Caffeine is estimated to be the most widely used legal psychoactive drug in the world—consumed daily by approximately 85 percent of U.S. adults. But what effect do caffeinated beverages, particularly coffee, have on health? And what should you tell patients who want to know how much caffeine is too much?
Refresh your knowledge with insights from Coffee Science: A Clinician’s Guide to the Beloved Bean, a podcast from Gaples Institute, and Caffeine and the Human Body, an educational video from JN Learning™.
Good news for your coffee-loving patients: People who drink up to four cups of coffee daily, compared to non-drinkers, show a 29 percent reduced risk of all-cause mortality over a seven-year period, a 15 percent reduction in all cardiovascular disease, and a reduced risk of developing type 2 diabetes and acute and chronic kidney disease. Studies also show that
greater amounts of habitual coffee consumption were associated with a lower risk of arrhythmia.
While caffeine is in the methylxanthine family and functions as an adenosine receptor antagonist, coffee and tea also have a wide range of biologically active polyphenols. “These are plant-derived chemicals that act both as anti-inflammatories and antioxidants,” says Dr. Steven Devries, a preventive cardiologist and executive director of Gaples Institute. “Perhaps the best of all studied in coffee is chlorogenic acid. It's a potent anti-inflammatory and antioxidant also found in peaches and eggplants.” Chlorogenic acid may be beneficial for glucose regulation and thus help prevent type 2 diabetes.
The FDA cites 400 milligrams as the daily limit for caffeine. (A 12-ounce cup of coffee is 135 mg.) But that doesn’t mean everyone should be starting the day with an extra-large Dunkin Donuts coffee. Many people are sensitive to caffeine and need a much lower intake. “Depending on the person, as you get up to 200 or 500 milligrams or more, then you start to exhibit some of the less pleasant effects: sweatiness and a bit of tremor, a bit of anxiety, or even palpitations, sort of a sensation of the awareness of your heartbeat” says Dr. David N. Juurlink, staff internist and head of the division of Clinical Pharmacology and Toxicology at Sunnybrook Health Sciences Centre in Toronto. “And there are other things that you won’t necessarily appreciate unless you’re measuring them like an increase in your heart rate or an increase in your systolic and diastolic, blood pressure.”
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How long caffeine stays in the body is different from person to person, and it can take up to 10 hours to clear from your bloodstream. “There's a lot of interindividual variability that is not easy to predict,” says Dr. Jennifer L. Temple, Director, Nutrition and Health Research Laboratory of University of Buffalo. “But people who are sensitive tend to know they are sensitive.” Genetics factor in, but certain medications can slow down caffeine metabolism, including oral contraceptives, certain antidepressants and some cardiovascular medications and antibiotics. The same is true for pregnancy, which is why it’s recommended that pregnant patients limit their caffeine consumption to less than 200 mg per day. Meanwhile, smoking cigarettes and eating charcoal-grilled foods or Brassica vegetables (broccoli, cabbage and Brussels sprouts) can speed up caffeine metabolism.
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