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Dr. Bernard Presser D.C.
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Americans are BIG on caffeine-90% get a jolt in one form or another including coffee, tea, soft drinks, and chocolate. Average caffeine intake is 193 milligrams per day. About 80% of adults drink coffee or tea daily. Over 100 million consume an average of 3.1 cups of coffee each day. Coffee is the primary dietary source of caffeine for most Americans, with soft drinks the second-most common source and tea as third. More people of all ages are consuming caffeine, including children-primarily from carbonated beverages, specialty coffees, tea, and chocolate. Many foods and drinks presumed to be caffeine-free are laced with caffeine (which can cause jitters, anxiety, even vomiting, diarrhea, cramps, and muscle twitching in small children). Caffeine is consumed in larger amounts than alcohol, nicotine, and "any and all other drugs put together." Not only does caffeine occur naturally in the leaves, seeds, or fruits of more than 60 plant species-including coffee, cocoa beans, maté, kola nuts, and tea leaves-but it is separated out and added into everyday foods, drinks, and drugs. Coffee is consumed, not for nutritional value, but for its taste and caffeine. Coffee does contain tiny amounts of chromium, flavonoids, magnesium, niacinamide, serotonin, antioxidants, and phytochemicals. But it is certainly not nutrient-dense. i
The ‘main target' of caffeine is the central nervous system. There is a balancing system in the brain for firing and dampening neurons and message-carrying neurotransmitters to keep the body in relative peace or equilibrium. Caffeine is thought to block some of the agents (especially adenosine) that restrict the neural cells from firing. The nerves increasingly fire and remain more excited. Caffeine may increase the release of epinephrine, norepinephine, rennin, serotonin, and dopamine-chemical messengers involved in stress reactions. The result is that familiar buzz-heart beats faster; breathing increases; mind focuses; reaction time decreases and energy increases. You are definitely awake and alert. Your blood vessels are constricted and your need for sleep is delayed. But why do many people want coffee first thing in the morning when they've just had a night's sleep? Sleep inertia. Some folks have more difficulty than others in making the transition from sleep to wakefulness-it can take up to two hours to really get functioning. Caffeine in coffee helps to jump-start the waking process. ii
The FDA doesn't demand that manufacturers list how much caffeine their products contain, but here's a sampling:
Caffeine Count- in milligrams (mg)
Coffee (8 ounces unless noted): Brewed or Drip 80-200, Instant (1 tspn, dry) 75, Espresso (1 fluid oz) 40-55, Flavored 25-75, Starbucks Coffee Frappuccino 83, Decaffeinated (brewed or instant) 2-5.
Tea (8 ounces): Black 40-120, Green 40, Decaffeinated black tea 4, Iced tea 20-40.
Carbonated beverages (12 fl oz): Cocoa-Cola Classic 34, Diet Coke 45, Barq's Root Beer 22, Pepsi Cola 38, Diet Pepsi 36, Sunkist Orange Soda 41, Surge 51, Red Flash 40, Mountain Dew 55, Mello Yello 51.
Other beverages: Cocoa (6 oz) 2-20, Planet Java (9.5 oz) 65, AMP Energy Drink (8 oz) 77, Red Bull (8.5 oz) 80, KMX Orange/Blue (8.4 oz) 38, SoBe Adrenaline Rush (8.3 oz) 79, Caffeinated Water (12 oz) 60-125.
Foods: Dannon coffee-flavored yogurt (6 oz) 36, Haagen-Dazs coffee ice cream (½ cup) 24, Breyers All Natural Chocolate Ice Cream (½ cup) 3, Baker's chocolate (1 oz) 26, Dark chocolate (1 oz) 5-35, Hershey's Milk Chocolate bar (1.55 oz) 10, Hershey's Genuine Chocolate Syrup (2 Tbs) 5.
Drugs: NoDoz (1 pill) 200, Excedrin (1 pill) 65, Triaminicin cold medication (1 capsule) 30, Anacin or Midol (2 pills) 32, Over-the-counter diet pills (various) 80-200.
Caffeine content of coffee varies greatly, not only between brands or types, but how and where it is made-the type of bean, how the beans are ground, how much is used, the type of machine, the brewing time, and so on. iii
There is a mild, short-term diuretic effect from coffee, so you may urinate a little more and sooner. But you don't end up with a net loss of fluid as the diuretic effect is compensated for by the coffee's water content. What you CAN lose are some minerals such as calcium, magnesium, sodium, chloride, and potassium. Women lose about 5 mg of calcium for every 6 ounces of coffee or 24 ounces of cola consumed-not substantial unless you're already deficient. Caffeine is absorbed from the gastrointestinal tract within 45-60 minutes; 95% of caffeine's metabolism occurs in the liver and the major route of elimination is the kidney. iv
Caffeine has been linked to a host of health problems as well as a plethora of health benefits. And there can be a big difference in its effects when it is part of a whole food rather than when it is separated out as a drug. The health effects of caffeine and coffee have been studied intensively and debated furiously. The controversy still percolates.
CARDIOVASCULAR DISEASES; THE STUDIES SHOW THAT:
Drinking coffee may reduce the risk of heart disease and the number of heart attacks. Drinking coffee may increase the risk of heart disease and the number of heart attacks. There is no link at all between coffee consumption and risk of coronary heart disease. Only heavy coffee consumption (5 cups a day) increases the risk of unstable angina, coronary heart disease, and heart attacks. People who drink as much as 4 to 5 cups of coffee a day have no more risk for heart disease than those who drink less than one cup a month. Those who drink a little more than 1 cup of coffee a day have increased levels of 4 so-called "markers" of heart disease (total cholesterol and inflammation). Consumption of coffee may inhibit inflammation and thus reduce the risk of cardiovascular and other inflammatory diseases. Drinking coffee may increase the risk of heart attack in people with a genetic tendency for slow caffeine metabolism.
Caffeine and regular coffee consumption contribute to stiffness of large arteries, elevating heart rate and blood pressure, especially in those who already have hypertension. Habitual coffee drinking does not lead to hypertension. The effect varies greatly from person to person, from occasional partakers to regular users, and by the amount consumed. Coffee intake of more than 3 cups a day by men with hypertension who also regularly consume alcohol may lower blood pressure. Overall, the evidence does not suggest a substantial effect of coffee consumption on the risk for high blood pressure or coronary heart disease. There is a huge difference between coffee and caffeine-isolated caffeine used as a drug and/or added to foods and beverages has a more detrimental effect than caffeine left intact in a food. Blood pressure elevations are 4 times greater for caffeine given as tablets. The difference is not explained by the caffeine dose, but chemical versus food. Coffee is a source of polyphenols, potassium, magnesium, and other plant-derived substances which can counterbalance harmful effects of caffeine. Many people smoke while drinking coffee, a combination found to significantly raise blood pressure. Sugared or diet cola has "a very consistent, direct and positive association" with an increased risk of high blood pressure. Is it the caffeine in the cola, the refined or artificial sweeteners, or both?
The "equivalent" of 2 cups of coffee-caffeine given in tablets or intravenously-reduced the body's ability to boost blood flow to the heart during exercise. Without the whole food "balancers" the effect of caffeine is pharmacological (drug effect). A Danish study found that people getting caffeine from coffee, tea, cola, cocoa, and chocolate did not have an increased risk for atrial fibrillation (quivering heart rhythm) or flutter. Another study gave people isolated caffeine and concluded that caffeine intake could lead to arrhythmia (irregular rhythm).
Coffee was accused of raising blood cholesterol levels, particularly LDL (the so-called "bad) cholesterol. But only unfiltered coffee was found to be at fault-boiled or brews like French press. In test tubes, coffee and cocoa protected LDL cholesterol from oxidation longer than black or herbal teas did; what happens in humans is not known. Men who reduced coffee consumption from 4 cups a day to zero reduced the risk of "cholesterol-related coronary disease" by 15% and "homocysteine-related disease" by 10%. Blood levels of homocysteine rise by drinking filtered coffee regularly. Homocysteine levels rise only if a lot (6 cups daily) of strong, unfiltered coffee is consumed for 2 weeks or more. Blood pressure and triglycerides may rise after drinking unfiltered coffee. Yet, over a 10-year follow-up, there were fewer heart disease deaths and nonfatal heart attacks among unfiltered coffee drinkers than among abstainers. v
Obviously, the results of studies on caffeine and heart disease are inconsistent-in fact, they're all over the map.
THE NERVOUS SYSTEM; THE STUDIES SHOW THAT:
Caffeine can enhance or intensify the effects of stress. A combination of stress and caffeine "has a multiplying or synergistically negative effect." Caffeine can produce symptoms of anxiety, panic, nervousness, tremulousness, irritability, tension, depression, occasional muscle twitching, sensory disturbances, insomnia, fear, restlessness, rapid breathing, palpitations, irregular heart rhythm, flushing, fatigue, dieresis, and gastrointestinal disturbances. However, people with a tendency toward anxiety, panic, insomnia, or those with psychological disturbances may be more sensitive-more reactive-to caffeine than are others. Even a single can of cola or a cup or two of coffee can be enough to provoke a panic attack in susceptible individuals. Reactions are more pronounced when separated caffeine is used. Blood levels of cortisol often increase, indicating an adrenal-stress reaction. Excessive amounts of caffeine can cause symptoms in most people; 10 cups of coffee can give almost anyone a panic attack. Women with premenstrual anxiety and mood swings may experience a worsening of these symptoms with caffeine intake. Children with hyperactive behavior may be reacting to caffeine in soft drinks, chocolate, or other sources. vi
A high intake of caffeine is associated with shorter periods of nighttime sleep and increased daytime sleep. Poor sleepers or people with insomnia, even if they consume caffeine only at breakfast, can have more sleep disturbances than others. They retain caffeine longer than usual-up to 40% of the caffeine consumed in the morning will still be in their system at bedtime. For most people, caffeine is gone after 4 or 5 hours. Drinking coffee late in the day reduces the quality and length of sleep by lowering the production of melatonin. Caffeine will help keep people awake when they are sleep deprived. Caffeine increases alertness, reduces feelings of fatigue or sleepiness during the day, may improve mental and psychomotor performance, short-term memory, attention, and reaction time. Yet, "the impact of caffeine on overall mental resources is still not clear." Any enhancing effects on psychomotor performance "are at best small and unstable." Some studies found no link between coffee intake and cognitive function. Individuals vary widely with respect to caffeine sensitivity; "the amount that can improve alertness in some may make others feel uncomfortable." Any improvement in exercise performance (increased energy, improved endurance) is probably due to a decreased perception of fatigue from the stimulating effect of caffeine. Use of large amounts of caffeine ups the chances for unpleasant side effects such as nausea, headaches, muscle tremors, and palpitations. Caffeine withdrawal can decrease performance. vii
Coffee and caffeine intake may lower the incidence of Parkinson's disease (PD), a nervous system disorder that causes gradual loss of motor functions. Men who drank no coffee were more likely to develop the disease than those who drank 1 to 4 cups a day. But the results may reflect other lifestyle factors. Caffeine acts on brain tissues influenced by dopamine, as do amphetamines and cocaine. In PD, this brain system loses neurons that produce dopamine, leading to depletion of this neurotransmitter and the resulting classic symptoms. Caffeine may indirectly stimulate transmission of dopamine, masking PD symptoms. Or, as a study on mice indicated, caffeine may block brain chemicals known as A2A receptors, slowing the disease's progression or inception. viii
ENERGY AND BLOOD SUGAR; THE STUDIES SHOW THAT:
Coffee and caffeine increase epinephrine levels and, to a lesser degree, norepinephrine-"fight or flight" hormones secreted during periods of acute stress. Three cups of coffee can up epinephrine by 80%, similar to what would occur with stressful or emotionally-charged situations. A 250-mg dose of caffeine can increase adrenal output of epinephrine by more than 200%. Cortisol, the "chronic stress" hormone, is increased with regular use of caffeine. In one study, people who got 300 mg of caffeine per day had elevated cortisol levels for 18 out of 24 hours. Elevated cortisol levels may compromise the immune system, affect mood, cause fatigue, interfere with sleep, and lower DHEA (associated with fatigue, aging, and a variety of illnesses).
Scientists used to think that caffeine helps the body break down fats and burn them for energy-getting attention from athletes and people hoping to lose weight-but recent research indicates the primary effects are on the nervous system. Caffeine may reduce fatigue or lessen the perception of muscular pain. It may make a workout feel easier, so a person can exercise more strenuously and/or longer at a given level of perceived exertion. But there are no clear answers yet. The effects of caffeine "vary from person to person". Some people feel caffeine puts wings on their heels; others find it gives them the jitters and an elevated heart rate, thus hindering their performance. Green tea may assist in weight loss efforts by very slightly increasing metabolic rate. ix
Caffeine may impair glucose tolerance and insulin sensitivity, increase insulin resistance (lowering the amount of blood sugar getting into cells) decrease glucose disposal and carbohydrate storage. Released epinephrine can inhibit peripheral glucose uptake. So caffeine may increase the odds of getting type 2 diabetes. People with diabetes have "exaggerated blood glucose and insulin responses" when consuming caffeine with carbohydrates. Caffeine raises blood sugar and increases energy expenditure for short terms, but long-term effects are not well known. Conversely, caffeine will increase the insulin response to blood sugar, lowering glucose and insulin concentrations and improving insulin sensitivity, allowing more blood sugar to get into cells. This means that coffee or caffeine consumption will lower the risk of developing type 2 diabetes. Some studies found a blood sugar rebound-hypoglycemia or lowered blood sugar-after caffeine ingestion, causing lightheadedness, headache, irritability, nervousness, and hunger. Other studies found no hypoglycemic reaction.x
LIVER/GALLBLADDER, PREGNANCY/HORMONES; STUDIES SHOW THAT:
Coffee or caffeine may help protect the liver from injury-due to excess alcohol consumption, hepatitis B or C, iron overload, obesity, or impaired glucose metabolism. Coffee consumption seems to help lower elevated levels of liver enzymes such as gamma-glutamyltransferase (GGT) and aminotransferace (ALT). On the other hand, unfiltered coffee increases the risk of liver disease and raises liver enzymes like GGT and ALT. With each cup of coffee a person drinks daily, the risk of cirrhosis drops. Conversely, an increase of 2 cups of coffee increases the risk of liver cirrhosis. Drinking four or more cups of coffee a day appears to lower the risk of gallstones in both men and women. However, coffee's true effects on bile acid production have not yet been elucidated. xi
Some studies show that caffeine may reduce the chance of women getting pregnant. Other studies don't. There have been studies that found delayed conception associated with caffeine intake and studies that have found no association. Miscarriage or spontaneous abortion has been linked to pregnant women's intake of caffeine. Small amounts of caffeine appear to have little or no effect, but 3 or more cups of coffee daily increased the risk. Caffeine intake may or may not be related to low birth weight of babies, increasing the risk of illness and death. Study results have not been consistent. Some show that coffee or caffeine consumption does not increase the risk of low birth weight. Even though the evidence for reduced fertility, risk of miscarriage, and birth defects is not clear-cut, to be safe, pregnant women should drink no more than 1 or 2 cups of coffee a day. Caffeine may help men improve sperm motility (activity), but does not address other problems of male infertility.
Caffeine has been associated with symptoms and severity of PMS-the higher the caffeine intake, the greater the symptoms. Mood swings, edema, headache, and other symptoms may be worsened by caffeine ingestion. It was thought that symptoms of fibrocystic breast disease could be alleviated by abstinence from caffeine. But a large case-control study found no connection between caffeine and benign tumors, breast cysts, or breast tenderness. Yet, some breast cysts respond to a regimen that removes caffeine from the diet. No effect was found on menstrual cycles or ovulation. Yet, caffeine may decrease levels of estradiol, one of the estrogens. This means that the more caffeine some women consume, the worse their PMS or menopausal symptoms will be. xii
BONES, CANCER, AND MISCELLANEOUS; THE STUDIES SHOW THAT:
Caffeine may increase the risk of bone loss, hip fracture, and osteoporosis in women and men, especially in women who don't obtain sufficient dietary calcium. Drinking 3 cups of coffee, 6 cups of tea, or more, increase the risk substantially. Urinary excretion of calcium and magnesium increases for at least 6 hours after caffeine consumption. Some studies showed only a slight or modest increase in the risk of osteoporosis from consuming 4 cups of coffee a day, but no increased risk from drinking tea. Other studies concluded that caffeine intake is not an important risk factor for low bone-mineral density. One factor is that heavy caffeine consumers are more likely to smoke, less likely to take nutritional supplements, and less likely to consume a "healthy diet." xiii
Increased coffee consumption has been associated with a reduced risk of colorectal cancer and liver cancer. Other studies have found no association between drinking coffee or tea and the risk of colorectal cancer. In lab mice, caffeine seemed to protect against skin cancer. In test tubes, coffee appeared to protect against DNA damage caused by free radicals, especially when combined with antioxidant chemicals. Green tea may be protective against development of various cancers, including non-Hodgkin's lymphoma, stomach, colon, skin, breast, and prostate cancer. Black tea may destroy colorectal cancer cells. The studies are not conclusive. xiv
Excessive intake of caffeine (about the amount in 3 or 4 cups of coffee) raised the odds for women to develop urinary incontinence or for anyone to develop an unstable bladder. While caffeine makes the bladder more active, it may also help reduce the risk of kidney stones by increasing the flow of more diluted urine, lowering the chance of a kidney stone forming. People who drink 4 or more cups of unfiltered coffee daily are more likely to get rheumatoid arthritis than are people drinking less. Filtered coffee may not have the same effect, and other lifestyle or diet factors may be involved. Caffeine can alter acid and pepsin secretion in the gastrointestinal tract, causing heartburn, diarrhea, and nausea. Caffeine increases respiratory rate. In fact, it is sometimes used to stimulate respiration in premature babies. And it dilates the bronchioles (or breathing tubes).
A survey (not conclusive) found a link between moderate-to-high coffee consumption and increased inflammatory process. Coffee can ease a migraine headache by constricting blood vessels going to the head, or it can cause headaches, especially during withdrawal. Some nutritional deficiencies have been associated with caffeine, particularly with excess intake. For one, caffeine appears to oxidize the available iron in food or supplements and convert it to a form that reduces its bioavailability. A single cup of coffee can reduce iron absorption by 39%. Some individuals with iron-deficiency anemia are "not curable" until they stop consuming caffeine. xv
IS CAFFEINE ADDICTIVE?
Some say caffeine does not fit all the criteria to classify it as addictive-alterations in brain chemistry, antisocial seeking behavior, reinforcing effects, tolerance, and withdrawal symptoms. The pleasurable effects and desire to prevent withdrawal symptoms are reinforcing effects. Tolerance develops when used regularly. But larger amounts are not needed to achieve a stimulant effect. If regular intake is stopped abruptly, some people have withdrawal symptoms, but these are inconsistent. Caffeine doesn‟t have the physical and social consequences observed with drugs of abuse. There is no antisocial behavior and there is no alteration of brain chemistry as seen with addicting drugs like cocaine or heroin. On the other hand, some argue that caffeine withdrawal symptoms meet the criteria of a bona fide mental disorder. A review of 66 studies cited 10 symptoms of caffeine withdrawal that met the standard-headache, fatigue, drowsiness, dizziness, decreased energy/activeness, decreased alertness, irritability, depressed mood, decreased contentedness, difficulty concentrating, feeling foggy/not clearheaded. There is a decline in mood after overnight caffeine deprivation. Even brief periods of caffeine deprivation of only a few hours beyond the time that caffeine would normally be consumed can result in "significant changes" in mood and other symptoms of withdrawal. Depression, anxiety, fatigue, sleepiness, yawning, difficulty concentrating, and reduced ability to work are reported from quitting a coffee habit of as little as just one cup a day. xvi
Everyone responds to caffeine and coffee differently. Some individuals are very sensitive to the effects of coffee or caffeine. Others can tolerate large amounts with seemingly no effects at all. The "half-life" (the time it takes the body to eliminate half of a given dose) of caffeine may be twice as long in folks who don't normally partake compared with those accustomed to it. Men and women often react to caffeine differently. In women, adverse effects occur at lower doses. For the average man, the effects of caffeine last from 2½ to 4½ hours. For most women, these effects can last for anywhere from 4 to 7 hours. Caffeine's half-life also depends upon a woman's menstrual cycle. Premenstrually (two weeks before her period), it can take a woman up to 7 hours to detoxify 1 cup of coffee, compared to 5.5 hours in the follicular phase of her cycle. Birth control pills and hormone replacement therapy can decrease the body's ability to clear caffeine, so women taking hormones require about twice the normal time of non-users to detoxify caffeine. Pregnant women, women with breast lumps, people with anxiety disorders, heartburn, palpitations, or high blood pressure may benefit from cutting back.
The scientific model fails to consider that coffee and other natural sources of caffeine are whole plant complexes that are not divisible into single chemical isolates without getting skewed results. Just as studying beta-carotene is not the same as studying a carrot, studying the benefits and harms of caffeine is not the same as understanding the interrelationship, the synergy of all a plant's constituents and their impact on human health. When analyzing the contents of coffee, the origin of the bean; the agricultural practices that grew it; the variations between species; as well as the handling, processing, brewing, and preferred ingestion practices are all "confounding variables." Some of the substances in coffee may aid in balancing the stimulatory effects of caffeine and/or enhance its potential benefits. Antioxidants make up about 10% of coffee beans, some of which are being separated out and looked at for pharmacological use. But this drug-seeking approach misses the essence of Nature-that complex packages of foods are collaborative networks in a harmonious symphony of elegant effectuation. xvii
Researchers say that a person may have caffeine dependence syndrome if he/she experiences 3 out of the 4 following signs:
*Withdrawal symptoms such as headache, depression, and fatigue.
*Continued consumption of caffeine despite physical problems.
*Unsuccessful attempts to cut back on or eliminate caffeine consumption.
*Tolerance (you need or can tolerate increasingly large intakes). Health risks associated with caffeine usually depend upon how sensitive you are to it-your personal tolerance-which can change over your lifetime.
To reduce or stop the consumption of caffeine, plan ahead and reduce gradually. A cold turkey approach usually leads to withdrawal symptoms and then failure. Decreasing coffee by ¼ to ½ cup every 1 or 2 weeks usually prevents withdrawal symptoms. If it's a hot beverage you want, use coffee substitutes, herb teas, or "instant grain beverages." If you drink caffeinated sodas, replace them gradually with carbonated spring water, juices, a combination, or just plain good, clean water. Withdrawal takes anywhere from 1 day to a week. Some people recover their energy right away. Others may take 2 or 3 weeks to bounce back in the morning without their regular caffeine jolt. Look for improvements in sleep, energy, digestion, skin, mood, and energy levels. xviii
It is best to build up your nutritional status for a month or two before trying to kick the habit, and continuing for a few months after.
THE BOTTOM, BOTTOM LINE
If coffee or caffeine bothers you in any way, then discontinue using it as you would any drug. On the other hand, if coffee or caffeine has no adverse effect on you, then happy imbibing.
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Originally published as an issue of Nutrition News and Views, reproduced with permission by the author, Judith A. DeCava, CNC, LNC.