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Caffeine: Friend, foe or something more - and then some?

Health Tips brought to you by U.S. HealthWorks Medical Group. Our experienced medical experts provide information here that we hope will broaden your healthcare knowledge.

With so many studies, articles and opinions on the benefits and concerns of caffeine, it’s hard to know whether caffeine consumption is good or bad. Today we hear more about caffeine from Dr. A.K. Misra, medical director for U.S. HealthWorks in South San Francisco. Dr. Misra is also double Board Certified in Sports Medicine and Internal Medicine.

Q: We have all seen all sorts of different reports about coffee; one week it is good for you, the next week it has some health detriments. And then sometimes there is altogether a different point of view. Can you provide some clarity about this topic, especially for coffee lovers?

A: Caffeine is a unique substance found in coffee as well as other food, drink and dietary products, and most people don’t understand it completely. While most commonly known for the jolt of energy it provides, caffeine also has medicinal uses, toxic effects and can even be used as a performance enhancer for athletes. I will attempt to provide a brief summary of each of these below:

  1. Medicinal use: Caffeine is actually a medicine for certain conditions. I started my career doing a dual residency of Internal Medicine and Pediatrics, and from my Pediatric education I learned that caffeine was used for a complex condition in infants known as bronchopulmonary dysplasia (a condition where the airways are not properly formed) and apnea of prematurity (poor breathing in premature babies). Caffeine is also used for medical conditions in adults such as orthostatic hypotension (low blood pressure when going from a seated to standing position).
  2. Toxic effects: In sufficiently high doses, caffeine can elevate blood pressure, induce urination and cause anxiety as well as stomach acid imbalance. In high enough doses, caffeine can even be fatal – however this is rare as a tremendously high dose would have to be ingested. Sadly, it is not that hard to actually do this through powdered caffeine supplements, for which the estimated lethal amount is less than a tablespoon. Nonetheless, caffeine is classified by the Food and Drug Administration as GRAS: “generally recognized as safe.” Toxic doses over 10 grams per day for an adult are much higher than the typical dose of under 500 milligrams per day.
  3. PED (Performance-enhancing drug): Unbeknownst to most, caffeine is a substance tested for in competitive sports by both the NCAA and in the Olympics. A level of 15 mg/L is considered too high and a sign of attempting to use it for a competitive edge in sports in the NCAA. It is even stricter in the Olympics, as a level of 12mg/L is the cut off by the IOC (International Olympic Committee).

Q: Is caffeine addicting? We hear about people being addicted to coffee all the time – is this dangerous?

A: Whether or not caffeine is an addictive substance depends on how an addiction is defined. It can produce a mild form of dependence resulting in withdrawal symptoms such as sleepiness, headaches and irritability when an individual stops using caffeine after repeated, habitual daily intake. People who drink coffee as a centerpiece of their daily routine often become habituated to it in this way.

Here are some measured doses of caffeine in the following popular commercial coffees:

Consumption of 1,000 to 1,500 mg per day is associated with a condition known as caffeinism. The Mayo Clinic has a nice informational piece of how much caffeine is in what beverages, and it is useful to review given this discussion. Caffeinism usually combines caffeine dependency with symptoms including nervousness, irritability, restlessness, insomnia, headaches and awareness of one’s own heartbeat (palpitations). This withdrawal syndrome is thought of by some as a recovery from a caffeine addiction.

Q: Is caffeine really all that bad? Do doctors recommend against consuming it?

I believe it is easy to miss this essential point in the coffee versus caffeine discussion. The two are obviously not interchangeable. The general recommendations that come out against coffee are generally made with the effort to curtail caffeine consumption. For example, when a doctor recommends against coffee consumption, they generally do not include green tea in the discussion because green tea, by comparison, has much less caffeine so it is harder to overdo it.

Certainly, the mild stimulant effect is helpful in some ways – and in such amounts as found in both black and green tea, and even a limited amount of coffee, the level of caffeine consumed is not particularly concerning.

Q: If someone want to reduce their amount of caffeine intake, what do you suggest they do?

I believe if someone wishes to do reduce their intake, they should off-shift from one of the listed beverages to one of a lesser caffeine content. For example, from the Mayo Clinic link above, one would have to drink four 8-ounce cups of green tea to equal just one 8-ounce cup of brewed coffee. When it comes to curbing a coffee or tea habit, substituting one warm beverage in the morning for another can be quite simple – there are a number of ways to mix and match different beverages that can reduce one’s caffeine load.

Q: Any other tidbits about caffeine or coffee we may find useful?

A: Yes – Approximately 1,500 chemical reactions take place when the fresh coffee bean is roasted, however these are only appreciated if the coffee beverage is then consumed almost immediately upon roasting. Sadly, many of these beneficial effects are never appreciated in spite of companies’ best efforts to use clever, air-tight packaging. This TED video does an excellent job explaining the difference between taking a fresh bean, roasting it and producing the beverage versus making coffee from what we ordinarily do on a daily basis. There is a massive difference between the two. One of the striking comments in it is, “95% of all the coffee roasted in the world is old, stale and dead.”

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  • American College of Physicians
  • Andrews Research & Education Foundation
  • American Board of Internal Medicine
  • JJM Medical College