ISSN2013 - Energy Drinks

Campbell et al.
Journal of the International Society of Sports Nutrition 2013, 10:1

http://www.jissn.com/content/10/1/1
REVIEW Open Access
International Society of Sports Nutrition position

stand: energy drinks
Bill Campbell1†, Colin Wilborn2†, Paul La Bounty3, Lem Taylor2†, Mike T Nelson4, Mike Greenwood5†,
Tim N Ziegenfuss6, Hector L Lopez6, Jay R Hoffman7, Jeffrey R Stout7, Stephen Schmitz8†, Rick Collins9†,
Doug S Kalman10, Jose Antonio11† and Richard B Kreider5*
Abstract
Position Statement: The International Society of Sports Nutrition (ISSN) bases the following position stand on a
critical analysis of the literature on the safety and efficacy of the use of energy drinks (ED) or energy shots (ES).
The ISSN has concluded the following. 1. Although ED and ES contain a number of nutrients that are purported to
affect mental and/or physical performance, the primary ergogenic nutrients in most ED and ES appear to be
carbohydrate and/or caffeine. 2. The ergogenic value of caffeine on mental and physical performance has been
well-established but the potential additive benefits of other nutrients contained in ED and ES remains to be
determined. 3. Consuming ED 10-60 minutes before exercise can improve mental focus, alertness, anaerobic
performance, and/or endurance performance. 4. Many ED and ES contain numerous ingredients; these products in
particular merit further study to demonstrate their safety and potential effects on physical and mental performance.
5. There is some limited evidence that consumption of low-calorie ED during training and/or weight loss trials may
provide ergogenic benefit and/or promote a small amount of additional fat loss. However, ingestion of higher
calorie ED may promote weight gain if the energy intake from consumption of ED is not carefully considered as
part of the total daily energy intake. 6. Athletes should consider the impact of ingesting high glycemic load
carbohydrates on metabolic health, blood glucose and insulin levels, as well as the effects of caffeine and other
stimulants on motor skill performance. 7. Children and adolescents should only consider use of ED or ES with
parental approval after consideration of the amount of carbohydrate, caffeine, and other nutrients contained in the
ED or ES and a thorough understanding of the potential side effects. 8. Indiscriminant use of ED or ES, especially if
more than one serving per day is consumed, may lead to adverse events and harmful side effects. 9. Diabetics and
individuals with pre-existing cardiovascular, metabolic, hepatorenal, and neurologic disease who are taking
medications that may be affected by high glycemic load foods, caffeine, and/or other stimulants should avoid use
of ED and/or ES unless approved by their physician.
Introduction ES, and sports drinks. Sports drinks are a unique cate-
According to published research, energy drinks (ED) are gory within the beverage industry and are marketed to
the most popular dietary supplement besides multivita- consumers with the primary function of promoting hy-
mins in the American adolescent and young adult popu- dration, replacing electrolytes and sustaining endurance
lation [1-3]. ED are also reported to be the most popular performance capacity. They typically provide a small
supplement among British athletes [4]. More recently, amount of carbohydrate (e.g., 6-8 grams/100 ml) and
energy shots (ES) have also been purported to possess electrolytes (sodium, potassium, calcium, magnesium).
ergogenic value on mental focus and/or performance ED, on the other hand, typically contain higher amounts
[5]. It is important to make a distinction between ED, of carbohydrate along with nutrients purported to im-
prove perceptions of attention and/or mental alertness.
* Correspondence: rkreider@hlkn.tamu.edu Low calorie ED are also marketed to increase mental
†
Equal contributors
5
Exercise & Sport Nutrition Lab, Department of Health & Kinesiology, Texas
alertness, energy metabolism, and performance. Energy
A&M University, College Station, Texas, TX 77843-4243, USA shots are typically 2-4 oz. servings of concentrated fluid
Full list of author information is available at the end of the article
© 2013 Campbell et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
Campbell et al. Journal of the International Society of Sports Nutrition 2013, 10:1 Page 2 of 16
containing various purported ergogens. Since ED and ES United States. The next section provides an overview of
contain carbohydrate, caffeine, and/or nutrients that may the potential ergogenic value of some of the most com-
affect mental focus and concentration, they have the monly found nutrients in ED/ES.
potential to affect exercise capacity and perceptions of
energy and/or fatigue. The purpose of this position stand Caffeine
is to critically evaluate the scientific literature and make Caffeine is the most common ingredient utilized in
recommendations in regards to the role that ED and/or energy drinks. Caffeine is extracted from the raw fruit of
ES may have on exercise performance and energy ex- over sixty species of coffee plants (coffea Arabica), all
penditure/metabolism. Additionally, we will discuss safety part of the methylxanthine family. Caffeine is also
considerations in regards to the use of ED and/or ES. extracted from tea, kola nuts, and cocoa. After ingestion,
caffeine is quickly absorbed and increases in plasma con-
Methods centrations are generally observed between 30 – 60 min-
This analysis represents a systematic review of the literature utes following ingestion [7]. The difference in absorption
on the effects of “energy drinks” on exercise and cognitive time is dependent on the physicochemical formulation
performance as well as primary ingredients contained in properties of the product dose [8]. Caffeine is a strong
popular energy drinks. A comprehensive literature search cardiovascular stimulant that increases epinephrine out-
was performed by searching the Medline database of the put to a greater extent when ingested via its anhydrous
US National Library of Medicine of the National Institutes formulation when compared to an equal amount of
of Health. The search strategy involved entering “energy brewed or instant caffeinated coffee [9,10]. In addition,
drinks” and commercial names of energy drinks and/or caf- caffeine’s half-life ranges from approximately 2 to 10
feinated beverages as well as a search of primary nutrients hours with 0.5% - 3.5% of its content excreted un-
contained in popular energy drinks (e.g., caffeine, carbohy- changed in urine and select amounts eliminated via per-
drate, taurine, glucoronolactone, Guarana, Yerba Mate, spiration [11]. A recent position stand from the Journal
etc.). It is important to note, from a United States regula- of the International Society of Sports Nutrition [7] sum-
tory perspective, several of these ED are marketed as diet- marized the effects of caffeine on exercise performance
ary supplements and not beverages, and the label on the as follows:
product will indicate which category of Food and Drug
Administration (FDA) authority the product falls under. 1. Caffeine is effective for enhancing sport performance
Each category has its own set of governing laws and regula- in trained athletes when consumed in low-to-moderate
tions. For example, depending on the category, the labels dosages (~3-6 mg·kgBM-1) and overall does not result
will include Supplement Facts (dietary supplements) or in further enhancement in performance when
Nutrition Facts (beverages). A paper summarizing the consumed in higher dosages (≥ 9 mg·kgBM-1).
literature related to ED was presented at the 2011 2. Caffeine exerts a greater ergogenic effect when
International Society of Sports Nutrition Annual meeting. consumed in an anhydrous state as compared to coffee.
Thereafter, a position stand writing team was organized to 3. It has been shown that caffeine can enhance
develop this paper. Drafts of this position stand were then vigilance during bouts of extended exhaustive
reviewed by all authors as well as the Research Committee exercise, as well as periods of sustained sleep
of the International Society of Sports Nutrition (ISSN). deprivation.
The final version of this paper was then adopted as the 4. Caffeine is ergogenic for sustained maximal
official position of the ISSN. endurance exercise, and has been shown to be highly
effective for time-trial performance.
Ergogenic/performance considerations 5. Caffeine supplementation is beneficial for
The ingestion of nutrients prior to, during, and/or fol- high-intensity exercise, including team sports such as
lowing exercise can affect exercise performance and/or soccer and rugby, both of which are categorized by
training adaptations [6]. ED typically contain water, car- intermittent activity within a period of prolonged
bohydrates (e.g., glucose, maltodextrin), vitamins, minerals, duration.
and “proprietary blends” of various nutrients purported to 6. The literature is equivocal when considering the
increase energy, alertness, metabolism, and/or perform- effects of caffeine supplementation on strength-power
ance (e.g., caffeine, taurine, amino acids, glucoronolactone, performance, and additional research in this area is
Guarana, Ginkgo biloba, Carnitine, Panax ginseng, Green warranted.
Tea, Yerba Mate, etc.). Therefore, ingestion of ED or ES 7. The scientific literature does not support
prior to, during, and/or following exercise could have caffeine-induced diuresis during exercise, or any
some ergogenic value. Tables 1 and 2 present a list of harmful change in fluid balance that would
ingredients found in several ED/ES marketed in the negatively affect performance.
Table 1 List of ingredients described on nutrient panels found in some energy drinks
Ingredient A B C D E
Calories 100 110 140 120 140
Carbohydrate 27 28 31 32 30
Calories from - - - -
Fat
Vitamin C - 100 mg - 100 mg 6.7mg
Thiamin - 0.1 mg - - 0.2 mg
Riboflavin B2 1.7 mg 1.5 mg 3.4 mg 20% 0.2 mg
Niacin B3 20 mg 21.7 mg 20 mg 10% 2.2 mg
Vitamin B6 40 mg 2.1 mg 2 mg 10% 1.5 mg
Vitamin B12 6 mcg 4.5 mcg 6 mcg 10% 4.7 mcg
Pantothenic - 36 mg - 10% 1.1 mg
Acid
Sodium 180 mg 200 mg 40 mg 75 mg 190 mg
Potassium - 10 mg 10 mg - 65 mg
Phosphorus - - - 40 mg 90 mg
Taurine 1,000 mg 600 mg 1000 mg - -
Panax 200 mg - 25 - -
Ginseng
Proprietary 2,500 mg L-Carnitine, Glucose, Caffeine 325 mg Ginko Biloba (150 mg), Guarana, maltodextrin, Citrulline Malate,
Blend Caffeine, Guarana, Inositol, (77 mg) Caffeine (80 mg), Guarana (25 mg), caffeine, taurine, L-Glutamine,
Glucuronolactone, Maltodextrin Inositol (25 mg), L-Carnitine (25 mg), panax ginseng, L-Arginine, Quercetin,
Milk Thistle (20 mg) calcium L-Leucine, L-Valine,
Table 2 List of ingredients described on nutrient panels found in some energy shots
Ingredient A B C D E
Calories 4 4 20 9 0
Carbohydrate - - 4g 1g 0
Calories from - - - -
Fat
Vitamin C - 100 mg - - 126%
Niacin 30 mg 33 mg 33 mg -
Vitamin B6 40 mg 40 mg 40 mg -
Folic Acid 400 mcg 400 mcg 400 mcg -
Vitamin B12 500 mcg 500 mcg 500 mcg -
Sodium 18 mg 0 mg 0 mg - 10
Potassium - 10 mg 10 mg - 26
Proprietary 1,870 mg 2,300 mg 2,200 mg 910 mg 527 mg
Blend Taurine, Glucouronolactone (425 mg), Glucouronolactone (420 mg), Caffeine Citrate, Beta-Alanine, Vitamin C,
Glucuronolactone, N-Acetyl L-Tyrosine (400 mg), L-Phenylalanine (380 mg), Caffeine Anhydrous, Caffeine Anhydrous
Malic Acid, L-Phenylalanine (375 mg), D-Ribose (350 mg), Evoburn, (158 mg), Evoburn,
N-Acetyl Taurine (350 mg), N-Acetyl L-Tyrosine (325 mg), Octapomine, N-Acetyl-L-Tyrosine,
L-Tyrosine, Malic Acid 300 mg), Malic Acid (300 mg), Gugulsterone E & Z, Hordinine,
L-Phenylalanine, Caffeine (200 mg), Caffeine (175 mg), Yerbe Mate, 5-Hydroxy-L-Trypotophan
Caffeine, Citicoline Green Tea Extract (150 mg), Green Tea Extract (150 mg), Green Tea, (5-HTP), Potassium,
Ginseng Extract (150 mg) Ginseng Extract (100 mg) Synephrine, cAMP, N-methyl Tyramine,
Vinpocetine, Sulbutlamine,
Yohimbe HCL Vinpocetine,
Yohimbine HCI,
St. John’s Wort Extract
As demonstrated below, several studies have reported Other nutrients

significant improvements in both aerobic and resistance Tables 3, 4, and 5 present a list of additional nutrients
exercise with a relative dosage of approximately 2 commonly found in ED or ES. Most ED and ES also
mg·kgBM-1of caffeine. This is less than the amount contain a small amount of vitamins (e.g., thiamin, ribo-
recommended (3-6 mg·kgBM-1) to enhance perform- flavin, niacin, Vitamin B6, Vitamin B12, pantothenic
ance [7], and may contribute to the hypothesis that the acid, Vitamin C) and electrolytes (e.g., sodium, potas-
synergistic effects of the various ingredients contained sium, phosphorus, etc.). While the addition of these
in ED/ES are responsible for the reported improve- nutrients may add to the nutrient density of these
ments in exercise performance. products, there is little evidence that ingestion of these
vitamins and minerals in the amounts found in ED and ES
Carbohydrate would provide any ergogenic benefit during exercise per-
Another common ingredient in most ED is some type of formance in well-nourished individuals [17,18]. Additio-
carbohydrate source (e.g., glucose, sucrose, maltodextrin, nally, ED and ES typically contain nutrients purported to
etc.). Energy drinks also typically contain glucuronolac- promote cognition and mental focus (e.g., Taurine, Ginkgo
tone, an ingredient which is involved in ascorbic acid biloba, L-Tyrosine, Citocoline, 5-Hydroxy-L-Tryptophan
synthesis and is metabolized into xylulose [12]. Evidence [5-HTP], St. John’s Wort, etc.), stimulants (e.g., caffeine,
from numerous studies indicates that carbohydrate fee- Guarana, Green Tea, Synephrine, Yerba mate, Yohimbine,
ding during exercise of about 45 minutes or longer can Tyramine, Vinpocetine, etc.), and/or various purported
improve endurance capacity and performance [13,14]. ergogenic nutrients (e.g., Panax Ginseng, L-Carnitine,
Mechanisms by which carbohydrate feeding prior to D-Ribose, β-Alanine, Inositol, Citrulline, Quercetin, etc.).
and during exercise improves endurance performance While there are data to support the potential ergogenic
include maintaining blood glucose levels, maintaining value of some of these nutrients on cognitive function
high levels of carbohydrate oxidation, and the sparing and/or exercise capacity [17,18]; the amounts found in ED
of liver and possibly skeletal muscle glycogen [15]. Peak and ES are generally much lower than the typical concen-
rates of carbohydrate oxidation are commonly around trations associated with an ergogenic effect. Consequently,
1 g of carbohydrate per minute or 60 g·hr-1. Glucose, it is unclear whether adding these nutrients to ED and/or
sucrose, maltodextrins and amylopectin are oxidized at ES provides a synergistic or additive effect to the carbohy-
high rates, while fructose, galactose and amylose are drate and caffeine found in these products. In addition,
oxidized at lower rates (approximately 25-50% lower) adding these nutrients to the caffeine found in ED and/or
[16]. Consequently, sports drinks typically contain a ES may change the adverse effect profile of these finished
mixture of various types of carbohydrates designed to products, and warrant further study.
optimize exogenous carbohydrate oxidation [17].
ED’s contain approximately 25-30 grams of carbohy- Exercise performance
drate per 240 mL (8 fluid ounces) serving. This amount Several studies have investigated the effects of ED con-
nearly meets the lower value of 30 grams/hour recom- sumption prior to exercise. The types of exercise that
mended during endurance exercise, but falls short of the were evaluated include resistance exercise [167,168], an-
upper range of 60 g·hr-1. In order to meet this upper level aerobic exercise [169], and aerobic/endurance exercise
of 60 grams of carbohydrate per hour during endurance [62,170-172].
exercise, approximately 530 mL (18 fluid ounces) of a
typical ED per hour would need to be consumed. While Ingestion prior to anaerobic exercise
the total carbohydrate content of typical ED is quite high, Many of the studies investigating the effects of ED in-
a shortcoming exists in regards to the concentration of gestion on anaerobic performance measures have been
commercially available energy drinks. The American conducted within the past several years. In a crossover
College of Sports Medicine [18] and the ISSN [6,17] study (separated by seven days), Forbes and colleagues
recommend ingesting carbohydrate in a 6-8% solution [168] gave 15 physically active college-aged students a
(6-8 grams per 100 ml of fluid) during endurance exercise. commercially available energy drink standardized with
A typical ED provides carbohydrates at a greater concen- 2 mg·kgBM-1of caffeine or an isoenergetic, isovolu-
tration, typically around an 11-12% solution. Ingesting metric, non-caffeinated placebo 60-minutes prior to
higher percentages (>10%) of carbohydrate in fluids has exercise. The exercise consisted of three sets of 70% one
been reported to delay gastric emptying and increase repetition maximum (1RM) bench press conducted to fai-
gastrointestinal distress [19,20]. Consequently, athletes lure on each set with one minute of rest between each set.
who want to use ED as sports drinks may need to dilute Following the resistance exercise bout, three x 30-second
the beverage and/or alternate consumption of ED and Wingate Anaerobic Capacity tests were also conducted
water during exercise. with two minutes of rest between each test. The ED
Table 3 Potential ergogenic nutrients contained in energy drinks that may affect cognition and/or mental performance
Ingredient Potential ergogenic value Scientific support
Taurine Improved mental focus, concentration, serve as antioxidant, Some supportive evidence with ED and fed animals
glucose homeostasis [21-24] [25-35]
Gingko Biloba Improve memory and mental concentration Some supportive evidence on memory (e.g., 120 mg/d)
[36-39]. No known effects at dosages found in ED or ES.
L-Tyrosine Prevents depletion of catecholamines, may ameliorate declines in Some supportive evidence on cognition (e.g., 2 g/d,
cognition with acute stress [40-47] 150 mg acute ingestion with cold exposure)
[41,43,46,48,49]. No effects on performance capacity
[42,50]. No known effects at dosages found in ED or ES.
Citicoline Intermediate in the generation of phosphatidylcholine from choline. Some supportive evidence with large doses
Increase dopamine receptor densities and delay memory (8.5 g prior to and during exercise) and in fed animals
impairment [51,52]. [52]. No known effects at dosages found in ED or ES.
5-Hydroxy-L- Precursor to serotonin [53,54]. Purported antidepressant, Some evidence in treatment of depression [53,55-58]
Trypotophan appetite suppressant, & sleep aid [53,55-58]. and 5-HT fed animals on muscle performance [54,59,60].
(5-HTP) Role on exercise performance at dosages found in ED
and ES is unknown.
St. John’s Wort Anti-depressant [56-58]. Some supportive evidence [56-58]. No known effects at
dosages found in ED or ES.
significantly increased total bench press repetitions over mg·kgBM-1of caffeine or a placebo beverage that was
three sets (approximately 6% more repetitions completed) similar in taste and appearance but contained only inert
but had no effect on Wingate peak or average power. substances. Following the ingestion of the ED, three
In a similarly designed study, a commercially available separate 20-second Wingate tests separated by about 15
energy drink (providing an average of 2.1 mg of caffeine minutes were performed. Results revealed that there
per kg of body mass) given to physically active male and were no significant differences between trials in any an-
female participants 45 minutes prior to exercise resulted aerobic power measure. In a recent publication, 12
in a significant increase in leg press total lifting volume healthy male and female non-resistance trained partici-
(12% increase as compared to a carbohydrate placebo) pants ingested a commercially available ED standardized
but had no effect on bench press total lifting volume at either 1 or 3 mg·kgBM-1of caffeine or a placebo beve-
[167] or multiple 20-second Wingate-type cycle sprints rage (containing no caffeine) in a randomized, repeated
[173]. Hoffman and colleagues [169] gave male strength/ measures design [65]. Sixty minutes following beverage
power athletes an ED containing an average of 1.8 ingestion, each participant completed 10-to-100% 1RM
Table 4 Potential stimulants contained in energy drinks that may affect performance capacity
Caffeine Stimulant. Increases metabolism and lipolysis [2,8,9,61]. Increases alertness, mood, cognitive function [2,8,9,61].
Increases fat oxidation, spares glycogen utilization,
improves exercise [7,9-11,62-65].
Guarana Natural source of caffeine. Similar properties to caffeine. Similar to caffeine effects.
Green Tea Contains high amounts of caffeine and catechin polyphenols Some supportive evidence of increased metabolism
Extract (e.g., epigallocatechin gallate or EGCG). Serves as antioxidant. [68-76]. Specific role at dosages found in ED is unknown.
Similar effects as caffeine [66,67]
Synephrine Alternative to ephedrine. Naturally derived from Citrus aurantium. Stimulant Evidence of a mild stimulant effect on metabolism and
with less cardiovascular effects than ephedrine. weight loss [77-82]. No known effects at dosages found
Purported to increase metabolism and promote weight loss. in ED.
Yerba mate Contains three xanthines (caffeine, theobromine, and theophylline). Similar Similar to caffeine effects. Some supportive evidence
properties to caffeine [83-85] No known effects at dosages found in ED
and ES.
Yohimbine Alkaloid with stimulant and aphrodisiac properties [86-90]. Similar to caffeine effects. Effects at dosages found in ED
are unknown.
Tyramine Naturally-occurring monoamine derived from tyrosine. Acts as a Mild cardiovascular stimulant. Effects at dosages found
catecholamine (dopamine, NE, Epi) releasing agent. Degraded to octopine. in ED / ES are unknown.
Increases blood pressure and can serve as neurotransmitter [91-93].
Vinpocetine Alkaloid of vincamine extracted from periwinkle plant (Vinca) minor. No known effects at dosages found in ED or ES.
Vasodilatory and memory enhancing properties [94,95].
Table 5 Other potential ergogenic nutrients contained in energy drinks that may affect performance
Panax Ginseng Contains ginsenosides which are purported to have Most well-controlled research does not support the ergogenic
anti-inflammatory, antioxidant, and anticancer effects. effects for ginseng [97-111]. No known effects at dosages
Purported to enhance perceptions of energy, increase found in ED and ES.
stamina and improve nitrogen balance [96].
L-Carnitine Involved in shuttling long chain fatty acids into Limited supportive ergogenic value in athletes or on weight
mitochondria. Purported to promote lipolysis [112]. loss [112]. No known effects at dosages found in ED and ES.
D-Ribose Involved in ATP synthesis. Theoretically, Some evidence of improved exercise capacity in clinical
D-ribose supplementation can increase ATP availability. populations [113] but limited evidence that high dose ribose
supplementation affects exercise capacity [114-119]. No
known effects at dosages found in ED and ES.
Beta Alanine Increases muscle carnosine levels, increases muscle Growing scientific evidence of improved anaerobic capacity
buffering, and attenuates fatigue during high intensity (2-4 g/d) [125-138]. No known effects at dosages found in ED
exercise [120-124]. and ES.
Inositol Carbohydrate that is not classified as sugar. Involved in No known effects at dosages found in ED or ES.
insulin signaling, nerve transmission, serotonin modulation,
and fat oxidation [139].
Citrulline Malate Optimizes blood flow via arginine-nitric oxide pathway; Some evidence that high dosages (e.g., 6 – 8 g) can affect
purported to reduce fatigue and buffer acidity during exercise capacity and/or anabolism [142-149]. No known
exercise [140,141]. effects at dosages found in ED and ES.
Quercetin Reported to have antioxidant, anti-inflammatory, antiviral, Several studies indicate that Quercetin supplementation
and immune-modulatory effects [150]. (e.g., 1 g/d for 7 d) increases maximal aerobic capacity and
time to fatigue [151-166]. No known effects at dosages found
in ED or ES.
power-load tests for the bench press and half-squat. Inges- supplemental carbohydrate was ingested prior to a
tion of the ED with 1 mg·kgBM-1of caffeine was not resistance-training bout did not report improvements
enough to raise the power output during the power-load in resistance training performance [176-178].
tests. However, the ingestion of an ED with 3 mg·kgBM-1of
caffeine increased maximal power output by 7% in both Conclusion
the half-squat and bench-press as compared to the inges- ED (containing approximately 2 mg·kgBM-1caffeine) con-
tion of a placebo [65]. A recent study by Gonzalez and sumed 45 to 60 minutes prior to anaerobic/resistance
colleagues [174] indicated that an energy matrix consis- exercise may improve upper- and lower- body total lifting
ting of caffeine, taurine and glucoronolactone consumed volume, but has no effect on repeated high intensity sprint
10-min prior to a workout resulted in an 11.9% improve- exercise, or on agility performance.
ment (p < 0.05) in the number of repetitions performed
during 4 sets of the squat or bench press exercise using Ingestion prior to endurance exercise
80% of the subject’s 1-RM. In addition, the average power Several studies have investigated the effects of ED inges-
output for the workout was significantly higher for sub- tion prior to aerobic exercise [62,170-172,179]. In the
jects consuming the energy drink compared to subjects earliest of these studies, Alford and colleagues [172]
consuming the placebo. investigated the effects of ingesting a commercial ED on
In addition to resistance and high intensity anaerobic aerobic endurance. In a repeated measures, crossover
exercise, the effects that ED exert on speed/agility perfor- design, young healthy participants ingested 250 mL of a
mance has also been investigated. Collegiate female soccer commercial ED (containing 80 mg of caffeine and 26
players ingested an ED containing 1.3 mg·kgBM-1of caf- grams of carbohydrate), a carbonated water beverage, or
feine and 1 gram of taurine or a caffeine and taurine-free no beverage at all 30 minutes prior to performing an en-
placebo 60 minutes prior to repeated agility t-tests [175]. durance exercise bout. Test days for separate treatments
No difference in agility t-test performance between the ED were assessed within a week. Aerobic performance was
and placebo groups was reported. Specifically, the highest analyzed by the amount of time that exercise could be
difference reported between the two groups was during maintained at 65-75% of maximum heart rate on a cycle
the third set of eight agility t-tests, and the difference ergometer. Significant improvements in aerobic per-
reached only 1.15% between the groups. It is unlikely that formance were reported for the commercial ED treat-
the carbohydrate content alone in ED is responsible for ment. Aerobic performance was 8% and 14% longer after
improvements in resistance exercise performance. In ingesting the commercial ED as compared to the carbo-
support of this view, the majority of studies in which nated water and no beverage treatment, respectively.
In one of only two studies that have investigated the cyclists and recreationally active participants. In the one
effects of ingesting a sugar/carbohydrate-free ED on per- investigation in which no aerobic performance improve-
formance capacity, Candow and colleagues [170] reported ment was reported, the ED (containing 2 mg·kgBM-1caf-
no improvements in high intensity run time-to-exhaustion feine) was ingested 60-minutes prior to the performance
performed at 80% of VO2max on a treadmill in physically assessment. In light of the other findings, ingestion of
active college-aged participants. The sugar-free ED con- the caffeine-containing ED 60-minutes prior to the exer-
tained 2 mg·kgBM-1caffeine and was ingested one-hour cise bout may be too long of a period to realize improve-
prior to the exercise bout [170]. In contrast, Walsh and ments in aerobic exercise performance.
colleagues [179] reported significant improvements in
treadmill run time to exhaustion following ingestion of a Mood/reaction time/alertness
carbohydrate-free ED. In this randomized cross-over inves- Reaction time, concentration, alertness, and subjective
tigation, 15 recreationally active participants ingested an feelings of energy/vitality are important in many com-
ED 10-minutes prior to engaging in a treadmill run-to petitive activities such as hitting a baseball, returning a
exhaustion test at 70% VO2max [179]. The ED utilized in serve in tennis, and dodging strikes and kicks in a mixed
this study did not contain any carbohydrate, and unlike martial arts competition. Strategies to improve these
other ED products, contained nearly eight grams of the attributes are often sought after by individuals compe-
amino acids L-leucine, L-isoleucine, L-valine, L-arginine ting in certain athletic endeavors. Over the past several
and L-glutamine. Unfortunately, the published study did years, research has investigated the effects that ED
not disclose the precise amount of caffeine contained in the ingestion has on these (and other) variables.
ED, but instead referred to a ~2 g “proprietary blend” of Seidl and coworkers [31] conducted a study utilizing
caffeine, taurine, and glucoronolactone. The placebo used three common ingredients (i.e., caffeine, taurine, glucu-
as a comparison was sweetened water that was similar in ronolactone) typically found in ED and compared it to a
color and volume. It was reported that participants con- placebo group. Participants were evaluated at night to
suming the ED were able to run 12.5% longer than during see if ingestion of these nutrients affected mood and
the placebo treatment [179]. motor function in fatigued participants. Interestingly,
The two most common protocols used to assess the investigators found that at the end of the experi-
aerobic performance are time to exhaustion at a given ment, reaction time was significantly longer in the pla-
exercise intensity (e.g., exercise at 70% of maximum oxy- cebo group, but remained unchanged in the group that
gen uptake until exhaustion) and time trial performance consumed the ED ingredients. Similarly, vitality scores,
for a set distance (e.g., 40 km time trial). Time trials feelings of well-being, and social extrovertedness were
have greater validity than time to exhaustion because all significantly decreased in the placebo group, but did
they provide a good physiological simulation of actual not change in the ED group [31].
performance and correlate with actual performance Scholey and colleagues [182] investigated the effects of
[180,181]. Ivy and colleagues [62] were the first research an ED (containing primarily caffeine, glucose, ginseng and
group to utilize a time trial component in conjunction ginkgo biloba drink) or a placebo beverage on five aspects
with ED consumption. In this investigation, trained male of cognitive performance and mood. Thirty minutes after
and female cyclists completed two trials in a repeated consuming ED, two of the five variables (i.e., “secondary
measures crossover design separated by one week. After memory” and “speed of attention”) were significantly
a 12 hour fast, the cyclists ingested a commercially avai- improved as compared to the placebo beverage [182].
lable ED providing approximately 2.3 mg·kgBM-1caffeine Other investigators also reported that when caffeine was
or an artificially colored, flavored, and sweetened-water combined with carbohydrates in a carbonated beverage,
placebo 40-minute prior to the exercise bout. Perfor- performance and mood were improved and/or maintained
mance during the exercise bout was measured as the during fatiguing and cognitively demanding tasks relative
time to complete a standardized amount of work equal to placebo [183]. Similarly, ED containing caffeine and
to 1 hr of cycling at 70% of maximal power output. glucose have also been shown to enhance event related
Results revealed a significant difference between the potentials (i.e., a measure of brain activity in real time
treatments in relation to performance with the ED treat- obtained from an electroencephalogram), which may
ment completing the time trial ~4.7% faster than the translate to improvements in reaction time [184].
placebo treatment [62]. Hoffman and colleagues [169] reported that when
male strength/power athletes consumed 120 ml of a
Conclusion commercially available ED or a placebo, reaction time
ED containing approximately 2 mg·kgBM-1caffeine con- and subjective feelings of energy and focus were signifi-
sumed 10 to 40 minutes prior to aerobic exercise im- cantly improved in those consuming the ED. Further-
prove cycling and running performance in both trained more, the investigators also noted a statistical trend
(p=0.06) towards an increase in alertness. In a similar value appears to be due to the caffeine and/or carbohydrate
study, Walsh and colleagues [179] examined the effects contained in these drinks. Individuals looking to enhance
of ingesting an “energy matrix” (2.05 g of caffeine, tau- reaction time, mental alertness, and/or focus may benefit
rine, glucuronolactone), amino acids (7.9 g of L-leucine, from consuming an ED prior to exercise.
L-isoleucine, L-valine, L-arginine and L-glutamine), di-
creatine citrate (5 g), and β-alanine (2.5 g) mixed with Energy drinks and their role in energy
500 ml of water or a placebo) 10-minutes prior to exer- expenditure and weight loss
cise on aerobic performance and subjective measures of As shown in Table 4, ED and some commercial be-
focus, energy, and fatigue in recreationally active male verages designed to increase metabolism typically contain
and females. Results revealed that participants ingesting a number of stimulants (e.g., caffeine, Guarana, Green Tea,
the ED increased time to exhaustion while running at synephrine, Yerba mate, Yohimbine, Tyramine, Vinocetine,
70% of VO2max by 12.5% (p = 0.012), they reported etc.). Several low-calorie ED and beverages have been
greater focus (p = 0.031), energy (p = 0.016), and less fa- marketed as “thermogenic blends” with a focus on increa-
tigue (p = 0.005) prior to exercise; and, that their ratings sing metabolism. Theoretically, ingestion of ED prior to
of focus (p = 0.026) and energy (p = 0.004) were greater exercise may increase energy expenditure which over time
10 minutes into exercise [179]. However, no significant could help manage and/or promote weight loss. In support
differences in energy, fatigue, and focus were observed of this theory, studies have shown that ingestion of caffeine
between groups immediately post-exercise [179]. (e.g., 200-500 mg) can increase acute (1-24 hours) energy
Howard and coworkers [185] evaluated the effects of expenditure [187-193], chronic (28 days) energy expen-
acute ingestion of a glucose containing ED on behavioral diture [194], and elevate plasma free-fatty acid and glycerol
control. In this study, 80 participants were randomly levels [187,194,195]. Collectively, these findings suggest that
assigned to consume 1.8, 3.6, or 5.4 ml/kg of an ED, a the stimulant properties of caffeine contained in ED can
placebo, or no drink in a counterbalanced manner. Parti- elevate an individual’s metabolic rate as well as elevate the
cipants completed a behavioral control task and subjec- rate of lipolysis in the body. However, these studies used
tive measures of stimulation, sedation, and mental various types of caffeine/stimulant/vitamin-enriched cof-
fatigue before and 30-minutes after ingestion of the fee [189-193], a caffeine/stimulant blend supplement
assigned drinks. Results revealed that those consuming [187,189,193], and various calorie-free thermogenic ED
the ED decreased reaction times on the behavioral con- [190,194-197]. Additionally, the dosage of caffeine used in
trol task, increased subjective ratings of stimulation and some of these beverages that are marketed as a thermo-
decreased ratings of mental fatigue. The greatest genic supplements is typically higher (e.g., 200-500 mg)
improvements in reaction times and subjective measures than the concentrations found in ED and ES marketed for
were observed with the lower dose and improvements increasing athletic performance or alertness (i.e., about
diminished as the dose increased. Earlier research con- 80 – 200 mg). With this said, there is some data that indi-
ducted by Alford and associates [172] supported these cates that acute ingestion of ED has been shown to en-
findings by demonstrating that individuals ingesting 250 hance energy expenditure, metabolic rate, catecholamine
ml of this same ED had significantly better reaction time, secretion, and/or lipolysis [187,198]
concentration, memory, and subjective alertness com- In terms of weight loss, Roberts and colleagues [194]
pared to a placebo. Smit and coworkers [183] suggested reported that 28 days of consumption of a calorie free
that caffeine is most likely the primary ingredient that ED (336 ml/day) promoted small (i.e., 18.9 ± 1.5 to 18.3
improves mood and performance during fatiguing and ± 1.5 kg) but statistically significant (p<0.05) reductions
cognitively demanding tasks, with carbohydrates playing in fat mass compared to controls (i.e., 18.1 ± 1.3 to 18.4
a minor role. However, caffeine and carbohydrate may 3± 1.2 kg). Similarly, Stout and associates [199] evaluated
act in a synergistic manner [182]. To support this view, the effects of consuming an ED or placebo 15-minutes
a recent paper by Pettitt et al [186] reported that while prior to exercise training and ad-libitum on non-training
ingestion of an ED prior to exercise affected aerobic me- days for 10-weeks on changes in body composition and
tabolism during and following cycling exercise, the sec- fitness. Results revealed that those consuming the ED
ondary ingredients found in the ED had no additive experienced greater changes in fat mass (-6.6% vs.
effects. -0.35%, p<0.05), peak aerobic capacity (+13.8% vs. 5.4%,
p<0.01), and treadmill time to exhaustion (+19.7% vs.
Conclusion 14.0%, p<0.01). These findings suggest that consumption
To date, most studies on ED have reported improve- of ED during training and/or weight loss may provide
ments in mood, reaction time, and/or markers of alert- some additive ergogenic benefits. However, it should be
ness, even though the relative importance of the various noted that recent review on ED by Higgins and asso-
ingredients is not fully understood. The primary ergogenic ciates [200] found that many of the commonly used
additional ingredients (e.g., Ma Huang, willow bark, As of December 2012, the US-FDA along with the US
synephrine, calcium, cayenne/black pepper extracts) that Congress has begun to study products marketed as ED
are contained in the “thermogenic blends” of several of or ES, however no formal new guidelines have been pub-
these products are not contained in some of the most lished. The Nutrition Facts Panel on food labels are not
commonly used ED. It is also important to note that required to always list caffeine since it is not a nutrient.
daily consumption of high calorie ED could promote However, if caffeine is added to a food, it must then be
weight gain. Consequently, additional research is neces- listed [210]; therefore many individuals may consume
sary to determine whether ingesting low-calorie ED or more caffeine than they realize [201,202]. In Canada,
ES may affect training adaptations and/or weight loss. caffeine levels are limited to 180 mg per drink [211].
The caffeine content of common ED and ES has been
Conclusion reported to range from about 100 to 286 mg [202]. As a
Consumption of low calorie ED and thermogenic be- comparison, the average cup of coffee or contains be-
verages have been reported to increase resting energy tween 40 and 150 mg caffeine, while a 20 oz. cup of
expenditure and fat metabolism on an acute basis. Pre- Starbucks regular drip coffee has been found to contain
liminary studies suggest that ingesting some types of ED as much as 480 mg of caffeine [212].
and thermogenic beverages prior to exercise during The potential side effects of caffeine include: insomnia,
training could promote positive adaptations in body nervousness, restlessness, gastric irritation, nausea, vomi-
composition. However, more research is needed to de- ting, tachycardia, tremors, and anxiety; which have been
termine whether daily use of ED would affect long-term reported at doses as low as 250 to 300 mg [5,201-204,209].
energy balance and body composition. Caffeine availability is ubiquitous and it is one of the most
extensively studied substances in the food supply with a
Safety considerations long history as generally regarded as safe when consumed
ED have had a negative connotation in the media and in moderation [61]. However, all substances may be toxic
more recently medical community, mostly related to po- under the right conditions, with toxicity being a function of
tential concerns about excessive caffeine intake [201,202] the interaction of many physiologic variables that include
and/or potential deleterious effects of mixing ED with the following: acute and chronic dosing, route of adminis-
alcohol [203]. While safety concerns and use of alcohol go tration, genetics, age, sex, environment, and intrinsic health
beyond the scope of this paper, the reader is referred to a of the individual being exposed. Young adults have been
recent viewpoint published in the Journal of the American found to have subclinical coronary atherosclerosis [213]. In
Medical Association related to safety concerns of mixing addition, post-mortem assessment of sudden cardiac death
ED with alcohol [203]. In terms of use of ED in the tra- in young persons (<35 years) reveals a variety of anatomic
ditional sense, most concerns have been based on case abnormalities of the coronary arteries, myocardium, valves
studies or adverse event reports that have serve only to and the conduction system [214]. Such unknown pre-
document a potential association, but does not establish existing risk factors may increase the risk of adverse events,
causality. In reality, there are currently only a few studies particularly cardiovascular ones, in individuals consuming
(acute or long term) that have investigated the side effects EDs, due to underlying disease. In fact, even water can be
of ED [204-209]. There appear to be two primary active toxic given certain conditions with an LD50 (lethal acute
nutrients in most ED and ES (i.e., carbohydrate and caf- dose for 50 percent in test species) of greater than 90 mL/
feine) that may possess safety concerns in some popula- kg in rats [215]. It is possible to overdose on caffeine and
tions. Many ED contain 25 – 50 g of simple sugars, there are a handful of case reports in the literature
therefore, ingestion of ED prior to exercise are likely to [5,209,216-218]. A lethal dose of caffeine has been typically
rapidly increase insulin in order to maintain normal blood in excess of 5 g [217], which equates to about 42 cups of
glucose levels. For this reason, diabetics and pre-diabetics coffee at 120 mg of caffeine per cup. Sepkowitz [201] re-
should avoid high glycemic load ED or consider consu- cently suggested that an intake of 3 grams of caffeine
ming low carbohydrate versions of ED [201,202]. (equivalent to ingesting 12 or so highly caffeinated ED
Very often, ED also contain various stimulants with within a few hours) could elicit significant adverse effects.
the most common being caffeine. Some concern has The average caffeine per serving in most ED and ES range
been raised about excessive caffeine intake that could be between 75 and 200 mg, an amount similar to the caffeine
obtained from consuming too many ED and/or from a found in a premium cup of coffee [202].
lack of knowledge that that some ingredients contained Nawrot and colleagues [219] stated that in a healthy adult
in ED may contain caffeine [201,202]. Currently in the population, up to 400 mg of caffeine daily was not asso-
United States, the FDA has regulated the limit of caf- ciated with any adverse effects. In another review, Higdon
feine in soft drinks to 0.02 percent (10mg/oz.) of the et al. [220] presented data in children stating no adverse
product, but this is not currently enforced for ED or ES. effects were seen with doses under 3 mg·kgBM-1·day-1. As
with most drugs, the exact amount of caffeine where side days. The experiment was then repeated after 7-days.
effects will occur varies from person to person based on The investigators found that maximum mean heart rate
genetics, age, liver cytochrome P450-CYP1A2 isozyme occurred at 4 hours with significant increases of 7.8%
function, concurrent medications or substances that may and 11.0% on days 1 and 7, respectively. Blood pressures
affect hepatic metabolism, body mass, and sensitivity. were increased approximately 7% after acute ingestion of
Additionally, it is unknown whether inclusion of other the ED on day 1 (significant increase) but no differences
stimulants in ED and/or ES may increase or decrease the were seen on day 7. Finally, in a case report, Usman and
threshold for experiencing side effects. For this reason, coworkers [221] reported that a young boy presented
some groups do not recommend ED or ES for athletes with palpitations and high blood pressure after con-
participating in exercise lasting less than 1 hour [200], sumption of an ED containing carbohydrate (40 g), so-
despite the admission of inadequate long-term data. The dium citrate, taurine (124 mg), caffeine, inositol (17 mg),
longest duration studies on ED or ES we were able to find Panax ginseng (6.98 mg), and other nutrients. The
was 10 weeks and these studies did not report any change tachycardia and hypertension returned to normal after
in clinical safety markers [199,206]. Nevertheless, since ED discontinuation of ED consumption.
and ES often contain other stimulants that can have a
synergistic effect with caffeine, more research is needed to Conclusion
determine the long-term effects of habitual intake of ED Individuals with certain medical conditions (e.g., meta-
and ES before definitive conclusions can be drawn. bolic syndrome or diabetes mellitus) should avoid con-
Several reports have expressed concern about the sumption of high glycemic drinks and/or foods and
safety of ED [5,200,205,221]. For example, Worthley and therefore should not consume the high calorie versions
associates [222] tested 50 young male and female adults of ED. It would be prudent for individuals with known
one hour before and one hour after consuming 250 ml cardiovascular disease to avoid altogether their use of
of a sugar-free ED containing approximately 80 mg of ED and/or ES, or other products with known cardio-
caffeine. The investigators found that mean arterial pres- stimulant effects. While ED containing caffeine and other
sure increased by approximately 3.8 mmHg while resting stimulants may have negative effects upon health and
heart rate was not affected. Additionally, platelet aggre- cardiac parameters in individuals with such pre-existing
gation increased by 13.7% compared to only a 0.3% health conditions, the current evidence (although small)
change in the control group while endothelial function suggests that consumption of ED and ES are safe in
decreased. The researchers noted that the component of healthy populations and similar to ingesting other foods
the ED that was associated with these results was not and beverages containing caffeine. Finally, although it is
clear. However, they suggested that since endothelial estimated that only 1% of all dietary supplement adverse
dysfunction and impaired platelet function are associated events are reported to FDA [224], given the number of
with elevated glucose levels, it is possible that glucuro- servings of these products that are consumed daily, the
nolactone contained in the ED might have contributed rate of adverse events appears low in the population of
to the observed detrimental effects of energy drinks consumers. Nevertheless, it is acknowledged that addi-
[222]. More research is needed to corroborate these tional short- and long-term studies are needed to better
findings as well as to determine whether these acute determine any factors that increase the risk for adverse
changes would pose any long-term health risk. events. Additionally, since ED often contain several nutri-
Bichler and cohorts [26] investigated a combination of ents that contain caffeine and/or other stimulants, care
caffeine and taurine (two common ingredients in ED) in should be taken to make sure that an excessive number of
a double-blind study of college students. Subjects con- ED are not consumed within a short period of time.
sumed either caffeine and taurine pills or a placebo and
then completed a memory assessment while heart rate Conclusions and recommendations
and blood pressure were monitored. The combination Based on a review of the available scientific and medical
caused a significant decline in heart rate and an increase literature related to the safety and efficacy of the use of
in mean arterial blood pressure. Steinke et al. [223] stu- ED or ES, the Research Committee of the Society makes
died 15 healthy adults who abstained from caffeine for the following conclusions and recommendations.
48 hours prior to and during the study in addition to
being fasted overnight. Baseline measurements of blood 1. Although ED and ES contain a number of nutrients
pressure and heart rate were measured. On day one of that are purported to affect mental and/or physical
the study, each participant consumed 500 mL (2 cans) of performance, the primary ergogenic nutrients in most
an ED and measurements were repeated 30 minutes, ED and ES appear to be carbohydrate and/or caffeine.
1 hour, 2 hours, 3 hours, and 4 hours later. Participants 2. The ergogenic value of caffeine on mental and
also drank 500 mL of the ED drink daily for the next 5 physical performance has been well-established but
the potential additive benefits of other nutrients Consultant currently to the United States Tennis Association (USTA),
contained in ED and ES remains to be determined. Boca Raton, Florida, and serves as the also as the Florida International
University, Department of Athletics, Sports Nutritionist. JA is a Sports Science
3. Consuming ED 10-60 minutes before exercise can Advisor to VPX/Redline in Weston FL. RBK has received external funding
improve mental focus, alertness, anaerobic from industry through the institutions he has been affiliated with to conduct
performance, and/or endurance performance. exercise and nutrition research, has served as a legal expert on exercise and
nutrition related cases, and currently serves as a scientific advisor for
4. Many ED and ES contain numerous ingredients; Woodbolt International.
these products in particular merit further study to
demonstrate their safety and potential effects on Authors’ contributions
physical and mental performance. RBK prepared and delivered the presentation on energy drinks at the 2011
International Society of Sports Nutrition (ISSN) National meeting. BC, CW, LT,
5. There is some limited evidence that consumption of MTN, and MG developed the presentation into a draft of a position stand for
low-calorie ED during training and/or weight loss review and editing by RBK. The final draft was then reviewed and edited by
trials may provide ergogenic benefit and/or promote TZ, HL, JRH, JRS, SS, RC, DSK and JA. RBK incorporated recommendations
into a final draft which was then reviewed, approved, and adopted as the
a small amount of additional fat loss. However, official position of the ISSN by the Research Committee. All authors read
ingestion of higher calorie ED may promote weight and approved the final manuscript.
gain if the energy intake from consumption of ED is
Author details
not carefully considered as part of the total daily 1
Exercise and Performance Nutrition Laboratory, Dept. of Physical Education
energy intake. and Exercise Science, University of South Florida, 4202 E. Fowler Avenue, PED
6. Athletes should consider the impact of ingesting high 214, Tampa, FL 33620, USA. 2Human Performance Laboratory, University of
Mary Hardin-Baylor, Belton, TX 76513, USA. 3Department of Health, Human
glycemic load carbohydrates on metabolic health, Performance, and Recreation, Baylor University, Box 97313, Waco, TX 76798,
blood glucose and insulin levels, as well as the effects USA. 4Department of Health and Human Performance, University of St.
of caffeine and other stimulants on motor skill Thomas, St. Paul, MN 55105, USA. 5Exercise & Sport Nutrition Lab,
Department of Health & Kinesiology, Texas A&M University, College Station,
performance. Texas, TX 77843-4243, USA. 6The Center for Applied Health Sciences, Stow,
7. Children and adolescents should only consider use of OH 44224, USA. 7Institute of Exercise Physiology and Wellness, Department
ED or ES with parental approval after consideration of Sport and Exercise Science, University of Central Florida, Orlando, FL
32816, USA. 8Medical Surveillance and Risk Management, Shire HGT, 300
of the amount of carbohydrate, caffeine, and other Shire Way, Lexington, MA 02421, USA. 9Collins, McDonald & Gann, PC,
nutrients contained in the ED or ES and a thorough Mineola, NY, USA. 10Miami Research Associates, Endocrinology & Nutrition
understanding of the potential side effects. Department, 6141 Sunset Drive - Suite 301, Miami, FL 33143, USA. 11Farquhar
College of Arts and Sciences, Nova Southeastern University, Fort Lauderdale,
8. Indiscriminant use of ED or ES, especially if more FL, USA.
than one serving per day is consumed, may lead to
adverse events and harmful side effects. Received: 28 December 2012 Accepted: 31 December 2012
Published: 3 January 2013
9. Diabetics and individuals with pre-existing
cardiovascular, metabolic, hepatorenal, and References
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Campbell et al.

Journal of the International Society of Sports Nutrition 2013, 10:1

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International Society of Sports Nutrition position

As demonstrated below, several studies have reported Other nutrients

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