Monday, September 16, 2013


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):
  • 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?

1. Holly Pohler, Caffeine Intoxication and Addiction, The Journal for Nurse Practitioners, Volume 6, Issue 1, January 2010, Pages 49-52, ISSN 1555-4155, (

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: