Caffeine
From the Beginning of
Time to Now
Frankie Roman MD JD
FOCUS Fall
Las Vegas
October 3, 2013
CAFFEINE
From the beginning of Time to Now
Frankie Roman,MD JD
Focus Conference
May 13,2010
History of Coffee
Discovery of caffeine rich leaves of Ilex Yuayusa in the tomb
of a Shaman from highland Bolivia dating from around 500
A.D.
The oldest existing text documenting caffeine in medicine
is written in The Canon of Medicine of the Islamic
physician, Avicenna (980-1037)
History of Coffee
The first commercial cultivation of coffee occurred in the
fourteenth century in Arabia.
Coffee spread to Europe in the seventeenth century and
then to South America and finally North America.
After oil, coffee is the second most valuable commodity in
the world.
Superstitions and Rituals
Tea leaf reading by Chinese fortune tellers
Turkish fortune tellers used the finished cup of coffee
containing both liquid and grounds by turning it onto the
saucer until cool, then cup turned back up and any coffee
grounds remaining in cup are “read”.
Caffeine
coffee – 100 to 150 mg of caffeine
Instant coffee – 85 to 100 mg
Tea – 60 to 75 mg
Cola – 40 to 75 mg
Cocoa – 50 mg
OTC cold preparations – 15 to 60 mg/tab
OTC stimulants – 100 to 200 mg
Caffeine
Half-life 3 to 7 hours
Effects may last as long as 8 to 14 hours
500 mg of caffeine has same alerting effects as
amphetamine 5 mg
Promote wakefulness by blocking adenosine receptors in
brain
Intoxication – restlessness, nervousness, flushed face,GI
disturbances and insomnia
Caffeine
Effects are prolonged in children,pregnant women, elderly
and hypothyroidism
May trigger panic attacks
Abrupt withdrawal –
irritability,dysphoria,fatigue,headache,EDS and flulike
symptoms 18-24 hours after last dose.
Gastrointestinal
Both caffeine containing and caffeine-free coffee stimulates
gastric acid secretion.
Both caffeine containing and caffeine-free coffee stimulate
gastrin release.
Basal Metabolic Rate
Caffeine increases resting metabolic rate in lean as well as
obese individuals for up to 24 hours after ingestion.
Caffeine ALONE is not effective in promoting weight loss
in overweight individuals in several controlled studies.
Smuggling
In the 1600s a Muslim pilgrim named Baba Budan
smuggled seven seeds out by taping them to his stomach
and cultivating them in southern India.
The Dutch smuggled one coffee tree to Holland
The French smuggled one coffee tree to Martinique in 1723
– believed that much of the world’s current supply
probably derives.
Bunn
Chewed
Brewed the leaves and berries with boiled water as a weak tea
Grounded the beans and mixed them with animal fat for a quick
energy snack
Made wine out of the fermented pulp
Made sweet beverage out of husks of coffee cherry – kisher
Finally someone roasted the beans, grounded them and made
infusion – coffee!
Coffee Producers
Brazil is world’s largest producer of coffee with 33.6 million
bags per year
Columbia – 11.8 million bags
Vietnam – 10.75 million bags
Note: 1 bag is equivalent to 132 pounds
Consumption
Over 100 million Americans consume an average of 3.1 cups per
day
Starbucks
- about 20,000 stores in the USA
- over 4000 stores overseas
- price of Venti Mocha
Moscow $ 8.98
New York City $ 4.71
Instant coffee
Instant coffee market – 21 billion dollars worldwide
Pervasive throughout Europe
About 80 % of coffee sales in the U.K.
Problems with interpretation of data
Cup size
Caffeine content of the different coffees used
Possibility that many people who drink coffee frequently may
drink weaker coffee (café americano)
Use of paper filters in brewing coffee
Cigarette smoking
Individual variability in metabolism of compounds found in
coffee.
1 Starbucks Grande Coffee
(Caffeine 330 mg) is equal to:
5.5 shots of espresso (caffeine 60 mg)
1.7 Wired Waffles (caffeine 200 mg)
5.5 Midol tablets (caffeine 60 mg)
253.8 Oreos (caffeine 1.3 mg)
4.1 Red Bulls (caffeine 80 mg)
9.4 Coca Colas (caffeine 35 mg)
6.1 Mountain Dews (caffeine 54 mg)
1.6 5-Hour Energy (caffeine 208 mg)
55 Kit Kat bars (caffeine 6 mg)
330 Hershey’s Kisses (caffeine 1 mg)
Energy Beverages
Red Bull introduced in Austria in 1987 and 10 years later in
the USA
Hundreds of different brands in the market place
Caffeine content ranges from 50 mg to an alarming 505 mg
per can or bottle
USA is world’s largest consumer with estimate of 290
million gallons in 2007
Energy Drinks
U.S. residents consumed estimated 2.3 billion energy
drinks in 2005 and 6 billion in 2010.
6% of young men in USA report consuming a daily energy
drink
In a recent survey of U.S. overseas troops., 45% reported
daily use.
Sales of energy drinks in the USA increased 16% in single
year to almost 9 billion dollars in 2011.
Caffeine - Legal
In 1911, under the authority granted by the FDA, U.S. agents
seized 40 kegs and 20 barrels of Coca-Cola syrup in
Chattanooga, Tennessee. The caffeine level was considered
to be a significant public health hazard ( both cocaine and
alcohol had been removed from recipe).
In 2012, the FDA investigating the caffeine containing
energy drinks due to safety concerns. Linked to unexpected
deaths in healthy persons.
Energy Beverage Consumption
has been shown to be positively
associated with:
Marijuana use
Sexual risk taking
Fighting
Failure to use seat belts
Taking risks on a dare
Smoking
Alcohol abuse
Illicit Drug use
Energy Drinks Mixed with
Alcohol
May offset the sedating effects of alcohol
Reduced sensation of intoxication impairs judgment
relative to risky behaviors
Reduced sensation of intoxication induces more alcohol
consumption which further impairs judgment and
neurocognitive function.
Energy Drinks Mixed with
Alcohol
experimental studies
Caffeine reverses alcohol related impairment on tests of
reaction time, psychomotor speed and simulated driving
performance at moderate but NOT HIGH levels.
Does NOT decrease error rates
Antagonizes the effects of alcohol on response execution
but NOT on inhibitory control (increase risk taking
behaviors)
Caffeine Poisoning
The Swedish Experience
Out of 5000 forensic autopsies ,1% had caffeine levels exceeding 10
ug/ml
1 cup of brewed coffee results in blood caffeine level of 1-2 ug/ml
20 cases had caffeine levels higher than 80 ug/ml ( lethal dose)
Arrhythmias were most common cause of caffeine related death (
average age 41)
Ingestion over a brief time of 3 to 10 grams of caffeine might be lethal.
Restriction of caffeine tablet sales from 250 to 30 pills per customer
appears to have decrease rate of fatal caffeine overdoses.
Energy Drinks Mixed with
Alcohol
Public Health Response
In 2008, 13 State attorney generals negotiated settlements by
which 2 national breweries agreed to remove caffeine and all
other stimulants from their products.
In 2010, FDA sent warning letters to 7 producers of premixed
caffeinated alcoholic beverages, halting production and sale.
In 2012, several states prohibited the sale of Four Loco (
premixed, caffeinated, high alcohol content beverage) after
significant number of students were treated for excessive
consumption.
Diabetes Protection
Meta-analysis of 18 studies conducted between 1966 and
2009 with information on 457,922 patients by Dr Rachel
Huxley of the George Institute for International Health,
Australia revealed:
1.Drinking 3-4 cups of coffee per day associated with 25%
lower risk of Type 2 diabetes than drinking 2 cups or less
2.Each additional cup of coffee consumed was associated
with a 7% reduction in the excess risk of diabetes.
Diabetes Protection
3.Results were independent of effects involving gender,
geographic region, dx vs self-reporting.
4. Three to four cups of DECAF coffee per day had about a
third lower risk of diabetes than those who didn’t drink
decaf.
5. Three to 4 cups of tea per day had about a 20% lower risk
of diabetes.
Diabetes Protection
Protective effects of tea and coffee may not be solely related
to caffeine
Possible role of other chemicals including magnesium,
lignans,and chlorogenic acids
Catechins in tea may decrease glucose production in GI
leading to lower levels of glucose and insulin
Green tea may prevent damage to pancreatic beta cells.
Coffee Break
Invention of the Pan American Coffee Bureau in 1952.
“Give yourself a coffee break – and get what coffee gives to
you”.
80 % of firms polled in 1952 introduced coffee breaks in
their work days.
Parkinson’s Disease
Inverse association between coffee intake and PD risk in
men in several large prospective cohort studies.
Men who regularly consumed at least 1 cup of coffee daily
had 50% less risk of developing PD over next 10 years than
nondrinkers.
Consumption of tea and other caffeinated beverages was
also inversely associated with PD.
Parkinson’s Disease
Inverse relationship of caffeine and risk of PD not found in
women (Nurses Health Study)
May be due to the modifying effect of estrogen
replacement therapy.
Coffee consumption was inversely associated with PD risk
in woman who had never used post menopausal estrogen.
Significant increase in PD risk in post menopausal
estrogen users who drank at least 6 cups of coffee daily.
Suicide Risk
10 year study of 128,000 pts participating in a California
health plan the relative risk of suicide decreased by 13% for
every cup of coffee consumed daily.
Reason for this inverse association unknown.
NOT ENOUGH DATA to support recommendations for
coffee consumption in clinically depressed patients.
Cardiovascular Disease
Acute consumption of coffee raises BP in normotensive and
hypertensive individuals
Two-three cups of coffee (200-250 mgs of caffeine) has
been found to increase systolic BP by 3-14 mm of mercury
and diastolic BP by 4-13 mm of mercury in normotensive
individuals
Pressure effect of caffeine may be more pronounced in
hypertensive individuals
Cardiovascular Disease
Cardiac arrhythmias – coffee or caffeine intake equivalent
to 5-6 cups daily was NOT found to increase the frequency
or severity of arrhythmias in healthy individuals, coronary
heart disease pts or people with pre-existing ventricular
ectopy.
Few studies regarding cerebral vascular accident have NOT
found a significant association between coffee
consumption and risk of stroke.
Cardiovascular Disease
Consumption of BOILED coffee dose dependently
increased serum total and LDL cholesterol
FILTERED coffee resulted in minimal change in serum
cholesterol
Cholesterol raising factors in unfiltered coffee have been
identified as cafestol and kahweol.
Cardiovascular Disease
Elevated plasma total homocystine concentration
associated with increase risk for coronary heart disease,
stroke, and peripheral vascular disease.
Plasma total homocystine has been positively associated
with coffee consumption in a dose dependent manner.
Abstention from coffee for at least 6 weeks resulted in 11%
decrease in fasting homocystine concentration (average of
4 cups of filtered coffee per day consumers)
Coronary Heart Disease
High coffee intake associated with significant increase risk of coronary
heart disease or myocardial infarction.
Older study found that acute coronary syndrome was three times
higher in people who drank 600 ml of coffee per day than nondrinkers.
Prospective cohort studies have not found significant association
between coffee consumption and risk of coronary artery disease.
Possible explanation – decrease consumption of BOILED coffee with
corresponding increase in consumption of FILTERED coffee.
Coffee Stop Campaign
Encourage drivers to stop every two hours for coffee as a
safety measure.
“Make that one for the road coffee”
Created a furor in the south – mistaken as encouraging
drunk driving
Changed to “Stay Alert, Stay Alive….Make it coffee when
you drive”.
Note: National Sleep Foundation has campaign Drive Alert,
Arrive Alive.
Special Risk Groups
Breast feeding infants and young children
Caffeine is detectable in breast milk within 15 minutes of
consumption and peaks one hour later
American Academy of Pediatrics – caffeine is a maternal
medication usually compatible with breast feeding
High maternal caffeine intake associated with irritability
and poor sleeping patterns in infants
No adverse effects reported at maternal intake of 2-3 cups
of coffee daily.
Young Children and Coffee
Meta analysis of nine short term clinical trials of caffeine in
children including 4 in normal children and 5 in children
with ADHD found:
NO significant effects on cognition and
behavior.
Coffee worker’s lung
Hypersensitivity pneumonitis
Antigen – coffee bean dust
Source of antigen – coffee beans
Coffee houses
Wealthy people had a coffee room in their homes
Coffee houses – kaveh kanes sprang up by the end of the
fifteenth century
Troublemaking social brew – “ranging from gambling to
involvement in irregular and criminally unorthodox sexual
situations”.
History of Coffee
Caffeine consumption goes back at least 1000 years
One of first reported consumption were by members of the
Galla tribe in Ethiopia.
Legend has it that an Ethiopian goat herder discovered
coffee’s stimulating effects when he noticed the friskiness
of the goats after munching on the red berries of a local
shrub.
Caffeinated Coffee Consumption
Conclusion 2013
NO evidence that it increases the risk for any form of
malignancy
NO conclusive evidence that it increases the risk of
fibrocystic breast disease
Can cause mild to moderate sleep disturbances
Can cause GI distress but not the result of caffeine as
similar symptoms can be seen with decaffeinated
Caffeinated Coffee Consumption
Conclusion 2013
Does not result in worsening of diabetic control
Does not increase risk for diabetic complications
May actually decrease risk for developing Type 2 diabetes
Caution is warranted in the use of energy drinks due to
recent reports of abuse and deaths in the 21 and under
population.