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NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.
Justin Evans ; John R. Richards ; Amanda S. Battisti .
Last Update: June 8, 2023 .
- Continuing Education Activity
Caffeine is a naturally occurring central nervous system (CNS) stimulant of the methylxanthine class and is the most widely taken psychoactive stimulant globally. This drug is most commonly sourced from the coffee bean but can also be found naturally occurring in certain types of tea and cacao beans, and it is also an additive to soda and energy drinks. The primary goal of caffeine consumption is to combat fatigue and drowsiness, but there are many additional uses. This activity reviews the mechanism of action, adverse event profile, toxicity, dosing, pharmacodynamics, and monitoring of caffeine, pertinent for clinicians and other interprofessional team members where caffeine is already in use or might be necessary.
- Review the FDA-approved on-label indications of caffeine, as well as other non-FDA uses.
- Identify the proposed mechanism of action of caffeine.
- Summarize the contraindications and associated risks associated with caffeine use.
- Outline interprofessional team strategies for improving care coordination and communication when considering or using caffeine or controlling its use by patients to improve outcomes.
Caffeine is a naturally occurring central nervous system (CNS) stimulant of the methylxanthine class and is the most widely taken psychoactive stimulant globally. This drug is most commonly sourced from the coffee bean but can also be found naturally occurring in certain types of tea and cacao beans. It is also an additive to soda and energy drinks. The primary goal of caffeine consumption is to combat fatigue and drowsiness, but there are many additional uses. 
The FDA has approved caffeine for use in the treatment of apnea of prematurity and prevention and treatment of bronchopulmonary dysplasia of premature infants.    Non-FDA-approved uses of caffeine include treating migraine headaches and post-dural puncture headaches and enhancing athletic performance, especially in endurance sports.   Caffeine has links with decreased all-cause mortality.   It is also under investigation for its efficacy in treating depression and neurocognitive declines, such as those seen in Alzheimer and Parkinson disease.   
- Mechanism of Action
Caffeine’s primary mechanism of action is on the adenosine receptors in the brain. As it is both fat and water-soluble, it readily crosses the blood-brain barrier, resulting in antagonism to all four adenosine receptor subtypes (A1, A2a, A2b, A3). Specifically, the antagonism of the A2a receptor is responsible for the wakefulness effects of caffeine.  
Adenosine receptors are not limited to the CNS but are present throughout the body. In cardiac muscle, direct antagonism of receptor A1 results in positive inotropic effects. Likewise, adenosine receptor antagonism stimulates the release of catecholamines, contributing to the systemic stimulatory effects of caffeine and further stimulating cardiac inotropy and chronotropy. At the vascular level, caffeine undergoes a complex interaction to control vascular tone, which includes direct antagonism of vascular adenosine receptors to promote vasodilation, as well as stimulation of endothelial cells to release nitric oxide. This action promotes further relaxation of vascular smooth muscle cells. This vasodilation becomes counteracted by increased sympathetic tone via catecholamine release and positive cardiac inotropic and chronotropic effects, promoting vasoconstriction. As there are multiple constriction and dilatation mechanisms at work, the overall result is individualized and dependent upon caffeine dose, the frequency of use, and comorbidities such as diabetes or hypertension. Overall, caffeine seems to increase systolic blood pressure by approximately 5 to 10 mmHg in individuals with infrequent use. However, there is little to no acute effect on habitual consumers.  
Furthermore, adenosine receptor blockage stimulates respiratory drive by increasing medullary ventilator response to carbon dioxide, stimulating central respiratory drive, and improving diaphragm contractility. Caffeine increases renal blood flow, glomerular filtration, and sodium excretion resulting in diuresis. It is also a potent stimulator of gastric acid secretion and gastrointestinal (GI) motility.  
Metabolism of caffeine primarily occurs in the liver via the cytochrome P450 oxidase system, specifically enzyme CYP1A2. Metabolism results in 1 of 3 dimethylxanthine, including paraxanthine, theobromine, and theophylline, each with unique effects on the body. These metabolites are then further metabolized and excreted in the urine.  
The half-life of caffeine is approximately 5 hours in the average adult. However, multiple factors can influence metabolism. Half-life is reduced by up to 50% in smokers compared to nonsmokers. Conversely, pregnant patients, especially those in the final trimester, will demonstrate a prolonged half-life upwards of 15 hours. Newborns will also have a significantly prolonged half-life, up to 8 hours for full-term and 100 hours for premature infants, due to reduced activity of cytochrome P450 enzymes and immature demethylation pathways. Children older than nine months will have similar half-life eliminations to that of adults. Additionally, patients with liver disease or those taking cytochrome inhibitors will also experience prolonged half-lives due to reduced enzyme activity.  
Caffeine has nearly 100% oral bioavailability and is the primary route of administration. Caffeine can be sourced from coffee beans, cacao beans, kola nuts, tea leaves, yerba mate, the guarana berry, as an additive to sodas and energy drinks, or consumed as powder or tablets.  When taken orally, onset typically occurs in 45 to 60 minutes and lasts approximately 3 to 5 hours. Absorption is somewhat delayed when taken with food. It can be administered via the parenteral route, which is a common method when treating apnea of prematurity in newborns or post-dural puncture headaches.
Alternatively, caffeine can be absorbed rectally, insufflated, or inhaled. Consumption via insufflation or inhalation is generally a form of misuse with the intention of "getting high." These routes lead to significantly faster absorption, usually within minutes, and bypass the first-pass metabolism. Although this route can lead to a faster onset of action, multiple studies have shown lower bioavailability from inhalation of caffeine; approximately 60% to 70%. When taken via this route, the duration of action is shorter.  
- Adverse Effects
As with most drugs or medications, there is a long list of adverse effects associated with their use, and caffeine is no different. The adverse effects of caffeine range from mild to severe to even fatal and are generally related to the dose consumed and an individual’s sensitivity to the drug. The most common side effects are listed below. Mortality is usually associated with cardiac arrhythmia, hypotension, myocardial infarction, electrolyte disturbances, and aspiration.  
Anxiety, restlessness, fidgeting, insomnia, facial flushing, increased urination, muscle twitches or tremors, irritability, agitation, elevated or irregular heart rate, GI upset
Disorientation, hallucinations, psychosis, seizure, arrhythmias, ischemia, rhabdomyolysis
Caffeine can also cause withdrawal symptoms if habitual users abruptly stop. These symptoms usually begin 12 to 24 hours from last consumption, peak in 1 to 2 days, and may persist for up to 1 week. Withdrawal is preventable if caffeine is tapered off instead of abruptly discontinued. If symptoms do arise, they are promptly reversible by re-administration of caffeine. 
Lastly, when used to treat apnea of prematurity, there is evidence of an increased risk of necrotizing enterocolitis in neonates. 
Although there are no absolute contraindications to caffeine, there are some medical conditions in which caution is necessary, which includes     :
- Severe anxiety
- Cardiovascular disease or symptomatic cardiac arrhythmias
- Peptic ulcer disease or gastroesophageal reflux disease
- Hepatic impairment
- Renal impairment
- Seizures (as may lower seizure threshold)
American College of Obstetricians and Gynecologists (ACOG) considers 200 mg daily safe during pregnancy.  There is no evidence to suggest caffeine increases the risk of congenital malformations.  However, some studies have concluded that high caffeine consumption during pregnancy (more than 400 mg per day) may be associated with lower birth weights from intrauterine growth restriction, increased risk of miscarriage, but not preterm birth.   However, the evidence regarding lower birth weight and miscarriage is presently inconclusive and pending further investigation.  Caffeine is considered a pregnancy class C drug. 
The average dose of caffeine is 2.4 mg/kg per day for adults; however, daily doses of up to 400 mg are considered safe.  Consumption of 100 mg of caffeine generally increases blood levels by 5 to 6 mg/L.  There are reports of severe intoxication that causes altered mentation, vomiting, and hypotension at levels of 80 mg/L. The average blood level of patients who succumb to caffeine toxicity is 180 mg/L (+/- 97 mg/L). 
For the treatment of apnea of prematurity, caffeine is administered as a 20 mg/kg loading dose, followed by 5 to 10 mg/kg per day of caffeine citrate via enteral or parenteral routes with therapeutic index goals of 5 to 25 mg/L.  
Caffeine consumption is generally recognized as safe. Most substances do not require FDA approval for additive caffeine as long as it falls within safe levels dictated by the statute. The typical dose of caffeine is roughly 70 to 100 mg per drink. Although there is no specific daily allowance for caffeine, doses of up to 400 mg a day are considered safe. 
The exact LD50 for humans is variable and largely dependent on sensitivity to caffeine. However, it is estimated to be 150 to 200 mg/kg. There are, however, case reports of doses as low as 57 mg/kg being fatal. A toxic dose of caffeine, or a dose at which significant unfavorable side effects begin to occur, for example, tachycardia, arrhythmia, altered mentation, and seizure, is estimated to be approximately 1.2 grams, while estimates of a life-threatening dose are in the range of 10 to 14 grams.  
Ultimately, treatment is primarily supportive in cases of mild ingestions. For more severe ingestions, additional interventions may be necessary. Patients may require intubation for airway protection from vomiting or altered mental status. Benzodiazepines can be given to abort any seizures that develop. Patients may require vasopressors to combat persistent hypotension if intravenous (IV) fluid resuscitation alone fails. The first-line vasopressor should be either phenylephrine or norepinephrine. However, phenylephrine is the ideal choice due to its pure alpha agonism as well as reflex bradycardia. Magnesium and beta-blockers can be used to combat cardiac arrhythmias secondary to the hyperadrenergic response.  The ultra-short acting beta-1 selective blocker esmolol has been used successfully in several case reports for this indication. In the event of lethal arrhythmias, patients will require defibrillation and resuscitation per ACLS protocol.  Activated charcoal, intralipid infusion, and hemodialysis can help prevent further metabolism and subsequent effects of caffeine overdose.  
- Enhancing Healthcare Team Outcomes
Caffeine consumption is relatively safe in limited amounts. The problem is that many people today are consuming high-energy drinks that contain massive amounts of caffeine, which can lead to complications. Today the issue of caffeine toxicity has been worsened with high-energy drinks. These concentrated caffeinated beverages are not only toxic themselves, but the problem becomes exacerbated when the individual combines caffeine use with other illicit agents, such as tobacco and alcohol. Over the past few years, there have been reports of many deaths following the consumption of such combinations.
Dealing with caffeine toxicity or side effects, or using caffeine therapeutically, requires an interprofessional healthcare team for optimal results. For therapeutic use, query the patient about other potential caffeine sources so that toxicity is not an issue with therapy. Team members are in a prime position to educate the public on the dangers of high-energy drinks and related foods. Clinicians, nursing staff, and pharmacists must be prepared to offer counsel to patients who may be overindulging in caffeine. While there are no absolute contraindications to caffeine, the public should be advised to avoid caffeine if they have cardiac disorders, panic disorder, anxiety, or elevated stress levels. An interprofessional team is the best means by which to convey this message. [Level 5]
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Disclosure: Justin Evans declares no relevant financial relationships with ineligible companies.
Disclosure: John Richards declares no relevant financial relationships with ineligible companies.
Disclosure: Amanda Battisti declares no relevant financial relationships with ineligible companies.
This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.
- Cite this Page Evans J, Richards JR, Battisti AS. Caffeine. [Updated 2023 Jun 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.
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Caffeine and Health
- 1 Associate Editor, JAMA
- Original Investigation Association of Coffee Drinking With Mortality by Genetic Variation in Caffeine Metabolism Erikka Loftfield, PhD; Marilyn C. Cornelis, PhD; Neil Caporaso, MD; Kai Yu, PhD; Rashmi Sinha, PhD; Neal Freedman, PhD JAMA Internal Medicine
- Original Investigation Assessment of Caffeine Consumption and Maternal Cardiometabolic Pregnancy Complications Stefanie N. Hinkle, PhD; Jessica L. Gleason, PhD, MPH; Samrawit F. Yisahak, PhD; Sifang Kathy Zhao, PhD; Sunni L. Mumford, PhD, MSc; Rajeshwari Sundaram, PhD, MS; Jagteshwar Grewal, PhD; Katherine L. Grantz, MD, MS; Cuilin Zhang, MD, PhD, MPH JAMA Network Open
Caffeine is a natural chemical stimulant that can also be created synthetically for consumption.
Natural caffeine is found in coffee beans, tea leaves, cacao beans, guarana berries, and yerba maté leaves. Caffeine preparations can be added to drinks, food, tablets, or powdered supplements. In the US, about 85% of adults consume caffeine daily, and average intake is 135 mg per day (equivalent to 12 oz of coffee). The most common source of caffeine is coffee for adults and soft drinks and tea for teenagers.
How Does the Body Absorb and Metabolize Caffeine?
Caffeine is absorbed into the bloodstream within 45 minutes after ingestion. Metabolism of caffeine varies among individuals, but its duration of action is typically 2.5 to 4.5 hours. Pregnancy and some medications (oral contraceptives, certain antidepressants, cardiovascular medications, and antibiotics) slow caffeine removal from the bloodstream. In contrast, cigarette smoking increases the rate of caffeine removal from the bloodstream.
Beneficial Effects of Caffeine
Caffeine in moderate doses (40-200 mg) acts within the brain to decrease fatigue, increase alertness, and decrease reaction time. Caffeine also may decrease appetite and slightly reduce weight gain. In moderate doses, caffeine has been associated with decreased risk of depression and suicide in some studies.
Medical Uses of Caffeine
Caffeine is used to treat intermittent pauses in breathing (apnea) in premature infants. Addition of caffeine to commonly prescribed pain relievers (such as acetaminophen) can decrease acute pain from certain conditions, such as migraines.
Common Negative Effects of Caffeine
Caffeine leads to temporary increases in blood pressure in individuals with minimal or no prior use. Caffeine, particularly in higher doses, can cause anxiety, as well as difficulty falling asleep if consumed late in the day. Abrupt cessation of caffeine in regular users may result in withdrawal symptoms, which typically peak at 1 to 2 days and include headache, fatigue, and depressed mood. Because higher caffeine intake in pregnancy is associated with lower infant birth weight, caffeine consumption should not exceed 200 mg per day during pregnancy.
Effects of Caffeine in Very High Doses
Ingestion of very high doses of caffeine (1200 mg or more) can cause agitation, severe anxiety, elevated blood pressure, and palpitations. This may occur with overuse of caffeine tablets or supplements in liquid form (energy drinks) or powdered form. Consuming caffeinated energy drinks or energy shots together with alcohol is dangerous and has resulted in deaths.
Possible Health Benefits of Drinking Coffee
Some studies have shown decreased mortality associated with drinking 2 to 5 standard cups of caffeinated or decaffeinated coffee per day. In some reports, regular consumption of both caffeinated and decaffeinated coffee has been associated with a reduced risk of type 2 diabetes and endometrial cancer. In other reports, both caffeinated and decaffeinated coffee consumption was associated with lower risk of liver cancer, gallstones, and gallbladder cancers, but the potential benefit was stronger with caffeinated coffee. Consumption of caffeinated coffee has also been associated with a reduced risk of Parkinson disease and liver cirrhosis.
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Conflict of Interest Disclosures: None reported.
Source: van Dam RM, Hu FB, Willett WC. Coffee, caffeine, and health. N Engl J Med . 2020;383(4):369-378. doi: 10.1056/NEJMra1816604
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June 21, 2018
The Healthy Addiction? Coffee Study Finds More Health Benefits
New research in mice details the mechanism of how caffeine seems to help the heart
By David Noonan
Farhad J Parsa Getty Images
It’s enough to make a tea drinker buy an espresso machine. In a new study scientists in Germany report they were able to modify a common age-related defect in the hearts of mice with doses of caffeine equivalent to four to five cups of coffee a day for a human. The paper—the latest addition to a growing body of research that supports the health benefits of drinking coffee—describes how the molecular action of caffeine appears to enhance the function of heart cells and protect them from damage.
It remains to be seen whether these findings will ultimately have any bearing on humans, but Joachim Altschmied of Heinrich Heine-University in Düesseldorf, who led the study with his colleague Judith Haendeler, says “the old idea that you shouldn’t drink coffee if you have heart problems is clearly not the case anymore.”
Previous research had suggested as much. For example, a 2017 report in the Annual Review of Nutrition , which analyzed the results of more than 100 coffee and caffeine studies, found coffee was associated with a probable decreased risk of cardiovascular disease—as well as type 2 diabetes and several kinds of cancer. The new paper, published Thursday in PLOS Biology , identifies a specific cellular mechanism by which coffee consumption may improve heart health.
The study builds on earlier work in which the two scientists showed caffeine ramps up the functional capacity of the cells that line blood vessels. The drug does so by getting into cells and stoking the mitochondria, structures within the cells that burn oxygen as they turn glucose into energy.“Mitochondria are the powerhouses of the cells,” Haendeler says. One of the things they run on is a protein known as p27. As Haendeler and Altschmied discovered (and describe in the current paper), caffeine works its magic in the major types of heart cells by increasing the amount of p27 in their mitochondria.
After the researchers induced myocardial infarction in the mice during their experiments, the extra stores of p27 in the caffeinated cells apparently prevented damaged heart muscle cells from dying. The paper says the mitochondrial p27 also triggered the creation of cells armed with strong fibers to withstand mechanical forces, and promoted repairs to the linings of blood vessels and the inner chambers of the heart. To confirm the protein’s importance, the scientists engineered mice with a p27 deficiency. Those mice were found to have impaired mitochondrial function that did not improve with caffeine.
The researchers also looked at caffeine’s potential role in modifying a common effect of aging in mice and humans: reduced respiratory capacity among mitochondria. (In this context “respiratory” refers to a complex sequence of biochemical events within the organelle .)
For this part of the experiment, 22-month-old mice received caffeine—the daily equivalent of four to five cups of coffee in humans—in their drinking water for 10 days. That was sufficient to raise their mitochondrial respiration to the levels observed in six-month-old mice, according to the study. Analysis showed the old mice had roughly double the amount of p27 in their mitochondria after the 10 days of caffeine.
Although this latest news about the potential health benefits of coffee involves just a single animal study, tea drinkers might well feel they are coming out on the wrong end of the coffee equation. According to the National Coffee Association, 64 percent of Americans 18 and over drink at least one cup of coffee a day, with an average daily consumption of 3.2 cups. Three cups of a typical breakfast tea contain less than 150 milligrams of caffeine, compared with the nearly 500 milligrams in the same amount of brewed coffee. So tea drinkers might wonder if they are missing out on a potential health benefit and should start drinking the other stuff.
“Absolutely not,” says Donald Hensrud, medical director of Mayo Clinic's Healthy Living Program. “You have to enjoy life, and if you enjoy tea, keep on enjoying it. It’s all good. There are health benefits to coffee, to black tea and to green tea.” But there can also be problems associated with higher doses of caffeine, he notes. The amount in more than two cups of coffee a day, for example, can interfere with conception and increase the risk of miscarriage. And, he says, because individuals metabolize caffeine at different rates, slow metabolizers may be more susceptible to side effects such as heartburn, insomnia, heart palpitations and irritability.
Haendeler, who drinks six cups of coffee a day, says it can be part of a healthy lifestyle—but is no miracle cure. And she is quick to point out there are no shortcuts to good health. “If you hear about this study and decide to drink coffee but you do nothing else—no exercise, no proper diet—then, of course, this will not work,” she says. “You cannot simply decide, ‘Okay, I’m sitting here and drinking four, five or six cups of coffee and everything is fine.'”
Caffeine: a potential drug of abuse
- PMID: 6391103
Recent investigations of caffeine abuse have questioned the indiscriminant use of this commonly accepted drug. In some individuals, chronic excessive caffeine consumption leads to the development of caffeinism, a syndrome which includes increased anxiety, depression, frequency of psychophysiological disorders, and possibly degraded performance. This paper reviews research demonstrating the abuse potential of caffeine. Special attention has been given those factors which mediate the wide individual differences in consumption patterns, susceptibility to abuse, and the varied psychological and physiological responses to this drug. While the development of caffeine abuse is probably best viewed as an idiosyncratic process, general guidelines for the recognition of potential abuse, and caffeinism proper, are offered.
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- Caffeine* / therapeutic use
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- Child, Preschool
- Coronary Circulation / drug effects
- Gastric Juice / metabolism
- Headache / chemically induced
- Infant, Newborn
- Maternal-Fetal Exchange
- Physical Exertion / drug effects
- Psychomotor Performance / drug effects
- Reaction Time / drug effects
- Sleep / drug effects
- Stimulation, Chemical
- Substance Withdrawal Syndrome / etiology
- Substance-Related Disorders / psychology*
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Caffeine Addiction Symptoms and Withdrawal
Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania.
What Is Caffeine Addiction?
- Caffeine Adverse Effects
- Caffeine Withdrawal
- Other Similar Disorders
- Are You Addicted to Caffeine?
- How to Cope
Caffeine addiction is the excessive and harmful use of caffeine over a period of time, such that it has negative effects on your health, social interactions, or other areas of your life.
Coffee and other caffeinated products can create a physical dependence, leading to chemical changes in the brain. Daily consumption can quickly lead to a caffeine addiction, characterized by cravings and withdrawal symptoms if intake is reduced or ceased.
According to the Centers for Disease Control and Prevention (CDC), approximately 80% of Americans consume caffeine daily.
To be clear, caffeine has been associated with many positive side effects. Research has connected this plant-derived stimulant to improved mood , relief from headaches , and perhaps a reduced risk of other major medical issues such as strokes , Parkinson's, and Alzheimer's . Large studies that tracked people over time found that coffee drinkers were less likely to die during follow-up.
Yet, some people experience negative issues due to caffeine use or have difficulty coping without caffeine. Though rare, there have even been cases of caffeine overdose.
Caffeine affects the brain's reward system, which triggers the release of a chemical called dopamine. Dopamine causes people to feel good, creating a reward cycle that motivates them to keep consuming it and experiencing that same level of reinforcement.
It also causes physiological dependence, which means that when you reduce or stop your caffeine intake, you will likely experience withdrawal symptoms like tiredness, headaches, and irritability .
When you have a caffeine addiction, it means that your caffeine use negatively disrupts your life, yet you're unable to stop consuming it. Or you consume it in amounts that are potentially dangerous to your health despite knowing that it may harm you mentally or physically.
Caffeine is the most widely used drug worldwide. Coffee and soda are the top caffeine sources in the United States, whereas African and Asian countries consume them in soda and tea . Caffeine is also present in many common foods (almost anything with chocolate ), making it easy to over-consume.
While caffeinated products like coffee, soda, and energy drinks are less reinforcing than other addictive substances, that does not mean they don't have potential adverse health effects.
Symptoms of Caffeine Addiction
Although caffeine addiction is not a formally recognized condition in the " Diagnostic and Statistical Manual of Mental Disorders (DSM-5) ," a manual used by clinicians to classify and diagnose mental health concerns, the publication mentions some caffeine-related issues, such as intoxication and withdrawal.
Caffeine intoxication, caffeine withdrawal, caffeine-induced anxiety disorder, and caffeine-induced sleep disorder are all recognized in the "DSM-5," and caffeine use disorder has been identified as requiring further study.
As caffeine is a stimulant, consuming too much can cause a cluster of symptoms associated with brain and nervous system stimulation. These symptoms include:
- Feeling shaky
- Increased blood pressure
- Racing heart, or other heartbeat abnormalities
- Sleep issues
This type of addiction can even overlap with work addiction , as some people use the stimulating effects of this substance to perform better at their job mentally and/or physically.
As with all addictions, the pleasurable effects of caffeine can also sometimes mask other issues. Lack of energy and depression may underlie caffeine addiction. People may rely on caffeine to compensate for sleep disorders.
How Caffeine Can Negatively Affect Your Health
Caffeine has various effects on the body that are potentially harmful to your health. Caffeine has been associated with increased blood pressure and heart rhythm changes.
Some caffeinated products, such as coffee and soda, can cause gastrointestinal disturbances.
There is also a question of whether caffeine might increase your risk of osteoporosis. One study found this to be the case for women in menopause with high caffeine intake.
Caffeine can also decrease your health by disturbing your sleep if consumed within six hours of bedtime.
When you are sleep deprived, it makes it harder to function efficiently during the day. Sleep is also when your body heals, making it essential for total health and immune function.
Excessive caffeine intake can also have an impact on mental health. Increased anxiety can occur, particularly in those sensitive to caffeine's effects or who have a previously existing anxiety disorder.
Some research has shown that caffeine may be linked to symptoms of psychosis and mania in people who have psychotic disorders or mood conditions.
Symptoms of Caffeine Withdrawal
Just as taking in too much caffeine can present issues, so can suddenly removing it from your diet. This can result in caffeine withdrawal , which produces symptoms that are the opposite of consuming too much. This effect can be especially profound in people who are addicted to caffeine.
The symptom most often noticed by people going through caffeine withdrawal is a headache, which may range from mild to severe.
Other symptoms associated with trying to cut back your caffeine habit or missing your daily "dose" are:
- Feeling tired or sleepy
- Reduced mental alertness
- Slower reaction times
- Worsened performance on memory tasks
Occasionally, people withdrawing from caffeine also experience flu-like symptoms, such as nausea as well as mood changes.
How Long Does Caffeine Withdrawal Last?
Symptoms of caffeine withdrawal typically start around 12 to 24 hours after your last caffeine dose. You may experience these symptoms for between two to nine days.
7 Quick Tips to Help with Caffeine Withdrawal
Caffeine addiction and other conditions.
The stimulating effects of caffeine can sometimes cause physical symptoms and behaviors that look and feel like—and therefore be easily confused with—other disorders. Therefore, it is important to let your doctor or mental health clinicians know how much caffeine you are consuming if you are being assessed for any condition.
For example, caffeine intoxication produces symptoms that can easily be confused with anxiety disorders , such as panic attacks. Too much caffeine can also worsen symptoms of these disorders by intensifying feelings of worry, causing racing thoughts, increasing heart rate, and preventing relaxation and good-quality sleep.
People who are overstimulated with caffeine can also exhibit symptoms consistent with attention deficit disorders . Conversely, caffeine withdrawal shares similar symptoms with mood disorders . Other health concerns that can be confused with caffeine intoxication include:
- Manic episodes
- Panic disorder
- Generalized anxiety disorder
- Sleep disorders
- Migraine and other headaches
- Viral illnesses
- Sinus conditions
- Medication-induced side effects, such as akathisia or an inability to stay still
It can also be mistaken for and worsen symptoms of withdrawal from other substances, such as amphetamines and cocaine . Stimulant drugs such as these are often cut with caffeine, increasing the likelihood that caffeine withdrawal is involved in withdrawal from these drugs.
Caffeine Can Induce Other Disorders
Some disorders are triggered by the use of caffeine. Examples of these types of disorders include caffeine-induced anxiety disorder and caffeine-induced sleep disorder.
Do You Have a Caffeine Addiction?
If you suspect that you are addicted to caffeine, such as if you have a coffee addiction, it is essential to take stock of your situation. Assessing your intake, the impact, and how you feel can help you better determine if you need to cut back.
Addiction involves excessive use of caffeine and relying on this stimulant to better cope with life despite any adverse effects you may be experiencing. To figure out whether you might be addicted, it helps to:
Assess Your Intake
Calculate how much caffeine you are consuming on a typical day. Remember that gourmet espresso, lattes, and cappuccino typically contain more caffeine than regular drip or instant coffee, soda, and other common caffeine-containing foods and drinks. Therefore, this should be accounted for when determining your normal intake.
Pay Attention to How You Feel
Make a note of any side effects you experience after consuming caffeine. Also, note any adverse effects you feel if you lower your normal intake or skip caffeine entirely. Pay attention to both mental and physical effects for a more complete picture of how you are impacted by its use.
Consider How Caffeine Affects Your Life
Think about your caffeine habit and how it affects your life as a whole. Do your relationships suffer if you don't get your morning coffee, for instance? Could your caffeine intake be contributing to your work anxiety ?
If you or a loved one are struggling with substance use or addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.
For more mental health resources, see our National Helpline Database .
Coping With a Caffeine Addiction
Caffeine addiction is so common that we don't even notice it most of the time. But when you can greatly reduce or quit caffeine to reduce the adverse effects it is having on you, you may find it easier to get back in touch with your own natural energy and can relax when night falls.
If you consume more caffeine than is healthy, you can reduce your caffeine intake or cut it out completely.
If your responses to caffeine (or a lack of caffeine) affect you negatively, speak to your healthcare provider. Similarly, if you have another health condition that might be impacted by caffeine use, such as heart disease, or even if you are pregnant or breastfeeding, discuss options with your doctor immediately.
Make a Plan to Cut Back or Quit
The vicious cycle of addiction is often the same with caffeine as with other addictive substances. As the effects of the caffeine begin to wear off, you might feel a crash in energy and that you can't keep going without another boost. Your doctor can help you move past this without giving in.
Gradually Lower Your Caffeine Intake
Since stopping "cold turkey" can make you feel worse, most people need to reduce caffeine intake gradually rather than abruptly. Your doctor can help you devise a suitable plan based on your typical caffeine consumption. This can help reduce or eliminate any withdrawal effects.
How to Taper Your Caffeine Dose
Instead of cutting your caffeine intake abruptly, try reducing your regular intake by about 10% every two weeks. One way to do this is to reduce the strength of your caffeinated drinks by diluting them with a decaffeinated version.
Find Ways to Manage Withdrawal Symptoms
Withdrawal symptoms such as headache and fatigue may leave you wanting to reach for a cup of coffee or a can of soda, so finding ways to cope with these symptoms is essential. Consider using over-the-counter pain medications like Tylenol or ibuprofen to relieve headache symptoms. Other strategies that can help include:
- Getting enough sleep
- Drinking plenty of water
- Finding ways to stay busy
- Engaging in physical exercise to boost energy levels
Seek Help for Mental Health Symptoms
If you feel you are using caffeine to cope with an emotional problem, such as depression or anxiety , talk to your physician about treatment options. The right treatment could make a huge difference for you.
Caffeine addiction often overlaps with other behavioral addictions, such as sugar addiction . So, you might find that evaluating your caffeine intake also identifies other behaviors that need to be addressed.
Caffeine is a stimulant often consumed daily in many forms, including coffee, soda, tea, energy drinks, and chocolate. Low or moderate amounts are safe and may even have certain health benefits. Excessive intake, however, can adversely affect health and lead to caffeine addiction.
If you think you have a coffee addiction or that you are consuming too much caffeine, gradually lowering your intake can help you get control of your caffeine habit.
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Sweeney MM, Weaver DC, Vincent KB, Arria AM, Griffiths RR. Prevalence and correlates of caffeine use disorder symptoms among a united states sample . Journal of Caffeine and Adenosine Research . 2020;10(1):4-11. doi:10.1089/caff.2019.0020
Bodar V, Chen J, Gaziano JM, Albert C, Djoussé L. Coffee consumption and risk of atrial fibrillation in the Physicians' Health Study . J Am Heart Assoc . 2019;8(15):e011346. doi:10.1161/JAHA.118.011346
Temple JL, Bernard C, Lipshultz SE, Czachor JD, Westphal JA, Mestre MA. The safety of ingested caffeine: A comprehensive review . Front Psychiatry . 2017;8:80. doi:10.3389/fpsyt.2017.00080
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By Elizabeth Hartney, BSc, MSc, MA, PhD Elizabeth Hartney, BSc, MSc, MA, PhD is a psychologist, professor, and Director of the Centre for Health Leadership and Research at Royal Roads University, Canada.
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Small UW study on alcohol, caffeine, sleep yields ‘unexpected finding’
University of Washington researchers discovered an “unexpected finding” while studying the effects of alcohol and caffeine on sleep .
In the first known study analyzing the effects of “the two most popular psychoactive drugs in the world,” researchers from UW and University of California, Berkeley, hypothesized that combining caffeine and alcohol would decrease sleep quantity and quality.
For six weeks, 17 study participants — who worked in financial trading, an occupation where the use of alcohol and caffeine is high, according to the researchers — logged their drink consumption and their quantity and quality of sleep.
At first, the study, published in the journal PLOS ONE , yielded unsurprising results: Alcohol and caffeine measurably affect snoozing.
On average, caffeine reduced sleep quantity by 10 minutes per cup consumed the previous day. Those who drank alcohol the day before reported a 4% decline in their sleep quality on average, according to the study.
But when consumed together, researchers found the negative impacts of caffeine and alcohol on sleep were offset.
“Compared to the nights when you might have one or the other, we thought we were going to see additional decline in subjective sleep quality or sleep duration,” lead researcher Frank Song said in a statement . “But actually, that interaction effect was the opposite of what we expected and ended up having an effect of offsetting each other’s negative impact on quality or quantity. And this was very intriguing to us.”
Researchers believe the offsetting effect lasts only for a short time, though.
In the long run, they believe combining alcohol and caffeine ultimately perpetuates a self-medication cycle of use.
“It’s a very, very nice thought, I think, in many people’s minds that you could just use caffeine to wipe off the hangover,” Song said. “But what we find is that while there may be greater alertness in the short term, it creates a sleep-state misperception contributing to continued use despite negative effects on sleep.”
Even though study participants were getting less sleep, they were not able to perceive a decrease in sleep quality, which suggests a mismatch in perception that may contribute to continued use of alcohol and caffeine despite negative effects on sleep, the researchers found.
This “ultimately ends up being a negative cycle for their sleep,” the study said.
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Coffee Flower Tea Is a Super Source of Anti-Inflammatory Flavonoids (and It’s Completely Jitter-Free)
Posted: November 30, 2023 | Last updated: November 30, 2023
Ironically, feeling torn between the two most magical morning beverages—coffee and tea—is exhausting. Instead of letting the pain of indecision (ahem) steep, brew yourself the best of both worlds: coffee flower tea.
Whether you’re trying to cut back on caffeine intake or you simply want something more subdued in flavor, coffee flower tea may just become your new drink of choice.
What is coffee flower tea?
According to Jordan Michelman and Zachary Carlsen ’s new book, But First, Coffee , turning coffee flowers—which are “aromatic and distinct, with notes of jasmine and honeysuckle” and grow on coffee trees—into tea is one of the smartest ways to reduce your coffee consumption-related waste.
“Like cascara [a beverage made from coffee cherry husks], coffee flower water uses a commonly discarded part of the coffee plant,” Michelman and Carlsen say. “A kind of herbal tisane made using hot water and coffee flowers has been known for centuries in coffee-growing communities.” In order to prepare the tea, coffee flowers are first sun-dried on raised beds. Then, you can steep them as you would a good tea or herbal tisane.
The health benefits of drinking coffee flower tea are bountiful, BTW
According to Lauren Manaker , MS, RDN, LD, CLEC, CPT, a registered dietitian based in Charleston, drinking coffee flower tea has some benefits. “It’s rich in antioxidants such as flavonoids, it helps combat oxidative stress, and reduces inflammation in the body,” Manaker says. “The tea also can provide a calming effect, reducing anxiety and promoting relaxation. Furthermore, its antibacterial properties can aid in oral health.”
Despite these potential benefits, Manaker says it’s always advisable to consume it in moderation and consult a healthcare professional for personalized advice on how to introduce it to your diet.
“[Coffee flower tea] is rich in antioxidants such as flavonoids, which helps combat oxidative stress and reduce inflammation in the body. The tea also can provide a calming effect, reducing anxiety and promoting relaxation.” —Lauren Manaker, MS, RD
Coffee flower tea vs. regular ol’ coffee
Although they may sound like closely-related siblings, they’re more akin to close cousins. “While coffee flower tea and traditional coffee come from the same plant, they differ significantly in terms of caffeine content, flavor, and health benefits,” Manaker says. For starters, herbal drink won’t trigger caffeine-induced jitters. “Unlike regular coffee , which is high in caffeine, the tea contains little to no caffeine, making it an excellent option for those looking to reduce their caffeine intake,” she says.
“Unlike regular coffee, which is high in caffeine, the tea contains little to no caffeine, making it an excellent option for those looking to reduce their caffeine intake.”
Then, in terms of flavor, the tea is much more subdued than, say, a double shot of dark roast brew. “The flavor profile of the two also varies. Coffee flower tea is noted for its light, floral taste, in contrast to the robust, full-bodied flavor of coffee,” Manaker says.
Finally, the health benefits are different between the two, and the tea may even possess a few more enticing qualities than its counterpart. “In terms of health benefits, both beverages are rich in antioxidants, but coffee flower tea is said to offer a broader range of benefits, such as improving blood sugar regulation and possessing antibacterial properties, but more data is needed to confirm this,” Manaker says.
Who shouldn’t drink coffee flower tea?
Before introducing this beverage into your morning ritual, it’s important to note that it may not be suitable for everyone. “People with an allergy to the coffee plant could potentially react to coffee flower tea. Plus, those with a sensitivity to plants in the Rubiaceae family should abstain due to the risk of cross-reactivity,” Manaker says. She also cautions that pregnant and breastfeeding people should be cautious and consult with a healthcare professional before consuming the tea, as there’s limited research on the tea’s effects in these instances. “Individuals with chronic health conditions or those currently taking any medication should seek medical advice before introducing coffee flower tea into their diet, as it could interact with certain drugs or exacerbate existing health issues.”
How to make coffee flower tea recipe
Yields 1 medium pot of tea
4 grams (1 teaspoon) dried coffee flowers
220 milliliters (not quite 1 cup) water heated to 176°F (80°C), which is just before boiling
1. Start with your favorite teapot, glass server, or sizable brewing vessel. A small Chemex works great here if that’s your preference.
2. Pour the hot water over the coffee flowers and start a timer set for two minutes. Allow the flowers to steep the full amount of time, then decant the brewed tea from your vessel—don’t over-steep the flowers.
Excerpted with permission from But First, Coffee by Jordan Michelman and Zachary Carlsen © 2023. Published by Union Square & Co. Photography © Zachary Carlsen
A registered dietitian shares the benefits of drinking regular ol’ coffee:
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