Doctors Urge F.D.A. to Restrict Caffeine in Energy Drinks

A group of 18 doctors, researchers and public health experts jointly urged the Food and Drug Administration on Tuesday to take action on energy drinks to protect adolescents and children from the possible risks of consuming high amounts of caffeine.

“There is evidence in the published scientific literature that the caffeine levels in energy drinks pose serious potential health risks,” the doctors and researchers wrote.In their letter to Dr. Margaret A. Hamburg, the F.D.A. commissioner, the group argued that energy drink makers had failed to meet the regulatory burden placed on them to show that the ingredients used in their beverages were safe, specifically where children, adolescents and young adults are concerned. As a result, the group urged the F.D.A. to restrict caffeine content in the products and to require manufacturers to include caffeine content on product labels.

A similar letter was sent to the agency by the San Francisco city attorney, Dennis J. Herrera, who is one of several public officials conducting investigations of the energy-drink industry.

Energy drink makers have insisted their products are safe and that their levels of caffeine, a stimulant, are on a par with other widely consumed drinks, like coffee.

The F.D.A. has said that it is safe for adults to consume about 400 milligrams of caffeine daily, though many experts say that most adults can consume 600 milligrams or more of caffeine without ill effect. A 16-ounce cup of Starbucks coffee has about 330 milligrams of caffeine, an amount about twice that of some similarly sized energy drinks.

Less is known about the safe level of caffeine for a young teenager, experts say, apart from the fact that it is considered to be lower than for an adult. In their letter Tuesday to Dr. Hamburg, the group of researchers and scientists also pointed out that makers of energy drinks aggressively marketed their products to young teenagers and urged them to consume the drinks quickly.

In recent years, the number of reported emergency-room visits in which an energy drink was cited as the primary cause of a health problem, or a contributing factor, has grown sharply. In 2011, there were 20,783 such visits, compared with 10,068 in 2007. Problems typically linked to excessive caffeine consumption can include anxiety, headaches, irregular heartbeats and heart attacks.

Scant Proof Is Found to Back Up Claims by Energy Drinks

Their rising popularity represents a generational shift in what people drink, and reflects a successful campaign to convince consumers, particularly teenagers, that the drinks provide a mental and physical edge.

The drinks are now under scrutiny by the Food and Drug Administration after reports of deaths and serious injuries that may be linked to their high caffeine levels. But however that review ends, one thing is clear, interviews with researchers and a review of scientific studies show: the energy drink industry is based on a brew of ingredients that, apart from caffeine, have little, if any benefit for consumers.

“If you had a cup of coffee you are going to affect metabolism in the same way,” said Dr. Robert W. Pettitt, an associate professor at Minnesota State University in Mankato, who has studied the drinks.

Energy drink companies have promoted their products not as caffeine-fueled concoctions but as specially engineered blends that provide something more. For example, producers claim that “Red Bull gives you wings,” that Rockstar Energy is “scientifically formulated” and Monster Energy is a “killer energy brew.” Representative Edward J. Markey of Massachusetts, a Democrat, has asked the government to investigate the industry’s marketing claims.

Promoting a message beyond caffeine has enabled the beverage makers to charge premium prices. A 16-ounce energy drink that sells for $2.99 a can contains about the same amount of caffeine as a tablet of NoDoz that costs 30 cents. Even Starbucks coffee is cheap by comparison; a 12-ounce cup that costs $1.85 has even more caffeine.

As with earlier elixirs, a dearth of evidence underlies such claims. Only a few human studies of energy drinks or the ingredients in them have been performed and they point to a similar conclusion, researchers say — that the beverages are mainly about caffeine.

Caffeine is called the world’s most widely used drug. A stimulant, it increases alertness, awareness and, if taken at the right time, improves athletic performance, studies show. Energy drink users feel its kick faster because the beverages are typically swallowed quickly or are sold as concentrates.

“These are caffeine delivery systems,” said Dr. Roland Griffiths, a researcher at Johns Hopkins University who has studied energy drinks. “They don’t want to say this is equivalent to a NoDoz because that is not a very sexy sales message.”

A scientist at the University of Wisconsin became puzzled as he researched an ingredient used in energy drinks like Red Bull, 5-Hour Energy and Monster Energy. The researcher, Dr. Craig A. Goodman, could not find any trials in humans of the additive, a substance with the tongue-twisting name of glucuronolactone that is related to glucose, a sugar. But Dr. Goodman, who had studied other energy drink ingredients, eventually found two 40-year-old studies from Japan that had examined it.

In the experiments, scientists injected large doses of the substance into laboratory rats. Afterward, the rats swam better. “I have no idea what it does in energy drinks,” Dr. Goodman said.

Energy drink manufacturers say it is their proprietary formulas, rather than specific ingredients, that provide users with physical and mental benefits. But that has not prevented them from implying otherwise.

Consider the case of taurine, an additive used in most energy products.

On its Web site, the producer of Red Bull, for example, states that “more than 2,500 reports have been published about taurine and its physiological effects,” including acting as a “detoxifying agent.” In addition, that company, Red Bull of Austria, points to a 2009 safety study by a European regulatory group that gave it a clean bill of health.

But Red Bull’s Web site does not mention reports by that same group, the European Food Safety Authority, which concluded that claims about the benefits in energy drinks lacked scientific support. Based on those findings, the European Commission has refused to approve claims that taurine helps maintain mental function and heart health and reduces muscle fatigue.

Taurine, an amino acidlike substance that got its name because it was first found in the bile of bulls, does play a role in bodily functions, and recent research suggests it might help prevent heart attacks in women with high cholesterol. However, most people get more than adequate amounts from foods like meat, experts said. And researchers added that those with heart problems who may need supplements would find far better sources than energy drinks.

Hiroko Tabuchi contributed reporting from Tokyo and Poypiti Amatatham from Bangkok.

Pepsi and Coke to Post Calories of Drinks Sold in Vending Machines

The program, which will add calorie counts and more low-calorie and no-calorie drinks to vending machines, will first appear in municipal buildings in Chicago and San Antonio early next year. It represents the latest effort by the industry to head off mounting criticism of its products as one of the chief villains responsible for the nation’s obesity crisis.

The American Beverage Association’s plan is to take its effort, called Calories Count, nationwide after seeing how it works in the two cities whose government employees are engaged in a competition to promote wellness programs, the industry group and the cities announced on Monday.

The beverage association had been working on plans to add calorie counts to its vending machines when Chicago’s mayor, Rahm Emanuel, called looking for a grant from the association to support a wellness challenge he wanted to mount with another city. Mr. Emanuel is trying to lower Chicago’s health care costs by encouraging municipal employees to sign up for a new health care plan that requires them to set goals for their health.

The cities are vying to see whose workers can make the greatest progress in improving their overall health, determined by a variety of factors, from weight loss to lowering blood pressure. The winning city receives $5 million from the beverage association foundation, and employees can win $1,000 for making the biggest improvements in their health.

“We believe partnerships like this — those which involve government, industry and civil society — can have a meaningful impact on the obesity issue,” Steven A. Cahillane, president and chief executive of Coca-Cola Refreshments, the unit of Coca-Cola responsible for its vending machine business, said in a statement.

Critics of the soda companies generally applauded the announcement. “People tend to overconsume products with sugar and for these companies to be doing something that may decrease consumption of their sugared beverages surprises me,” said Kelly D. Brownell, director of the Rudd Center for Food Policy and Obesity at Yale University. “But it does seem to me to be a positive move.”

Sales of carbonated sodas have been declining for the last decade, as American consumers have embraced new choices of beverages and, more recently, become more aware of how much sugar they contain. Coke and Pepsi have greatly expanded their portfolios, adding bottled waters, juices and sports drinks that have helped reduce their reliance on their core brands, though they still defend them.

In a note Monday morning, John Sicher, the publisher of Beverage Digest, an influential trade publication, said he thought the new effort might be a way to get consumers to drink more of their low-calorie and no-calorie drinks.

Mr. Sicher said sales through vending machines accounted for 12.5 percent of the total volume of carbonated soda sold annually.

The trend toward calorie disclosure is already under way nationally at fast food and other chain restaurants. All restaurants with more than 20 locations must post calorie counts on their menus, under the health care bill upheld this summer by the Supreme Court, though the regulations have not been completed. Panera Bread restaurants put calorie counts on menus and last month, McDonald’s restaurants began printing calorie counts on all its menus.

Dr. Brownell noted that the beverage companies were under fire at the local level. Many cities, including Chicago, are considering taxing sodas, while others like Seattle and Philadelphia have instituted strong public education programs to make people aware of how many of the calories they consume come from sodas and sugary drinks.

One 12-ounce regular soda contains eight teaspoons of sugar, or 130 calories and zero nutrition, according to the American Heart Association. Mayor Michael Bloomberg has become the industry’s Public Enemy No. 1 with his institution of a ban on the sale of sugary drinks in containers larger than 16 ounces in New York City. The ban is to take effect in March 2013. Beverage companies have argued that such measures were discriminatory and ineffective because the obesity rate has risen despite declines in the sales of sugary sodas.

Under the new program, big stickers saying, Calories Count — Check Before You Choose, will be applied to vending machines in city offices in Chicago and San Antonio, and calorie count labels will be inserted next to prices.

“This allows us to learn operationally how it works and ramp it up more quickly, but our intent is to take it nationwide,” said Susan K. Neely, chief executive of the American Beverage Association.

Coca-Cola and PepsiCo own about 35 percent of soda vending machines; the rest are owned by food service and vending machine companies.

In Chicago, the beverage companies are working with Canteen Vending Services, which controls the machines in the city’s buildings. In San Antonio, the machines are owned by Coca-Cola Refreshments.

Sugared drinks had been removed from those machines under a program in 2010 started by Sheryl Sculley, San Antonio’s city manager, so Coke will only have to add labels to them.