Mickie Cathers
Sports and energy drinks have exploded on the scene and now crowd the shelves with bright new brands and flavors. There are thousands of choices for the consumer in grocery stores, pharmacies, and online, all offering a host of benefits beyond simple hydration. But do we know what we’re drinking?
The expanding popularity of caffeinated energy drinks, and the larger hydration category of supplements, is expected to continue growing by almost $70 billion from 2022 to 2027. According to The Vitamin Shoppe’s Health & Wellness Trend Report 2023, the hydration category has seen an over 200% surge in website searches over the past year. Consumers are seeking branded, flavor-infused hydration products with added electrolytes. Industrywide, this category has seen massive growth as ready-to-drink combinations as well as in powders, tablets, and stick packs.
Traditionally, hydration products such as sports and energy drinks were associated with exceptionally active individuals such as athletes, but now sales data show it’s new, younger consumers driving the sharp increase in hydration sales. The Vitamin Shoppe reported that about 25% of new customers ranged between 19 and 30 years old.
The booming business of energy drinks is supported by celebrities, professional and college athletes, and social media influencers, with some advertising targeted at those under 18 years.
“The rapid increase of marketing ‘sports drinks’ to younger athletes and targeting youth sports is highly concerning,” said Ashley Anderson, RPh, MBA, clinical sports pharmacist. “Social media influencers with no medical training are promoting products that are questionable, despite their enormous popularity.”
Energy drinks versus sports drinks
The line between sports and energy drinks has been blurred and for most, telling the difference between the two is difficult—especially when these drinks are stored on shelves next to one another.
“There is a difference between energy and sports drinks,” said Jessica Beal-Stahl, PharmD, clinical sports pharmacist for The Athlete’s Pharmacist and director of clinical services at Hobbs Pharmacy in Merritt Island, FL. “Energy drinks usually contain caffeine or other stimulants as ingredients. Sports drinks don’t usually contain caffeine but offer carbohydrates and electrolytes intended to refuel athletes with sugar and electrolytes lost while training or competing.”
Sports drinks
Popular sports drinks include Gatorade, Accelerade, Powerade, Nuun, VitaminWater, and Propel, among others. These are primarily used by athletes and those engaging in sports in which sweat and sodium is lost.
“Sports drinks were made to rehydrate and refuel,” said Beal. “Athletes need both carbohydrates and electrolytes for training or competition for peak performance. Yet, many people use sports drinks as just regular hydration, which is not their intended purpose. When used outside of sports, they supply high amounts of simple sugars that can cause blood glucose spikes and crashes, yielding more fatigue.”
Energy drinks
Popular energy drinks include Red Bull, Monster, Prime, Ghost, ZOA, Celsius, and Rockstar and can include ashwagandha, branched-chain amino acids (BCAAs), B vitamins, coconut water, electrolytes, l-theanine, and mushrooms. Per CDC, energy drinks typically include large amounts of caffeine, added sugars, other additives, and stimulants such as guarana, taurine, and l-carnitine.
Despite providing boosts in energy, the stimulants in these drinks can have harmful effects on the nervous system and may increase BP, heart rate, and breathing. Adverse effects include dehydration, heart complications (e.g., irregular heartbeat or heart failure), anxiety, and insomnia.
These drinks are advertised as increasing and supporting focus, alertness, energy, and performance in exercise, workouts, and gaming or esports. Energy drinks are available in dozens of flavors, with the most popular being fruit flavors such as peach, sour pink lemonade, tropical punch, or sour gummy candies.
“Sports drinks may have a place for teen athletes, but not energy drinks,” said Beal. “Many teens may take energy drinks to give them an ‘edge’ in sports, but the American Academy of Pediatrics warns that safe consumption levels of energy drinks have not been established for adolescents. The NCAA also has limits to the amount of caffeine an athlete can have in their system before [they are] considered to be at a banned level.”
Caffeine levels
The American Academy of Pediatricians recommends children under the age of 12 years consume no caffeinated beverages. A general guideline for those over 12 years is a maximum of about 100 mg/day of caffeine. FDA regulates the amount of caffeine in sodas, but not in energy drinks. FDA also doesn’t recognize a difference between energy and sports drinks, and they don’t review labels of either to determine safety.
“Caffeine is the main ‘energy’ ingredient in energy drinks,” said Beal. “Its ability to enhance performance, under certain conditions, has been well documented. Usually, 100–200 mg is an acceptable amount to improve alertness.”
Some energy drinks contain massive amounts of caffeine, which can dramatically impact sleep quality and quantity, cause headaches, GI symptoms such as upset stomach or diarrhea, nervousness, increased anxiety, or heart palpitations. The energy drink popular with youth sports, Prime, lists 200 mg of caffeine per serving on the label, but also contains other stimulants. Plus, most consumers don’t stop at one serving.
What to tell your patients
“Pharmacists, as a trusted source of information, can act now to dispel misinformation by starting conversations with patients, and colleagues, friends, and coaches,” said Anderson.
Many patients may substitute these products for soda or water consumption without awareness of what ingredients are in sports and energy drinks or the impact the ingredients may have on their physical or mental health.
“Sometimes having that conversation with patients about what they are drinking and eating can help prevent adding medication,” said Beal. “Often, I find that many don’t realize the impact that the sugar of sports drinks has on their blood glucose, and thus nervous system and mood.”
When asking patients about hydration and what they prefer to drink, be aware of sodium content and keep in mind that many medications influence thirst, urinary output, or loss of electrolytes, added Anderson. ■
The danger of electrolyte imbalance
Our bodies need electrolytes—such as potassium, sodium, magnesium, and calcium—in order to maintain fluid balance, turn nutrients into energy, and support muscle control and heart rhythm. Sport drinks are sold with the promise of replenishing electrolytes, but an imbalance can lead to a whole host of issues.
- Too much sodium (hypernatremia) can cause dizziness, vomiting, and diarrhea.
- Too little sodium (hyponatremia) can cause nausea, vomiting, headache, and confusion.
- Too much potassium (hyperkalemia) can impact kidney function and cause heart arrhythmia, and nausea.
- Too much magnesium can cause muscle weakness, nausea, dizziness, confusion, and heart arrhythmia.
“Patients may be drinking a coconut water ‘blend’ that has a high potassium content, added BCAAs, and glucoranolactone, but may not be balanced to replace the actual losses of electrolytes from sweating and heavy breathing,” said Ashley Anderson, RPh, MBA. “This type of unscientific formulation is potentially unsafe, raising a risk of hyponatremia or hyperkalemia. Many younger athletes are already at elevated risk of exercise-induced rhandomyolysis with intense training in the heat, or after a summer break and returning to intense training. This, combined with having less oversight from athlete support personnel (compared to amateur or elite athletes who receive more expert guidance), can lead to harmful effects.” ■