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Sunday, September 03, 2006

Coffee and Caffeine : More than You Ever Wanted to Know

Coffee is an integral component of many societies, not only from an ingestable standpoint, but also due to the psychological and socio-economic significance of the substance. Beginning with the historical narrative of Coffee, this paper examines the physical composition of coffee, short and long term physiological effects, and the current status of health related coffee/caffeine research. Issues of dependency, addiction, real and perceived benefits, side-effects, and possible long term consequences will also be examined.
According to the Arcade Dictionary of Word Origins, the word “coffee” originated from the middle east .... from where it is believed the coffee tree is descended. Early translations do not distinguish between the beverage as it is known today and an ancient form of wine, however, by the 17th century the Italian word “caffe” is easily distinguished (Ayto, 1990). This European historical narrative correlates the origins of the word with the emergence of coffee into Europe via Arabia and Turkey. However, sources familiar with the botanical origin of coffee dispute this traditional view and report that coffee originated not from Arabia but rather Ethiopia (Kowalchik, C., and Hylton, W., 1987). Coffee as it is now known in North America, is an herbal concoction (actually it is a decoction...where large pieces of a plant are simmered in water in order to draw out the essential properties) derived from the fruit of the Coffea Arabica plant. Coffee trees are evergreens which grow to a height of 15 to 40 feet and may live to be 100 years old given the proper conditions (Kowalchick, C., and Hylton, W., 1987).
During the 17th century, Italian fleets actively traded around the world. It is speculated that during this time the widespread use of coffee was popularized. Within a century, coffee was introduced throughout Europe and an established industry of trade. Soon coffee peddlers increased the fame of coffee beyond the supply capacity of Arabia. Coffee smugglers began stealing the beans in order to re-introduce the plants into favorable climates around the globe. The West Indies, Java, India, and Brazil soon produced enough coffee to meet demand; with an “unlimited” supply of coffee available, the “golden era” of coffee was born. Coffeehouses became popular in Europe and North America by catering to intellectuals, artists, politicians, and “thinkers” association still strongly linked to coffee consumption. As American settlers began moving west, coffee spread as a drink among “common” persons.
Today coffee is one of the most widely used beverages in the world and spawns entire economies through the growth, production, and distribution of the substance. In Europe and North America, as before, coffeehouses are again increasing in popularity...this time with themes such as computer linked stations or poetry recitals. Roadside stands at outdoor events, kiosks in malls, and sections of franchise bookstores have taken advantage of the latest wave of coffee well as coffee manufacturing industries who offer a variety of blends, styles, and choices of coffee.
In the midst of this trend it is easy to find persons who spend more time selecting and preparing coffee than meals; in fact, for many persons coffee has taken the place of breakfast and afternoon snacks. Due to the high rate of coffee consumption among segments of the population the composition, metabolism, and safety of the substance has been thoroughly researched.
The principle active ingredient of coffee is caffeine and therefore the primary research subject when observing the physical or physiological effects of coffee consumption. It may be noted however, sociological factors have not adequately addressed the differentiation between coffee consumption and other methods of caffeine ingestion in regard to the societal attitudes and expectations surrounding “coffee-breaks” and other associated coffee rituals.
It is recognized that caffeine is “the worlds most common drug”. Despite years of ingestion, it was not until 1820 that caffeine was first isolated from coffee. According to the Alcoholism and Drug Addiction Research Foundation, (1991):
The caffeine content of coffee beans varies according to the species of the coffee plant. Beans from Coffea arabica, grown mostly in Central and South America, contain about 1.1% caffeine. Beans from Coffea robusta, grown mostly in Indonesia and Africa, contain about 2.2% caffeine...In North America, the caffeine content of a cup of coffee averages about 75 mg, but varies widely according to cup size, the method of preparation, and the amount of coffee used. Generally cups prepared from instant coffee contain less caffeine (average 65 mg) and cups prepared by drip methods contain more caffeine (average 110 mg.). (p. 1)
In comparison, cups of tea average approximately 30 mg, cola averages about 35 mg, and hot chocolate contains 4 mg of caffeine. Although coffee is the main source of caffeine for persons over the age of 25, it is by no means the only source. Caffeine is present/routinely added to pain relievers, colas, chocolate, and numerous food products.
Consumption Patterns
The average daily consumption of caffeine among American adults is estimated at 280 mg...the equivalent of three cups of coffee per day with 80 percent of the adult population using some form of caffeine on a regular basis ( Fenton, 1995).
Short Term Effects
Short term effects of a drug are those which appear after the ingestion of a single dose and disappear within hours. The effects of caffeine appear as early as 15-45 minutes after ingestion, with peak central nervous system inclusion reached at approximately 30 minutes after ingestion. Caffeine is a central nervous system stimulant resulting in increased heartbeat, respiration, basal metabolic rate, and the production of stomach acid and urine. Caffeine does not accumulate in the body and is excreted within several hours. The “half-life” of caffeine is the amount of time it takes the body to eliminate one-half of the consumed caffeine from the body, generally three to four hours in most adults.
According to the Alcoholism and Drug Addiction Research Foundation, 1991, the short term effects of ingesting one to two cups of coffee cause several physiological responses:
As the general metabolism increases it is expressed as an increase in activity or raised temperature, or both. The rate of breathing increases, as does urination and the levels of fatty acids in the blood and of gastric acid in the stomach. Caffeine may increase blood pressure. Caffeine stimulates the brain and behavior...caffeine elevates neural activity...postpones fatigue, and enhances performance at simple intellectual tasks and at physical work that involves endurance but not fine motor coordination. (p. 2)
Tolerance and Dependence
Tolerance refers to the body’s increased need for a substance in order to achieve the same desired effect. It is often the first stage of a dependence or addiction to a substance. Caffeine is considered a psychoactive substance and as such, the most widely used drug in the world (ADARF, 1991). However, it is difficult to assess the impact/effect of caffeine on a comprehensive basis because most adults consume caffeine in one form or another. Research has demonstrated that individuals are able to build a tolerance to caffeine thereby increasing the amount consumed in order to achieve the same desired effect. After the individual use of caffeine reaches 350 mg (or more) per day, physical dependency results (ADARF, 1991). Interruption of the source of caffeine ( coffee for most adult Americans) results in withdrawal syndrome symptoms.
Caffeine withdrawal is characterized by “headache, drowsiness, irritability, fatigue, nausea, and even vomiting...symptoms start about 12 to 24 hours after the last regular “dose”...peak at about 20 to 38 hours, and last for about a total of one week” (Fenton, 1995).
Psychological dependence is also a common observation among heavy coffee users who often “feel” or “think” it is necessary to drink coffee in order to get through the day. Social coffee drinkers often relate experiences similar to alcoholics regarding the discontinuation of coffee and the use of decaffeinated substitutes. For these individuals specific rituals, social expectations, and activities are strongly associated with the consumption of coffee and the corresponding manifestations. Despite these superficial similarities, the Presidents Office of National Drug Control Policy (1992):
does not view caffeine as a “gateway drug”...linking caffeine to drugs of abuse...undermines the effectiveness of a drug prevention program...most caffeine consumers do not demonstrate dependent, compulsive behavior, characteristic of dependency to drugs of abuse. Although pharmacologically active, the behavioral effects of caffeine typically are minor. (Rigby, 1992)
This view is supported by the American Psychiatric Association which states “drugs of dependence cause occupational or recreational activities to be neglected in favor of drug-seeking activity” (Hughes, J.R., Higgins, S.T., Bickel, W.K. et al., 1988).
Although unlikely, it is possible to overdose or even die from caffeine. Large doses of caffeine may produce what is termed “caffeinism”. Symptoms of caffeinism may appear after 250 to 750 mg (approximately 2 to 7 cups of coffee) and include restlessness, nausea, headache, tense muscles, sleep disturbances, and irregular heartbeats. Doses over 750 mg may produce delirium, tinnitis, and visual hallucinations as well as caffeine induced mental disorder (Lopez-Ortiz, 1995). According to the DSM-3-R of the American Psychiatric Association (1987), the guidelines for caffeine induced organic mental disorder include:
1. Recent consumption of caffeine, usually in excess of 250 mg.
2. At least five of the following signs:
1. Restlessness
2. Nervousness
3. Excitement
4. Insomnia
5. Flushed face
6. Diuresis
7. Gastrointestinal disturbances
8. Muscle twitching
9. Rambling flow of thought and speech
10. Tachycardia or cardiac arrhythmia
11. Periods of inexhaustibility
12. Psychomotor agitation

According to the Alcoholism and Drug Addiction Research Foundation:
Near fatal doses cause a crisis resembling the state of a diabetic without insulin, including high levels of blood sugar and the appearance of acetone-like substances in urine. The lowest known dose fatal to an adult has been 3,200 mg-administered intravenously by accident. The fatal oral dose is in excess of 5,000 mg- the equivalent of 40 strong cups of coffee taken in a very short space of time. (1996)
Long Term Effects
The International Food Information Council Foundation states that caffeine was placed on the Food and Drug Administration (FDA) list of Generally Recognized as Safe (GRAF) in 1958. In 1978 the FDA recommended additional research be conducted into the safety of caffeine. The Alcoholism and Drug Addiction Research Foundation (1991) states:
...long term effects of caffeine usage do not appear evident when regular caffeine use is below 650 mg per day-equivalent to eight or nine average cups of coffee. Above this level, users may suffer from chronic insomnia, persistent anxiety and depression, and stomach ulcers. Caffeine use appears to be associated with irregular heartbeat and may raise cholesterol levels...the evidence is unclear concerning caffeine and cancer.
Caffeine and some of its metabolites can cause changes in the cells of the body and in the way in which they reproduce themselves, and caffeine certainly enhances this kind of action by some known carcinogens. However, although caffeine is suspected as a cause of cancer, the evidence is contradictory and does not allow a clear conclusion...Caffeine certainly has the ability to cause a variety of reproductive effects in animals, including congenital abnormalities and reproductive failures, reduced fertility, prematurity, and low birth weight. What is unknown is whether these findings are relevant to the use of ordinary amounts of caffeine containing beverages by pregnant women. (p.2-3)
Despite the FDA’s placement of caffeine on the GRAS list, concern regarding the safety and acceptable dosage of caffeine intake remains. This is especially true in regard to pregnant women. Conflicting interpretation of research findings and the inability to determine strictly defined limits of usage have perpetuated the confusion regarding caffeine consumption. The following represent the most common health related concerns and findings.
Caffeine related research previously suggested a relationship between ingestion of caffeine and some forms of cancer (bladder, rectal, colon or pancreatic ). Following the FDA’s call for further research into the safety of caffeine, numerous studies demonstrate “no association between caffeine consumption and the incidence of cancer” (IFIC, 1993). The IFIC cites research by Rosenberg who reviewed 13 epidemiologic and clinical studies consisting of over 20,000 subjects, which “failed to establish a relationship between coffee or tea consumption and the incidence of bladder, rectal, colon or pancreatic cancers” (Rosenberg, L., 1990). Research conducted by Lubin and Ron (1990) was cited by the IFIC in response to the concern of increased risk of breast cancer due to caffeine consumption. In this research, 11 total case controlled studies were reviewed with no link between caffeine and breast cancer established. In summary, the IFIC, 1993, concluded:
Overall, the universal scientific research does not support a relationship between caffeine consumption and cancer development. As a result, the American Cancer Society’s Guidelines on Diet, Nutrition, and Cancer state there is not indication that caffeine is a risk factor in human cancer and the National Academy of Sciences’ National Research Council reports there is not convincing evidence relating caffeine to any type of cancer. (P. 3)
Cardiovascular Disease
Findings presented by the IFIC in regard to recent research into caffeine and cardiovascular disease are almost to good to be true. In fact, consumers and health practitioners alike continue to question the relationship between caffeine and cardiovascular disease. It is recognized that large doses of caffeine may cause transient symptoms of cardiovascular disease including elevated blood pressure and/or arrhythmia’s. However, the relationship between normal usage of caffeine and the causation or progression of cardiovascular disease/disorders has been
re-evaluated in recent years.
A number of studies were cited by the IFIC including the 45,589 subject Framingham Heart Study which concluded that caffeine consumption caused “no substantial increase in the risk of coronary heart disease or stroke” (Grobee, D.E., Rimm, E.B., Giovannuci, E. Et al, 1990). In regard to blood pressure, Dr. Myers of the cardiology division in Toronto reviewed the scientific literature of caffeine and blood pressure and concluded, “caffeine does not cause any persistent increase in blood pressure”(Myers, M.G., 1988). Finally, the effects of caffeine on cardiac arrhythmia’s was also reviewed... “The American Medical Association’s (AMA) Council on Scientific Affairs concluded that abstaining from caffeine did not significantly influence the occurrence or frequency of arrhythmia’s”(AMA, 1984). The IFIC concludes, “Despite continued consumer questions on caffeine and heart disease, there is a significant amount of data that demonstrates there is no link between moderate caffeine consumption and cardiovascular disease” (IFIC, 1993).
In 1988 a study conducted by Wilcox, Weinberg and Baird of the National Institute of Health found the caffeine equivalent of 1-2 cups of coffee per day may affect fertility in women (Wilcox, A., Weinberg, C. & Baird, D., 1988). Research conducted by the Centers for Disease Control and Harvard University in 1990, as well as an epidemiological study of 11,000 Danish women published in 1991, failed to confirm these findings.
Perhaps the most conservative area in regard to caffeine consumption is the impact of caffeine upon fetal growth and development. In the early 1980’s, animal studies conducted by the FDA reported an increased risk of birth defects associated with caffeine consumption during pregnancy. Later this study was criticized due to the large doses of caffeine administered to the animal subjects. In 1993, the National Institute of Health published results which concluded “moderate caffeine consumption during pregnancy did not increase the risk of spontaneous abortion or abnormal fetal growth” (Mills, J.L., Holmes, L.B., Aarons, J.H. et al., 1993). The FDA currently recommends women consume no more than two cups of coffee or two units of caffeine per day while pregnant.
Benign Breast Disease
In the 1970’s the relationship between symptoms of fibrocystic breast disease and caffeine suggested that eliminating caffeine from the diet may alleviate or reduce symptoms. In 1986, the National Cancer Institute conducted a study of 3,000 women which demonstrated “no evidence of an association between caffeine intake and benign tumors, fibrocystic breast disease or breast tenderness” (McDonald, A.D., Armstrong, B.G., & Sloan, M., 1993). This conclusion is corroborated by the AMA Council on Scientific Affairs.

Caffeine is known to increase the excretion of calcium in the urine thereby hypothetically increasing the risk of Osteoporosis. Separate studies conducted by Pennsylvania State University, Creighton University School of Medicine, and the Mayo Clinic each concluded that despite a slight increase in urinary calcium excretion due to caffeine consumption, caffeine intake had no significant impact upon overall bone density and was not considered an important risk factor for osteoporosis. The minimal impact of caffeine was adequately compensated by the inclusion of 600 mg of calcium per day (Lloyd, T., Schaeffer, J.M., Walker, M.A. et al., 1991; Barger-Lux, M.J., Heaney, R.H., & Stegman, M.R., 1990; and Cooper, C., Atkinson, E.J., Wahner, H.W. et al., 1992).
Interactions With Other Drugs/Substances
Caffeine is such a widely used substance it is often mistakenly overlooked in the examination of drug interactions. Commonly used drugs including oral contraceptives are known to increase the effect of caffeine whereas caffeine is known to increase the effect of thyroid hormone supplements. Other drugs such as sedatives may prove less effective while illegal substances including Marijuana and Cocaine may result in over stimulation. (Griffith, W., 1988).
Therapeutic and Beneficial Uses
With the concern surrounding the safety of caffeine intake, the beneficial aspects are often forgotten or overlooked. Medicinally caffeine is frequently used to enhance the effectiveness in analgesic preparations both oral and topical as well as the performance of stimulants. The use of caffeine as a cardiac and respiratory stimulant has been of particular interest in the treatment of apnea in newborn babies. Caffeine is a known diuretic and at times has also been used as an enema in alternative cancer therapy. Other controversial caffeine therapies include the treatment of skin fungi, fertility problems in men, enhancement of the toxic effects of chemicals used in cancer therapy, and promotion of seizures during electroconvulsive therapy (ADARF, 1991).
Future Trends
The economic future of coffee consumption appears bright. According to the Specialty Coffee Association of America, the specialty coffee market has increased 30 percent for three years in a row and is expected to reach $3 Billion dollars by 1999. Combined with foodservice shares, the total retail sales are projected to reach $5 Billion by the year 2000. The number of coffeehouses and outlets has grown from approximately 250 in the 1970’s to an anticipated 10,000 in 1999 (LaPoint, K., 1997). These statistics reflect the rise in specialty coffee alone. As a nation, America consumes over one-third of the worlds small feat when you realize “in the entire world, coffee is second only to petroleum as the most important legal export commodity”(Parrish, J., 1997). In the United States, coffee ranks third in imports, behind oil and steel, with an estimated 80 percent of Americans drinking coffee daily, and 10 percent consuming more than ten cups of coffee per day (Parrish, J., 1997). As small countries in Latin America attempt to “cash in” on the latest craze in coffee production, new concerns regarding long term environmental effects upon land use, production techniques, and chemical exposure have become areas of concern. Economically and socially, coffee is a significant contribution to worldwide affairs.
The history of coffee reflects significant economic and social impact on a worldwide basis with near universal appeal. Caffeine and the “addictive” nature of the substance is partially responsible for such abundant use, but does not adequately address social and psychological factors associated with consumption. Health related concerns regarding the safety of caffeine prompted research into various factors including short and long term effects, tolerance and dependence, overdose, and associated risk of selected disease/disorders. Finally, the future trend and economic impact of coffee virtually ensures the continued consumption of coffee on a global scale.


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