Regular energy drinks may pose similar risks to public health and safety as the alcoholic versions that the FDA banned last November, commentary published online first in the Journal of the American Medical Association suggests.

“To promote informed consumer choices, regulatory agencies should require specific labeling regarding caffeine content, with warnings about the risks associated with caffeine consumption in adolescents and in pregnant women, as well as with explicit information about the potential risks associated with mixing energy drinks with alcohol,” wrote Amelia M. Arria, PhD, of the University of Maryland School of Public Health in College Park, MD, and Mary Claire O’Brien, MD, of Wake Forest University School of Medicine in Winston-Salem, N.C.

Energy drinks contain anywhere from 50 to 505 mg of caffeine per serving, compared with the average 34 to 54 mg in a 12 oz. cola, or the 77 to 150 mg in a 6 oz. cup of coffee, according to background information in the article. Still the FDA has not yet set an upper limit for maximum allowable caffeine content in energy drinks, despite an existing cap of 71 mg per 12 oz cola serving.  

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“Scientists and health professionals cannot wait for further FDA action — available scientific evidence indicates that action is needed now,” the researchers wrote.

They urged health care providers to warn the public about certain risks associated with energy drink consumption — such as increased BP and sleep disturbances among adolescents and an increased risk for late miscarriages, stillbirths and small-for-gestation infants among pregnant women.

Of particular concern are consumers who mix energy drinks and alcohol, the researchers warned. “Although consumers might be under the impression that caffeine counteracts the adverse effects of alcohol, research has demonstrated that individuals who combine energy drinks with alcohol underestimate their true level of impairment.”

The combination has also been linked to higher alcohol consumption per drinking session, drinking while intoxicated and alcohol-related sexual assault. Other research has linked energy drinks with alcohol dependence and nonmedical prescription drug use, although the underlying mechanisms remain unclear.

More research is needed to guide further regulatory decisions concerning energy drinks. In the meantime, educating the public about known risks is the “collective priority of health professionals,” Arria and O’Brien wrote.