Caffeine

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Latest Edit: Hector 2014-03-17 (EDT)

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Caffeine.jpg

Caffeine can be found naturally in the leaves, seeds, or fruits of over 60 plants. These include coffee beans, cacao beans, kola nuts, guarana berries, and tea leaves including yerbe matte and green tea. Caffeine is commonly used as a stimulant which serves to increase nervous system activity leading to increased energy and alertness. It also belongs to the drug class known as xanthenes along with cardiac stimulants and theophylline (found in tea and other substances) and theobromine (found in chocolate and other substances). Caffeine is the only stimulant considered safe by the U.S. FDA for use in over-the-counter medications.[1]

Sources

Caffeine is commonly found in coffee, chocolate, energy drinks, tea, and cola beverages.

Uses

The following are the primary uses for caffeine:

Article Caffeine: Performance enhancement for activities of prolonged duration, IHP, [2], October 2010
Article The Complex Health Effects of Coffee, revisiting coffee's effects on health and mortality, NMJ, [3], 2012 September
  • Exercise Performance: Caffeine has long been used as an ergogenic aid, or aid to increase performance. It appears to work best for activities of moderate intensity and longer duration. It increases heart rate, respiratory rate, and blood pressure. Caffeine also changes the metabolism of cells by increasing the breakdown of fat and inhibiting the breakdown of glycogen (the storage form of glucose). This shift means that the body is using fat to create energy and conserves glycogen stores, increasing endurance. Caffeine appears to aid in activities such as running, cross-country skiing, and cycling- all activities of longer duration and moderate intensity. Doses may vary depending on a person's intake of caffeine on a regular basis, higher doses being necessary for the more habitual coffee drinker, for instance. Furthermore, the anxiety provoking effects of caffeine may be attenuated by exercise. These positive benefits of caffeine can be achieved at levels that are within legal limits according to the International Olympic Committee, but one should always use ergogenic aids with caution when enhancing performance at a competitive level [2].
  • Cognitive performance and mood: Caffeine is commonly used by many people as a means to boost alertness in order to perform a demanding task requiring mental stamina. According to one study, L-theanine (a non-protein amino acid) and caffeine (both found naturally in tea) at doses of 97mg and 40mg respectively helped to improve accuracy during task switching and subjective alertness and reduced fatigue.[3]
  • Respiratory disorders: Caffeine has been shown to have a broncodilatory effect meaning that it opens the airways. It also reduces respiratory muscle fatigue. For these reasons, it has been considered for the treatment of asthmatic episodes. A 2010 Cochrane review concluded that caffeine modestly improves airway function for up to 4 hours in asthmatic individuals [4] In a study comparing caffeine and albuterol (short-acting beta-2 agonist used for asthma) and their effectiveness in treating exercise-induced asthmatic episodes, caffeine at moderate to high doses taken before exercise was found to provide protection from such episodes. It is also proposed as a suitable agent to aid in the reduction of daily use of short-acting beta-2 agonists which have some negative side effects [5]
  • Apnea in Infants: Apneic episodes are common in preterm infants, causing low blood oxygen and slowed heart rate which can be severe enough to require ventilation assistance. According to a 2010 Cochrane review, caffeine is an effective treatment for infant apnea in preterm infants with better longer term outcomes. It appears to be safer than other methylxanthine drugs such as theophylline and aminophylline.[6].
  • Headaches: Some people find that coffee can alleviate a headache.
  • Cirrhosis: Drinking coffee might actually be protective against the development of cirrhosis.[7]

Cautions

The following conditions are associated with the consumption of caffeine.

Article Managing Caffeine Withdrawal in the Patient Undergoing Detoxification, NDNR, 2011 December
  • Adrenal fatigue
  • Insomnia is strongly associated with caffeine consumption.
  • Caffeine can contribute to hypertension.
  • Caffeine consumption increases blood pressure, heart rate, respiration rate, and metabolism, and causes the release of adrenalin, noradrenalin, and cortisol.
  • Because it is a diuretic, it can also cause a deficiency in nutrients that are needed for sleep such as B vitamins, calcium, magnesium, zinc, and iron.[8]

Prescribing Considerations

The recommended dosages varies based on age and health status. To determine what your specific requirements are talk to your naturopathic doctor or other trained medical professional.

  • Child and Adolescent: A typical therapeutic oral dose ranges from 80-300mg. Higher doses have also been used.
  • Adult: A typical oral dose ranges from 200-400mg but it is dependent on body weight; some conditions warrant doses that are much higher.
  • Pregnancy and Lactation: Caffeine is not recommended at this time.

An 8 ounce cup of regular brewed coffee contains 65-120mg of caffeine. An 8 ounce cup of brewed tea has about 20-90mg.

Safety

  • General Adverse Effects
  • The effects are brief as caffeine is typically metabolized and cleared within a few hours, adverse effects may include dehydration, hypertension, palpitations, increased heart rate, gastrointestinal disturbances, jitteriness, restlessness, nervousness, sleep disturbances, and increased urination.
  • Children: Not recommended for general use in children.
  • Adults: Moderate consumption is considered safe in most adults (100-200mg/day).
  • Pregnancy Breastfeeding
  • Caffeine is not recommended at this time as it can cause spontaneous abortion and low birthweight. It can also be transferred into breast milk, causing anxiety in infants who are breastfeeding. However, in women who do consume caffeine during pregnancy and nursing, it should not exceed 200mg/day.
  • Contraindications
  • Long-term administration in preterm infants, pre-exisiting mitral valve prolapse, Marfan syndrome, autosomal recessive polycystic kidney disease
  • Precautions
  • use cautiously in persons with heightened sensitivity to caffeine, clotting disorders, hypertension, hyperlipidemia, diabetes, movement disorders, osteoporosis, sleep disorders, seizure disorders, overactive bladder, glaucoma, psychiatric disorders, risk of nephrolithiasis, fibrocystic breast lumps, acute kidney inflammation, high grade inflammation, immune deficiency, eating disorders.
  • Drug Interactions
  • Caffeine interacts with the following drugs: adenosine, alcohol, amphetamine, analgesics, antibiotics, anticoagulants and antiplatelets, anticonvulsants, antidiabetics, antihypertensives, anti-inflammatories, antilipemics, antineoplastics, antiobesity agents, antipyrine, antipsychotics, antiulcer agents, beta-agonists, beta-blockers, celecoxib, clozapine, CNS stimulants, CNS depressants, cocaine, contraceptives, cytochrome P450-metabolized agents, darifenacin, dipyridamole, disulfiram, dopamine antagonists, drugs that may lower seizure threshold, ephedrine, ergot derivatives, estrogens, flubendiamide, fluconazole, furafylline, hydrocortisone, immunosuppresants, inotropes, iron salts, lithium, methoxsalen, methylenedioxymethamphetamine, methylphenidate, mexiletine, nicotine, opiates, oseltamivir, perazine, phenylpropanolamine, phenytoin, quinolones, riluzole, rosuvastatin, sedative, terbinafine, theophylline, verapamil
  • Herb/Supplement Interactions
  • Caffeine interacts with the following herbs and supplements: analgesics, antibacterials, anticoagulants and antiplatelets, anticonvulsants, anti-inflammatory herbs, antilipemics, antineoplastics, antiobesity agents, antioxidants, antiulcer herbs and supplements, caffeine-containing agents, coffee, creatine, contraceptives, cordyceps, cytochrome P450-metabolized herbs and supplements, danshen, echinacea, ephedra, ergogenic herbs and supplements, green tea, guarana, herb/supplements that lower seizure threshold, hypoglycemics, hypotensives, immunosuppressants, inotropes, iron salts, kudzu, Liu Wei Di Huang Wan, matte, muscle relaxants, nicotine, phytoestrogens, sedatives, stimulants, thermogenic herbs and supplements
  • Food Interactions

References

  1. Stargrove Mitchell Bebel, Treasure Jonathan, McKee Dwight L (2008) Herb, Nutrient, and Drug Interactions; Clinical Implications and Therapeutic Strategies, Mosby.
  2. Committee on Military Nutrition Research, Food and Nutrition Board. Caffeine for the Sustainment of Mental Task Performance: Formulations for Military Operations, The National Academies Press [1]
  3. Giesbrecht T, Rycroft JA, Rowson MJ, De Bruin EA (Dec 2010) The combination of L-theanine and caffeine improves cognitive performance and increases subjective alertness. Nutr Neurosci;13(6):283-90.
  4. Welsh EJ, Bara A, Barley E, Cates CJ (Jan 2010) Caffeine for asthma. Cochrane Database Syst Rev 20(1):CD001112.
  5. VanHaitsma TA, Mickleborough T, Stager JM, Koceja DM, Lindley MR, Chapman R (April 2010) Comparative effects of caffeine and albuterol on the bronchoconstrictor response to exercise in asthmatic athletes. Int J Sport Med;31(4):231-6.
  6. Henderson-Smart DJ, De Paoli AG (Dec 2010) Methylxanthine treatment for apnoea in preterm infants. Cochrane Database Syst Rev;(12):CD000140.
  7. Muriel P, Arauz J (Jul 2010) Coffee and liver diseases Fitoterapia;81(5):297-305. PMID: 19825397.
  8. Ross Herbert, Brenner Keri (2000) Sleep Disorders: Clinically Proven Alternative Therapies To Help You Get a Good Night's Rest Alternativemedicine.com'