Among the latest entrants in the energy industry's caffeine race is a pocket-size squeeze bottle called Mio Energy.
Each half-teaspoon serving of Mio, which is sold by Kraft Foods, releases 60 milligrams of caffeine in a beverage, the amount in a six-ounce cup of coffee, the company says. But one size of the bottle, which users can repeatedly squeeze, contains 18 servings, or 1,060 milligrams, of caffeine — more than enough, health specialists say, to sicken children and some adults, and even send some of them to the hospital.
Several countries are reining in sales of energy drinks, pointing to the risks of excessive caffeine consumption by teenagers and even some adults. By year's end, Canada will cap caffeine levels in products like Monster Energy, Red Bull and Rockstar. Also, countries like Mexico, France and India have or are considering steps, including taxing the drinks more heavily to discourage their use.
As consumption of energy drinks soars in the United States, some members of Congress have called for a review of the industry, and the New York state attorney general is investigating the practices of several producers. However, critics say the Food and Drug Administration has allowed the drinks to languish in a regulatory gray area and does not require companies to disclose how much caffeine their products contain.
“Their approach has been laissez faire,” said Dr. Bruce A. Goldberger, a toxicologist at the University of Florida in Gainesville, who has been an industry critic. “The question is, what is it going to take to cause them to take action?”
FDA officials say they lack sufficient evidence to act on caffeine levels in energy drinks but continue to study the issue. Also, producers can market an energy drink as either a beverage or a dietary supplement, which are differing regulatory categories with different labeling and ingredient rules.
“We don't have energy drinks defined by any regulation,” said Daniel Fabricant, the director of the FDA's dietary supplement division. “It is a marketing term.”
Agency officials, however, may soon face more pressure to regulate the products after the disclosure last week that the agency had received reports of five deaths since 2009 that could be linked to Monster Energy, a top seller. The drink's manufacturer, Monster Beverage, disputed any suggestion that its products are unsafe.
The fatalities are also raising broader questions about whether companies monitor reports of deaths and serious injuries that appear to be tied to their products. A spokeswoman for Monster Beverage said last week that the company was unaware of four of the five deaths reported to the FDA, even though such incident reports were part of an agency database.
The mother of a 14-year-old Maryland girl who died last December from a heart arrhythmia after drinking two large cans of Monster Energy in 24 hours obtained the records by requesting them under the Freedom of Information Act. Last week, she filed a lawsuit against Monster Beverage, a publicly traded company based in Corona, Calif., seeking unspecified damages.
Under the new Canadian rules, the big, 24-ounce size of Monster Energy that the Maryland teenager, Anais Fournier, drank will be banned because it contains 240 milligrams of caffeine, 60 milligrams more than the limit set by the new standards. Companies there will also track the types of consumers using their products and compile data about any health problems linked to them.
In the United States, a report last year by the federal Substance Abuse and Mental Health Services Administration found that the annual number of emergency room visits in this country linked to energy drinks rose to more than 12,000 in 2009, the latest year for which data is available. The figure represents a tenfold jump from the number of such visits reported in 2005.
The caffeine used in the beverages, which are also high in sugar, can come from a variety of sources, like synthetic caffeine, the guarana plant and tea extracts. Producers can mask the caffeine level by including it among other ingredients as part of a drink's “energy blend.”
The issue of how, or whether, to restrict levels of caffeine in energy drinks sold in the United States is being raised as a seismic shift is occurring in beverage consumption. In some stores, sales of energy drinks now outpace those of sodas.
Overall, sales of energy drinks in the United States grew an estimated 16 percent last year to $8.9 billion, a record level, according to Beverage Digest, a trade publication.
Even industry critics acknowledge that the boom represents a triumph of sleek packaging and promotion that centers on advertising the drinks to young people with appealing images and claims. While many 16-ounce energy drinks sell for $2.99 a can, over-the-counter drugs like NoDoz that contain about the same amount of caffeine cost about 30 cents a tablet.
Medical specialists say that healthy adults can safely consume 400 milligrams or more of caffeine daily. The drug, which acts as a stimulant, also provides benefits, like increased alertness.
Far less is known, however, about the impact of high caffeine use on teenagers, and specialists say the drug can pose dangers to those with undiagnosed health conditions like heart problems.
Roland Griffiths, a caffeine specialist at Johns Hopkins University and an industry critic, said that high caffeine use by young people can cause a cycle of rushes and crashes that can add “a degree of variance to their moods and psychological well-being that they don't really need.”