I
love a good cupa' joe as much as the next bloke, but I've also experienced what
happens in the case of over-consumption (have to finish a paper or project,
sleep-deprived, classes the next day...): gastrointestinal distress, heart
pounding a wee bit too fast, anxious thoughts about really random stuff, acid
reflux... Needless to say, that was sufficient motivation for me to not go
overboard again. But I freely admit that you probably don't want to
attempt to talk to me in the morning if I haven't drank (drunk?) at
least a cup of coffee already. Thank
you grad school for encouraging caffeine addiction!
Caffeine is possibly
one of the most widely abused substances and the most widely accepted addiction
in our country, if not the entire world.
How
does caffeine work? In an article by Holly
Pohler (1), she briefly describes the mechanism by which caffeine
works and how they affect the body: "Virtually
every organ system is affected when caffeine is taken in
excess... Caffeine consumption elicits a prolonged stress response in
the body by competitively antagonizing adenosine receptors, inhibiting
phosphodiesterase, and increasing circulating catecholamines and intracellular cAMP.
There is a corresponding increase in blood pressure and heart rate,
release of blood glucose by the liver, an increase in gastric acid
secretion, a decrease in lower esophageal sphincter tone, and an
increased colonic contractile activity." So in plain english, what does this mean? Basically, it is a
potent central nervous system stimulant that increases heart rate,
causes vasodilation, stimulates release of adrenaline, and indirectly affects
metabolism of sugars and lipids. Also, the increase in gastric acid and decreased
esophageal sphincter tone means that excess caffeine consumption can lead to
acid reflux - which I've heard is NOT pleasant.
Caffeine
and nicotine are often used together for a synergistic effect - in the
addictions and eating disorders community. (For more on caffeine and nicotine
in substance abuse recovery, see an article written by David A. Wiss, RDN over
at Nutrition in Recovery: "Caffeine,
Nicotine, Nutrition: Practical Implications for Substance Abuse Recovery" (starts
on page 13).
But
getting on to the role of caffeine in the eating disorders realm - it ends up
often being the case of too much, and for all the wrong reasons.
Primary reasons given by patients for increasing caffeine consumption are (2) (3):
Primary reasons given by patients for increasing caffeine consumption are (2) (3):
- To
boost their metabolism (doesn't have much of an effect)
- To
boost energy (instead of eating)
- To
feel full
- To
suppress appetite
But,
symptoms of eating disorders that are already present can be exponentially
exacerbated by excess caffeine consumption.
- Compounds
in caffeinated products can inhibit absorption of vital minerals and
vitamins (e.g. calcium, folate, vitamin B12, magnesium, iron...)
- Abnormalities
in fluid balanceGastrointestinal issues, such as delayed gastric emptying,
erratic bowel motility, and constipation
- Caffeine
is a diuretic and thus can increase likelihood of dehydration
- Contribute
to electrolyte imbalances
- Cardiovascular
issues, such as bradycardia, orthostatic hypertension, and cardiac
arrhythmias, could obviously be made worse by a substance that increases
the heart rate
- Overall
malnutrition will only increase if you are consuming non-nutritive
products that make you feel full and give you energy, instead of actual
food that provides your body with the macro- and micro-nutrients it needs
to correctly function and thrive.
- Caffeine
increases adrenaline secretion (fight or flight hormone) which means that
anxiety could go through
the roof if you have too much caffeine. Many
patients with eating disorders already have anxiety disorders, so you add
in some caffeine and you're just asking for a panic attack.
A
couple of cups (8-10 oz. mugs -- not those humungous "cups") is fine,
but more than that and you're starting to dabble with less healthy doses.
Withdrawal from caffeine is not fun, and many eating disorder treatment
facilities will have a caffeine taper routine to help patients get off high
doses with minimal side effects. Usually headaches are the most common
complaint, and you can't take Excedrin because... ba-da-boom, caffeine is how
that med works! Slow and steady wins the caffeine taper race :)
What
steps can you take to reduce your caffeine intake?:
- Be
patient with yourself - these things take time!
- Work
on tapering down to the equivalent of a couple cups of coffee over the
course of a month. Make yourself a chart with realistic goals.
- Try
substituting tea for coffee
- Reduce
(or eliminate) diet sodas later in the day
- Don't
buy items with caffeine - reducing caffeine stimuli in your house will
help you not be as tempted to "engage"
- Get
enough sleep! Sounds simple, but it is so crucial
- Talk
to your treatment team
- Therapist can help you identify
what triggers you to seek out caffeine and what coping skills may help
you
- Psychiatrist can determine if meds
are needed to address anxiety, depression, or sleep issues. All of those
issues can definitely impede the eating disorder recovery process.
- Dietitian can help you
negotiate food issues for better energy, manageable hunger and fullness
levels, and mental acuity
- Find
social support - people who can be your cheerleader when the going gets
rough
There's
not a lot of research out there on caffeine and eating disorders, and I can't
determine if it's because it's an established issue or if it's the least of
healthcare provider's worries - maybe some of both. Anecdotally, I've noticed
that in outpatient treatment, caffeinated products sometimes don't make it on
to food logs because often the product doesn't contain calories, and therefore
the patient rationalizes it doesn't need to be on the food log. But I think
it's something that needs to be checked on at every appointment because it
affects mood, hunger and satiety signals, sleep patterns, gastrointestinal
wellbeing, and so much more!
For
many reasons, I think that the initial assessment of patients with eating
disorders (by the doctor and/or dietitian) needs to include multiple specific questions
about caffeine consumption. Such as:
1.
What are
you sources of caffeine? Pills, energy drinks, coffee, diet soda, etc.?
2.
How much
of each item do you consume each day?
3.
What are
some potentially negative effects that you have noticed from consuming
caffeinated products?
4.
When is
the last time you went without a caffeinated product?
5.
Why do
you consume the caffeinated products that you do?
What has been your experience with caffeine?
Do you think that this is a notable problem in patients with eating disorders?
What suggestions do you have for healthcare providers in handling this issue in the eating disorder field?
Do you think that this is a notable problem in patients with eating disorders?
What suggestions do you have for healthcare providers in handling this issue in the eating disorder field?
1.
Holly Pohler, Caffeine Intoxication and Addiction, The Journal for Nurse
Practitioners, Volume 6, Issue 1, January 2010, Pages 49-52, ISSN 1555-4155, http://dx.doi.org/10.1016/j.nurpra.2009.08.019.
(http://www.sciencedirect.com/science/article/pii/S1555415509004991)
2.
Striegel-Moore, R. H., Franko, D. L., Thompson, D., Barton, B., Schreiber, G.
B. and Daniels, S. R. (2006), Caffeine intake in eating disorders. Int. J. Eat.
Disord., 39: 162–165. doi: 10.1002/eat.20216
3.
Hart, S., Abraham, S., Franklin, R. C. and Russell, J. (2011), The reasons why
eating disorder patients drink. Eur. Eat. Disorders Rev., 19: 121–128.
doi: 10.1002/erv.1051
Please meet Kelsey Wallour! She is currently in her Master's and dietetic internship at the University of Tennessee,
Knoxville, with a concentration in public health nutrition. She is passionate about behavioral health nutrition – specifically, eating disorders.
When she graduates, she aspires to work with patients that struggle with eating
disorders, whether that is inpatient, intensive outpatient, or outpatient. She is constantly striving to learn all she can about eating disorders and nutrition so
she can treat patients with excellent, evidence-based methods. Anticipated graduation
date is August 2014. Please find her blog at: http://krunr20rd2be.
