Natural ingredients aren't always harmless.
Even the most pure substances, such as water, can be dangerous if too much is ingested.
In 2007, a woman died from water toxicity after participating in a Sacramento radio contest. The 28-year-old mother of three entered the "Hold Your Wee for a Wii" competition, where the goal was to drink as much water as possible without urinating to win a Nintendo Wii game console.
She died just hours after the contest.
Like water and salt, vitamins are a daily part of most people's lives and are necessary for body function at healthy levels.
What is niacin?
Niacin, also known as vitamin B3, is a water-soluble vitamin that occurs naturally in humans, plants and animals. It can be used to lower cholesterol and help prevent heart attacks in people with high cholesterol. It can also be used to treat coronary artery disease, according to Drugs.com.
Peanut butter, seafood and beef liver contain high amounts of niacin and shouldn't be an issue if taken in moderate portions.
Niacin is a common ingredient in most energy drinks and is found at high levels in the beverage. This is normally overlooked by consumers because it's often labeled as a 'natural ingredient'.
Niacin helps convert food into energy which is why it's used in the beverages.
When niacin levels become too high, it's dangerous.
Catching a case of vitamin B3
A 50-year-old man who was previously healthy, was recently hospitalized after experiencing abdominal pain, nausea, vomiting, yellowing of the skin and other symptoms uncharacteristic of his normal health.
The man said he wasn't on any prescription medications or other drugs or alcohol, but told doctors he'd been drinking 4 to 5 energy drinks a day for the past three weeks, according to a BMJ case report.
Doctors concluded the man had acute hepatitis, with an underlying chronic hepatitis C (HCV) infection. Acute hepatitis develops into HCV which causes liver damage.
The man claimed he'd gotten a tattoo in his 20s but had never received a blood transfusion or engaged in high-risk sex, both common ways of getting hepatitis, according to the report. He also had no family history of liver disease but showed liver damage.
After ruling out all causes of the infection, doctors found energy drinks to be the cause of liver damage, according to the report.
How are energy drinks linked to hepatitis?
The high levels of niacin in energy drinks can be toxic. Niacin is the only ingredient in most energy drinks directly linked to hepatotoxicity, which is drug-induced liver damage normally presented as hepatitis.
The case report said each one of the man's energy drink of choice contained 40 mg of niacin, or 200 percent of the recommended daily value. Multiply that by the four or five drinks he was consuming a day, and it reaches thousands of times the safe guidelines per day.
ABC10 called the California Poison Control information line and asked about niacin. A poison control expert explained although niacin overdoses are almost unheard of, it's very common for people to get the 'niacin flush'.
People who take niacin pills for cholesterol control or other health reasons can sometimes turn bright red and experience a rising body temperature with sweating and itchiness.
Niacin flush is much less severe than the damage which can be caused by the levels of niacin found in energy drinks, especially if numerous drinks are being consumed every day consistently like in the case report.
According to the report, people should be educated and aware of the potential risks of hepatotoxicity with the overconsumption of niacin-loaded energy drinks, even if it's rare.
Who regulates energy drinks?
The U.S. Food and Drug Administration (FDA) regulates energy products under the Federal Food, Drug, and Cosmetic Act (the FFDCA) but manufacturers label some as dietary supplements and others as conventional foods. The requirements are different for both.
Dietary ingredients, or the 'active ingredient' in dietary supplements require no FDA preapproval.
Niacin is approved and regulated by the FDA.
Niacin levels are stated on beverage labels so consumers can be aware of what they're ingesting and how much of a substance is in a drink.