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Coffee deprivation.

The medical clinical research world has reinvented the wheel. After several hundred years of public coffee drinking, they rediscovered that when coffee drinkers give up the brew even for a couple of days--half of them get a headache, while the other half appeared to be unaffected. Not only did they get headaches; people deprived of their brew suffered even more debilitating symptoms of caffeine deprivation such as drowsiness, fatigue and depression.

The research study demonstrating this effect was performed at the Department of Psychiatry and Behavioral Science, John Hopkins University in Baltimore, Maryland, by Drs. Kenneth Silverman PhD, Suzette Evans PhD, and Eric Stride M.D. of the John Hopkins School of Medicine and of the Addiction Research Center in Baltimore.

The study was published in the October 15, 1992 issue of the New England Journal of Medicine entitled "Withdrawal Syndrome After the Double-Blind Cessation of Caffeine Consumption". The double-blind adjective refers to the fact that neither patient nor doctor knew which participant received or was deprived of caffeine.

As a background for the study, the doctors stated that "People who stop consuming caffeine may have symptoms, but severity and incidence of caffeine withdrawal are not known. This study was performed to determine the effects in the general population of ending dietary intake of caffeine."

Sixty-two random normal adults, whose intake of caffeine was low to moderate, were studied. Normal was considered an average daily 235 mg equivalent to two and a half cups of brew per day. They completed questionnaires about symptoms and tests of their mood and performance when consuming their normal diets; at the end of two 48-hour test periods, during which they consumed caffeine-free diets; and under double-blind conditions received caffeine-free sugar pills or pills containing their average amounts of caffeine. Data was then analyzed for effect of caffeine deletion.

Psychiatric tests for indecisiveness, work difficulty, fatigability, indicated that these were all increased in moderate degree during caffeinefree periods as were confusion, bewilderment and total mood disturbances. Vigor, friendliness, well-being, desire to socialize or work were all decreased. Drowsiness, yawning, lethargy, fatigue were also increased.

Deprivation of caffeine affected answers in some way of every subject during their caffeine-free days, as well as performance tasks. For all of the measures explored, results were significantly different during the caffeine-free period than the others. Energy and self-satisfaction were decreased with no caffeine.

Statistically, the severity of the effects that followed assessed the cessation of caffeine intake was assessed by comparing the percentages of subjects with abnormal responses on several criteria. For example, during the dummy pill period, 52% reported moderate to severe headaches compared to 6% when receiving the caffeine capsules.

A larger percentage of subjects violated the dietary restrictions of taking medication during the caffeine-free days: 13% vs 2% for the ones receiving the caffeine capsules. The medicine was analgesic drugs like aspirin.

A typical physical test used is the tapping test wherein the subjects tap 200 times on a key as fast as they can for three consecutive trials, separated from one another by approximately 10 seconds apart. For each trial, this test indicated that the tapping rate during the dummy pill treatment was significantly lower than the other two periods; whereas in no trial did the rates in the other two periods differ significantly from each other. This indicates that lack of caffeine can cause impairment in performance.

The authors confirm that, in normal adults, abruptly ceasing the daily consumption of caffeine results in a clinically relevant withdrawal syndrome. Half the subjects had moderate or severe headaches. Why the other half did not was not investigated, but merits exploration. Some 8-11% had symptoms associated with depression and anxiety; 13% required over-the-counter and prescription analgesics during the caffeine-free period. Motor performance was also disrupted. Those who had abnormal responses during the caffeine-free period provided anecdotal comments a year later, characterizing the caffeine-free withdrawal syndrome as severe and disruptive of their normal activities.

"The subjects consumed low to moderate amounts of caffeine and appear to be representatives of the general population. Half consumed less than 226 mg per day and all but four less than 400 mg per day. This distribution is consistent with amounts ingested by adults in the U.S. who consume caffeine regularly (82% of adults); the mean intake for caffeine consuming adults has been estimated at 227 mg per day with 99% consuming less than 563 mg per day."

These results may be of significance to physicians who often prescribe caffeine in the treatment of anxiety, arrhythmia, esophagitis or hiatal hernia, insomnia, palpitations and tachycardia. On the other hand, surgeons should permit coffee drinkers their brew and not abruptly terminate it before an operation to avoid the distress of caffeine withdrawal.

Caffeine withdrawal ills have been well-known to most chronic coffee drinkers for several centuries. More research is needed on its mechanism, not on the fact that it occurs.
COPYRIGHT 1992 Lockwood Trade Journal Co., Inc.
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Copyright 1992 Gale, Cengage Learning. All rights reserved.

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Title Annotation:Coffee Break with Dr. Samuel Lee
Author:Lee, Samuel
Publication:Tea & Coffee Trade Journal
Article Type:Column
Date:Dec 1, 1992
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