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Energy drinks and alcohol: research supported by industry may be downplaying harms

BMJ 2013; 347 doi: (Published 12 September 2013) Cite this as: BMJ 2013;347:f5345

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Re: Energy drinks and alcohol: research supported by industry may be downplaying harms

Red Bull meets the Australian Dietary Guidelines

Peter Miller is right to be concerned about the role of manufacturers in the production of scientific knowledge around ‘energy drinks’ particularly when they are mixed with alcohol.(1) In many respects, this issue is no different to the difficult line that researchers tread with pharmaceutical companies or medical appliance manufacturers and it needs to be treated as seriously. At the very least is there is certainly the issue of propriety. Then there is the very real potential of distorting the scientific evidence, even if it is simply by not posing the hard questions and instead swamping the literature with experimental evidence of no harm from one can of energy drink mixed with modest amounts of alcohol. This does not reflect real world levels of use (especially among young people) of these highly caffeinated beverages with and without alcohol and why there is so much concern about them.(2)(3)

What happened next with the scientific evidence is even more concerning. When the draft Australian Dietary Guidelines came out in December 2011 for public consultation it read, as below. However, when the final guidelines were published in 2013, the section Interaction of alcohol with caffeine and other stimulants was rather reduced – the main parts excised have been italicised:

‘A new category of alcoholic drinks is now being marketed in Australia with added caffeine and sometimes other stimulants. The effects of alcohol and other components in these energy drinks appear to be synergistic, resulting in increased intoxication. In comparison to alcohol alone, the combination of alcohol and energy drink significantly reduces the intensity of subjective perceptions of headache, dry mouth, weakness and impairments of motor coordination.(4) The concern is that consuming caffeine, a central nervous system stimulant, and alcohol, a depressant, at the same time will reduce subjective perceptions of alcohol-induced impairment in comparison to alcohol alone.(5)(6) Reduced ability in recognising alcohol impairment may enhance risk-taking behaviour and possibly lead to greater alcohol intake.(7)

'In the absence of any research to quantify safe levels of concurrent consumption of energy drinks and alcohol, this combination should be avoided.(8)

So, by 2013 what was previously to be avoided was now to be ‘used with caution’(9) and of the four studies quoted in the final guidelines, two were as in the draft guidelines(4)(5) along with one new one sponsored by Red Bull(10) and one new review.(11) Of the three authors of the review, two had received funding from Red Bull within the last three years, and one of these funded researchers was a co-author on the other new (sponsored) paper.

It seems unlikely that it can be good for public health policy discussion and debate for so much industry funded research, researchers(12)(13)(10)(14) (15)(16) and comment(17) on one issue to have gained so much traction.

Author email:

1. Miller P. Energy drinks and alcohol: research supported by industry may be downplaying harms. Bmj 2013;347:f5345.
2. Gunja N, Brown JA. Energy drinks: health risks and toxicity. The Medical journal of Australia 2012;196(1):46-9.
3. Pennay A, Lubman DI. Alcohol and energy drinks: a pilot study exploring patterns of consumption, social contexts, benefits and harms. BMC research notes 2012;5:369.
4. Ferreira SE, de Mello MT, Pompeia S, de Souza-Formigoni ML. Effects of energy drink ingestion on alcohol intoxication. Alcohol Clin Exp Res 2006;30(4):598-605.
5. Price SR, Hilchey CA, Darredeau C, Fulton HG, Barrett SP. Energy drink co-administration is associated with increased reported alcohol ingestion. Drug and alcohol review 2010;29(3):331-3.
6. Thombs DL, O'Mara RJ, Tsukamoto M, Rossheim ME, Weiler RM, Merves ML, et al. Event-level analyses of energy drink consumption and alcohol intoxication in bar patrons. Addictive behaviors 2010;35(4):325-30.
7. Weldy DL. Risks of alcoholic energy drinks for youth. Journal of the American Board of Family Medicine : JABFM 2010;23(4):555-8.
8. National Health and Medical Research Council. Australian dietary guidelines, incorporating the Australian guide to healthy eating: providing the scientific evidence for healthier Australiand diets. In: National Health and Medical Research Council, editor: Australian Government, 2011.
9. National Health and Medical Research Council. Eat for health: Australian dietary guidelines. In: Department of Health and Ageing Commonwealth of Australia, editor. Canberra: National Health and Medical Research Council, 2013.
10. de Haan L, de Haan HA, van der Palen J, Olivier B, Verster JC. Effects of consuming alcohol mixed with energy drinks versus consuming alcohol only on overall alcohol consumption and negative alcohol-related consequences. International journal of general medicine 2012;5:953-60.
11. Verster JC, Aufricht C, Alford C. Energy drinks mixed with alcohol: misconceptions, myths, and facts. International journal of general medicine 2012;5:187-98.
12. de Haan L, de Haan HA, Olivier B, Verster JC. Alcohol mixed with energy drinks: methodology and design of the Utrecht Student Survey. International journal of general medicine 2012;5:889-98.
13. Benson S, de Haan HA, de Haan L, van der Palen J, al. e. Cognitive and mood effects of alcohol and ernergy drinks alone and in combination. Drug and alcohol review 2012;31:47.
14. de Haan L, de Haan HA, van der Palen J, al. e. Mixing alcohol with energy drinks decreases alcohol consumption. Drug and alcohol review 2012;31:46.
15. Alford C, Hamilton-Morris J, Verster J. Do energy drinks mask subjective awareness of alcohol intoxication. Drug and alcohol review 2012;31:46.
16. Alford C, Hamilton-Morris J, Verster JC. The effects of energy drink in combination with alcohol on performance and subjective awareness. Psychopharmacology 2012;222(3):519-32.
17. Verster JC, Alford C. Unjustified Concerns about Energy Drinks. Current drug abuse reviews 2011;4(1):1-3.

Competing interests: No competing interests

11 October 2013
Genevieve A. Cowie
Doctor of Public Health candidate
Monash University School of Public Health and Preventive Medicine Department of Epidemiology and Preventive Medicine
99 Commercial Rd Melbourne VIC 3004 Australia