Red Bull was introduced in Austria in 1987 and in the United States in 1997. Since then, the energy beverage (EB) market has grown exponentially. Hundreds of different brands are now marketed, with caffeine content ranging from a modest 50 mg to an alarming 505 mg per can or bottle. In the United States, Red Bull enjoyed a 65% share of the $650-million energy/power drink market in 2005, and its sales are growing at about 35% per year. The United States is the world’s largest consumer of EBs by volume, roughly 290 million gallons in 2007, or 3.8 qt per person per year. Consumption of EBs is most common among those aged 11 to 35 years, and 24% to 57% of this age group reported that they drank an EB within the past few months.
Regulation of EBs, including content labeling and health warnings, differs across countries, with some of the laxest requirements existing in the United States. For instance, no EBs are banned in the United States, and EB companies can say whatever they want regarding energy and performance effects. This is in stark contrast to countries in which some EBs have been banned, and companies are not allowed to outline the performance effects that their products may or may not provide. This absence of oversight has resulted in aggressive marketing of EBs, targeted primarily toward young men and openly promoting psycho active, performance-enhancing, and stimulatory effects.
Alarmingly, EB consumption has been shown to be positively associated with high-risk behavior, including marijuana use, sexual risk taking, fighting, failure to use seat belts, and taking risks on a dare, as well as with smoking, drinking, problems stemming from alcohol abuse, and illicit drug use. In an era in which Gatorade and Powerade, termed sportdrinks (SDs) for the purposes of this article, have paved the way as optimal hydration fluids that boast superiority to water, uncertainty is growing with regard to where EBs fit and how they are consumed. Convenience stores now display EBs next to the SDs, which can mislead the consumer into thinking that they are similar products. Whereas SDs can indeed provide hydration and replenishment of electrolytes and carbohydrates, the elevated levels of caffeinein EBs have diuretic effects, more pronounced in the first time user, that increase urinary output and natriuresis. Additionally, EBs may have thermogenic effects.
Moreover, EBs supply an amount of carbohydrate far beyond that recommended for physically active people, which can slow the rate at which fluid is absorbed into the bloodstream or lead to gastrointestinal distress. Finally, the effects due to the interaction of substances on which little research has been done (eg, glucuronolactone) are not well understood. This review of EBs describes the various ingredients, discusses their safety, and provides recommendations regarding their use. Although most research studies and observational data have come from athletics, our research query included studies and information involving non athlete consumers. Also, the review differentiates between these populations and offers recommendations specific to each group.