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Cans of an alcoholic drink made by Geloso Beverage Group in a fridge at a corner store in Montreal on March 13, 2018.Dario Ayala

The Quebec government announced this week that it will ban high-sugar, high-alcohol drinks from grocery and convenience stores. The news came two weeks after a 14-year-old girl died after reportedly consuming such a product hours before she died.

The beverage, removed from store shelves and discontinued, came with an 11.9 per cent alcohol content, guarana (a natural stimulant that contains caffeine) and lots of sugar, a mix that’s particularly unsafe for young people who don’t have experience drinking alcohol.

The tragic case in Quebec is the latest to spur changes in policy, but the combination of sugar, caffeine and alcohol is not a new public-health concern.

It’s important for kids and parents to know the risks associated with sweet alcoholic beverages and mixing alcohol with caffeine, whether it’s from natural ingredients or energy drinks.

The sheer quantity of alcohol in these types of beverages, sold in large single-serve cans, dwarfs the amount in a standard alcoholic drink.

A 24-ounce serving of an 11.9 per cent alcoholic beverage, for example, contains 4.8 standard drinks. A standard drink contains 14 g of alcohol and is considered five ounces of wine (12 per cent alcohol), 12 ounces of beer (5 per cent alcohol) or 1.5 ounces of spirits (40 per cent alcohol).

What’s more, the intense flavour and sugar content of these drinks mask their high alcohol content, causing people to not realize how much alcohol they are actually drinking.

Alcoholic beverages with high caffeine levels may also conceal the sedating effects of alcohol. People who consume the two together could end up “wide-awake drunk,” making it harder for them to realize how intoxicated they are and more likely they’ll continue drinking.

Studies conducted on university campuses revealed that students who drank caffeinated alcoholic beverages were more likely to drink and drive, ride with an intoxicated driver, be taken advantage of sexually, or require medical treatment than those who didn’t mix alcohol with caffeine.

It’s not only premixed caffeinated alcoholic beverage products that are a concern. Mixing alcohol with caffeinated energy drinks such as Red Bull, Monster or Rockstar poses the same health risks.

In 2010, the U.S. FDA effectively banned caffeinated alcoholic beverages when, after conducting a safety review, it told manufacturers to remove caffeine and other stimulants from their products.

In Canada, caffeine is not allowed to be added to premixed alcoholic beverages. It is legal, however, to add flavouring agents that contain caffeine, such as guarana and coffee, to alcoholic drinks.

After the Quebec teen’s death, Health Canada is now reviewing the safety of large volume, single-serve alcoholic beverages.

Risks of caffeinated energy drinks

Caffeinated energy drinks don’t have to be mixed with alcohol to cause adverse health effects.

Energy drinks contain added sugar (often high-fructose corn syrup), caffeine, B vitamins, stimulant herbs (e.g. guarana, ginseng) and natural or artificial flavours and colours. Sugar-free products contain artificial sweeteners such as aspartame, sucralose and acesulfame potassium.

Some products have ingredients touted to boost mental and physical energy such as taurine (an amino acid found in meat and fish) and glucoronolactone and L-carnitine (natural compounds made by the body).

A 16-ounce (473 ml) can of watermelon-flavoured Rockstar energy drink, for example, delivers 62 g (15 teaspoons) of added sugar (that’s 25 per cent more sugar than in the same amount of cola) and 160 mg of caffeine (the amount found in eight ounces of brewed coffee). It also provides six days’ worth of vitamin B12 and two days’ worth of niacin (vitamin B3) along with taurine, ginseng and other natural ingredients.

In Canada, the caffeine content of energy drinks is capped at 180 mg of per serving.

Studies have linked energy drinks to heart palpitations, muscle twitching, anxiety, depression, restlessness, fatigue, sleep problems and even death.

Research published earlier this year in the journal CMAJ Open found that among 2,055 Canadian youth surveyed (ages 12 to 24 years), 74 per cent had consumed energy drinks. Among them, half (55 per cent) had experienced at least one negative health effect, including rapid heart rate, difficulty sleeping, headache, nausea or vomiting, chest pain and seizures.

While many participants reported such symptoms while mixing energy drinks with alcohol or drinking them while engaging in physical activity, nearly half (48 per cent) who reported adverse effects drank energy drinks without doing either.

According to a 2014 World Health Organization (WHO) study, the serious risks from energy drinks are largely because of their high caffeine content.

Yet there is a lot we don’t know about the effects of stimulants and other additives in energy drinks.

According to a small study published last year in the Journal of the American Medical Association, blood pressure and heart rhythm changes observed in participants after they drank two cans (32 ounces) of an energy drink were the result of non-caffeine ingredients rather than caffeine.

Caffeinated energy drinks should not be mixed with alcohol. Nor should they be consumed before, during or after exercise.

Energy drinks are also not recommended for women who are pregnant or nursing and people who are sensitive to caffeine.

Leslie Beck, a Toronto-based private practice dietitian, is Director of Food and Nutrition at Medcan.

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