Prohibiting the Sale of Energy Drinks to Children: Proposing Alternative Complementary Measures

Background

As part of its Childhood Obesity: a plan for action ^[1], the government of the United Kingdom has proposed prohibiting the sale of ‘energy drinks’ to children, defining ‘energy drinks’ as beverages “other than tea or coffee” containing over 150 mg of caffeine per litre ^[2]. The ban would apply only to England meaning that ‘energy drinks’ would still be available for sale to minors throughout the rest of the UK; furthermore, the specifics of the law, such as whether the minimum age to purchase would be 16 or 18 years old, have yet to be finalised and are subject to a public consultation ^[3]. If enacted, the law would not be the first of its kind, with existing laws prohibiting the sale of ‘energy drinks’ to minors in Colombia ^[4], Lithuania ^[5], Latvia ^[6] and other countries; however England would be the world’s largest economy with such a law in force.

The government’s definition of ‘energy drinks’ as beverages containing more than 150 mg of caffeine per litre is based on European Union Regulation 1169/2011 ^[7], which requires that products containing over 150 mg of caffeine per litre disclose their caffeine content on the label and bear the phrase “High caffeine content. Not recommended for children or pregnant or breast-feeding women”. This makes ‘150 mg per litre’ a convenient figure at which to set a threshold, but not necessarily one which translates to sound policy.

Remarkably, coffee and tea products are specifically excluded from the 1169/2011 labelling requirements, meaning that products such as ready-to-drink espresso coffee, despite containing 2,121 ^[8] to 2,900 ^[9] to 3,409 ^[10] mg of caffeine per litre (14 to 19 to 22 times the proposed threshold), carry no warning statements and are not required to disclose caffeine content on the label, thereby implicitly suggesting that these products are appropriate for consumption by children and pregnant and lactating women. Since these regulations became law, the lack of warnings on coffee and tea products has reinforced the notion that these products are safer than ‘energy drinks’, as consumers are only exposed to warning statements on ‘energy drinks’. The status of coffee and tea as ‘natural’ sources of caffeine has also added to consumers’ false impression that ‘natural’ sources of caffeine are less harmful than synthetic caffeine.

The government has unfortunately decided to retain this exemption for tea and coffee in its proposals, stating that “the drinks in scope would be any drink, other than tea or coffee” and “where caffeine is added for flavouring” ^[2]. The government does not specify whether cacao (Theobroma cacao), guarana (Paullinia cupana), yerba mate (Ilex paraguariensis), kola nut (Cola nitida, acuminata), or other natural sources of caffeine, would be exempt from the ban, though it is likely that these sources would also be exempt.

The proposals serve to benefit coffee, tea and soda manufacturers

These proposals are critically flawed through their inclusion of this exemption for natural sources of caffeine as, rather than reducing caffeine intake among children, the proposals may increase demand for tea, coffee and soda products, which typically contain both more caffeine and more calories, with tea and coffee manufacturers ready to cater to this shift in demand. Despite the government expecting the proposals to cost the UK economy £70m overall between 2017 and 2027 ^[11], there will be as much as £328m of benefits to coffee, tea and soda manufacturers over this period, and as much as £656m of benefits to these groups between 2017 and 2042. The government’s impact assessment of the proposals admits that “90% of lost energy drink sales are displaced. This means there will be a benefit to other manufacturers” ^[11].

Inconsistencies in the objectives of the proposals

A glaring issue with the proposals is that they are largely motivated by a desire to reduce childhood obesity rates, yet caffeine consumption is not associated with increased obesity rates. An article announcing the proposals ^[12] cited childhood obesity rates as the primary reason behind the need for a change in the law:

“while many of us will recognise that consuming too much fatty, sugary food is one of the key causes of obesity and other health problems, some of the facts about energy drinks are simply astounding. One 250 ml can of energy drink can contain around 80 mg of caffeine … this is why today we’re launching a consultation on banning the sale of energy drinks to children”

The article makes no link between the presence of caffeine in ‘energy drinks’ and childhood obesity rates. The statements highlight the perceived confusion and inconsistency which lies at the heart of these proposals, and the misalignment of science and policy. If these proposals are targeted at reducing childhood obesity, then surely the sugar content of these beverages should be the focus of any legislation, rather than the caffeine content. A proportion of ‘energy drinks’ available on the market use non-caloric sweeteners in place of sugar, meaning that they do not directly contribute to obesity; the government could instead require that only low-sugar or sugar-free versions of ‘energy drinks’ could be sold to children.

The Institute of Economic Affairs has denounced the proposals, describing them as “draconian and unnecessary” ^[13] and contending that “it is not clear what problem the Government is trying to tackle with this consultation. If the issue is the sugar in these drinks, then why isn’t the Government proposing a ban on the sale of sugary drinks to people under the age of 18? If the issue is caffeine then why isn’t the Government proposing a [ban on] … coffee to people under the age of 18?” ^[13]. Similarly, Energy Drinks Europe condemned the proposals as “arbitrary, discriminatory and not effective” ^[14], citing the fact that ‘energy drinks’ contain “the same amount of sugar as in the same-sized apple juice, orange juice or conventional soft drink … for all ages, there are much greater contributors of caffeine and sugar in the diet than energy drinks” ^[14].

Discrepancies in the definition of ‘children’

The proposals are inconsistent in their definition of children, in that they cite the Regulation 1169/2011 warning statement as a reason to prevent children from accessing these products, yet they define children as those aged below 16 or 18, despite the fact that EFSA, in its Scientific Opinion on the safety of caffeine ^[15], defines ‘children’ as those aged 9 or younger, which suggests that beverages which carry the 1169/2011 warning statement are only unsafe for children aged 9 or younger. Those aged 10–18 are defined by EFSA as adolescents. Therefore adolescents would be wrongfully prevented from accessing ‘energy drinks’ considering that the warning statement does not apply to them. The government’s impact assessment uses standard weight data, combined with EFSA’s conclusion that children should not consume more than 3 mg of caffeine per kg of bodyweight per day, to demonstrate that the caffeine content of a standard ‘energy drink’ would only exceed safe levels for those aged 7 or under, suggesting that only the youngest consumers are at risk. Ending the sale of high-caffeine products to those under 10 (instead of under 16 or 18) would reduce the negative impact of age-restrictions on ‘energy drinks’ manufacturers’ future revenues.

Coffee, tea, and soda are responsible for the majority of caffeine intake among children and adolescents

The government’s own proposals note that, beyond the caffeine derived from ‘energy drinks’, “the majority of the remaining caffeine comes from coffee, tea, chocolate and sodas” ^[2]. Even among the highest consumers of ‘energy drinks’, ‘energy drinks’ never account for more than half of total caffeine intake, suggesting that restricting the sale of ‘energy drinks’ alone would be ineffective. According to EFSA data ^[17]:

Among European children aged 3–10: only 18.8% of respondents declared that they consumed one or more ‘energy drinks’ per year; among this group, 56% declared that they consumed no more than one ‘energy drink’ per week. Among all respondents, ‘energy drinks’ accounted for only 17% of caffeine intake. Among those who consumed one or more ‘energy drinks’ per year, ‘energy drinks’ accounted for only 42.8% of caffeine intake. Only 16% of ‘energy drink’ consumers were considered high-chronic; among this group, ‘energy drinks’ accounted for only 47.5% of caffeine intake. Even at the 95th percentile of intake, ‘energy drinks’ accounted for only 33.8% of caffeine intake among all respondents.

Among European adolescents aged 10–18: although 68% of respondents declared that they consumed one or more ‘energy drinks’ per year, only 26% of respondents declared that they consumed more than one ‘energy drink’ per week. Among ‘energy drink’ consumers, 51% consumed only one can of ‘energy drink’ per session and only 4.5% were considered ‘high-chronic’ and ‘high-acute’. ‘Energy drinks’ accounted for only 10.7% of caffeine intake among respondents overall. Among ‘energy drink’ consumers, ‘energy drinks’ accounted for only 12.7% of caffeine intake. Among ‘high-chronic’ consumers, ‘energy drinks’ accounted for only 15.7% of caffeine intake. Even at the 95th percentile of intake, among ‘high-chronic’ ‘energy drink’ consumers, ‘energy drinks’ accounted for only 10.3% of caffeine intake, contradicting the hypothesis that ‘energy drink’ use is concentrated in a small group of users.

In the United States, an economy with a market structure and regulatory environment similar to those of the UK, a survey on caffeine intakes from beverages also found that the majority of exposure to caffeine from beverages comes from tea, coffee, and soda ^[18]. The survey found that:

• 43% of children aged 2–5 consume caffeinated beverages; among this group, only 1.3% consume ‘energy drinks’, and ‘energy drinks’ account for only 1.27% of caffeine intake.
• 63% of children and adolescents aged 6–12 consume caffeinated beverages; among this group, only 3.7% consume ‘energy drinks’, and ‘energy drinks’ account for only 5.19% of caffeine intake.
• 83.2% of adolescents aged 13–17 consume caffeinated beverages; among this group, only 10.3% consume ‘energy drinks’, and ‘energy drinks’ account for only 7.33% of caffeine intake. Even at the 90th percentile of intake, ‘energy drinks’ account for only 24.6% of caffeine intake.

Mitchell et al. conclude that “overall mean caffeine intakes in the U.S. remain driven by the consumption of coffee and, to a lesser extent, tea and CSDs [caffeinated soft drinks]. Energy drinks, energy shots, and chocolate milk beverages contributed minimally to total caffeine intakes. These results provide little support to the notion that the introduction of additional caffeinated beverages into the market over the past decade has contributed to proportionally higher caffeine intakes by the various populations of consumers” ^[18].

As ‘energy drinks’ are not a major contributor to caffeine intake and are not consumed as frequently as coffee, tea and soda, it is unlikely that the proposals will result in any material reduction in the intake of either calories or caffeine; this is reflected in the Government’s own impact assessment, which estimates that the proposals would result in a meagre reduction of only 2.3 kilocalories per capita per day for those aged 6–9, 8.6 kilocalories for those aged 10–15, and 11.4 kilocalories for those aged 16–17 ^[11]. For comparison, 11.4 kilocalories is equivalent to just 8% of the calories found in a single 330 ml can of Coca Cola Classic, and 0.6% of the typical daily intake of 2,000 kilocalories.

Coffee and tea contain higher concentrations of caffeine than ‘energy drinks’

Red Bull, the best-known ‘energy drink’ and one of the most popular brands by market share, contains 80 mg of caffeine per 250 ml can ^[19] (258 g of liquid by weight according to the USDA ^[20]) equivalent to 320 mg per litre, just over double the proposed threshold. Most ‘energy drinks’ are formulated with similar concentrations of caffeine, though some may be sold in 500 ml cans and therefore contain 160 mg of caffeine per can.

Contrary to the widely-held belief that tea contains less caffeine than coffee, which is particularly relevant given the high intakes of tea in the UK, according to USDA data the highest source of caffeine by weight is unsweetened instant tea powder, which contains 5,714 mg of caffeine per 100 g ^[21]; the second highest source is instant coffee powder, which contains 3,142 mg of caffeine per 100 g ^[22]. However, it would be unfair to evaluate coffee and tea based on their caffeine content per 100 g of dry material alone, given that only a small quantity of coffee or tea is typically used per beverage. On an as-brewed basis, according to USDA data, 258 g of brewed coffee contain 103 mg of caffeine ^[23], or 412 mg per litre, a considerably higher caffeine concentration than Red Bull and other ‘energy drinks’; brewed black tea contains 200 ^[24]/220 ^[15] mg of caffeine per litre, which exceeds the proposed threshold but is a lower caffeine concentration than Red Bull.

EFSA’s Scientific opinion on the safety of caffeine ^[15] compared the caffeine concentrations of various caffeinated beverages used in ten different studies. The comparison found that the caffeine concentration of ‘coffee drink’ and ‘instant coffee’ beverages was consistently higher than the caffeine concentration of ‘energy drinks’. The average caffeine concentration of ‘coffee drink’ beverages was 500 mg per litre and some beverages contained as much as 1,780 mg of caffeine per litre; the average caffeine concentration of ‘instant coffee’ beverages was 470 mg per litre and some beverages contained as much as 856 mg of caffeine per litre. In comparison, the average caffeine concentration of ‘energy drinks’ was 263 mg per litre, though some beverages contained as much as 665 mg of caffeine per litre.

The impact of serving sizes on caffeine intake from coffee and tea

Even if the concentration of caffeine in a coffee or tea beverage falls below the proposed threshold, serving sizes also have a role in influencing caffeine and calorie intake from coffee and tea, as the quantity of liquid served often determines the quantity consumed. Whereas one might consume a single 250 ml can of ‘energy drink’, the smallest sized coffee beverage in a café might be considerably larger than 250 ml; for example, in the UK the smallest size available (for all drinks) at Starbucks ^[25], Costa Coffee ^[26] and Caffè Nero ^[27] is 355 ml. Though these beverages are greater in volume than a can of Red Bull, they are nonetheless sold as a single serving. A child would be just as likely to consume an entire can of Red Bull as they would be likely to consume an entire latte.

At Starbucks, the 473 ml grande size beverage is often marketed as the standard size and is the default setting on Starbucks’ website and mobile app ^[28], despite the tall size (355 ml) being the smallest size available (for all beverages) ^[25]. In the UK, a grande “Fresh Filter Coffee” from Starbucks contains 308 mg of caffeine ^[25] and a venti contains 387 mg ^[25], both considerably higher caffeine concentrations than Red Bull. Even a short “Fresh Filter Coffee” (237 ml, Starbucks’ smallest size, not available for all beverages) contains 157 mg of caffeine ^[25], a significantly higher caffeine concentration than Red Bull. The short size is not listed on in-store menu boards however, leading most consumers to purchase a larger tall or grande.

The caffeine content of many individual Starbucks beverages far exceeds that of Red Bull and other ‘energy drinks’. At Starbucks in the United States:

• a grande “Coffee Frappuccino” (473 ml) contains 95 mg of caffeine ^[29].
• a grande “Mocha Frappuccino” contains 110 mg of caffeine ^[30].
• a venti “Blonde Roast” contains 475 mg of caffeine ^[31].
• a grande “Nitro Cold Brew” contains 280 mg of caffeine ^[32].
• a grande “Americano” contains 225 mg of caffeine ^[33].
• a 44 ml Starbucks espresso contains 150 mg of caffeine, equivalent to 3,409 mg of caffeine per litre ^[34].

Concerningly, in the United States, Starbucks even offers an 887 ml trenta size ^[35]. An unsweetened trenta “Iced Coffee” contains 330 mg of caffeine ^[36]. In-store, Starbucks’ menu enables customers to add shots of espresso to any beverage, meaning that the caffeine content of any beverage can be effectively ‘supersized’ for a small additional fee. Overall, the practice of mixing coffee with ice, milk, sugar and flavoured syrups makes coffee beverages far more appealing to children and masks the bitter taste of caffeine, enabling children to consume more of the beverage.

Even the smallest sized beverages available from Costa Coffee contain more caffeine than a can of Red Bull. A primo “Flat White” (355 ml, the smallest size available) contains 277 mg of caffeine ^[37], a primo “Americano” contains 185 mg of caffeine ^[37], and a primo “Caffè Latte” contains 92 mg of caffeine ^[37]. A massimo “Caffè Mocha” (591 ml, the largest size available) contains 395 mg of caffeine ^[37], equivalent to 99% of EFSA’s safe daily intake level for caffeine ^[15] in a single beverage.

Data suggests that natural sources of caffeine are more dangerous

Deaths from caffeine overdose are extremely rare. According to data from the American Association of Poison Control Centers ^[38], in 2016 there were no deaths reported from ‘energy drink’ exposure in any form. Exposures are categorised by type of ‘energy drink’:

• ‘energy drinks’ containing caffeine from “guarana, kola nut, tea, yerba mate, cocoa, etc” (natural source);
• ‘energy drinks’ containing caffeine only (synthetic source);
• ‘energy drinks’ containing ethanol and caffeine (natural source);
• ‘energy drinks’ containing ethanol and caffeine (synthetic source).

Concerningly, exposures to ‘energy drinks’ containing natural source caffeine (893 exposures) were significantly higher than exposures to ‘energy drinks’ containing only synthetic source caffeine (706 exposures), suggesting that natural sources of caffeine are more harmful than synthetic caffeine. Despite the lack of deaths, exposures to ‘energy drinks’ containing natural source caffeine resulted in 5 ‘major’ outcomes and 87 ‘moderate’ outcomes, significantly greater than exposures to ‘energy drinks’ containing synthetic source caffeine (1 ‘major’ outcome, 39 ‘moderate’ outcomes).

Natural caffeine ‘energy drinks’ also resulted in greater instances of adverse reactions (147 instances) than synthetic caffeine ‘energy drinks’ (76 instances). There were significantly greater exposures to ‘energy drinks’ containing ethanol and natural source caffeine (36 exposures) than exposures to ‘energy drinks’ containing ethanol and synthetic source caffeine (3 exposures). Surprisingly, no adverse reactions were reported for ‘energy drinks’ containing ethanol, both natural and synthetic.

In terms of harms to children, exposure to ‘energy drinks’ mostly affects children aged 5 or younger. 480 of the 893 exposures to ‘energy drinks’ (natural sources) were in children aged 5 or younger (54%), whereas children aged 6–19 accounted for only 24% of exposures. Similarly 451 of the 706 exposures to ‘energy drinks’ (synthetic caffeine) were in children aged 5 or younger (64%), whereas children aged 6–19 accounted for only 17% of exposures.

Preventing purchase does not necessarily prevent consumption

It is highly unlikely that children aged 5 or younger are capable of visiting a retail store and purchasing ‘energy drinks’ by themselves; it is far more likely that these exposures to caffeine occurred in the home through the accidental consumption of ‘energy drinks’ purchased by adults. The above exposure data therefore suggests that age-restriction would have little effect in preventing the vast majority of exposure to ‘energy drinks’ among the youngest of consumers. As the majority of exposure occurs in the home, the proposals also understate the importance of parental responsibility in preventing the consumption of ‘energy drinks’ by children; according to EFSA data ^[17], 35% of European children usually consume ‘energy drinks’ at home and 26% usually consume ‘energy drinks’ at parties, suggesting that adults have a significant role in furnishing children with ‘energy drinks’.

The proposals would not decrease calorie consumption due to the added cholesterol, saturated fat, and sugar intake associated with coffee and tea consumption

The government’s impact assessment ^[11] claims that “a displacement from energy drinks to other soft drinks would result in a decrease in calorie consumption”, however an assessment of the current market suggests otherwise.

Whereas traditional ‘energy drinks’ are cholesterol-free and fat-free, coffee, tea, and cacao, whether purchased from a retailer or made at home, commonly use milk and/or cream as an ingredient, which adds cholesterol, saturated fat, and sugar (lactose) to the product, helping to mask the bitter and astringent tastes of caffeine and other components of coffee. For example, a 192 ml can of “Starbucks Doubleshot Espresso Salted Caramel Cream” contains 3.5 g of saturated fat and 20 mg of cholesterol ^[39], whereas these substances are absent from ‘energy drinks’ such as Red Bull. At Starbucks in the UK, a grande “White Chocolate Mocha” with whole milk contains 15 g of saturated fat ^[25] and a venti “Caffè Latte” with whole milk contains 10.1 g of saturated fat ^[25]. Fat contributes 9 kilocalories per gram, whereas sugar contributes only 4 kilocalories per gram ^[7]; accordingly, the aforementioned venti “Caffè Latte” contains 298 kilocalories ^[25], of which 48% is derived from fat and only 27% of calories is derived from sugar. If children are displaced to drinking beverages of this nature, there will be increases in calorie consumption. A 200 ml can of Starbucks Doubleshot Espresso provides 142 kilocalories ^[40] whereas a 250 ml can of Red Bull provides only 115 kilocalories ^[41].

It is logical to assume that children would mostly be displaced to caffeinated soda specifically, as these are the next most similar and accessible caffeinated beverage, supported by the finding that a majority of children know the difference between ‘soda’ and ‘energy drinks’ ^[17] and as such know that soda is often a source of caffeine. In other words, children would not be displaced to Sprite or Fanta as these are not caffeinated.

In reality, an assessment of the market reveals that Red Bull (full sugar variety) contains 11 g of sugar per 100 ml ^[42] and Sainsbury’s Blue Bolt (full sugar variety) contains 9.8 g of sugar per 100 ml ^[43], whereas the leading full-sugar caffeinated sodas contain identical or greater concentrations of sugar: Coca Cola Classic contains 10.6 g of sugar per 100 ml ^[44], Pepsi (full sugar variety) contains 11 g of sugar per 100 ml ^[45], Mountain Dew contains 13 g of sugar per 100 ml ^[46]. Furthermore, the standard serving sizes of caffeinated sodas (330 ml) tend to be larger than the standard serving sizes of ‘energy drinks’ (250 ml); 60% of adolescent European ‘energy drink’ consumers usually consume a single 250 ml can of ‘energy drink’ ^[17], meaning they would consume less sugar than if they consumed a can of soda.

The masking of caffeine’s natural bitterness with sweeteners and flavourings enables its overconsumption

According to EFSA, 60% of children consume ‘energy drinks’ for their taste, compared to only 30% for their ‘energy’, suggesting that children are attracted to the beverages for their sugar and flavourings ^[17].

A ban on ‘energy-drinks’ is not a ban on caffeine altogether

The government is not seeking to end the underage sale of beverages below the threshold of 150 mg per litre, so children would still be able to purchase and consume unlimited quantities of beverages containing caffeine at concentrations below this threshold. 150 mg of caffeine per litre is still a substantial concentration of caffeine, particularly for children. Under the proposed rules, children would effectively be presented with two legal choices in the marketplace:

1. consume a larger quantity of unrestricted soda beverages containing less than 150 mg of caffeine per litre.
2. consume unrestricted traditional caffeinated foods and beverages, such as tea, coffee and cacao (as well as ‘energy drinks’ based on these sources) which are legally unlimited in potency.

In the first scenario, in order to consume the same quantity of caffeine in a 250 ml can of Red Bull (80 mg), a child would have to consume 2.5 cans of “Coca Cola Classic” (330 ml each, 825 ml of liquid ^[44]), or 1.9 cans of “Diet Coke” (629 ml of liquid ^[47]). At the proposed 150 mg/l threshold, in order to consume 80 mg of caffeine, a child would need to consume a minimum of 533 ml of liquid. At this concentration, assuming a sugar content of 11 g per 100 ml, 533 ml of liquid provides 58 g of sugar, a significantly greater sugar content than a 250 ml can of Red Bull. Age-restriction of only high-caffeine products could give children the false impression that unrestricted products are safer or ‘low’ in caffeine. This could potentially encourage the binge-drinking of caffeinated soda among children.

However, rather than consuming half a litre of soda, it would be much easier for children to consume smaller, reasonable quantities of tea, coffee and cacao instead. Children most dependent on caffeine would likely switch to drinking espresso coffee, which provides the most caffeine per litre.

Energy drinks formulated with coffee, tea and other natural caffeine sources can still be sold to children

However, as children tend to dislike the bitter taste of caffeine in coffee and tea, manufacturers of coffee and tea products have sought to formulate sweetened and flavoured coffee and tea beverages which appeal to children. ‘Energy drinks’ formulated with coffee and tea (and their extracts) are already available on the market and often contain higher concentrations of caffeine than traditional (synthetic caffeine) ‘energy drinks’. ‘Energy drinks’ formulated with coffee and tea use the same branding, language and marketing tactics as traditional ‘energy drinks’ in order to appeal to consumers. If the current proposals become law, children would be displaced to these beverages instead.

With coffee and tea exempt from the proposals, products such as Red Bull and other ‘energy drinks’ could also be easily reformulated with ‘green coffee bean extract’ or ‘green tea extract’ as the source of caffeine, resulting in very few changes to formula and flavour. Indonesian green coffee bean extract has been found to contain as much as 81.7 g of caffeine per kg ^[48], or 8.17 g of caffeine per 100 g, more than double the 3.14 g of caffeine found in 100 g of regular instant coffee powder ^[22]. Concerningly, this is already becoming a reality, with Coca Cola having announced plans to introduce a line of ‘energy drinks’ known as ‘Coca Cola Energy’ ^[49], formulated with “naturally-derived caffeine and guarana extract” rather than synthetic caffeine, thereby enabling the product to bypass the government’s proposals and be sold to children. In 2018, Red Bull, under its ‘Organics by Red Bull’ line, launched ‘Simply Cola’, a beverage containing (per 250 ml can) 32 mg of caffeine derived from coffee ^[50], in addition to kola nut and cacao extracts.

Real examples of ‘energy drinks’ formulated with coffee, tea and other natural sources of caffeine

Starbucks sells a range of canned coffee-based ‘energy drinks’ known as Starbucks Doubleshot. In the United States, Doubleshot products are sold in a small 192 ml can variety and a larger 443 ml can variety. The larger variety, Starbucks Doubleshot Energy, contains 145 mg of caffeine per 443 ml can ^[51], equivalent to 327.3 mg of caffeine per litre, more than double the proposed threshold. The caffeine is derived from both coffee and guarana extract. By using the word ‘energy’ in the product name, the product explicitly appeals to consumers of ‘energy drinks’. Starbucks Doubleshot Energy products are also formulated with inositol, taurine and ginseng, ingredients commonly added to traditional ‘energy drinks’, to further appeal to ‘energy drink’ consumers. The smaller variety, Starbucks Doubleshot Espresso, contains as much as 120 mg of caffeine per 192 ml can ^[39], equivalent to 150% more caffeine than a 250 ml can of Red Bull. The caffeine is derived only from coffee and contains no guarana. This means that despite containing 625 mg of caffeine per litre, well above the legal threshold, Starbucks Doubleshot Espresso would remain legal for sale to children under the current proposals. Similarly, Monster Energy’s line of coffee-based ‘energy drinks’ known as “Espresso Monster”, which contain 150 mg of caffeine per 250 ml can ^[52], would be legal for sale to children despite containing nearly double the caffeine content of Red Bull.

In the United States, Starbucks also sells a brand of “sparkling green coffee energy drinks” known as “Starbucks Refreshers”, which contain 50 mg of caffeine per 355 ml can or 141 mg per litre ^[53]. Though these fall below the 150 mg/litre threshold, the front label of these beverages describe the products as a “sparkling juice blend” with the phrase “Real coconut water. Real fruit juice” displayed prominently, making no reference to the inclusion of green coffee extract or the presence of caffeine. Although green coffee extract is stated in the ingredients list on the back of the product, not all consumers check the ingredients list, especially children. These products are potentially deceptive as consumers could be misled into believing they were purchasing fruit juice rather than a caffeinated beverage.

The timing of both the introduction of voluntary retail bans and the introduction of the government’s proposals coincides with Coca Cola preparing for a UK launch of Honest Coffee ^[54], a line of ready-to-drink bottled coffee beverages, which would be exempt from the proposals. Coca Cola already sells a line of ready-to-drink bottled tea beverages known as Honest Tea ^[55]. A 500 ml bottle of Honest Tea Organic Honey Green Tea contains 94 mg of caffeine ^[56], more than a can of Red Bull.

Guayakí is a brand of yerba mate based ‘energy drinks’. A 473 ml can of Guayakí Yerba Mate contains 150 mg of caffeine ^[57], equivalent to 317 mg of caffeine per litre, which is effectively the same caffeine concentration as Red Bull. Guayakí also sells a 59 ml ‘energy shot’ which contains 140 mg of caffeine, equivalent to 2,373 mg per litre ^[58]. These products demonstrate that ‘energy drinks’ can be formulated with natural sources of caffeine. Guayakí states on its website that “yerba mate has the strength of coffee, the health benefits of tea, and the euphoria of chocolate, all in one beverage” ^[59] and uses product names like ‘bluephoria’ and ‘lemon elation’. The use of terms like ‘euphoria’ and ‘elation’ explicitly associate the consumption of yerba mate with psychoactive effects. Furthermore a scale – ranging from light, bright, lifted, glowing, mighty – is printed on the label of Guayakí products, with products containing 150 mg of caffeine marked ‘mighty’ and products containing less caffeine scoring lower on the scale. The use of such language like ‘lifted’ and ‘glowing’ explicitly references language associated with drug use.

In the United States, “5-Hour Energy”, a brand of ‘energy shots’, sells “5-hour Tea”, a variety of tea-based ‘energy shot’ which contains 200 mg of tea-derived caffeine per 57 ml shot ^[60], equivalent to 3,509 mg of caffeine per litre. Although not sold in the UK, products such as this further demonstrate how ‘energy drinks’ and ‘energy shots’ can be reformulated with natural sources of caffeine.

The proposals affect consumers of legal purchase age

Consumers who are of legal age to purchase ‘energy drinks’, but who appear younger than the minimum age, will be burdened by the requirement to show identification in order to purchase ‘energy drinks’, meaning that potentially anyone between the ages of 16 and 30 will have to remember to bring ID when trying to purchase ‘energy drinks’. This added inconvenience will ultimately deter purchases within this age group and consumers will opt for tea and coffee instead. An assessment of the ‘energy drinks’ market in the United States found that “the targeted demographic group is teenagers, young adults, 18 to 34 years old” ^[61], meaning that the very target market for ‘energy drinks’ will be most frequently asked for identification. ‘Energy drinks’ manufacturers will lose sales when consumers forget to bring their identification with them; tea and coffee manufacturers will then capitalise on their products being easier to purchase as a result of being unrestricted.

The harms associated with caffeine consumption deserve regulatory measures far beyond age restriction

Though the government has chosen to focus on sugar and obesity and give only a passing mention to the harms of caffeine, its proposals represent an acknowledgement that there are real harms associated with caffeine consumption. There is every reason to prevent children from accessing caffeine, however, preventing underage access to ‘energy drinks’ alone would be to ignore the presence of caffeine and other active substances in tea, coffee and cacao. The following evidence suggests that measures exceeding age restriction may be necessary to prevent harm to children, and that measures which would reduce the intake of caffeine among adults would have additional benefits to public health.

EFSA has stated in its Scientific Opinion on the safety of caffeine that “single doses of 100 mg of caffeine may increase sleep latency and reduce sleep duration” ^[15] in adults, adolescents, and children, regardless of whether the caffeine is synthetic or naturally derived. EFSA also cites “studies showing a dose-dependent positive association between caffeine intakes during pregnancy and the risk of adverse birth weight-related outcomes in the offspring” ^[15] as the reason for its recommendation that pregnant women restrict caffeine intake to less than 200 mg per day.

Similarly, a report by an Australia New Zealand Food Authority (now Food Standards Australia New Zealand) Expert Working Group concludes that “there are reports of increased anxiety levels … at doses of 95 mg in children … and at 210 mg in adults” ^[62], “caffeine has been reported to reduce the ability to sleep at doses of 100 mg” ^[62] and “caffeine at doses typically consumed in the diet may lead to withdrawal effects and some physical dependence in adults” ^[62]. The report also noted “the appearance of cardiac effects in pregnant women at doses of 90 mg” of caffeine ^[62].

A Health Canada report authored by Nawrot et al. concluded that “caffeine toxicity in adults can present a spectrum of clinical symptoms, ranging from nervousness, irritability and insomnia to sensory disturbances, diuresis, arrhythmia, tachycardia, elevated respiration and gastrointestinal disturbances” ^[63] and further add that “chronic exposure to caffeine has been implicated in a range of dysfunctions involving the gastrointestinal system, liver, renal system and musculature” ^[63]. The report also notes that “excessive caffeine intake may increase the risk of detrusor instability development in women. For women with preexisting bladder symptoms, even moderate caffeine intake … may result in an increased risk for detrusor instability” ^{[63, referencing Arya et al., Obstetrics Gynecology, 2000]}, and concludes that “habitual daily use of caffeine [greater than 500–600 mg] … represents a significant health risk and may therefore be regarded as ‘abuse’” ^[63].

The report notes that “caffeine induces an increase in systolic (5–15 mmHg) and/or diastolic (5–10 mmHg) blood pressure, most consistently at doses 250 mg/person, in adults of both sexes, irrespective of age, race, blood pressure status, or habitual caffeine intake. The effect is most pronounced in elderly, hypertensive or caffeine-naive individuals” ^[63]. The report also cites findings by Barger-Lux et al. “that caffeine intakes of 400 mg [per] person [per] day for 19 days led to evidence of altered bone remodelling in healthy premenopausal women between the ages of 35 and 44” ^{[63, referencing Barger-Lux et al., American Journal of Clinical Nutrition, 1990]}. The report concludes that “consumption of caffeine at dose levels of 300 mg [per] day may reduce fecundability in fertile women” ^[63] and that “caffeine consumption at dose levels of 400 mg [per] day may decrease sperm motility” ^[63].

All of these conclusions concern caffeine from all sources; the harms of caffeine are equally present in both natural and synthetic sources of caffeine. These conclusions also demonstrate that adults are equally at risk of caffeine-related harms as children and adolescents, suggesting that measures to reduce caffeine consumption among adults would improve public health, and that a total prohibition on the sale of all caffeinated products to children would have additional benefits beyond those provided by the age restriction of only high-caffeine products.

Harms unique to coffee, tea, and cacao consumption

As coffee and tea are natural products, caffeine content can be highly variable and can be influenced by growing conditions, cultivar, species, processing methods, storage and other factors. Thus the same volume of coffee from two different retailers may contain differing quantities of caffeine, making it difficult for consumers to estimate and monitor their caffeine intake. At any time, a coffee retailer could switch to serving coffee with a higher caffeine content, without needing to inform its customers.

The caffeine content of coffee can also be dangerously high, demonstrated by the sale of products such as “Death Wish Coffee” (746 mg of caffeine per prepared 355 ml serving ^[64]), “Cannonball Coffee Maximum Charge” (1,101 mg of caffeine per prepared 355 ml serving ^[65]), and “Biohazard Coffee” (928 mg of caffeine per prepared 355 ml serving ^[66]). These products would remain unrestricted under the current proposals and can easily be ordered online.

In contrast, the caffeine content of ‘energy drinks’ is standardised, thereby making them more consistent and more reliable for consumers monitoring their caffeine intake. Furthermore, whereas ‘energy drinks’ are reconstituted beverages composed of single-molecule ingredients such as water, sugar, organic acids, flavourings and synthetic caffeine, natural sources of caffeine such as coffee, tea and cacao contain many other naturally-occurring psychoactive substances in addition to caffeine.

Psychoactive substances in coffee, tea, and cacao

Besides caffeine, coffee contains the β-carboline alkaloids norharman and harman ^[67]. β-Carboline, also known as norharman, is the prototype for a class of alkaloids known as the β-Carbolines. Harman is a methylated derivative of norharman. Both harman and norharman are also found in tobacco smoke ^[68], with coffee being “the main exogenous source of these alkaloids in addition to smoking” ^[69]. β-carbolines are monoamine oxidase inhibitors (MAOIs), a class of compounds used in medicine to treat a range of mental disorders including depression as well as anxiety, personality and post-traumatic stress disorders. According to Herraiz, “carbolines exert a wide spectrum of pharmacological and psychopharmacological effects, including antidepressant-like effects” ^[69]. It is possible that coffee consumption among those with mental illness, whether diagnosed or undiagnosed, may be an attempt to self-medicate and self-regulate internal monoamine oxidase levels.

The presence of harman and norharman in coffee was identified in 2002 by Herraiz ^[67]. Espresso and brewed coffee were found to contain the highest concentrations of β-carbolines, as much as 165.6 μg of norharman per gram and as much as 39.9 μg of harman per gram ^[67]. These substances are not removed by decaffeination, with decaffeinated instant coffee having been found to contain as much as 9.34 μg of norharman per gram and as much as 1.41 μg of harman per gram ^[67]. Caffeinated instant coffee was found to contain less norharman (7.53 μg per gram) but more harman (1.67 μg per gram) ^[67]. In 2006 Herraiz and Chaparro confirmed that the presence of these compounds in coffee indeed “acted as good competitive and reversible inhibitors of MAO A (norharman and harman) and MAO B (norharman)” ^[69]; harman inhibited MAO-A 44% and norharman inhibited MAO-A 30% and MAO-B 38% ^[69]. The presence of β-carbolines in tobacco smoke and coffee may explain why cigarettes and coffee are often consumed together. Talhout et al. note that “tobacco smoking and coffee drinking are often characterized by concurrent use … the close association between coffee and tobacco use may be at least partly due to an interaction between harman (and norharman) and nicotine” ^[70]. Herraiz et al. noted that “MAO inhibition in smokers may be linked with the addictive properties of cigarettes, depression” ^[68], suggesting it could play a similar role in caffeine addiction. The authors added that β-carbolines “might also exert other neuropharmacological and behavioral effects” ^[69]. Furthermore, Nawrot et al. state that “cigarette smoking is associated with about a twofold increase in the rate at which caffeine is eliminated” ^[63].

The cholesterol-raising factor in coffee

Nawrot et al. note that “two diterpenoid alcohols, cafestol and kahweol, found at significant levels in boiled coffee have been identified as hypercholesterolaemic components” ^[63]. Although these components can be mostly removed from coffee through the use of a paper filter ^[71], “there is some evidence that consumption of filtered coffee is associated with small increases in serum cholesterol levels” ^{[63, referencing Thelle, Current Opinion in Lipidology, 1995]}.

Urgert, Katan et al. found that “each 10 mg of cafestol consumed per day elevates cholesterol by 5 mg/dL” ^[72]. Scandinavian boiled coffee was found to contain as much as 12.1 mg of cafestol per 150 ml cup and French press coffee was found to contain as much as 5.5 mg of cafestol per cup ^[72]. Urgert, Katan et al. also found that “daily consumption of large amounts of cafetiere coffee [equivalent to 38 mg of cafestol and 33 mg of kahweol per day] raises alanine aminotransferase concentrations for at least six months” ^[73].

Significantly, cafestol and kahweol “are not removed by decaffeination” ^[74]. Urgert et al. recommend that “patients at increased risk of heart disease who drink much coffee should thus be advised to select brews low in diterpenes” ^[74]. Grobbee et al. note that “consumption of decaffeinated coffee was associated with a moderate and marginally significant increase in risk of coronary heart disease” ^[75].

‘Energy drinks’ formulated with synthetic caffeine do not contain these hypercholesterolaemic diterpenes, however, ‘energy drinks’ formulated with coffee or green coffee extract may still contain them.

Carcinogens in coffee

In March 2018, as part of Center for Education and Research on Toxics vs. Starbucks Corporation ^[76], a California Superior Court judge ruled that coffee must carry a ‘Proposition 65’ cancer warning due to the presence in coffee of acrylamide, a carcinogen formed during the roasting process. The “Safe Drinking Water and Toxic Enforcement Act of 1986”, commonly known as Proposition 65 “requires businesses to provide warnings to Californians about significant exposures to chemicals that cause cancer, birth defects or other reproductive harm” ^[77]. Coffee retailers, including Starbucks, must clearly display signs in their stores which state that coffee, baked goods and other products contain acrylamide. For reference, ready-to-drink coffee has been found to contain 6.25 μg of acrylamide per 250 g ^[78] and coffee is a major contributor to acrylamide exposure, accounting for 39% of total acrylamide exposure in Sweden ^[78]. In comparison, ‘energy drinks’ do not contain acrylamide, although incidentally ‘energy drinks’ typically contain added taurine, a substance which has been found to inhibit the formation of acrylamide ^[79].

As a result of prior lawsuits such as Center for Education and Research on Toxics vs. McDonald’s Corporation ^[80], according to Metzger Law Group “fast food companies in California now give consumers such cancer hazard warnings regarding acrylamide in french fries. The lawsuit also prompted potato chip manufacturers such as Frito Lay to improve their production process to reduce the acrylamide content of their potato chips to safe levels” ^[81], which suggests that reducing acrylamide in coffee is equally achievable. Denmark-based biotech company Novozymes has developed Acrylaway, a form of the enzyme asparaginase, which is capable of reducing acrylamide content in coffee by over 60% ^[82].

Psychoactive components of cacao

Cacao is often overlooked as a source of caffeine and experiences perhaps the least stigma surrounding its use, as its consumption is promoted even in childhood; cacao products, including chocolate milk, bars, confectionery, and breakfast cereals, are specifically marketed towards children. Although the caffeine content of cacao is lower than that of coffee, tea, and ‘energy drinks’, the total methylxanthine content of cacao is high. Theobromine is another methylxanthine found alongside caffeine in cacao, which, like caffeine, is also a diuretic and “has a significantly stronger diuretic effect than caffeine” ^[83].

A 44 g bar of milk chocolate (USDA standard bar size for milk chocolate) contains 99 mg of total methylxanthines ^[84], according to USDA data. When children reach adulthood, they are expected to ‘graduate’ to dark chocolate, which contains even more theobromine and caffeine than milk chocolate. A 44 g bar of dark chocolate (70–85% cacao solids) contains 388 mg of total methylxanthines ^[85]. Hot cocoa contains 175 mg of methylxanthines per 250 g ^[86], a significantly higher methylxanthine concentration than Red Bull. Unsweetened cocoa powder contains only 230 mg of caffeine per 100 g but contains 2,057 mg of theobromine per 100 g ^[87]; ‘alkalized’ cocoa powder contains less caffeine but contains more theobromine, at 2,634 mg of theobromine per 100 g ^[88]. On the basis of weight, consumption of cacao products could potentially lead to higher total intakes of methylxanthines than coffee or tea consumption; whereas coffee, for example, is usually consumed as one or two teaspoons of coffee powder dissolved in water, cacao is mixed with cacao butter, sugar and flavorings to mask its bitter taste, enabling it to be consumed in greater quantities.

Anandamide in cacao

Anandamide is an endogenously produced cannabinoid (endocannabinoid) which also occurs naturally in cacao, contributing to its psychoactive effects. Samples of cocoa powder and chocolate have been found to contain as much as 90 μg of anandamide per gram ^[89]. This means that a 44 g bar of chocolate, containing 85% cocoa solids, could potentially contain 3.37 mg of anandamide, as well as other N-acylethanolamines, such as N-oleoylethanolamine and N-linoleoylethanolamine, which “could act as cannabinoid mimics either directly (by activating cannabinoid receptors) or indirectly (by increasing anandamide levels)” ^[89]. Cacao products have also been found to contain as much as 6 μg of oleamide per gram ^[90], “a sleep-inducing substance that inhibits the hydrolysis of anandamide” ^{[90, referencing Cravatt et al., Science, 1995, Mechoulam et al., Nature, 1997, and Bisogno et al., European Journal of Biochemistry, 1998]}. Bruinsma and Taren note that “elevated brain anandamide levels could magnify the sensory properties of chocolate that are fundamental to craving” ^[91].

Biogenic amines in cacao

Cacao products also contain significant quantities of biogenic amines, including serotonin, tryptamine, tyramine, and phenethylamine. Phenethylamine, “a neuromodulator of brain synapses, is structurally and pharmacologically similar to catecholamines and amphetamine” ^{[91, referencing Michener and Rozin, Physiology Behavior, 1994, and Sabelli and Javaid, Journal of Neuropsychiatry, 1995]} and “is pharmacologically active and … stimulatory when administered” ^{[91, referencing Sabelli and Javaid, Journal of Neuropsychiatry, 1995, and Philips and Robson, Neuropharmacology, 1983]}. Milk chocolate has been found to contain as much as 27.2 μg of serotonin per gram ^[92] and 6.6 μg of phenethylamine per gram ^[92], equivalent to 1.2 mg of serotonin and 290 μg of phenethylamine per standard 44 g bar of milk chocolate. Bruinsma and Taren add that “craving for chocolate may be an attempt to self-regulate brain phenethylamine level” ^[91].

The presence of caffeine and other psychoactive substances in cacao products blurs “the once distinct line between foods and drugs” ^[91]. Chocolate flavoured varieties of staple products (i.e. chocolate milk as opposed to plain milk) increase the dependence-forming potential of these foods and create confusion as consumers might falsely attribute the psychoactive effects of methylxanthines, biogenic amines and anandamide to feelings of nourishment. Bruinsma and Taren note that “chocolate consumption may be motivated in some part by magnesium deficiency” ^[91], owing to the high magnesium content of cacao products; they add that “because chocolate is generally consumed in an extremely sweet form, it has been suggested that chocolate preference may be confounded with preference for sugar” ^[91].

From this perspective, ‘energy drinks’ are a safer version of traditional caffeinated beverages because they lack these additional psychoactive compounds. ‘Energy drinks’ such as Red Bull also have higher levels of the B vitamins niacin, pantothenic acid, pyridoxine and cobalamin ^[20] than brewed coffee or black tea. ‘Energy drinks’ are to tea and coffee as vaping is to smoking: a less harmful, but not harmless, alternative.

Remove coffee bars from our schools

Concerningly, Costa Coffee, through an agreement with foodservice company Sodexo, operates coffee bars in over seventy schools ^[96]; the decision by schools to permit the installation of a coffee bar within the school sends a message to students that coffee and tea consumption is established and approved of by adults. At the time of writing, Coca Cola is in the process of acquiring Costa Coffee ^[97], which would enable Coca Cola to compete directly against Starbucks and Caffè Nero. This acquisition combined with the launch of its Honest Coffee line gives Coca Cola a powerful presence in cafés, supermarkets and schools.

Caffeine and theobromine content labelling for all products

Regardless of whether the proposals become law, caffeine content labelling should be required for all products, regardless of the source of caffeine. Caffeine content labelling is a reasonable and effective measure which would enable consumers to make an informed purchase. The stated caffeine content should be based on genuine values obtained through analysis of samples of each batch, rather than calculated from standard reference databases. As the caffeine and acrylamide content of coffee can be influenced by the roasting process, the requirement to test every batch would likely reduce the practice of in-store roasting, with roasting instead carried out at a central facility where testing equipment is present.

We expect the same basic safety regulations for other natural sources of legal psychoactive substances; for alcoholic drinks, ethanol content must be stated on the label as ‘alcohol by volume’; for tobacco products such as cigarettes, the nicotine, tar and carbon monoxide content must be stated on the label and furthermore these levels are limited by law in the European Union ^[98]. The limiting of nicotine, tar and carbon monoxide levels in cigarettes establishes a precedent for the limiting of active ingredients in a natural drug, such as the limiting of caffeine in coffee. European Union Regulation 1169/2011 requires confectionery and beverages containing certain amounts of glycyrrhizinic acid derived from the liquorice plant Glycyrrhiza glabra to bear the following statement: “contains liquorice – people suffering from hypertension should avoid excessive consumption” ^[7]; this further demonstrates that the requirement for a natural product to bear a warning statement is not unprecedented.

Limit the caffeine content of coffee, tea, cacao, and other natural sources of caffeine

Under the current proposals, restricted ‘energy drinks’ (greater than the lower limit of 150 mg of caffeine per litre) could still contain an effectively unlimited concentration of caffeine. As an alternative or a complement to age-restriction, the government could place an upper limit on the concentration of caffeine permitted in foods and beverages. In Australia and New Zealand for example, the caffeine concentration of beverages is limited by law, whereby “cola-type drinks” must contain no more than 145 mg of caffeine per litre ^[99] and “formulated caffeinated beverages” (FCBs) must contain no less than 145 mg of caffeine per litre and no more than 320 mg of caffeine per litre from all sources, including guarana ^[100], although tea and coffee are exempt from all limits and labelling requirements ^[62], as in the EU. Having different requirements for ‘cola’ and ‘FCBs’ attempts to create a clear distinction between two different classes of product. Establishing a caffeine concentration upper limit of 320 mg per litre (equivalent to 80 mg per 250 ml, the same caffeine concentration as Red Bull) could help to limit the severity of caffeine overdoses among adults, as well as among children who have managed to obtain access to restricted beverages. Unless an exemption is made, a caffeine concentration limit would also effectively prohibit the sale of ‘energy shots’, products which contain large doses of caffeine in a small quantity of liquid, for example, “5-Hour Energy”, which contains 200 mg of caffeine in a 57 ml shot ^[101].

Although coffee and tea are exempt from Australia and New Zealand regulations, applying caffeine concentration limits to natural sources of caffeine such as coffee, tea and cacao would still be possible. Limiting the level of caffeine in coffee and tea could be somewhat controversial because the quantity of tea or coffee used in manufacturing can be integral to the beverage’s flavour; however, doing so is technically and economically viable, with decaffeinated coffee being a testament to coffee manufacturers’ ability to maintain coffee flavour and aroma while reducing caffeine content. Espresso coffee variants would be effectively prohibited as these can contain several grams of caffeine per litre. Rather than viewing this as a limitation on business, from an innovation and public health perspective it presents a tremendous opportunity. Limiting the concentration of caffeine in natural products would require retailers to be more careful when sourcing tea and coffee, and cafés such as Starbucks and Costa Coffee would have to implement identity verification in their stores, in order to serve adults. However, businesses would not lose out on revenue from younger customers. Several options are available:

• Low-caffeine cultivars: businesses opt for varieties of tea and coffee which are naturally lower in caffeine. This could also lead to the development of selectively-bred or genetically-engineered low-caffeine varieties of coffee and tea plants. A variety of Coffea arabica in Ethiopia was found to be “almost completely free of caffeine” ^[102], though it still contains significant quantities of theobromine. Furthermore, a species of coffee known as Coffea charrieriana is naturally caffeine-free ^[103].
• Substitutes: the flavour and aroma of coffee is easily replicated through coffee substitutes made from roasted grains such as barley, malted barley, rye, and wheat, from roasted roots such as chicory, beet and dandelion, and even from roasted soybeans; these popular caffeine-free alternatives to coffee are already available on the market. Barley-based coffee substitutes are popular among children in Italy, with products such as Orzo Bimbo ^[104], which translates to “baby barley”, marketed specifically for children as a caffeine-free coffee substitute. Substitutes for tea made from herbs and flowers such as rooibos, hibiscus and chamomile are already available on the market.
• Blend: the aforementioned coffee substitutes can be added to ground coffee to reduce the concentration of caffeine. During coffee shortages such as in wartime, ground coffee was often adulterated with coffee substitutes. Grains, roots and beans are significantly cheaper than coffee beans, potentially meaning greater profit margins for these products.
• Decaffeinate: use partial decaffeination to reduce the caffeine in tea and coffee products. This could lead to innovations in decaffeination technologies.

Standardised concentrations of caffeine in ready-to-drink coffee and tea products would make these products more reliable for consumers who are sensitive to caffeine or trying to monitor their caffeine intake. Standardised caffeine content would help to prevent caffeine overdoses and would take dangerously high-caffeine varieties of coffee off the market. Promotion of grain, bean and root-based coffee substitutes would benefit the UK economy as these products could be produced domestically, whereas coffee is always imported from overseas.

Maximum dose per unit sold

Rather than limiting the caffeine concentration of prepared and ready-to-drink beverages, a simpler way to regulate the caffeine content of coffee and tea would be to limit caffeine content by serving size or by package instead. For example, a maximum dose of 200 mg of caffeine could be established, based on EFSA’s conclusion that “single doses of caffeine up to 200 mg from all sources do not give rise to safety concerns for the general healthy adult population” ^[15], meaning that, for example, a 200 ml can of iced espresso, an instant coffee pod, a 500 ml can of ‘energy drink’, a 250 ml bottle of iced coffee, and a 1 litre bottle of iced tea could each only contain a maximum of 200 mg of caffeine. This would enable espresso coffee variants to be sold, if the prepared shot of espresso contains no more than 200 mg of caffeine.

Restrictions on the sale of unprepared coffee, tea, and cacao

If restrictions are placed on ready-to-drink and prepared caffeinated beverages, it would be necessary to age-restrict the sale of unprepared caffeinated products such as coffee beans, ground coffee, instant coffee, tea bags, tea leaves, and cacao beans; these products would remain unrestricted under the current proposals. As dry products such as instant coffee are sold in bulk quantities, often equivalent to months worth of coffee at standard rates of use, keeping these products unrestricted creates a loophole whereby children would be prevented from accessing ready-to-drink and prepared beverages (where the caffeine concentration is controlled and standardised on a per-product basis at least) but simultaneously be able to access caffeine in the aforementioned dry forms in bulk quantities. By restricting access to ready-to-drink beverages alone, children would be incentivised to purchase dry tea and coffee in bulk and create their own beverages at home, where the caffeine concentration cannot be controlled. This could potentially lead to greater dependence on caffeine and increases in caffeine overdoses.

Of particular concern are sachet-based products, such as sachets of instant coffee and products such as Starbucks VIA Instant Refreshers, a flavoured instant beverage containing 50 mg of caffeine per sachet ^[105]. As these products lack the water weight of ready-to-drink beverages, they could easily be traded in schools; additionally there is no control over the quantity of water used to dissolve the sachet and therefore no control over the caffeine concentration of the final beverage. A child could dissolve the sachet contents in less water than is recommended, creating a beverage with a much higher caffeine concentration, akin to a shot of espresso. Similarly, a child could dissolve two or more sachets in the same quantity of water, creating a beverage with double the caffeine content.

Resealable packaging

As a complement to child-resistant packaging, the government could require that caffeinated products be sold in resealable enclosures. Beverages sold in non-resealable enclosures with openings, such as metal cans with stay-on tabs and disposable cups with vented lids, can easily spill through these openings; if carbonated, these openings cause the beverage to quickly lose carbonation. These characteristics encourage the consumer to finish the beverage quickly in one sitting, as they are unable to reseal the product. The ability to close the beverage and drink the rest later would reduce the amount of caffeine consumed within one sitting, regardless of the age of the consumer.

Plain packaging

Australia, the United Kingdom, and numerous other countries have adopted regulations requiring plain, standardised packaging for tobacco products. The lack of colour and branding in combination with large pictorial health warnings is intended to make tobacco products less appealing, thereby reducing consumption. Such requirements for caffeinated products would be disproportionate in relation to the low number of deaths associated with caffeine consumption ^[38]; however, plain packaging for caffeinated products would make these products far less visually appealing to children. Regardless of whether the proposals become law, a child would still be able to access caffeinated products at home, by consuming products purchased by an adult who neglected to keep them out of the child’s reach. Whereas age restrictions only prevent access at the point of sale, plain packaging discourages consumption at the point of use, long after the product has been purchased.

Minimum unit pricing

Minimum unit pricing for caffeinated products could also be implemented, similar to the Scottish government’s approach to minimum unit pricing for alcoholic beverages ^[110]. For instance, a minimum price of £1 per 200 mg of caffeine could be implemented, which would prevent the sale of cheap ‘energy drinks’, such as the “4 for £1” multibuy deals mentioned in the government’s impact assessment ^[11]. With minimum pricing in effect, purchasing four cans of ‘energy drink’ would cost at least £1.60. A standardised package of instant coffee (containing the suggested maximum 2,800 mg of caffeine) would cost at least £14.