Fatigue & insomnia
The caffeine controversy
by Marcelle Pick, OB/GYN NP
If you are like many of my patients at Women to Women, you may be thoroughly confused
by the conflicting voices sounding off on caffeine. Does caffeine harm or help your
body? Does coffee cause breast lumps? Hot flashes? Ulcers? Does it help liver disease,
diabetes, Alzheimer’s or Parkinson’s? How much is safe? What constitutes
an addiction to caffeine? It feels as if we can’t go a month without hearing
some new report weighing in on the relative dangers or health benefits of caffeine
use.
Simultaneously, drinking a cup of coffee or tea is a huge source of pleasure for
many: a personal or social routine that provides a wonderful sense of warmth and
connectedness.
It seems like the more we investigate caffeine, the hazier the picture gets. The
AMA and the ADA suggest that one to two cups of coffee per day is a safe amount
(approximately 100–200 mg of caffeine), but in reality you may be sensitive
to less or able to safely tolerate more.
In my opinion, caffeine tolerance varies from woman to woman and depends largely
on how caffeine interacts with her individual physiology and how efficiently she
detoxifies — but there’s the rub. In order for a woman to hear her body’s
real signals, she’s got to remove caffeine long enough to tune in. And because
it’s addictive, even this temporary caffeine withdrawal can be a real source
of anxiety and discomfort for many women.
So whether you have a one-cup or one-pot-a-day habit, it may be time to look at
your caffeine use. Is it time for you to go on a brief caffeine holiday? Let’s
learn more and find out.
The caffeine culture
Caffeine has been used by humans in various forms for thousands of years to promote
wakefulness, mental clarity, and social interaction. It is a compound (xanthine
alkaloid) found naturally in many plants, primarily coffee beans and leaves,
tea leaves, yerba maté, guaraná berries, Yaupon holly, and the kola
nut.
Ninety percent of Americans (including children) consume caffeine every day. It
is everywhere. Coffee, teas, chocolate, blended smoothies, power and energy drinks
— even enhanced waters! Starbuck’s has revolutionized caffeine use by
ensuring that wherever its customers go in the world a consistently good cup of
coffee and pleasant atmosphere await them. And Dunkin’ Donuts’ new campaign
tells us that “America runs on Dunkin’” — and its high-sugar,
high-fat Coffee Coolattas. (A small Coolatta contains 22 grams of fat, 14 of them
saturated. A large has 28 grams of saturated fat, 700 calories, and 25 teaspoons
of sugar.)
If you are having trouble with the idea of giving up your daily caffeine, you have
good reason. Caffeine is addictive on many levels, not the least being its role
in social, historical, commercial and private ritual. If you’re not sure whether
or not you are addicted, take our quiz and find out.
The caffeine addiction quiz
Answer yes or no to the following questions.
- Do you use caffeine to facilitate a physical activity (for example: waking up, exercising,
having a bowel movement, concentrating)?
- Do you have to have caffeine in the morning? Can you substitute hot water
with lemon?
- Do you crash or have caffeine/sugar cravings in the afternoon/early evening?
- Do you grow irritable, have headaches, feel disembodied if you miss your caffeine
fix?
- Do you have difficulty falling asleep at night and waking feeling refreshed?
- Do you need caffeine to heighten the effects of other substances, e.g., nicotine,
alcohol, sugar?
- Do you feel your social routines would suffer without caffeine use?
- Does the idea of going without caffeine seem impossible to you?
Caffeine tolerance
If you answered yes to two or more of these questions, the time may be ripe to examine
your attachment to caffeine. Anytime a woman feels she cannot be herself without
using a substance (natural or synthetic), it raises a big red flag for me.
Some women, like my colleague’s 80-year-old grandmother, can drink coffee
every day of their adult life with no problem. Another woman may tolerate caffeine
well for some years only to find it worsens her chronic anxiety and fatigue as she
approaches menopause. And yet another may find any amount of caffeine triggers more
severe concerns.
In my opinion, caffeine tolerance relates largely to how well a woman is able to
detoxify. Since we detoxify most efficiently in our sleep, the very thing caffeine
works against, I believe that for many women, habitual and/or excessive caffeine
use ultimately sabotages the body’s defenses. In my years of treating women,
I’ve seen that even moderate caffeine use causes particular problems for three
kinds of patients:
- women suffering from adrenal burn-out (a rapidly growing group);
- women who are insulin resistant and aren’t getting their energy from food;
and
- slow detoxifiers, a smaller but significant group.
So the last and most relevant question for you to answer is: How do I respond to
caffeine?
The caffeine cycle — energy boost, then the letdown
One way to begin to understand the part caffeine plays in your health picture is
to look at how it affects the inner workings of your body.
Caffeine fools your fatigue factor:
The molecular structure of caffeine resembles that of the neurotransmitter adenosine,
but has the opposite effect on brain cells. Adenosine helps you feel drowsy by slowing
down nerve cell activity within the brain’s arousal centers. This allows the
brain’s blood vessels to dilate, in turn allowing more oxygen in during sleep.
Adequate adenosine levels are critical for good sleep cycles. And since our brains
and bodies detoxify and heal with sleep, adenosine levels have a role in our larger
health picture.
Because of its similar structure, caffeine binds to adenosine receptors on nerve
cells, like a key in a lock, so that the nerve cells can’t interact with real
adenosine. Instead of slowing nerve cells down, caffeine speeds them up and constricts
the blood vessels in the brain. This is how caffeine can impact sleep cycles, diminishing
healing and detoxification efforts in the body. This also explains why caffeine
is often used as a headache treatment, because it shuts down swelling blood vessels
in the brain.
Caffeine flips the fight-or-flight switch:
Caffeine increases the rate at which your neurons fire, stimulating your central
and sympathetic nervous systems through the HPA (hypothalamic-pituitary-adrenal)
axis. It also triggers an upswing in cortisol and the neurotransmitter
dopamine, which activates the pleasure center in the brain. In this way
caffeine is similar to, but less potent than cocaine, amphetamines, and other psychoactive
stimulants.
I’ve written more about these effects in my article on
caffeine and adrenal health, but to summarize, caffeine interferes with
the normal stress response and our day-to-day cortisol rhythms.
Crash and burn:
When the rush is over and adrenaline levels drop, fatigue, irritability, inability
to concentrate, headache and weariness take over, setting the stage for a big caffeine
— and sugar — craving. Caffeine is a habit-forming drug, and over time
it takes more and more caffeine to produce the desired effect. It also enhances
the effects of other stimulants, such as nicotine. Habitual users will experience
real caffeine withdrawal symptoms within hours of reducing intake, usually headache
and a drop in blood pressure, nausea, fatigue, irritability,
anxiety, and depression.
Caffeine clearance in the liver
The half-life for caffeine in the body is anywhere from 3.5 to 6 hours, depending
on the individual. So many of you can blame that afternoon slump on your morning
coffee!
Caffeine has three metabolites: paraxanthine, which increases lipolysis
from the liver (free fatty acids into the blood); theobromine, which dilates
blood vessels and increases urine output; and theophylline, which relaxes
smooth muscles of the bronchi. These metabolites are broken down further and excreted
in the urine.
Coffee and tea do contain antioxidants that help
detoxify the liver and fight disease. The journal Gastroenterology
reported in 2005 that more than two cups of coffee a day may actually halve the
risk of serious liver damage in people who are obese, diabetic, alcoholic, or have
too much iron in their blood — that is, those who are at higher risk for liver
diseases. Whether we like to admit it or not, the reality is that coffee and tea
are the major source of antioxidants for some people.
A subset of people who are slow detoxifiers may have a genetic variant of the caffeine-metabolizing
enzyme CYP1A2. These people metabolize caffeine at a slower rate so it lingers longer,
increasing the potential for negative effects. According to a recent study, carriers
of the gene variant who drank two to three cups of coffee a day had a 36% higher
risk of heart attack than those with the faster gene. When intake increased to four
cups daily, the risk shot up to 64% greater — and even to four-fold for people
under 50!
Which underscores my point that caffeine in and of itself may not be a problem if
you are an efficient detoxifier. If, however, you have this genetic variant or your
detoxification system is overloaded in other ways, caffeine use may tip your health
over the edge. It’s also possible that the myriad other chemicals in coffee
and tea (like pesticide residues) are what tips the balance.
Standard genetic testing would be extremely useful here — but until then,
self-knowledge would be your best bet.
Special considerations for women and caffeine
My biggest concerns for most women with chronic caffeine use are increased anxiety,
insomnia, inflammation, and adrenal burn-out. Symptoms of fatigue, PMS, sleeplessness,
and breast tenderness are exacerbated by caffeine use. Caffeine distances you from
your natural energy cycles, tricking your body into a constant state of alert. This
ultimately makes you more tired. If you use caffeine to cope with stress, you can’t
ignore the fact that your solution may be part of the problem.
Chronic caffeine use makes a huge demand on your
adrenals. Most of my patients who abuse caffeine do it because they are
stressed-out and tired all the time. Often they combine caffeine with sugar or simple
carbs, a potent duo that triggers all the alarms in the body and sets the adrenals
on an energy rollercoaster. And this equation may worsen with time.
If you are trying to conceive, even one cup of coffee a day can decrease your success
rate. In addition, caffeine crosses the placenta, so if you are pregnant and drink
coffee, you are sharing the risks with your baby. Even moderate use doubles the
risk of delivering underweight babies and miscarriage.
Nursing mothers who drink coffee may inadvertently cause withdrawal symptoms in
their infants, because caffeine is carried through breast milk. If your baby is
colicky, try going without caffeine for a few weeks and see if there’s a difference!
There is also some suggestion that caffeine causes breast tenderness and may increase
the incidence of fibrocystic breast lumps in women of all ages. Clearly, if you
are pregnant, nursing, or want to be, or if you have a history of lumpy or tender
breasts, it’s best to avoid or severely limit caffeine.
Many of my patients who never had a problem previously with caffeine find it affects
them differently as their hormones begin to shift. This is likely caused by a combination
of estrogen loss and the decrease in rates of metabolism and detoxification that
occur naturally with age.
During menopause, caffeine can heighten symptoms like anxiety, hot flashes, bone
loss (by leaching calcium), heart palpitations, insomnia and mood swings. And because
it is addictive, it can be very hard to stop caffeine use at this time when so many
women already feel physically off-balance.
The bottom line is there is no way to know what power caffeine holds over you until
you try eliminating it for a little while.
Breaking the caffeine cycle: the Women to Women approach
Keep in mind that no one is suggesting you live the rest of your life without caffeine
— only that you move toward a healthier relationship with it.
But be prepared — caffeine is not an easy drug to quit for some women. I see
patients in my office willing to make every other single lifestyle change I suggest,
yet who break down in tears when I suggest giving up caffeine to take an adrenal
test. So don’t stop cold-turkey unless you want to. There are many half-measures
that can ease the way, like substituting beverages with less caffeine.
And while you slowly cut down on your caffeine consumption, you can build a better
support system by adopting the following measures.
- Recognize that caffeine is not food or a fluid replenisher.
Although coffee and tea contain antioxidants, they are in no way a good substitute
for real, whole food. Drinking coffee on an empty stomach increases stomach acid,
which can cause peptic ulcers, heartburn, and worsen GERD (gastroesophageal reflux
disease). Complementing your coffee with a big sugary snack, or adding a lot of
sugar to sweeten it, upsets insulin and cortisol levels, particularly if there is
no protein or healthy fat to take the edge off. Drink a glass of water upon arising
and then eat a high-protein breakfast. If you still want your cup of coffee or tea,
drink it after you have eaten. If your hunger is actually thirst, drink a glass
of water or herbal, decaffeinated tea before you turn to coffee or caffeinated teas.
- Go to bed earlier. There has been research linking higher
caffeine consumption with people who are “night owls” relative to “larks”
(early-risers). So, weaning from caffeine may be easier if you set an earlier bedtime
and strictly adhere to it. Allow yourself a full eight hours of sleep. Not only
is this important for detoxifying, it may transform your energy levels in the morning,
lessening your need for that first — or second or third — cup of caffeine.
- Increase your optimal nutrition levels with a multivitamin, complete
with essential fatty acids, calcium, and magnesium. If you drink caffeine,
you are depleting your body of necessary nutrients (it’s a lot of work to
stay in crisis mode). Caffeine increases the uptake of calcium from bone, so supplemental
calcium is important. And your fatigue may be due in
large part to inadequate nutrients.
- Drink more water to help detoxify. Caffeine is a diuretic,
meaning it dehydrates. If you up your intake of water, you may find you have less
craving for soda, coffee or tea. Water also helps flush toxins through the system,
including caffeine. What’s more, caffeine is very acidifying. Detoxification
is more efficient in an alkaline environment. Although water itself is neutral,
it helps dilute acidifying agents.
- Choose organic coffee and tea to cut the amount of pesticides
you ingest with each cup. Ask for an ingredients list with your favorite brand name
caffeine-enhanced drink. Pay attention to all the extra chemicals, sweeteners and
flavorings (not to mention calories). Caffeine may only be the tip of the toxic
iceberg.
- Consider buying Organic Fair Trade coffee to promote the
ethical treatment of coffee farmers around the world (most of whom live in poverty-stricken
regions). Coffee farmers are not the ones getting wealthy off our consumption: the
Fair Trade coffee wholesale minimum price for a pound of picked coffee beans is
only US $1.41 — less than one cup of drip coffee at any gourmet coffee shop.
Your health is connected with the health and prosperity of the planet.
- Examine your caffeine addiction. If you really need caffeine
to feel like yourself, or the idea of going without it throws you into a state of
anxiety, ask yourself what’s going on. Is there something else that can fill
that need? If it’s just the morning ritual you love, try a decaf variety,
or herbal tea, or a glass of hot water with lemon juice and a pinch of cayenne pepper.
If you are using caffeine as an antidote or enhancement to other substances (like
alcohol and nicotine), you may be dealing with several addictions at once. Acupuncture
and talk therapy are two great ways to free oneself from addiction. The goal is
to have the power to choose what you ingest, not to have it control you.
- Once you have a good foundation, it’s time to try and wean yourself
off the stuff. Switch to half caf/half decaf. Make sure your coffee
is decaffeinated without chemicals (e.g., Swiss water–processed). Start by
substituting one soda or cup of coffee/tea with a decaffeinated variety. If you
drink caffeine throughout the day, alternate with water. Each day, remove more caffeine,
slowly weaning yourself to lessen any withdrawal symptoms. After two weeks, you
should be drinking decaffeinated beverages entirely. Then keep going — decaf
can have up to a third the caffeine of the “high-test.”
Natural energy is limitless
Forty years ago, the idea of a store being open from 7 a.m.–11 p.m. was a
novelty. Now 24/7 is the norm, with productivity fueled by Starbuck’s, Dunkin’
Donuts, and Red Bull. Caffeine use is probably not the worst habit for most women
— as long as you’re not a pathological detoxifier, experiencing side
effects, or drinking a gazillion cups a day — but in the end, this kind of
artificial energy takes more than it gives.
Our Personal Program is a great place to start
The Personal Program promotes natural hormonal balance with nutritional supplements, our exclusive endocrine support formula, dietary and lifestyle guidance, and optional phone consultations with our Nurse–Educators. It is a convenient, at-home version of what we recommend to all our patients at the clinic.
If you have questions, don't hesitate to call us toll-free at 1-800-798-7902. We're here to listen and help.
We’re always happy to welcome new patients to our medical clinic in Yarmouth, Maine, for those who can make the trip. Click here for information about making an appointment.
Related to this article:
References & further reading on effects
of caffeine
Original Publication Date: 06/08/2006
Last Modified:
08/24/2009
Principal Author: Marcelle Pick, OB/GYN NP