Sunday, December 16, 2012

Caffeine and IBD


Caffeine, Crohn's, and Ulcerative Colitis



Caffeine is a naturally occurring stimulant drug and is commonly found in coffee, tea, chocolate, cola, and other products.  Caffeine is one of the most commonly ingested drugs, and is one of the most studied.  Caffeine use for IBD patients has historically been contraindicated, however the contraindication is not well supported by clinical research.

Negative effects of caffeine consumption are highly individual dependent and are due in part to the regularity of caffeine consumption.  Like many drugs, individuals who regularly consume caffeine develop a tolerance, and both the stimulant and side effects are generally reduced over time.  Additionally, caffeine is an addictive substance.  When caffeine intake is curtailed, withdrawal can occur resulting in headaches, irritability, difficulty sleeping, and abdominal pain.  Symptoms can persist for up to a week following the last intake of caffeine. 

The primary negative effects of caffeine are related to its function as a central nervous system stimulant.  Consuming more than 250mg of caffeine in one day can lead to nervousness, irritability, restlessness, difficulty sleeping, headaches, and heart arrhythmias.  Side effects are less when consuming small amounts of caffeine.

Caffeine has the positive effects of a stimulant as well.  Consuming products with caffeine can reduce drowsiness and increase alertness for short periods.  Caffeine has been included in some headache medicines as an adjunct treatment, and consumption has been shown to have a positive reduction in the incidence of certain cancers.

For those with IBD, the primary concerns behind consumption of caffeine are increases in inflammation and the diuretic effect of the drug.  For inflammation, there is currently no good evidence linking caffeine consumption to C-Reactive Protein levels, a common inflammation marker in IBD testing.(1)  Additionally, caffeine consumption has been shown to suppress tumor necrosis factor alpha (TNF-α) production. (2) TNF-α has been directly linked to inflammation related to IBD and suppression of TNF-α is the focus of several drugs, including Remicade, Cimzia, Enbrel, and Humira. 

While caffeine has been shown to have a small diuretic effect when first consumed, regular consumers have shown no incident increase in the diuretic properties against placebo.  Specifically, the risk of dehydration due to increased urination from caffeine is small but present for those who don’t regularly drink it, but the effect quickly goes away.  Because of this, caffeine should not be avoided exclusively because of IBD – it has not been shown to worsen symptoms.  Consumption of caffeine for IBD sufferers should be an educated, personal choice based on the side effects and positive properties unrelated to IBD. (3)

Caffeine levels for many commonly consumed products like coffee and tea vary greatly depending on the agricultural source and preparation.  A good baseline for non-excessive daily caffeine consumption is 8 to 16 ounces of coffee.  The average caffeine content of common foods and beverages is shown below.
 
Product
Serving Size
Amount of Caffeine (in mg)
Espresso
4 oz
254
Rockstar Energy Drink
16 oz
160
Coffee
8 oz
95
Red Bull
8.5 oz
80
Coffee, instant
8 oz
65
Tea, black
8 oz
47
Diet Coke
12 oz
45
Coca Cola Classic
12 oz
34
Hershey chocolate bar
1 bar
9
Lipton BRISK iced tea
12 oz
7
Coffee, decaffeinated
8 oz
2

 The information above is for the caffeine itself.  Specific drinks, such as coffee or soda, have multiple ingredients that can exacerbate the effects of caffeine or, alternatively, have pallative effects.  As such, caffeine should not be the only consideration in choosing what to eat or drink for those with IBD.

Bottom Line

  • Small amounts of caffeine (the equivalent of one cup of coffee a day) are not generally associated with negative side effects.
  • Large amounts of caffeine can exacerbate general health problems, though not specifically those related to IBD.
  • Caffeine reactions are highly dependent on the tolerance of the individual consuming it.

(1)  Rodrigues, I. M., & Klein, L. C. Boiled or Filtered Coffee?: Effects of Coffee and Caffeine on Cholesterol, Fibrinogen and C-Reactive Protein. Toxicological Reviews.  2006.

(2)  Horrigan, L. A., Kelly, J. P., & Connor, T. J.  Caffeine suppresses TNF-α production via activation of the cyclic AMP/protein kinase A pathway. International Immunopharmacology, 2004.

(3)  Maughan, R. J., & Griffin, J. Caffeine ingestion and fluid balance: a review. Journal of Human Nutrition and Dietetics, 2003.



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