About the BDA

1.1.               The BDA is the only body in the UK representing the whole of the dietetic workforce. We are a trade union and professional body representing the professional, educational, public and workplace interests of our members. Founded in 1936, we are one of the oldest and most experienced dietetic organisations in the world. The majority of our members work in the NHS, Social Care or for an NHS funded service.

1.2.               Membership is open to anyone working in dietetics, in nutrition, or who has an interest in diet or food, throughout the world. We represent the whole of the dietetic workforce - practitioners, researchers, educators, support workers and students.

Executive Summary

2.1.               Energy Drinks are consumed in significant quantities by young people and specifically young males.

2.2.               Excess consumption of caffeine can have a negative effect on blood pressure, sleep and headaches in children and adolescents. It can also have impact on absorption of calcium. Excess consumption of free sugars contained in some energy drinks can have an impact on diabetes and obesity.

2.3.               Mental health effects due to consumption of energy drinks can include sensation-seeking behaviour, self-destructive behaviour, insomnia, problems with behavioural regulation and poor lifestyle behaviours, such as poor diet and consumption of fast food.

2.4.               Advertising, sponsorship and social media activity are all used by energy drink companies to target young people to encourage them to purchase energy drinks.

2.5.               Restrictions on energy drinks sales in the UK are limited, although a number of retailers have put in place voluntary bans. Restrictions on sales and industry wide codes on the promotion of energy drinks are needed to reduce consumption. Health professionals should be advising and educating patients, the public and industry on the potential harmful effects of energy drinks.

2.6.               Any efforts to reduce energy drink intake must be linked to wider education campaigns to encourage healthier diets amongst children and adults.

Health Impact of Energy Drinks

Who consumes energy drinks?

3.1.               Energy drink consumption amongst young people is very high. EFSA research has indicated that approximately 68% of those aged 10-18 interviewed were consumers of energy drinks.  Among these, about 12% were “high chronic” consumers, with an average consumption of 7 litres a month, and 12% were “high acute” consumers (defined as approximately >1L per session) [1].

3.2.               In the UK, increased energy drink consumption can be linked with being male, an older adolescent, having special educational needs and being eligible for free school meals[2]. A systematic review also concluded that males are more likely to consume higher amounts of energy drinks than girls, while girls who skip breakfast are more likely to then rely on energy drinks later in the day. In addition, if a child is either underweight or obese, they are more likely to consume energy drinks[3].

Physical health impacts

3.3.               Physical effects from over-consumption of energy drinks are mostly related to caffeine. Increased caffeine consumption in children and adolescents results in increased blood pressure, sleep disturbances, headaches and stomach aches. Self-reported injury due to hyperactivity has also been reported.

3.4.               Adolescence is also the time of maximum bone deposition and consumption of energy drinks instead of calcium-rich containing drinks such as milk may comprise calcium intake and deposition in bones[4].

3.5.               There have also been reported differences seen to ECG traces for adults after energy drink consumption. Whilst caffeine has been found to have no ill effects on cardiac output, one study from the American Heart Association found that consumption of energy drinks showed a significant prolongation of the QTc interval in adults. This elongation of the QTc interval can be a sign of increased risk for fatal arrhythmias, and for individuals who may have underlying cardiac problems this may be dangerous[5].

3.6.               Energy drinks are also potentially playing a role in the obesity crisis. Sugar-sweetened beverage consumption is linked with diabetes, dental decay and increased BMI in young people[6]. In addition, a link between energy drink use and sedentary behaviour has been noted in some[7]

Mental health impacts

3.7.               In addition to physical effects, mental health effects due to consumption of energy drinks can include sensation-seeking behaviour, self-destructive behaviour, insomnia, problems with behavioural regulation and poor lifestyle behaviours, such as poor diet and consumption of fast food. The use of energy drinks in adolescents may also be affecting future food and drinks choices in young people due to alterations in the developing reward and addiction centre of the brain and the addiction due to the high caffeine content1,[8].

3.8.               The consumption of energy drinks in young people is also linked with the consumption of alcohol due to their use as mixers for spirits. One study found young people used the energy drinks as a ‘pick me up’ and it made parties more ‘fun’[9]. The EFSA found that in adolescents, 53% of energy drinks are consumed with alcohol. Those who consumed energy drinks mixed with alcohol were more likely to report binge-drinking behaviours, illicit drug use, and drink driving[10].

3.9.               Energy drinks are also used as a tool to help keep weight low in young people with eating disorders. Low sugar versions of energy drinks may form a way of boosting energy through caffeine and stimulants plus promote loose stools and supress appetite. Young people with eating disorders are at a higher risk of cardiac arrhythmias due to their low weight, so the use of these products may be particularly worrying1.

Marketing and controls

Drivers of consumption

4.1.               The reason that young people choose energy drinks is hard to pinpoint. Advertising and brand loyalty play a large part in the desire to consume these products and young people report that they see these products being advertised on television, on the internet, through sports sponsorships, video games and in shops, despite pledges from advertisers to reduce this3.

4.2.               It has been noted by some research that “energy drink manufacturers aggressively market their products to children, adolescents, and young adults. The absence of regulatory oversight in many countries has contributed to the aggressive marketing of energy drinks targeted primarily toward young males”[11]. Market leaders have comprehensive and highly successful marketing strategies that target young people, particularly males, on social media and through sponsorship of sports and events. In 2016, Red Bull, the biggest selling energy drink company, was the most shared video brand online, with more than double the reach of the next biggest brand, Samsung[12].

4.3.               Taste and the need for a quick ‘energy boost’, as marketing would suggest, may also be a reason to consume energy drinks, with hectic lifestyles also seen as a key driver for this market[13]. Parental influence may drive child and adolescent use based on the modelling theory which suggests children’s diets are affected by what their parents consume3,[14].

Regulation

4.4.               There is no current limitation on the sale of these products to young people in the UK, despite the British Soft Drinks Association says that high-caffeine products are not recommended for young people. Some supermarkets, starting with Waitrose[15], have independently decided to introduce bans on sales to under-16s.While this is certainly a positive development, there remain many routes through which energy drinks can still be purchased by children under 16.

4.5.               There are examples of stricter regulation from abroad. Lithuania has had a ban in place for the sale of high-caffeine drinks to under 18s since 2014[16]. Other countries have introduced a sugar tax which capture some of these high-caffeine products; consumption has been reportedly reduced and income has been generated for ‘Get Healthy’ programmes[17].

4.6.               With the government expecting to introduce a levy on products with more the 5g and 8g of sugar per 100ml in 2018, it is predicted that the consumption of sugar sweetened beverages will fall[18]. However, it is not clear what effect this might have on energy drink consumption, although, it is reported that young people do already find energy drinks expensive3. It is noticeable that demand is already increasing for low calories energy drinks which contain reduced sugar but still contain high levels of caffeine and other stimulants13.

4.7.               The evidence recommends that “regulatory agencies enforce industry-wide standards for responsible marketing of energy drinks and ensure that the risks associated with energy drink consumption are well known”12.

4.8.               The British Medical Journal states that health professionals should be advising and educating patients, the public and industry on the potential harmful effects of energy drinks, especially when being mixed with alcohol9. Seifert et al go further to say that the use of energy drinks should be included in standard health screening for young people, especially in at-risk populations such as those with high-risk behaviours and certain health conditions e.g. heart problems, anorexia nervosa or anxiety4.

4.9.               As nutritional professionals, dietitians should communicate that energy drink consumption, at present, appears to have more negative than positive outcomes[19]. Due to the heterogeneity of the products that are currently available on the market, it is very difficult to advise which products may be safer than others, indicating that energy drinks should potentially be avoided altogether in preference for other options such as fruit juice, water or milk for young people9.

4.10.          Any steps to reduce energy drink intake, like steps to reduce sugar sweetened beverage intake, should be part of a wider range of measures aimed at reducing obesity and improving diet amongst young people and adults. Bans or taxes alone will be insufficient. For more information see the BDA’s statement on Interventions which reduce the consumption of energy from sugary drinks in children[20].

April 2018