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
I don’t know how many times I’ve been told this by health care providers, and/or read it. “Healing isn’t linear; progress isn’t a straight trajectory; setbacks are a part of the process.” My history of being alive on this planet and rational, logical, thinking would say that this is true. In those moments when I am feeling well, energized, vibrant, clear-minded, and my energy feels directed into something meaningful and beneficial, it feels easier to recognize this. To look back and say “oh yeah, that was rough, but it was temporary, and I am so grateful for what I learned about myself and from my body during that time.”
I’ve found it is quite a bit more challenging to access this perspective when I am IN IT. And for the last month, I feel like I have been IN IT. For the last couple of years, I feel like I have been plugging away on my healing journey, consulting with health practitioners, reading, reflecting, and rearranging the way I approach life to create more space for health and vitality to pour forth. There have definitely been ups, downs, and even spirals, as I’ve found healing can actually occur in a circular fashion; patterns emerge and re-emerge and I learn more deeply from them, how to be with them, and how to move through them or allow them to move through with each iteration. I felt capable of holding space for that. I was in acceptance with it (for the most part).
And then last month, I experienced a GI episode that felt more severe than any other pain I remember experiencing. It was a truly scary experience, and the aftermath has been shaky as well. It feels scary that there is a lack of clarity around what took place. Perhaps it was just an acute, episodic form of gastritis, or an ulcer, or pancreatitis, or an endometrial cyst bursting. It is possible and even likely that there are subconscious emotional and mental patterns that are connected to these physical symptoms. I am hopeful that there are tests and practitioners that I will be connected with who work with me to get to the bottom of it.
But right now, I feel no closer to understanding what took place in my system than I did the day it happened. And I would actually be ok with just letting it go, except since then, I have trouble digesting many more foods, and experience bouts of vertigo, brain fog, and waves of panic that bring me back to my first experiences with panic attacks in college. Right now, all of the time spent reading about different protocols and healing methods and working with practitioners feels all for nothing. Right now, feeling good, vital, energized, and productively accomplishing goals feels very far away. Right now, my mind is latching on to all of the health challenges I’ve experienced over the past couple of years and is projecting them onto the future with thoughts like “what if this is how I feel for the rest of my life?” “What if I am never able to accomplish any of my personal or professional goals?” “What if I am unable to take care of/provide for/support myself for the rest of my life?”
And while I do know that this experience won’t stay the same (the more present we are with our experience, the more we recognize that our experience is always shifting), I don’t know for how long these symptoms are going to hang around. I don’t know if or when my digestive system will feel robust again. I don’t know if or when my hormones will regulate themselves. I don’t know if or when my menstrual cycles will ease up in severity or this adult acne will subside. I don’t know if I will accomplish the personal or professional goals that I have been working towards.
What I DO know, is that I am not the only one who is feeling this way. What I do know is there are many of you out there too, who are not feel as well as you once did, and are feeling like you are IN IT. There are many of you feeling overwhelmed by the vast amount of information, clinical and anecdotal, traditional and alternative, and are wondering where to start. There are many of you who are feeling lost and alone in this journey, and starting to lose hope, or starting to wonder if the practitioners who told you “it’s all in your head” or people in your life who’ve said “you’re just too sensitive” are right, and you should just ignore it and try to “act normal” even though you feel like you are only minimally functioning compared to how you used to feel.
I do know that I don’t have the answers for you; I won’t be another well-intentioned voice saying “just cut this out, or add this in, or try this supplement, or read this book.” I won’t say it because I’ve been on the receiving end of it, and tried it, A LOT of it, and while some if it helped some of the time, no one thing has been miraculously transformative for me. I don’t know your story, your history, and your healing truths. But I do know that feeling empowered is CRUCIAL to healing. So I WILL help you find your answers. I WILL support you, honor your voice, and your instincts. And as for my own healing journey, I will continue to show up. I will continue to love and care for myself in the best way that I know how. I will continue to learn and seek growth in the process. I will continue to honor my healing truth and seek the support I need to do so.
In The Way of Meditation class this past weekend, Rev. Michael Beckwith said, “we are not here to be do-gooders. We are here to be PRESENCE.” Do-gooders act or do what they think is best, without consulting those they are trying to help. Presence allows, holds space for, and is willing to be on a journey with someone without needing to place their ‘right way’ onto them. Presence asks, “how can I be of benefit to you, right now?” And while I know that when we are feeling weak, scared, and in pain, it can be tempting to give our power over to an “expert” who take control of the situation, I encourage you to stay engaged in your healing. Stay present. And if I can offer strength and support to your own healing essence, please, don’t hesitate to reach out.
You should sit in meditation for 20 minutes a day, unless you are too busy; then you should sit for an hour." - Zen Proverb
Our minds are funny about time like that, aren’t they? When we are feeling stressed or overwhelmed, it can feel like the last few seconds we will ever experience are ticking away, and we become paralyzed with indecision on how to spend them. Yet, almost all of us can recount a time (no matter how long ago) when we felt relaxed and in the flow, and hours passed by that felt like only minutes.
This morning, I woke up feeling the former. My mind woke already scanning my to-do list over the next few days, and if I hadn’t been aware of it, I would have done what I’ve done in the past:
rush to get up, hurriedly get ready, maybe/not eat breakfast, pretty much hold my breath until I got to work, and then spring into “doing” whatever fell in front of me- ALL.DAY.LONG. as the tension, anxiety, and irritability mounted.
Sound familiar? It can be a challenging pull to intervene with. Thankfully, (over the past couple of years) I have created a new routine to replace the default:
I wake, take a deep breath and say a prayer of gratitude for another day, brush my teeth, wash my face, drink a glass of water, and meditate.
I have carved out a special place in our homes (we’ve moved, and I create a little nook wherever we go) for this practice.
I sit down and take a deep breath. I check in with my body (just notice what sensations are presenting themselves where). I write down what is present and any dreams that I had/remember.
Then I set a timer and meditate. I follow my breath: the belly moving away from the spine on the inhale and it’s moving toward the spine on the exhale. As the breath deepens and flows, I zoom my attention out to the body and my surroundings.
I (attempt to) neutrally observe thoughts. When the mind (I say “mind” and not “I” because the mind is not who we are; how can it be if we can also watch it?) gets distracted, I come back to following the breath. Time and time again. I come back to the breath.
At first, this practice felt wildly uncomfortable; my mind was heavily resistant to sitting still. “This is a waste of time. Why are you doing this? It’s not working. You could be doing X, Y, Z, on your to-do list.”
Thankfully I had experienced teachers, and also a deep desire to “be a good student” (which actually supported me in this practice), and that kept me showing up. Slowly, over time, I realized I am in WITNESS to the mind, I am the OBSERVER of it. It doesn’t control me. It’s content is not me. And I can choose how I want to respond to it. We can choose. If we choose to let it run in the background without becoming clearly aware of what it is saying, we are likely being controlled by its actions, and also perhaps missing out on our mind/body system trying to communicate with us.
I was reminded of that this morning. I felt the discomfort of overwhelm and a racing mind as I moved through the first part of my morning routine. I sat down on my meditation cushion and said “what’s up?”. What I noticed first was that the base of my body felt light, and super ungrounded, like it could float up off the ground. My head, in contrast, felt so heavy that it could fall over forward! What’s up with that?
How I interpreted that feedback, was that my root chakra (which is concerned with survival and base needs) needed some love, and my third eye chakra (concerned with intuition) was feeling smothered by overthinking and overanalyzing in the mind. In other (less mystical) words, I needed to get out of my head and into my body. I also became aware of the most present causative factor: I am leaving for an international trip in a couple of days. I tend to be a nervous flyer, and a light sleeper, and this trip entails three flights, including an overnight. When I feel afraid or unsafe, my default tendencies are to plan, control, and stay really busy to feel like I am “doing” something.
I noticed this as I sat with the breath. I acknowledged it (we must if we want it to release). I spoke kindly to my body/mind: “Ok. I can see you are nervous about the upcoming travel. I understand. What can I do to support you, right now?”. And almost immediately my whole system exhaled, and solutions became readily available:
So that’s the system that really supports me. I am sharing it in the hopes that it can serve as a template for you to create your own.
Stress is at the root of almost every illness, and is an exacerbating trigger for those chronic conditions our society seems to be plagued with today.
We cannot control our outer world. And to the ego mind, who THRIVES on PERCEIVED control, that really sucks. But we CAN learn to control how we respond to EVERYTHING internally and externally, which in turn influences our thoughts, emotions, biology, physiology, and the way we experience the world around us.
That’s pretty powerful.
And it all begins with becoming intentional about what you want, and aligning your energy and actions with that intention.