Are Sugar Free Energy Drinks Bad for You?

Wondering if switching to sugar-free energy drinks is actually healthier? We asked a nutrition expert to evaluate the potential health impacts of these popular beverages. While marketed as a healthier alternative to sugary options, the evidence might surprise you. From cardiovascular effects to long-term metabolic concerns, learn what science reveals about these widely consumed stimulant beverages and the hidden risks that might be lurking in your caffeine fix.

Cornelie Nienaber-Rousseau has answered Likely

An expert from North-West University in Nutrition

Energy drink consumption is growing worldwide and the industry has proven extremely profitable (Heckman et al., 2010). However, questions regarding the nutritional content and health effects should be raised and answered. These drinks can be ready-to-drink, shots, or presented in powder form (Heckman et al., 2010). Energy drinks can be carbonated and contain sugar (to give energy) or artificial sweeteners (for a low energy alternative), herbal extracts, can be fortified with micronutrients (some B-vitamins involved in energy metabolism) or macronutrients such as the amino acid taurine and stimulants such as caffeine. Marketing strategies for these formulations include statements purporting to increase energy utilization, boost energy, improve mood, enhance physical endurance, increase longevity and vitality, reduce mental fatigue and increase reaction time (Heckman et al., 2010). However, in certain population subdivisions consumption and in all groups excessive consumption might actually be harmful depending the specific cocktail used in the composition of the drink.

When energy drinks are used occasionally and in realistic amounts to for instance to counteract driver sleepiness (Reyner & Horne, 2002) or to increase physical endurance for athletes (Alford et al., 2001), the high sugar content can be justified as a source of discretionary energy for those of a healthy weight without diabetes. However, given the prevalence of overweight/obesity and the frequent consumption the high sugar content of sugar containing energy drinks are of concern. Currently the evidence indicates that dietary added sugar is notoriously associated with dental caries, contributes to weight gain and several other risk factors for non-communicable diseases as well as the diseases themselves (World Health Organization). Unfortunately sugar free energy drinks cannot necessarily be considered to be a healthier version, because even though artificial sweeteners are regarded as generally safe there seems to be several long term health effects including that going “diet” is actually leading to weight gain (Brown et al., 2010; Chia et al., 2016; Fowler et al., 2008; Fowler et al., 2015). Please check out my previous answer on whether artificially sweetened foods and drinks are less healthy than their sugary counterparts.

Caffeine intake’s safety has been evaluated among adults. It is safe for the typical healthy adult to consume a total of 400 mg of caffeine a day (Mayo Clinic; European Food Safety Authority, 2015). This is equivalent to 4 cups of coffee (90 mg each) or approximately 2 1/2 standard cans (250 ml) of energy drink provided that it contains 160 mg each/80 mg per serving. However, not all countries regulate the amount of caffeine permitted in energy drinks and, therefore, some can contain more per serving. The American Academy of Pediatrics (2011) recommends that children not consume caffeine and also not caffeinated energy drinks. Disturbingly Seifert et al. (2011) observed that energy drinks containing high and unregulated amounts of caffeine are also consumed by 30-50% of adolescents and young adults and that of the caffeine overdoses reported in 2007 in the US, 46% occurred in individuals younger than 19 years. In a summary of studies Grosso and others (2017) indicated that caffeine was associated with a probable decreased risk of Parkinson’s disease and type-2 diabetes and an increased risk of pregnancy loss and increased blood pressure. Energy drinks have been associated with serious adverse effects such as seizures, diabetes, mood and behavioral disorders including risk-seeking behaviors, poor mental health, adverse cardiovascular effects, and metabolic, renal, or dental conditions and increase the risk of dehydration (Al-Shaar et al., 2017; Higgins et al., 2015; Seifert et al., 2011). As summarized by Al-Shaar et al. energy drink consumption may also disrupt sleep patterns, cause headaches, stomach-aches and lead to irritation. Most research focused on the effect of caffeine and sugar and failed to address potentially harmful effects of the other ingredients in the energy drink cocktails. Summaries of studies on the effects of energy drinks have not been done and because there is some inconsistencies in the studies regarding the above mentioned risks, systematic reviews and meta-analyses are urgently needed.

The pharmacological safety of some of the herbal extracts should be evaluated individually. Komihon and others (2016) showed in their summary of randomized controlled clinical trials that ginseng appears to have neutral vascular effects – therefore it is neither beneficial nor harmful. Also guarana is generally considered to be safe even though it contains high amounts of caffeine (Patrick et al., 2019), but more research is needed. A summary of studies on Ginkgo biloba in patients with cognitive impairment and dementia indicated that it could stabilize or slow decline for cognitive function especially for those patients presenting with neuropsychiatric symptoms (Tan et al., 2015). Yerba mate which is regarded as a stimulant is also used as an ingredient in some energy drinks. Yerba mate has several adverse health effects such as causing some types of cancers and also some beneficial effects such as lowering cholesterol (Heck & de Mejia, 2007). Therefore, the risk versus benefits of yerba mate should be carefully evaluated by researchers to protect consumers. I have not mentioned here all herbal extracts that could be present in energy drinks – consumers should consult their dietician, pharmacist or doctor about the effects of these herbal extract and possible interactions with prescription medication should be considered. While certain formulations in energy drinks can be safe the unregulated nature of the sectors makes it difficult for consumers to know when to steer clear.

There is an alarming trend of mixing energy drinks with alcohol. The reason why this is potentially dangerous is the masking effect that energy drinks are proposed to have over alcohol intoxication. According to Oteri and others (2007) the combination of the stimulatory effect of caffeine and the depressant effect of alcohol on the body, hinders awareness of the warning signs of alcohol intoxication such as drowsiness. More research investigating the potential dangers that could result from the combination of alcohol and caffeinated beverages is needed while the public should be made aware of the potential risk of drinking such concoctions. Energy drinks are considered to be possible gate way drugs because their consumption often coincides with substance abuse (Holubcikova et al., 2017; Reissig et al., 2009; Terry-McElrath et al., 2014). Reasons for this could be that energy drink companies are using intentionally defiant names (Full Throttle, Ammo, Havoc, Hydrive, Morning Spark, Monster) for their products (Energy Fiend, 2009) drawing a certain population group to consume their products who are more prone to substance abuse to begin with. However, it could also be related to increased risk taking behavior associated with the consumption of the drinks (as reviewed by Al-Shaar et al., 2017).

Another issue to consider is the underlying medical or lifestyle reasons for feeling fatigued and in need of an energy boost. Consumers regularly using energy drinks to compensate for a lack of sleep (Miller, 2008) should reconsider their lifestyle and sleeping patterns as this in itself can be harmful (see Metafact consensus paper on sleep). Furthermore, iron deficiency anemia is a world wide problem with serious adverse effect such as chronic fatigue that could and should be treated. Research from our group showed that maintaining your iron status is not only important to prevent fatigue but also for cardiovascular health ensuring optimal blood coagulation and clot breakdown (Rautenbach et al. entitled: “Certain Associations between Iron Biomarkers and Total and γ’ Fibrinogen and Plasma Clot Properties are Mediated by Fibrinogen Genotypes” recently accepted for publication in Frontiers in Nutrition). Therefore, if you are in need of using energy drinks consider which harmful symptoms you are masking and consult with medical professionals for advice.

In summary, some of the ingredients often found in energy drinks are not regulated and are understudied and their effects are not known. The public especially need to be aware of the possible effects of energy drinks in vulnerable populations such as the youth, caffeine-naïve or caffeine-sensitive, pregnant, competitive athletes and people with underlying cardiovascular disease (Higgins et al., 2015). Al-Shaar and others (2017) recommend that policy makers consider creating a separate regulatory category for energy drinks, that there should be an evidence-based upper limit on caffeine, sales of these drinks should be restricting and regulating and marketing should not be targeted towards the children and adolescents. Furthermore, on a personal note one should start paying attention to the amount of caffeine one is ingesting from foods such as chocolate or energy bars and beverages by reading the labels, but keep in mind that not all labels will list caffeine. Also consider making (plain clean safe) water the principal source of hydration and only occasionally (if at all) drinking energy drinks provided that you do not fall within the vulnerable population subgroups who should not consume energy drinks for optimal health and well-being.

Verdict: Sugar-Free Doesn’t Mean Risk-Free.

Sugar-free energy drinks still contain high caffeine levels and artificial sweeteners that pose significant health risks. These include cardiovascular issues, sleep disruption, and potential weight gain. Limited consumption is advised, with water remaining the healthiest hydration choice.

Find more research on energy drink ingredients and health effects on Consensus.

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