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Consider this: We all know that adrenal hormones play a major role in the management of inflammation. (For example, prednisone is a synthetic adrenal hormone that is used to reduce inflammation in a wide variety of illnesses.) Adrenal hormones also help regulate the immune system, preventing immune cells from attacking healthy tissues. Rheumatoid arthritis has both an inflammatory and an immune system component. Recent research has shown that laboratory rats bred to have insufficient adrenal hormone production develop rheumatoid arthritis far more frequently than normal rats. It is also known that people with an adrenal disorder known as Cushing’s disease are at high risk for depression, fatigue, and rheumatoid arthritis.
Recent research has found that abnormal adrenal hormone production in
animals commonly leads to mood disorders. Clinicians have long noted that patients with rheumatoid arthritis frequently exhibit a type of depression characterized by fatigue, excessive sleep, and irritability. But it was always thought that this condition was the result of chronic arthritis pain: Now researchers are starting to think that the mood disorder and the inflammation may both be related to adrenal insufficiency.192
The adrenal insufficiency model of autoimmune disease makes sense when you learn that the onset of these disorders in humans is frequently associated with severe or chronic stress. Myasthenia gravis, for example, is an autoimmune disorder characterized by progressive loss of muscle strength and coordination.
Current research suggests a strong adrenal stress component.193
THE
DHEA CONNECTION
In Chapter 3, we learned that there is an inverse relationship in the body between stress hormones (primarily cortisol) and the “vitality hormone,” DHEA, which is also .produced by the adrenal glands. In Phase 1 of the caffeine/adrenal relationship, stress hormones are pumped out in excessive amounts. This action suppresses immunity and increases risk for a number of health disorders, especially cardiovascular disease. It also lowers production of DHEA, a hormone critical to the optimum functioning of your immune, cardiovascular, reproductive, and nervous systems.
Ultimately, the resulting stress leads to Phase 2 and adrenal exhaustion. The decrease in stress hormone production characteristic of Phase 2, however, does not result in increased DHEA. On the contrary, the exhausted adrenals are unable to produce either sufficient DHEA or cortisol, and this double whammy sets the stage for autoimmune disease. Men have a secondary supply of DHEA from testicular production, while women do not, which may help explain why women report more cases of autoimmune disease.
It is also interesting to note that a number of adrenal dysfunction disorders involve low levels of insulin-like growth factor-1.194 IGF-1 is one of the body’s chief repair and rebuild biochemicals, and its maintenance at optimal levels appears to be dependent on DHEA.
Until recently, however, very little attention was paid to the therapeutic benefits of DHEA. Asthma, allergy, and autoimmune disorders were treated with synthetic adrenal (glucocorticoid) hormones such as prednisone. And while these drugs certainly play an important role in the acute stage of inflammation, the
drugs certainly play an important role in the acute stage of inflammation, the adverse side effects make long term use extremely unwise. Chronic use of glucocorticoid drugs can cause weight gain, hypertension, seriously reduced immunity, emotional disturbances, and bone mineral loss leading to osteoporosis.
DHEA may provide an alternative treatment. Researchers today are finding that, in at least one autoimmune disorder known as lupus, treatment with DHEA produces significant improvement.195, 196 Most importantly, DHEA appears actually to help restore adrenal function.197
THE ALLERGY
AND ASTHMA PARADOX
The relationship between asthma and allergy is well known. In most asthma patients, allergy is an important trigger. But few understand the connection between stress, caffeine, and these conditions. I believe that is because both allergy and asthma are commonly treated with adrenal hormones. For example, when a person has a serious allergy attack (anaphylaxis), the throat may swell, breathing may become difficult, and often the patient is rushed to the emergency room, where epinephrine (a synthetic adrenal hormone) is administered. Within minutes the swelling begins to subside and the patient improves. This is no mystery. It simply demonstrates that adrenal hormones are very effective in dampening the inflammatory response, no matter what the initiating cause might be.
Asthma is typically treated with adrenal hormones and a caffeine metabolite known as theophylline. So the short view would naturally be, “Well, I guess caffeine is good for my asthma.” To get the truth, however, you need to take the long view. Chemically, theophylline is a dimethylxanthine, differing from caffeine only by the absence of one methyl group. (Caffeine is a trimethylxanthine.) When you consume caffeine, theophylline is one of the intermediate products that your liver makes as it breaks down and detoxifies the drug. Thus both the shortterm and long-term problems associated with theophylline are very similar to caffeine.
Now, what would you think if you went to the doctor for your asthma and were told to take theophylline for the rest of your life? Your first question might be, “Is that Safe?” To which a well-informed doctor might reply, “Well, actually, the drug is likely to upset your stomach, make you nervous, disturb your sleep, and suppress your immune system.198–199, 200, 201, 202 If you take too much, it
might trigger an epileptic seizure.203 Oh, and by the way, the immune suppression will primarily affect the immune cells you need to fight viruses and cancer.204 But hey, for now, you’ll breathe easier.”
Obviously, in real life doctors don’t give (and patients usually don’t ask for) the long view. We want instant relief, even if there’s a steep payback later on—and that’s the hallmark of caffeine. In clinical practice, I saw hundreds of patients with allergy and asthma, and with uncanny frequency, they would relate to me the following scenario:
When they drank three or four cups of coffee during the day, they would be pretty much asthma-free for the whole day, but their condition would then be much worse at night when they could not suppress the symptoms with caffeine or theophylline. I would explain that they did not have asthma due to a caffeine or theophylline deficiency, and that their long-term chances of success in eliminating the problem depended to a great extent on how well they treated their adrenals.
Those who were willing to follow my Off the Bean program invariably experienced significant improvements. Of course the program was combined with a sensible diet and lifestyle approach that included reduced exposure to inhalant and food allergens as well as stress management and nutritional supplementation to reduce the hypersensitivity of their airways. Remember also that some people are allergic to caffeine itself, and avoiding the substance in any form leads to almost immediate improvement.205
THE HYPERSENSITIVITY CONTINUUM
Once again, allergy is not an all-or-nothing phenomenon. The best way to visualize allergy-related disease is on a continuum, from nonreactive all the way to a condition known as multiple chemical sensitivity (MCS) (see figure below).
MCS patients are sometimes unable to leave their homes because even minimal exposure to outside air or pollution of any kind can trigger an allergic reaction.
Your position on this continuum is very much related to the ability of your adrenal glands to maintain adequate (but not excessive) levels of cortisol and epinephrine. Because caffeine and stress weaken the adrenal response, they exert a pressure that, over time, pushes us farther and farther to the right.
FIBROMYALGIA
Fibromyalgia is a chronic syndrome of pain that can range (and change) from tolerable to incapacitating. While the pain is arthritis-like, fibromyalgia is not a type of arthritis. The pain, rather than centering on the joints, is experienced more in muscles, tendons, and ligaments, and can shift unpredictably. For the moment, fibromyalgia remains a mysterious disorder, diagnosed from a symptom review and the existence of specific “tender poin
ts” on the body where even mild pressure causes undue soreness.
Current research suggest multiple causative factors, and there is a very significant caffeine-stress connection. New research has shown conclusively that patients with fibromyalgia suffer from an adrenal weakness that includes insufficient cortisol secretion.206, 207 The pituitary hormone signal that stimulates adrenal production of cortisol (ACTH) may be more than adequate, but the adrenal response is still weak. Exercise, a positive stress that in a healthy person stimulates a rise in cortisol, produces only a modest response in the fibromyalgia patient.208, 209 In effect, the syndrome fits perfectly into the Phase 2 model described above.
The simple solution is to give fibromyalgia patients synthetic adrenal hormones, but as we have already noted, the adverse side effects of these steroid medications are far too dangerous over the long term. We are left, therefore, wondering how to restore adrenal function naturally. That topic will be covered in Chapter 10. As you might have guessed, step one is to stop harming your adrenals with caffeine.
In fact, there are four good reasons why anyone with fibromyalgia should avoid all sources of caffeine.
1. Recovery is unlikely as long as your adrenals are stressed. Avoiding caffeine will greatly increase your chance of recovery, a process that may take ten years or more.
2. The restoration of deep sleep is critical to the healing process. Sleep disturbance (specifically reduced S-4 sleep) is one of the most common and long-lasting symptoms of fibromyalgia.210 The medical term for this disturbance is “alpha intrusion of Stage 4 sleep.”
As we discussed in Chapter 3, deep (S-4) sleep is essential for repairing tissue damage. Anyone with disturbed Stage 4 sleep will have aches and pains from unrepaired microtrauma that occurs in the muscles and connective tissue. Whether from overexercise of a particular muscle group, a new activity that involves use of different muscles, or simply an activity that you haven’t done in a while (gardening in the spring), minor muscular injuries are common and are normally repaired in deep sleep. In patients with fibromyalgia, these injuries appear to accumulate211—and any caffeine intake only worsens S-4 sleep disturbance.
3. Caffeine causes anxiety, which is part of the vicious cycle of stress and fatigue. The net result is that inflammation and pain are intensified.
4. Caffeine exacerbates other symptoms of fibromyalgia, including: • Decreased circulation to the fingers and toes (known as Raynaud’s phenomenon)
• Tension headaches and migraine
• Irritable bowel
CHRONIC FATIGUE SYNDROME
(CFS)
CFS is another multifactorial disorder with marked similarities to fibromyalgia.
Many medical texts group the two conditions together for diagnosis and treatment. In CFS, however, the most striking feature is debilitating physical and mental fatigue.
What caught the attention of early researchers was the similarity of CFS
symptoms to another condition known as post-viral fatigue syndrome. But the search for a viral cause (such as Epstein-Barr virus or EBV) turned out to be a dead end. EBV infection may play a role in chronic fatigue, but the vast majority of American adults test positive for EBV and only a small percent have chronic fatigue. There must be another factor that causes some individuals to fall apart in the face of viral or other infection, and that factor may very well be adrenal dysfunction.
As in fibromyalgia, recent research confirms that chronic fatigue patients
have low adrenal function212 and low levels of cortisol, both at morning and evening time points.213, 214 The tie-in with fibromyalgia is obvious, but researchers are now beginning to see that CFS may be part of the wider picture of adrenal dysfunction215—in which caffeine intake is a major contributing factor.
I’m not saying that caffeine causes CFS or the other disorders we’ve discussed in this chapter. However, one should not ignore the proven and wellunderstood damage that caffeine inflicts on the adrenal glands and nervous system. It’s important to take the long view, and CFS patients should be advised that using caffeine to get through the day will only prolong and deepen their debilitating illness.
There’s yet another factor to consider. CFS patients have been found to have impaired clearance of metabolic toxins, in itself a significant biochemical stress.
These metabolic toxins result from the normal metabolism of food, and they include bacteria, volatile fatty acids, amines, and bile acids. Additional bowel toxins are produced by parasites and yeast organisms. It is the job of the intestinal wall to prevent these substances from entering the bloodstream and surrounding tissues. In “Caffeine and Gastrointestinal Health,” this chapter, I presented evidence that caffeine and coffee both tend to impair the barrier function of the intestinal tract, leading to increased absorption of toxic material into the body.
THE BOTTOM LINE
Anyone with allergy, asthma, fibromyalgia, chronic fatigue, or any other autoimmune disease will tell you that their symptoms worsen or flare up when they’re under stress. In many cases, these people can pinpoint exactly when their condition first appeared and relate it to a specific trauma or stress in their life. If there is one essential lesson to be learned from this book, it is that stress is the invisible saboteur of health and wellness. Conversely, anything that you can do to enhance your experience of ease and peace will improve your life in myriad ways. The first step, as you know by now, is to get off the bean.
Men’s Health
Earlier in this chapter, I presented a discussion of cardiovascular disease, by far the most significant health risk for men related to caffeine. But as male baby
the most significant health risk for men related to caffeine. But as male baby boomers reach their fifth decade of life, prostate health becomes a more and more pressing issue
The most common symptom of prostate dysfunction is abnormal growth of the prostate, which then presses upon the urethra and causes problems with urination. Men with enlarged prostates (known as benign prostate hypertrophy or BPH) have trouble voiding their bladder, so pressure builds up and is difficult to release. Adding to the discomfort, this pressure also causes frequent awakenings to urinate during the night. Most importantly, BPH is a risk factor for prostate cancer, the second leading cause of cancer death in men.
As men age, the incidence of prostate infection and inflammation (prostatitis) also increases. All of these maladies are treated with drugs. Some work by inhibiting the metabolism of testosterone, some actually reduce testosterone production, and others fight underlying infection. Still, drug treatments of BPH, prostatitis, and prostate cancer are not what you would call remarkably successful. Surgery is being used more and more, and even the newest antibiotics often fail to eradicate prostate infections. Moreover, surgery and drug therapies often have adverse side effects, including decreased libido and impotence.
Thus, any man over forty is like to have a very uneasy feeling about his future health and sexuality. By age seventy, more than 50 percent will have enlarged prostates, and by age eighty, the number goes up to 80 percent. Here’s the good news: Men can significantly reduce their risk for urinary and prostate problems by getting off coffee and caffeine. Milton Krisiloff, M.D., a urologist in Santa Monica, California, was one of the first to notice that dietary modification, including the elimination of all sources of caffeine, actually resolved prostatitis in the large majority of his patients.216 In addition, he has clinical evidence that his simple program (the Krisiloff Diet) results in decreased PSA scores for many men. High PSA (prostate specific antigen) is an indication of increased risk for prostate cancer.217
Work by other investigators identifying an association between caffeine and urinary problems in men supports these clinical observations,218, 219 and recently prostate cancer risk was found to be directly linked to intake of theobromine, a methylxanthine related to caffeine. In that study, men who consumed high levels of theobromine (commonly found in chocolate) had more than twice the risk of prostate cancer
compared to men who consumed very little of that substance.220
ISSUES
OF MALE REPRODUCTIVE HEALTH
By now most everyone knows that sperm counts among men in Western nations are declining, and the rate of decline is fairly alarming. A likely explanation for this is the increasing exposure to pesticides and environmental pollutants, many of which are powerfully toxic to the reproductive organs of men and women.221
As I have mentioned, coffee is the most heavily sprayed of all consumable commodities, but residues in the final roasted product are reported to be quite low.222 Still, coffee and caffeine have to be considered in any discussion of reproductive health for three reasons.
1. Beyond the directly toxic effects, pesticides, fungicides, and herbicides can have cumulative effects on human health by altering hormone levels and hormone receptor sites in the body. These endocrine modulating effects can be virtually invisible for decades, producing symptoms only after many years of exposure. Thus, shortterm research will miss important long-term causative factors.
2. Clearly negative health consequences to animals are produced when they are fed caffeine, and the ill effects are almost always centered on the nervous and reproductive systems. Rats fed caffeine suffer testicular atrophy and low sperm counts as a result. Studies show, in fact, that of all methylxanthines, caffeine has the highest reproductive toxicity.223
What’s more, the amount of caffeine required to produce these adverse effects is not massive. One study with rabbits found marked suppression of sperm formation at roughly the equivalent of three mugs of coffee for a 150-pound man.224
Now, I know that you cannot equate rabbits and rats to human beings, but animal studies do have relevance, especially when you consider that human beings with agricultural exposure to pesticides exhibit precisely the same constellation of symptoms.225 And here’s one more extremely intriguing observation: Men with agricultural exposure to pesticides who father children have an astronomical prevalence of female offspring (83.4 percent versus the normal of 48 percent).226 The same thing happens when male rodents are fed caffeine.227