisȱ bodyȱ weights:ȱ 40Ȭ70ȱ kg).ȱ Thisȱ doseȱ wouldȱ suggestȱ thatȱ quicklyȱ absorbedȱ intoȱ theȱ body,ȱ equilibratesȱ withȱ adolescentsȱ couldȱ consumeȱ 100ȱ toȱ 175ȱ mgȱ ofȱ caffeineȱ endogenousȱpoolsȱofȱtaurineȱandȱthatȱexcessȱamountsȱareȱ daily,ȱ dependingȱ onȱ theȱ individualȱ bodyȱ weightȱ ofȱ theȱ rapidlyȱeliminatedȱbyȱtheȱkidneys.ȱTheȱstudyȱalsoȱshowedȱ adolescent.ȱȱ thatȱ aȱ 14Ȭdayȱ repeatȱ treatmentȱ withȱ taurineȱ didȱ notȱ ȱ changeȱ theȱ fateȱ ofȱ theȱ lastȱ singleȱ oralȱ doseȱ (Svedȱ etȱ al.ȱ Itȱ shouldȱ beȱ notedȱ thatȱ allȱ ofȱ theseȱ recommendedȱ 2007),ȱ whichȱ suggestsȱ thatȱ theȱ bodyȱ canȱ metabolicallyȱ maximumȱ intakesȱ ofȱ caffeineȱ areȱ consideredȱ aȱ dailyȱ handleȱrelativelyȱlargeȱamountsȱofȱtaurineȱdaily.ȱ amountȱ thatȱ wouldȱ beȱ theȱ resultȱ ofȱ cumulativeȱ ȱ consumptionȱ throughoutȱ theȱ day.ȱ Theȱ ingestionȱ ofȱ theȱ Theȱacuteȱoralȱtoxicityȱofȱtaurineȱisȱconsideredȱrelativelyȱ dailyȱmaximumȱintakeȱinȱaȱbriefȱperiodȱofȱtime,ȱthatȱisȱ low,ȱ suchȱ thatȱ noȱ adverseȱ effectsȱ haveȱ beenȱ observedȱ 1Ȭ2ȱ hours,ȱ mayȱ causeȱ adverseȱ reactions,ȱ suchȱ asȱ followingȱaȱsingleȱadministrationȱinȱratsȱupȱtoȱ7000ȱmg/kgȱ insomnia,ȱheadache,ȱstomachȱache,ȱnervousness,ȱnauseaȱ bwȱorȱinȱhumansȱupȱtoȱ150ȱmg/kgȱbwȱ(equalȱtoȱ10,500ȱmgȱ orȱ moreȱ seriousȱ reactions.ȱ Forȱ example,ȱ studiesȱ haveȱ forȱaȱ70ȱkgȱadult).ȱȱ shownȱ thatȱ aȱ singleȱ ingestionȱ ofȱ moreȱ thanȱ 250ȱ mgȱ ofȱ ȱ caffeineȱbyȱaȱhealthyȱadultȱcanȱalsoȱcauseȱanȱincreaseȱinȱ InȱshortȬtermȱstudiesȱwithȱhumanȱsubjects,ȱtheȱingestionȱ bloodȱpressureȱ(MaughanȱandȱGriffin,ȱ2003)ȱwhileȱmoreȱ ofȱ upȱ toȱ 6000ȱ mgȱ perȱ dayȱ forȱ 42ȱ daysȱ andȱ 1500ȱ mgȱ perȱ thanȱ 450ȱ mgȱ ofȱ caffeineȱ mayȱ resultȱ inȱ tachycardiaȱ dayȱ forȱ 90ȱ daysȱ showedȱ noȱ evidenceȱ ofȱ adverseȱ effectsȱ (Nawrotȱetȱal.ȱ2003).ȱȱ (SCFȱ 2003).ȱ Inȱ aȱ 90Ȭdayȱ studyȱ inȱ rats,ȱ taurineȱ wasȱ 4.3ȱȱ Taurineȱ administeredȱ byȱ gavageȱ toȱ groupsȱ ofȱ animalsȱ (20ȱ animals/sex/dose)ȱ atȱ dosesȱ ofȱ 0,ȱ 300,ȱ 600ȱ orȱ 1000ȱ mg/kgȱ Taurineȱisȱanȱaminoȱacidȱthatȱisȱnaturallyȱpresentȱinȱtheȱ bw/day.ȱ Noȱ taurineȬrelatedȱ changesȱ ofȱ standardȱ diet.ȱ Specifically,ȱ itȱ isȱ foundȱ inȱ meatȱ andȱ seafood.ȱ toxicologicalȱ parametersȱ wereȱ observed.ȱ Theȱ exceptionȱ Estimatesȱofȱhumanȱdailyȱintakeȱofȱtaurineȱrangeȱfromȱ40ȱ wasȱ aȱ doseȬrelatedȱ behaviouralȱ changeȱ (increasedȱ mgȱtoȱ400ȱmgȱ(HayesȱandȱTrautweinȱ1994).ȱTheseȱdietaryȱ activity,ȱselfȬinjury)ȱthatȱwasȱobservedȱinȱallȱthreeȱtreatedȱ

12 Int. food risk anal. j., 2013, Vol. 3, 4:2013 www.intechopen.com ȱ !

groupsȱ andȱ inȱ bothȱ sexesȱ ofȱ theȱ testȱ animalȱ (SCFȱ 2003).ȱ 4.4ȱȱ DȬGlucuronoȬ·Ȭlactoneȱ Subsequently,ȱ aȱ secondȱ 90Ȭdayȱ studyȱ wasȱ conducted,ȱ whereȱtaurineȱwasȱadministeredȱbyȱgavageȱtoȱgroupsȱofȱ DȬGlucuronoȬ·Ȭlactoneȱ (glucuronolactone)ȱ isȱ theȱ·Ȭ ratsȱ(20ȱanimals/sex/dose)ȱatȱdosesȱofȱ0,ȱ600ȱorȱ1000ȱmg/kgȱ lactoneȱ ofȱ glucuronicȱ acid.ȱ Itȱ isȱ aȱ normalȱ humanȱ bw/day,ȱ andȱ anotherȱ setȱ ofȱ ratsȱ (20ȱ animals/sex/dose)ȱ metaboliteȱandȱformedȱfromȱglucoseȱandȱglucuronicȱacid.ȱ receivedȱtaurineȱinȱdrinkingȱwaterȱatȱdosesȱofȱ0,ȱ1000ȱorȱ Itȱseemsȱtoȱbeȱfoundȱnaturallyȱinȱonlyȱaȱsmallȱnumberȱofȱ 1500ȱmg/kgȱbw/day.ȱInȱadditionȱtoȱstandardȱtoxicologicalȱ foodsȱsuchȱasȱwineȱandȱplantȱgumsȱ(e.g.ȱguarȱgum,ȱgumȱ parameters,ȱ aȱ functionalȱ observationalȱ batteryȱ andȱ Arabic).ȱ Anȱ estimateȱ ofȱ theȱ meanȱ dailyȱ intakeȱ isȱ 1.2ȱ locomotorȱ activityȱ dataȱ wereȱ collectedȱ atȱ 0,ȱ 6ȱ andȱ 12ȱ mg/dayȱ andȱ aȱ highȱ dailyȱ intakeȱ isȱ suggestedȱ toȱ beȱ 2.3ȱ weeksȱofȱtheȱstudyȱandȱconductedȱinȱaȱblindȱmannerȱ(theȱ mg/dayȱ (SCFȱ 1999).ȱ Theseȱ intakeȱ valuesȱ areȱ veryȱ smallȱ previousȱ 90Ȭdayȱ study’sȱ findingsȱ wereȱ arguedȱ byȱ theȱ whenȱcomparedȱtoȱtheȱintakeȱofȱglucuronolactoneȱofȱ600ȱ study’sȱauthorȱtoȱbeȱbiasedȱsinceȱtheyȱwereȱnotȱblinded).ȱ mgȱfromȱtheȱconsumptionȱofȱaȱsingleȱservingȱofȱaȱtypicalȱ Theȱ resultsȱ indicatedȱ thatȱ thereȱ wereȱ noȱ taurineȬrelatedȱ energyȱ drink.ȱ Itȱ isȱ claimedȱ thatȱ glucuronolactoneȱ isȱ aȱ deaths,ȱ clinicalȱ toxicities,ȱ bodyȱ weightȱ changes,ȱ foodȱ orȱ quickȱenergyȱsourceȱandȱmayȱassistȱinȱtheȱdetoxificationȱ waterȱ consumptionȱ differences,ȱ orȱ macroscopicȱ changes.ȱ ofȱxenobioticsȱ(SCFȱ1999).ȱ Theȱ functionalȱ observationalȱ batteryȱ andȱ locomotorȱ ȱ Humanȱ andȱ ratȱ studiesȱ showȱ thatȱ whenȱ ingested,ȱ activityȱ dataȱ didȱ notȱ showȱ anyȱ taurineȬrelatedȱ effect.ȱ glucuronolactoneȱ isȱ rapidlyȱ absorbed,ȱ metabolisedȱ andȱ Thereȱ wereȱ noȱ adverseȱ behaviouralȱ effectsȱ observedȱ inȱ excretedȱ asȱ glucaricȱ acid,ȱ xylitolȱ andȱ LȬxylulose.ȱ Theseȱ thisȱsecondȱstudy.ȱAȱNOAELȱforȱtaurineȱwasȱestablishedȱ compoundsȱ areȱ notȱ consideredȱ toȱ beȱ toxicologicallyȱ atȱtheȱlevelȱofȱ1000ȱmg/kgȱbw/day,ȱbasedȱonȱtheȱhighestȱ doseȱ testedȱ inȱ theȱ firstȱ 90Ȭdayȱ study,ȱ whichȱ includedȱ aȱ significantȱ (ANZFAȱ 2001).ȱ Inȱ contrastȱ toȱ humans,ȱ miceȱ andȱ ratsȱ haveȱ anȱ additionalȱ metabolicȱ pathwayȱ thatȱ histopathologicalȱassessmentȱ(EFSAȱ2009).ȱȱ allowsȱthemȱtoȱuseȱglucuronicȱacidȱtoȱsynthesizeȱvitaminȱ ȱ Aȱ developmentalȱ toxicityȱ studyȱ inȱ miceȱ showedȱ thatȱ C.ȱ Rodentsȱ canȱ alsoȱ useȱ exogenousȱ glucuronolactoneȱ toȱ whenȱ orallyȱ administeredȱ atȱ aȱ doseȱ ofȱ 4000ȱ mg/kgȱ yieldȱ glucuronicȱ acidȱ andȱ thenȱ generateȱ vitaminȱ C.ȱ Thisȱ bw/dayȱ onȱ daysȱ 7ȱ toȱ 14ȱ ofȱ gestation,ȱ taurineȱ wasȱ notȱ aȱ additionalȱ pathwayȱ inȱ theȱ rodentȱ createdȱ someȱ teratogen,ȱthatȱis,ȱitȱdidȱnotȱcauseȱbirthȱdefectsȱ(Takahashiȱ uncertaintyȱwithȱrespectȱtoȱtheȱappropriatenessȱofȱrodentsȱ etȱal.ȱ1972).ȱȱ asȱ aȱ modelȱ forȱ humansȱ (SCFȱ 1999).ȱ However,ȱ furtherȱ ȱ examinationȱofȱtheȱissueȱhasȱdeterminedȱthatȱtheȱrodentȱ Inȱ theȱ additionalȱ studiesȱ conducted,ȱ taurineȱ hasȱ notȱ metabolicȱ pathwayȱ isȱ relativelyȱ minorȱ inȱ theȱ animal’sȱ shownȱanyȱmutagenicȱorȱgenotoxicȱpotentialȱinȱbacterialȱ handlingȱ ofȱ glucuronolactone,ȱ whichȱ suggestsȱ thatȱ orȱmammalianȱcellȱinȱvitroȱassayȱsystemsȱ(S.A.ȱLaidlawȱetȱ toxicologicalȱ resultsȱ fromȱ rodentsȱ areȱ relevantȱ toȱ theȱ al.ȱ1989;ȱR.ȱCossiȱetȱal.ȱ1995).ȱ humanȱsituationȱ(SCFȱ2003.ȱ ȱ ȱ ThereȱareȱnoȱlongȬtermȱtoxicityȱorȱcarcinogenicityȱstudiesȱ Theȱ acuteȱ oralȱ toxicityȱ ofȱ glucuronolactoneȱ isȱ veryȱ low,ȱ conductedȱtoȱassessȱtheȱcarcinogenicȱpotentialȱofȱtaurine;ȱ suchȱ thatȱ inȱ miceȱ theȱ oralȱ LD50ȱ isȱ greaterȱ thanȱ 20000ȱ however,ȱ thereȱ isȱ noȱ indicationȱ thatȱ taurineȱ isȱ aȱ mg/kgȱ bwȱ andȱ inȱ ratsȱ itȱ isȱ approximatelyȱ 11000ȱ mg/kgȱ carcinogenȱbasedȱonȱshortȬtermȱtoxicityȱstudies.ȱ bw.ȱTheȱshortȬtermȱoralȱtoxicityȱofȱglucuronolactoneȱwasȱ ȱ assessedȱ inȱ aȱ studyȱ whereȱ groupsȱ ofȱ ratsȱ (20ȱ Inȱoverȱthirtyȱstudiesȱwithȱadult,ȱchildȱandȱinfantȱsubjects,ȱ animals/sex/dose)ȱ wereȱ administeredȱ aȱ singleȱ dailyȱ theȱ useȱ ofȱ taurineȱ hasȱ notȱ demonstratedȱ anyȱ safetyȱ gavageȱdoseȱofȱ0,ȱ300,ȱ600ȱorȱ1000ȱmg/kgȱbw,ȱforȱupȱtoȱ90ȱ concerns.ȱMostȱofȱtheseȱstudiesȱinvolvedȱtheȱingestionȱofȱ daysȱ(SCFȱ2003).ȱTheȱresultsȱshowedȱnoȱtreatmentȬrelatedȱ taurineȱonȱaȱdailyȱbasisȱwithȱdosesȱinȱtheȱrangeȱofȱ3000ȱtoȱ deaths,ȱ noȱ significantȱ differenceȱ inȱ bodyȱ weights,ȱ foodȱ 6000ȱmgȱforȱperiodsȱofȱupȱtoȱoneȱmonthȱorȱlongerȱwithoutȱ consumption,ȱ hematologicalȱ orȱ clinicalȱ chemistryȱ anyȱapparentȱadverseȱhealthȱeffectsȱ(EFSAȱ2009).ȱȱ parameters.ȱ Urinalysisȱ showedȱ thatȱ malesȱ treatedȱ withȱ ȱ 1000ȱmg/kgȱbwȱgroupȱhadȱurineȱwithȱaȱlowerȱpHȱthanȱtheȱ Oneȱ doubleȬblindȱ studyȱ inȱ humanȱ volunteersȱ (14ȱ controlȱ group,ȱ andȱ malesȱ inȱ theȱ 600ȱ andȱ 1000ȱ mg/kgȱ subjects)ȱ showedȱ thatȱ aȱ combinationȱ ofȱ caffeineȱ andȱ groupsȱ hadȱ aȱ lowerȱ specificȱ gravityȱ thanȱ theȱ controlȱ taurine,ȱatȱlevelsȱpresentȱinȱaȱtypicalȱenergyȱdrink,ȱhadȱnoȱ group.ȱ Resultsȱ fromȱ histopathologicalȱ examinationȱ effectȱ onȱ shortȬtermȱ memory,ȱ asȱ indicatedȱ byȱ anȱ showedȱ vacuolisationȱ andȱ inflammatoryȱ changesȱ abbreviatedȱ versionȱ ofȱ aȱ standardȱ testȱ forȱ shortȬtermȱ localisedȱtoȱtheȱpapillaȱofȱtheȱkidneyȱinȱfemalesȱsuchȱthatȱ memory.ȱ However,ȱ thisȱ combinationȱ didȱ induceȱ aȱ atȱ dosesȱ ofȱ 0,ȱ 300,ȱ 600ȱ andȱ 1000ȱ mg/kgȱ bw/day,ȱ theȱ decreaseȱ inȱ heartȱ rateȱ andȱ anȱ increaseȱ inȱ meanȱ arterialȱ incidencesȱwereȱrespectivelyȱ11/20,ȱ9/20,ȱ11/20ȱandȱ11/20.ȱ bloodȱpressure.ȱThisȱfindingȱisȱunexpectedȱsinceȱcaffeineȱ TheȱincidenceȱofȱeffectȱwasȱnotȱdoseȬrelatedȱbutȱreviewersȱ generallyȱstimulatesȱheartȱrate.ȱFurtherȱinvestigationȱintoȱ ofȱtheȱstudyȱnotedȱthatȱtheȱseverityȱofȱthisȱkidneyȱlesionȱ theȱ combinationȱ ofȱ theseȱ twoȱ substancesȱ isȱ warrantedȱ showedȱanȱincreaseȱwithȱdose.ȱAtȱdosesȱofȱ0,ȱ300,ȱ600ȱandȱ (Bichlerȱetȱal.,ȱ2006).ȱ 1000ȱ mg/kgȱ bw/day,ȱ theȱ incidencesȱ ofȱ aȱ gradeȱ 2ȱ lesionȱ www.intechopen.com Joel Rotstein, Jennifer Barber, Carl Strowbridge, Stephen Hayward, Rong Huang and Samuel Benrejeb Godefroy: 13 ȱ Energy Drinks: An Assessment of the Potential Health Risks in the Canadian Context !

(mildȱseverity)ȱwereȱrespectivelyȱ1/20,ȱ1/20,ȱ5/20ȱandȱ8/20.ȱ Itsȱ useȱ wasȱ notȱ observedȱ toȱ causeȱ anyȱ adverseȱ effectsȱ Theȱ reviewersȱ concludedȱ thatȱ theȱ NOAELȱ forȱ theȱ studyȱ (KohlerȱandȱSchmidȱ1980).ȱ wasȱ300ȱmg/kgȱbw/day.ȱȱ ȱ 4.5ȱȱ Inositolȱ Inȱ aȱ secondȱ 90Ȭdayȱ studyȱ inȱ rats,ȱ theȱ toxicityȱ ofȱ Myoinositolȱ (inositol)ȱ isȱ aȱ constituentȱ ofȱ glucuronolactoneȱ wasȱ assessedȱ withȱ specificȱ focusȱ onȱ theȱ phosphatidylinositol,ȱ aȱ phospholipid,ȱ whichȱ playsȱ anȱ kidneysȱ (SCFȱ 2009).ȱ Theȱ previousȱ gavageȱ studyȱ wasȱ essentialȱroleȱinȱgrowth,ȱmetabolismȱregulationȱandȱsignalȱ repeatedȱ withȱ anȱ additionalȱ fourȱ setsȱ ofȱ animalsȱ (20ȱ transduction.ȱ Inositolȱ isȱ aȱ normalȱ componentȱ ofȱ humanȱ animals/sex/dose)ȱ thatȱ receivedȱ glucuronolactoneȱ inȱ tissueȱandȱcanȱbeȱsynthesizedȱinȱsomeȱtissues.ȱItȱisȱaȱnormalȱ drinkingȱwater;ȱwithȱbothȱroutesȱofȱadministrationȱanimalsȱ partȱofȱfoodȱderivedȱfromȱplantsȱinȱtheȱformȱofȱphytateȱandȱ receivedȱnominalȱdosesȱofȱȱ0,ȱ300,ȱ600ȱorȱ1000ȱmg/kgȱbwȱforȱ fromȱ animalsȱ inȱ theȱ formȱ ofȱ freeȱ andȱ phosphorylatedȱ 90ȱdays.ȱThereȱwereȱnoȱtreatmentȬrelatedȱdeaths,ȱnoȱeffectsȱ inositolȱ andȱ asȱ inositolȱ phospholipid.ȱ Itȱ isȱ estimatedȱ thatȱ onȱclinicalȱobservations,ȱfoodȱorȱwaterȱconsumption,ȱbodyȱ adultsȱ ingestȱ aboutȱ 500ȱ toȱ 1000ȱ mgȱ ofȱ inositolȱ daily.ȱ Thisȱ weights,ȱ clinicalȱ parameters,ȱ organȱ weightsȱ orȱ clinicalȱ amountȱ isȱ relativelyȱ largeȱ comparedȱ toȱ theȱ 50ȱ mgȱ ofȱ chemistryȱparametersȱrelatedȱtoȱrenalȱfunction.ȱUrinalysisȱ inositolȱ presentȱ inȱ aȱ singleȱ servingȱ ofȱ aȱ typicalȱ energyȱ demonstratedȱ noȱ treatmentȬrelatedȱ effectsȱ andȱ noȱ drink,ȱasȱdescribedȱinȱTableȱ1.ȱPotentialȱbenefitsȱofȱinositolȱ differencesȱ betweenȱ theȱ gavageȱ andȱ drinkingȱ waterȱ mayȱ includeȱ decreasedȱ cholesterolȱ levelsȱ andȱ thusȱ aȱ groups.ȱLastlyȱthereȱwereȱnoȱtestȱmaterialȬrelatedȱgrossȱorȱ loweredȱriskȱofȱcardiovascularȱdiseaseȱ(ANZFAȱ2001).ȱȱ microscopicȱ findings.ȱ Thisȱ includedȱ theȱ kidneysȱ whichȱ ȱ showedȱ typicalȱ amountsȱ ofȱ backgroundȱ lesionsȱ forȱ thisȱ Theȱ toxicityȱ associatedȱ withȱ inositolȱ isȱ veryȱ low.ȱ Inȱ miceȱ strainȱ ofȱ rat.ȱ Thereȱ wasȱ noȱ testȱ materialȬrelatedȱ theȱoralȱLD50ȱisȱreportedȱtoȱbeȱ10000ȱmg/kgȱbw.ȱThereȱareȱ vacuolisationȱofȱtheȱcellsȱliningȱtheȱcollectingȱtubulesȱofȱtheȱ noȱ reproductiveȱ orȱ developmentalȱ toxicityȱ studiesȱ orȱ kidney.ȱ Thisȱ suggestsȱ thatȱ theȱ kidneyȱlesionsȱ observedȱ inȱ genotoxicityȱ studiesȱ thatȱ assessedȱ inositol.ȱ Althoughȱ theȱ firstȱ studyȱ wereȱ notȱ significant,ȱ sinceȱ theȱ drinkingȱ inositolȱ wasȱ notȱ testedȱ asȱ aȱ carcinogen,ȱ severalȱ studiesȱ waterȱadministeredȱinȱtheȱsecondȱstudyȱwasȱmoreȱrelevantȱ assessedȱ itsȱ abilityȱ toȱ preventȱ cancerȱ developmentȱ inȱ toȱtheȱhumanȱsituation.ȱTheȱNOAELȱforȱtheȱstudyȱwasȱsetȱ mouseȱmodels.ȱTheȱresultsȱshowedȱthatȱaȱ3%ȱlevelȱinȱtheȱ atȱ1000ȱmg/kgȱbw/day,ȱtheȱhighestȱdoseȱtested.ȱ dietȱ(equivalentȱtoȱaȱdoseȱofȱ6000ȱmg/kgȱbw/day)ȱdidȱnotȱ ȱ increaseȱcancerȱformationȱ(EstensenȱandȱWattenbergȱ1993).ȱȱ Reproductiveȱ andȱ developmentalȱ toxicityȱ studiesȱ forȱ ȱ glucuronolactoneȱ wereȱ notȱ availableȱ butȱ wereȱ notȱ Inȱ humans,ȱ inositolȱ hasȱ beenȱ usedȱ asȱ anȱ experimentalȱ consideredȱ necessaryȱ toȱ conduct,ȱ asȱ partȱ ofȱ theȱ safetyȱ therapyȱ forȱ depression,ȱ panicȱ disorder,ȱ andȱ obsessiveȱ evaluationȱsinceȱglucuronolactoneȱinȱtheȱbodyȱhydrolysesȱ compulsiveȱdisorder.ȱThereȱisȱaȱreportȱofȱpeopleȱconsumingȱ toȱglucuronicȱacid,ȱwhichȱisȱanȱendogenousȱmetaboliteȱinȱ upȱtoȱ20,000ȱmgȱofȱinositolȱdailyȱforȱ2ȱweeksȱ(Arendrupȱetȱal.ȱ humansȱandȱpresentȱinȱnormalȱhumanȱdietsȱ(EFSAȱ2009).ȱ 1989).ȱ Anotherȱ reportȱ citesȱ theȱ administrationȱ ofȱ 18ȱ gȱ ofȱ ȱ inositolȱ dailyȱ forȱ 6ȱ weeksȱ (Koponenȱ etȱ al.ȱ 1997).ȱ Inȱ theseȱ Glucuronolactoneȱ wasȱ shownȱ notȱ toȱ beȱ mutagenicȱ inȱ aȱ reportsȱandȱseveralȱothers,ȱnoȱadverseȱeffectsȱwereȱobservedȱ bacterialȱreverseȱmutationȱsystemȱ(Kurodaȱetȱal.ȱ1986).ȱȱ (ColondyȱandȱHoffmanȱ1998).ȱȱ ȱ Oneȱ studyȱ (Ahrensȱ etȱ al.ȱ 1987)ȱ assessedȱ theȱ longȬtermȱ 4.6ȱȱ BȱVitaminsȱ toxicityȱ ofȱ glucuronolactone.ȱ Groupsȱ ofȱ 25ȱ maleȱ ratsȱ wereȱ Mostȱ energyȱ drinksȱ containȱ addedȱ Bȱ vitaminsȱ includingȱ administeredȱorallyȱ0ȱmgȱ(water),ȱ125ȱmgȱofȱglucuronicȱacid,ȱ thiamine,ȱriboflavin,ȱniacin,ȱvitaminȱB6,ȱvitaminȱB12,ȱandȱ 250ȱmgȱofȱglucuronicȱacidȱorȱ125ȱmgȱofȱglucuronolactoneȱperȱ pantothenicȱacid.ȱȱ dayȱfromȱtheȱageȱofȱaboutȱ1ȱyearȱtoȱdeathȱ(aboutȱ3ȱyearsȱofȱ age).ȱTheȱdailyȱamountȱofȱglucuronolactoneȱwasȱequivalentȱ 4.6.1ȱThiamineȱ(VitaminȱB1)ȱ toȱ aboutȱ 250ȱ mg/kgȱ bw/day.ȱ Thereȱ wereȱ noȱ significantȱ differencesȱ betweenȱ theȱ treatmentȱ groupsȱ withȱ respectȱ Thiamineȱ isȱ widelyȱ foundȱ inȱ foods,ȱ includingȱ meat,ȱ toȱ causeȱ ofȱ death,ȱ bodyȱ weightsȱ atȱ deathȱ orȱ autopsyȱ legumes,ȱ andȱ wholeȱ orȱ enrichedȱ grainȱ products.ȱ Theȱ findings.ȱ Theȱ carcinogenicȱ potentialȱ ofȱ glucuronolactoneȱ Recommendedȱ Dietaryȱ Allowanceȱ (RDA)8ȱ forȱ thiamineȱ wasȱ notȱ assessedȱ inȱ thisȱ orȱ anyȱ otherȱ study,ȱ however,ȱ forȱ adultȱ malesȱ isȱ 1.2ȱ mg/dayȱ andȱ forȱ adultȱ females,ȱ 1.1ȱ thereȱ isȱ noȱ indicationȱ thatȱ glucuronolactoneȱ isȱ aȱ carcinogen,ȱ basedȱ onȱ shortȬtermȱ toxicityȱ studiesȱ andȱ itsȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ roleȱinȱnormalȱhumanȱmetabolism.ȱȱ 8ȱTheȱ Dietaryȱ Referenceȱ Intakesȱ (DRIs)ȱ areȱ nutrientȱ referenceȱ ȱ valuesȱ thatȱ replaceȱ theȱ 1990ȱ Recommendedȱ Nutrientȱ Intakesȱ (RNIs)ȱ inȱ Canadaȱ andȱ theȱ 1989ȱ Recommendedȱ Dietaryȱ Itȱhasȱbeenȱreportedȱthatȱglucuronolactoneȱhasȱbeenȱusedȱ AllowancesȱinȱtheȱUnitedȱStatesȱ(HealthȱCanada,ȱhttp://www.hcȬ atȱ dosesȱ ofȱ 1ȱ toȱ 3ȱ g/dayȱ (1000ȱ toȱ 3000ȱ mg/day)ȱ inȱ longȬ sc.gc.ca/fnȬan/nutrition/reference/dri_usingȬutil_anrefȬeng.php).ȱ termȱtherapyȱforȱcarriersȱofȱtheȱtyphoidȱorganismȱbecauseȱ TheȱDRIsȱincludeȱRecommendedȱDietaryȱAllowanceȱ(RDA)ȱandȱ ofȱitsȱabilityȱtoȱinhibitȱviralȱandȱbacterialȱΆȬglucuronidase.ȱ AdequateȱIntakeȱ(AI).ȱȱ

14 Int. food risk anal. j., 2013, Vol. 3, 4:2013 www.intechopen.com ȱ !

mg/dayȱ (IOMȱ 1998).ȱ Basedȱ onȱ dataȱ fromȱ theȱ Canadianȱ (ANZFAȱ 2001).ȱ Availableȱ subȬchronicȱ dataȱ fromȱ humanȱ Communityȱ Healthȱ Surveyȱ (CCHS)ȱ (2004),ȱ theȱ 95thȱ studiesȱ andȱ pharmacokineticȱ studiesȱ doȱ notȱ showȱ percentileȱofȱdietaryȱintakeȱindicatesȱthatȱadultsȱconsumeȱ reportedȱeffectsȱonȱoralȱtoxicityȱofȱriboflavin.ȱApartȱfromȱ upȱ toȱ 4ȱ mgȱ ofȱ thiamineȱ perȱ day.ȱ Theȱ formulationȱ ofȱ aȱ aȱ fewȱ minorȱ gastrointestinalȱ disorders,ȱ whichȱ areȱ notȱ typicalȱenergyȱdrinkȱproductȱasȱdescribedȱinȱTableȱ1ȱdoesȱ clearlyȱrelatedȱtoȱriboflavinȱintake,ȱitȱisȱfreeȱfromȱseriousȱ notȱcontainȱthiamine;ȱhowever,ȱotherȱenergyȱdrinksȱmayȱ sideȱeffectsȱ(EuropeanȱCommissionȱ2000).9,10ȱ containȱupȱtoȱ5ȱmgȱofȱthiamineȱperȱserving.ȱ ȱ 4.6.3ȱNiacinȱ(VitaminȱB3)ȱ TheȱUSȱInstituteȱofȱMedicineȱ(IOM)ȱwasȱnotȱableȱtoȱsetȱaȱ NiacinȱisȱtheȱtermȱusedȱtoȱdescribeȱvitaminȱB3;ȱnicotinicȱ tolerableȱupperȱintakeȱlevelȱ(UL)ȱforȱthiamineȱdueȱtoȱtheȱ acidȱandȱnicotinamideȱareȱtwoȱdifferentȱformsȱofȱniacin.ȱ lackȱ ofȱ dataȱ onȱ adverseȱ effectsȱ (IOMȱ 1998).ȱ Inȱ addition,ȱ Theȱ bestȱ dietaryȱ sourcesȱ ofȱ niacinȱ includeȱ tuna,ȱ beef,ȱ theȱEuropeanȱCommissionȱconcludedȱthatȱwhileȱitȱisȱnotȱ otherȱ meats,ȱ andȱ cerealȱ grainsȱ (Groffȱ &ȱ Gropperȱ 2000).ȱ possibleȱ toȱ deriveȱ aȱ ULȱ forȱ thiamine,ȱ currentȱ levelsȱ ofȱ TheȱRDAȱforȱniacinȱforȱadultȱmalesȱisȱ16ȱmg/dayȱandȱforȱ intakeȱfromȱallȱsourcesȱdoȱnotȱrepresentȱaȱhealthȱriskȱforȱ adultȱfemales,ȱ14ȱmg/dayȱ(IOMȱ1998).ȱBasedȱonȱdataȱfromȱ theȱ generalȱ populationȱ (Europeanȱ Commissionȱ 2001).ȱ CCHSȱ (2004),ȱ theȱ 95thȱ percentileȱ ofȱ dietaryȱ intakeȱ However,ȱ theȱ Australiaȱ Newȱ Zealandȱ Foodȱ Authorityȱ indicatesȱthatȱadultsȱconsumeȱupȱtoȱ76.7ȱmgȱofȱniacinȱperȱ (ANZFA)ȱsetȱaȱmaximumȱlimitȱforȱthiamineȱofȱ20ȱmg/250ȱ day.ȱ Theȱ typicalȱ energyȱ drink,ȱ asȱ definedȱ inȱ Tableȱ 1,ȱ mlȱinȱformulatedȱcaffeinatedȱbeveragesȱasȱaȱconservativeȱ containsȱ18ȱmgȱofȱniacinȱperȱ250ȱmlȱservingȱwhileȱotherȱ limitȱthatȱwasȱbasedȱonȱaȱmaximumȱoneȬdayȱquantityȱofȱ energyȱ drinksȱ mayȱ containȱ upȱ toȱ 40ȱ mgȱ ofȱ niacinȱ perȱ 40ȱmgȱthiamineȱ(ANZFAȱ2001).ȱȱ serving.ȱTheȱniacinȱinȱtheseȱproductsȱisȱgenerallyȱpresentȱ ȱ inȱtheȱformȱofȱnicotinamideȱandȱisȱmostȱlikelyȱaddedȱdueȱ Orallyȱ ingestedȱ thiamineȱ hasȱ aȱ longȱ historyȱ ofȱ useȱ asȱ aȱ toȱitsȱroleȱinȱenergyȱmetabolism.ȱȱ supplementȱ withoutȱ reportedȱ adverseȱ effects.ȱ Thereȱ areȱ ȱ noȱ reportsȱ ofȱ adverseȱ effectsȱ ofȱ oralȱ thiamine,ȱ evenȱ atȱ Theȱ Instituteȱ ofȱ Medicineȱ (IOM)ȱ inȱ theȱ Unitedȱ Statesȱ dosagesȱ ofȱ severalȱ hundredȱ milligramsȱ perȱ dayȱ (1998)ȱ setȱ aȱ ULȱ ofȱ 35ȱ mg/dayȱ forȱ niacinȱ basedȱ onȱ theȱ (EuropeanȱCommissionȱ2001).ȱAȱCanadianȱevaluationȱofȱ adverseȱ effectȱ ofȱ flushing11.ȱ Flushingȱ isȱ firstȱ observedȱ micronutrientȱsafetyȱclassifiedȱthiamineȱasȱaȱnutrientȱwithȱ afterȱ excessȱ niacinȱ intakeȱ andȱ isȱ generallyȱ observedȱ atȱ noȱknownȱadverseȱeffectsȱ(ProgramȱonȱFoodȱSafetyȱ1996).ȱȱ lowerȱdosesȱthanȱareȱotherȱeffects.ȱFlushingȱthatȱresultsȱinȱ 4.6.2ȱRiboflavinȱ(VitaminȱB2)ȱ patientsȱ decidingȱ toȱ changeȱ theȱ patternȱ ofȱ niacinȱ intakeȱ (i.e.,ȱreduceȱtheȱamountȱtakenȱatȱaȱtimeȱorȱwithdrawȱfromȱ Riboflavinȱ isȱ foundȱ inȱ aȱ wideȱ varietyȱ ofȱ foodsȱ butȱ milkȱ treatment)ȱwasȱselectedȱasȱtheȱmostȱappropriateȱendpointȱ andȱmilkȱproductsȱareȱthoughtȱtoȱcontributeȱtheȱmajorityȱ onȱ whichȱ toȱ baseȱ aȱ UL.ȱ Althoughȱ nicotinamideȱ appearsȱ ofȱ dietaryȱ riboflavin.ȱ Eggs,ȱ meat,ȱ andȱ legumesȱ alsoȱ notȱ toȱ beȱ associatedȱ withȱ flushingȱ effects,ȱ aȱ ULȱ forȱ provideȱ riboflavinȱ inȱ significantȱ quantitiesȱ (Groffȱ &ȱ nicotinicȱ acidȱ thatȱ isȱ basedȱ onȱ flushingȱ isȱ consideredȱ Gropperȱ2000).ȱTheȱRDAȱforȱriboflavinȱforȱadultȱmalesȱisȱ protectiveȱ againstȱ potentialȱ adverseȱ effectsȱ ofȱ 1.3ȱmg/dayȱandȱforȱadultȱfemales,ȱ1.1ȱmg/dayȱ(IOMȱ1998).ȱ nicotinamideȱ(IOMȱ1998).ȱ Basedȱ onȱ dataȱ fromȱ CCHSȱ (2004),ȱ theȱ 95thȱ percentileȱ ofȱ ȱ dietaryȱintakeȱindicatesȱthatȱadultsȱconsumeȱupȱtoȱ4.5ȱmgȱ Otherȱ jurisdictionsȱ haveȱ setȱ ULsȱ forȱ bothȱ nicotinicȱ acidȱ ofȱ riboflavinȱ perȱ day.ȱ Theȱ typicalȱ energyȱ drinkȱ productȱ andȱnicotinamide.ȱHowever,ȱasȱnicotinamideȱisȱtypicallyȱ formulation,ȱasȱdescribedȱinȱTableȱ1,ȱcontainsȱ1.65ȱmgȱofȱ foundȱinȱenergyȱdrinks,ȱonlyȱtheȱULsȱrelatingȱtoȱthisȱformȱ riboflavinȱ perȱ 250ȱ mlȱ servingȱ whileȱ otherȱ energyȱ drinksȱ ofȱniacinȱ areȱ discussed.ȱTheȱEuropeanȱ Commission set a mayȱcontainȱupȱtoȱ5ȱmgȱofȱriboflavinȱperȱserving.ȱ UL ofȱ900ȱmg/dayȱ(12.5ȱmg/kgȱbw/day)ȱforȱnicotinamideȱ ȱ basedȱ onȱ aȱ NOAELȱ ofȱ 25ȱ mg/kgȱ bw/d,ȱ derivedȱ fromȱ IOMȱwasȱnotȱableȱtoȱsetȱaȱULȱforȱriboflavinȱdueȱtoȱtheȱlackȱofȱ studiesȱinȱsubjectsȱwithȱorȱatȱriskȱofȱdiabetes.ȱ(Europeanȱ dataȱ onȱ adverseȱ effectsȱ (IOMȱ 1998).ȱ Inȱ addition,ȱ theȱ Commission,ȱ2002).ȱȱ Europeanȱ Commissionȱ concludedȱ thatȱ whileȱ itȱ isȱ notȱ ȱ possibleȱtoȱderiveȱaȱULȱforȱriboflavin,ȱcurrentȱlevelsȱofȱintakeȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ fromȱ allȱ sourcesȱ doȱ notȱ representȱ aȱ riskȱ toȱ humanȱ healthȱ 9ȱ Whileȱ thisȱ manuscriptȱ wasȱ inȱ preparation,ȱ Healthȱ Canadaȱ (Europeanȱ Commissionȱ 2000).ȱ However,ȱ ANZFAȱ setȱ aȱ publishedȱ theȱ documentȱ Categoryȱ Specificȱ Guidanceȱ forȱ maximumȱ limitȱ forȱ riboflavinȱ ofȱ 20ȱ mg/dayȱ inȱ formulatedȱ TemporaryȱMarketingȱAuthorization:ȱCaffeinatedȱEnergyȱDrinksȱ caffeinatedȱbeveragesȱbasedȱonȱtheȱcompositionȱofȱRedȱBullȱ (Marchȱ 2012).ȱ Aȱ dailyȱ maximumȱ levelȱ ofȱ 5ȱ mg/dayȱ wasȱ setȱ forȱ theȱadditionȱofȱthiamineȱtoȱenergyȱdrinks.ȱ andȱknowledgeȱofȱregularȱconsumptionȱofȱ500ȱmlȱperȱdayȱofȱ 11ȱ Healthȱ Canada’sȱ Categoryȱ Specificȱ Guidanceȱ forȱ Temporaryȱ thisȱproductȱ(ANZFAȱ2001).ȱȱ Marketingȱ Authorization:ȱ Caffeinatedȱ Energyȱ Drinksȱ (Marchȱ ȱ 2012)ȱsetȱaȱdailyȱmaximumȱlevelȱofȱ27ȱmg/dayȱforȱtheȱadditionȱofȱ Theȱ toxicityȱ ofȱ riboflavinȱ isȱ consideredȱ toȱ beȱ extremelyȱ riboflavinȱtoȱenergyȱdrinks.ȱ ȱ lowȱ dueȱ inȱ partȱ toȱ readyȱ excretionȱ ofȱ excessȱ amountsȱ 11ȱFlushingȱrefersȱtoȱaȱtransitoryȱsensationȱofȱextremeȱheat.ȱ www.intechopen.com Joel Rotstein, Jennifer Barber, Carl Strowbridge, Stephen Hayward, Rong Huang and Samuel Benrejeb Godefroy: 15 ȱ Energy Drinks: An Assessment of the Potential Health Risks in the Canadian Context !

Theȱ Expertȱ Groupȱ onȱ Vitaminsȱ andȱ Mineralsȱ (Foodȱ ANZFAȱsetȱaȱmaximumȱlimitȱforȱvitaminȱB6ȱofȱ10ȱmg/dayȱ Standardsȱ Agencyȱ 2003)ȱ setȱ aȱ guidanceȱ levelȱ ofȱ 560ȱ inȱ formulatedȱ caffeinatedȱ beveragesȱ basedȱ onȱ historyȱ ofȱ mg/dayȱ forȱ nicotinamideȱ asȱ theȱ limitedȱ dataȱ onȱ theȱ use,ȱratherȱthanȱtheȱU.S.ȱULȱ(ANZFAȱ2001).ȱȱ occurrenceȱ ofȱ nicotinamideȱ toxicityȱ indicatesȱ thatȱ itȱ isȱ ȱ quiteȱlow.ȱȱ Thereȱ areȱ noȱ safetyȱ concernsȱ inȱ relationȱ toȱ vitaminȱ B6ȱ ȱ intakeȱfromȱfoodȱsources.ȱHowever,ȱadverseȱneurologicalȱ ANZFAȱsetȱaȱmaximumȱlimitȱforȱniacinȱofȱ40ȱmg/dayȱ(2ȱ effectsȱ haveȱ beenȱ detectedȱ inȱ humansȱ afterȱ veryȱ highȱ cansȱ ofȱ 20ȱ mg/250ȱ ml)ȱ inȱ formulatedȱ caffeinatedȱ dosesȱ (>500ȱ mg/day,ȱ equivalentȱ toȱ approximatelyȱ 8ȱ beveragesȱbasedȱonȱtheirȱassessmentȱ(ANZFAȱ2001).12ȱ mg/kg/day)13.ȱ Minorȱ neurologicalȱ symptomsȱ mayȱ beȱ ȱ apparentȱatȱdosesȱofȱ100ȱmg/dayȱorȱmoreȱifȱconsumedȱforȱ Thereȱ isȱ noȱ evidenceȱ ofȱ adverseȱ effectsȱ fromȱ theȱ longȱperiods.ȱThereȱareȱnoȱsubgroupsȱthatȱareȱknownȱtoȱ consumptionȱofȱnormalȱlevelsȱofȱniacinȱinȱfoods.ȱAdverseȱ beȱunusuallyȱsusceptibleȱtoȱtheȱadverseȱeffectsȱofȱvitaminȱ effectsȱ haveȱ beenȱ observedȱ withȱ intakesȱ ofȱ nicotinamideȱ B6ȱ(EuropeanȱCommissionȱ2000).ȱ greaterȱ thanȱ 3000ȱ mg/dayȱ comparedȱ withȱ intakesȱ ofȱ nicotinicȱ acidȱ ofȱ 1500ȱ mg/dayȱ (ANZFAȱ 2001).ȱ Adverseȱ 4.6.5ȱCobalaminȱ(VitaminȱB12)ȱȱ effectsȱcanȱbeȱobservedȱfollowingȱhighȱintakesȱofȱnicotinicȱ Theȱonlyȱ dietaryȱ sourcesȱofȱvitaminȱ B12ȱforȱ humansȱ areȱ acid,ȱ whichȱ mayȱ beȱ achievedȱ throughȱ consumptionȱ ofȱ fromȱ animalȱ products,ȱ whichȱ haveȱ derivedȱ theirȱ pharmacologicalȱ preparationsȱ orȱ dietaryȱ supplementalȱ cobalaminsȱ fromȱ microorganisms.ȱ Theȱ bestȱ sourcesȱ ofȱ products.ȱ Adverseȱ effectsȱ associatedȱ withȱ theȱ useȱ ofȱ cobalaminsȱ areȱ meatȱ andȱ meatȱ products,ȱ poultryȱ andȱ nicotinicȱacidȱasȱaȱdrug,ȱespeciallyȱinȱdosesȱofȱ1ȱgȱorȱmoreȱ eggs.ȱ Theȱ RDAȱ forȱ vitaminȱ B12ȱ forȱ adultȱ malesȱ andȱ perȱdayȱinclude:ȱ femalesȱ isȱ 2.4ȱ mcg/dayȱ (micrograms/day)ȱ (IOMȱ 1998).ȱ ȱ Basedȱ onȱ dataȱ fromȱ CCHSȱ (2004),ȱ theȱ 95thȱ percentileȱ ofȱ x Possibleȱinjuryȱtoȱtheȱliver,ȱasȱindicatedȱbyȱelevatedȱ dietaryȱintakeȱindicatesȱthatȱadultsȱconsumeȱupȱtoȱ6ȱmcgȱ serumȱ levelsȱ ofȱ enzymesȱ ofȱ hepaticȱ originȱȱ ofȱ vitaminȱ B12ȱ perȱ day.ȱ Theȱ typicalȱ amountȱ usedȱ forȱ (e.g.,ȱ transaminases)ȱ andȱ byȱ obstructionȱ ofȱ normalȱ energyȱdrinks,ȱasȱdescribedȱinȱTableȱ1,ȱcontainsȱ1ȱmcgȱofȱ bileȱflowȱfromȱtheȱliverȱtoȱtheȱsmallȱintestine;ȱ vitaminȱB12ȱperȱ250ȱmlȱservingȱwhileȱotherȱenergyȱdrinksȱ x Developmentȱ ofȱ dermatologicalȱ problemsȱ suchȱ asȱ mayȱcontainȱupȱtoȱ20ȱmcgȱofȱvitaminȱB12ȱperȱserving.ȱ itching;ȱandȱ ȱ x Elevationȱ ofȱ plasmaȱ glucoseȱ levelsȱ (Groffȱ andȱ IOMȱwasȱnotȱableȱtoȱsetȱaȱULȱforȱvitaminȱB12ȱdueȱtoȱtheȱ Gropperȱ2000).ȱ lackȱ ofȱ dataȱ onȱ adverseȱ effectsȱ (IOMȱ 1998).ȱ Similarly,ȱ theȱ EuropeanȱCommissionȱconcludedȱthatȱitȱisȱnotȱpossibleȱtoȱ 4.6.4ȱPyridoxineȱ(VitaminȱB6)ȱȱ deriveȱaȱULȱforȱvitaminȱB12ȱasȱthereȱareȱnoȱclearlyȱdefinedȱ Excellentȱ sourcesȱ ofȱ vitaminȱ B6ȱ inȱ commonlyȱ consumedȱ adverseȱ effectsȱ producedȱ fromȱ thisȱ vitaminȱ (Europeanȱ foodsȱ areȱ bananas,ȱ navyȱ beans,ȱ andȱ walnutsȱ (Groffȱ &ȱ Commissionȱ 2000).ȱ ANZFAȱ setȱ aȱ maximumȱ limitȱ forȱ Gropperȱ2000).ȱTheȱRDAȱforȱvitaminȱB6ȱforȱadultȱmalesȱisȱ vitaminȱ B12ȱ ofȱ 10ȱ mcg/dayȱ inȱ formulatedȱ caffeinatedȱ 1.3Ȭ1.7ȱ mg/dayȱ andȱ forȱ adultȱ females,ȱ 1.3Ȭ1.5ȱ mg/dayȱ beveragesȱbasedȱonȱhistoryȱofȱuseȱ(ANZFAȱ2001).ȱȱ (IOMȱ 1998).ȱ Basedȱ onȱ dataȱ fromȱ CCHSȱ (2004),ȱ theȱ 95thȱ ȱ percentileȱofȱdietaryȱintakeȱindicatesȱthatȱadultsȱconsumeȱ Noȱ adverseȱ effectsȱ haveȱ beenȱ associatedȱ withȱ excessȱ upȱ toȱ 4.5ȱ mgȱ ofȱ vitaminȱ B6ȱ perȱ day.ȱ Theȱ typicalȱ energyȱ vitaminȱB12ȱintakeȱfromȱfoodȱorȱsupplementsȱinȱhealthyȱ 14 drink,ȱ asȱ describedȱinȱ Tableȱ1,ȱ containsȱ2ȱmgȱ ofȱ vitaminȱ individualsȱ(EuropeanȱCommissionȱ2000).ȱ ȱ B6ȱ perȱ 250ȱ mlȱ servingȱ whileȱ otherȱ energyȱ drinksȱ mayȱ 4.6.6ȱPantothenicȱacidȱ(VitaminȱB5)ȱȱ containȱupȱtoȱ10ȱmgȱofȱvitaminȱB6ȱperȱserving.ȱ ȱ Meatsȱ (especiallyȱ liver),ȱ eggȱ yolk,ȱ legumes,ȱ andȱ wholeȱ IOMȱ setȱ aȱ ULȱ forȱ vitaminȱ B6ȱ ofȱ 100ȱ mg/dayȱ basedȱ onȱ aȱ grainȱ cerealsȱ areȱ goodȱ sourcesȱ ofȱ pantothenicȱ acid.ȱ Theȱ NOAELȱ ofȱ 200ȱ mg/dayȱ andȱ applyingȱ anȱ uncertaintyȱ adequateȱintakeȱ(AI)ȱforȱpantothenicȱacidȱforȱadultȱmalesȱ factorȱ ofȱ 2ȱ toȱ accountȱ forȱ theȱ limitationsȱ inȱ dataȱ (IOMȱ andȱfemalesȱisȱ5ȱmg/dayȱ(IOMȱ1998).ȱCCHSȱ(2004)ȱdidȱnotȱ 1998).ȱTheȱEuropeanȱCommissionȱsetȱaȱULȱofȱ25ȱmg/dayȱ haveȱ anyȱ dietaryȱ intakeȱ dataȱ onȱ pantothenicȱ acid;ȱ forȱ vitaminȱ B6ȱ (Europeanȱ Commissionȱ 2000)ȱ byȱ takingȱ however,ȱanotherȱsourceȱindicatesȱthatȱaverageȱintakesȱofȱ theȱaverageȱintakesȱofȱvitaminȱB6ȱ(100ȱmg)ȱfromȱtheȱstudyȱ adultsȱrangeȱbetweenȱ3Ȭ12ȱmg/dȱ(EuropeanȱCommissionȱ byȱDaltonȱandȱDaltonȱ(1987)ȱandȱapplyingȱanȱuncertaintyȱ 2002).ȱ Theȱ typicalȱ energyȱ drink,ȱ asȱ definedȱ inȱ Tableȱ 1,ȱ factorȱofȱ4ȱtoȱaccountȱforȱlongȬtermȱintake.ȱȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ 13ȱAtȱdosesȱlessȱthanȱ500ȱmg/day,ȱtheȱadverseȱeffectsȱwereȱreversible.ȱ 12ȱ Healthȱ Canada’sȱ Categoryȱ Specificȱ Guidanceȱ forȱ Temporaryȱ 14ȱ Healthȱ Canada’sȱ Categoryȱ Specificȱ Guidanceȱ forȱ Temporaryȱ Marketingȱ Authorization:ȱ Caffeinatedȱ Energyȱ Drinksȱ (Marchȱ Marketingȱ Authorization:ȱ Caffeinatedȱ Energyȱ Drinksȱ (Marchȱ 2012)ȱsetȱaȱdailyȱmaximumȱlevelȱofȱ450ȱmg/dayȱforȱtheȱadditionȱ 2012)ȱsetȱaȱdailyȱmaximumȱlevelȱofȱ25ȱmcg/dayȱforȱtheȱadditionȱ ofȱnicotinamideȱtoȱenergyȱdrinks.ȱ ofȱvitaminȱB12ȱtoȱenergyȱdrinks.ȱ ȱ

16 Int. food risk anal. j., 2013, Vol. 3, 4:2013 www.intechopen.com ȱ !

containsȱ 6ȱ mgȱ ofȱ pantothenicȱ acidȱ perȱ 250ȱ mlȱ servingȱ Theȱhealthȱhazardȱassessmentȱconcludedȱthatȱtheȱgeneralȱ whileȱ otherȱ energyȱ drinksȱ mayȱ containȱ upȱ toȱ 10ȱ mgȱ ofȱ adultȱ populationȱ couldȱ consumeȱ 2ȱ servingsȱ ofȱ aȱ typicalȱ pantothenicȱacidȱperȱserving.ȱ energyȱ drinkȱ perȱ dayȱ withȱ noȱ expectedȱ negativeȱ healthȱ ȱ consequences.ȱThisȱconclusionȱwasȱbasedȱonȱtheȱsafetyȱofȱ IOMȱwasȱnotȱableȱtoȱsetȱaȱULȱforȱpantothenicȱacidȱdueȱtoȱ theȱnonȬcaffeineȱingredientsȱofȱenergyȱdrinksȱ(i.e.ȱtaurine,ȱ theȱlackȱofȱdataȱonȱadverseȱeffectsȱ(IOMȱ1998).ȱInȱaddition,ȱ glucuronolactone,ȱinositolȱandȱBȱvitamins)ȱatȱthisȱlevelȱofȱ theȱ Europeanȱ Commissionȱ concludedȱ thatȱ whileȱ itȱ isȱ notȱ consumption,ȱandȱtheȱfactȱthatȱcaffeineȱfromȱotherȱdietaryȱ possibleȱtoȱderiveȱaȱULȱforȱpantothenicȱacid,ȱcurrentȱlevelsȱ sourcesȱinȱadditionȱtoȱthatȱinȱ2ȱservingsȱofȱenergyȱdrinksȱ ofȱintakeȱfromȱallȱsourcesȱdoȱnotȱrepresentȱaȱhealthȱriskȱforȱ wouldȱ notȱ poseȱ aȱ healthȱ riskȱ toȱ theȱ generalȱ adultȱ theȱ generalȱ populationȱ (Europeanȱ Commissionȱ 2000).ȱ population.ȱȱ ANZFAȱsetȱaȱmaximumȱlimitȱofȱ10ȱmg/dayȱforȱpantothenicȱ ȱ acidȱ inȱ formulatedȱ caffeinatedȱ beveragesȱ basedȱ onȱ theȱ Moreȱ specifically,ȱ theȱ respectiveȱ meanȱ dailyȱ intakesȱ ofȱ compositionȱofȱtheȱreferenceȱproductȱknownȱasȱRedȱBull™ȱ caffeineȱ fromȱ allȱ dietaryȱ sourcesȱ forȱ adultȱ Canadianȱ andȱknowledgeȱofȱregularȱconsumptionȱofȱ500ȱmLȱperȱdayȱ malesȱ andȱ femalesȱ areȱ 281ȱ andȱ 230ȱ mg.ȱ Withȱ bodyȱ ofȱthisȱproductȱ(ANZFAȱ2001).ȱ weightsȱofȱ80ȱandȱ65ȱkg,ȱthesesȱintakesȱareȱequivalentȱtoȱ ȱ aȱ dailyȱ doseȱ ofȱ 3.5ȱ andȱ 3.1ȱ mg/kgȱ bw,ȱ respectivelyȱ Thereȱ areȱ noȱ reportsȱ ofȱ pantothenicȱ acidȱ orȱ panthenolȱ (Statisticsȱ Canada,ȱ Canadianȱ Communityȱ Healthȱ toxicityȱinȱhumans.ȱMinorȱgastrointestinalȱeffectsȱsuchȱasȱ Survey,ȱ 2004).ȱ Theȱ consumptionȱ ofȱ twoȱ servingsȱ ofȱ aȱ occasionalȱdiarrheaȱandȱwaterȱretentionȱoccurredȱonlyȱatȱ typicalȱ energyȱ drinkȱ containingȱ 80ȱ mgȱ ofȱ caffeineȱ perȱ veryȱ highȱ intakesȱ (10Ȭ20ȱ g/day)ȱ (Europeanȱ Commissionȱ servingȱwouldȱresultȱinȱtheȱadditionȱofȱ160ȱmgȱcaffeineȱ 2002).15ȱ toȱtheȱdiet.ȱInȱmales,ȱthisȱwouldȱresultȱinȱaȱdailyȱdoseȱofȱ 5.5ȱmg/kgȱbwȱandȱinȱfemales,ȱaȱdailyȱdoseȱofȱ6.0ȱmg/kgȱ 4.7ȱSummaryȱȱ bw.16ȱ Healthȱ Canada’sȱ recommendedȱ maximumȱ dailyȱ intakeȱofȱcaffeineȱforȱadultsȱisȱ6.5ȱmg/kgȱbwȱorȱaboutȱ400ȱ Healthȱhazardȱdataȱonȱenergyȱdrinksȱareȱextremelyȱlimitedȱ mgȱ forȱ anȱ adultȱ weighingȱ 65ȱ kgȱ (Nawrotȱ etȱ al.,ȱ 2003).ȱ andȱ thereforeȱ theȱ hazardȱ assessmentȱ wasȱ basedȱ onȱ Givenȱ thatȱ theȱ additionȱ ofȱ twoȱ servingsȱ ofȱ aȱ typicalȱ individualȱ ingredients.ȱ Caffeineȱ wasȱ identifiedȱ asȱ theȱ energyȱ drinkȱ toȱ theȱ dietȱ wouldȱ notȱ exceedȱ theȱ ingredientȱ inȱ energyȱ drinksȱ havingȱ theȱ greatestȱ potentialȱ recommendedȱmaximumȱdailyȱintakeȱofȱcaffeine,ȱitȱcanȱ forȱ intakesȱ ofȱ healthȱ concern.ȱ Assumingȱ noȱ additionalȱ beȱconcludedȱthatȱ thisȱ levelȱofȱconsumptionȱ wouldȱnotȱ caffeineȱfromȱtheȱdiet,ȱitȱwasȱdeterminedȱthatȱnoȱmoreȱthanȱ poseȱ anȱ additionalȱ healthȱ hazardȱbasedȱ onȱ theȱ caffeineȱ 5ȱ servingsȱ perȱ dayȱ ofȱ aȱ typicalȱ energyȱ drinkȱ shouldȱ beȱ contentȱofȱtheseȱproducts.ȱȱ consumedȱbyȱtheȱgeneralȱadultȱpopulation.ȱAtȱthisȱlevelȱofȱ ȱ consumption,ȱtheȱlevelsȱofȱtaurineȱandȱglucuronolactoneȱinȱ Theȱ consumptionȱ ofȱ energyȱ drinksȱ byȱ subpopulations,ȱ aȱ typicalȱ energyȱ drinkȱ areȱ notȱ expectedȱ toȱ poseȱ aȱ healthȱ suchȱasȱchildrenȱandȱpregnantȱandȱbreastfeedingȱwomen,ȱ hazardȱ inȱ theȱ shortȱ term.ȱ Althoughȱ thereȱ areȱ limitedȱ isȱnotȱgenerallyȱrecommended.ȱBasedȱonȱcaffeineȱcontent,ȱ hazardȱ dataȱ onȱ energyȱ drinksȱ asȱ formulatedȱ inȱ theȱ publishedȱliterature,ȱactualȱuseȱofȱenergyȱdrinksȱhasȱbeenȱ consumptionȱ ofȱ suchȱ drinksȱ byȱ anyȱ groupȱ shouldȱ beȱ associatedȱwithȱsomeȱadverseȱreactions.ȱHowever,ȱdueȱtoȱ limitedȱ toȱ theirȱ recommendedȱ maximumȱ dailyȱ intakeȱ ofȱ theȱ absenceȱ ofȱ longȬtermȱ safetyȱ dataȱ onȱ highȱ levelsȱ ofȱ caffeine.ȱExcessȱconsumptionȱofȱenergyȱdrinksȱwouldȱbeȱ consumptionȱ ofȱ taurineȱ andȱ glucuronolactone,ȱ theȱ expectedȱtoȱresultȱinȱhealthȱconsequencesȱsimilarȱtoȱthoseȱ potentialȱ interactionȱ ofȱ theseȱ substancesȱ withȱ caffeine,ȱ fromȱexcessȱexposureȱtoȱcaffeine.ȱȱ andȱforȱmostȱconsumers,ȱtheȱknownȱadditionȱofȱcaffeineȱ 5.ȱSurveysȱandȱStudiesȱonȱEnergyȱDrinkȱȱ fromȱ otherȱ dietaryȱ sources,ȱ itȱ wasȱ concludedȱ thatȱ theȱ ConsumptionȱLevelsȱandȱPatternsȱ longȬtermȱconsumptionȱofȱ5ȱservingsȱofȱenergyȱdrinksȱperȱ dayȱ couldȱ notȱ beȱ consideredȱ toȱ representȱ noȱ healthȱ 5.1ȱIntroductionȱ concernȱforȱtheȱgeneralȱadultȱpopulation.ȱȱ ȱ Aȱlimitedȱnumberȱofȱqualitativeȱandȱquantitativeȱsurveysȱ Also,ȱtheȱevidenceȱexaminedȱsuggestsȱthatȱmostȱofȱtheȱBȱ andȱ studiesȱ onȱ energyȱ drinkȱ consumptionȱ haveȱ beenȱ vitaminsȱandȱotherȱconstituentsȱofȱaȱtypicalȱenergyȱdrinkȱ carriedȱ outȱ inȱ otherȱ jurisdictionsȱ sinceȱ theȱ lateȱ 1990’s.ȱ wouldȱ notȱ poseȱ aȱ healthȱ hazardȱ inȱ theȱ shortȱ term,ȱ butȱ Dataȱ onȱ levelsȱ ofȱ intakeȱ asȱ wellȱ asȱ patternsȱ ofȱ longȬtermȱsafetyȱdataȱwereȱnotȱavailableȱforȱthisȱlevelȱofȱ consumptionȱ wereȱ collectedȱ forȱ variousȱ ageȱ groupsȱ asȱ consumption.ȱ describedȱinȱtheȱsurveyȱandȱstudyȱsummariesȱbelow.ȱȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ 16ȱInȱmales,ȱthisȱwouldȱresultȱinȱaȱdailyȱdoseȱofȱ5.5ȱmg/kgȱbwȱ(=ȱ 15ȱ Healthȱ Canada’sȱ Categoryȱ Specificȱ Guidanceȱ forȱ Temporaryȱ 441ȱmgȱofȱcaffeine/ȱ80ȱkgȱbwȱ=ȱ281ȱmgȱofȱcaffeineȱ+ȱ160ȱmgȱfromȱ Marketingȱ Authorization:ȱ Caffeinatedȱ Energyȱ Drinksȱ (Marchȱ 2ȱservingsȱofȱenergyȱdrinksȱ/ȱ80ȱkgȱbw)ȱandȱinȱfemalesȱinȱaȱdailyȱ 2012)ȱsetȱaȱdailyȱmaximumȱlevelȱofȱ50ȱmg/dayȱforȱtheȱadditionȱofȱ doseȱofȱ6.0ȱmg/kgȱbwȱ(=ȱ390ȱmgȱofȱcaffeineȱ/ȱ65ȱkgȱbwȱ=ȱ230ȱmgȱ pantothenicȱacidȱtoȱenergyȱdrinks.ȱȱ ofȱcaffeineȱ+ȱ160ȱmgȱfromȱ2ȱservingsȱofȱenergyȱdrinksȱ/ȱ65ȱkgȱbw).ȱ www.intechopen.com Joel Rotstein, Jennifer Barber, Carl Strowbridge, Stephen Hayward, Rong Huang and Samuel Benrejeb Godefroy: 17 ȱ Energy Drinks: An Assessment of the Potential Health Risks in the Canadian Context !

5.2ȱInternationalȱsurveyȱdataȱ Aȱmarketȱresearchȱsurveyȱofȱ1260ȱpeopleȱagedȱ11Ȭ35ȱyearsȱ wasȱ conductedȱ inȱ Northernȱ Irelandȱ andȱ theȱ Republicȱ ofȱ DataȱfromȱtheȱEuropeanȱCommissionȱ(ECȱ1999)ȱindicatedȱ Irelandȱinȱ2001.ȱTheȱresultsȱofȱtheȱsurveyȱwereȱsimilarȱtoȱ thatȱ9%ȱofȱtheȱpopulationȱcouldȱbeȱdescribedȱasȱ‘regularȱ thoseȱ obtainedȱ inȱ theȱ Austrianȱ survey.ȱ Inȱ Northernȱ consumers’ȱ ofȱȱenergyȱ drinks,ȱ withȱ intakeȱ byȱ theseȱ IrelandȱandȱRepublicȱofȱIrelandȱrespectively,ȱ51%ȱpercentȱ consumersȱlikelyȱtoȱbeȱinȱtheȱorderȱofȱ500ȱmlȱperȱdayȱ(2ȱxȱ andȱ 37%ȱ ofȱ participantsȱ reportedȱ ‘ever’ȱ consumingȱ 17 250ȱmlȱcans). ȱ energyȱ drinksȱ andȱ 10%ȱ andȱ 11%ȱ reportedȱ consumingȱ ȱ energyȱ drinksȱ frequently.ȱ Amongȱ ‘ever’ȱ consumers,ȱ Anȱ Australianȱ surveyȱ assessedȱ theȱ incidenceȱ ofȱ averageȱ consumptionȱ wasȱ 3ȱ (250mL)ȱ cans/weekȱ andȱ forȱ consumptionȱofȱenergyȱdrinksȱwithinȱaȱtwoȬweekȱperiodȱ theȱ 95thȱ percentileȱ consumers,ȱ itȱ wasȱ 8ȱ cans/week.ȱ Theȱ inȱ 1999.ȱ However,ȱ thisȱ studyȱ didȱ notȱ recordȱ quantitiesȱ mostȱnumberȱofȱcansȱconsumedȱinȱaȱsingleȱsessionȱamongȱ consumedȱorȱfrequencyȱofȱconsumption.ȱTheȱresultsȱfromȱ ‘ever’ȱ consumersȱ averagedȱ approximatelyȱ 3ȱ cans,ȱ risingȱ thisȱsurveyȱareȱgivenȱinȱTableȱ7.ȱ toȱ8ȱ cansȱ amongȱtheȱ highestȱconsumers;ȱ theȱcomparableȱ ȱ figureȱforȱ11Ȭ14ȱyearȬoldsȱwasȱapproximatelyȱ2ȱcans.ȱȱ Sampleȱ %ȱConsumersȱ ȱ 141ȱȱ 27%ȱmalesȱagedȱ8Ȭ12ȱyearsȱ Inȱ theȱ Irelandȱ survey,ȱ energyȱ drinkȱ consumptionȱ wasȱ 12%ȱfemalesȱagedȱ8Ȭ12ȱyearsȱ stronglyȱ relatedȱ toȱ alcoholȱ consumption.ȱ Amongȱ thoseȱ 240ȱ 24%ȱmalesȱagedȱ12Ȭȱ18ȱyearsȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ20%ȱfemalesȱ agedȱ12Ȭȱ18ȱyearsȱ whoȱ everȱ consumedȱ energyȱ drinks,ȱ 84%ȱ ofȱ allȱ respondentsȱhadȱconsumedȱtheȱdrinkȱwithȱalcohol,ȱwhileȱ Tableȱ7.ȱEnergyȱdrinkȱconsumptionȱinȱAustraliaȱinȱaȱTwoȱWeekȱ 56%ȱ reportedȱ consumingȱ theȱ drinksȱ withȱ alcoholȱ Periodȱduringȱ1999ȱ regularly.ȱȱȱ Newȱ Zealandȱ dataȱ areȱ availableȱ fromȱ theȱ Panoramaȱ ȱ surveyȱ ofȱ 12ȱ 000ȱ respondentsȱ agedȱ 10ȱ yearsȱ andȱ over,ȱ O’Deaȱ(2003)ȱconductedȱaȱstudyȱtoȱobtainȱqualitativeȱdataȱ conductedȱ byȱ ACNielsenȱ inȱ 1999.ȱ Twoȱ hundredȱ andȱ aboutȱ theȱ typeȱ ofȱ nutritionalȱ supplementsȱ andȱ drinksȱ sixtyȬfourȱ (264)ȱ individualsȱ agedȱ 10ȱ toȱ 14ȱ yearsȱ wereȱ consumedȱ byȱ adolescentsȱ inȱ Australia.ȱ SemiȬstructuredȱ interviewedȱ regardingȱ theirȱ consumptionȱ ofȱ energyȱ focusȱ groupȱ interviewsȱ wereȱ conductedȱ amongȱ 78ȱ drinks,ȱ andȱ theȱ resultantȱ dataȱ forȱ theȱ 64ȱ (24%)ȱ whoȱ participantsȱ agedȱ 11Ȭ18ȱ years.ȱ Participantsȱ reportedȱ reportedȱdrinkingȱthemȱareȱpresentedȱinȱTableȱ8.ȱȱ consumingȱ sportȱ drinks,ȱ aȱ numberȱ ofȱ nutritionalȱ ȱ supplementsȱ andȱ energyȱ drinks.ȱ Resultsȱ ofȱ theȱ studyȱ Consumptionȱrateȱ No.ȱ Percentageȱ10Ȭ14ȱyearȱ indicatedȱ thatȱ adolescentsȱ appearȱ toȱ beȱ incorrectlyȱ consumersȱȱ oldsȱ attributingȱtheȱ‘creation’ȱofȱenergyȱtoȱtheseȱsupplementsȱ Atȱleastȱonceȱperȱdayȱ 6ȱ 2ȱ whenȱ theȱ actualȱ effectȱ isȱ aȱ stimulantȱ effectȱ causedȱ byȱ Onceȱaȱweekȱȱ 21ȱ 8ȱ caffeine,ȱandȱotherȱstimulantsȱinȱproductsȱsuchȱasȱenergyȱ Atȱleastȱonceȱaȱ 37ȱ 4ȱ drinks.ȱ Theȱ authorȱ notedȱ thatȱ manyȱ ofȱ theȱ misguidedȱ monthȱȱ ‘energyȱcreation’ȱbeliefsȱmayȱbeȱattributedȱtoȱinformationȱ providedȱ toȱ consumersȱ inȱ advertisingȱ andȱ marketingȱ ofȱ Tableȱ8.ȱEnergyȱdrinkȱconsumptionȱinȱNewȱZealandȱbyȱ10ȱtoȱ14ȱ yearȱoldsȱ theseȱproducts.ȱAccordingȱtoȱtheȱauthor,ȱtheȱadolescentsȱ inȱ theȱ studyȱ hadȱ deliberatelyȱ soughtȱ anȱ ‘energyȱ boost’,ȱ Inȱ 2001,ȱ Redȱ Bullȱ Gmbhȱ conductedȱ aȱ surveyȱ ofȱ energyȱ andȱhadȱreceivedȱitȱinȱtheȱformȱofȱaȱstimulantȱeffectȱfromȱ drinkȱconsumptionȱinȱAustria.ȱTheȱsurveyȱwasȱconductedȱ theȱcaffeineȬcontainingȱsupplementsȱandȱdrinks.ȱȱ onȱ 8500ȱ Austriansȱ agedȱ 15ȱ yearsȱ andȱ over.ȱ FortyȬtwoȱ ȱ percentȱ ofȱ theȱ sampleȱ consumedȱ energyȱ drinksȱ atȱ leastȱ Malinauskasȱ etȱ al.ȱ (2007)ȱ conductedȱ aȱ surveyȱ ofȱ energyȱ occasionallyȱ andȱ 12%ȱ wereȱ regularȱ usersȱ whichȱ wereȱ drinkȱconsumptionȱpatternsȱamongȱUnitedȱStatesȱcollegeȱ definedȱasȱthoseȱwhoȱconsumedȱatȱleastȱoneȱenergyȱdrinkȱ studentsȱwhereinȱconsumptionȱpatternsȱofȱ496ȱrandomlyȱ perȱ week.ȱ Forȱ theȱ surveyedȱ population,ȱ meanȱ chronicȱ surveyedȱ collegeȱ studentsȱ wereȱ assessed.ȱ Fiftyȱ oneȱ consumption,ȱchronicȱconsumptionȱatȱtheȱ95thȱpercentile,ȱ percentȱ ofȱ thoseȱ surveyedȱ reportedȱ consumingȱ greaterȱ andȱ acuteȱ consumptionȱ atȱ theȱ 90thȱ percentileȱ wereȱ thanȱoneȱenergyȱdrinkȱeachȱmonthȱinȱanȱaverageȱmonthȱ approximatelyȱ0.47ȱcansȱperȱday,ȱ1.4ȱcansȱperȱdayȱandȱ2.6ȱ forȱtheȱsemester.ȱTheȱmajorityȱofȱusersȱconsumedȱenergyȱ cansȱperȱday,ȱrespectivelyȱ(1ȱcanȱ=ȱ250ȱmL).ȱ drinksȱ forȱ insufficientȱ sleepȱ (67%),ȱ toȱ increaseȱ energyȱ ȱ (65%),ȱ andȱ toȱ drinkȱ withȱ alcoholȱ whileȱ partyingȱ (54%).ȱ Theȱmajorityȱofȱusersȱconsumedȱoneȱenergyȱdrinkȱinȱmostȱ situations,ȱ althoughȱ consumingȱ threeȱ orȱ moreȱ withȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ ȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱȱ alcoholȱwhileȱpartyingȱwasȱaȱcommonȱpracticeȱ(49%).ȱForȱ 17ȱWhileȱthisȱmanuscriptȱwasȱinȱpreparation,ȱtheȱEuropeanȱFoodȱ Safetyȱ Authorityȱ (EFSA)ȱ releasedȱ aȱ study,ȱ Gatheringȱ theȱ majorityȱ ofȱ studentsȱ (73Ȭ86%),ȱ energyȱ drinksȱ wereȱ consumptionȱdataȱonȱspecificȱconsumerȱgroupsȱofȱenergyȱdrinks.ȱ consumedȱ 1Ȭ4ȱ daysȱ inȱ aȱ month.ȱ Fiveȱ toȱ 12%ȱ ofȱ studentsȱ (Zucconiȱetȱal.,ȱ2013),ȱdetailingȱtheȱconsumptionȱofȱenergyȱdrinksȱ consumedȱenergyȱdrinksȱelevenȱorȱmoreȱdaysȱaȱmonth.ȱ byȱEuropeans.ȱȱ

18 Int. food risk anal. j., 2013, Vol. 3, 4:2013 www.intechopen.com ȱ !

5.3ȱCanadianȱsurveyȱdataȱ drinksȱ wereȱ usedȱ asȱ surrogateȱ dataȱ forȱ energyȱ drinksȱ inȱ orderȱ toȱ generateȱ possibleȱ patternsȱ ofȱ anȱ exposureȱ Basedȱ onȱ theȱ mostȱ recentȱ Canadianȱ Communityȱ Healthȱ modelȱthatȱincludesȱenergyȱdrinks.ȱȱ Surveyȱ (CCHS),ȱ 2004,ȱ aȱdeterminationȱofȱdailyȱexposureȱ ȱ ȱ ȱ ȱ levelsȱ isȱ notȱ possibleȱ dueȱ toȱ theȱ limitedȱ reportingȱ ofȱ ȱ ȱ ȱ ȱȱ ȱ of ȱ of ȱ energyȱdrinkȱconsumptionȱinȱthatȱsurvey.ȱ for ȱ CSDs ȱ ȱ ȱ ȱ ȱ ȱ ȱ 1 1 persons for ȱ ȱ ȱ ȱ persons ACNielsenȱcarriedȱoutȱsurveysȱfromȱ2006Ȭ2009ȱtoȱprovideȱ ȱ ȱ consumers consumers Ȭ Ȭ ȱ All ȱ All consumers ȱ ȱ bw/day) nationalȱ salesȱandȱconsumerȱ purchaseȱandȱdemographicȱ consumers ȱ Ageȱinȱ ȱ substituted for volume non non ȱ ȱ for ȱ ȱ for bw/day) ȱȱ ȱ ȱ for bw/day) dataȱ forȱ Naturalȱ Healthȱ Productsȱ (NHPs)ȱ ofȱ interest.ȱ bw/day) ȱȱ ȱ

yearsȱ ȱ ȱ CSDs) volume by ȱ ȱ ȱ EDs and and substituted ȱ of ȱ (gender) ȱ

Whileȱ theȱ ACNielsenȱ dataȱ offerȱ anȱ indicationȱ ofȱ theȱ ȱ (mg/kg by ȱ if intake ȱȱ ȱ intakes intake

relativeȱ size,ȱ strengthȱ andȱ demandȱ forȱ energyȱ drinksȱ inȱ ȱ (mg/kg ȱ CSDs intakes EDs (mg/kg (mg/kg ȱ ȱ if CSDs Canada,ȱtheȱdataȱdoȱnotȱprovideȱsufficientȱinformationȱtoȱ ȱ CSDs) determineȱ dailyȱ consumptionȱ levelsȱofȱ energyȱ drinksȱ byȱ ȱ Median of Median Median (consumers (consumers Median Canadians.ȱȱ CSDs 2Ȭ3ȱ 0.06ȱ 0.06ȱ 0.98ȱ 2.62ȱȱ 5.4ȱȱ Summaryȱ 4Ȭ5ȱ 0.13ȱ 0.13ȱ 1.18ȱ 3.19ȱ 6Ȭ8ȱ 0.14ȱ 0.14ȱ 1.35ȱ 3.41ȱ Theȱ Canadianȱ andȱ internationalȱ consumptionȱ dataȱ forȱ 9Ȭ11ȱ 0.15ȱ 0.15ȱ 1.19ȱ 2.94ȱ energyȱ drinksȱ areȱ consideredȱ veryȱ limited.ȱ Inȱ addition,ȱ (male)ȱ internationalȱdataȱthatȱareȱavailableȱfromȱearlyȱ2000ȱmayȱ 9Ȭ11ȱ 0.14ȱ 0.14ȱ 0.97ȱ 2.46ȱ notȱreflectȱcurrentȱenergyȱdrinkȱconsumptionȱpatternsȱinȱ (female)ȱ Canadaȱ asȱ theseȱ productsȱ haveȱ becomeȱ muchȱ moreȱ 12Ȭ14ȱ 0.18ȱ 0.18ȱ 1.05ȱ 2.81ȱ pervasiveȱinȱtheȱCanadianȱmarketplaceȱinȱrecentȱyears.ȱ (male)ȱ 12Ȭ14ȱ 0.15ȱ 0.15ȱ 0.86ȱ 2.65ȱ 6.ȱModellingȱExposureȱScenarioȱȱ (female)ȱ 15Ȭ16ȱ 0.37ȱ 0.47ȱ 1.00ȱ 2.57ȱ Theȱhealthȱriskȱassessmentȱofȱtheȱingredientsȱinȱaȱtypicalȱ (male)ȱ energyȱ drinkȱ determinedȱ thatȱ caffeineȱ hasȱ theȱ greatestȱ 15Ȭ16ȱ 0.17ȱ 0.17ȱ 1.08ȱ 2.89ȱ potentialȱtoȱpresentȱaȱhazard.ȱAȱsingleȱ250ȱmlȱservingȱofȱaȱ (female)ȱ typicalȱenergyȱdrinkȱcontainsȱ80ȱmgȱofȱcaffeine.ȱAlthoughȱ 17Ȭ19ȱ 0.55ȱ 1.26ȱ 1.17ȱ 2.55ȱ (male)ȱ thisȱamountȱisȱhalfȱtheȱ160ȱmgȱofȱcaffeineȱthatȱaȱsingleȱ250ȱ 17Ȭ19ȱ 0.62ȱ 0.95ȱ 0.98ȱ 2.75ȱ mlȱ servingȱ ofȱ coffeeȱ canȱ contain,ȱ itȱ isȱ doubleȱ theȱ 40ȱ mgȱ (female)ȱ presentȱ inȱ aȱ 355ȱ mlȱ servingȱ ofȱ aȱ caffeinatedȱ carbonatedȱ 20+ȱ 2.23ȱ 2.66ȱ 2.67ȱ 4.19ȱ softȱdrinkȱ(CSD).ȱInȱanyȱcase,ȱtheȱamountȱofȱcaffeineȱinȱaȱ (male)ȱ typicalȱenergyȱ drinkȱcanȱmakeȱaȱsignificantȱcontributionȱ 20+ȱ 2.21ȱ 2.46ȱ 2.70ȱ 4.07ȱ toȱtheȱtotalȱdietaryȱcaffeineȱintake.ȱȱ (female)ȱ ȱ Pregnant 0.48ȱ 0.53ȱ 1.19ȱ 2.18ȱ Inȱ orderȱ toȱ determineȱ theȱ totalȱ dietaryȱ intakeȱ ofȱ 1ȱCaffeinatedȱcarbonatedȱsoftȱdrinksȱwereȱsubstitutedȱwithȱenergyȱdrinksȱ caffeine,ȱ Healthȱ Canadaȱ accessedȱ dataȱ onȱ theȱ onȱ aȱ volumeȱ basis.ȱ Theȱ caffeineȱ concentrationȱ ofȱ caffeinatedȱ carbonatedȱ softȱdrinksȱrangedȱfromȱ73ȱtoȱ140ȱppmȱandȱofȱenergyȱdrinksȱwasȱ320ȱppm.ȱȱ consumptionȱ ofȱ aȱ wideȱ varietyȱ ofȱ foods,ȱ includingȱ foodsȱ containingȱ caffeine,ȱ byȱ variousȱ ageȱ groupsȱ Tableȱ9.ȱExposureȱmodellingȱofȱtotalȱdietaryȱcaffeineȱintakeȱforȱ(1)ȱ (Statisticsȱ Canada,ȱ Canadianȱ Communityȱ Healthȱ Allȱ personsȱ (consumersȱ andȱ nonȬconsumersȱ ofȱ caffeinatedȱ carbonatedȱ softȱ drinksȱ (CSDs)),ȱ (2)ȱ Allȱ persons,ȱ ifȱ allȱ CSDsȱ areȱ Surveyȱ Cycleȱ 2.2.,ȱ 2004).ȱ Usingȱ foodȱ intakeȱ dataȱ fromȱ replacedȱbyȱtypicalȱenergyȱdrinksȱ(EDs),ȱ(3)ȱConsumersȱofȱCSDs,ȱ thisȱ survey,ȱ caffeineȱ consumptionȱ wasȱ determinedȱ (4)ȱ Consumersȱ ofȱ CSDsȱ ifȱ allȱ CSDȱ consumptionȱ isȱ replacedȱ byȱ fromȱ allȱ foodȱ sources,ȱ includingȱ coffee,ȱ teaȱ andȱ softȱ typicalȱenergyȱdrinksȱȱ drinks.ȱHowever,ȱintakeȱdataȱspecificȱtoȱenergyȱdrinksȱ wereȱ notȱ availableȱ becauseȱ thereȱ wasȱ anȱ insufficientȱ Theȱabsenceȱofȱconsumptionȱmodellingȱforȱenergyȱdrinksȱ numberȱ ofȱ respondentsȱ whoȱ reportedȱ energyȱ drinkȱ isȱ acknowledged.ȱ Therefore,ȱ theȱ modelȱ belowȱ wouldȱ beȱ consumptionȱ inȱ theȱ 2004ȱ survey.ȱ Inȱ theȱ absenceȱ ofȱ moreȱ aȱ representationȱ ofȱ aȱ worstȱ caseȱ scenario,ȱ asȱ intakeȱ dataȱ specificȱ toȱ energyȱ drinks,ȱ theȱ patternsȱ ofȱ opposedȱ toȱ aȱ descriptionȱ ofȱ anȱ expectedȱ consumptionȱ potentialȱexposureȱtoȱcomponentsȱofȱenergyȱdrinksȱcanȱ pattern.ȱ Otherȱ factorsȱ suchȱ asȱ taste,ȱ costȱ andȱ theȱ timeȱ beȱ determinedȱ fromȱ intakeȱ dataȱ forȱ aȱ foodȱ forȱ whichȱ betweenȱservingsȱ(binging)ȱmayȱultimatelyȱinfluenceȱtheȱ consumptionȱ canȱ beȱ assumedȱ toȱ beȱ similarȱ toȱ thatȱ ofȱ leastȱconservativeȱ andȱ theȱ worstȱ caseȱmodelsȱforȱ energyȱ energyȱ drinks.ȱ Inȱ theȱ followingȱ exposureȱ assessmentȱ drinkȱconsumption.ȱ patterns,ȱ intakeȱ dataȱ forȱ caffeinatedȱ carbonatedȱ softȱȱ ȱ ȱ

www.intechopen.com Joel Rotstein, Jennifer Barber, Carl Strowbridge, Stephen Hayward, Rong Huang and Samuel Benrejeb Godefroy: 19 ȱ Energy Drinks: An Assessment of the Potential Health Risks in the Canadian Context ! ȱ ȱ ȱȱ ȱ ȱ ȱ if ȱ if ȱ ȱ ȱȱ for ȱ ȱȱ ȱ 2 ȱ ȱ CSDs RMDI ȱ ȱ RMDI ȱ EDs ȱ of RMDI ȱ ȱȱ ȱ ȱ (mg/kg ȱ ȱ ȱ for CSDs ȱ ȱ ȱ ȱ persons ȱ EDs substituted if with ȱ ȱ bw/day) consumers ȱ EDs ȱ ȱ ȱ ȱ ȱ ȱ 1 ȱ 2 ȱ ȱ ȱ Ageȱinȱ All 1 ȱ ȱ exceeding exceeding Ageȱinȱ ȱ bw/day) bw/day) with ȱ ȱ ȱ ȱ CSD intakes with exceeding yearsȱ CSDs ȱ for ȱ ȱ ȱ ȱ ȱ bw/day) bw/day) consumers ȱ RMDI ȱ ȱ ȱ CSDs yearsȱ ȱ if RMDI (mg/kg ȱ

(gender)ȱ ȱ for ȱ RMDI for

(gender)ȱ ȱ bw/day) substituted ȱ (mg/kg (mg/kg persons intake EDs person ȱ ȱ ȱ ȱ Median (mg/kg (mg/kg consumers ȱ persons All substituted ȱ intake intakes All ȱ exceeding ȱ ȱ ȱ substituted ȱ CSDs ȱ with of of ȱ % All ȱ CSD ȱ ȱ Median % % of ȱ CSDs Median Median 2Ȭ3ȱ 2.5ȱ 0.06ȱ 2.3ȱ 0.06ȱ 4.9ȱ % 4Ȭ5ȱ 0.13ȱ 3.5ȱ 0.13ȱ 7.8ȱ 2Ȭ3ȱ 2.5ȱ 0.98ȱ 3.3ȱ 2.62ȱ3ȱ 56.8ȱ 6Ȭ8ȱ 0.14ȱ 3.1ȱ 0.14ȱ 8.2ȱ 4Ȭ5ȱ 1.18ȱ 8.3ȱ 3.19ȱ 68.9ȱ 9Ȭ11ȱ 0.15ȱ 0.15ȱ 6Ȭ8ȱ 1.35ȱ 13.5ȱ 3.41ȱ 62.9ȱ 3.8ȱ 13.2ȱ (male)ȱ 9Ȭ11ȱ 1.19ȱ 14.0ȱ 2.94ȱ 61.3ȱ 9Ȭ11ȱ 0.14ȱ 0.14ȱ (male)ȱ 2.9ȱ 9.1ȱ (female)ȱ 9Ȭ11ȱ 0.97ȱ 7.3ȱ 2.46ȱ 46.7ȱ 12Ȭ14ȱ 0.18ȱ 0.18ȱ (female)ȱ 3.4ȱ 17.2ȱ (male)ȱ 12Ȭ14ȱ 1.05ȱ 8.2ȱ 2.81ȱ 59.3ȱ 12Ȭ14ȱ 0.15ȱ 0.15ȱ (male)ȱ 2.4ȱ 21.9ȱ (female)ȱ 12Ȭ14ȱ 0.86ȱ 6.7ȱ 2.65ȱ 55.7ȱ 15Ȭ16ȱ 0.37ȱ 0.47ȱ (female)ȱ 6.7ȱ 21.5ȱ (male)ȱ 15Ȭ16ȱ 1.00ȱ 12.6ȱ 2.57ȱ 52.0ȱ 15Ȭ16ȱ 0.17ȱ 0.17ȱ (male)ȱ 10.3ȱ 20.8ȱ (female)ȱ 15Ȭ16ȱ 1.08ȱ 20.4ȱ 2.89ȱ 60.6ȱ 17Ȭ19ȱ 0.55ȱ 1.26ȱ (female)ȱ 14.6ȱ 30.9ȱ (male)ȱ 17Ȭ19ȱ 1.17ȱ 19.6ȱ 2.55ȱ 59.0ȱ 17Ȭ19ȱ 0.62ȱ 0.95ȱ (male)ȱ 17.8ȱ 27.6ȱ (female)ȱ 17Ȭ19ȱ 0.98ȱ 17.3ȱ 2.75ȱ 54.1ȱ 20+ȱ 6.0ȱ 2.23ȱ 2.66ȱ (female)ȱ 14.3ȱ 17.5ȱ (male)ȱ 20+ȱ(male) 6.0ȱ 2.67ȱ 16.2ȱ 4.19ȱ 29.4ȱ 20+ȱ 2.21ȱ 2.46ȱ 20+ȱ 2.70ȱ 15.5ȱ 4.07ȱ 28.1ȱ 13.0ȱ 15.2ȱ (female)ȱ (female)ȱ Pregnantȱ 4.6ȱ 0.48ȱ 4.7ȱ 0.53ȱ 5.4ȱ Pregnant 4.6ȱ 1.19ȱ 9.7ȱ 2.18ȱ 14.9ȱ 1ȱRMDIȱisȱtheȱrecommendedȱmaximumȱdailyȱintake.ȱȱ 1ȱ Recommendedȱ Maximumȱ Dailyȱ Intake.ȱ Adolescentsȱ areȱ conservativelyȱ 2ȱCaffeinatedȱcarbonatedȱsoftȱdrinksȱwereȱsubstitutedȱwithȱenergyȱdrinksȱ assumedȱtoȱhaveȱaȱRMDIȱequalȱtoȱchildren.ȱȱ onȱ aȱ volumeȱ basis.ȱ Theȱ caffeineȱ concentrationȱ ofȱ caffeinatedȱ carbonatedȱ 2ȱCaffeinatedȱcarbonatedȱsoftȱdrinksȱwereȱsubstitutedȱwithȱenergyȱdrinksȱ softȱdrinksȱrangedȱfromȱ73ȱtoȱ140ȱppmȱandȱofȱenergyȱdrinksȱwasȱ320ȱppm.ȱȱ onȱ aȱ volumeȱ basis.ȱ Theȱ caffeineȱ concentrationȱ ofȱ caffeinatedȱ carbonatedȱ 3ȱFiguresȱinȱboldȱequalȱorȱexceedȱtheȱRMDIȱforȱcaffeineȱintakeȱforȱthatȱageȱ softȱdrinksȱrangedȱfromȱ73ȱtoȱ140ȱppmȱandȱofȱenergyȱdrinksȱwasȱ320ȱppm.ȱȱ group.ȱ 3ȱFiguresȱinȱboldȱequalȱorȱexceedȱtheȱRMDIȱforȱcaffeineȱintakeȱforȱthatȱageȱ Tableȱ 10.ȱ Potentialȱ Healthȱ Riskȱ forȱ (1)ȱ Allȱ personsȱ (consumersȱ group.ȱ andȱnonȬconsumersȱofȱcaffeinatedȱcarbonatedȱsoftȱdrinksȱ(CSDs),ȱ Tableȱ11.ȱPotentialȱHealthȱRiskȱforȱ(1)ȱConsumersȱofȱcaffeinatedȱ (2)ȱ Allȱ personsȱ ifȱ allȱ CSDȱ consumptionȱ isȱ replacedȱ byȱ typicalȱ carbonatedȱ softȱ drinksȱ (CSDs),ȱ (2)ȱ Consumersȱ ofȱ CSDsȱ ifȱ allȱ energyȱdrinksȱ(EDs)ȱ caffeinatedȱ carbonatedȱ softȱ drinkȱ consumptionȱ isȱ replacedȱ byȱ typicalȱenergyȱdrinksȱ(EDs)ȱ Tableȱ9ȱshowsȱexposureȱtoȱcaffeineȱforȱallȱpersonsȱandȱforȱ 7.ȱPotentialȱHealthȱRiskȱ consumersȱofȱcaffeinatedȱcarbonatedȱsoftȱdrinksȱinȱvariousȱ ageȱ groups,ȱexpressedȱasȱmg/kgȱbw/day.ȱMedianȱcaffeineȱ Theȱpotentialȱhealthȱriskȱposedȱbyȱtheȱcaffeineȱinȱenergyȱ intakeȱfromȱallȱdietaryȱsourcesȱisȱdepictedȱforȱconsumersȱofȱ drinksȱ canȱ beȱ characterizedȱ byȱ consideringȱ theȱ hazardȱ softȱ drinksȱ containingȱ caffeineȱ atȱ “currentȱ marketȱ use”ȱ dueȱtoȱcaffeineȱandȱtheȱpotentialȱexposureȱtoȱallȱsourcesȱ levels.ȱTableȱ9ȱalsoȱshowsȱtheȱmedianȱdoseȱofȱcaffeineȱfromȱ ofȱdietaryȱcaffeine,ȱincludingȱenergyȱdrinks,ȱwithinȱanȱageȱ allȱ dietaryȱ sourcesȱ forȱ allȱ personsȱ andȱ consumersȱ ofȱ groupȱorȱsubgroupȱofȱtheȱpopulation.ȱȱ caffeinatedȱ carbonatedȱ softȱ drinks,ȱ ifȱ energyȱ drinksȱ wereȱ ȱ substitutedȱ forȱ caffeinatedȱ carbonatedȱ softȱ drinksȱ onȱ aȱ HealthȱCanadaȱusedȱscientificȱdataȱonȱtheȱhealthȱhazardȱ volumeȱbasisȱ(“substitutedȱbyȱvolume”).ȱThisȱisȱnotȱtoȱbeȱ posedȱ byȱ caffeineȱ toȱ establishȱ recommendedȱ maximumȱ construedȱasȱanȱestimateȱofȱexposureȱinȱtheȱtrueȱpopulationȱ dailyȱ intakeȱ (RMDI)ȱ valuesȱ forȱ childrenȱ (2.5ȱ mg/kgȱ sinceȱ energyȱ drinkȱ consumptionȱ isȱ likelyȱ toȱ beȱ lessȱ onȱ aȱ bw/day),ȱ adultsȱ (6.0ȱ mg/kgȱ bw/day)ȱ andȱ womenȱ ofȱ volumetricȱscaleȱthanȱcaffeinatedȱcarbonatedȱsoftȱdrinks.ȱ reproductiveȱ ageȱ (4.6ȱ mg/kgȱ bw/day).ȱ Thereȱ areȱ

20 Int. food risk anal. j., 2013, Vol. 3, 4:2013 www.intechopen.com ȱ !

insufficientȱ dataȱ toȱ determineȱ aȱ separateȱ RMDIȱ forȱ ȱ Allȱpersonsȱ adolescents.ȱ Asȱ aȱ precautionaryȱ approach,ȱ adolescentsȱ (consumersȱandȱ Consumersȱofȱ canȱ beȱ consideredȱ toȱ beȱ asȱ sensitiveȱ asȱ childrenȱ toȱ nonȬconsumersȱofȱ CSDsȱ caffeine,ȱ inȱ whichȱ case,ȱ theȱ RMDIȱ forȱ childrenȱ canȱ beȱ CSDs)ȱ

Percentȱ ȱ ȱ ȱ ȱ ȱ

conservativelyȱappliedȱtoȱadolescents.ȱȱ ȱ 2 the

consumingȱ ȱ ȱ 1 total CSD ȱ CSDs ȱ ȱ ȱ Theȱ resultsȱ ofȱ exposureȱ modellingȱ indicateȱ thatȱ theȱ ȱ RMDI ȱ exceeds ȱ substituted medianȱ totalȱ dietaryȱ caffeineȱ intakeȱ byȱ allȱ consumersȱ substituted ȱ ȱ whose ȱ ȱ volume volume ȱ (Tableȱ 10)ȱ andȱ byȱ consumersȱ ofȱ caffeinatedȱ carbonatedȱ Ageȱinȱ ȱ including ȱ by by ȱ ȱ intake CSDs yearsȱ CSDs ȱ ȱ softȱdrinksȱȱ(Tableȱ11)ȱdoȱnotȱexceedȱtheȱRMDIȱinȱanyȱofȱ ȱ exceeding RMDI if if ȱ ȱ (gender) ȱ EDs EDs ȱ theȱageȱgroups.ȱTheȱsituationȱforȱmedianȱintakeȱremainsȱ ȱ consumers ȱ essentiallyȱunchangedȱforȱallȱpersonsȱwhenȱenergyȱdrinksȱ persons, ȱ caffeine ȱ with with

areȱsubstitutedȱforȱcaffeinatedȱcarbonatedȱsoftȱdrinks,ȱthatȱ All CSD ȱ ȱ exceeding exceeding ȱ ȱ consumers, % % % isȱnoȱageȱgroupȱexceedsȱitsȱRMDIȱ(Tableȱ10).ȱInȱcontrast,ȱ % whenȱ energyȱ drinksȱ areȱ substitutedȱ forȱ caffeinatedȱ dietary carbonatedȱsoftȱ drinks,ȱ theȱmedianȱ totalȱ dietaryȱcaffeineȱ 2Ȭ3ȱ 6%ȱ 2.3ȱ 4.9ȱ 3.3ȱ 56.8ȱ intakeȱ byȱ CSDȱ consumersȱ inȱ everyȱ populationȱ groupȱ ofȱ 4Ȭ5ȱ 7%ȱ 3.5ȱ 7.8ȱ 8.3ȱ 68.9ȱ childrenȱ andȱ adolescentsȱ meetsȱ orȱ exceedsȱ itsȱ RMDI,ȱ 6Ȭ8ȱ 12%ȱ 3.1ȱ 8.2ȱ 13.5ȱ 62.9ȱ 9Ȭ11ȱ 19%ȱ whileȱthoseȱofȱadultsȱandȱpregnantȱwomenȱdoȱnotȱ(Tableȱ 3.8ȱ 13.2ȱ 14.0ȱ 61.3ȱ 11).ȱ Theȱ resultsȱ alsoȱ showȱ thatȱ theȱ percentageȱ ofȱ (male)ȱ 9Ȭ11ȱ 16%ȱ consumersȱ inȱ eachȱ populationȱ groupȱ whoȱ exceedȱ theirȱ 2.9ȱ 9.1ȱ 7.3ȱ 46.7ȱ (female)ȱ RMDIȱ increasesȱ dramaticallyȱ whenȱ energyȱ drinksȱ areȱ 12Ȭ14ȱ 29%ȱ substitutedȱforȱcaffeinatedȱcarbonatedȱsoftȱdrinksȱbothȱforȱ 3.4ȱ 17.2ȱ 8.2ȱ 59.3ȱ (male)ȱ allȱpersonsȱ(Tableȱ10)ȱandȱCSDȱconsumersȱ(Tableȱ11).ȱForȱ 12Ȭ14ȱ 22%ȱ 2.4ȱ 21.9ȱ 6.7ȱ 55.7ȱ example,ȱ theȱ greatestȱ increaseȱ (fromȱ 3%ȱ toȱ 57%)ȱ inȱ theȱ (female)ȱ percentageȱofȱCSDȱconsumersȱwhoȱexceedȱtheirȱRMDIȱisȱ 15Ȭ16ȱ 36%ȱ 6.7ȱ 21.5ȱ 12.6ȱ 52.0ȱ observedȱ inȱ 2Ȭȱ toȱ 3ȬyearȬoldsȱ (althoughȱ itȱ isȱ consideredȱ (male)ȱ thatȱ thisȱ scenarioȱ wouldȱ beȱ highlyȱ unlikely,ȱ givenȱ thatȱ 15Ȭ16ȱ 25%ȱ 10.3ȱ 20.8ȱ 20.4ȱ 60.6ȱ thisȱ ageȱ groupȱ wouldȱ normallyȱ notȱ beȱ givenȱ energyȱ (female)ȱ 17Ȭ19ȱ 40%ȱ drinksȱtoȱconsume)ȱ(Tableȱ11).ȱ 14.6ȱ 30.9ȱ 19.6ȱ 59.0ȱ ȱ (male)ȱ 17Ȭ19ȱ 27%ȱ Usingȱ theȱdataȱ fromȱTablesȱ 10ȱ andȱ11,ȱaȱcomparisonȱ forȱ 17.8ȱ 27.6ȱ 17.3ȱ 54.1ȱ (female)ȱ exposureȱmodellingȱpurposesȱisȱmadeȱinȱTableȱ12ȱofȱtheȱ 20+ȱ 24%ȱ 14.3ȱ 17.5ȱ 16.2ȱ 29.4ȱ percentageȱ ofȱ allȱ personsȱ andȱ consumersȱ ofȱ CSDsȱ whoȱ (male)ȱ exceedȱtheirȱRMDIȱforȱcaffeineȱunderȱtwoȱscenarios.ȱTheȱ 20+ȱ 16%ȱ 13.0ȱ 15.2ȱ 15.5ȱ 28.1ȱ firstȱ scenarioȱ assumesȱ currentȱ marketȱ use,ȱ whileȱ theȱ (female)ȱ secondȱassumesȱthatȱallȱCSDsȱwereȱreplacedȱwithȱenergyȱ Pregnant 18%ȱ 4.7ȱ 5.4ȱ 9.7ȱ 14.9ȱ drinks.ȱ Sinceȱ onlyȱ aȱ portionȱ ofȱ anyȱ givenȱ populationȱ 1ȱ Dataȱ fromȱ Theȱ Canadianȱ Communityȱ Healthȱ Surveyȱ Bȱ Cycleȱ 2.2ȱ onȱ groupȱ consumesȱ CSDs,ȱ theȱ percentȱ ofȱ CSDȱ consumersȱ Nutrition,ȱStatisticsȱCanada,ȱ2004.ȱȱ thatȱexceedsȱtheȱRMDIȱforȱthatȱpopulationȱgroupȱcanȱbeȱ 2ȱRMDIȱisȱtheȱrecommendedȱmaximumȱdailyȱintake.ȱTheȱvalueȱforȱchildren,ȱ muchȱ greaterȱ thanȱ theȱ percentageȱ ofȱ allȱ personsȱ thatȱ adultsȱandȱpregnantȱfemalesȱareȱ2.5,ȱ6.0ȱandȱ4.6ȱmg/kgȱbw/day,ȱrespectively.ȱ AdolescentsȱareȱconservativelyȱassumedȱtoȱhaveȱaȱRMDIȱequalȱtoȱchildren.ȱ exceedȱtheȱRMDI.ȱForȱexample,ȱamongȱ2Ȭȱtoȱ3ȬyearȬolds,ȱ onlyȱ 6%ȱ consumeȱ CSDs.ȱ Replacingȱ CSDsȱ withȱ energyȱ Tableȱ12.ȱAȱcomparisonȱofȱpercentȱofȱtotalȱdietaryȱcaffeineȱintakesȱ thatȱ exceedȱ theȱ caffeineȱ RMDIȱ betweenȱ (1)ȱ consumersȱ ofȱ drinksȱ inȱ thisȱ ageȱ groupȱ bringsȱ theȱ percentageȱ ofȱ caffeinatedȱcarbonatedȱsoftȱdrinksȱ(CSDs),ȱwithȱorȱwithoutȱenergyȱ consumerȱ whoȱ exceedȱ theȱ RMDIȱ toȱ 57ȱ %ȱ comparedȱ toȱ drinkȱ substitution;ȱ andȱ (2)ȱ “allȱ persons”ȱ (consumersȱ andȱ nonȬ onlyȱ5%ȱofȱallȱpersonsȱwhoȱdoȱso.ȱȱ consumersȱofȱCSDs),ȱwithȱorȱwithoutȱenergyȱdrinkȱsubstitution.ȱ ȱ Theȱ previousȱ sectionȱ presentedȱ aȱ worstȱ caseȱ exposureȱ Itȱmayȱbeȱreasonablyȱarguedȱthatȱtheȱdietȱofȱchildrenȱ(2Ȭ11ȱ scenarioȱinȱwhichȱtheȱconsumptionȱofȱenergyȱdrinksȱwasȱ yearsȱ old)ȱ isȱ monitoredȱ andȱ thatȱ parents,ȱ knowingȱ theȱ patternedȱafterȱthatȱofȱcaffeinatedȱcarbonatedȱsoftȱdrinksȱ potentialȱ ofȱ adverseȱ effectsȱ ofȱ excessiveȱ caffeine,ȱ areȱ andȱ resultedȱ inȱ moreȱ thanȱ 50%ȱ ofȱ childrenȱ andȱ unlikelyȱtoȱpermitȱtheseȱbeveragesȱinȱtheirȱchildren’sȱdiet.ȱ adolescents,ȱ aboutȱ 30%ȱ ofȱ adultsȱ andȱ 15%ȱ ofȱ pregnantȱ Further,ȱ youngȱ childrenȱ (2Ȭ8ȱ yearsȱ old)ȱ doȱ notȱ readilyȱ femalesȱ exceedingȱ theirȱ respectiveȱ recommendedȱ haveȱ theȱ abilityȱ toȱ purchaseȱ theseȱ products,ȱ whichȱ areȱ maximumȱ dailyȱ intakeȱ (RMDI)ȱ forȱ caffeine.ȱ Itȱ isȱ thereforeȱ muchȱ lessȱ likelyȱ toȱ beȱ partȱ ofȱ theirȱ diet.ȱ Theȱ importantȱtoȱassessȱhowȱrealisticȱthisȱworstȱcaseȱexposureȱ percentageȱ ofȱ childrenȱ exceedingȱ theȱ RMDIȱ forȱ caffeineȱ scenarioȱis.ȱȱ fromȱtheȱconsumptionȱofȱenergyȱdrinksȱisȱthereforeȱveryȱ

www.intechopen.com Joel Rotstein, Jennifer Barber, Carl Strowbridge, Stephen Hayward, Rong Huang and Samuel Benrejeb Godefroy: 21 ȱ Energy Drinks: An Assessment of the Potential Health Risks in the Canadian Context !

unlikelyȱ toȱ beȱ inȱ theȱ rangeȱ ofȱ 48ȱ toȱ 69%ȱ asȱ indicatedȱ inȱ intakesȱ areȱ veryȱ closeȱ toȱ theȱ conservativeȱ recommendedȱ Tableȱ 11ȱ andȱ 12,ȱ whichȱ isȱ basedȱ onȱ theȱ scenarioȱ thatȱ maximumȱdailyȱintakeȱofȱ2.5ȱmg/kgȱbw/day,ȱtheyȱwouldȱ energyȱdrinksȱwouldȱreplaceȱcaffeinatedȱcarbonatedȱsoftȱ beȱunlikelyȱtoȱposeȱaȱhealthȱhazard.ȱȱ drinksȱforȱthisȱageȱgroup.ȱȱ ȱ ȱ Oneȱorȱtwoȱservingsȱofȱaȱtypicalȱenergyȱdrinkȱ(80ȱmgȱofȱ Itȱcanȱalsoȱbeȱarguedȱthatȱadultsȱ(20ȱyearsȱandȱolder)ȱareȱ caffeine/serving)ȱ wouldȱ thereforeȱ beȱ unlikelyȱ toȱ poseȱ anȱ capableȱ ofȱ monitoringȱ theirȱ ownȱ caffeineȱ intakeȱ andȱ acuteȱhealthȱhazardȱbasedȱonȱcaffeineȱcontent.ȱHowever,ȱ wouldȱrecognizeȱtheȱacuteȱadverseȱeventsȱassociatedȱwithȱ itȱisȱknownȱthatȱsomeȱveryȱyoungȱ(12Ȭ14ȱyear)ȱadolescentȱ excessȱ caffeineȱ intakeȱ andȱ thenȱ moderateȱ theirȱ malesȱ(aboutȱ56ȱkgȱbw)ȱandȱfemalesȱ(aboutȱ52ȱkgȱbw)ȱwillȱ consumptionȱ accordingly.ȱ Excessȱ energyȱ drinkȱ consumeȱ aȱ largeȱ volumeȱ ofȱ carbonatedȱ softȱ drinkȱ inȱ aȱ consumptionȱ wouldȱ resultȱ inȱ similarȱ effectsȱ asȱ excessȱ singleȱ episode,ȱ aboutȱ 760ȱ mlȱ andȱ 519ȱ ml,ȱ respectivelyȱ coffeeȱ consumptionȱ (aȱ typicalȱ energyȱ drinkȱ containsȱ 80ȱ (Canadianȱ Communityȱ Healthȱ Surveyȱ 2.2,ȱ 2004).ȱ Thisȱ isȱ mgȱofȱcaffeineȱperȱ250ȱmlȱcomparedȱtoȱcupȱofȱcoffeeȱwithȱ furtherȱcorroboratedȱbyȱtheȱprevalenceȱofȱlargerȱvolumesȱ 76Ȭ180ȱ mgȱ ofȱ caffeineȱ perȱ 237ȱ ml).ȱ Similarlyȱ pregnantȱ ofȱ energyȱ drinkȱ cans,ȱ inȱ comparisonȱ toȱ otherȱ softȱ drinkȱ womenȱ areȱ capableȱ ofȱ monitoringȱ theirȱ ownȱ caffeineȱ cansȱ (710ȱ mlȱ cansȱ versusȱ 355ȱ mlȱ cans).ȱ Ifȱ thisȱ patternȱ ofȱ intake.ȱForȱtheseȱreasons,ȱitȱisȱunlikelyȱthatȱtheȱworstȱcaseȱ consumptionȱisȱappliedȱtoȱenergyȱdrinks,ȱthenȱthereȱcouldȱ exposureȱ scenarioȱ wouldȱ applyȱ toȱ theseȱ groupsȱ withinȱ beȱveryȱyoungȱadolescentsȱwhoȱdrinkȱtwoȱcontainersȱofȱaȱ theȱgeneralȱpopulation.ȱȱ 250ȱmlȱenergyȱdrink,ȱorȱoneȱcontainerȱofȱaȱ473ȱmlȱenergyȱ ȱ drink,ȱandȱyoungȱadolescentȱmalesȱwhoȱcouldȱdrinkȱaȱfullȱ Adolescentsȱ(12Ȭ19ȱyearsȱold)ȱpresentȱaȱmoreȱcomplicatedȱ 710ȱ mlȱ energyȱ drinkȱ inȱ aȱ singleȱ episode.ȱ Givenȱ theȱ situation.ȱ Inȱ theȱ absenceȱ ofȱ adequateȱ safetyȱ dataȱ toȱ amountȱ ofȱ caffeineȱ inȱ typicalȱ andȱ someȱ nonȬtypicalȱ establishȱ aȱ RMDIȱ ofȱ caffeineȱ forȱ adolescents,ȱ Healthȱ energyȱ drinks,ȱ theseȱ adolescentsȱ couldȱ haveȱ excessiveȱ Canadaȱ followedȱ aȱ precautionaryȱ approachȱ andȱ appliedȱ caffeineȱ intake,ȱ especiallyȱwhenȱconsumingȱ largeȱ formatȱ theȱmaximumȱdailyȱdoseȱrecommendedȱforȱchildrenȱ(2.5ȱ energyȱdrinks.ȱ mg/kgȱ bw/day)ȱ toȱ adolescents.ȱ Theȱ applicationȱ ofȱ theȱ ȱ childrenȇsȱ RMDIȱ toȱ adolescentsȱ isȱ likelyȱ veryȱ Givenȱthatȱmarketingȱforȱenergyȱdrinksȱtendȱtoȱtargetȱsomeȱ conservative.ȱ Thereȱ isȱ noȱ compellingȱ safetyȱ reasonȱ toȱ subsetsȱofȱadolescents,ȱthatȱtheyȱareȱcapableȱofȱpurchasingȱ suggestȱ thatȱ 19ȬyearȬoldȱ adolescentsȱ canȱ onlyȱ consumeȱ theseȱproductsȱ(unlikeȱchildren),ȱandȱareȱlessȱfamiliarȱwithȱ 2.5ȱ mg/kgȱ bw/dayȱ ofȱ caffeineȱ whereasȱ adultsȱ (20ȱ yearsȱ adverseȱ effectsȱ ofȱ excessiveȱ caffeineȱ (unlikeȱ adults),ȱ itȱ isȱ andȱolder)ȱcanȱconsumeȱ6ȱmg/kgȱbw/day.ȱItȱisȱmoreȱlikelyȱ reasonableȱtoȱconcludeȱthatȱtheȱcaffeineȱpresentȱinȱenergyȱ thatȱ adolescentsȱ couldȱ increaseȱ theirȱ maximumȱ dailyȱ drinksȱcouldȱposeȱaȱhealthȱriskȱforȱadolescents.ȱ intakeȱ ofȱ caffeineȱ fromȱ 2.5ȱ toȱ 6ȱ mg/kgȱ bw/dayȱ asȱ theyȱ matureȱwithoutȱappreciableȱhealthȱrisks.ȱNevertheless,ȱinȱ 7.1ȱSummaryȱ theȱ absenceȱ ofȱ dataȱ toȱ allowȱ theȱ establishmentȱ ofȱ aȱ specificȱRMDIȱforȱadolescents,ȱitȱwasȱconsideredȱprudentȱ Basedȱ onȱ theȱ hazardȱ characterisationȱ ofȱ eachȱ ofȱ theȱ toȱ setȱ theȱ maximumȱ recommendedȱ dailyȱ intakeȱ ofȱ ingredientsȱinȱaȱtypicalȱenergyȱdrink,ȱasȱdefinedȱinȱTableȱ caffeineȱ byȱ adolescentsȱ closerȱ toȱ thatȱ recommendedȱ forȱ 1,ȱitȱwasȱdeterminedȱthatȱtheȱexposureȱassessmentȱshouldȱ childrenȱthanȱthatȱrecommendedȱforȱadults.ȱȱ focusȱ onȱ caffeine.ȱ However,ȱ limitedȱ informationȱ isȱ ȱ availableȱtoȱdateȱonȱactualȱconsumptionȱofȱenergyȱdrinkȱ Inȱ theȱ worstȱ caseȱ exposureȱ scenario,ȱ describedȱ inȱ theȱ productsȱ inȱ Canada.ȱ Researchȱ isȱ beingȱ consideredȱ toȱ fillȱ previousȱ section,ȱ theȱ percentageȱ ofȱ adolescentsȱ whoȱ consumptionȱ dataȱ gapsȱ andȱ toȱ provideȱ furtherȱ insightsȱ exceededȱ theirȱ RMDIȱ rangedȱ fromȱ 47%ȱ toȱ 61%ȱ ofȱ intoȱ whetherȱ theȱ labelȱ instructionsȱ relatedȱ toȱ caffeinatedȱcarbonatedȱsoftȱdrinksȱconsumers,ȱdependingȱ consumptionȱ adviceȱ onȱ energyȱ drinksȱ areȱ effectiveȱ (i.e.ȱ onȱ ageȱ andȱ genderȱ (Tableȱ 12).ȱ Asȱ suggestedȱ inȱ theȱ areȱfollowed).ȱȱ paragraphȱabove,ȱitȱisȱlikelyȱmostȱadolescentsȱcanȱtolerateȱ ȱ greaterȱamountsȱofȱcaffeineȱthanȱtheirȱRMDI.ȱAsȱshownȱinȱ Inȱ theȱ absenceȱ ofȱ criticalȱ consumptionȱ data,ȱ exposureȱ Tableȱ11,ȱtheȱmedianȱintakesȱofȱcaffeineȱbyȱsubgroupsȱofȱ modellingȱ wasȱ conductedȱ byȱ substituting,ȱ onȱ aȱ volumeȱ adolescentsȱareȱlessȱthanȱ3.0ȱmg/kgȱbw/day,ȱandȱthereforeȱ basis,ȱ energyȱdrinksȱforȱ caffeinatedȱcarbonatedȱsoftȱ drinks,ȱ onlyȱslightlyȱgreaterȱthanȱtheȱRMDIȱofȱ2.5ȱmg/kgȱbw/day.ȱȱ forȱwhichȱthereȱisȱintakeȱdata.ȱThisȱapproachȱconservativelyȱ ȱ assumesȱ thatȱ energyȱ drinksȱ areȱ consumedȱ inȱ aȱ mannerȱ Theȱ intakeȱ inȱ excessȱ ofȱ theȱ RMDIȱ isȱ similarȱ toȱ whatȱ anȱ similarȱ toȱ thatȱ forȱ caffeinatedȱ carbonatedȱ softȱ drinks,ȱ andȱ adolescentȱ (12Ȭ19ȱ yearsȱ old)ȱ whoȱ drankȱ aȱ cupȱ ofȱ strongȱ thatȱenergyȱdrinkȱlabelȱinstructionsȱareȱnotȱfollowed.ȱItȱalsoȱ coffeeȱ (180ȱ mgȱ ofȱ caffeine/237ȱ ml)ȱ wouldȱ beȱ exposedȱ to.ȱ assumesȱthatȱaȱvolumeȱbasisȱofȱsubstitutionȱisȱaȱmoreȱlikelyȱ Forȱ example,ȱ theȱ caffeineȱ intakeȱ fromȱ aȱ singleȱ cupȱ ofȱ thanȱaȱservingȱbasisȱofȱsubstitution.ȱȱ coffeeȱ wouldȱ resultȱ inȱ aȱ doseȱ ofȱ 3.14ȱ andȱ 2.8ȱ mg/kgȱ ȱ bw/dayȱ forȱ anȱ adolescentȱ femaleȱ (aboutȱ 57ȱ kgȱ bw)ȱ andȱ Theȱresultsȱofȱtheȱexposureȱassessmentȱthatȱconsideredȱaȱ maleȱ (aboutȱ 64ȱ kgȱ bw)ȱ respectively.ȱ Sinceȱ theseȱ caffeineȱ worstȱ caseȱ scenarioȱ determinedȱ thatȱ ofȱ theȱ consumersȱ

22 Int. food risk anal. j., 2013, Vol. 3, 4:2013 www.intechopen.com ȱ !

whoȱ replaceȱ caffeinatedȱ carbonatedȱ softȱ drinksȱ withȱ Inȱthisȱdocumentȱaȱtypicalȱenergyȱdrinkȱformulationȱwasȱ energyȱ drinks,ȱ moreȱ thanȱ 50%ȱ ofȱ childrenȱ andȱ definedȱbyȱitsȱingredientsȱandȱservingȱsize,ȱwhereȱaȱsingleȱ adolescents,ȱ aboutȱ 30%ȱ ofȱ adultsȱ andȱ 15%ȱ ofȱ pregnantȱ canȱservingȱofȱ250ȱmlȱcontainsȱ80ȱmgȱofȱcaffeine,ȱ1000ȱmgȱ femalesȱ wouldȱ exceedȱ theirȱ respectiveȱ recommendedȱ ofȱ taurine,ȱ 600ȱ mgȱ ofȱ glucuronolactoneȱ andȱ severalȱ Bȱ maximumȱdailyȱintakesȱofȱcaffeineȱandȱthereforeȱmayȱbeȱ vitamins.ȱȱ susceptibleȱ toȱ theȱ adverseȱ effectsȱ associatedȱ withȱ excessȱ ȱ caffeineȱ consumption.ȱ Consumersȱ ofȱ caffeinatedȱ Theȱliteratureȱonȱhealthȱeffectsȱofȱenergyȱdrinksȱisȱlimitedȱ carbonatedȱ softȱ drinksȱ representȱ roughlyȱ 8%ȱ ofȱ youngȱ toȱlessȱthanȱaȱdozenȱstudies,ȱeachȱwithȱaȱsmallȱnumberȱofȱ childrenȱ(1Ȭȱ8ȱyearsȱold),ȱ22%ȱofȱolderȱchildrenȱ(9Ȭ14ȱyearsȱ subjectsȱ (N<ȱ 50ȱ subjects/study).ȱ Theseȱ studiesȱ old),ȱ32%ȱofȱadolescents,ȱ20%ȱofȱtheȱadultȱpopulationȱandȱ demonstrateȱ thatȱ consumingȱ 1Ȭ2ȱ servingsȱ ofȱ aȱ typicalȱ 13%ȱofȱpregnantȱfemales.ȱȱ energyȱ drinkȱ formulationȱ willȱ temporarilyȱ increaseȱ ȱ alertnessȱ andȱ attentiveness,ȱ asȱ wellȱ asȱ temporarilyȱ Theȱ amountȱ ofȱ caffeineȱ inȱ energyȱ drinksȱ wouldȱ poseȱ aȱ increaseȱ bloodȱ pressureȱ andȱ heartȱ rate,ȱ inȱ aȱ mannerȱ healthȱconcernȱifȱconsumedȱbyȱchildrenȱ(2Ȭ11ȱyearsȱold).ȱ similarȱtoȱotherȱcaffeinatedȱbeverages.ȱȱ However,ȱ parentsȱ areȱ likelyȱ toȱ beȱ awareȱ thatȱ excessiveȱ ȱ caffeineȱ canȱ beȱ harmfulȱ andȱ wouldȱ keepȱ energyȱ drinksȱ Studiesȱ thatȱ examineȱ energyȱ drinkȱ useȱ priorȱ toȱ exerciseȱ outȱ ofȱ theirȱ children’sȱdiets.ȱEnergyȱ drinksȱareȱ thereforeȱ showedȱ thatȱ itȱ mayȱ enhanceȱ physicalȱ endurance.ȱ Inȱ notȱaȱhealthȱconcernȱforȱthisȱageȱgroup.ȱȱ contrast,ȱtheȱconsumptionȱofȱanȱenergyȱdrinkȱafterȱexerciseȱ ȱ mayȱresultȱinȱaȱdelayȱofȱtheȱreturnȱtoȱaȱrestingȱheartȱrate.ȱȱ Adultsȱ (20ȱ yearsȱ andȱ older)ȱ andȱ pregnantȱ womenȱ areȱ ȱ capableȱ ofȱ monitoringȱ theirȱ ownȱ caffeineȱ intake.ȱ Theyȱ Studiesȱ alsoȱ suggestȱ thatȱ theȱ combinedȱ consumptionȱ ofȱ wouldȱ recognizeȱ acuteȱ adverseȱ eventsȱ associatedȱ withȱ energyȱ drinksȱ andȱ alcoholȱ mayȱ poseȱ aȱ healthȱ risk.ȱ Theȱ excessȱintakeȱandȱmoderateȱtheirȱconsumptionȱaccordingly.ȱȱ potentialȱ consequenceȱ isȱ thatȱ aȱ personȱ consumingȱ anȱ ȱ energyȱdrinkȱwithȱalcoholȱmayȱbecomeȱintoxicatedȱmoreȱ Theȱ situationȱ ofȱ adolescentsȱ (12Ȭ18ȱ yearsȱ old)ȱ isȱ moreȱ quicklyȱ andȱ mayȱ beȱ lessȱ awareȱ ofȱ theirȱ physicalȱ complex.ȱ Becauseȱ ofȱ inadequateȱ safetyȱ dataȱ currentlyȱ impairment,ȱwhichȱmayȱleadȱtoȱriskyȱbehaviour,ȱsuchȱasȱ available,ȱ Healthȱ Canadaȱ conservativelyȱ appliedȱ theȱ excessiveȱalcoholȱconsumption.ȱAtȱpresent,ȱclearȱevidenceȱ RMDIȱforȱchildrenȱ(2.5ȱmg/kgȱbw/day)ȱtoȱthisȱageȱgroupȱ supportingȱthisȱsuggestionȱisȱlackingȱbutȱitȱmeritsȱfurtherȱ usingȱaȱworstȱcaseȱscenarioȱ(patterningȱenergyȱdrinkȱuseȱ investigation.ȱ onȱ caffeinatedȱ carbonatedȱ softȱ drinkȱ consumption)ȱ toȱ ȱ Itȱwasȱconcludedȱthatȱtheȱpublishedȱinformationȱavailableȱ determineȱ potentialȱ healthȱ risk.ȱ Theȱ percentageȱ ofȱ onȱ energyȱ drinksȱ wasȱ insufficientȱ toȱ characterizeȱ theȱ adolescentsȱwhoȱexceededȱtheirȱRMDIȱrangedȱfromȱ47%ȱ hazardȱ thatȱ thisȱ productȱ asȱ aȱ wholeȱ mayȱ pose.ȱ Forȱ thisȱ toȱ 61%ȱ ofȱ caffeinatedȱ carbonatedȱ softȱ drinksȱ consumers.ȱ reason,ȱ aȱ reviewȱ ofȱ eachȱ ofȱ theȱ majorȱ ingredientsȱ But,ȱatȱlessȱthanȱ3.0ȱmg/kgȱbw/day,ȱmedianȱintakesȱwereȱ containedȱ inȱ aȱ typicalȱ energyȱ drinkȱ wasȱ conducted,ȱ i.e.,ȱ onlyȱ slightlyȱ greaterȱ thanȱ theȱ RMDIȱ andȱ likelyȱ toȱ beȱ theȱ potentialȱ healthȱ effectsȱ ofȱ caffeine,ȱ taurine,ȱ tolerated.ȱTheȱcaffeineȱcontentȱofȱoneȱorȱtwoȱservingsȱofȱaȱ glucuronolactone,ȱ inositolȱ andȱ theȱ Bȱ vitaminsȱ wereȱ typicalȱ energyȱ drinkȱ (80ȱ mgȱ caffeine/serving)ȱ wouldȱ beȱ assessed.ȱ Inȱ doingȱ so,ȱ andȱ inȱ contrastȱ withȱ previouslyȱ unlikelyȱtoȱposeȱanȱacuteȱhealthȱhazard.ȱ publishedȱinformation,ȱ theȱ adverseȱ reactionȱ dataȱ relatedȱ ȱ toȱ eachȱ ofȱ theȱ ingredientsȱ inȱ theȱ formulationȱ thatȱ wereȱ However,ȱsomeȱyoungȱadolescentsȱ(12Ȭ14ȱyear)ȱconsumeȱ presentedȱ inȱ thisȱ documentȱ attemptedȱ toȱ reflectȱ toȱ theȱ largeȱvolumesȱofȱcaffeinatedȱcarbonatedȱsoftȱdrinksȱ(upȱtoȱ extentȱ possibleȱ “theȱ realȱ worldȱ use”ȱ ofȱ theȱ productsȱ asȱ 760ȱ ml)ȱ inȱ aȱ singleȱ episode.ȱ Applyingȱ thisȱ patternȱ ofȱ formulated,ȱinȱvariousȱuserȱpopulations.ȱȱ consumptionȱ toȱ energyȱ drinksȱ couldȱ resultȱ inȱ excessiveȱ ȱ caffeineȱintakeȱbyȱaȱproportionȱofȱyoungȱadolescents.ȱȱ Withȱ respectȱ toȱ caffeine,ȱ anȱ earlierȱ reviewȱ conductedȱ byȱ ȱ HealthȱCanada’sȱFoodȱDirectorateȱconcludedȱthatȱaȱhealthyȱ Inȱconclusion,ȱtheȱmodellingȱexposureȱscenarioȱasȱappliedȱ adultȱcouldȱtolerateȱaȱmaximumȱintakeȱofȱ400ȱmgȱcaffeineȱ toȱchildrenȱandȱadultsȱisȱunlikelyȱtoȱrepresentȱaȱrealisticȱ perȱ day,ȱ whichȱ couldȱ beȱ equivalentȱ toȱ 5ȱ servingsȱ ofȱ aȱ healthȱrisk.ȱHowever,ȱforȱadolescentsȱtheȱlikelihoodȱofȱaȱ typicalȱenergyȱdrinkȱperȱday.ȱThisȱamountȱofȱcaffeineȱwasȱ healthȱriskȱisȱgreater,ȱwhichȱmayȱreflectȱtheȱconservativeȱ notȱassociatedȱwithȱadverseȱeffectsȱsuchȱasȱgeneralȱtoxicity,ȱ assumptionsȱmadeȱaboutȱthisȱsubpopulation.ȱȱ cardiovascularȱ effects,ȱ effectsȱ onȱ boneȱ status,ȱ changesȱ inȱ 8.ȱOverallȱSummaryȱandȱConclusionsȱ behaviour,ȱ effectsȱ onȱ maleȱ fertilityȱ orȱ increasedȱ incidenceȱ ofȱcancerȱdevelopment.ȱFurther,ȱtheȱstudyȱconcludedȱthatȱ Theȱpurposeȱofȱthisȱdocumentȱisȱtoȱprovideȱaȱhealthȱriskȱ reproductiveȬagedȱ womenȱ couldȱ tolerateȱ aȱ maximumȱ assessmentȱ ofȱ energyȱ drinkȱ productsȱ whenȱ theyȱ areȱ intakeȱ ofȱ300ȱ mgȱcaffeineȱperȱday,ȱbasedȱonȱ reproductiveȱ consumedȱasȱfoodsȱinȱCanada.ȱ considerations.ȱItȱwasȱalsoȱconcludedȱthatȱchildren,ȱagedȱ4ȱ

www.intechopen.com Joel Rotstein, Jennifer Barber, Carl Strowbridge, Stephen Hayward, Rong Huang and Samuel Benrejeb Godefroy: 23 ȱ Energy Drinks: An Assessment of the Potential Health Risks in the Canadian Context !

toȱ 12ȱ years,ȱ couldȱ tolerateȱ aȱ maximumȱ ofȱ 45ȱ toȱ 85ȱ mgȱ ofȱ thanȱtheȱtolerableȱupperȱlimitȱforȱniacinȱ(35ȱmg/adult/day)ȱ caffeineȱ perȱ day,ȱ basedȱ onȱ transientȱ mildȱ behaviourȱ andȱ isȱ unlikelyȱ toȱ poseȱ aȱ healthȱ concern.ȱ However,ȱ theȱ changes.ȱConcerningȱadolescents,ȱagedȱ13ȱtoȱ18ȱyears,ȱthereȱ consumptionȱofȱ2ȱservingsȱperȱdayȱcouldȱpotentiallyȱresultȱ wereȱ insufficientȱ dataȱ toȱ determineȱ aȱ dailyȱ maximumȱ inȱ flushing.ȱ Inȱ contrast,ȱ whenȱ niacinȱ isȱ presentȱ asȱ intakeȱ ofȱ caffeine.ȱ However,ȱ theȱ adultȱ recommendedȱ nicotinamide,ȱ thereȱ areȱ noȱ healthȱ concernsȱ atȱ theȱ maximumȱdailyȱintakeȱwasȱconsideredȱinappropriateȱsinceȱ consumptionȱ levelȱ ofȱ 5ȱ servingsȱ perȱ day,ȱ sinceȱ someȱ manyȱ adolescentsȱ haveȱ aȱ lowerȱ bodyȱ weightȱ thanȱ theȱ jurisdictionsȱhaveȱtolerableȱupperȱlimitsȱofȱnicotinamideȱupȱ averageȱ adult,ȱ butȱ moreȱ importantlyȱ theȱ growingȱ toȱ900ȱmg/adult/day.ȱȱ adolescentȱwasȱconsideredȱtoȱbeȱmoreȱsensitiveȱtoȱcaffeine.ȱ ȱ Dueȱ toȱ thisȱ uncertainty,ȱ itȱ wasȱ moreȱ recentlyȱ concludedȱ Basedȱonȱcaffeineȱcontentȱalone,ȱitȱcouldȱbeȱsuggestedȱthatȱ that,ȱ asȱ aȱ precaution,ȱ adolescentsȱ shouldȱ consumeȱ aȱ doseȱ aȱhealthyȱadultȱcouldȱconsumeȱupȱtoȱ5ȱservingsȱofȱaȱtypicalȱ noȱ greaterȱ thanȱ thatȱ forȱ childrenȱ (2.5ȱ mg/kgȱ bw/day).ȱ Atȱ energyȱ drinkȱ perȱ dayȱ inȱ theȱ absenceȱ ofȱ anyȱ otherȱ dietaryȱ thisȱ dose,ȱ adolescentsȱ couldȱ consumeȱ 100ȱ toȱ 175ȱ mgȱ ofȱ sourceȱofȱcaffeine.ȱAȱtypicalȱenergyȱdrinkȱcontainsȱ80ȱmgȱofȱ caffeineȱ daily,ȱ dependingȱ onȱ theȱ individualȱ bodyȱ weightȱ caffeineȱ andȱ 5ȱ servingsȱ wouldȱ beȱ equalȱ toȱ 400ȱ mg,ȱ theȱ (estimatedȱ toȱ rangeȱ fromȱ 40–70ȱ kg).ȱ LighterȬweightȱ maximumȱ dailyȱ intakeȱ ofȱ caffeineȱ forȱ anȱ adult.ȱ Fiveȱ adolescentsȱ (40ȱ kgȱ bw)ȱ wouldȱ meetȱ theȱ suggestedȱ servingsȱ perȱ dayȱ wouldȱ beȱ equalȱ toȱ 5000ȱ mgȱ ofȱ taurine,ȱ maximumȱ intakeȱ ofȱ caffeineȱ withȱ slightlyȱ moreȱ thanȱ aȱ 3000ȱ mgȱ ofȱ glucuronolactoneȱ andȱ 300ȱ mgȱ ofȱ inositol.ȱ singleȱ servingȱ ofȱ aȱ typicalȱ energyȱ drink,ȱ whereasȱ heavierȱ Consideredȱ individually,ȱ theseȱ ingredientsȱ consumedȱ atȱ teensȱ (70ȱ kg)ȱ couldȱ consumeȱ 2ȱ servingsȱ perȱ dayȱ inȱ theȱ theseȱlevelsȱwouldȱnotȱbeȱexpectedȱtoȱcauseȱadverseȱeffectsȱ absenceȱofȱotherȱsourcesȱofȱdietaryȱcaffeine.ȱȱ inȱtheȱshortȬterm,ȱbasedȱonȱanimalȱstudies.ȱHowever,ȱlongȬ ȱ termȱ studiesȱ onȱ taurineȱ andȱ glucuronolactoneȱ haveȱ notȱ Taurine,ȱglucuronolactoneȱandȱinositolȱwereȱconsideredȱtoȱ beenȱ conducted.ȱ Inȱ theȱ absenceȱ ofȱ suchȱ studies,ȱ aȱ betterȱ beȱ normalȱ constituentsȱ ofȱ theȱ dietȱ andȱ easilyȱ handledȱ byȱ understandingȱofȱtheȱhumanȱmetabolismȱandȱphysiologicalȱ ordinaryȱ metabolicȱ processes.ȱ Whileȱ generallyȱ consideredȱ impactȱofȱtheseȱhighȱdosesȱwouldȱbeȱrequiredȱtoȱincreaseȱ toȱ beȱ ofȱ veryȱ lowȱ orȱ lowȱ toxicity,ȱ thereȱ wasȱ someȱ confidenceȱ inȱ theȱ conclusionȱ thatȱ thoseȱ levelsȱ wouldȱ notȱ uncertaintyȱ aboutȱ theȱ safetyȱ ofȱ theȱ levelsȱ ofȱ theseȱ likelyȱcauseȱadverseȱeffects.ȱȱ substancesȱ inȱ aȱ typicalȱ energyȱ drink,ȱ sinceȱ theȱ levelsȱ ofȱ ȱ someȱ greatlyȱ exceededȱ theȱ amountȱ consumedȱ throughȱ aȱ Inȱ conclusion,ȱ consumingȱ 5ȱ servingsȱ perȱ dayȱ forȱ anȱ adult,ȱ normalȱdiet.ȱForȱexample,ȱaȱhighȱdietaryȱintakeȱofȱtaurineȱisȱ whereȱ aȱ servingȱ isȱ representedȱ byȱ 250ȱ mlȱ ofȱ theȱ typicalȱ estimatedȱtoȱbeȱ400ȱmg/adult/day,ȱwhereasȱtheȱintakeȱfromȱ energyȱdrinkȱproductȱformulation,ȱcannotȱbeȱrecommendedȱ 5ȱ servingsȱ ofȱ aȱ typicalȱ energyȱ drinkȱ wouldȱ provideȱ 5000ȱ basedȱ onȱ possibleȱ exposureȱ toȱ otherȱ dietaryȱ sourcesȱ ofȱ mg/adultȱ /day.ȱ Glucuronolactoneȱ hasȱ anȱ estimatedȱ dailyȱ caffeine,ȱ uncertaintiesȱ aboutȱ theȱ longȬtermȱ effectsȱ ofȱ someȱ dietaryȱ intakeȱ ofȱ 2.3ȱ mg/adult/day,ȱ comparedȱ toȱ theȱ 3000ȱ ingredients,ȱ theȱ potentialȱ interactionȱ betweenȱ ingredientsȱ mg/adult/dayȱ intakeȱ fromȱ 5ȱ servingsȱ ofȱ aȱ typicalȱ energyȱ andȱ theȱ impactȱ ofȱ chronicȱ consumptionȱ ofȱ highȱ levelsȱ ofȱ drink.ȱ Basedȱ onȱ aȱ reviewȱ ofȱ 90Ȭdayȱ feedingȱ studiesȱ inȱ certainȱBȱvitaminsȱ(seeȱtableȱinȱAppendixȱI).ȱȱ laboratoryȱanimals,ȱknowledgeȱofȱtheȱmetabolismȱofȱtheseȱ ȱ twoȱ substancesȱ andȱ informationȱ aboutȱ theirȱ experimentalȱ Despiteȱ theȱ uncertaintiesȱ aboutȱ possibleȱ interactionsȱ therapeuticȱ use,ȱ itȱ wasȱ concludedȱ thatȱ noȱ hazardȱ wasȱ betweenȱ someȱ ofȱ theȱ ingredients,ȱ 2ȱ servingsȱ ofȱ aȱ typicalȱ demonstratedȱatȱtheȱlevelȱofȱ5ȱservingsȱperȱdayȱinȱtheȱshortȬ energyȱ drinkȱ perȱ dayȱ wouldȱ notȱ beȱ expectedȱ toȱ poseȱ aȱ term;ȱ however,ȱ longȬtermȱ useȱ inȱ theȱ dietȱ posedȱ anȱ healthȱ riskȱ forȱ theȱ generalȱ adultȱ population.ȱ Thisȱ uncertainty.ȱ Further,ȱ thereȱ wasȱ uncertaintyȱ aboutȱ theȱ conclusionȱ wasȱ basedȱ onȱ theȱ safetyȱ ofȱ theȱ nonȬcaffeineȱ possibleȱinteractionȱofȱtaurineȱwithȱcaffeineȱonȱtheȱnervousȱ ingredientsȱ ofȱ energyȱ drinksȱ atȱ thisȱ levelȱ ofȱ consumptionȱ system.ȱȱ andȱ theȱ factȱ thatȱ caffeineȱ fromȱ otherȱ dietaryȱ sourcesȱ inȱ ȱ additionȱtoȱthatȱinȱ2ȱservingsȱofȱenergyȱdrinksȱwouldȱnotȱ Concerningȱ theȱ Bȱ vitamins,ȱ itȱ wasȱ concludedȱ thatȱ theȱ exceedȱ Healthȱ Canada’sȱ recommendedȱ maximumȱ dailyȱ consumptionȱ ofȱ 5ȱ servingsȱ ofȱ aȱ typicalȱ energyȱ drinkȱ perȱ intakeȱ ofȱ caffeineȱ forȱ theȱ generalȱ adultȱ population.ȱ Theȱ dayȱwouldȱnotȱexceedȱtheȱtolerableȱupperȱlimitȱofȱmostȱofȱ consumptionȱofȱenergyȱdrinksȱbyȱotherȱsubȬgroupsȱwouldȱ theseȱvitaminsȱandȱtheyȱwouldȱbeȱunlikelyȱtoȱposeȱaȱhealthȱ needȱtoȱbeȱlimitedȱbasedȱonȱtheȱrespectiveȱrecommendedȱ riskȱinȱtheȱshortȱterm.ȱThereȱisȱuncertaintyȱinȱtheȱsafetyȱofȱ maximumȱ dailyȱ intakeȱ ofȱ caffeine.ȱ However,ȱ itȱ canȱ beȱ lifeȬlongȱconsumptionȱatȱthisȱlevelȱsinceȱtheȱrestȱofȱtheȱdietȱ notedȱthatȱcurrentȱcaffeinatedȱenergyȱdrinkȱproductȱlabelsȱ wouldȱ alsoȱ contributeȱ toȱ theȱ totalȱ intakeȱ ofȱ theseȱ doȱnotȱrecommendȱconsumptionȱbyȱchildren,ȱpregnantȱorȱ substances,ȱ whichȱ couldȱ leadȱ toȱ excessiveȱ intakeȱ andȱ breastfeedingȱwomen,ȱorȱcaffeineȬsensitiveȱpersons.ȱȱ potentialȱ adverseȱ healthȱ effects.ȱ Niacin,ȱ whichȱ canȱ beȱ ȱ presentȱ asȱ nicotinamideȱ orȱ nicotinicȱ acid,ȱ wasȱ aȱ uniqueȱ Thisȱassessmentȱwouldȱalsoȱapplyȱtoȱotherȱenergyȱdrinks,ȱ case.ȱ Whenȱ presentȱ asȱ nicotinicȱ acid,ȱ theȱ amountȱ inȱ 1ȱ describedȱinȱthisȱreport,ȱwhichȱcontainȱmajorȱingredientsȱatȱ servingȱofȱaȱtypicalȱenergyȱdrinkȱ(20ȱmg)ȱwasȱnotȱgreaterȱ levelsȱ greaterȱ thanȱ thoseȱ inȱ theȱ typicalȱ formulationȱ ofȱ

24 Int. food risk anal. j., 2013, Vol. 3, 4:2013 www.intechopen.com ȱ !

energyȱdrinkȱproducts.ȱTheseȱproductsȱmayȱbeȱconsumedȱ asȱtoȱtheȱlevelsȱofȱcaffeineȱpresentȱinȱenergyȱdrinkȱproductsȱ byȱ adultsȱ atȱ aȱ levelȱ equivalentȱ toȱ 2ȱ servingsȱ ofȱ aȱ typicalȱ madeȱ availableȱ forȱ saleȱ inȱ aȱ largeȱ volumeȱ containerȱ (710ȱ energyȱ drink.ȱ However,ȱ thereȱ isȱ uncertaintyȱ aboutȱ theȱ ml),ȱ whichȱ areȱ becomingȱ prevalentȱ andȱ likelyȱ toȱ beȱ safetyȱ ofȱ consumingȱ greaterȱ amountsȱ ofȱ theseȱ otherȱ consumedȱbyȱthisȱsubsetȱofȱtheȱpopulation.ȱ formulations.ȱ Itȱ wasȱ alsoȱ notedȱ thatȱ severalȱ productsȱ ȱ containȱ otherȱ bioactiveȱ ingredientsȱ suchȱ asȱ nutrientsȱ (e.g.ȱ Specificȱ riskȱ managementȱ measureȱ toȱ addressȱ potentiallyȱ folicȱ acid)ȱ orȱ otherȱ herbalȱ orȱ naturalȱ extractsȱ (e.g.ȱ ginkgoȱ highȱcaffeineȱlevelsȱinȱlargerȱvolumeȱenergyȱdrinkȱproductsȱ biloba).ȱ Theseȱ otherȱ formulationsȱ wouldȱ needȱ toȱ beȱ wouldȱhelpȱmitigateȱsomeȱrisksȱassociatedȱwithȱexceedingȱ reviewedȱonȱaȱcaseȬbyȬcaseȱbasis.ȱȱ Healthȱ Canada’sȱ maximumȱ recommendedȱ caffeineȱ intakeȱ ȱ inȱoneȱconsumptionȱsetting.ȱȱ Exposureȱdataȱ toȱenergyȱdrinksȱinȱ Canadaȱareȱlimited,ȱinȱ ȱ thatȱ consumptionȱ informationȱ isȱ notȱ reliableȱ basedȱ onȱ Healthȱ Canada’sȱ proposedȱ riskȱ managementȱ approachȱ forȱ Canadianȱsurveyȱdata.ȱ Inȱ theȱabsenceȱofȱestimatesȱofȱ realȱ energyȱ drinksȱ announcedȱ inȱ Octoberȱ 2011ȱ (http://hcȬ consumptionȱdata,ȱtheȱhealthȱriskȱposedȱbyȱenergyȱdrinksȱ sc.gc.ca/ahcȬasc/media/nrȬcp/_2011/2011Ȭ132Ȭeng.php)ȱ andȱ dueȱ toȱ theȱ caffeineȱ contentȱ wasȱ estimatedȱ byȱ modellingȱ updatedȱ inȱ 2012ȱ (http://hcȬsc.gc.ca/fnȬan/legislation/guideȬ exposureȱusingȱcaffeinatedȱsoftȱdrinkȱconsumptionȱdataȱasȱ ld/guidanceȬcafȬdrinkȬboissȬtmaȬamtȬeng.php)ȱhelpsȱaddressȱ aȱsurrogateȱforȱenergyȱdrinkȱconsumption.ȱȱ aȱ numberȱ ofȱ theseȱ concerns,ȱ throughȱ settingȱ caffeineȱ ȱ concentrationȱ limits,ȱ totalȱ caffeineȱ amountȱ limits,ȱ andȱ Inȱaȱworstȱcaseȱmodellingȱexposureȱscenario,ȱenergyȱdrinksȱ maximumȱ levelsȱ ofȱ vitamins,ȱ mineralsȱ andȱ otherȱ wereȱsubstitutedȱforȱcaffeinatedȱcarbonatedȱsoftȱdrinksȱonȱ formulationȱ constituents.ȱ Caffeineȱ andȱ otherȱ nutritionȱ aȱvolumeȱbasisȱandȱtheȱenergyȱdrinkȱcaffeineȱconcentrationȱ labellingȱrequirementsȱwereȱalsoȱimposed.ȱTheseȱmeasuresȱ setȱtoȱ320ȱppmȱforȱmodellingȱpurposes.ȱTheȱresultsȱshowedȱ contributeȱ toȱ mitigatingȱ someȱ ofȱ theȱ risksȱ relatedȱ toȱ theȱ thatȱ ofȱ theȱ consumersȱ whoȱ drinkȱ caffeinatedȱ carbonatedȱ consumptionȱ/ȱoverconsumptionȱofȱenergyȱdrinkȱproductsȱinȱ softȱdrinks,ȱmoreȱthanȱ50%ȱofȱtheȱchildrenȱandȱadolescentsȱ thoseȱareasȱwhereȱinterventionȱisȱpossibleȱbyȱaȱfederalȱfoodȱ wouldȱ beȱ aboveȱ theȱ recommendedȱ maximumȱ dailyȱ regulatorȱwithinȱtheȱCanadianȱfoodȱregulatoryȱsystem.ȱ caffeineȱintakeȱifȱallȱcarbonatedȱsoftȱdrinksȱwereȱreplacedȱ ȱ byȱaȱtypicalȱenergyȱdrink.ȱFurther,ȱslightlyȱlessȱthanȱ30%ȱofȱ maleȱandȱfemaleȱadultsȱandȱaboutȱ15%ȱofȱpregnantȱfemalesȱ Givenȱ theȱ behaviouralȱ aspectsȱ relatedȱ toȱ someȱ ofȱ theȱ wouldȱ exceedȱ theȱ Healthȱ Canada’sȱ recommendedȱ potentialȱ risksȱȬȱcoȬconsumptionȱ withȱ alcohol,ȱ overȱ maximumȱ dailyȱ intakeȱ forȱ caffeine.ȱ Consumersȱ ofȱ exposureȱ toȱ caffeineȱ dueȱ toȱ excessiveȱ andȱ uninformedȱ caffeinatedȱ carbonatedȱ softȱ drinksȱ areȱ howeverȱ onlyȱ aȱ consumptionȱ –ȱ itȱ isȱ acknowledgedȱ thatȱ otherȱ areasȱ ofȱ subsetȱ ofȱ theȱ populationȱ andȱ representȱ roughlyȱ 8%ȱ ofȱ intervention,ȱ suchȱ asȱ responsibleȱ marketingȱ andȱ youngȱchildrenȱ(1Ȭȱ8ȱyearsȱold),ȱ22%ȱofȱolderȱchildrenȱ(9Ȭ14ȱ advertising,ȱasȱwellȱasȱeducationȱandȱawareness,ȱwouldȱbeȱ yearsȱold),ȱ32%ȱofȱadolescents,ȱ20%ȱofȱtheȱadultȱpopulationȱ requiredȱinȱaȱconcertedȱfashion.ȱ andȱ13%ȱofȱpregnantȱfemales.ȱȱ ȱ ȱ Moreȱ researchȱ andȱ surveillanceȱ wouldȱ beȱ requiredȱ toȱ Althoughȱtheȱintakeȱmodelingȱshowedȱthatȱchildrenȱ(2Ȭ11ȱ ascertainȱ theȱ effectivenessȱ ofȱ theȱ variousȱ facetsȱ ofȱ theȱ yearsȱ old)ȱ wouldȱ exceedȱ Healthȱ Canada’sȱ recommendedȱ proposedȱriskȱmanagementȱapproach.ȱ levelsȱ forȱ caffeine,ȱ theȱ correspondingȱ healthȱ concernȱ isȱ ȱ limited,ȱgiven,ȱthatȱchildrenȱareȱlessȱlikelyȱtoȱobtainȱtheseȱ Variousȱdataȱgapsȱ haveȱ beenȱ notedȱinȱthisȱassessment,ȱinȱ productsȱ onȱ theirȱ ownȱ andȱ thatȱ parentsȱ areȱ expectedȱ toȱ particular:ȱȱ keepȱenergyȱdrinksȱoutȱofȱtheirȱchildren’sȱdiets.ȱItȱwasȱalsoȱ ȱ concludedȱ thatȱ adultsȱ (20ȱ yearsȱ andȱ older)ȱ andȱ pregnantȱ ȬDataȱthatȱsupportȱtheȱhazardȱcharacterisationȱinȱparticularȱ womenȱ areȱ capableȱ ofȱ monitoringȱ theirȱ ownȱ caffeineȱ asȱtheyȱpertainȱtoȱpossibleȱinteractionȱofȱtheȱeffectsȱofȱtheȱ intake.ȱTheyȱwouldȱalsoȱbeȱmoreȱlikelyȱtoȱrecognizeȱacuteȱ variousȱ activeȱ ingredientsȱ inȱ energyȱ drinkȱ productȱ adverseȱeventsȱassociatedȱwithȱexcessȱintakeȱandȱmoderateȱ formulationȱ (e.g.ȱ theȱ combinedȱ effectȱ ofȱ taurineȱ andȱ theirȱconsumptionȱaccordingly.ȱȱ caffeineȱatȱhighȱconsumptionȱlevels)ȱ ȱ ȱ Applyingȱ theseȱ hypotheticalȱ consumptionȱ patternsȱ ofȱ ȬȱDataȱthatȱsupportȱanȱimprovedȱcharacterisationȱofȱenergyȱ energyȱ drinksȱ toȱ adolescentsȱ hasȱ identifiedȱ aȱ potentialȱ toȱ drinkȱ consumptionȱ patternsȱ inȱ Canadaȱ byȱ variousȱ exceedȱ theȱ recommendedȱ caffeineȱ intakeȱ byȱ aȱ significantȱ populationȱsubsetsȱ(e.g.ȱolderȱchildrenȱandȱadolescents).ȱȱ proportionȱofȱyoungȱadolescents.ȱTheseȱscenariosȱcouldȱnotȱ ȱ beȱexcluded,ȱgivenȱthatȱenergyȱdrinksȱtendȱtoȱbeȱmarketedȱ Effortsȱareȱcurrentlyȱunderwayȱtoȱinitiateȱresearchȱactivitiesȱ toȱ adolescentsȱ whoȱ (unlikeȱ children)ȱ areȱ capableȱ ofȱ enablingȱsomeȱaspectsȱofȱtheȱdataȱcollection.ȱThisȱassessmentȱ accessingȱtheseȱproducts,ȱincludingȱtheȱlargerȱvolumes,ȱbutȱ willȱthereforeȱbeȱupdatedȱuponȱavailabilityȱofȱnewȱCanadianȱ mayȱ beȱ lessȱ likelyȱ thanȱ adultsȱ toȱ adhereȱ toȱ consumptionȱ dataȱandȱtakingȱintoȱaccountȱanyȱnewȱfindingsȱonȱtheȱsafetyȱ recommendations.ȱ Attentionȱ mayȱ thereforeȱ beȱ warrantedȱ ofȱenergyȱdrinksȱdomesticallyȱandȱinternationally.ȱ www.intechopen.com Joel Rotstein, Jennifer Barber, Carl Strowbridge, Stephen Hayward, Rong Huang and Samuel Benrejeb Godefroy: 25 ȱ Energy Drinks: An Assessment of the Potential Health Risks in the Canadian Context !

9.ȱAppendixȱ1ȱ

Upperȱtolerableȱ limitȱ Dailyȱ Amountȱ Amountȱ Amountȱ (UL)/Maximumȱ Requiredȱ Ingredientȱ dietaryȱ perȱ perȱ2ȱ perȱ5ȱ recommendedȱ Otherȱsafetyȱdataȱ dailyȱintakeȱ intakeȱ servingȱ servingsȱ servingsȱ intakeȱ (MRI)/Maximumȱ Limitȱ(ML)ȱ Caffeineȱ Notȱ 160ȱmgȱ 80ȱmgȱ 160ȱmgȱ 400ȱmgȱ 400ȱmgȱ=ȱMRIȱ ȱ applicableȱ Taurineȱ Notȱ 40ȱ–ȱ400ȱ 1000ȱmgȱ 2000ȱmgȱ 5000ȱmgȱ Notȱestablishedȱ 6000ȱmg/dayȱ=ȱNOAELȱ applicableȱ mgȱ inȱ42ȱdayȱhumanȱstudyȱ ȱ 1000ȱmg/kgȱbw/dayȱ=ȱ NOAELȱinȱ90Ȭdayȱratȱ studyȱ Glucuronolactoneȱ Notȱ 1.2Ȭȱ2.4ȱ 600ȱmgȱ 1200ȱmgȱ 3000ȱmgȱ Notȱestablishedȱ 3000ȱmg/dayȱ=ȱNOAELȱ applicableȱ mgȱ asȱexperimentalȱtherapyȱ inȱhumanȱ 1000ȱmg/kgȱbw/day=ȱ NOAELȱinȱ90Ȭdayȱratȱ studyȱ Inositolȱ Notȱ 500Ȭ1000ȱ 50ȱmgȱ 100ȱmgȱ 250ȱmgȱ Notȱestablishedȱ 18000ȱmg/dayȱ=ȱNOAELȱ applicableȱ mgȱ inȱ42ȱdayȱtherapyȱinȱ humanȱstudyȱ 6000ȱmg/kgȱbw/dayȱ=ȱ NOAELȱinȱ24ȱweekȱ mouseȱstudyȱ Thiamineȱ 1.1Ȭ1.2ȱmgȱ 4ȱmgȱ 5ȱmgȱ 10ȱmgȱ 25ȱmgȱ 40ȱmgȱ=ȱMLȱ Littleȱdangerȱofȱthiamineȱ toxicityȱassociatedȱwithȱ oralȱintakeȱofȱlargeȱ amountsȱ(500ȱmgȱdailyȱ forȱ1ȱmonth)ȱ Riboflavinȱ 1.1Ȭ1.3ȱmgȱ 4.5ȱmgȱ 1.65ȱmgȱ 3.30ȱmgȱ 8.25ȱmgȱ 20ȱmgȱ=ȱULȱ 50ȱmg/kgȱbw/dayȱ=ȱ NOAELȱinȱ13ȱweekȱ feedingȱstudyȱinȱrats.ȱ Noȱpublishedȱdataȱwithȱ toxicȱeffectsȱinȱhumans.ȱ Niacinȱ (asȱ 16ȱmgȱ 77ȱmgȱ 18ȱmgȱ 36ȱmgȱ 90ȱmgȱ 900ȱmgȱ=ȱULȱ 3Ȭ9ȱg/dayȱnicotinamideȱ nicotinamide)ȱ forȱseveralȱdaysȱresultedȱ inȱnauseaȱinȱsingleȱ subjectȱandȱhepatitisȱinȱ anotherȱsubject.ȱ VitaminȱB6ȱ 1.3Ȭ1.7ȱmgȱ 0.9Ȭ4.5ȱ 2ȱmgȱ 4ȱmgȱ 10ȱmgȱ Notȱestablishedȱ 100ȱȬ500ȱmgȱcausesȱ mgȱ neurologicalȱsymptomsȱ VitaminȱB12ȱ 2.4ȱmcgȱ 2Ȭ6ȱmcgȱ 1ȱmcgȱ 2ȱmcgȱ 5ȱmcgȱ 20ȱmcgȱ=ȱMLȱ Oralȱandȱparenteralȱ supplementationȱwithȱ dosagesȱbetweenȱ1Ȭ5ȱmgȱ everyȱ2ȱweeksȱorȱmonthȱ haveȱbeenȱgivenȱforȱupȱ toȱatȱleastȱ5ȱyears,ȱinȱ patientsȱwithȱ compromisedȱvitaminȱ B12ȱabsorption,ȱwithoutȱ anyȱidentifiedȱadverseȱ effects.ȱ PantothenicȱAcidȱ 5ȱmgȱ 3Ȭ12ȱmgȱ 6ȱmgȱ 12ȱmgȱ 30ȱmgȱ 20ȱmgȱ=ȱMLȱ 10000ȱmgȱcausesȱ gastrointestinalȱeffectsȱinȱ humansȱ Notes:ȱMLsȱforȱthiamine,ȱvitaminȱB12ȱandȱpantothenicȱacidȱwereȱspecificallyȱassignedȱtoȱenergyȱdrinksȱbyȱNHPD.ȱTheseȱfiguresȱareȱnotȱULsȱorȱMLsȱ forȱtheseȱBȱvitaminsȱforȱtheȱtotalȱdiet.ȱULȱforȱniacinȱwasȱdeterminedȱbyȱtheȱEuropeanȱCommunity.ȱȱ TableȱA1.ȱSummaryȱofȱSafetyȱAssessmentsȱofȱtheȱIngredientsȱinȱaȱTypicalȱEnergyȱDrink

26 Int. food risk anal. j., 2013, Vol. 3, 4:2013 www.intechopen.com ȱ !

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www.intechopen.com Joel Rotstein, Jennifer Barber, Carl Strowbridge, Stephen Hayward, Rong Huang and Samuel Benrejeb Godefroy: 29 ȱ Energy Drinks: An Assessment of the Potential Health Risks in the Canadian Context