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'Energy Drinks': Boost or Bust?

The idea of a soft drink that boosts energy and metabolism is appealing, to be sure. But nutritionists warn that so-called energy drinks -- potent mixes of herbal extracts, ephedra, caffeine, and sugar -- are a pharmacological Pandora's box, and you don't know what you're going to find when you open one. By Laurie Barclay

WebMD Medical News

Aug. 13, 2001 -- To keep alert while driving from Maryland to Florida, 20-year-old Morgan Schatz drank a bottle of SoBe Lean, an "energy drink" she bought at a gas station.

"When I got out of the car, my legs were so rubbery I could barely walk, and I was twitching, jittery, and nauseated," this University of South Florida senior tells WebMD. "It's on the shelf with the sports drinks, so you think it's good for you. But not all 'health food' is healthy -- you've got to be careful."

Energy drinks like Red Bull and SoBe contain "metabolic boosters" said to intensify energy, weight loss, and peak performance. But many experts say these products are more marketing hype than anything else, and that some users can react badly to the drinks' various additives.

"I would never recommend these to boost energy or in sports events, because they contain so many bizarre ingredients," says Allison Sarubin, NSRD, a nutrition consultant in San Francisco and author of The Health Professional's Guide to Popular Dietary Supplements.

Drugs in Your Drinks

The most potentially dangerous of these ingredients is ephedra, or ma huang, a chemical related to powerful stimulants found in cold medications, Ritalin, and even speed.

"Why not just add Sudafed or Primatene tablets to your soda?" asks Billy J. Gurley, PhD, associate professor of pharmaceutical sciences at the University of Arkansas in Little Rock. "Most people may not have adverse effects, but some will."

Ephedra can cause heart complications, high blood pressure, seizures, strokes, even death, especially when combined with other stimulants like caffeine, guarana, and ginseng -- which are also common ingredients in these drinks. In the early 1980s, the FDA banned pills combining ephedra and caffeine, but a 1994 law removed dietary supplements from FDA control.

Although side effects to supplements do not have to be reported, about 800-1,200 serious reactions to ephedra have been -- less than 10% of the actual number, estimates Gurley. "I get calls literally every day from consumers, lawyers, and doctors describing bad reactions to ephedra," he says. "The public is not aware of the hidden dangers of these products."

When 15-20 different herbal extracts and "metabolic boosters" mix with ephedra and caffeine, side effects may be delayed or unpredictable, including insomnia, nervousness, headache, nausea, tremor, and heart palpitations. Some are serious or even fatal, like seizures, heart attack, kidney stones, and stroke.

"It's a pharmacological Pandora's box," Gurley says. "You don't know what you're going to get."

What Helps Peak Performance, What Doesn't

Extra carbs: Most 8-ounce "energy drinks" contain 125 calories and about 20-30 grams of carbohydrates, mostly as sugars. For those wanting "metabolic boosters" to melt away fat, the extra calories can actually pack on more pounds.

According to Applegate, sports drinks containing only 6-8% carbohydrates, like Gatorade and PowerAde, are better during exercise, as more concentrated carbohydrates may cause nausea and cramping.

"I don't consider 'energy-boosters' in the same category as sports drinks," Sarubin says. "Sports drinks are good for the serious athlete-in-training. But the weekend warrior doesn't need them."

Salt: As the sodium and electrolytes in sports drinks can help correct salt loss from prolonged sweating, Sarubin says they're helpful for Iron Man or triathlon events, but not for a casual set of tennis.

Caffeine: "It's a [brain] stimulant that makes users feel that they're exerting themselves less, making physical activity easier," Liz Applegate, PhD, a lecturer in nutrition at University of California, Davis, tells WebMD.

Add this effect to its enhanced fat burning, and endurance goes up by 10-20%, explains Applegate, who is also author of Eat Smart, Play Hard, released in July by Rodale Books.

She suggests no more than 200-300 mg caffeine, about the amount in 2-3 cups of coffee, before or during exercise, for athletes accustomed to it. While caffeine acts as a diuretic, drawing water out of the body, this effect is not as pronounced during exercise.

One sports drink that capitalizes on the positive effects of caffeine, carbs, and electrolytes while avoiding most additives is ProLyte.

"I use ProLyte during most training days and every [bike] race," says Tyler Benedict, president of P.R. Performance Inc., and founder of ProLyte in Greensboro, N.C.

Ephedra: Forget about it! All experts interviewed agreed that this stimulant has not been shown to have any positive effect on athletic performance. Ephedra-containing products are banned by virtually every athletic association, including the IOC.

Other additives: "In the short-term, ginseng, B vitamins, taurine, and guarana have not been shown to improve athletic performance," Stewart says, and most experts agree.

"Ginseng is very safe for the athlete," Sarubin says. "It's been used in Chinese medicine for thousands of years. But those with high blood pressure should avoid it."

Guarana is a natural caffeine source, but contains chemicals that inhibit the enzyme monoamine oxidase, adding to the buzz from other stimulants and interfering with drugs such as antidepressants.

"When Red Bull added taurine and it became so popular, you can be sure everyone else did," Applegate says. "Getting more B vitamins is good for people who eat badly, as many users of these drinks do. But there are much better and cheaper ways to get them than in these drinks."

Before you use any "energy booster," experts recommend checking the ingredients with your doctor, especially if you have heart disease or other health problems.

Who's Most at Risk?

Pregnant women should avoid energy drinks, Gurley says, as drugs like ephedra may cause heart deformities in the developing fetus and increase risk of miscarriage.

In those who do not regularly drink coffee, including children, caffeine can cause poor hand-eye coordination, diarrhea, jitters, or heart palpitations.

"If you drink caffeine when you're not used to it, you could find yourself in a Porta-Potty the whole time instead of running the race," Sarubin says.

Athletes aside, what about those who just want a little lift to help them through the day? Cynthia Sass, a registered dietitian at the University of South Florida and spokesperson for the American Dietetic Association, is concerned that fatigue may be masking a more serious condition. "There are lots of better ways to increase your energy level without risk," she says. "Are you taking care of yourself, getting enough rest, going for regular checkups?"

Stimulants and exercise can be a deadly combination for those with high blood pressure, heart disease, or obesity, Sass says.

A Boost With Your Booze?

Energy drinks alone can be scary enough -- but how about mixed with alcohol? Red Bull cocktails are all the rage at trendy bars. Message boards on their web site suggest that consumers mix it with beer, tequila, and even peppermint schnapps.

"They claim the caffeine and other additives give them a bigger high," Applegate says.

"Using these drinks as a stimulant so they can drink more is especially dangerous," Gregory W. Stewart, MD, co-medical director of the Tulane Institute of Sports Medicine in New Orleans, tells WebMD. "They don't pass out as quickly, so they may get alcohol poisoning."

Nor can energy drinks prevent hangover, even though Applegate says certain brands of vodka, including those mixed with Red Bull for club drinks, are marketed as being hangover-free.

Marketing Pays Off

Check out the turbo-charged web sites of Red Bull and SoBe and you'll be bombarded with images of speed and energy. Not to mention names like Adrenaline Rush and Mad River Energy Hammer, and punchy slogans like "Get it up, keep it up -- any questions?"

"The marketing hype far outpaces any of the claims," Gurley says.

And don't be fooled if you find these drinks on supermarket shelves next to the mint tea, or in convenience store coolers between the soda and the V8.

"These are not sports drinks, but they're marketed in gyms," Sarubin says.

Even if you don't get hurt by these products, your pocketbook may feel the pain. When confronted with an exotic blend of vitamins, herbals, and additives, your body may just dump them all.

"Americans have the most expensive urine in the world," Stewart says.

"Most people are paying for and getting additives present in insignificant amounts," Applegate says. "It's a fascinating lesson in consumer perception -- they see a new ingredient like taurine, and it's much more seductive than the old standbys."