Issue 117 give me energy by NH Publishing Ltd

NHD EXTRA: PUBLIC HEALTH

GIVE ME ENERGY . . . Review by Ursula Arens Writer; Nutrition & Dietetics

While sweet and sugary drinks face all-round critique from dietitians, it is a mystery that the sector of self-proclaimed ‘energy’ drinks seems to be thriving. Correction: not ‘seems to be’ - ‘is’…

Ursula has spent most of her career in industry as a company nutritionist for a food retailer and a pharmaceutical company. She was also a nutrition scientist at the British Nutrition Foundation for seven years. Ursula guides the NHD features agenda as well as contributing features and reviews

The link to virile masculinity and gungho disruptiveness seems to transcend any concerns over bad teeth and obesity. In debates about energy drinks amongst politicians and regulators, the sugar content of energy drinks is low down over the other contentious ingredients of too much caffeine and mysterious herbals. The sector is booming. More than half of the global market is dominated by two brands: Red Bull and Monster. According to market researcher Euromonitor International, global sales of energy drinks in 2015 were more than €38 billion. More than one third of the global market is the US. China had lower sales than Western Europe in 2015 (€6 vs €7 billion), but is the fastest growing market, predicted to double by 2020 and overtake the US by 2025. Interestingly, two of the top three brands are privately owned: Dietrich Mateschitz owns Red Bull and Russ Weiner owns Rockstar - perhaps they swim in the stuff. The number two brand, Monster, is coowned by the Coca Cola Company.

The success of energy drinks must be due to the many meanings of the word ‘energy’. Dietitians need no review of the meaning of food energy. However, the consumer meaning drives the communication of these products: take your pick of the string of synonyms: vigor/forceful effect/power/capacity to do work/ oomph/ get-up-and-go/ drive/vim - and many other terms. Clearly, a drink that delivers these traits is valued, rather than the dietetic interpretation that the drink contains calories. However, the energy contents of energy drinks are very similar to levels found in other sweet beverages (Table 1). The quandary is that the drinks correctly state that they contain energy (kcals); however they are strongly communicating other meanings of the word. And this is the meaning that (young, male) consumers are receiving loud-and-clear. So what do food labelling experts mean by the word ‘energy’. Statements about energy are permitted on food labelling, but relate entirely to absolute

Table 1: Sugars and caffeine contents Per 100ml

kcals

sugars

caffeine

Red Bull

11g

32mg

Monster

11g

32mg

Rockstar

13.5

32mg

Lucozade energy*

8.7g

12mg

Coca cola

10.6g

10mg

Orange Juice

8.6g

50mg

Pro Plus tablet (1)

* Lucozade Energy contains less sugars but more energy than other similar drinks. This is because some of the carbohydrate in the ingredient ‘glucose syrup’ is in the form of oligosaccharide.

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NHD EXTRA: PUBLIC HEALTH

and relative amounts in relation to kcals content. They are defined by Regulation (EC) No 1924/2006, amended by Regulation (EU) No 1047/2012. Low energy means less than 40kcals per 100g (or half this for liquids). Energy-reduced means a value lower by at least 30% (compared to a standard or reference food). Lastly, energyfree means less than 4.0kcals per 100ml. And that is all. But there is an interesting development on the labelling of nutrients in foods versus nutrients in the body. An article 13.5 claim just approved by the European Commission in June 2016, allows statements on ‘lower blood sugar rise’ for products where at least 30% of sugars are replaced by non-digestible carbohydrates. The merge of labelling statements of (sugar) contents in foods to (sugar) levels in blood, suggests possible future concepts between energy contents in foods and ‘energy’ in the body. The term energy on food and drink labels appears to be multi-meaning and the Australian shopper is also confused.com. In a detailed interview of more than 400 shoppers in Sydney, packets of breakfast cereals, muesli bars and frozen meals were used to tease out the understanding of terms energy and calories. Results reported by Wendy Watson and colleagues were bizarre, but also very logical and understandable from the consumer viewpoint. Higher energy breakfast cereals were judged as healthier, as were, in contrast, lower energy ready meals. Participants with lower 58

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incomes were significantly more likely to state that higher energy products were healthier, the main reason being that these products were best for sustaining energy. Shockingly, only 40% of participants correctly recognised that kilojoules and kilocalories were different units for the same thing. The researchers were anxious that food energy concepts and units of measurement were a mystery to Australia shoppers and were concerned that further food and menu labelling initiatives expanding energy content declarations may result in accidental promotion of less healthy foods. A nutrition education campaign was needed (they concluded.) What else can be said about energy drinks? Caffeine is a well-described stimulant, and the content in energy drinks is about three times the levels in cola drinks per 100ml, although portion sizes in bullet cans may be smaller that cola cans or bottles (Table 1). All drinks containing more than 15mg caffeine per 100ml require labelling statements that the product is not suitable for children, or pregnant or breastfeeding women, and such statements are displayed. But there have been many concerns over the high caffeine content in energy drinks. And particularly their consumption by children. There is particular alarm that the promotion of (valid) claims about the effects of the stimulant caffeine, may lead people to believe in the (not valid) super-powers of energy drinks. In July 2016, the European Commission in Strasbourg was asked to adopt four health claims labelling statements on caffeine, approved by the

Table 2: EFSA approved health claims for caffeine Contributes to an increase in endurance performance Contributes to an increase in endurance capacity Helps increase alertness Helps to improve concentration

European Food Safety Agency (EFSA) (Table 2). These claims had been ‘on hold’ for more than five years. Although scientific data supporting stimulant effects is strongly based in evidence, approving such communication on food labels promises another marketing boost for energy drinks. The Danish MEP, Christel Schaldemose, strongly opposed the official yes-to-caffeine claims on labelling: survey data shows that nearly 80% of under-18 teens and nearly 20% of under10s, consumed energy drinks and further (mis) communication suggesting better performance in school or sport was irresponsible. In the vote, the concerns were accepted and approval of caffeine claims on labelling were rejected by the MEPs. The energy drinks industry was angry that caffeine in coffee was acceptable, but caffeine in non-coffee drinks was opposed. They called the outcome of the vote a disgraceful victory of politics over science, and taunted that energy-boosting claims could be made on such drinks regardless, by the additions of small amounts of B vitamins. Another marketing ingredient in energy drinks is taurine (except ‘marketing ingredient’ is unfair on caffeine, as it does have proven physiological effects). Between 2009-2011, various health claims regarding taurine were submitted for consideration to EFSA. Proposed statements included descriptions supporting physical and mental performance, and enhancing vitality. However, the substantiating evidence for all eight proposed claims was judged to be inadequate, and all labelling statements for taurine were not authorised. Some further specific assessments were made by EFSA in relation to the safety of the ingredient taurine. There had been anecdotal and case

reports of acute and adverse effects from drinking energy drinks, and an opinion was requested from the Panel on Food Additives and Nutrient Sources Added to Food. They calculated that the mean daily intakes of taurine from omnivore diets was at most 400mg per day, whereas the levels in a 250ml can was 4,000mg, so levels 10fold that of dietary intakes. Review of possible adverse cases suggested that very high amounts of energy drinks had been consumed (six cans per occasion) always combined with other factors such as intense exercise or alcohol. The Panel concluded that the possible adverse effects reported were more likely due to well described side effects of very high caffeine intakes; the possible relationship with high intakes of taurine lacked any scientific evidence. So, what is so get-up-and-go about energy drinks? They contain carbohydrates (sugars) and caffeine, but you could easily get this in a more enjoyable form, for example, with the classic combo of coffee and cake/cookie. They contain taurine and other marketing ingredients, which are not harmful, but which have not been demonstrated as effective either. Unlike other food and drinks, however, energy drinks do contain magic sparkle and ‘wings’ developed by many millions of pounds of sponsorship and advertising, communicating risk taking and physical vigour. The association between these images and these products explains why so many people are willing to pay £££s for small cans of fizzy drinks. It is time for more energy to be put into the critiquing of energy drinks and dietitians should be lassoing in the misleading and over-hyped claims of… bull.

Information sources: • Arens U (2009). A load of old bull. Network Health Dietitians Magazine; 59, 16 • EFSA (2009) Panel on Food Additives and Nutrient Sources Added to Food. The use of taurine and D-glucurono-gamma-lactone as constituents of the so-called ‘energy’ drinks. DOI: 10.2903/j.efsa.2009.935 • Harrison-Dunn AR. MEPs brew final caffeine claims battle as approval beckons. www.beveragedaily.com - 14 June 2016 • Harrison-Dunn AR. MEP caffeine vote ‘disgraceful’ victory of politics over science: Industry. www.foodnavigator.com - 8 July 2016 • Watson WL et al (2013). How well do Australian shoppers understand energy terms on food labels? Public Health Nutrition, 16, 03, 409-417