Monday, April 5, 2004

Like many who need their morning caffeine boost, nutrition consultant Edith Howard Hogan is “not a happy camper” without one or two cups of java.

“I wouldn’t want that third cup. You are not addicted to it in that sense … but you can become dependent on it,” she says, adding, “I feel better to have my coffee in the morning.”

If Ms. Howard Hogan, a registered and licensed dietitian and an independent consultant in the Metro area, abruptly stopped drinking coffee, health care professionals say, it would take a few days to get over any dependency she may have on the caffeine, a central nervous system stimulant that can boost energy levels, increase alertness and improve memory and concentration.

Initially, Ms. Howard Hogan could experience withdrawal symptoms of headaches, drowsiness and listlessness and feel a little depressed, says Dr. David Pearle, professor of medicine and director of the coronary care unit at Georgetown University Hospital in Northwest. “It is not hard to withdraw,” he says, “but if you are used to coffee every day and go without it, you probably will get some symptoms.”

Because withdrawing from coffee is not in Ms. Howard Hogan’s plans, she can continue drinking up to three 8-ounce cups of coffee, or consume 200 to 300 milligrams of caffeine a day — the recognized limit for keeping caffeine intake at a moderate level.

An 8-ounce cup of brewed coffee has an average of 85 milligrams of caffeine, and drip coffee has 65 to 120 milligrams, while the same amount of tea has 40 milligrams and caffeinated soft drinks 20 milligrams, she says. The actual amount of caffeine in these products varies according to how they are prepared, the serving sizes and, for coffee and tea, the variety of the plant used.

As for chocolate, a 1- or 2-ounce bar of milk chocolate has 3 to 10 milligrams of caffeine and an ounce of dark chocolate 5 to 35 milligrams, says Susan Smith, spokeswoman for the National Confectioners Association in Vienna.

Caffeine, which has no nutritional value, is a naturally occurring substance found in the leaves, seeds and fruit of 63 plant species worldwide, the most common sources being coffee and cocoa beans, kola nuts and tea leaves used in coffee, chocolate and black, green and other teas. It also is produced synthetically and used as an additive in caffeinated soft drinks and over-the-counter medications, such as pain relievers and cold medicines.

When consumed, caffeine does not accumulate in the bloodstream and is excreted; half of it is metabolized within five hours.

The effects caffeine has on the body have yet to be proved, says Hardeep Kaur, clinical dietitian at Inova Mount Vernon Hospital, south of Alexandria. She points to studies showing that caffeine may affect the body’s absorption of calcium and iron on a short-term basis and, because it is a mild diuretic, may cause dehydration. “It’s so nebulous. There’s so much more to be done,” she says.

Other studies show evidence that caffeine consumption may cause bone loss and increase the risk of osteoporosis and, for pregnant women who consume more than 500 milligrams a day, increase the risk of miscarriage, says Lisa Pawloski, who holds a doctorate in nutritional anthropology and is assistant professor of nutrition at the College of Nursing and Health Science at George Mason University in Fairfax.

Recent studies also show moderate coffee consumption may decrease the risk for type 2 diabetes and, for men, the risk for Parkinson’s disease.

“All of these studies generally are showing that moderation is the key,” she says.

The strongest data is for the effect caffeine can have on the heart rate, along with blood pressure, says Dr. Patricia Davidson, cardiologist at Washington Hospital Center in Northwest.

“If you’re prone to have abnormal heartbeats, it can stimulate your heart to beat more rapidly,” she says.

Nonhabitual coffee drinkers may experience a slight increase in their blood pressure, but studies show coffee consumed in moderation does not cause heart disease, says Dr. Cleveland Francis, a cardiologist at Inova Mount Vernon Hospital. “People should look at all of the labeling to see how much caffeine is in a beverage. If you have trouble sleeping or a cardiac problem, you may want to stop,” he says.

Caffeine can cause several side effects if consumed in excess, including jitters, nervousness, restlessness and insomnia. If insomnia is the problem, Ms. Kaur recommends that coffee drinkers cut down on their intake and stop consuming caffeine by early afternoon.

“If they don’t take care of the underlying reason why they are tired, this is a false high,” she says. “If they don’t get enough sleep, they have to keep themselves awake and active with stimulants [and] may have trouble falling asleep. It could be a vicious cycle.”

Ms. Kaur and other health professionals provide advice for cutting caffeine from the diet, saying withdrawal symptoms can last from one to four days.

“I would suggest people get into more tea and less coffee, especially with the tea showing particular benefits,” Dr. Davidson says, pointing out that black and green tea as well as chocolate contain antioxidents, chemicals that fight oxidation in the artery walls.

In addition, black tea has half the caffeine of coffee, while green tea has a third, says Scott Graham, director of product development at Celestial Seasonings in Boulder, Colo. “By consuming that, you are weaning yourself off a larger amount of caffeine,” he says.

Soda also has less caffeine than coffee, regulated at 6 milligrams per ounce. Most colas have 3 milligrams per ounce, according to Richard Adamson, who holds a doctorate in pharmacology and is vice president for science and technical affairs at the National Soft Drink Association in Northwest. “We encourage people to drink soft drinks in moderation and drink a variety of beverages,” he says.

Another way to cut caffeine is to switch to decaffeinated coffee or to mix it with the caffeinated version. Decaffeinated coffee has about 2 to 5 milligrams of caffeine, regulated to 3 percent of the original caffeine content. “It’s so minimum. If anything, it’s probably more psychological, unless you’re very sensitive to caffeine,” Ms. Kaur says.

Dr. Pearle advises his patients to stop “cold turkey,” but if that is not a favorable option for them, he suggests they cut the amount of caffeine they consume in half for two to three days, then by another half for the next couple of days before stopping.

“Some people don’t like to take anything that is addicting. This is such a mild addiction, I don’t think it’s a big problem,” he says. “In terms of major health risks, it doesn’t seem to be a problem.”

Health professionals recommend that those who want their daily caffeine boost should keep consumption moderate, or consume no more than 200 to 300 milligrams per day.

Caffeine content, in milligrams, for an 8-ounce serving:

Brewed coffee, 85

Drip coffee, 65-120

Decaffeinated coffee, 2-5

Tea, 40

Caffeinated soft drinks, 20

Caffeine content for a 12-ounce serving:

Red Bull, 80

Jolt, 71.2

Mountain Dew, 55

Caffeine content for a 16.9-ounce serving:

Java Water, 125

Aqua Blast, 90

Water Joe, 60-70

Aqua Java, 59-60

1- to 2-ounce bar of milk chocolate, 3-10

1 ounce dark chocolate, 5-35

1-ounce cup of espresso, 30-50

1-ounce shot espresso, cappuccino, 30-50

1-ounce shot espresso, latte, 30-50

1-ounce shot espresso, moccachino, 35-55

Information, based on average amounts, is provided by health professionals, the National Soft Drink Association, the National Coffee Association and the Center for Science in the Public Interest, a nutrition advocacy organization based in Washington, D.C.

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