by Bianca Garilli, ND, USMC Veteran
Energy drinks have become a common sight in today’s fast-paced, “get the job done” world. In fact, according to the National Institutes of Health (NIH), next to multivitamins, energy drinks are currently the most popular dietary supplement consumed by American teens and young adults.1 These drinks are marketed as a means to improve energy, stamina, athletic performance, and concentration, as well as reducing fatigue.1-3 Energy drinks are sometime considered “functional beverages” while also falling under the umbrella of drinks or dietary supplements.1,3
The main ingredient in energy drinks is caffeine at levels 70-240 mg in a 16oz drink or 113-200 mg if consumed as an energy “shot”.1 For comparison, a 12oz can of soda contains around 35 mg of caffeine, while an 8oz cup of coffee provides approximately 100 mg.1 In addition to caffeine, many energy drinks also contain other ingredients which might include: B vitamins, various forms of sugar, guarana, taurine, ginseng, glucuronolactone, yohimbe, carnitine, and bitter orange; it is important to note that some of these ingredients further increase the quantity of caffeine in the energy drink, while others may substantially spike blood glucose levels.1 There are currently no regulations in place requiring the amount of caffeine to be printed on energy drink labels.1
Sales of energy drinks have skyrocketed dramatically in the past years increasing to $9.7 billion in sales in 2015 in the US alone.3 Consumption of energy drinks may have negative health consequences, including higher levels of risk-seeking behaviors, poor mental health outcomes, adverse cardiovascular effects, and heightened risk for metabolic, renal, and dental conditions.3
With marketing campaigns geared towards teenagers and the young adult population, it’s not surprising to find that males between the ages of 18-34 are the highest consumers of these drinks.1 Moreover, one-third of teenagers consume energy drinks regularly, while 51% of college students report their consumption at least once per month.1,3
Energy drinks have a strong appeal to military service members as well, particularly with the drinks’ promises of reduced fatigue and enhanced mental and physical performance. Due to the specialized nature of their work, military personnel often seek ways to:
- Improve high-endurance physical performance
- Maintain focused concentration and acuity
- Sustain elevated energy levels and stamina
- Reduce fatigue while enduring little to no sleep for long intervals
In fact, during the wars in Afghanistan and Iraq, energy drinks were frequently made available to US troops at no cost, with the anticipation that energy drinks would answer some of these unique concerns.2
Statistics estimate that energy drink consumption by military personnel mirrors or exceeds that of the general public, yet the health consequences of long-term, high energy drink use in military troops has not been adequately researched.2 A recent study aimed to learn more about the associations between energy drink consumption and health outcomes in military personnel post-deployment.2 In particular, mental health variables including sleep problems, depression, anxiety, PTSD, alcohol misuse, aggressive behaviors, and overall fatigue were compared to the frequency and quantity of energy drink consumption in 627 male infantry Army soldiers 7 months post-combat deployment.2
Results from this study published in Military Medicine found that approximately 75% of soldiers reported consuming energy drinks with nearly 30% of those reporting at least daily use and 16.7% reporting high level consumption (≥ 2 drinks/day).2
Additionally, when compared to the low-frequency group (no consumption of energy drink or < 1 drink/week), the high-frequency group (≥ 2 drinks/day) had increased rates of sleep problems, depression, anxiety, PTSD, and alcohol misuse; they were also more likely to demonstrate aggressive behavioral characteristics.2 Similarly, the moderate-frequency group (at least once per week or 1 drink/day) showed greater depressive symptoms when compared to the low-frequency group.2
Although energy drinkss are marketed to consumers as a means to reduce fatigue, the results from this study demonstrated that moderate and high energy drink users experienced heightened fatigued when compared to low or no use.2 The high use of energy drink may, in fact, be a hindrance to both the mission objectives and troop welfare. Authors of this study conclude that, “future research should examine whether energy drink use results in greater fatigue over time.”2
Realizing that mental health, aggressive behaviors, and PTSD are potential concerns among military personnel, the high prevalence of energy drink use in this population should be reviewed. Revised guidelines from military healthcare leaders on the consumption of energy drink would be prudent to support safe and appropriate utilization of these drinks within the military.
Why is this Clinically Relevant?
- Energy drink consumption is common in the US military population, and high energy drink intake is associated with deleterious health outcomes2
- Military healthcare leaders should consider whether the use of energy drink on the job is a benefit or determinant for long- and short-term mission accomplishment and troop welfare
- Military healthcare providers are key to providing evidence-based guidelines and education to troops on healthy consumption of energy drinks
- Alternative suggestions for enhancing cognition, focus, energy, and stamina and for reducing fatigue in troops may include optimizing nutrition, supporting adrenal, thyroid, and hormonal function, and utilizing targeted botanical and nutraceutical supplementation such as adaptogenic herbs and B vitamins
- NIH. National Center for Complementary and Integrative Health. Energy drinks. https://nccih.nih.gov/health/energy-drinks. Accessed January 2, 2019.
- Toblin RL, Adrian AL, Hoge CW, Adler AB. Energy drink use in U.S. service members after deployment: associations with mental health problems, aggression, and fatigue. Military Medicine. 2018:183(11-12);e364–e370.
- Al-Shaar L, Vercammen K, Lu C, Richardson S, Tamex M, Mattei J. Health effects and public health concerns of energy drink consumption in the United States. Front Public Health. 2017;5:225.