Helpful Hints From A Former Caffeine Fiend

Okay, so my Continuing Medical Education Provider gave me every imaginable disclaimer on this one.

Abstracts at a meeting, so the demands were not as rigorous as for published articles. There could be confounding factors. A British study; maybe they aren’t wired the same way us yanks are. People who take a nap of at least a half hour during the day have lower blood pressure 4 mm. lower 24 hr. average systolic than folks who don’t. Espresso, on the other hand, raises blood pressure. This study was done on Italians.  Are they wired like us? Drinking enough espresso may also be increasing the incidence of type 2 diabetes, by some kind of an effect on long term glucose (sugar) metabolism.

To his credit, Ian Graham, M.D., the author, agreed about the cautious interpretation of the data. As for what else he said we should do with the results, he said, bravely, “This is a call to try harder.” Let’s start with the coffee. A clever little doctor at the Las Vegas VA medical center once got me off a couple of blood pressure pills by telling me to cut back caffeine. I have cured cases of panic attack and all sorts of anxiety by telling people to cut back their caffeine.

Slowly.  Not by more than 20% to 25% of their weekly consumption. I have seen folks chug-a-lug Diet Coke–to the tune of multiple two liter bottles daily. Or a couple of pots full of coffee. That is because the withdrawal headache is easier to avoid than it is to treat. Me, I’ve been pretty much caffeine-free for years now. I say “pretty much,” since the FDA classifies it as a food additive as well as a drug. I am a lot more compulsive about label-reading than I used to be.  Caffeine turns up in treats I may occasionally indulge in, like chocolate flavored stuff. Generally, I hassle cafes and restaurants and the like about getting me some caffeine-free herbal tea. When I was a kid, I never, but never, tasted coffee in my parents’ house. I was told I was not old enough for it, and that was that. When I was 18 and started working the front desk of the emergency room at Mass. General, I was not permitted to work after 8 PM until I turned 21. The job was mostly done by men.  They were fairly thin and not particularly attractive men who made me pretty sure back then I would never want to get married. They were all required to wear neckties which they all hated so much they brought them in a pocket and draped and tied them when they started work and undraped and untied them the moment they walked. We were all doing the best we could to work our ways through school. They all laughed when I said I was going to be a doctor.  One told me he thought that working in an emergency room would cure me of such wishes. They sometimes would work “double shifts,” from 8 to 4 and 4 to midnight. I would have liked that kind of pay, but I was a physically inept pudgeball and could never have come up with that kind of stamina. One of the people who did that indicated that it was okay to get coffee at the coffee machine in the doctor’s lounge, and that everybody did it. He told me that the taste was certainly nothing to expect to be pleasant, but the staff and the doctors found it very helpful to maintain stamina during the long hours. I checked with my administrator, who said I could indeed.  I didn’t tell him or anyone, that it would be the first time in my life I tried the mysterious liquid. I figured a little would not hurt, on one of those few days I had convinced my mother to let me work 12 hours, from 8 AM to 8 PM. I barely covered the bottom of the paper cup with it. The doctors’ lounge was busy, and I was being thoroughly ignored. It did not even occur to me to inquire about either cream or sugar. It tasted foul. The next thing I remember was being in the rest room, trying to avoid barfing all over my dress. I was gently introduced to iced tea, and did coffee awhile several months later, at something at my university, with sugar and cream, of course. The legend is that in ancient Arabia, a shepherd observed that an animal (a goat, I think) would munch on the berries and run around all night. Whatever. “Caffeinism” is clinically indistinguishable from panic disorder, and can impersonate other anxiety disorders, not to mention insomnia. All those patients hear about caffeine from me. Bipolars hear, if they are on lithium, that in addition to its stimulating abilities, it can (and does) lower lithium levels. And that is a drug metabolized by the kidney.  Caffeine is also a bit of a diuretic. I had one unforgettably eccentric patient while I was still a resident in Kansas, who forced himself grossly psychotic by abusing the (non-prescription and very legal) caffeine pills intended for use by truck drivers, to prolong their alertness. Caffeine is mostly metabolized by the liver, in the cytochrome system (CYP1A2). It can actually raise blood levels of clozaril and theophylline, a prescription antipsychotic and a prescription medicine to help with breathing. It can raise the blood level of aspirin, which may not be a big deal unless someone is using it regularly enough; it can affect blood clotting. Of course, it raises pulse rate … and blood pressure. I can understand people who feel they need stimulation the way I did, when I was young and tired and wanted to work a little longer. I have always found it easier to understand people who choose stimulants.  Intuitively, I can see how people would feel that increased energy would help them to partake in life in a way made somehow richer. It is harder for me to relate to people who choose self-sedation, by things such as alcohol. I have often wondered what I could suggest as other legal substances that may have less of an effect on pulse and blood pressure. A search a while ago failed to turn up any kind of comparative studies from which I could infer anything useful. I like mint tea, myself. Small amounts of ginger or ginseng don’t seem to do anything dramatic to my blood pressure. Coffee shops go zero for three of the above substances. Even an eccentric old iconoclast like me realizes it is a little unusual to try and get mint tea in a coffee shop. Sometimes, I have carried my own ginger in my purse. The feeling of being in a group is powerful. I remember a long time ago in some sort of “sensitivity training” class, being in the center of people circling around me, and being asked to describe the feelings of same (pleasant). Then, I was outside a circle, trying to get in, and was not allowed.  Felt damned awful, even though I knew that people were just doing as they had been instructed. Now I am older and (with some luck) a bit thinner (about 200 lbs.)  This does make stamina a little easier to access. By some mechanism I cannot yet accurately describe.  I would never be able to tolerate more than a quasi-microscopic amount of the ginger I once put in drinks. At any rate, there is no doubt to me that the most abused substance in America is neither alcohol nor tobacco, although both are often cited.  I am sure it belongs on the list of things which, ideally, doctors ought to warn folks about. Of course there is little time, and pretty much all doctors are overworked. But people can’t possibly even try to change, unless they have the knowledge, which experience suggests to me they are unlikely to search for spontaneously. As for a nap of at least a half-hour at lunch time lowering blood pressure — well, I don’t find that terribly hard to buy. In many cultures in warmer climates, the midday siesta is certainly culturally validated. I have seen scattered reports where it enhances creativity at work and the like. I think the problem here is first, getting employers to admit such time would be usefully spent. I have worked several jobs where I had to fight tooth and nail to get (and sometimes could not get) the daily breaks required by federal and state wage and hour laws. Once someone is labor and another person is management, whoever is management seems to start worrying like crazy if they are really getting their money’s worth from whoever has been identified as labor. There is another block.  I wonder how many people are comfortable enough at work (or, I suppose, fatigued enough at work) to fall asleep. I fell asleep once, in my office during an (alleged) lunch hour. I knew about it, and let myself do that. I figured that I would be of more use that afternoon if I grabbed a few minutes of real rest. The person who walked in on me was a pleasant woman I was supposed to be supervising.  She woke me by knocking.  I answered her question, and chatted normally, and didn’t skip a beat. She was a good enough clinical observer to be able to tell I was dozing. I could tell (I am not a bad behavioral observer myself) she was uncomfortable. I knew the front desk would call me when my patient arrived. I told her I would continue my nap until 1:00. She looked uncomfortable and said nothing. I was (as usual) out of the group.  Not behaving as people would expect. God knows I am no stranger to that. I only know this one behavior I do not intend to try to minimize by drinking coffee.