When you think about sugary drinks and the potential harm to oral health, do energy drinks immediately spring to mind? If not, perhaps they should. Sales have increased substantially in recent years. Between 2005 and 2011, consumption in the UK increased from 270 to 495 million litres per year, with average consumption now totalling 7.9l per person. Thirty to 50 per cent of children and adolescents are thought to regularly consume energy drinks and market research in England has estimated that the percentage of 16-24 year olds consuming them is higher still, at 73 per cent.
Energy drinks are defined as traditional, glucose-based, functional or stimulant drinks, which claim a particular energy boost from caffeine, guarana, taurine, ginseng and other herbs, or some combination of these ingredients. Soft drinks containing caffeine are therefore classed as being energy drinks. This makes them distinct from sports drinks, which are defined as containing fluids, electrolytes and carbohydrate.
Energy drinks and health
The potential adverse side effects of energy drink consumption on health, particularly in children and adolescents, are becoming well documented. The high sugar levels may contribute to increased calorie intake, obesity and diabetes and regular consumption can also encourage tooth decay. To put it into context, in recent laboratory studies, energy drinks eroded twice the amount of tooth enamel as sports drinks.
Unlike other soft drinks, energy drinks have a high caffeine content. When consumed in large quantities, they can cause insomnia, nervousness, headaches, tachycardia, and seizures. In October 2012, it was reported that the Food and Drug Administration in the US was investigating reports of five deaths that may be associated with energy drink consumption. Due to concerns over the effect on health, schools in the UK are banning energy drinks, and asking local retailers not to sell them to pupils.
Those working in dentistry play an important role in helping children, young people, and their families understand how energy drinks can impact on their health and well-being. In order for any health professional to offer good advice, we need to understand the reasons why energy drinks are becoming so popular. So what is all the hype?
Young people’s views
In Cumbria, focus groups have been held with young people aged 14-15 years, to find out their views on energy drinks and why they buy them. Many of the young people involved in the study described a positive mental and physical state following energy drink consumption, which they described as ‘hyper’. When asked what ‘hyper’ meant, words such as ‘happy’ and ‘lots of energy’ were given. This suggests that in keeping with the image promoted by energy drink companies, young people view the stimulating effects of caffeine favourably.
The young people also felt that energy drinks were easily available, pleasant-tasting, and cheap. Sugar was collectively identified as giving energy drinks a likeable taste, but only a small number within the focus groups acknowledged sugar as having a potentially negative impact on health, such as obesity and dental caries. Participants said they did not drink sugar-free versions, simply because they did not like the taste.
Low cost, high quantity
An unexpected finding from the Cumbrian study was that cost is an important consideration to the young people when buying energy drinks. They opted for the cheapest brands available, because it meant they could buy more and get better value for money. They felt that branding was unimportant, because all energy drinks tasted the same. This finding seems to be unique to energy drinks. For example, research carried out in the North East of England recently, found that young people assigned hierarchical meaning to different brands, for example Coca-Cola was seen as more likely to be consumed by a ‘cool’ young person, rather than a supermarket own-brand equivalent.
From a public health perspective, the acceptance of cheaper brands is a worrying finding. Low cost, it seems, is an incentive to young people when buying energy drinks. Quantity seemed to be more important than quality, and the low cost encourages young people to consume greater quantities. A 250ml can was described as a ‘half-can’ by the male participants in the study, indicating that lager-can sized 500ml options were considered a normal serving. A 500ml can contains on average, 55-65g of sugar. This is the equivalent of adding 10-12 teaspoons of sugar to a large cup of coffee.
The cost of sugar-sweetened soft drinks was recently highlighted in the report Measuring Up by the Academy of Medical Royal Colleges. The academy represents the views of the vast majority of the UK’s 220,000 practising doctors, and the report highlighted the growing concerns around the rising levels of obesity. The report called for a sugary drink tax to be piloted for one year, in order to assess the impact upon consumption patterns and producer/retailer responses. This would mean increasing the price by at least 20 per cent (the cost of a non-branded 500ml can of energy drink would rise from 69p to 83p; a relatively small increase, when the starting price is so low to begin with).
Advising consumers
Clearly any efforts to reduce the consumption of sugar-sweetened drinks would be welcomed by those working in dentistry, but as the report acknowledges, there is no single, simple solution. This is why it is important that all health professionals, including dentists and dental care professionals are aware of the growing trend of energy drink consumption amongst children and young people, understand the reasons why the drinks are so popular, and offer advice accordingly. The bottom line is that energy drinks are not suitable for children, pregnant women and persons sensitive to caffeine. In addition, anyone consuming them should be informed about the potential impact of the high caffeine and sugar content on their health.
References available on request.