Over the past decade, with the rise in Positive Psychology as a field of study, gratitude has become an increasingly studied are of interest. Why? Well, proponents of gratitude have said that it can improve mood, health, comradery, relationship bonds, increase altruism, and potentially even part of a clinical intervention for depression! Gratitude has been on my radar for a few years now, and a practice I have incorporated into my life in varying levels of intensity. But recently, I saw a post where someone shared that their psoriasis had actually diminished and that they hadn’t had a flare in 6 months since picking up a daily gratitude practice!
Wow! That’s powerful I thought, and away I went, diving into what research actually has to say about the positive, negative, and neutral when it comes to gratitude.
First, it is important to acknowledge that there is not one universally accepted definition of gratitude and this can cause some confusion in researching it. Is it an attitude? A personality trait? An emotion? A reaction to a kind act? A behavior? A coping mechanism? A life orientation?
It has actually been studied as all of the above and is likely implicated in the variation in outcomes of studies exploring gratitude! To keep things broad at the beginning, let’s start where other reviewers of the literature have landed in saying, “Gratitude is a life orientation toward recognizing and appreciating the good; that is, a thankfulness for what is valuable and meaningful to you.” (Gratitude: Defined; Sansone & Sansone, 2010).
In embodied practice, Dr. Robert Emmons (see What good is gratitude? Online Lecture), a leading expert on the topic, says that gratitude:
Sounds pretty powerful, right? But what does the available research actually say about gratitude when it comes to our health and wellbeing?
Let’s take a look:
Research on gratitude:
Gratitude is consistently related to subjective/perceived well being and life satisfaction (Wood, Froh, & Geraghty, 2010; Sansone et al, 2010). As a construct, it appears to be related to but separate from similar markers of well being such as optimism and hope (Wood et al, 2010). It is (as we might expect) multifaceted, and includes aspects such as: individual differences in grateful affect, appreciation of others, a focus on what one has, feelings of awe in the presence of beauty, expressive behaviors, appreciation for the fact that life is short, a focus on the positive in the present moment, and positive social comparisons (Wood et al, 2010). One comprehensive review of the literature surmises that trait gratitude is made up of all of these factors, and the extent to which one experiences them with consistency, frequency, and intensity (Wood et al, 2010). This life orientation approach to understanding gratitude appears to account for the variety ways people recount experiencing it, not simply thankfulness for being on the receiving end of a favor, which, in fact, might actually detract from well-being by encouraging a feelings of indebtedness and an external orientation to life’s events.
The available research on gratitude consistently links it with positive, adaptive personality traits, including: emotional warmth; greater openness to feelings, ideas, and values; altruism; dutifulness; and achievement striving, and inversely relates to anger, hostility, and depression (as defined by Costa & McCrae). As mentioned above, studies have consistently positively linked gratitude with subjective and psychological (eudaemonic) well being. Beyond individual wellbeing, a large and growing body of evidence suggests that gratitude is strongly related to the factors implicated in relationship development and maintenance (Wood et al, 2010). The relationship between health and gratitude is relatively understudied; yet the available research suggests that gratitude is related to decreased stress and may be especially important in sleep quality; both of which we KNOW are strongly implicated in health and thriving. In one study, gratitude was related to total sleep quality, duration, latency, subjective quality, and daytime dysfunction (Wood, Joseph, Lloyd, & Atkins, 2009). Each of the aforementioned were specifically linked to gratitude via pre-sleep thought patterns (i.e., pre-sleep positive thinking). In addition to these lifestyle factors, there appear to be many clinical implications.
For example, one study (Kashdan, Uswatte,& Julian, 2006) examined gratitude in war veterans with and without PTSD. The results suggested that those experiencing PTSD had lower dispositional gratitude; and dispositional gratitude was significantly predictive of many aspects of well-being in those with PTSD over and above symptomatology and positive and negative affect. Additionally, in both groups, a daily practice of gratitude was uniquely related to each of the aspects of wellbeing measured. Many studies have examined these and similar constructs (e.g., thankfulness; eudaemonic wellbeing) in the context of epidemiological cohort studies and have found these traits to be predictive of significantly lower risk of depression, anxiety, and substance dependence and abuse later in life (Wood et al, 2010). Thus, gratitude as a life orientation and as a practice shows promise as an intervention for many clinical conditions, as well as a method of cultivating increased resiliency from them.
Limitations to consider:
Gratitude as a construct in wellbeing is again a relatively new topic of research; thus there is much room for further research and greater understanding. Currently, much of the research is observational (meaning we cannot draw causal conclusions) and cross-sectional (which only gives us a small snapshot of a particular population at one specific point in time). Gratitude shares a lot of overlap with other traits, although much of the research that has controlled for overlap shows that gratitude has a unique relationship with well being (e.g. above and beyond general positive affect). It is also unclear whether wellbeing causes gratitude or gratitude causes wellbeing; although here again, the experimental and longitudinal research that has explored this has demonstrated that it is gratitude that increases well being.
Great, so if gratitude appears to increase wellbeing, both immediately and over time, and is positively implicated in relationships, health, and thriving, how do we cultivate it? Can we? What’s the best way?
Let explore that!
There are a number of different ways to approach gratitude interventions, including:
Of these, daily gratitude lists are the most commonly reported in the literature, and appear to be comparable in effective as clinical interventions for certain conditions (e.g., body dissatisfaction; excessive worry), and with less attrition than traditional clinical interventions; they me also have a more lasting effect than other gratitude interventions (see Wood et al 2010). Grateful contemplation and writing and delivering a gratitude letter appear to have a more immediate positive effect on mood (see Wood et al 2010 for review). Their effectiveness must be tempered with the acknowledgement that many of these studies did not include a “true” control group (i.e., many of the control groups completed an activity that could have skewed the results in some way); yet, another review of the literature (Sansone et al 2010) cited a study where this was accounted for and the gratitude group showed increased well being as compared to the controls.
So, to be clear, the research is a bit like braving the wilderness; there is still much to be discovered. Yet what is available suggests that gratitude is consistently positively linked with many aspects of well being, is readily applicable in simple but effective exercises like a gratitude list, and stands to foster greater positive affect, health, relationships, and resiliency, across many ages and groups in society.
So, are there any groups for which gratitude could be counterproductive?
Actually, yes!! And Final topic of discussion!
When gratitude is counterproductive:
As you might suspect, this section is brief, but I feel, equally important to cover. Gratitude can backfire when:
Alright, there you have it! The deep dive on gratitude!
Now I’d LOVE to hear from you!
PLEASE SHARE YOUR GRATITUDE AHA'S BELOW!
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*The information on this website is intended for educational purposes only. Please consult with your health care team before making any lifestyle changes.
EPISODE 2 is HERE!!
This week is a brief follow up to last week's deep dive!
We discuss: "What if I KNOW my tolerance is LOW/sensitivity is HIGH, but I still want to drink caffeinated Coffee/Tea for PURE ENJOYMENT of it?"
First, let me just say "YES!" to that. It's simply a CHOICE. There aren't RIGHT/WRONG's here. Simply making a CHOICE, feeling into it's after effect, and choosing again, in alignment with what is most important to us. And ENJOYMENT can be an IMPORTANT CHOICE!
Here are the resources discussed:
Nervous system feeling depleted by stress? Would you like to receive support?
Schedule a FREE discovery call with me: https://bit.ly/2kRWjgB
*All of the information provided in this video is meant for educational purposes only; it is NOT meant to be a replacement or substitute for medical advice. Please consult with your practitioner before making any changes.
Caffeine is the most widely consumed psychoactive substance in the world (1), whose rate is steadily increasing. According to one source (2), daily consumption has risen from 9% in 1999 to 41% in 2017- and that’s just in specialty coffee! More broadly, it is reported that over 85% of American adults consume caffeine daily, in the amount of 180 mg, which is akin to about two cups of coffee (1). So what’s the buzz? Is caffeine a productivity superpower or an adrenal draining ultra-drug? While many studies have been conducted on the benefits and health consequences of caffeine, the data remain inconclusive. How is this possible? Well, the effects of caffeine are HIGHLY individual, and depend on potential factors such as brain receptor sensitivity, and the presence or absence of certain genes and metabolic enzymes, which can be further influenced by certain medications, health conditions, and other lifestyle factors such as stress, gut health, and activity level! So let’s dive into the available research and information on caffeine, and empower YOU to determine your ideal caffeine intake.
READY TO DIVE IN?
Caffeine: the basics
Caffeine, or to be scientific, 1,3,7 trimethylxantine, is a naturally occurring substance found in coffee beans, tea leaves, the shrub seeds of yerba mate and gurana, the kola nut, and cocoa (3). In more recent years, it has increasingly been added artificially to foods, beverages, beauty products, and over-the-counter medications (1). It is most commonly ingested, and because it is both water and lipid soluble, it easily crosses the blood-brain barrier, is rapidly absorbed by the small intestine and can be found in most bodily fluids, including: saliva, semen, breast milk, amniotic fluid, and cerebrospinal fluid (1; 4). Most report feeling the effects of ingested caffeine within 10 minutes of consumption, with its peak effect of focus, concentration, alertness (and depending upon sensitivity, perhaps heart palpitations, breathlessness, and anxiety) occurring within 30 to 45 minutes (4). Caffeine is clinically recognized as an addictive substance (Kresser), with corresponding withdrawal symptoms (1). It is recommended that one wean down or off caffeine slowly over time if trying to decrease intake (e.g., 5; 6).
While many feel and enjoy the “buzz” from consuming caffeine, purely defined, caffeine is not actually a stimulant. So how does it do what it does?
Caffeine: molecular structure
The molecular structure of caffeine is quite similar to that of another neurotransmitter: adenosine. Adenosine concentrations parallel neuronal activity (i.e., the more neuronal activity the higher the concentration of adenosine) (7; 8). Once adenosine reaches a certain threshold, it will begin to bind with adenosine receptors, creating a calming, sleepiness effect. That is, unless caffeine comes in! Upon intake, caffeine will bind to the adenosine receptors, blocking the adenosine and thus its calming, sedative effects: vasodilation, lowered heart rate and blood pressure (8; 3). In fact, caffeine’s counteraction of vasoconstriction along with its anti-inflammatory properties is what makes it an effective addition to OTC and prescription pain medications (1).
FUN FACT: - we have adenosine receptors NOT ONLY in the central and peripheral nervous system, but in various organs too (1)- including the kidneys and colon- when caffeine binds to these receptors it triggers the urge to use the restroom (4).
Speaking of restroom- caffeine is a diuretic (it makes ya pee!), and this expedited passing of urine can also increase the release of vitamins and minerals from the body (e.g., potassium, magnesium, zinc, calcium, vitamin c, and the b vitamins) which can increase the risk of deficiency and related symptomatology (e.g, anxiety, panic, mood swings, and fatigue) (9).
Caffeine has a half-life of approximately six hours (again, it depends on individual factors), which means it takes about six hours for the original concentration of caffeine in the body to reach half of that amount. This is one of the reasons people may reach for another cup throughout the day. This is ALSO why drinking caffeine late into the afternoon may be a hindrance to quality sleep later that evening!
Ok, now that we’ve got the basics down, let’s dig deeper into the pro’s, con’s, and most importantly some of the individual factors to consider in your empowered choice to consume caffeine!
Because if its popularity among consumer’s, many of us have already been exposed to the benefits of coffee and caffeine. For thoroughness, let’s briefly review:
caffeine: potential benefits
While there appear to be beneficial relationships between caffeine consumption and reduced risk of decline and disease, the studies are often limited to being of an observational nature with specific population details and thus we cannot conclude causation (i.e., a direct effect) or generalize to all people (including ourselves!). There are also certain populations for whom the literature would suggest caffeine could be harmful.
Let’s take a look:
caffeine: potential risks
Ok, so there’s a snapshot of the big picture when it comes to current research on the benefits and potential harms in consuming caffeine. Feeling any closer to what’s best for you?
If so, great! If not, I completely understand and my hope is that you feel more informed. Research in this fashion can give us an idea of TRENDS as well as potential benefits and harms in CERTAIN POPULATIONS that don’t readily generalize to us as individuals. So, what’s an Empowered Patient to do? Be aware of the research and become your own health detective! What I mean by that is, most likely, we will be best served by honing in on our own current health, lifestyle factors, and tolerance levels to determine the type and amount of caffeine that is best for us right now!
Let’s take a look at tolerance and sensitivity:
caffeine: Tolerance & sensitivity
On average, for “healthy” adults, a daily intake of 200-400 mg (i.e. two to four cups/day) is considered to be “safe” in that it is not associated with adverse health effects (1; 13).
FUN FACT: according to one study (14), the heritability of coffee consumption is estimated to be 50%; there may be a small percentage of the population that carry a gene linked to higher caffeine intake with no adverse risks (i.e. caffeine hyposensitivity).
On the other side of the spectrum, those with caffeine hypersensitivity may experience adverse effects after consuming only a relatively small amount (e.g., 30-50 mg or less) of caffeine. This reaction, which can include symptoms such as heart palpitations, sweating, jitteriness, increased anxiety, insomnia, muscle tension, restlessness, and blood sugar dysregulation (5; 9; 13) is separate from a caffeine allergy (which can be tested and diagnosed). The later is often more severe, and can include: sneezing, hives, itching and hoarseness of the throat, swelling of face, mouth, and throat, eczema, pain in the chest, hyperventilation, confusion, inability to focus, dizziness, mood swings, paranoia, and hallucinations (9).
What are you gathering as you read this?
Are you feeling like you have a pretty good idea of where you fall on the spectrum generally with caffeine tolerance?
Keep in mind that life events such as periods of ongoing stress, chronic illness, HPA axis disregulation (i.e. adrenal fatigue), gut health issues, sleep deprivation, over-training, and the use of certain medications change that! In addition to lifestyle factors, there are certain genetic and metabolic factors that can influence our caffeine tolerance.
Additionally, there are specific genetic and metabolic factors to consider:
Caffeine: genetic & metabolic considerations
The CYP1A2 is the gene that codes for the enzyme primarily responsible for metabolism of caffeine in the liver (1;5). This gene appears to have a large genetic variability (1;14); it is reported that approximately 50% of the population has a variant of the CYP1A2 that leads to slower metabolism of caffeine (5). It may be that those who feel hypersensitive to caffeine consumption produce less copies of the gene that clears caffeine from the system and therefore, experience heightened, prolonged, and adverse effects (5; 6; 8; 13), although some of the adverse effects have been reported in slow metabolizers (5).
FUN FACT: the CYP1A2 gene is expressed in a circadian rhythm (and thus caffeine will have a different impact at different points in the day), and is the same enzyme that metabolizes steroid hormones (1). The impact is that steroid hormones SLOW the metabolism of caffeine; this is why the half-life of caffeine increases in pregnant women (up to 16 hrs longer!) and in women taking oral contraceptives (it tends to DOUBLE!). If you are interested in learning more about your genetic variations as they relate to caffeine consumption, there are tests available (i.e. 23andme).
So we've taken a pretty extensive look at CAFFEINE... but what about those of us who know we are sensitive/prefer to consume DECAF?
Here are just a FEW Things to consider:
If it is an issue of caffeine sensitivity, decaf may be the way to go (with approximately 2 mg per serving in coffee)- opt for Swiss-water-processed decaf if you can! Keep in mind, with coffee, that even decaf retains its diuretic properties, the proteins that often cross-react with gluten, and acids that can alter cortisol and thus blood sugar regulation (6). Again, this is not true for everyone, just data that can ground your own experience.
Alright, that’s it for now! As you can see, there is A TON of available and sometimes conflicting information out there on caffeine and coffee consumption. As an Empowered Patient, it really comes down to awareness and paying attention to our own experience over time.
Now, I’d love to HEAR FROM YOU!
How was your journey through this information?
What did you learn?
Are you a hyper-responder? Hypo-responder? Land somewhere in-between?
What aspects are you most interested in? Have you taken genetic/other tests? Did you find them helpful/informative?
How are you going to consume caffeine going forward?
PLEASE SHARE YOUR COMMENTS BELOW!!
Here to support you along the way!
Your Health Advocate,
P.S. If you have a question or would like a deep dive on a specific health/wellness topic and would like me to cover it in this series, please email me at : firstname.lastname@example.org