Caffeine Withdrawal: Procedures and Symptoms.

How to cut caffeine intake?

Most people report a very good success ratio by cutting down caffeine intake at the rate of 1/2 cup of coffee a day. This is known as Caffeine Fading . Alternatively you might try reducing coffee intake in discrete steps of two-five cups of coffee less per week (depending on how high is your initial intake). If you are drinking more than 10 cups of coffee a day, you should seriously consider cutting down.

The best way to proceed is to consume caffeine regularly for a week, while keeping a precise log of the times and amounts of caffeine intake (remember that chocolate, tea, soda beverages and many headache pills contain caffeine as well as coffee). At the end of the week proceed to reduce your coffee intake at the rate recommended above. Remember to have substitutes available for drinking: if you are not going to have a hot cup of coffee at your 10 minute break, you might consider having hot chocolate or herbal tea, but NOT decaff, since decaff has also been shown to be addictive. This should take you through the works without much problem.

Some other people quit cold turkey. Withdrawal symptoms are quite nasty this way (see section below) but they can usually be countered with lots of sleep and exercise. Many people report being able to stop drinking caffeine almost cold-turkey while on holidays on the beach. If quitting cold turkey is proving too hard even in the beach, drinking a coke might help.

What are the symptoms of caffeine withdrawal?

Regular caffeine consumption reduces sensitivity to caffeine. When caffeine intake is reduced, the body becomes oversensitive to adenosine. In response to this oversensitiveness, blood pressure drops dramatically, causing an excess of blood in the head (though not necessarily on the brain), leading to a headache.

This headache, well known among coffee drinkers, usually lasts from one to five days, and can be alleviated with analgesics such as aspirin. It is also alleviated with caffeine intake (in fact several analgesics contain caffeine dosages).

Often, people who are reducing caffeine intake report being irritable, unable to work, nervous, restless, and feeling sleepy, as well as having a headache. In extreme cases, nausea and vomiting has also been reported.

References.

Caffeine and Health. J. E. James, Academic Press, 1991. Progress in Clinical and Biological Research Volume 158. G. A. Spiller, Ed. Alan R. Liss Inc, 1984.

What happens when you overdose?

 From Desk Reference to the Diagnostic Criteria from DSM-3-R (American Psychiatric Association, 1987):

Caffeine-Induced Organic Mental Disorder 305.90 Caffeine Intoxication

Recent consumption of caffeine, usually in excess of 250 mg.
At least five of the following signs:

• restlessness
• nervousness
• excitement
• insomnia
• flushed face
• diuresis
• gastrointestinal disturbance
• muscle twitching
• rambling flow of thought and speech
• tachycardia or cardiac arrhythmia
• periods of inexhaustibility
• psychomotor agitation

Not due to any physical or other mental disorder, such as an Anxiety Disorder.

Basically, overdosing on caffeine will probably be very very unpleasant but not kill or deliver permanent damage. However, People do die from it.

Toxic dose The LD_50 of caffeine (that is the lethal dosage reported to kill 50% of the population) is estimated at 10 grams for oral administration. As it is usually the case, lethal dosage varies from individual to individual according to weight. Ingestion of 150mg/kg of caffeine seems to be the LD_50 for all people. That is, people weighting 50 kilos have an LD_50 of approx. 7.5 grams, people weighting 80 kilos have an LD_50 of about 12 grams.

In cups of coffee the LD_50 varies from 50 to 200 cups of coffee or about 50 vivarins (200mg each).

One exceptional case documents survival after ingesting 24 grams. The minimum lethal dose ever reported was 3.2 grams intravenously , this does not represent the oral MLD (minimum lethal dose).

In small children ingestion of 35 mg/kg can lead to moderate toxicity. The amount of caffeine in an average cup of coffee is 50 - 200 mg. Infants metabolize caffeine very slowly.

Symptoms

• Acute caffeine poisoning gives early symptoms of anorexia, tremor, and restlessness. Followed by nausea, vomiting, tachycardia, and confusion. Serious intoxication may cause delirium, seizures, supraventricular and ventricular tachyarrhythmias, hypokalemia, and hyperglycemia.
• Chronic high-dose caffeine intake can lead to nervousness, irritability, anxiety, tremulousness, muscle twitching, insomnia, palpitations and hyperreflexia. For blood testing, cross-reaction with theophylline assays will detect toxic amounts. (Method IA) Blood concentration of 1-10 mg/L is normal in coffee drinkers, while 80 mg/L has been associated with death. Treatment

A symptom lacking in the clinical manual but reported by at least two people on the net is a loss of motor ability: inability to move, speak, or even blink. The experience is consistently described as very unpleasant and not fun at all, even by those very familiar with caffeine nausea and headaches.

Effects of caffeine on pregnant women.

Caffeine has long been suspect of causing mal-formations in fetus, and that it may reduce fertility rates.

These reports have proved controversial. What is known is that caffeine does causes malformations in rats, when ingested at rates comparable to 70 cups a day for humans. Many other species respond equally to such large amounts of caffeine.

Data is scant, as experimentation on humans is not feasible. In any case moderation in caffeine ingestion seems to be a prudent course for pregnant women. Recent references are Pastore and Savitz, Case-control study of caffeinated beverages and preterm delivery. American Journal of Epidemiology, Jan 1995.

On men, it has been shown that caffeine reduces rates of sperm motility which may account for some findings of reduced fertility.

Caffeine and Osteoporosis (Calcium loss)

From the Journal of AMA: (JAMA, 26 Jan. 1994, p. 280-3.)

"There was a significant association between (drinking more) caffeinated coffee and decreasing bone mineral density at both the hip and the spine, independent of age, obesity, years since menopause, and the use of tobacco, estrogen, alcohol, thiazides, and calcium supplements [in women]."

Except when:

"Bone density did not vary [...] in women who reported drinking at least one glass of milk per day during most of their adult lives."

That is, if you drink a glass of milk a day, there is no need to worry about the caffeine related loss of calcium.

Studies on the side-effects of caffeine.

OAKLAND, California (UPI) -- Coffee may be good for life. A major study has found fewer suicides among coffee drinkers than those who abstained from the hot black brew.

The study of nearly 130,000 Northern California residents and the records of 4,500 who have died looked at the effects of coffee and tea on mortality.

Cardiologist Arthur Klatsky said of the surprising results, ``This is not a fluke finding because our study was very large, involved a multiracial population, men, women, and examined closely numerous factors related to mortality such as alcohol consumption and smoking.''

The unique survey also found no link between coffee consumption and death risk. And it confirmed a ``weak'' connection of coffee or tea to heart attack risk -- but not to other cardiovascular conditions such as stroke.

The study was conducted by the health maintenance organization Kaiser Permanente and was reported Wednesday in the Annals of Epidemiology.

Caffeine and your metabolism.

Caffeine increases the level of circulating fatty acids. This has been shown to increase the oxidation of these fuels, hence enhancing fat oxidation. Caffeine has been used for years by runners and endurance people to enhance fatty acid metabolism. It's particularly effective in those who are not habitual users.

Caffeine is not an appetite suppressant. It does affect metabolism, though it is a good question whether its use truly makes any difference during a diet. The questionable rationale for its original inclusion in diet pills was to make a poor man's amphetamine-like preparation from the non-stimulant sympathomimetic phenylpropanolamine and the stimulant caffeine. (That you end up with something very non-amphetamine like is neither here nor there.) The combination drugs were called "Dexatrim" or Dexa-whosis (as in Dexedrine) for a reason, namely, to assert its similarity in the minds of prospective buyers. However, caffeine has not been in OTC diet pills for many years per order of the FDA, which stated that there was no evidence of efficacy for such a combination.

From Goodman and Gilman's The Pharmacological Basis of Therapeutics: