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The Highs and Lows of Caffeine
Many Americans regularly consume caffeine, the most widely used behaviorally active drug in the world. But does caffeine cause more than just a morning boost?
Over the years, caffeine has been singled out as a possible factor in cancer and birth defects, among others. Here is a look at why most experts say that moderate caffeine intake is not a habit worth losing sleep over and advice for people who drink too much coffee and want to cut back.
Energy drinks are the latest entry into the beverage market and perhaps the most potent way to get a caffeine fix. The popularity of these carbonated, caffeine-loaded drinks has skyrocketed since they first appeared on the market in the late 1990s. They are particularly popular among the younger generation, including teenagers.
The US Food and Drug Administration monitors the harmful side effects of energy drinks. Although some were serious, energy drinks are safe. As with other forms of caffeine, moderation and common sense should be applied.
Caffeine and Addiction
In a manner of speaking, yes. The majority of Americans regularly consume caffeine, a drug that acts as a central nervous system stimulant. It increases heart rate, boosts urine production, and raises the metabolic rate. The metabolic rate is the speed at which the body burns calories to fuel necessary functions like breathing. Anyone who cannot get going in the morning without a cup of coffee, tea, or a caffeine-containing soft drink knows all too well that caffeine can be habit-forming.
While most experts say addiction is too strong a word to be used with caffeine, researchers have identified a condition they call caffeine dependence syndrome. It is characterized by the following:
- Withdrawal symptoms, such as headache, fatigue, and depression
- Caffeine consumption despite causing physical or psychological problems or making them worse
- Unsuccessful attempts to cut back or control caffeine intake
- Tolerance to caffeine—not getting the desired effect with typical consumption or the need to drink more to get the desired effect
Caffeine and Your Health
The idea of being dependent on caffeine can be unsettling. However, most healthy people who drink a cup or two of coffee, tea, or soda every day suffer no more serious physical symptoms than jitteriness, irritability, and minor gastrointestinal upsets. Why, then, have scientists long suspected that caffeine might contribute to heart disease, cancer, birth defects, and other problems?
The snag here is that much of the early research linking caffeine to various conditions was clouded by a number of issues. When questioning people about their caffeine-consuming habits, for example, many researchers failed to ask about caffeine sources other than coffee or tea, such as soft drinks, chocolate, and certain medications (see chart).
Another confounding issue is that even though caffeine and coffee drinking may not contribute to disease alone, they may go hand-in-hand with a lifestyle that does. For example, coffee drinkers may also smoke, drink alcohol, or eat high-fat diets. All these factors must be considered when researching caffeine use.
Recent studies have failed to link only consumption of caffeine to heart disease or death. In fact, many observational studies have suggested that caffeine consumption may actually lower these risks.
Health Conditions and Caffeine
Some people would clearly do well to limit their caffeine consumption or avoid it altogether. For example, people with dyspepsia or heartburn should keep their caffeine use in check. It stimulates the secretion of acid, which can irritate the lining of the gastrointestinal tract.
Pregnant women should watch the amount of caffeine they consume as well. While moderate amounts (1-2 cups of coffee per day) have not been proven to cause birth defects, caffeine does cross the placenta. After caffeine enters the fetal bloodstream, large amounts can alter the unborn baby's normal heart rate and breathing.
Some research also suggests that large amounts of caffeine may decrease blood flow to the placenta, which may raise the risk of having a small baby or a miscarriage. However, other research has not found a link between coffee consumption and pregnancy problems.
Women who breastfeed their babies should also avoid the substance. Although caffeine may make a new mother more alert, the caffeine passed to her child through breast milk may mean more time comforting a fussy child.
People with chronic headaches are strongly advised to limit all caffeinated products. While caffeine combined with medications can be used to treat headaches, regular use can cause headaches or make them worse.
Even if you only drink a cup or two of coffee, tea, or soda each day, try to cut back on caffeine gradually. Moderate caffeine users who stop cold turkey can suffer from withdrawal symptoms such as headaches, fatigue, moodiness, and nausea. Instead of switching over completely to decaffeinated coffee, substitute decaf for half your regular blend for a couple days and gradually wean yourself. Or, alternate decaf sodas with the regular version throughout the day until you feel comfortable weaning yourself from the caffeinated version completely.
A Special Note for Smokers
Smokers need more caffeine to get a kick than their nonsmoking counterparts because smoking causes caffeine to be metabolized more quickly. This is one reason so many smokers get caught up in the coffee-and-cigarette habit. When a smoker kicks the cigarette habit however, caffeine lingers in the bloodstream longer. This can add to the jitteriness and irritability that goes with giving up nicotine. Smokers who quit cigarettes may want to cut back on caffeine at the same time.
Caffeine in Common Products
|Beverages, Food, and Over-the-Counter Medicine||
|Coffee (8 oz cup), instant||57|
|Starbucks brewed coffee (grande—16 oz)||330|
|Dunkin’ Donuts coffee (medium—14 oz)||210|
|Starbucks Latte (grande—16 oz, 2 shots of espresso)||150|
|Starbucks Espresso, solo (1 oz)||77|
|Decaffeinated coffee (8 oz cup), brewed or instant||3-12|
|Tea (8 oz cup), brewed, black, steeped for 3 minutes||30-80|
|Instant iced tea (8 oz glass)||10-50|
|Starbucks Tazo Chai Tea Latte (grande—16 oz)||100|
|Snapple Lemon Tea (16 oz)||37|
|Arizona Iced Tea (20 oz)||38|
|Soft Drinks (12 oz)|
|Monster Energy (16 oz)||160|
|5-hour Energy (1.9 oz)||200|
|Rockstar (16 oz)||160|
|Red Bull (8.3 oz)||80|
|SoBe Power Fruit Punch (20 oz)||77|
|AMP Energy Boost Original (16 oz)||142|
|Starbucks hot chocolate (grande—16 oz cup)||25|
|Hershey's chocolate lowfat milk (12 oz bottle)||2|
|Hershey's Chocolate Bar (1.6 oz)||9|
|Hershey's Special Dark Bar (1.5 oz)||20|
|Hershey's Kisses (9 pieces)||9|
|Anacin (2 tablets)||64|
|Excedrin Migraine (2 tablets)||130|
|No-Doz, Vivarin (1 caplet)||200|
Many manufacturers add caffeine to pain relievers because it helps the drugs ease muscular aches and other discomforts (like some headaches) more effectively. Some research also suggests that caffeine acts independently to relieve pain. The caffeine content of products may change, so contact the manufacturer for information on products you use frequently.
Food Insight—International Food Information Council Foundation
National Coffee Association USA
Dietitians of Canada
Brown, CR, Jacob P 3rd, Wilson M, Benowitz NL. Changes in rate and pattern of caffeine metabolism after cigarette abstinence. Clin Pharmacol Ther. 1988;43(5):488-491.
CFSAN Adverse Event Reporting System Voluntary and Mandatory Reports on 5-Hour Energy, Monster Energy, and Rockstar Energy Drink January 1, 2004 through October 23, 2012. US Food and Drug Administration website. Available at: http://www.fda.gov/downloads/AboutFDA/CentersOffices/OfficeofFoods/CFSAN/CFSANFOIAElectronicReadingRoom/UCM328270.pdf. Accessed February 3, 2017.
Caffeine content. Caffeine informer website. Available at: http://www.caffeineinformer.com. Accessed February 3, 2017.
Caffeine content of food and drugs. Center for Science in the Public Interest. Available at: https://cspinet.org/eating-healthy/ingredients-of-concern/caffeine-chart. Accessed February 3, 2017.
Dietary recommendations for cardiovascular disease prevention. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115449/Dietary-interventions-for-cardiovascular-disease-prevention. Updated January 23, 2017. Accessed February 3, 2017.
Functional dyspepsia. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114754/Functional-dyspepsia. Updated September 1, 2016. Accessed February 3, 2017.
Jahanfar S, Sharifah H. Effects of restricted caffeine intake by mother on fetal, neonatal and pregnancy outcome. Cochrane Database Syst Rev. 2013;(2):CD006965.
Questions and answers about energy drinks and health. International Food Information Center website. Available at: http://www.foodinsight.org/articles/questions-and-answers-about-energy-drinks-and-health. Updated May 31, 2011. Accessed February 3, 2017.
Substance use and exposure in pregnancy. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T906521/Substance-use-and-exposure-in-pregnancy. Updated April 25, 2016. Accessed February 3, 2017.
- Reviewer: Michael Woods, MD, FAAP
- Review Date: 02/2017
- Update Date: 02/03/2017