Caffeinated energy drinks in the Canadian context: health risk assessment with a focus on cardiovascular effects

Abstract

In Canada, Caffeinated Energy Drinks (CEDs) currently sold under Temporary Marketing Authorizations must meet strict eligibility criteria. These criteria, which include compositional and labelling requirements, were developed based on the outcome of a health risk assessment conducted by Health Canada (HC) in 2013. HC updated its assessment by reviewing new information with the focus on potential cardiovascular (CV) effects associated with the consumption of CEDs available for sale in Canada. Due to limited data on CED consumption among Canadians to derive accurate exposure information, the composition of a typical CED was characterized to assess the potential effects of single ingredients and synergistic interactions between ingredients, on the cardiovascular system. Surveillance data on potential adverse effects related to CED consumption was also analysed. After extensive review, HC’s updated assessment confirms the current risk management approach for CEDs is health protective for Canadian consumers, including the potential for cardiovascular effects. The available evidence supports that moderate consumption (up to 500 ml per day) of a typical CED authorized for sale in Canada is safe for the general population of healthy adults and adolescents. It also re-confirms vulnerable sub-populations (i.e., children, pregnant and/or breastfeeding women, and caffeine-sensitive individuals) should not consume CEDs.
 
 NOVELTY:
 • Consumption up to 500 ml per day of a typical CED is not associated with an increased risk of cardiovascular effects
 • Children, pregnant and/or breastfeeding women, and caffeine-sensitive individuals should not consume CEDs

Effects of caffeinated energy drinks on cardiovascular responses during exercise in healthy adults: a systematic review and meta-analysis of randomized controlled trials

“…In this same period, there was a steady growth in the review literature focusing on cardiovascular (CV)-related concerns, with research largely based in nonexercise, resting conditions. Based on these type of data, a recent health risk assessment corroborated Health Canada's recommendation that the maximum daily caffeine intake of ≤400 mg/day is safe in healthy adults (La Vieille et al 2021). In contrast, a few published case reports have described occurrences of sudden cardiac arrest (Avcı et al 2013;Higgins et al 2015;Lévy et al 2019), sudden cardiac death, ventricular tachycardia, and atrial fibrillation (Lévy et al 2019), in healthy adults, during exercise, after consuming moderate intakes of CEDs (500-750 mL volumes containing ∼160 to ∼240 mg caffeine).…”

“…In addition, the variability in methodologies, designs, and interventions (caffeine and CEDs, conditions and regimens) of these reviewed studies likely impeded comparisons and conclusive interpretations. While the effects on resting BP responses after consuming CEDs have also not always been consistent (Ehlers et al 2019), more congruence of small significant increases in SBP (a few mm Hg) with caffeine intakes between 100 and 320 mg (Ehlers et al 2019;Wikoff et al 2017;La Vieille et al 2021) has been reported. It is possible that the exercise-based trials in this review, with reasonably similar methodologies, designs and treatments, enhanced comparability of HR and BP responses, potentially leading to more conclusive, robust findings.…”

“…Our review contributes further understanding of the potential impacts of CEDs on in-exercise CV effects, which have been predominately investigated in nonexercising conditions. From comprehensive reviews on the subjects, the effects of caffeine (Wikoff et al 2017) and CEDs (Ehlers et al 2019;La Vieille et al 2021) have concluded effects on HR responses at rest as contradictory and ambiguous. However, the use of vote counting to compare the proportion of studies with statistically significant results, especially studies that are statistically underpowered to detect changes, may offer more potential for errors in validity.…”

The extent of energy drink marketing on Canadian social media

“…Although most EU countries have made voluntary commitments to restrict CED marketing to children, certain countries, such as Denmark, prohibit the sales of CEDs altogether [ 21 , 22 ]. In Canada, under the Food and Drugs Act (FDA), companies that manufacture CEDs must receive a Temporary Marketing Authorization to market their product under specific conditions and require presenting a caution statement on the packaging warning against child consumption [ 15 , 23 ]. In addition, CED marketing to children under 12 years old is prohibited [ 23 ].…”

“…Caffeine is the most common ingredient in CEDs and is primarily associated to CED-related adverse events due to caffeine toxicity in high doses [13]. CEDs also contain several other ingredients that may produce cardiovascular effects and interact synergistically with caffeine, such as taurine, herbal extracts, B vitamins, and minerals, which may further increase the risk of toxicity [13,15,16]. Additionally, the sugar content in CEDs is comparable to traditional sugar-sweetened beverages and soft drinks, which presents additional health implications, particularly for childhood obesity [3,10].…”