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It ain't so! I don't have to give up my cup of joe?

Coffee, Dr. Judith Reichman says, has many positive effects and can be good for you too. But bottom line is that caffeine is still a drug.

It's summer and time for those wonderful iced, blended coffee drinks. But wait, don’t they have caffeine? One of the medical maxims we’ve heard for years from our mothers, friends, and yes, our doctors is that caffeine is not good for us. “Today” medical contributor Dr. Judith Reichman was invited on the “Today” show to reevaluate the use of caffeine and reassure us that we don’t necessarily have to say no to that hot or cold cup of joe.

Most of us start our morning with a cup of coffee. Can it (and caffeine) actually be good for you? There are many positive aspects to coffee and its primary ingredient, caffeine.  Caffeine prevents sleepiness and sharpens your thinking by blocking the action of the neurotransmitter adenosine. It can lift your mood by affecting another neurotransmitter, dopamine. It also “revs you up” by promoting the release of adrenaline. It can actually improve muscle coordination and strength if consumed just prior to exercise and it can, to a small extent, help your muscles burn calories. 

Caffeine has positive affects on several other organs and physical conditions:  

Caffeine and AsthmaCaffeine relaxes the bronchial airways and may help decrease asthma attacks in those who suffer from this condition. 

Caffeine and ConstipationCaffeine increases intestinal peristalsis and can act as a laxative. Many individuals use that morning cup to help with “regulation.” 

Caffeine and GallstonesStudies have shown that men who drink two to three cups of coffee daily have fewer gallstones than those who drink decaf or are teetotalers.

Caffeine and Parkinson’s DiseaseIn a study of Japanese-American men, coffee drinkers had a lower incidence of Parkinson’s disease. 

So we drink it to wake up, feel alert, work at our computers, help us exercise, and perhaps breathe better, but shouldn’t we worry about its addictive qualities? 

There’s no question that caffeine is addictive. As a matter of fact, it’s considered to be as addictive as nicotine or even cocaine. Like these drugs it increases the level of dopamine, a neurotransmitter that stimulates the internal reward system in our brain. Once you start, your coffee cravings are quickly set and reinforced. You can become addicted on as little as one cup of coffee a day. If you try to stop cold turkey, you may experience withdrawal symptoms that include headache, fatigue, irritability, depression and even flu-like symptoms. These can last up to two weeks. (Caffeine withdrawal, for pre-operative patients who cannot eat or drink before surgery, is the major cause for headache the day after surgery.The current recommendation is to let them have their coffee as soon as they can tolerate fluids.) 

What’s the average daily consumption of caffeine and do most people get it through coffee?  Our average daily consumption of caffeine is about 280 milligrams, or the equivalent of two and a half 6-ounce cups of brewed coffee a day, but we can get coffee in so many other beverages, as well as sweets, coffee-flavored foods and over the counter and prescription medications that many of us are consuming. 

Here is a list of caffeine sources, which I’ve titled “caffeine is everywhere.”

Coffee                                          Serving Size       Caffeine Content

Coffee (drip)                               8 oz                130 mg

Coffee (instant)                           8 oz                95 mg

Espresso (depending on brand)       1 oz                50 mg

Decaf (drip or instant)                   8 oz                3 mg

Iced coffee blended drink               16 oz              130 mg (Note: Starbucks' Frappuccino has 260 calories, Vanilla Frappuccino has 470 calories, Coffee Bean Vanilla Ice Blended has 330 calories and the sugar-free version has 170 calories.)

Other Beverages                 Serving Size      Caffeine Content

Classic and Diet Coke               12 oz                 46 mg

Pepsi and Diet Pepsi                 12 oz                 36 mg

Sunkist Orange County             12 oz                 40 mg

Mountain Dew                         12 oz                 54 mg

Java Water                              8 oz                 62 mg

Chocolate Milk                          8 oz                  8 mg

                          Serving Size       Caffeine Content

Black Tea (3-minute brew)           6 oz                  35 mg

Instant Tea                               6 oz                  25 mg

Green Tea                                 6 oz                  25 mg

Sweets                                    Serving Size        Caffeine Content

Ben & Jerry’s Nonfat Coffee         1 cup                 85 mg     Fudge frozen yogurt

Starbucks Low-fat                     1 cup                 50 mg    Mocha ice cream

Haagen Dazs Coffee ice cream     1 cup                 58 mg

Hershey’s special dark                 1.5 oz                31 mg   chocolate

Baking chocolate                        1 oz                   25 mg

Coffee-flavored foods         Serving Size           Caffeine Content

Dannon Coffee yogurt                8 oz                    45 mg

Dannon Light Cappuccino            8 oz                     0 mg  Yogurt

OTC Medications                    Serving Size          Caffeine Content

No Doz Maximum Strength          1 tablet               200 mg

Excedrin                                  2 tablets             130 mg

Anacin                                    2 tablets              64 mg

Mydol, Maximum Strength           1 tablet               60 mg

Prescription Medications       Serving Size         Caffeine Content

Fiorinal                                    1 tablet               40 mg(for tension headaches) 

Darvon Compound 65                 1 capsule             32.4 mg(pain reliever)

How much is too much?
At high doses (defined as anywhere between 200 and 800 milligrams), we can see negative effects even in “low risk” adults, which include nervousness, anxiety and rapid heartbeat.   

We’ve talked about the positive affects, but clearly there can be some “ill” effects from caffeine, especially in certain conditions.

Caffeine and PregnancySome studies have shown as much as a 30 percent increase in early miscarriage of normal pregnancies for women who drink two cups of coffee a day. This goes up to 40 percent with four cups. We know that when we’re pregnant, we metabolize caffeine much more slowly than when we are in our non-pregnant state. Moreover, caffeine passes through the placenta and the fetus can’t metabolize it. We wouldn’t put caffeine in the baby bottle, so caffeine intake during pregnancy should be radically diminished or stopped. There’s also concern that caffeine consumption may affect fertility. Some studies have shown infertility rates double for women who drink more than two and a half cups of coffee a day.

Caffeine and CancerThere seems to be no connection to caffeine consumption and cancer. Traditionally we do tell women who have lumpy, painful breasts (fibrocystic changes) to cut caffeine consumption.  Anecdotal experience shows this may be helpful, but multiple studies have not shown that caffeine restriction provides a true benefit for fibrocystic breast conditions.

Caffeine and OsteoporosisCaffeine can block absorption of vitamins and minerals, especially calcium and iron. Also, it’s a diuretic and causes more frequent urination. The concern is that this will cause calcium to be excreted in the urine. So it would be reasonable to assume that over-consumption of caffeine could increase risk of osteoporosis. However, the National Osteoporosis Society has stated that, based on their review of studies, there is no conclusive link between caffeine consumption and thin bones. My personal recommendation is that if you’re drinking coffee, add plenty of milk. That at least will add back any calcium that you may be losing. 

Concerns about too much caffeine intake are focused on adolescents, who are most at risk for poor bone construction if they don’t get adequate calcium. If they are consuming caffeinated beverages, especially sodas in lieu of milk, they forego their major source of calcium and may end up with low bone density, predisposing them to osteoporosis later in life. 

Caffeine and HypertensionCaffeine can raise blood pressure for a few minutes or even a few hours, but in general, caffeine consumption does not seem to cause an ongoing hypertensive disorder. If, however, you already have hypertension and it’s not well controlled, know that coffee can raise your blood pressure, and especially in high-stress settings you could ultimately increase your risk of stroke.

Caffeine and Heart DiseaseCaffeine, especially in large amounts or in individuals who are not used to drinking caffeine, can cause palpitations and an irregular or fast heartbeat. So if you have an existing abnormal heart rate or heart disease, this could be a problem. There is a study that found an increased risk of cardiac arrest in non-smokers who consumed six or more cups of coffee a day (obviously way too much caffeine.) 

Caffeine and HeadachesCaffeine does increase the effectiveness of headache medication (hence its presence in Anacin, Excedrin and Fiorinal), but when taken for more than a few days, these products, which usually combine aspirin or Tylenol with caffeine, can cause rebound headaches, so the recommendation is not to use over the counter medications with caffeine for more than two days at a time.

Caffeine and PMSCaffeine works as a diuretic and should theoretically decrease some bloating, but it can also cause a fall in blood sugar, which may worsen the symptoms of PMS.  Some studies have shown a three-fold increase in PMS when we drink three to four cups of coffee a day. 

Caffeine and Bladder ConditionsCaffeine feeds fluids to our kidneys so that we have to go more frequently. It can also irritate the bladder, causing urge incontinence where the bladder contracts. You feel like you have to go and sometimes don’t make it to the bathroom. So, women with urge incontinence should probably limit caffeine (and might consider reducing spicy foods, sugar and too much citrus). If you’re flying, remember that caffeine and its diuretic effect cause you to be dehydrated. This, plus the lack of moisture in the airplane, will definitely rob you of your fluids. And if you have to go more frequently, remember that there may be too few bathrooms for the too many passengers on your flight. 

Caffeine and SleepBecause caffeine revs you up, obviously it can affect your sleep. It also affects levels of melatonin, which promote sleep. It takes four to seven hours to metabolize caffeine, and the older we are the longer it takes. If you’re on birth control pills or estrogen, the half-life of caffeine may even be greater, and an afternoon cup of coffee can cause late night sleeplessness. 

Caffeine and Anxiety or Panic AttacksHigh doses of caffeine do increase the levels of brain chemicals associated with anxiety and can exacerbate panic attacks.

Caffeine and HeartburnEven decaffeinated coffee can increase stomach acid production, and caffeine does affect the closing of the valve between the stomach and esophagus, which can increase reflux and heartburn. If you’re currently on medication to reduce reflux, you should not only decaffeinate, you need to de-decaffeinate. 

Based on all this, should we put down our cup of joe? (Say it isn’t so!) I tell most of my patients that if they feel good on the equivalent of one to two cups of coffee a day and if they’re not having sleep problems, heart palpitations, severe breast tenderness, PMS or heartburn, or if they’re not planning to get pregnant, they can continue to drink their coffee.    

Dr. Reichman's Bottom line:  Caffeine is a drug. If you drink more than three cups you should cut down on the amount. Don’t forget that caffeine is present in many of our favorite foods, as well as in pain medications, and those blended iced coffee drinks count … in caffeine and in calories!

Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," which is now available in paperback. It is published by William Morrow, a division of .