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Does any of this information surprise you? The fact is that caffeine has powerful neurological effects, and it is unreasonable to expect that the drug would not cause harm to those whose nervous systems are already shattered and stressed.
As if more evidence were required, two revealing studies have recently been conducted with psychiatric patients. In the first, researchers gave schizophrenic patients a dose of caffeine equivalent to about four cups of coffee. The caffeine raised blood levels of stress hormones and produced significant behavior disturbances, as well as increased blood pressure.69 The second study measured the effect of withdrawing caffeine from the diet of severely retarded adult patients. Two weeks without caffeine produced no real improvement in sleep pattern or behavior, but reintroduction of caffeine was accompanied by a highly significant increase in ward disturbance ratings.70 These findings are consistent with the fact that it would take three weeks or longer for caffeine-free patients to exhibit positive behavior changes.
“Our data suggest that inquiry into caffeine consumption should be included routinely for psychiatric patients, e.g., at admission, because patients with a psychotic disorder undergo a higher risk for an excessive caffeine consumption.”
Source: M. Rihs, C. Muller, and P. Baumann, “Caffeine
Consumption in Hospitalized Psychiatric Patients,” European Archives of Psychiatry and Clinical Neuroscience, 1996;246(2):8392.
“[D]eleterious effects may result from the interaction of caffeine with commonly prescribed psy-chotropic drugs. … Increased public education about potential health problems related to caffeine consumption is suggested, and further controls of caffeine in psychiatric settings are recommended.”
Source: A. Kruger, “Chronic Psychiatric Patients’ Use of Caffeine:
Pharmacological Effects and Mechanisms,” Psychology Reports, June 1996;78(3 Pt l):915-23.
Common Profiles of Caffeine Abusers
A great many people are addicted to caffine and abuse it without being aware of the consequences. Depending on individual sensitivity, as little as two cups of coffee per day has been shown to produce anxiety, insomnia, irritability, and dizziness.71
Dr. Michael Liepman, a clinician who works in addiction psychiatry at Michigan State University/Kalamazoo Center for Medical Studies, has identified the following types of patients who commonly abuse caffeine. Are you among them?
1. Patients with insomnia who are unaware that caffeine can disturb sleep for up to eight hours. These individuals often obtain sleep medications (from physicians who do not take a caffeine history) and then become doubly addicted, often escalating dosages of both drugs over time.
2. Patients with anxiety disorder (panic disorder, generalized anxiety disorder [GAD]) whose symptoms are aggravated by caffeine.
3. Alcohol abusers who drink to counteract the anxiety and/or depression produced by excess caffeine intake.
4. Recovering alcoholics who switch to caffeinated beverages once sober from alcohol. They become anxious, experience an overwhelming craving for alcohol sedation, and then relapse.
5. Hyperactive-appearing children who start on caffeinated beverages and chocolate (a source of caffeine and theobromine). Such children often become wild and uncontrollable, either ending up on stronger stimulants or sedating themselves with alcohol, marijuana, or other drugs.
6. Patients on sedating drugs who increase their intake of caffeine to resist the sedation.
7. Patients who are taking drugs that include caffeine (e.g., painkillers) without knowing that they contain caffeine.
8. Fetuses, newborn infants, and nursing infants whose mothers ingest caffeine from multiple sources. The babies have disturbed sleep, which causes the mothers to become sleep-deprived, whereupon the mothers increase their caffeine intake in order to function.
This last group is arguably the most serious because there are two “victims,”
This last group is arguably the most serious because there are two “victims,”
both of whom are caught in a spiral of addiction and pain. We know, for example, that when pregnant women consume caffeine, their babies are often born with a caffeine dependency. If these babies are bottle-fed, they will experience withdrawal symptoms, and if you can imagine a newborn baby with insomnia and a splitting headache, you understand the tragic consequences. Even if they are breast-fed, breast milk does not contain as much caffeine as they were getting in the womb, and that may also trigger withdrawal symptoms.
Then there’s the mother, who now has to deal with a child who cannot be consoled. Readers who have raised fussy children will understand the strain that this creates. Multiply fussy times ten, and you have the stress of a baby addicted to caffeine. As mentioned above, these mothers often turn to caffeine to get through the day, and thus fall farther into the abyss of stress, disturbed sleep, neurological damage, and emotional pain.
To Sleep, Perchance to Dream …
As described in Chapter 3, sleep is a critical factor in emotional and physical health. A perfectly healthy and optimistic person will start to exhibit clear symptoms of emotional illness after only three nights of disturbed sleep. In my clinical practice, I took a careful sleep inventory and found that fewer than 25
percent of my patients had satisfactory sleep habits, in terms of duration, consistency, and restfulness. The vast majority woke up feeling tired. And in most cases, significant improvements were achieved simply by reducing or eliminating caffeine.
There is no mystery to this. Medical research conclusively shows that as stress hormones increase, sleep duration and quality suffer greatly.72, 73 In many cases, this produces a welldefined vicious cycle of caffeine intake -> anxiety ->
depression -> impaired sleep -> increased caffeine use.74
Reducing or eliminating caffeine is obviously the way to interrupt this cycle and restore a sense of balance in one’s life. Invariably what surprised my patients was the profound difference they felt. As sleep improves, you would expect an increase in energy, but the ripple effect of benefits also included decreased pain, better mood, decreased reliance on prescription and over-thecounter drugs, enhanced immune function, and improvements in memory and learning. Most important, patients reported “feeling themselves” again. In some cases, where caffeine consumption had been lifelong, they were literally discovering who they were for the first time.
discovering who they were for the first time.
Anger and Hostility
Getting off caffeine also tended to reduce feelings of irritability and hostility.
This, of course, turns out to be extremely valuable both from an individual and a social perspective. In the section on heart disease (Chapter 5) I will present the connection between caffeine intake, stress hormones, and behaviors like anger and hostility. You’ll learn that these behaviors are clearly linked to increased risk for stroke and heart attack.75 Well, as you can imagine, cardiovascular disease is not the only condition affected by anger and hostility. Mind-body research (known as psychoneuroimmunology) tells us that the cycle of stress hormones and caffeine plays an important role in many if not most health disorders, even traffic accidents.
According to the National Highway Traffic Safety Administration, rage is a key factor in twothirds of all fatal car crashes.76 That’s about 28,000 highway deaths each year. In addition, of course, are the untold numbers of nonfatal accidents caused by tailgating, speeding, weaving, exchanges of insults, honking, screaming, and actual gunfire.
Issues surrounding caffeine affect each and every one of us. We live, work, and play within a social framework that depends upon personal interaction. We know that the quality of this interaction depends to a great extent on the level of harmony, peace, cooperation, patience, and forgiveness we are able to maintain.
We also know that caffeine often works to the detriment of these factors.
• A study of locomotive engineers showed that coffee consumption was linked with increased negative mood and decreased positive
mood.77
• A sample of 144 inmates from a maximum-security penitentiary reported that those who consumed high levels of caffeine experienced poorer general mood levels than any other group. Caffeine consumption in this sample population averaged 800 milligrams per day—well above the amount considered damaging to health.78
• Importantly, there appears to be a time-dose factor in the development of caffeine and stress-related disorders. The body is able to compensate for increased stress hormone levels, but not forever. At some point (and this depends on myriad individual factors that are impossible to predict) the body’s stress management system (known as the hypothalamic-pituitaryadrenal axis, or HPA) starts to malfunction. This results in a welldefined
adrenal axis, or HPA) starts to malfunction. This results in a welldefined breakdown pattern with clear biochemical abnormalities and symptoms of physical and emotional illness.
Recently, a group of researchers wanted to test the hypothesis that people with borderline hypertension could be distinguished from those with normal blood pressure simply by looking at the health of their HPA axis. Sure enough, there was a high correlation between abnormal stress hormone levels and the incidence of borderline hypertension, proving that a failure of the stress management system is a factor early in the disease process. Importantly, this biochemical defect also produced a characteristic alteration of mood and behavior, marked by feelings of exhaustion and emotional distress. The researchers referred to this condition as “a defeat type of reaction to stress.”79
The good news is that the converse is also true. There are steps you can take that will reliably lower your stress hormone levels and even restore balance to the HPA axis. As you well know, getting off caffeine is an important first step, but yoga, meditation, prayer, tai chi, and biofeedback can also help a great deal, and have been shown to produce often dramatic improvements in energy and mood, with decreased tension, decreased anger, and increased feelings of wellbeing.80, 81
Background Stress—The Saboteur of Health
At this point, you know that there are serious health risks associated with caffeine consumption, and we have explored many of these in detail. The arguments I present are carefully documented from the scientific and medical literature. Some health risks are easy to quantify. For example, you can have the level of cortisol in your blood checked, or you can compare the incidence of various diseases among coffee drinkers and nondrinkers. But there are more subtle factors at work as well, what I call disposition and outlook.
The image I get regarding life for most people today is one of pots on a stove.
We’re constantly putting on lids to prevent pots from boiling over, and switching pots to “back burners.” Well, what if we were able simply to turn down the heat?
Wouldn’t that make a great deal of sense? In other words, life is complex. If you can simplify things (i.e., by taking pots off the stove), good for you. But sometimes that’s not possible or even desirable, and life remains complex and busy. In that case, reducing the background level of stress and tension is critically important to maintaining the balance and quality of your life.
critically important to maintaining the balance and quality of your life.
Getting off caffeine is like turning down the heat. Everything becomes more manageable. There may still be half a dozen pots on the stove, but they’re simmering nicely instead of boiling over. Once again, the decision is up to you as to which experience of life you desire.
Another View
When I am challenged by representatives of the caffeine industry, their arguments are most often based upon the lack of scientific consensus regarding caffeine and mental health. I admit that this is so. There is no universal agreement concerning the effects that caffeine produces in the body or the mind.
But I would like to make two points:
First, no one is arguing that caffeine is good for us. The only debate concerns the degree to which it is harmful. Second, I would like to suggest looking at the issue from a different angle. Take the association between caffeine and anxiety disorders. This chapter presents solid and convincing evidence that caffeine causes anxiety in great numbers of people. In many cases, anxiety affects the quality of life to the point of producing incapacitating emotional illness such as panic disorder. Still, there are those who will say the data is not strong enough.
To them I put the following question: Do people suffering from anxiety improve when they reduce or eliminate caffeine?
The answer to this question is a resounding yes. Not only do I know it from clinical experience, but careful research has also proven the benefits of caffeine reduction. A landmark study published in the British Journal of Clinical Psychology found that patients suffering from anxiety tend to consume more caffeine than the general population. In fact, more than one-third of their study group was categorized as “heavy caffeine users.” After a period of caffeine reduction, these patients saw their symptoms decrease by a mean of 42 percent and, importantly, the improvement was directly proportional to the caffeine intake. In other words, those who reduced caffeine a little improved a little, while those who made very significant reductions in caffeine intake showed the greatest improvement.82
Take the Challenge!
Most people have no idea what life would be like without the background of caffeine and stress hormones coursing through their veins. Even if you’re only having a few cups a day, chances are your personality is affected in ways that may be too subtle for you to associate with caffeine. As you’ve seen in this chapter, caffeine’s contribution to anxiety and depression alone are reasons enough to kick the habit.
enough to kick the habit.
I want to encourage you to conduct a trial period without caffeine. You owe it to yourself. Use the Off the Bean program in Chapter 10 to break the habit.
Remember that you must go through the entire detoxifying process, which takes a minimum of three weeks, before you can begin to measure the results—and that it takes sixty days total before you can fully assess the benefits of being caffeine free.
Assure yourself that if you don’t feel significantly better, you can always go back to caffeine. But at least you’ll know that you explored the option, and are not simply a slave to the coffeepot. Not only your mood, but your entire outlook on life, stands to benefit as a result.
CHAPTER 5
Specific Health Disorders: The Caffeine Connection
Caffeine and Cardiovascular Disease
I know, you’ve heard it a thousand times: Cardiovascular disease is the nation’s number one killer. But have you ever thought about what that actually means? If we translate the abstract numbers into concrete terms, the picture becomes much more real and immediate. Only then will we be motivated to do something about it—in our own lives and in the lives of those we love.
Cardiovascular disease (CVD) encompasses disorders of the heart and blood vessels, including heart attack, stroke, chest pain, hypertension, rheumatic heart disease, and atherosclerosis (hardening or blockage of the arteries). In 1997, more than 960,000 Americans died of cardiovascular disease. Remarkably, there are societies on earth where CVD is rather rare, so we know that it’s not one of the inevitable consequences of aging. In fact, CVD is preventable. Nevertheless, unless people take action toward prevention, things will go on just as they have for decades.
In America today, nearly one-third of men between the ages of fifty and sixty will die within the next ten years from cardiovascular disease. And if that surprises you, consider that this disease now kills more women than men. More people die of cardiovascular disease than succumb to all cancers, all accidents, pneumonia, influenza, suicide, and AIDS combined: one life every thirtythree seconds.1
HEART DISEASE
Coronary heart disease (or heart disease) is by far the most common form of cardiovascular disease. According to the American Heart Association, every twenty seconds, an American suffers a heart attack, and every sixty seconds somebody dies from on
e. If you picked up your morning paper and read that three jumbo jets had crashed the day before, you would be greatly alarmed.
What if this happened every morning, 365 days a year? That’s the impact heart disease has on our nation, and yet the efforts at prevention are limited. Sure, there have been significant advances in hospital coronary care units, and more people are trained in CPR, but that’s not prevention—that’s simply rapid response.
The goal, after all, is to prevent heart attacks, and present efforts toward that end fall into two categories: drugs and dietary change to lower cholesterol, and
end fall into two categories: drugs and dietary change to lower cholesterol, and drugs and dietary change to lower blood pressure. As valuable as these measures are, they are still not primary prevention. What about preventing cholesterol levels and blood pressure from rising in the first place, and what about all of the other risk factors in heart disease?
Given a complex issue, people (especially the media) naturally look for a simple explanation. Heart disease was thus reduced to a “cholesterol problem,”
which of course turned out to be untrue. Plenty of people have high cholesterol and never have heart attacks, and every day people with low cholesterol are rushed to the hospital in cardiac arrest.
Even adding the blood pressure factor does not produce an accurate picture of heart disease, but these two considerations are the only ones that receive much attention. And since coffee-induced increases in cholesterol and bipod pressure appear to be relatively small, the professional and popular press have written off coffee as a risk factor. But nothing could be farther from the truth.
“The strong association between coffee consumption and coronary heart disease risk found in several different studies and the implications for the large population at risk are compelling arguments for concern about adverse cardiovascular effects of caffeine consumption.”