Roger Clemens

As global concerns grow over obesity, the food industry’s marketing of "energy" is both puzzling and challenging. In the United States, the energy drink business experienced significant growth in sales and product types in recent years, reaching $3.5 billion in revenue in 2005. These products convey both directly and indirectly the promise of mental alertness, raw muscle power, and sexual prowess through the addition of "pharmaceutically charged" ingredients, which when consumed in a bolus may contribute to an array of increased health risks as well as benefits.

For example, caffeine levels, which often exceed the amount in a cup of coffee, may be a potent stimulant of the central nervous system (to keep one awake and alert), and function as a natural diuretic and natriuretic. Caffeine may also contribute to episodes of tachycardia or periods of an elevated pulse.

Taurine, a sulfur amino acid synthesized within our body, is frequently referred to as a conditionally essential nutrient during periods of physical stress and illness, and may affect cardiac contractility (Baum and Weiss, 2001). This amino acid presents pharmacological properties that mimic some of the actions of angiotensin converting enzyme (ACE) inhibitors, which are the frontline drugs in treating heart disease (Schaffer, Lombardini, and Azuma, 2000).

The dynamics of these kinds of energy, the sometimes exotic ingredients, and emerging health concerns have triggered numerous regulatory guidelines. While the U.S. Food and Drug Administration has not issued any regulatory warning letters relative to energy drinks, Health Canada recommends that daily consumption be limited to 500 mL while the agency investigates reports of adverse events associated with consuming these drinks. France, Denmark, Norway, and Sweden have banned energy drinks!

Energy balance is essential for maintaining health. An imbalance of energy typically contributes to increased adiposity and numerous complications and increased health risks associated with cardiovascular disease, Type 2 diabetes, and cancer (Wolfgang and Lane, 2006; Rankinen and Bouchard, 2006). Energy status is naturally monitored and regulated through the expression and secretion of an array of neuropeptides that influence food intake and energy expenditure. Food-derived peptides inhibit fatty acid synthesis and produce metabolic effects similar to leptin. These effects influence energy balance, resulting in reduced food intake and subsequent weight reduction as evidenced in diet-induced or ob/ob obese animal models.

Energy intake or eating behavior traits may be linked to genetic heritage. Family and twins studies suggest a strong familial relationship and genetic effect on eating behavior traits (van den Bree, Eaves, and Dwyer, 1999). Similar relationships exist for eating disorders anorexia nervosa, bulimia nervosa, and binge eating.

Future molecular genetic studies may identify and map more than the eight specific chromosomal regions that influence relevant dietary traits. Human studies to confirm and translate these observations and to assess their impact on gene expression and behavior are essential. Such studies may offer significant opportunities for the food industry in the global obesity issue, while stimulating an alternative design to energy drinks.

Without detailing commonplace branding and advertising practices, it should suffice to note that colorful, distinctive cans and text embodying extreme sport and wild "kicks" on many other dimensions seem unprecedented as effective marketing. As we explore the potentials of foods and food supplements with frank medical impact, we really must think about our responsibility to public health, as well. The food industry is not and should not be a value-neutral enterprise focused only on the bottom line. Now, as we evolve toward a "medical food technology" or "clinical food science," we must look to creating, defining, and sustaining just what is efficacious and safe.

by Roger Clemens, Dr.P.H.,
Contributing Editor 
Special Projects Advisor,
ETHorn, La Mirada, Calif. 
[email protected]

by Peter Pressman, M.D.,
Contributing Editor 
Attending Staff, Internal Medicine,
Cedars-Sinai Medical Center, Los Angeles, Calif. 
[email protected]


Baum M. and Weiss M. 2001. The influence of a taurine-containing drink on cardiac parameters before and after exercise measured by echocardio-graphy. Amino Acids 20: 75-82.

Rankinen T. and Bouchard C. 2006. Genetics of food intake and eating behavior phenotypes in humans. Annu. Rev. Nutr. 26: 413-34.

Schaffer S.W., Lombardini J.B., and Azuma J. 2000. Interaction between the actions of taurine and angiotensin II. Amino Acids 18: 305-318.

van den Bree M.B.M., Eaves L.J., Dwyer J.T. 1999. Genetic and environmental influences on eating patterns of twins aged ≥ 50 y. Am. J. Clin. Nutr. 70: 456-65.

Wolfgang M.J. and Lane M.D. 2006. Control of energy homeostasis: role of enzymes and intermediates of fatty acid metabolism in the central nervous system. Annu. Rev. Nutr. 26: 23-44.