Story ID: 366
AINsight: Energy Drinks and Flying
By: Robert Sancetta
Caption: Do your research on what you consume because energy drinks are unregulated and the impact of use are raising concern.
Word Count: 1247
Energy Drinks have become popular in many parts of society across a wide range of age groups, and certainly among pilots. This popularity raises the need to discuss pilot responsibility for what they put into their bodies.
Energy drinks can now be bought just about anywhere, from grocery stores to convenience stores to vending machines in airports and FBOs. They are unregulated and contain many ingredients that I have never heard of. But rather than praise or disapprove of their consumption, instead, my focus is on reminding pilots that there may be dangers in doing so. A pilot needs to be responsible for anything consumed, as the ethics of FAR 61.53 require a pilot to understand whether he/she is fit to fly at any given time, and to self-ground if there are any concerns about personal airworthiness.
To boost energy, given that there are no proverbial magic bullets to do so, energy drinks often contain large amounts of sugar and caffeine. There is often significantly more caffeine in an energy drink than there would be in a simple cup of coffee.
The other components of energy drinks are too numerous to list, but a simple search of the ingredients can raise alarming concerns. And, yes, people have died consuming energy drinks that remain popular and on the market. In 2019, the Food and Drug Administration (FDA) investigated more than 30 deaths that occurred likely as a result of energy drink consumption.
Also in 2019, an article in the Journal of the American Heart Association stated that “energy drinks have been linked to an increase in emergency room visits and deaths.” Numerous cardiac risks to energy drink consumption were discussed in the peer-reviewed journal article.
The stimulant properties of these drinks can raise blood pressure and therefore increase the risks of heart attack and stroke. For those pilots already at some risk for irregular heartbeats (such as atrial fibrillation), energy drinks could precipitate an event that may cause incapacitation in that pilot. Energy drinks were noted to change aspects of electrocardiograms (ECG) that can precipitate an irregular heartbeat, along with other serious complications. They can also promote anxiety and irritability. At least one component, when taken in high quantity, has been known to precipitate seizures.
As a former international corporate and airline pilot myself, I too understand the struggles of staying awake and alert during a long duty day. Paradoxically, there is then the need to go to sleep afterward as the pilot may have “minimum rest” after a long duty period.
One of the other problems that energy drink consumption potentially can create is that of insomnia. You can stay awake when on duty, but then you can’t sleep afterward. The pilot remained awake during a long duty period both due to the stress hormones that are naturally secreted by the endocrine system and as a result of energy drinks or simple caffeine consumption in coffee.
The frustration is that, when arriving at a hotel, often dead tired, the pilot cannot fall asleep. The naturally-occurring stress hormones and the stimulants consumed during flight conspire against the pilot’s ability to get to sleep. 
There are also ongoing questions as to whether the waking state promoted by the energy drink actually improves cognitive performance.
What is a pilot to do to combat insomnia that resulted from consumption of stimulants during the duty period?  The FAA frowns on pilots taking sleep-promoting substances during short rest periods (either prescription or over-the-counter), but that is a topic for a separate discussion in the future. There are very specific protocols for which sleep-inducing agents are approvable for pilots, and what specified waiting periods must elapse before flying.
What is the FAA’s stance on energy drinks? The FAA doesn’t have much of one, given that these drinks are unregulated. The FAA is very clear, as is the FARs, on which substances of abuse a pilot cannot consume. However, it is impossible to provide specific rulings on the multitudes of unregulated yet legal drinks and other supplements that are easily obtainable on the open market.
Can the AME or the FAA guarantee that a pilot would not test positive for some banned substance on a DOT test after consuming an unregulated product such as an energy drink? That is impossible to do. There is not sufficient research that is specific to the potential cross-reactions on DOT testing for all of the components of these types of products.
Could a stimulant contained in an energy drink cause a DOT-positive test? There have been internet posts that they might, but I personally have not seen any cases in my AME practice of a positive test for amphetamines, for instance, as a result of energy drink consumption.
But who wants to risk their career by being the “index case” to prove that a legal substance ingested caused a false positive on a DOT test? This must then be fought through legal channels and the complicated and extensive FAA medical process.
This theoretical risk brings up another point that is indeed germane to this discussion. There have been DOT-positive tests for THC (the mood-altering substance in marijuana) from the consumption of CBD products.  
A DOT-positive test is just that—a positive test. The FARs were written long before there were any state-by-state legalizations of marijuana (which is still illegal on a federal level), and long before there were any CBD products.
CBD is all the rage these days, supposedly alleviating arthritic symptoms and possibly promoting sleep, among many other theoretical benefits to its use. The problem is no different than energy drinks: these are unregulated substances.
There are CBD products that supposedly guarantee that no THC is included. One of the pilots who I am working with right now unfortunately tested positive for THC after taking a CBD product that made that “no THC” guarantee to him.
A pilot who tests positive for a banned substance faces the specter of losing medical and usually also pilot certificates. Even if it can be proven that the ingestion of the banned substance was incidental or accidental, the pilot still faces revocation of certificates and a long, expensive, and stressful road towards regaining them. 
Without trying to sound overly alarmist, consuming unregulated substances that promote energy, sleep, and/or relief from arthritis, among others, puts a pilot’s career at risk. I am not saying that all unregulated substances are harmful and should be avoided at all costs.
On the contrary, we are all adults, and pilots must make the decisions that are best for their individual circumstances and baseline health status. I am only reminding pilots that they potentially put their careers at risk when consuming unregulated substances. Do your research.
I am, however, offering a bit of caution specifically regarding the consumption of energy drinks themselves. In my opinion, the risks may very well outweigh the benefits of consuming them.
The opinions expressed in this column are those of the author and not necessarily endorsed by AIN.