Health Committee on June 8th, 2010

[The Chair, Conservative, Joy Smith]

Good morning, everybody. Welcome to the health committee this morning.

I'm so pleased that our witnesses are here with us this morning.

Today is going to be a very interesting day. I have to tell you that because of the number of witnesses we have this morning, we will have five-minute presentations, and you'll have to forgive me, but I will be paying very close attention to the time. I will have to leave briefly to go into the House to table a report at a quarter to 10, at which time Ms. Murray will be taking the chair until I return.

Following that, we do have committee business. We will be adjourning this part of the committee at a quarter to 11 to finish off our committee business, our housekeeping things like budgets and things like that.

So we welcome you today, pursuant to Standing Order 108(2), on the study of Health Canada's authorization of the broader use of caffeine as a food additive in all carbonated soft drinks.

First of all, I'd like to hear from the Department of Health.

Mr. Godefroy, please.

[Dr. Samuel Godefroy, Director General, Food Directorate, Health Products and Food Branch, Department of Health]

Good morning, Madam Chair and honourable members. Thank you for giving us the opportunity to come before the committee today to discuss Health Canada's recent authorization of the broader use of caffeine as a food additive in carbonated soft drinks.

As a food safety regulator, Health Canada is responsible for setting regulations, policies, and guidelines that help ensure the safety of Canada's food supply. The Food and Drug Regulations require certain substances used in food, such as food additives, to undergo a thorough safety and efficacy assessment before they can be added to foods allowed for sale in Canada.

It is only when Health Canada scientists are satisfied that food additives would not pose a risk to Canadians' health that Health Canada would recommend their use under specified conditions.

In parallel, the Department aims at providing Canadian consumers with the information they need to follow a balanced diet and make healthy food choices as part of its mandate to protect and maintain the health of Canadians.

Synthetic forms of caffeine used in some carbonated drinks are regulated as a food additive under the Food and Drug Regulations. This means that a new use would require a submission made to Health Canada and a thorough safety assessment by Health Canada scientists before it is permitted.

Until recently, synthetic caffeine could only be added to cola-type beverages up to a maximum of 200 mg/Litre under the Food and Drug Regulations.

Due to a number of food additive submissions received by Health Canada for the expansion of use of synthetic caffeine to non-cola soft drinks, Health Canada conducted a detailed safety assessment of caffeine in carbonated soft drinks. This assessment took several years and concluded that expanding the permitted use of caffeine as a food additive to non-cola carbonated soft drinks up to a maximum of 150 milligrams per litre would not pose a health risk to consumers.

In reviewing these food additive submissions, Health Canada scientists conducted a thorough assessment of the possible toxicological effects of caffeine as well as the various exposure scenarios that correspond to the Canadian context.

The toxicological assessment confirmed that caffeine exhibits a number of biological effects resulting from its diuretic and stimulant properties. Scientific research also has shown that some sensitive individuals experience side effects such as insomnia, headaches, irritability, and nervousness. These effects are, however, transient and would cease when caffeine consumption is stopped.

As a result of this assessment, Health Canada scientists established that the average adult can consume as much as 400 milligrams of caffeine per day without any adverse health effects. This would equate to approximately three to five cups of coffee per day--again, depending on the way it is made or brewed--or about eight cans of cola or diet cola per day--again, not that Health Canada would recommend that level of consumption of this type of beverage.

Health Canada's evaluation has also determined that children, adolescents and women of childbearing age may be at greater risk from caffeine intake. As a result, Health Canada developed specific recommendations for these individuals.

Our scientists continue to review new research findings to ensure that recommended daily caffeine intake levels are based on the results of the most up-to-date scientific evidence.

On the labelling front, it is currently a regulatory requirement for the label on most prepackaged foods to declare a list of ingredients, including food additives such as caffeine, in descending order of proportion. However, there is no regulatory provision for mandatory quantitative labelling of caffeine, that is, the number of milligrams of caffeine per stated serving size.

To mitigate any confusion this expanded use could create among consumers and to provide Canadian consumers with tools to enable them to make informed choices, Health Canada has recently issued a guidance document requesting that food manufacturers indicate on product labels the total caffeine from all sources that is contained in a product.

Quantitative labelling of caffeine--

[The Chair, Conservative, Joy Smith]

I have to ask you to please wrap up, because the time is going, Dr. Godefroy.

[Dr. Samuel Godefroy]

I'm actually almost done.

The quantitative labelling of caffeine will provide consumers with information they can use to more accurately determine daily caffeine consumption.

Health Canada will be monitoring the labelling practices of industry in this regard to assess whether regulatory action is required. After such an evaluation, the Department will examine the need to impose these labelling requirements through regulations.

Thank you, Madam Chair.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Godefroy.

We'll now go to Mr. Shepherd.

[James Shepherd, As an Individual]

Thank you.

Good morning.

I would like to thank the members of this committee for inviting me to follow up on the research paper into the questionable nature of energy drinks, which I sent in March 2010.

In one 12-hour period from 7:30 a.m. to 7:30 p.m. on January 6, 2008, I lost a vibrant, healthy, and much-loved 15-year-old son. My son, Brian, died from an unexplained arrhythmia several hours after being witnessed drinking a Red Bull energy drink given to him in a free handout by Red Bull representatives.

I buried him. And then I did some research. I learned. And I learned a lot. I learned that my late son's death is one of an ever-growing number of deaths for which no one can find a definitive cause of death.

But given the intake of an energy drink the day he died, I suspect that energy drinks were at least a contributing factor to his death, if not the whole cause. I'm disheartened by the information I've learned since Brian's death and I tried to distill the essence of my research in a paper that I submitted to this committee in March 2010.

Let me take you through some material by Refreshments Canada, an umbrella group for a wide variety of beverages, including some energy drinks. I will quote from the material.

Claim number one states, “Energy drinks are currently sold in every major regulatory jurisdiction and in more than 150 countries around the world”. It says, “Health authorities and scientific expert panels in these various jurisdictions around the world have assessed energy drinks and their ingredients and have concluded that energy drinks are beverages that can be safely consumed”. False.

Claim number two states, “Energy drinks are formulated and recommended for adults”. False.

Claim number three states, “...our members fully support the International Council of Beverages Association's guidelines regarding marketing and children that were adopted in 2008. The ICBA guidelines permit no marketing or advertising of beverages other than water, fruit juice, and berry-based beverages, to children less than 12 years of age”. False.

Claim number four states, “Energy drinks are non-alcoholic beverages and are not recommended to be mixed with alcohol”. Intentionally misleading.

You'll find an addendum at the end of these remarks that lists the sources I used for this section.

My main goal is to protect youth by keeping these products out of the hands of minors. How? By banning sales to minors, by placing restrictions on the advertising and marketing of energy products, and by creating regulations that allow regulators to take potentially unsafe products off the market immediately.

Recently, Health Canada allowed the further use of caffeine in more soft drinks, a drug that leads to addiction and dependence. I remember when, decades ago, some courageous and discerning individual started to examine cigarette smoking with regard to a possible link to cancer. I'm going out on a limb here; I predict that there is a parallel between the past questioning of cigarette smoking and the present challenge to an increased use of caffeine. We will never be wrong if we act with what is called “an abundance of caution”, especially where children are concerned.

The methods we used in the past have proven ineffective at making positive change in our society. What are these methods? Essentially, waiting until enough harm has occurred before we act.

Instead, let's act on what could be called the “just in case principle”. When something threatens harm, even though there's no definitive proof, we take precautions just in case.

I ask this committee to carefully consider my energy drink concerns and return to Parliament with strong recommendations: one, to stop the abusive marketing and advertising to youth; two, to ensure that mistaken regulations like allowing the injection of caffeine in more soft drinks than in the past be changed and that unenforceable regulations are replaced; and three, to inspire your provincial counterparts by taking the lead in banning the sale to minors.

Please work together regardless of party affiliation. Start by reversing the decision to allow the broader use of caffeine in all carbonated soft drinks. This can only lead to the further demise of health in our children. I promised my late son that I would continue to advocate for change until our youth are safe. I hope that you will make my promise your promise.

I'm available to this committee at any time. I thank you for your patience and your courtesy.

[The Chair, Conservative, Joy Smith]

Thank you, Mr. Shepherd, for giving us that presentation today. I know it must have been hard for you to do, but thank you for being here today.

We'll now go on to Dr. Lamont Sweet, deputy chief health officer of the Department of Health and Wellness.

Welcome, Dr. Sweet.

[Dr. Lamont Sweet, Deputy Chief Health Officer, Department of Health and Wellness, Government of Prince Edward Island]

Thank you very much.

I will summarize because of the time restrictions. Thank you for inviting me.

I am concerned about the so-called energy drinks being sold in Canada. I will focus mainly on what happened in Prince Edward Island in 2008, including the negative reaction and our attempts to address the issue, and I will make some overall comments.

On May 3, 2008, the P.E.I. government lifted the ban on the sale of canned soft drinks in the province and suddenly the energy drinks appeared across the province. Almost immediately, teachers in schools noted students becoming hyperactive, agitated, and unable to concentrate.

The beverage industry initiated a campaign by providing refrigerators to stores and pharmacy owners in return for their stocking them with energy drinks. A local wrestling match featured a lethargic wrestler who consumed a can of energy drink, was suddenly revitalized, and vigorously overcame his opponent.

A review was conducted by the public health division of the Department of Health and we found some disturbing items. The classification as “natural health products” seemed inappropriate. Their concentration of caffeine is enormous compared to the cola drinks, leading to possibly toxic amounts that would not be expected in a natural food.

They were sold as energy drinks. Is the sugar content or caffeine in these drinks safe? Could they be mistaken for hydration liquids? Will the sugar content lead to further problems in Canada with obesity and being overweight? Caffeine leads to dependency or is addictive. Does the industry now substitute the nicotine of the tobacco industry with the caffeine in these drinks?

Mixing alcohol and energy drinks is a concern. Alcohol is a depressant and causes drowsiness, while caffeine is a stimulant and keeps people awake. The result is obvious: people can stay awake to consume more alcohol up to the time when they can have injury or toxic effects.

As I said, school performance is decreased with these energy drinks. Also, sudden unexplained death is a major concern, because caffeine can cause heart irregularities both in normal hearts and in abnormal hearts. Upon autopsy, there are no specific findings as to whether the heart rate has been the cause of death. It is very difficult to measure caffeine levels after death and to come to any definite conclusions. The peak levels can occur 30 minutes after ingestion of caffeine, but as for when the heart rate becomes abnormal, that is something we don't know.

We have a major concern about these fatalities. We are trying to establish a system to get some reliable means of correlating them. In our province, we have to send out tests for levels of caffeine. In P.E.I. the school boards have prohibited the sale of energy drinks in the school and prohibited their being brought onto the property. The medical society has called for a ban on these energy drinks for children and youth. The coroner is asking about energy drink consumption in any unexplained death of a child or young adult, and we are trying to get caffeine levels done after unexplained deaths.

Our recommendations to Health Canada follow.

The monitoring of energy drinks and their classification as a natural health product have provided virtually no assessment of the safety of these beverages, particularly in the high concentrations that are being consumed. The small labelling wording is not of any help in keeping energy drinks out of the hands of children.

With regard to the Public Health Agency of Canada and medical health officers of Canada, we would recommend that there be wider health involvement and input into the regulations for energy drinks, that the dieticians and the nutritionists of Canada be involved, and that the Public Health Agency of Canada coordinate an effort to facilitate communications to the relevant divisions of Health Canada.

Coroners across the country need to be aware of the possibility of sudden death and ask about the consumption of these energy drinks, and there needs to be a national monitoring program.

[The Chair, Conservative, Joy Smith]

Dr. Sweet, I'm sorry, but your time is up.

[Dr. Lamont Sweet]

Thank you.

[The Chair, Conservative, Joy Smith]

A closing sentence would be fine, if you choose to do that, one sentence.

[Dr. Lamont Sweet]

Yes. That would be fine.

We are saying that we think it's a major problem, that serious effects can possibly occur because of these drinks, and that we have major concerns. We need help in order to control the sale of these energy drinks in Canada.

[The Chair, Conservative, Joy Smith]

Thank you.

We'll now go to Ms. Lyse Lefebvre, pharmacist and scientific consultant, environmental health and toxicology, Institut national de santé publique du Québec.

[Lyse Lefebvre, Pharmacist and Scientific Consultant, Environmental Health and Toxicology, Institut national de santé publique du Québec]

Madam Chair, Members of the House of Commons, thank you for having me.

Caffeine is an alkaloid methylxanthine, which is probably the most consumed psychostimulant in the world today. It is found everywhere: in tea leaves, in coffee beans, in yerba mate leaves and in guarana seeds. Caffeine is contained in many natural substances, but it is mainly found in consumer products, such as carbonated drinks, energy drinks, chocolate and candy. Last week, I even read that caffeinated flavoured water will be released soon. Caffeine is the main active ingredient in energy drinks. Supposedly, it is added for its stimulant properties.

The amount of caffeine found in food varies widely. People who choose to consume caffeine should not exceed the maximum daily intake recommended by Health Canada, whose main responsibility is the health of Canadians. The recommended maximum intake is 400 mg for adults and 2.5 mg per kilogram for children, that is, very small doses. For children from 1 to 5 years of age, the maximum intake is 45 mg, which is barely more than what a bottle of cola contains.

Consumption statistics show that most Canadian adults do not exceed the recommended maximum intake of 400 mg. The caffeine they consume comes from diverse sources: 60% from coffee, 30% from tea and 10% from various sources, such as cola beverages, chocolate, and so on. However, we already know that children aged 1 to 5 get 55% of their total caffeine intake from cola beverages. That is to say, cola drinks are their main source of caffeine.

The effects of caffeine consumption are numerous. Caffeine improves mental alertness, concentration, reaction time and energy levels. We also know that it raises a person's fatigue threshold and lowers their reaction time. We know that it increases catecholamine secretion, that it improves free fatty acid mobilization and that it increases triglyceride use. We also know that it has cholesterol-related effects and that it improves muscle fibre contraction.

However, we are unable to show that doses found in drinks have systematic effects, aside from that of stimulating the central nervous system. Even moderate consumption can have undesirable effects. Even the caffeine contained in beverages can cause side effects, such as sinus tachycardia, increased heart rate, palpitations, insomnia, restlessness, nervousness, shaking, headaches and abdominal pains, depending on the quantities consumed.

Caffeine is a known, albeit mild, diuretic. By consuming 250 mg of caffeine, a person can experience a significant increase in diuresis. However, caffeine is not a powerful diuretic.

As for caffeine consumption increasing the risk of coronary disease, the available data is still very contradictory. A number of studies on the subject were conducted using coffee that contained substances other than caffeine. Therefore, we cannot rule out the effects of, for instance, diterpenes or chlorogenic acids on heart rate increase.

Hypertension is a major coronary disease risk factor, as are stroke and heart failure. We know that when very high doses of caffeine are consumed, blood pressure can rise, but it then becomes stable with chronic consumption. So, no study has demonstrated a significant difference in blood pressure or an increase in blood pressure in chronic coffee consumers.

Current data shows that moderate caffeine consumption, that is less than 400 mg a day, should not adversely affect the cardiovascular health of the general population. However, we do not possess sufficient epidemiological data to come to any firm conclusions as to the risk of coronary disease or mortality associated with caffeine consumption in excess of 1,000 mg.

Clearly, we are not talking here about acute intoxication. The consumption of carbonated drinks is not expected to cause acute intoxication, since these beverages contain only 15 mg of caffeine per kilogram. Regarding chronic intoxication, we know that chronic caffeine consumption can cause, among other things, a syndrome called caffeinism, which is quite different from caffeine withdrawal syndrome. Caffeinism develops through caffeine consumption.

[The Chair, Conservative, Joy Smith]

Your time is just about up, Ms. Lefebvre. Can you wrap it up now, please?

[Lyse Lefebvre]

To sum things up, the addition of caffeine in carbonated drinks, other than colas, at a rate of 150 parts per million, does not pose a health risk from a strictly scientific point of view, as long as users' total caffeine consumption does not exceed the recommended maximum. However...

[The Chair, Conservative, Joy Smith]

Thank you so much.

Keep in mind that during the questions and answers, if there's some point you want to get across--

[Nicolas Dufour, Bloc, Repentigny, QC]

Excuse me, Madam Chair, but Ms. Lefebvre said “however.” So, we would like to hear the end of the sentence, if possible.

[The Chair, Conservative, Joy Smith]

I'm sorry. She's way over time.

If you want to quickly do it for Mr. Dufour, go ahead, but we are running out of time and it takes away from others.

Go ahead.

[Lyse Lefebvre]

I just wanted to say that it is important to clearly indicate the presence and quantity of caffeine in drinks or food on their labels to help people calculate their daily intake.

[The Chair, Conservative, Joy Smith]

Monsieur Dufour, are you happy today? That's good.

[Voices]

Oh, oh!

[The Chair, Conservative, Joy Smith]

Thank you so much.

We will now go on to Refreshments Canada and Justin Sherwood.

[Justin Sherwood, President, Refreshments Canada]

Good morning, Madam Chair and members of the committee. Thank you for having me here today.

My name is Justin Sherwood. I'm the president of Refreshments Canada. Refreshments Canada is the national association representing the non-alcoholic beverage sector in Canada. Our members produce a variety of beverages, including soft drinks, juices, sports drinks, iced teas, energy drinks, and several brands of bottled water.

Refreshments Canada would like to reaffirm our sector's commitment to producing safe, effective, quality products that meet or exceed all regulatory requirements. No one--not the consumer, not the government, and not the beverage sector--stands to gain through the production of unsafe products.

According to Health Canada, Canadians get an estimated 90% of their caffeine from coffee and tea. The remaining 10% comes from other beverages, chocolate products, and medicines.

The beverage sector utilizes caffeine in two key product categories: in all energy drinks and in some soft drinks.

Caffeine has been used in soft drinks in Canada since the introduction of cola and cola-type beverages. Caffeine levels are regulated and are generally in the marketplace at levels between 25 and 30 milligrams per 250 millilitres. This is roughly a quarter of the caffeine of a 237-millilitre serving of filter-dripped coffee. Caffeine is used in colas and cola-like beverages as a flavouring agent that imparts a certain degree of bitterness within the overall flavour profile of the product.

Prior to March of this year, provisions of the Food and Drugs Act and regulations permitted caffeine in cola-like carbonated soft drinks at levels of 200 parts per million. Following the March decision by Health Canada, caffeine will now also be permitted in other non-cola carbonated beverages at a reduced level of 150 parts per million. Health Canada has asked manufacturers of these beverages to voluntarily declare quantity of caffeine on their labels, and Refreshments Canada and our members are committed to that transparency.

Refreshments Canada is also prepared to partner with Health Canada in a communications strategy to educate consumers on responsible consumption of caffeine and caffeine-containing products, something that we have communicated to Health Canada.

The other product category in which the beverage sector utilizes caffeine in the ingredient profile is energy drinks. Energy drinks are a relatively new product in Canada, entering the market in 2004. Like any new product category, growth rates in percentage terms appear high. However, in absolute terms, the market is very small. In volume terms, in litres, the energy drink segment in Canada is just 0.46% of all commercial non-alcoholic beverages sold in Canada.

Mainstream energy drinks contain approximately 80 milligrams of caffeine per 250-millilitre serving, compared to a cup of coffee that contains anywhere from 118 milligrams to 179 milligrams per 237-millilitre serving. There is a small number of products with higher levels, but they still fall within the caffeine levels of one to two cups of coffee.

Energy drinks are subject to tight controls in Canada relative to the efficacy, safety, and quality of these products, as set out by the NHP regulations. As a matter of law, these products are regulated as drugs. Claims relative to efficacy must be clearly substantiated, safety must be thoroughly investigated, and the quality must be highly controlled, all of which is subject to regulatory review by Health Canada.

I would like to make a few key points on energy drinks. The caffeine levels in energy drinks from all sources, natural or synthesized, are quantitatively listed on the label, as are usage and precautionary statements.

The category has been subjected to extensive review and analysis by regulatory authorities worldwide, including the European Food Safety Authority and Australia. Without exception, these reviews have all confirmed the safety of these products. In fact, in all other jurisdictions, they are regulated as food or food supplements.

The industry takes consumer complaints and spontaneously reported adverse events very seriously. It is for that reason that we recommended to Health Canada and to the minister that a thorough science-based “pharmacovigilance” analysis be undertaken. The industry has already retained independent pharmacovigilance experts to examine the information very recently provided to us by Health Canada. Their preliminary analysis is as follows.

There is no evidence of a causal relationship in any cases that can be used to draw any conclusions. Detection of a safety signal requires a rigorous assessment of evidence that goes well beyond spontaneously reported events to include, for example, background incidences in unexposed populations to put the events into perspective.

In fact, based on the information provided to us, in many cases it cannot even be confirmed that energy drinks were actually consumed; if so, how much; and additionally, the temporal relationship to any event.

My last sentence--

[The Chair, Conservative, Joy Smith]

Mr. Sherwood, your time is up, so please, very quickly.

Monsieur Dufour, is that okay...?