TEEN HEALTH:

Getting The Buzz on Caffeine

by Dr. Ann L. Engelland

(November 21, 2006) Our community was recently presented with the “2006 Communities that Care Youth Survey” and its latest data on alcohol, marijuana, cocaine and inhalant use among our middle and high school age kids. (See: Alcohol and Drug Use Rises Among MHS Students.) With Mamaroneck alcohol use well above the national average for eighth, tenth and twelfth grades, and binge drinking reported at twice the national rates for high school students, one might wonder why we should be at all concerned about caffeine in our childrens’ bodies.

Is caffeine just one more thing to worry about? Can’t we let our kids have their ventis and cappuccinos and their macchiatos? Should we just lighten up about this issue and focus on more dangerous concerns? Let’s look at it.

If we think of caffeine as a drug (which it is), we can look at it the way we would ibuprofen or insulin or antibiotics. In other words, there are pharmacology, dosing, side effects, tolerance and addiction characteristics.

The Pharmacology

Caffeine is the most commonly consumed psychoactive drug in the world. It works by stimulating norepinephrine and epinephrine secretion. These chemicals in turn have multiple effects on the brain, peripheral nervous system, heart, gastrointestinal tract, kidneys, and vascular system (blood vessels).

Dosing and Side Effects

At low doses the effects include increased heart rate, wakefulness, alertness, sociability and feelings of increased energy. At higher doses, most people know it can cause anxiety, insomnia, nausea, abdominal discomfort, decreased manual dexterity and high blood pressure. When people consume higher doses, either at one shot or over the course of a day, they experience the negative side effects of the drug. Little and young bodies tend to max out at lower doses than older and larger bodies. Research shows that hypertension is more of a problem for African American kids than it is for Caucasians.

Tolerance

Tolerance is the phenomenon of requiring more of a drug to achieve the same desired effect. Many of us know the feeling of escalating to three or four cups of coffee a day in order to “stay awake.” Tolerance can build up very quickly, with three cups of regular coffee a day for three days enough to start dependency.

Addiction

Come the fall and Yom Kippur with its required fast, including the injunction against coffee, I annually experience the terrible symptoms of caffeine withdrawal, a sure sign of “addiction.” These include irritability, depression, anxiety, fatigue and of course headache.

How much caffeine is in some common drinks?

And how about hidden sources of caffeine:

There are no US guidelines about coffee consumption for children. But the Canadian government recommends a maximum of 45 mg per day for 4- to 6-year- olds, 62.5mg per day for 7- to 9-year-olds, and 85 mg per day for 10- to 12- year-olds. But most agree there is very little data to go on. However, all agree that caffeine has never been shown to stunt growth, a myth still firmly entrenched in urban lore.

As a frontline pediatrician, what are my concerns about caffeine and our kids?

--- That kids are drinking coffee instead of eating healthy meals.

About half of my patients do not eat breakfast. Too many girls are using caffeine as a diet pill and too many guys are using it as a pre-sports energizer. A granola bar in both cases would do a better job.

--- That kids are consuming way too many calories and too much fat in their sweetened, caffeinated drinks.

A Venti (20 0z) Caffé Mocha from Starbucks at 490 calories is essentially a Quarter Pounder with Cheese in a cup according to a September, 2006 issue of Nutrition Action Healthletter.

--- That kids are too jazzed by the end of the day to wind down, spend some time relaxing and get enough sleep.

Caffeine contributes to and enables the supercharged, over-scheduled lives we are teaching our kids to lead. Caffeine enables multi-tasking and in the short run it will lower sleep requirements. But we forget that teenagers need time to daydream and relax and plenty of sleep for their brain development.

--- That athletes use the “charge” of high caffeine drinks to energize their game, increasing the risk of injury and violent play.

Being alert, awake, rested and fit contribute to a good game. Jitteriness, anxiety, edginess, and aggressive attitude do not.

--- That kids begin a habit of using extraneous chemicals (ie caffeine) to fuel a life style that is too fast paced, stressful and unhealthy.

This is the argument that caffeine is a “gateway drug” - coffee today, alcohol tomorrow. No one has proven that this is so, but no one has really studied this in high school kids in recent years when we know caffeine consumption has sky-rocketed. What concerns me most is the notion that we need chemicals to bring us up, then different ones to bring us back down, then yet something else to put us somewhere right in between. We lose track of what feeling clean and natural can be like.

--- That kids begin to mix their drugs in order to experiment with the pharmacology.

Combining Red Bull and alcohol is a common habit, meant to titrate precisely the disinhibiting effect of alcohol with the energizing effects of the caffeine/taurine effect of Red Bull. Early reports from Europe suggested that Red Bull, especially when combined with alcohol, may have been responsible for some sudden deaths in young, healthy people. Fortunately, such disasters have not been seen or reported with any increased frequency since high energy drinks have hit the US market full force.

On the other hand, a research team from Sao Paulo, Brazil, published a study in April, 2006 showing that alcohol significantly reduced the perception of headache, weakness, dry mouth and impaired motor coordination but had no impact on objective measures of motor coordination and visual reaction time. In other words, chugging down a Red Bull after an alcoholic binge will not improve driving skills any more than a coffee ever did. That’s to say, not at all.

Does Starbucks have some responsibility for our childrens’ health? An August, 2006 report on Salon.com quotes the company as stating that its “overall marketing, advertising and event sponsorship efforts are not directed at children or youth.” But in this same report, several teens interviewed talked about how they call the sweet, creamy caffeinated drinks the “kids’ menu” at Starbucks. Coffee has become the “comfort food” for some. And for others, especially girls, it is the new diet food.

Let’s look carefully at the strategic placement of Starbucks near our very own high school. It’s not all bad. It’s a place to hang out (when they let you) and a place to socialize or do homework. If you wanted, it might be an (expensive) alternative place to buy breakfast. Generally speaking, these are GOOD things. Except, too many kids are buying the High Fat, High Calorie, High Caffeine Breakfast in a Cup. It would be much healthier to buy a regular coffee with low fat milk and eat a small muffin or bagel with it.

What is a person to do?

The Nutrition Action Healthletter suggests the following:

• Go Nonfat. Choose nonfat milk over whole milk.
• Skip the whipped cream. It adds 120 calories and 7 grams of very bad fat.
• Get unsweetened drinks and add your own natural or artificial sweetener
• Watch the caffeine content. Starbucks and Dunkin Donuts do not post their nutrition information, but you can check out your favorite drink online at their websites. Try to limit daily caffeine to 300 mg at most.

In addition, make a conscious effort to eat meals, stop consuming caffeine after mid-afternoon and consume high energy, super-charged drinks cautiously and mindfully.

Coffee is here to stay. What is usually true is true again: moderation is the safest way to go.

Dr. Engelland has a practice in Mamaroneck devoted to Adolescent Primary Care. She can be reached at 698-5544. Have a teen health question? Use the form below to send it to Dr. Engelland. Please note: Dr Engelland cannot respond privately to individual queries online. Comments are welcome and anonymous questions may be answered in future columns. Serious medical problems should be referred to your own physician.

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