Caffeine — Is It Beneficial, or Risky for MC Patients?

By Wayne Persky

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A recent Medscape online article points out some interesting observations regarding the health benefits and risks associated with caffeine, based on recent studies (Spriano, 2024, October 11).1 And although the article doesn't mention how microscopic colitis (MC) patients might be affected by caffeine, we can certainly coordinate the information in the article with the vast amount of epidemiological evidence available in the shared experiences that have been posted to the database of our discussion and support forum over the last couple of decades in order to fill in the blanks.​

Looking at the chemical characteristics and pharmacokinetics of caffeine.

Caffeine is a methylxanthine that is completely absorbed (within 45 minutes) and peaks in the bloodstream between 15 minutes and 2 hours after ingestion. Its half-life in adults is generally 2.5-4.5 hours, but several factors can extend or reduce this time, such as smoking (reduces half-life) and the use of oral contraceptives (doubles the half-life). Caffeine crosses the blood-brain barrier, where it blocks adenosine receptors, increasing alertness and reducing fatigue, but also having broader impacts on brain function.

Caffeine has Cognitive and Neurological Benefits.

1. Caffeine is widely used to enhance alertness and work productivity by reducing fatigue and improving reaction times.​

2. It may also have antidepressant-like effects by reducing the risk of depression in some populations.

3. Caffeine enhances the effectiveness of painkillers such as acetaminophen (paracetamol), aspirin and other NSAIDs, and opioids, in treating headaches and other types of pain. This effect is especially beneficial in treating headaches, migraines, and post-surgical pain, where combinations of caffeine and painkillers are sometimes used.

It enhances the effectiveness of painkillers by:

1. speeding up the absorption of certain medications, allowing for faster and sometimes stronger effects
​
2. blocking adenosine receptors, which helps to reduce the perception of pain

For us, boosting the efficacy of safe painkillers can be a huge benefit.

The antidepressant-like effects (for some individuals) can certainly be considered beneficial for MC patients, considering that MC tends to be a very depressing disease. But the available options of safe painkillers are so very limited, with acetaminophen being the number one choice for most of us, when treating our routine aches and pains, that the benefits of boosting the efficacy of painkillers can be a huge benefit for most of us when our situation causes us to reach for a painkiller.

Caffeine has cardiovascular benefits.

Despite early concerns about its impact on blood pressure (BP), moderate coffee consumption has not been linked to increased long-term risk for hypertension and may even reduce the risk of developing it. Studies also show that regular coffee consumption is not associated with an increased risk of atrial fibrillation (AF) or cardiovascular events, and in fact, it may reduce the risk of AF in a dose-dependent manner.

Caffeine reduces all cause mortality risk for type 2 diabetes patients.

At least that statement is true for Japanese diabetes patients, since Japanese patients were used in the study. In fact, the study showed a dose response relationship for the reduction in all cause mortality. And the beneficial effects of caffeine were even greater when coffee was consumed along with green tea.

​These benefits must be weighed against possible adverse effects.

1. Caffeine can at least temporarily affect blood pressure levels.

​While caffeine can acutely raise BP somewhat after 200-300 mg), these effects are temporary and typically do not last longer than three hours. In patients who consume coffee regularly, this effect tends to diminish due to tolerance. Occasional coffee drinkers, however, may experience a more significant hypertensive response.

2. Caffeine can affect cholesterol levels.

There's evidence suggesting that unfiltered coffee, due to its high cafestol content, can raise cholesterol levels, particularly LDL cholesterol and triglycerides. However, filtered coffee and instant coffee have much lower cafestol levels, thereby reducing this effect. Results from studies on coffee’s impact on cholesterol levels remain inconsistent.

​3. Caffeine can increase anxiety and cause sleep disturbances.

High caffeine intake (for example, 400 mg per day, or more) can lead to anxiety and sleep disruptions, although individual responses vary due to genetic factors and caffeine metabolism rates. Some individuals are more susceptible to these effects than others.

4. Caffeine overdose can lead to toxic effects.

Caffeine overdose rarely occurs due to traditional consumption methods (for example,, coffee or tea), but it can occur when using caffeine tablets or energy drinks, particularly in young people, or those consuming caffeine along with alcohol, or engaged in intense exertion.​

The article referenced in the first paragraph points out that consuming large amounts of energy drinks (around 1 liter, containing 320 mg of caffeine, for example) can cause acute cardiovascular problems such as elevated BP, QT-segment prolongation, and palpitations.

5. Caffeine can be addictive.

When consumed regularly, caffeine tends to cause users to develop a tolerance, which leads to a dependency, and therefore, suddenly avoiding caffeine can lead to withdrawal symptoms, including headaches, fatigue, decreased attention, and mood disturbances.

6. Caffeine can be a major concern for migraine sufferers.

Because regular caffeine consumption can lead to dependency, if caffeine levels drop suddenly, the withdrawal symptoms can not only trigger headaches, but they can trigger migraines. For some individuals, even one missed or delayed dose of caffeine can lead to withdrawal symptoms. Caffeine can contribute to rebound headaches, particularly if used frequently in combination with pain relief medications, and this can make migraines more challenging to manage, possibly leading to a cycle of morning headaches.​

This can happen because caffeine constricts blood vessels, which tends to initially relieve migraines. But once the caffeine wears off, blood vessels may dilate again, which can trigger a rebound migraine.

Note that in many cases, published research shows that magnesium deficiency (which is associated with MC) may be the cause of migraines, and for these patients, magnesium deficiency would probably be a much more likely cause of migraines than caffeine. 

But this is a two-way street.

​In small doses, caffeine can actually help stop a migraine in progress by constricting blood vessels and enhancing the effectiveness of painkillers such as aspirin, or in the case of MC and other IBD patients, acetaminophen. This is why caffeine is included in some over-the-counter migraine medications.

Therefore, for some people, occasional caffeine intake can alleviate migraine symptoms, but it’s generally advised against regular use for chronic migraine sufferers due to the risk of dependency and rebound headaches.

Certain consumer products are concerning.

Energy drinks are particularly concerning due to their high caffeine content and potential to cause adverse cardiovascular effects when consumed in large quantities or combined with alcohol. Energy drinks also pose a risk due to the lack of tolerance developed from occasional use, making young people especially vulnerable to their stimulant effects.​

Many weight loss supplements contain high concentrations of caffeine along with other ingredients intended to boost metabolism. These products can be easily misused, especially given their easy availability and marketing claims, leading to adverse health outcomes.

How do various products that contain caffeine compare?

Coffee

The average cup of coffee contains approximately 95 milligrams of caffeine. However, this amount can vary depending on several factors, such as the type of coffee bean, the brewing method, and the serving size. Here’s a breakdown of the typical caffeine content in different types of coffee:
​

• Brewed coffee (drip coffee): 70-140 mg per 8-ounce cup, with an average of around 95 mg.
• Espresso: Approximately 63 mg per 1-ounce shot.
• Instant coffee: 30-90 mg per 8-ounce cup, depending on the brand and strength.
• Decaffeinated coffee: 2-5 mg per 8-ounce cup, though it can vary.​

​These values serve as general estimates, but individual variations in brewing strength can influence caffeine content. And note that coffee contains more than just caffeine.

Note that coffee contains over 1, 000 chemical compounds.

 So not just caffeine, but a huge number of other chemical ingredients contribute to its aroma, flavor, and effects on the body. And it's certainly likely that some of these other ingredients may contribute not only to coffee's beneficial attributes, but also to some of its negative attributes, such as withdrawal symptoms, anxiety risks, and possible sleep disruptions..

While these compounds may have negative health effects, moderate coffee consumption (usually 1-3 cups per day for most people) is generally considered safe. As is often noted in posts on our MC discussion and support forum, if coffee didn't bother us before we developed MC, then it's probably still safe to drink (in moderation) after we developed MC. However, individuals with specific health concerns, like acid reflux, high cholesterol, or kidney stone susceptibility, may benefit from moderating their coffee intake or choosing filtered coffee to minimize exposure to some of these compounds.

Although we can't be sure, because there's no published research to back this up, it's likely that the gastrointestinal distress (sometimes referred to as "coffee gut") that sends some people to the bathroom soon after they drink a cup of coffee is probably not due to caffeine. It's more likely to be caused by some of the natural acids in coffee, such as chlorogenic and quinic acids. These acids can not only cause gastric discomfort, but they can also contribute to acid reflux, and heartburn, especially for people with sensitive stomachs or gastroesophageal reflux disease (GERD).

Tea

The average cup of tea contains approximately 20 to 60 milligrams of caffeine, depending on the type of tea and how it is brewed. Here's a general breakdown of caffeine content for different types of tea (per 8-ounce cup):

• Black tea: 40-70 mg
• Green tea: 20-45 mg
• White tea: 15-30 mg
• Oolong tea: 30-50 mg
• Herbal teas: Typically 0 mg, as these are usually caffeine-free unless mixed with caffeinated ingredients.

As with coffee, the brewing time and tea variety can affect the exact amount of caffeine in your cup. For example, brewing tea for a longer period can increase its caffeine content.

Colas

The average cola-type soft drink contains approximately 30 to 40 milligrams of caffeine per 12-ounce (355 mL) can. Here's a general range for some popular cola drinks:

• Coca-Cola: About 34 mg per 12-ounce can.
• Pepsi: About 38 mg per 12-ounce can.
• Diet versions: Typically similar, with around 30-40 mg of caffeine per 12-ounce can.

In comparison with coffee or tea, the caffeine content in cola is significantly lower. However, many energy drinks or specialized sodas may contain much higher amounts of caffeine.

Energy drinks

The caffeine content in energy drinks varies widely, but it typically ranges from 70 to 300 milligrams per serving. Here are examples of popular energy drinks and their caffeine content:

• Red Bull (8.4 oz can): 80 mg
• Monster Energy (16 oz can): 160 mg
• Rockstar Energy (16 oz can): 160 mg
• Bang Energy (16 oz can): 300 mg
• 5-Hour Energy Shot (1.93 oz): 200 mg

The caffeine content can vary depending on the brand, serving size, and specific product line. Some energy drinks, especially those marketed for extreme energy or performance, can have significantly higher caffeine levels. It's important to check the label to know the exact amount.

Guidelines for keeping caffeine beneficial, and minimizing the risks:

Caffeine brings both benefits and risks, and understanding the context of use, dose, and individual susceptibility is critical in managing its impact on health. Moderation is the key. Most of the risks are associated with high doses of caffeine, particularly from energy drinks or caffeine tablets. Encouraging moderate consumption of coffee or tea can help mitigate these risks while still offering some health benefits. Specific patient considerations (such as hypertension, anxiety disorders, or pregnancy) should guide the decision on whether and how much caffeine consumption is advisable.​

And as MC patients, caffeine may convey a special benefit when we desperately need a painkiller. Since the safe choices of painkillers typically boil down to acetaminophen, taking the acetaminophen with a cup of coffee may help to make it a much more effective painkiller. And the antidepressant -like effects of the caffeine in that cup of coffee may help to provide another much-needed benefit for many of us as we continue to deal with this depressing disease.

Reference

1. Spriano, P. (2024, October 11). Ready for a Jolt? Caffeine Brings Benefits and Risks. Medscape, Retrieved from https://www.medscape.com/viewarticle/ready-jolt-caffeine-brings-benefits-and-risks-2024a1000ilx