2Effects of consumption on children
14.In this Chapter we set out the evidence relating to the health and behavioural effects of children consuming energy drinks and explore whether the effects of these products differ between children and adults.
Health effects
15.Dr Amelia Lake, a researcher at the Centre for Translational Research in Public Health, told us that energy drinks were “strongly associated with negative results in the health of children”.20 Other witnesses pointed to a range of effects:
- The British Dietetic Association (BDA) told us that consumption of energy drinks led to signs of “increased risk for fatal arrhythmias [abnormal heart beat]”;21
- The BDA also pointed to anorexia nervosa;22
- Several witnesses highlighted an association between energy drink consumption and anxiety; and23
- A number of witnesses, including the Jamie Oliver Food Foundation, told us that energy drink consumption was linked to increased sleeplessness and insomnia.24
16.The Government consultation on banning the sale of energy drinks to children, stated that:
Research has found that adolescents (aged 12–18) who consume energy drinks several times a day are 4.5 times more likely to report experiencing headaches, 3.5 times more likely to report sleeping problems, and 3.4 times more likely to report experiencing tiredness than adolescents who do not consume energy drinks.25
17.We also asked the pupils that we surveyed in the Parliamentary Education Centre whether they thought energy drinks had a negative effect on their health. Nearly 60% of respondents thought that consuming energy drinks could negatively affect their health compared to less than 20% who thought it would not.26
18.We heard limited evidence that there were health-related benefits associated with energy drink consumption. Fuse, the Centre for Translational Research in Public Health, explained that there had been some evidence which suggested a positive effect on sport performance, however, they urged caution with this study as it was “based on small numbers of elite junior athletes”.27 When we pressed Dr Ashley Roberts, a toxicologist and adviser to Monster Energy, about whether there were any health benefits associated with energy drink consumption he conceded that there were none that he knew of.28
19.Monster Energy argued that energy drinks were unfairly associated with negative health effects, on the basis that “children and adolescents experience no particular or unique safety effects from caffeine”.29 They told us that “the fear that energy drinks may have potential physical and mental health effects on children and adolescents is based on misconceptions”.30 Energy Drinks Europe also noted that:
The safety of key [energy drink] ingredients has been assessed and confirmed by European risk assessment institutions, including the United Kingdom Food Standards Agency (FSA), and the European Food Safety Authority (EFSA), and by many other health authorities around the world.31
Dr Roberts told us that health effects, such as anxiety, due to consumption of energy drinks did not affect children differently to adults:
There was a study by Stein, and a placebo-controlled study by Bernstein, looking at signs of anxiety. […] The only adverse effect from that study was that the children felt nervous and jittery. That is no different from what would be perceived in adults.32
The British Soft Drinks Association (BSDA) and Monster Energy agreed with this assessment.33
Behavioural effects
20.Darren Northcott, representing the NASUWT teaching union, told us that school teachers were concerned about the effects of energy drink consumption on pupil behaviour:
From their perspective of working with children in classrooms, teachers were increasingly drawing a link between what they saw as problematic behaviours—behaviours in classrooms, an inability to concentrate and, as we have heard, impacts on sleep—and increased consumption of energy drinks.34
He told us that 13% of teachers responding to a survey by NASUWT had cited the use of caffeine and energy drinks as a driver of poor pupil behaviour”.35
21.A number of witnesses, including NASUWT and the Jamie Oliver Food Foundation, linked the consumption of energy drinks to a lack of concentration and hyperactivity.36 Anisa Ashraf, a student who regularly consumed energy drinks, told us that: “A new study led by the Yale school of public health found that those students who consume energy drinks are 66% more likely to be at risk from hyperactivity and inattention symptoms”.37 In its recent consultation on energy drinks the Government cited a 2015 study,38 which found that “34% of adolescents who consumed energy drinks said that their ability to concentrate at school was affected by not getting enough sleep, compared to 18% for non-energy drink users”.39 Further, the Royal College of Paediatrics and Child Health cited a longitudinal study in the Netherlands of 509 adolescents which found that the consumption of one or more energy drinks per day may have a negative impact on “daily life behaviours related to executive function (i.e. mental processes that enable us to plan, focus attention, remember instructions, and juggle multiple tasks successfully)”.40
22.A 2015 scientific opinion from the European Food Safety Authority (EFSA) on safety of caffeine (not specifically energy drinks) found that single doses of caffeine did have some impact on children and adolescent’s behaviour, but argued that the effects of longer term habitual consumption were more uncertain:
Like for adults, caffeine doses of about 1.4 mg/kg bw may increase sleep latency and reduce sleep duration in some children and adolescents, particularly when consumed close to bedtime. […]
As only limited studies are available on the longer-term effects of caffeine on anxiety and behaviour in children and adolescents, there is substantial uncertainty regarding longer-term effects of habitual caffeine consumption in this age group […] but the limited studies available regarding the longer-term effects of caffeine on anxiety and behaviour in children and adolescents support the proposed caffeine intake level of no safety concern [3mg/kg bodyweight].41
23.Although many witnesses believed that energy drinks had a negative impact on an individual’s behaviour, including their concentration, NASUWT for example, conceded that this was exacerbating poor behaviour rather than causing it.42 NASUWT went on to explain that where energy drinks were prohibited from being consumed at school there were “positive implications for pupil behaviour and learning” observed by staff.43 Similarly, when Steve Brine MP, Parliamentary Under-Secretary of State for Public Health and Primary Care, gave evidence to us he explained that he would expect to see a “step change in difference of behaviour” as a result of any restrictions on the consumption of these products in schools.44
24.We also asked the pupils that we surveyed in the Parliamentary Education Centre about the effects of energy drinks on their concentration. Their perception of the effects of energy drink consumption on their concentration did not reflect these studies. Of those who consumed energy drinks, just 16% felt that they had a negative impact on their concentration.45 Similarly we asked visiting pupils whether energy drink consumption made it difficult to sleep. The majority of those who drank energy drinks (60%) believed that there was no effect on their sleeping.46
25.The British Soft Drinks Association argued that several pieces of research had shown that energy drinks had limited or no effect on mood and behaviour:
For children, the Scientific Committee on Food (SCF) considered seven publications reporting on intervention studies conducted in pre school and school children with caffeine doses up to 10 mg/kg bw (3, 5, or 10 mg/kg bw), either as a single dose or on a daily basis for periods up to two weeks. In these studies, either no effect or small, inconsistent effects were noted on mood, behavioural, cognitive and motor functions.47
Increased ‘energy’?
26.Professor Russell Viner, President of the Royal College of Paediatrics and Child Health, argued that these products should be referred to as “so-called energy drinks”, on the basis that caffeine did not itself provide the body with energy. He explained that “energy drinks result in fatigue and sleep deprivation. There is very little evidence that, with this excess caffeine, they give you extra energy. If they are full of sugar, that is an energy substrate”.48
Diet
27.Fuse, the Centre for Translational Research in Public Health, highlighted a study that they had conducted in 201549 which found that energy drinks had been used by children as breakfast substitutes.50 Similarly, the Jamie Oliver Food Foundation told us that: “These drinks, with their lack of nutritional value, are also becoming a replacement for meals. A 2013 study found that 1 in 20 children have an energy drink for breakfast”.51 More broadly, Annabel Gipp, Specialist Paediatric Eating Disorders Dietitian, British Dietetic Association (BDA), explained that consumption was correlated with eating disorders: “Research says that, mostly, the trend is that children who are either underweight or overweight are the ones who are consuming these beverages”.52
28.The BDA explained that consumption of energy drinks was linked with diet-related medical conditions, such as diabetes, dental decay and increased Body Mass Index (BMI) in young people. There was also a “link between energy drink use and sedentary behaviour”.53 The BDA went on to explain that dietary choices as children could affect future dietary choices as adults:
The use of energy drinks in adolescents may also be affecting future food and drinks choices in young people due to alterations in the developing reward and addiction centre of the brain and the addiction due to the high caffeine content.54
Association with other risk-taking behaviours
29.A number of witnesses highlighted a correlation between consuming energy drinks and other risk-taking behaviour such as smoking, although they emphasised that the data did not establish a causal link.55 For instance, the EFSA in 2013 found that 59% of 15–18 year-old energy drink consumers drank energy drinks with alcohol.56
30.Monster Energy argued that this correlation had been overplayed in some of the evidence we had received, arguing that “many of the submissions ignore the basic scientific concept that correlation does not equal causation”.57 Dr John Thompson, a member of the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment (COT), emphasised that there was merely an association between these types of behaviours, which did not establish a causal link.58 As Professor Viner, President, Royal College of Paediatrics and Child Health, put it, it is “unclear whether there is a common cause that leads children and young people either to smoke or to take energy drinks, or whether there are causal connections this way”.59
Are energy drinks different to other soft drinks?
31.We focus here on the caffeine levels of energy drinks and not their sugar content. Nevertheless, energy drinks can contain substantial amounts of sugar; for instance, a 450ml can of Monster Energy contains 48g of sugar, substantially more than the Government Dietary Recommendations of less than 33g of sugar per day for 11–18 year old boys.60 However there are similar concerns about the sugar content of many other soft drinks, and the amounts of sugar are comparable in some cases. For instance, Monster Energy and Red Bull both contain 11g of sugar per 100ml, compared with 10.8g per 100ml in Coca Cola (although zero-sugar versions are available, and portion sizes vary). Clearly energy drinks are not ‘healthy’ products, despite any positive associations with the word ‘energy’.” Sugar concerns relating to energy drinks would be covered by the Soft Drinks Industry Levy, rather than restrictions on sale, and are being addressed through the Government’s obesity strategy.61
32.Jenny Oldroyd, a Deputy Director at the Department of Health and Social Care, told us that concern about over-consumption of caffeine through energy drinks had been raised with the Government, but tea and coffee had not been highlighted as an issue:
the concern we are picking up, and which we can see in the evidence, is around real over-consumption of energy drinks among a particular group of the population. We have not had anyone come to us to suggest that there are the same kinds of issues with coffee and tea62
33.We looked at a number of energy drinks (including Monster, Relentless, Red Bull, Bolt and Boost) to compare their caffeine content with an equivalent amount of coffee. In general, the energy drinks we looked at contained around 30–32mg of caffeine per 100ml. This means that smaller cans (250ml) contain around 80mg of caffeine, but larger serving sizes (up to 500ml in some cases) can contain around 160mg of caffeine. Information on coffee from Starbucks shows that the amount of caffeine in a “short” drink (c. 236ml) ranged from 75 to 150mg (equal to between 32 and 64 mg per 100ml),63 and for a one-shot coffee from Costa caffeine levels varied from 92 to 277mg (the equivalent per 100ml figure cannot be calculated as the size of the drink is unknown).64 It is clear from this that while energy drinks are referred to as being ‘high-caffeine’, in many cases coffee can be much stronger.
34.Annabel Gipp, representing the British Dietetic Association, acknowledged that “even though one portion, in a small can, may be okay in terms of food safety, people are not sticking to those allocated portions”.65 Indeed, the Government’s consultation on restricting the sale of energy drinks noted that “a quarter of children who consume energy drinks will have three or more in one sitting”.66
35.Energy Drinks Europe reported that the EFSA study found that “In the UK adolescent population (10–18 year old), about 90 percent of all caffeine comes from sources other than energy drinks (39% from tea, 33% from colas, 10% from coffee and 8% from chocolate)”.67 The 2015 scientific opinion from EFSA on caffeine consumption explained that “The highest contribution to total caffeine intakes from “energy drinks” was found for adolescents in the UK (11%)”.68
36.Steve Brine MP, Parliamentary Under-Secretary of State for Public Health and Primary Care, argued that the issue with energy drinks was that they were “more quaffable” than coffee meaning consumers drank more of them.69 However, Monster challenged this view:
there remains a misconception that energy drinks are necessarily more quaffable than coffee, and that the effects of caffeine depend on the temperature of the beverage and how rapidly it is consumed. These statements have been shown to be false, and they cannot be reconciled with reports that indicate that cold drinks represent more than 50% of sales at Starbucks stores, most of which drinks are flavoured, such as Starbucks Frappuccinos.70
Do the effects of energy drinks on children differ from the effects on adults?
37.We have alluded to earlier in this Report (see, for example, paragraph 19) that there is a debate between whether adults and children are affected differently by the consumption of energy drinks. Some witnesses, including Dr John Thompson, Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment (COT), explained that there was not a lot of children-specific research on the effects of energy drinks to reach their conclusions, so they had to rely on recommendations for adult intakes. However, they noted that “If anything, children metabolise caffeine more quickly than adults”.71
38.Dr Amelia Lake, told us that there were ethical issues related to carrying out research on children: “it would be very unethical to give caffeine to children to see the effect”, which meant that the evidence available was necessarily limited.72 However, she also explained that evidence on the effects of energy drinks on adults was lacking as well: “We have little evidence about what they do to adults, and very little evidence about what they do to children”.73 As we explained at paragraph 19 Dr Roberts, a Toxicologist and adviser to Monster Energy, told us that there had been studies which found that the effects on energy drinks were not distinct in children compared to adults.74
39.We discussed at paragraph 26 that one effect of energy drinks was that they could make consumers more tired. Professor Viner from the Royal College of Paediatrics and Child Health told us that young people needed more sleep: “Teenagers need much more sleep than adults, and even young children”.75 Thus he seemed to suggest that children were more affected by sleep loss compared to adults. However, Dr Roberts explained that the effect of energy drink consumption on sleeping patterns applied to both adults and children.76
What is a safe level of caffeine?
40.Professor Viner told us that “There is clear evidence of harm [of caffeine] in excess”.77 The European Food Safety Authority (EFSA) provides the most comprehensive guidance on a safe level of consumption of caffeine (not just that consumed via energy drinks) for children and adolescents. EFSA explained that:
For children and adolescents, the information available is insufficient to derive a safe caffeine intake. The Panel considers that caffeine intakes of no concern derived for acute caffeine consumption by adults (3 mg/kg bw per day) may serve as a basis to derive single doses of caffeine and daily caffeine intakes of no concern for these population subgroups.78
If a child weighed 55kg this would mean that they could safely consume 165mg of caffeine per day. As outlined in paragraph 33, some drinks in larger cans reach this level in one portion, although smaller serving sizes do not. However, the aforementioned 2015 EFSA study (which covered a number of countries, including the UK), found that for adolescents (those aged 10–18 years) average consumption was between 0.4 and 1.4mg per a kilogram of body weight, therefore within the levels of safe consumption.79 Dr Kevin Hargin, Head of Food Hygiene and Animal Health Policy Unit, Food Standards Agency, told us that they were “content that a level of no concern at 3 mg per kilogram of body weight is reasonable and appropriate” for children.80 However, Dr Ashley Roberts suggested that the EFSA guideline was conservative: “I do not believe that the 3 mg per kilogram limit that was set by EFSA is an upper limit of safety. Even the EFSA opinion showed quite clearly that, on a day-to-day basis, those levels may be exceeded”.81
Is there enough evidence?
41.Professor Russell Viner, President, Royal College of Paediatrics and Child Health, for example, told us that there was a need for more research as the impact of caffeine was “an area in which we do not have a huge amount of research”.82 The Association of Convenience Stores also supported this call for more research.83 The Minister, Steve Brine MP, agreed and explained that he “would be the first to say that more research is needed fully to understand their impact on children”.84
Conclusions
42.Many young people choose to consume energy drinks, and some consume them in significant volumes. Energy drink consumption is higher on average in the UK than in other countries in Europe. Nevertheless, young people consume caffeine from a variety of sources, including tea, coffee, cola and chocolate.
43.Drinking energy drinks is correlated with young people engaging in other risky behaviours such as drinking alcohol and smoking, but it is not possible to determine whether there is any causal link.
44.In our view, there is insufficient evidence as to whether children’s consumption habits are significantly different for energy drinks compared with other caffeinated products such as tea and coffee. We recommend that in the next six months the Government should commission independent research to establish whether energy drinks have more harmful effects than other soft drinks containing caffeine in order to support evidence-based decision-making. There are ethical questions related to undertaking research on the effects of energy drink consumption on children, which would need to be borne in mind when designing further research.
23 See for example, Jamie Oliver Food Foundation (END0014), British Dietetic Association (END0026), Qq8–9 and Qq14–15.
25 Department of Health and Social Care, Consultation on proposal to end the sale of energy drinks to children, August 2018
26 15.4% of respondents did not know whether energy drink consumption would negatively affect their health and 6.9% did not want to say.
36 NASUWT (END0022) and Jamie Oliver Food Foundation (END0014). See also for example Fuse, The Centre for Translational Research in Public Health (END0002).
37 Miss Anisa Ashraf (END0004), Yale University, “Energy drinks significantly increase hyperactivity in schoolchildren, study finds” ScienceDaily, 9 February 2015, and NASUWT (END0022)
38 Fiona M. Brooks, Ellen Klemera, Josefine Magnusson and Kayleigh Chester, “Young People and Energy Drink Consumption in England”—analysis commissioned by the Department of Health and Social Care.
39 Department of Health and Social Care, Consultation on proposal to end the sale of energy drinks to children, August 2018
41 European Food Safety Authority, Scientific Opinion on the safety of Caffeine: EFSA Panel on Dietetic Products, Nutrition and Allergies, 2015
45 11.5% said that they did not know whether it affected their concentration and 6.1% did not want to say.
46 9.5% said that they did not know whether it affected their sleep and 5.0% did not want to say.
49 Fuse, “The HYPER (Hearing Young People’s Views on Energy Drinks: Research) Study Final Report”, September 2015
55 See for example, Royal College of Paediatrics and Child Health (END0010), NASUWT (END0022) and British Dietetic Association (END0026).
56 European Food Safety Authority, External Scientific Report: Gathering consumption data on specific consumer groups of energy drinks, 2013, p4
60 Public Health England, “Government Dietary Recommendations: Government recommendations for energy and nutrients for males and females aged 1 –18 years and 19+ years.”, August 2016
61 “Soft Drinks Industry Levy comes into effect”, GOV.UK, 5 April 2018
63 Starbucks, “Holiday FY19 Beverage Nutrition Information”, accessed 1 November 2018
64 Caffeine Informer, “Costa Coffee”, accessed 1 November 2018
66 Department of Health and Social Care, Consultation on proposal to end the sale of energy drinks to children, August 2018
68 European Food Safety Authority, Scientific Opinion on the safety of Caffeine: EFSA Panel on Dietetic Products, Nutrition and Allergies, 2015
78 European Food Safety Authority, “EFSA explains risk assessment: caffeine”, 2015
79 European Food Safety Authority, “EFSA explains risk assessment: caffeine”, 2015
Published: 4 December 2018