by Неизвестный
The increased work hours started to cause problems at home. She was late picking up her son at child care more often than she was on time, and family demands only added to her stress. When Roberta came to see me, she was near the breaking point. She was experiencing headaches and muscle pain, and she hadn’t exercised in months.
“All I need is a rest,” she said. “Can you help me get through these next few months till my vacation?” I explained that I didn’t agree with her line of thinking, and pointed out that unless she handled the underlying stress, she would be in the same plight a few weeks after her vacation. She insisted that a vacation would fix everything, so I drew the following diagram to make my point. I call it “the vacation illusion.”
Roberta thought that she could push herself to the breaking point and that periodic vacations would prevent her from experiencing stress-induced disease and breakdown. Stress, however, has a cumulative effect, and this is compounded by caffeine. What she didn’t take into consideration was that the damage being done to her nervous system would make her less and less able to cope with her job. For Roberta and millions of others, the vacation reality actually looks like this:
Note the upward slope of the stress curve. Each vacation provides less relaxation and rejuvenation, followed by greater stress, building to ultimate burnout. The question Robert asked, of course, was how to get off this upward spiral without quitting her job. And my answer was “Get off caffeine and give yourself a thirty-minute stressmanagement break every day.”
Now you’re probably thinking that without caffeine, you couldn’t accomplish everything that needs to be done, so I will give you the same suggestion I gave Roberta: Follow my Off the Bean program, which includes a nutritional plan to enhance energy and mental acuity, and see how it makes life easier and more enjoyable. My program worked splendidly for Roberta. She was not only better able to cope with the various tasks of her job, but she found that she was working more efficiently with co-workers and spending less time “spinning her wheels.” As she told me, “When I was running on caffeine, I thought I was doing a bang-up job, but I was really just banging around.”
Don’t Be Happy—Be Worried
To review, caffeine interferes with adenosine receptors, which normally control
the rate of neuron firing in the brain. In addition, the drug interferes with the metabolism of GABA, an important biochemical that helps us filter information and plan sensible action strategies.4 So the caffeine-stress combination, in effect, turns up the activity level in your brain while at the same time lowering your coping skills and decreasing your ability to relax. The result? Anxiety and irritability.
The amazing thing is that even without knowing how this occurs, most people know that caffeine makes them nervous. Yet a common reaction is not to decrease intake of caffeine, but to reach for anti-anxiety drugs. Today, one out of every five American adults takes some form of tranquilizer or antidepressant.
Since seven out of every ten American adults drink coffee, it’s safe to assume that many individuals drink coffee and take tranquilizers. This behavior is equivalent to driving with one foot on the brake and one foot on the gas. No wonder so many people are falling apart.
Truth in Advertising
An ad recently ran in national magazines that asked, “Does your life have signs of persistent anxiety?” It went on to list symptoms such as sleep disturbance, irritability, muscle tension, restlessness, and fatigue. Is this a “quit coffee” ad? No, this was an advertisement for Buspar, a new anti-anxiety drug from Bristol-Myers Squibb. Nowhere did the ad mention that every one of these symptoms could result from the consumption of caffeine. Nor did the prescribing information (in the Physicians’ Desk Reference) recommend that doctors query their patients regarding their caffeine intake before prescribing the drug.
Beyond Anxiety: Panic Disorder
For an estimated 5 million Americans, anxiety progresses to a condition known as panic disorder.5 The onset of panic “attacks” usually occurs in the third decade of life, and it afflicts women three times more often than men. Panic disorder is characterized by unexpected, unprovoked and intense fear, usually including feelings of impending doom. The accompanying symptoms of rapid heartbeat, shortness of breath, palpitation, dizziness, sweating, and a feeling of helplessness make this condition truly and deeply frightening. A panic attack may last only minutes, or it,, may last hours.
Now I’m not saying that panic attacks are caused by caffeine, but look back at the model of emotional resilience and imagine a paper-thin margin of
at the model of emotional resilience and imagine a paper-thin margin of emotional health. Think of the possible triggers that could send someone’s nervous system into a tailspin. One of the most significant is caffeine.
CHECKLIST
#1: ANXIETY/PANIC DISORDER
Medical and scientific analysis of anxiety/panic disorder has revealed welldefined abnormalities in physiology and brain biochemistry in people who suffer from the condition.6–7, 8, 9, 10 These include:
1. Overproduction of adrenal stress hormones, including increased norepinephrine and cortisol.
Is caffeine a factor? Yes_
2. Increased incidence of mitral valve prolapse (MVP).
Is caffeine a factor? Yes_
3. Decreased nighttime melatonin production.
Is caffeine a factor? Yes_
4. Dysfunction of GABA metabolism.
Is caffeine a factor? Yes_
5. Increased neuron firing in the brain.
Is caffeine a factor? Yes_
6. Decreased blood circulation to the brain.
Is caffeine a factor? Yes_
What’s more, in someone prone to this disorder, caffeine ingestion can trigger panic attacks.11 Still, caffeine promoters dismiss this characterization of their product, claiming that if caffeine were so bad, nearly everyone would have an anxiety disorder. That response is reminiscent of the cigarette makers who (until recently) defended their product by stating, “If cigarettes are so bad, every smoker would get cancer.” Of course not every smoker gets cancer and not every caffeine user has panic attacks. But it is important to understand that there is a continuum of effects. Everyone who smokes is destroying lung tissue, and in many cases that will progress to cancer. Likewise, everyone who abuses caffeine is harming his or her nervous system, and in many cases, that will progress to anxiety and perhaps panic attacks.
A Look at the Literature
Evidence of a connection between caffeine and anxiety/panic disorder is well established in the medical literature. Back in 1936, the New England Journal of Medicine reported that a woman became “confused, disoriented, excited, restless and violent” after ingesting a large number of caffeine pills. She was brought to the hospital, where the staff, ignorant of her caffeine binge, made the diagnosis of “psychoneurosis, anxiety type, with a hysterical episode.”
Five weeks later, the same woman again took over 1,000 milligrams of caffeine tablets, and was returned to the hospital. When she did not improve, she was transferred to a psychiatric hospital, where she was strapped to her bed.
After two months during which she made a slow recovery, she suddenly took a turn for the worse. Finally, someone noticed that she was drinking four cups of coffee per day. When the coffee was withdrawn, “she became entirely normal and was dismissed froni the hospital.”12
A more recent study published in the, Journal of Clinical Psychiatry reported that caffeine is not only capable of triggering panic attacks, but can also increase their frequency and intensity.13 Even moderate intake of caffeine has been found to worsen anxiety,14 and in a typical vicious cycle, individuals with anxiety and depression have been found to exhibit increased sensitivity to caffeine.15, 16
Finally, a report in the Archives of General Psychiatry found that caffeine produced significant increases in anxiety, nervousness, fear, nausea, palpitations, restlessness, and tremors in patients with agoraphobia and panic disorders. In fact, 71 p
ercent of the patients reported that the behavioral effects of caffeine were similar to those experienced during panic attacks.17
Is the caffeine connection widely unrecognized? Surveys document that 70
percent of patients with panic disorder visited physicians ten or more times before they experienced relief of their symptoms.18 The fact is that few physicians conduct a careful evaluation of caffeine intake, even though the medical literature is conclusive on the benefits of caffeine reduction in virtually all anxiety disorders.
Where Are You on the Caffeine/Anxiety Scale?
Emotional health is not an all-or-nothing state. There is a continuum of feelings and experiences that range all the way from deep serenity to panic. Where would
and experiences that range all the way from deep serenity to panic. Where would you place yourself on this scale, and where would you like to be?
Mostly at
Slightly
Anxious
Panic
Ease
Tense
You
You
You
You experience a You experience
experience experience
experience an
level of tension feelings of
some stress tension or
extraordinary
or anxiety that is helplessness and
but it is
anxiety that is
sense of peace
sometimes
are sometimes
temporary
sometimes
in your life at
impossible to
seized by intense
and easy to difficult to
all rimes.
control.
fear.
relieve.
relieve.
The popular notion that habitual use diminishes this stress response has also been debunked. A landmark study published in Psychosomatic Medicine examined the effects of moderate caffeine intake on stress reactivity in both habitual and light consumers of caffeine. Psychosocial stress (e.g., giving subjects a demanding task and distracting them at the same time) caused an increase in the stress hormones epinephrine and cortisol, but the addition of a moderate amount of caffeine more than doubled the stress response.19
Importantly, the researchers found that habitual and light caffeine consumers had basically the same increase in stress hormones, proving that people do not develop a tolerance to the anxiety-producing effects of caffeine. Rather, people simply become accustomed to the feelings of stress, irritability, and aggressiveness produced by the drug.
Deep Serenity
Damned If You Do…
The interesting thing about caffeine is that it potentiates or magnifies the stress in our lives. This effect occurs not only when one consumes it, but also when habitual drinkers are deprived of their “fix” for even a few hours.20–21, 22
Remember that caffeine is not a mood elevator except in the sense that metabolic stress tends to increase alertness. In other words, caffeine doesn’t improve one’s mood; it simply helps to avert the fatigue and depression associated with withdrawal. This fatigue and depression can come on quickly (within three hours of deprivation), and just about anyone can become dependent on caffeine, not only heavy or habitual users. Careful research conducted by the department of
psychiatry and behavioral sciences at Johns Hopkins University School of Medicine shows that low to moderate caffeine intake (as little as one fourteenounce mug per day) can quickly produce withdrawal symptoms, including depression, anxiety, irritability, fatigue, and headache.23
The Depression Connection
Depression is the single most common psychiatric diagnosis in America. It is estimated that 23 percent of American women and 12 percent of American men will seek medical or psychiatric help for this problem at some point in their lives. These figures are staggering. We’re not talking about transient blues or feeling a bit down, but rather clinical depression, which involves the inability to pull yourself out of the mood.24, 25
What’s more, many experts believe these figures under estimate the true problem, since only one person in three suffering from depression seeks professional help. Medical research strongly suggests that the disorder is generally underdiagnosed, undertreated, and often inappropriately treated by health-care providers.26
Few people would say that caffeine makes them depressed, but that’s only because the depressive effect is delayed. Studies show, for example, that most people given a group of substances over time will ascribe any changes in the way they feel to the last substance they took. Thus, feelings of tiredness and depression that come three hours after a cup of coffee are seldom associated with caffeine. We blame something else, like the weather or a boring job.
In reality, however, caffeine does contribute to depression in welldefined ways. The first is what I call the caffeine “rebound” effect. This has to do with the complex interactions between the stress response (adrenal stimulation) and brain biochemistry. We touched on this in Chapter 3 in the discussion of dopamine and addiction. There I presented evidence that caffeine raises dopamine levels in the brain in a way that is similar to amphetamines, albeit less dramatic.
The rebound depression is also similar, and to understand this, you don’t have to be familiar with pharmacology. Have you ever felt a “letdown” after an exciting event—even something really good? The intense stimulation subsides and is then replaced by a creeping sense of depression or languor. This happens because your dopamine receptors, the brain cells associated with excitement, have all been fired. What follows is a metabolic rebound that you must experience until your stores of dopamine are replenished. Caffeine can trigger this stress/depression roller coaster, and it may involve more than dopamine, since caffeine also appears to stimulate serotonin release as well.27
The second way that caffeine contributes to depression is, of course, the withdrawal reaction, the most prevalent symptoms being headache, depression, and fatigue. Three facts are important to grasp in regard to withdrawal. First of all, each of the symptoms compounds or magnifies the depressive effect.
Secondly, withdrawal can occur even in light caffeine users.28 And third, withdrawal reactions can be evident even when caffeine is withheld for just a few hours.29 Some people feel depressed or anxious if they’re simply late for their morning or afternoon cup. That’s not only a powerful motivation to consume the beverage, but it also creates an often-unidentified source of background stress.
CASE STUDY
A clinical report published in the Journal of Affective Disorders graphically illustrates the connection between caffeine and depression. A woman suffered for twenty years with recurrent depression. She was treated with a variety of drugs, including lithium, chlorpromazine, haloperidol, and Valium. After years of drug therapy, she decided to quit drinking coffee. Within one month, she was able to eliminate the Valium and all but one of her medications. At the time the clinical report was published, she had gone five years without a single episode of depression.30
Another Vicious Cycle
Depression can also occur as an adverse side effect of certain medications, and once again, caffeine is often a factor. Consider the example of a fifty-year-old man with high blood pressure who is put on a popular class of drugs called betablockers (e.g., propranolol). Depression and fatigue are common side effects with these drugs.31 Now the fellow is also drinking coffee, which contributes to his hypertension, and, faced with depression and fatigue, he then drinks even more coffee to break out of the depressed state. Thus, his blood pressure stays elevated and his doctor responds by increasing the medication dose, which causes the man to become more depressed.
A Word about Antidepressants
The pharmaceutical industry continues to spend billions to develop and market antidepressant drugs. Three main categories, including tricyclic antidepressants (TCAs), MAO inhibitors, and the new class of selective serotonin reuptake inhibitors (SSRIs) ca
n all be very valuable, and all can have significant side effects. Of the three classes, MAO inhibitors have the longest list of serious side effects, mostly having to do with increased risk of heart disease.
Common side effects include headache, dizziness, and insomnia. TCAs also have significant cardiovascular risks (elevated blood pressure, rapid heartbeat, palpitation, arrhythmias), and the new SSRIs, while having numerically fewer side effects, have as their primary disadvantage frequent reports of anxiety, insomnia, nervousness, and tremor.32, 33 Believe it or not, with these common adverse side effects, none of these drugs list coffee as a beverage to avoid in their professional or patient literature.
CHECKLIST
#2: DEPRESSION
Mental health professionals have observed that depression is often the other side of anxiety.34, 35 In other words, a drug (like caffeine) that creates anxiety will ultimately contribute to depression. Depression is characterized by welldefined biochemical and behavioral abnormalities, all of which are aggravated by caffeine.36–37, 38, 39, 40 They include:
1. Overproduction of stress hormones, including increased ACTH and cortisol.
Is caffeine a factor? Yes_
2. Strong association with insomnia and sleep disturbance.
Is caffeine a factor? Yes_
3. Decreased nighttime melatonin production.
Is caffeine a factor? Yes_
4. Dysfunction of GABA metabolism.
Is caffeine a factor? Yes_
5. Alteration of serotonin levels in the brain.
Is caffeine a factor? Yes_
6. Strong association with life stress.
Is caffeine a factor? Yes_
But I’m Not Depressed!
If you’re a coffee drinker, you may be thinking, “Well, I drink coffee and I’m not depressed.” It’s necessary to state again that everyone is different, and also that depression can be quite subtle. Throughout this book, I am suggesting that you will never know the full effect the drug is having on you until you experience what life is like caffeine free. Over the years, I have heard similar responses from hundreds of clients: “Wow, I never realized that caffeine made me so [select one: anxious, depressed, irritable].”