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Coffee and Caffeine

Ahh, the sweet smell of coffee in the morning. Truly, a beautiful thing. And several benefits have been linked to a cup of joe each day, including lowering the risk of type 2 diabetes, promoting weight management, and reducing the risk of depression. Working in hepatology and liver transplant, I see many patients with Fatty Liver Disease and Alcoholic Liver Disease, both of which cause steatosis, or an increase of fat content, within the liver. Several studies have found that 2-3 cups of coffee a day can reduce the amount of fat in the liver, so I recommend this beverage (caffeinated or decaffeinated) to all of my patients. However, like everything in life, there are also drawbacks to coffee. The overconsumption of caffeine is linked to anxiety, dehydration, headaches, abdominal pain, rapid heart rates, and dependency.

While in physician assistant school, I consumed coffee on daily basis. I was convinced that it helped me focus and stay awake during lectures and afternoon study sessions. However, I also drank it on days off to avoid the caffeine withdrawals that would ensue if I missed a daily dose. In doing so, I looked past the stomach upset that was also happening as I consumed it. A few semesters into school, I found myself with a case of medical schooling hypochondria. After finishing our gastroenterology section, I figured that the burning pain in my stomach over the last few months must certainly be... cancer. So, like any worried and overly concerned student studying medicine would do, I convinced a gastroenterologist that I must have an endoscopy to rule out cancer, as well as pre-cancerous changes in my esophagus and bleeding peptic ulcers in my stomach. Much to my relief, my endoscopy showed none of the above. It was much more boring than my imagination. The biopsies showed gastritis, also known as inflammation of the stomach. I was told to take an acid-suppressing medication and avoid foods that were associated with heartburn, including fatty foods, dairy products, citrus fruits, tomatoes, peppermint, chocolate, and also, coffee. I knew right away, that coffee was my culprit. So, I reluctantly switched to tea, black tea, mind you, to keep my caffeine content high. My gastritis eventually resolved and my stomach pain went away. However, it wasn’t until a year later, after I completed an elimination diet, that I realized caffeine was, in part, the source of my fatigue. The caffeine I had been dependent upon to wake me up in the morning, was the reason I felt so tired by midday. I now try to limit my caffeine intake to just a few days per week, and my coffee consumption to occasional. That way I can truly enjoy its effects rather than allow it to control me.

So, how would you describe your coffee and caffeine consumption? Do you have control over it, or does it have control over you? Are you noticing fatigue or stomach upsets? If you miss a day, do you notice withdrawal symptoms, such as headaches or irritability? Would taking some time to detox be a beneficial change? You may have to plan for some withdrawal headaches, but to prevent them in the future, you could try alternating your days with caffeinated and decaffeinated coffee. You could also substitute some days with an herbal tea, which has several health benefits as well. Or maybe you're someone who can have coffee on a daily basis and feel just fine, and that is great, too!

Generalized labels of "bad or good" and "all or nothing" are not always helpful. What is healthy for someone may not work for you, and that's okay. Can you find the balance that's right for you? Can you listen to what your body likes best?

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