US students turn to energy drinks despite health fears

Acting on a late-night tip, Drew McMillan bounded up to the third floor of James Madison University's Rose Library and found a black filing cabinet with a homemade sign on top: "Test answers."

He pulled open a drawer, revealing dozens of cans of Red Bull, a free finals-week gift from the energy company's on-campus promoters. He snapped a photo, posted it on Facebook, and tweeted: "Is this real life?"

Within minutes last week, McMillan's phone blew up with texts from friends wanting to know where the stash was. Soon, the library's tables and study rooms were dotted with Red Bull's slim trademark cans.

With finals season in full swing this month, weary students are looking for anything that can help them endure late-night study sessions. Energy drink companies, whose products are already popular on college campuses, are increasingly looking to replace coffee as a student's go-to answer for a stamina boost during finals — and then for late nights after graduation. As one Red Bull advertisement states: "Nobody ever wishes they'd slept more during college."

But this biannual marketing blitz comes amid renewed calls from lawmakers and health activists in recent months for the Food and Drug Administration (FDA) to regulate such beverages more strictly, in the aftermath of several deaths that could be connected to energy drinks.

"We wouldn't survive nursing school without caffeine," said Kelsey Sipe, 22, a senior at JMU who mostly drinks coffee, but often adds in energy drinks. "We tell others not to drink them, because they can increase your blood pressure, and then — kcssshhhh! — we open one."

A 2008 study of undergraduates at a large public university found that 39 percent of students had consumed at least one energy drink in the past month, with considerably higher rates for males and white students. The study, funded with a National Institute on Drug Abuse grant, noted that energy drink marketing tactics are "similar to those used to sell tobacco and alcohol to youths."

Fifteen years ago, energy drinks barely existed. Now it's a booming industry that continues to grow. In the past year, U.S. energy drink sales totaled more than $8 billion, up more than 15 percent from a year ago, according to SymphonyIRI Group, a Chicago-based market research firm.

In that time nationwide, Red Bull sold more than a billion cans and Monster sold more than 1.2 billion, a total that would equate to more than seven cans per American. And that's just for those two leading brands.

Red Bull, which hit the country in the late 1990s, is credited with creating this industry using a Thai recipe. Today there are hundreds of energy drinks on the market, ranging from 1.93-ounce 5-Hour Energy shots to 32-ounce cans of Monster. Even Starbucks has gotten into the game, producing sparkling energy drinks and canned espresso beverages.

That proliferation has intensified debate about a long-standing question: Are energy drinks safe?

The focus of that question is often one of the main ingredients: caffeine. Energy drinks contain from 2.5 to 35.7 milligrams of caffeine per ounce; energy shots may have as much as 170 milligrams of caffeine per ounce, according to researchers.

Energy drink companies often say their products contain about the same amount of caffeine, if not less, than strongly brewed coffee. Estimates for the amount of caffeine in coffee can go as high as 30 milligrams per ounce.

The FDA limits the amount of caffeine in soft drinks to about 71 milligrams for a 12-ounce can. Energy drinks and shots are usually sold as dietary supplements or food products, which don't have a caffeine limit. And other ingredients in energy drinks touted for purported benefits — such as taurine and ginseng — aren't regulated by the FDA.

Studies have set different limits for the amount of caffeine an adult can handle safely, ranging from 2oo to 400 milligrams a day. Consumption of more than 500 to 600 milligrams can lead to "caffeine intoxication," which can cause insomnia, anxiety, irritability, upset stomach, increased heart rate or muscle tremors. In rare cases, caffeine can contribute to a person's death, but experts say the stimulant alone usually isn't enough to kill healthy adults.

But for children and adolescents, more than 200 milligrams of caffeine can be dangerous, and the American Academy of Pediatrics advises against giving children energy drinks.

In December 2011, a 14-year-old girl in Hagerstown, Md., drank two 24-ounce Monster drinks she bought at a mall. The two cans combined contained at least 480 milligrams of caffeine, the equivalent of 14 cans of Coca-Cola or two very strong cups of coffee.

Within hours of finishing the second can, Anais Fournier went into cardiac arrest and later died. Fournier had a preexisting condition that was complicated by the change in her heartbeat caused by the caffeine, according to a lawsuit her parents filed in October.

In response to the lawsuit, Monster Beverage said in a statement: "Neither the science nor the facts support the allegations that have been made. Monster reiterates that its products are and have always been safe."

Fournier's death last year prompted two senators and a host of health activists to urge further FDA investigation into energy drinks. This fall the FDA disclosed that it is investigating more than 100 reports filed during the past five years of "adverse events" possibly tied to energy drinks or shots, including at least 18 deaths.

Companies that make the drinks and supplements maintain that their products are safe.

The increased focus on energy drinks this fall has also become the topic du jour for parental lectures.

Nicholas Marsilio, a junior history major at James Madison, said his mother frequently asks whether he's drinking energy drinks — and urges him to find a natural energy jolt from exercise or sleep.

"My parents never had energy drinks. They don't get it," said Marsilio, 21. "Their energy drinks were coffee at two in the morning. . . . That's definitely a generation switch."

Marsilio said he started drinking Monster when he was in high school so he could stay up late playing video games. Then he enrolled at James Madison, a public university about two hours southwest of Washington in Virginia's Shenandoah Valley. At first, Marsilio would buy cases of energy drinks. Now, he buys them one at a time from a campus dining facility, which has a contract with Coca-Cola and sells the company's energy drink brand, NOS.

"I like it," Marsilio said, sipping a citrus-flavored NOS in James Madison's Carrier Library at 10 p.m. last week. "It's really the taste for me."

There are dangers for some: Experts say that chugging energy drinks, especially while working out, can reveal an unknown heart condition in an otherwise healthy young person. Low-calorie, sugar-free energy drinks are sometimes used by students with serious eating disorders. And then there's the sometimes deadly combination of energy drinks and alcohol.

In November 2010, the FDA deemed it unsafe to sell pre-mixed caffeinated alcoholic drinks, such as Four Loko, which has since removed caffeine from its products. Although drinking usually comes with the depressive effects of alcohol, energy drinks and caffeine can keep drinkers awake and alert, ready to drink more. Many bars stock energy drinks as mixers.

After the ban was imposed, a group of health researchers wrote to the FDA, telling officials that college students can still mix their own alcoholic energy drinks and urging further action.

"Energy drink use is highly prevalent," they wrote. "A trip to any college campus would reveal that energy drinks have become enmeshed in the subculture of partying on US college campuses."

Energy drinks were originally marketed primarily to college students, especially athletes. Red Bull and Monster sponsor extreme sports teams and hire outgoing students to promote their products on campuses and in clubs.

McMillan, the James Madison junior who found the Red Bull trove in the library, said finals week has become an extreme sport for him. This year he tried "this nocturnal thing" — sleeping during the day and studying through the night when distractions were few and Facebook was quiet. A string of Monsters and Red Bulls helped him do it.

"If I were to just stay at home and away from the library, I would probably get way more done," he said. "There is an ideal or an expectation that just because it's finals week, you go crazy. It's so hard not to get into it. It's almost fun. . . . You have to go to extreme measures to get stuff done."