National Federation of State High School Associations (NFHS)
Sports Medicine Advisory Committee (SMAC)
Background: Energy drinks have become increasingly popular among adolescents and young adults in recent years. In 2006, nearly 500 new brands were introduced to the market place, and over 7 million adolescents reported that they had consumed an energy drink. Estimated sales of energy drinks for 2011 are expected to exceed $9 billion. These beverages are particularly popular among young athletes who see the consumption of energy drinks as a quick and easy way to maximize athletic and academic performance.
The NFHS SMAC strongly recommends that:
WARNING: The exact content and purity of energy drinks cannot be insured, as there are no regulatory controls over these products. Thus, there is the risk for adverse side-effects, potentially harmful interactions with prescription medications (particularly stimulant medications used to treat ADHD), or positive drug tests.
Frequently Asked Questions
What is an energy drink?
- An energy drink is a beverage marketed to both athletes and the general public as a quick and easy means of relieving fatigue and improving performance. In addition to water, nearly all energy drinks contain carbohydrates and caffeine as their main ingredients. The carbohydrates provide nutrient energy while the caffeine acts as a stimulant to the central nervous system.
What are the differences between an energy drink and a sports drink?
- Sports drinks are designed to provide re-hydration during or after athletic activity. While contents vary, most sports drinks contain a 6 to 8% carbohydrate solution and a mixture of electrolytes. The carbohydrate and electrolyte concentrations are formulated to allow maximal absorption of the fluid by the gastrointestinal tract.
- Energy drinks often contain a higher concentration of carbohydrate (usually 8 to 11%), and thus a larger number of calories than sports drinks. They also contain high amounts of caffeine and, in some cases, other nutritional supplements. Energy drinks are not appropriate for re-hydrating athletes during physical activity and should not be used in such circumstances.
What ingredients are found in energy drinks?
- Carbohydrates- Most energy drinks have from 18g to 25g of carbohydrate per 8 ounces. The high carbohydrate concentration can delay gastric emptying and impede absorption of fluid in the gastrointestinal tract.
- Caffeine- Nearly all energy drinks contain some quantity of “natural” or synthetic caffeine. The caffeine concentration may range from the equivalent to an 8 ounce cup of coffee (85mg) to more than three times that amount.
- Herbs- Many energy drinks include herbal forms of caffeine such as guarana seeds, kola nuts, and Yerba mate leaves, in addition to synthetic caffeine. The “performance enhancing” effects, safety, and health benefits of other herbs like Astragalus, Echinacea, Ginko biloba, ginseng, and countless others have not been well established by scientific studies.
- Vitamins- Athletes with even reasonably good diets should be assured that they are at low risk for vitamin deficiency and typically do not need supplementation. There is no evidence to suggest that vitamin supplementation improves athletic performance. Female athletes may benefit from iron and calcium supplements; but, those are more easily and inexpensively obtained in pill form rather than from energy drinks.
- Proteins and amino acids- Only a small amount of protein is used as fuel for exercise. Carbohydrates are utilized as the primary fuel source. To date, there is no definitive evidence that amino acid supplementation enhances athletic performance.
- Other ingredients- With the hundreds of energy drink brands that are available, the potential ingredients which they may contain are virtually unlimited. Possible additions include pyruvate, creatine, carnitine, medium-chain triglycerides, taurine and even oxygen.
What are the possible negative effects of using energy drinks?
- Central nervous system- Caffeine often has the effect of making a person feel “energized.” Studies have shown some performance-enhancing benefits from caffeine at doses of 6mg/kg of body weight. However, these and higher doses of caffeine may produce light headedness, tremors, impaired sleep, difficulty with fine motor control, and may exceed drug testing caffeine thresholds.
- Gastrointestinal system- The high concentrations of carbohydrates often found in energy drinks may delay gastric emptying, resulting in a feeling of being bloated. Abdominal cramping may also occur. Both carbohydrates and caffeine in the high concentrations found in most energy drinks may cause diarrhea.
- Dehydration- Energy drinks should not be used for pre- or re-hydration. The high carbohydrate concentration can delay gastric emptying and slow absorption from the gastrointestinal tract and may cause diarrhea. Caffeine can act as a diuretic and, therefore, may result in increased fluid loss.
- Positive drug tests- Like all nutritional supplements, there is little or no regulatory oversight of energy drinks. The purity of the products cannot be assured and it is possible that they may contain substances banned by some sports organizations.
- Consumption of energy drinks by adolescents and young adults has been linked to heart arrhythmia and liver problems.
- Sales of certain energy drinks have been banned in Denmark, Turkey, Uruguay, Germany, and Austria. Some states in the U.S. have introduced legislation to restrict sales of energy drinks to adolescents and children. In September 2010, the Virginia High School League banned the use of energy drinks.
- Recently, healthcare providers have voiced increasing concerns about the consumption of energy drinks in association with alcohol because of the interaction of the stimulant effects of energy drinks and the depressant effects of alcohol.
American Academy of Pediatrics. Clinical Report. Sports drinks and energy drinks for children and adolescents: Are they appropriate? Pediatrics 2011;6:1182-1189.
Bonci L. Energy drinks: help, harm, or hype? Sports Science Exchange 2002:1.
Casa DJ, Armstrong LE, Hillman SK, et al. National Athletic Trainers’ Association position statement: Fluid replacement for athletes. Journal of Athletic Training 2000;35:212-224.
McKeag DB, Moeller JL. ACSM’s Primary Care Sports Medicine. 2nd Ed, Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins, 2007.
Meadows-Oliver M, Ryan-Krause P. Powering up with sports and energy drinks. Journal of Pediatric Health Care 2007;21:413-416.
Worcester S. Energy drink sales hit $3 billion: at what health cost? Pediatric News 2007;41:1-4.
Seifert SM, Schaechter JL, Hershorin ER, Lipshultz EL. Health effects of energy drinks on children, adolescents, and young adults. Pediatrics 2011;127:511-28.
Revised and Approved October 2011
DISCLAIMER – NFHS Position Statements and Guidelines
The NFHS regularly distributes position statements and guidelines to promote public awareness of certain health and safety-related issues. Such information is neither exhaustive nor necessarily applicable to all circumstances or individuals, and is no substitute for consultation with appropriate health-care professionals. Statutes, codes or environmental conditions may be relevant. NFHS position statements or guidelines should be considered in conjunction with other pertinent materials when taking action or planning care. The NFHS reserves the right to rescind or modify any such document at any time.