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Abstract
People from all age groups and genders are visiting emergency departments at a growing
rate for problems related to the adverse effects of the high levels of caffeine in energy drinks.
Often people that are consuming the energy drinks dont understand the serious health risks
associated with them. This study is an examination of the most current data on the levels off
caffeine in energy drinks and the health dangers contributed to the high levels of caffeine in
energy drinks. It also focuses on what is currently being done to resolve the negative medical and
behavioral problems associated with over-consumption of caffeine from energy drinks. In just
four years, the number of energy drink-related emergency department visits in the United States
has over doubled. Because the power drinks are classified as dietary supplements by the FDA,
they are immune to the regulations of conventional foods where the caffeine would be required
to be displayed. However, some companies such as Monster Energy are responding to wrongful
death lawsuits associated with the caffeine level in their drinks by providing the caffeine content
on the label and adhering to the FDA guidelines for conventional foods. This study suggests that
a key step in resolving the problems associated with high levels of caffeine in energy drinks is to
get the information to the companies responsible for the power drinks, and getting them to
comply with conventional food standards set by the FDA. This work is part of a growing body of
knowledge on the controversy of high caffeine levels in energy drinks.

Introduction
Caffeine is a white crystalline xanthine alkaloid that is found in the beans, leaves, and
fruits of various plants. It is a central nervous system stimulant in humans, and it is the most
consumed psychoactive substance in the world. On a daily basis in North America, 90% of adults

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consume caffeine. The FDA says caffeine is multiple purpose generally recognized as a safe
food substance (Caffeine). It is important to look at caffeine in energy drinks specifically
because they have higher levels of caffeine than other foods, beverages, and supplements. The
higher levels have additional effects on the body rather than just the desired alertness and
increased energy.
In 1949 Dr Enuf was introduced in Tennessee as an alternative to sugary soft drinks. It
had added caffeine and vitamins, but was mostly a soda with more ingredients. Then in 1985 Jolt
Cola was introduced with more caffeine and all the sugar. In 1995 PepsiCola introduced Josta,
but it didnt sell good and it was discontinued in 1999. All of these drinks werent widely
popular, and they were basically sodas with a little different recipe. However, these drinks are
considered the beginning of energy drinks. In 1997 the energy drink market in the United States
changed forever with the introduction of Red Bull on the west coast. By 2001, just four years
after Red Bull came to the United States, the energy drink market was $8 million a year. It
continued to grow, and in 2007 it was a $5.4 billion industry. The energy drink market is still on
the rise and sometime in 2013 it is supposed to reach a $19.7 billion value (Reissig).
Energy drinks are intended to provide energy, improve performance, improve
concentration, and improve endurance. Companies market the drinks specifically to athletes,
students, and people with professions that require them to stay awake for extended periods of
time. Ninety-nine percent of all energy drinks have three basic ingredients: water, caffeine, and
sugar. Some have other ingredients such as vitamins, ginseng, carbohydrates, and amino acids to
make them appear more healthy. Sometimes taurine is used, but this is only used to increase the
effects of caffeine.

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When caffeine is consumed, it is absorbed in the GI tract. It is detectable in plasma just
five minutes after ingestion, and peak levels occur about thirty to sixty minutes after ingestion.
Caffeine moves to the liver where it is primarily metabolized by the cytochrome P450 (CYP)
oxidase system in the liver. Caffeine is broken down into its primary metabolites, which can be
seen in figure 1, by pulling off methyl groups on the caffeine molecule. Caffeine and its
metabolites bind to adenosine receptors throughout the body. When the caffeine binds to A1 and
A2 receptors, the stimulants block the proteins from interacting with the adenosine. Adenosine is
responsible for regulating nerve cell activity and the release of neurotransmitters such as
dopamine. When the adenosine cant do its job, nerve activity in the brain and heart decreases.
This is a great deal responsible for many symptoms associated with caffeine. Also, when caffeine
is consumed repeatedly, the brain becomes accustomed to the effects and withdrawal can occur.
Symptoms of withdrawal include muscle pain, fatigue, irritability, nervousness, and poor sleep
habits (Wolf).
This study was conducted to increase my knowledge about the levels of caffeine in
energy drinks and to learn more about what the caffeine can do to the body. In college there are
many times when it is necessary to stay up late, and often energy drinks are consumed to stay
awake. There have been reports of death associated with energy drinks in the past few years, and
the media has also been keeping this topic in the news. I wanted to have the knowledge to decide
for myself whether or not the caffeine levels in energy drinks are dangerous to the body. The
results from this study should be shared with other college students so that they know the risks
associated with energy drinks.

Discussion

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Energy drinks vary in caffeine content, containing anywhere from about 75 mg of
caffeine to almost 300 mg of caffeine (Quick Chart). Figure 2 shows the caffeine content of
many popular drinks and energy drinks. Caffeine jitters can occur after consuming just 300 mg
of caffeine. Caffeine jitters causes trembling, nervousness, and difficulty keeping still or focusing
(Wolf). Many people experience these symptoms without realizing they had consumed a large
amount of caffeine. The problem is that many foods, medicines, and beverages other than energy
drinks contain caffeine. Caffeine has a half life of about 4.9 hours, which means that in 4.9 hours
only half of the total amount of caffeine consumed is no longer in the body. The half-life of
caffeine can vary depending on gender, with males metabolizing the caffeine faster than females.
Also, women on oral contraceptives metabolize the caffeine much slower than those not taking
them. Caffeine from all of the different things accumulates and can cause issues for people with
underlying health conditions (Wolf).
Moderate caffeine consumption, which is considered as consuming less than 400 mg a
day, can be beneficial to the body (Heckman). Long term benefits include reducing the risk of
developing Parkinsons disease, type II diabetes, liver disease, and cardiovascular disease. Short
term benefits include increased memory and attention, increased physical performance and
muscular recovery (Smith). Energy drinks are marketed for their short term benefits of alertness,
and increased attention and physical performance.
Caffeine consumption can also have negative effects, with one being addiction. After
repeated intake of caffeine, it takes more and more to reach the desired effects just like other
drugs. In the long term caffeine can increase the likelihood of experiencing hallucinations, and it
can accelerate bone loss in post-menopausal women (Rapuri). In the short term caffeine can

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cause headaches, anxiety, rapid heartbeat, restlessness, confusion, frequent urination, nausea,
ringing in the ears, and insomnia. There is not a large amount of data on the negative effects of
caffeine for a couple of reasons: the energy drink companies have a lot of money and influence,
and they hire their own researchers that are not going to talk about the harmful effects, also, the
concept of high caffeine consumption is fairly new. The fatal amount of caffeine is 10 g, which is
much more than even the highest level in an energy drink.
In regards to the negative effects of caffeine, the number of emergency department visits
related to the adverse effects of caffeine continues to rise. As seen in figure 3, the number of
energy drink related emergency department visits has doubled from 10,068 in 2007 to 20,783 in
2011. These visits include anything from a headache to a heart attack after consuming an energy
drink. As shown in figure 4, the number of emergency department visits related to energy drinks
had the greatest increase in the 40 and older age category, with an over 200 percent increase from
2007 to 2011. This is related to the 40 and older age category having underlying conditions that
make them especially susceptible to the negative effects of caffeine, as the 18 to 25 age group
consumes the most energy drinks.
Another growing trend that makes the caffeine in energy drinks more dangerous is the
consumption of energy drinks in combination with other drugs and substances. In 2010 energy
drinks that contained high levels of caffeine and alcohol, such as four-loko, were required by the
FDA to change their recipes as too many incidents had occurred from the combination of
caffeine and alcohol. The alcohol increased the negative effects of the caffeine and caused people
to have heart problems and other major health concerns. Energy drinks in combination with other
drugs accounts for 42% of all of the energy drink related emergency department visits. The most

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common thing people use with energy drinks is pharmaceuticals, accounting for 27% of the total
emergency department visits related to energy drinks. Other things such as marijuana, alcohol,
and illicit drugs also contribute to the emergency department visits. There is not currently
information about how the substances work with the caffeine in energy drinks to cause various
effects in the body, but it is a growing research topic in many countries (Smith). Also, research is
currently being done on how high levels of caffeine affect the body, and what the level is that
causes problems for the average person.
There have been 5 deaths associated with Monster and 13 deaths associated with 5-hour
energy. In 2011 a 14 year old Maryland girl died after consuming 2 cans of Monster in a two day
period. She suffered a heart attack that was brought on by caffeine toxicity. She had an
underlying health condition that weakened her blood vessels, which put her at risk for problems.
Her parents are suing Monster energy as they claim Monster failed to warn consumers about the
risks of drinking its products. Monster, which dominates about 39% of the energy market, says
they are unaware of their product causing any fatalities. The FDA is investigating but they say
that there is nothing to prove the caffeine in the energy drink killed her. Until there can be proof
that energy drinks cause death, the FDA wont take action. Compared to other sources of death in
the United States, deaths associated with caffeine in energy drinks is very slim.
After the wrongful death lawsuits, companies such as Monster Beverage Corp are
responding by making their products adhere to conventional food standards set by the FDA,
rather than keeping them as dietary supplements. This means that they will have to display
ingredients and the amount of caffeine. Also, the FDA does more tests on conventional foods to
make sure they are safe to consumers. This also has financial benefits to the company as

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conventional foods can be purchased with food stamps. Monster lost profits after the wrongful
death lawsuits, and they are looking for a way to make more money. Another thing the
companies are now doing is putting more warnings on the labels of the products. Companies
dont plan on changing ingredients, including the amount of caffeine.

Conclusions
Caffeine levels in energy drinks vary greatly, and it is ultimately the responsibility of the
consumer to think about the risks before drinking an energy drink. There are both benefits and
negative effects associated with caffeine consumption. For those with underlying health
conditions, it may be best to refrain from consuming energy drinks as they are at greatest risk for
experiencing serious adverse effects. In the future energy drink companies could reduce the
amount of caffeine in their drinks as there is no apparent benefit to having such high amounts.
Caffeine in energy drinks is not always dangerous, but like with any drug, people need to educate
themselves.

Literature Cited
"CAFFEINE." Caffeine. University of Michigan, n.d. Web. 03 Apr. 2013. <http://
www.uhs.umich.edu/caffeine>.
Gilliam, Mike. "Energy Drink Ban Goes into Place in Suffolk County Read More: Http://
pix11.com/2013/03/20/energy-drink-ban-goes-into-place-in-suffolk-county/
#ixzz2QBWupAcy." PIX 11. N.p., 20 Mar. 2013. Web. 5 Apr. 2013.
Hall, Rachel. "Caffeine & How It Absorbs in the Body." LIVESTRONG.COM. The Livestrong
Foundation, n.d. Web. 10 Mar. 2013.

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Heckman, Sherry K., and E. Gonzalez De Mejia. "Energy Drinks: An Assessment of Their
Market Size, Consumer Demographics, Ingredient Profile, Functionality, and Regulations
in the United States." Comprehensive Reviews in Food Science and Food Safety, n.d.
Web. 19 Mar. 2013.
"Quick Chart: Compare Caffeine Amounts." Quick Chart: Compare Caffeine Amounts. N.p., n.d.
Web. 29 Mar. 2013.
Rapuri, PB, Gallagher, JC, Kinyamu, HK, Ryschon, KL (2001). "Caffeine intake increases the
rate of bone loss in elderly women and interacts with vitamin D receptor genotypes". The
American journal of clinical nutrition 74 (5): 694700.Reissig, Chad J., Eric C. Strain,
and Roland R. Griffiths. "Caffeinated Energy Drinks -- A Growing Problem." US
National Library of Medicine National Institutes of Health. National Institute of Health,
n.d. Web. 20 Mar. 2013.
Smith, A (2002). "Effects of caffeine on human behavior". Food and Chemical Toxicology 40
(9): 124355Substance Abuse and Mental Health Services Administration, Center for
Behavioral Health Statistics and Quality. (January 10, 2013). The DAWN Report: Update on
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Concern. Rockville, MD. Web. 20 March 2013.
Wolf, Lauren K., and C&EN Washington. "Caffeine Jitters." Chemical and Engineering News
91.5 (2013): 9-12. CEN RSS. Chemical and Engineering News. Web. 23 Mar. 2013.

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Tables and Figures

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Figure 1: Caffeine and its primary metabolites after methyl groups are removed.

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Figure 2: Caffeine content of various drinks in mg. As you go up the chart, the level of caffeine
increases.

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Figure 3. Reason for Energy Drink-Related Emergency Department (ED) Visits, by Year: 2005 to
2011. The number of energy drink related ED visits has doubled from 2007 to 2011.

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Figure 4. Energy Drink-Related Emergency Department (ED) Visits, by Age Group: 2007 and
2011. The greatest percent increase from 2007 to 2011 of ED visits related to energy drinks was
the 40+ age category