Michael Smith, MD (Host): Welcome to Meaningful Medicine, the podcast by Novant Health. I'm your host, Dr. Mike, and joining me today is Dr. John Card, an Internist from Novant Health. In this episode, we're going to dive into the topic, how much caffeine is too much, as Dr. Card shares the pros and cons of caffeine, and we're going to explore whether there's healthier ways maybe to help wake us up and get through the day.

Dr. Card, welcome to the show.

Dr. John Card: Thank you Dr. Mike. I appreciate it my friend.

Host: Listen, I gotta tell you, I like my cup of coffee in the morning. I don't think it's going to go anywhere. I'm just telling you I will take everything you say. I will listen. I'll even take notes, but I'm still going to have my cup of coffee in the morning. What about you? Are you a coffee drinker?

Dr. John Card: I have to admit my friend, I do mostly an iced coffee, so I do have to have it in the mornings though. I agree with you.

Host: Nice. Okay, so we're, we're all set there. So we're not saying coffee never, but maybe there's things we need to learn a little bit about the caffeine and all that kinda stuff. So, a lot of people, when they hear this topic, they may not want to listen to this at all because like me. I mean, come on. They love that latte, that whatever they get, and they're like, I don't want to hear if it's bad for. I don't want to hear anything that Dr. Card's going to make me not want to do it, but let's start there. Is it bad to have some coffee every day?

Dr. John Card: No, I don't think it's bad at all, Dr. Mike. I think that there are some nasty rumors on the street, as I'll say, about caffeine and coffee, as well. I definitely feel like there are some benefits to it, but like with most things we just have to just use it in moderation as well. I think if you finish the whole coffee pot, then we might have to have a conversation about that okay.

Host: Yeah, I get that. Well, what, okay, so there are some benefits. What are some of the health benefits of a cup of coffee or two a day? Like, what, what can we expect?

Dr. John Card: Yeah, so what we notice when it comes to the use of caffeine in its different forms is that it can help with alertness, it can help some with even memory, and it helps to give us a little bit of that energy, to just get us going, especially during the start of the day as well.

Host: Yeah. And that's good stuff because we need that kick. And it gets a little harder as you get older too, let's be honest. I mean, it does. Now, I've been reading a little bit about, there may be some health benefits to cardiovascular health, even longevity. Do you buy into some of that research or what do you think?

Dr. John Card: I am with you, Dr. Mike. I've seen some of the research as it relates to caffeine use and what we believe from it is that by helping us, as far as like cognitive functions, as far as our memory, as it relates to energy, it may help to slow down the process of dementia over time. It may help us by being more invigorated.

We may actually do a little more, such as exercise and things of that nature, which does offer us some heart healthy benefits as well. There's even some studies to suggest that caffeine may be helpful in combating some liver issues such as fibrosis or even cirrhosis of the liver. I think some studies are still need a little bit more research, but I think the preliminary look at it, it's looking promising, but again, in moderation is still the key.

Host: Yeah, so, we kind of started this conversation at the top, having some fun with coffee and stuff. We're really talking about caffeine overall here, right? I just wanted to ask your opinion on this. When you look at coffee, do you think it is the caffeine bringing some of those like heart benefits, longevity benefits, or is it something else in the coffee?

Dr. John Card: With coffee itself, I think it depends on the different types of coffee as well. There are now so many different coffee products out there, but in all fairness, I think it's still the caffeine that's the main driver of what we're seeing as far as health related benefits.

Host: Is it addictive? Is, is caffeine addictive?

Dr. John Card: Caffeine is addictive, my friend. It because of how it stimulates our response to things. So if there's anything that actually gives us that feeling of euphoria or energy over time, we can either be addicted to it in the form of, ooh, I still want that, need that. Or our body is starting to say you need that in order to get to this level of energy or activity.

But unfortunately over time that may be that your body's saying, I need more in order to achieve that same level as well. And that's where we start to get into trouble.

Host: It's when you have to have more and more and more and more to get the same basic, that's the problem. Right?

Dr. John Card: Exactly.

Michael Smith, MD (Host): So, the caffeine consumption overall in this country on a daily basis for most adults is pretty high. It's in a lot of products and, and drinks, right?

Dr. John Card: Correct, my friend. And that's the concern is how aware are we and especially our youth when it comes to utilizing these products. So you have the energy drinks that are out there, the Jolts and other things like that, that promotes, Hey, get that energy that you need to get through your day.

Well, it also has some other products in there that we have to worry about, such as sugar, you know, with most energy products, there's not just a caffeine part of it, but there's a sugar part of it as well. We also look at it for maybe weight loss because of how it stimulates that energy as well.

But again, that's not going to be sustainable over time and that's where I talk to folks about, Hey, yes, some of these products can help you lose the weight initially, and it can help give you the energy initially. However, you can't sustain that. And the issue is, is that that's going to cause more dependency and other things to occur later on.

Host: Yeah. Doing things in our lifestyle, diet, exercise. We want to do things that we can keep doing. That makes sense, right? And that's where that becomes a problem. So if I am consuming too much caffeine, which I think is a true statement for a lot of people, what are those health risks? Like what should I be concerned about?

Dr. John Card: Great question, Dr. Mike. And I think that the things that we may notice is we may start to have issues with palpitations or an increase in our heart rate and rhythm. We might notice that our blood pressures are starting to get elevated and we're having difficulty with getting that back under better control.

 We might also notice that we're having heightened issues of anxiety that we weren't experiencing before, and we may also notice that it's a little bit more difficult for us to even get sleep and rest in the evenings because of the amount of caffeine that our bodies are consuming.

Host: We talked a little bit about where you get caffeine from. It's not just the coffee. I want to talk a little bit more about the sodas and those energy drinks. You touched on a lot of it. It's not just the caffeine, it's the sugar and even some, maybe other who knows ingredients in some of these products.

A lot of these energy drinks, they are loaded with caffeine, by the way. I mean like high, high levels. But also about the equivalent amount of sugar, right. Is that the main concern with those kind of drinks? It's too much caffeine, but then now you're adding in I don't know how much sugar, but it's a lot right?

Dr. John Card: Exactly my friend. And I think for some people, if they have other health conditions such as diabetes, which is very common as well in our society, if you're consuming these drinks that are high in caffeine and sugar, yeah, there may be a some evidence that suggests that little bit of caffeine can help with diabetes in our body's metabolism, but too much along with the sugar definitely is going to be a negative effect, as it relates to diabetes.

And if you have heart disease or high blood pressure, again, that overuse of caffeine with the added sugars could definitely cause problems with managing your blood pressure or contributing to ongoing issues with your heart as well.

Host: You know what I just thought of? It's not just the energy drinks and the sodas. There's a lot of people that go to some of their favorite coffee spot. They get their coffee and then they add into it all these flavorings and syrups and then put some whipped cream on. Is that really a morning coffee at that point like it's like a dessert, I think. Right?

Dr. John Card: I was just going to say, Dr. Mike, that's a morning dessert right there, my friend. On, on that rare occasion, if you did that maybe once a month, just to treat yourself, I think that's fine. But right. We can't do that daily. Exactly. That is the self-care and I agree with you there as well. The other thing I think, just to touch on as it relates to those drinks, what's getting popular now are zero drinks.

 So the zero drinks it's giving you flavor without sugar. But we also have to remember that even though there's no sugar, it still may have the caffeine in certain products, unless it truly says it's caffeine free, but it still also has a sweetener in it. So we still have to be mindful, again, of how much we're doing. We get the, Hey Doc, I switched over to the zero drinks, I'm doing some diet drinks, but I'm not drinking that, Dr. Pepper, Mountain Dew that I used to drink all the time. I say, well, you know what? Hey, you definitely made a better choice. But we still need to moderate how much of that we're doing in a day as well. I always say water is always your first drink that we should have, and that should be the majority of those liquids that we take in.

Host: For sure. Yeah, when it comes to some of those alternative sugars, right? There's the classic artificial ones which are way, way sweet and all that kinda stuff, but more and more you're seeing the natural, the stevia, the, the monk fruit, where do you fall in that? Like if, I am going to make a better choice, would you rather me be on the natural side of that or the artificial side of that?

Dr. John Card: I still would say the natural is going to be a better alternative than even the artificial. Now, stevia, monk fruit, I think those are products that again, are good ones to try as a substitute for us. But anything, and I hate to say it this way, Dr. Mike, but we know anything that really tastes great, we still have to moderate.

Okay. So we just can't use that as the now new source because our bodies get smart to that. They recognize that, okay, you've made a change from the traditional granulated white sugars, pure cane sugars as well. But this is still a sweetener, and our body eventually starts to respond to that as if it were like a sugar. So.

Host: So we still have to be careful with the, it always does come back to moderation, right? I mean, at the end of the day, it's yeah, and that's hard today because we're over consumption. That's what we are in our society, so it's tough. Let's bring this back to caffeine specifically now.

If you told me, if I was one of your patients and you said, okay, I really think we need to bring down that caffeine level, whatever that reason may be, blood pressure, whatever that is. And I said to you, okay, I can do tea in the morning and I like black tea specifically, or I like this kind of tea. What's your first thought about that?

Dr. John Card: Yeah. And we do get that commonly Dr. Mike. So, tea is a good alternative to coffee, but you just hit the nail on the head type deal is that black tea is almost equivalent to coffee as it relates to the caffeine amount. Green tea or herbal teas are going to be less caffeinated than your black tea as a source.

But what tends to happen, Dr. Mike, is we tend to consume more of it because we're still trying to reach that effect that we were getting before. So we have to encourage that, hey, try to still limit how much of that you're doing a day. For folks who are coffee drinkers. I'll be honest, I try to say, try to limit it to about one to two cups a day. And that's my recommendation. Yes. National recommendations may say up to about three to four cups, but I try to say, eh, let's try to stick to more, to one to two cups actually.

Host: That's great. And for me, you know, when you look at the different types of teas, they do taste different and everybody's going to have kind of their own preference, right for those teas. But even regardless of what you choose, you still also have to be careful that you're not putting syrups, that you're not putting all this other stuff right.

Because now you can make the tea another dessert. Right. Every weekend. We can do that all the time. So you still gotta be careful with that stuff, right?

Dr. John Card: I agree. Something that can help that though. Slice up some fruit, do some infusion of fruit into those teas. And that can at least give you a little bit of that flavor without getting all the processed sugars from it.

Host: Let me ask you this. Sleep's a big issue in this country. A lot of reports showing clearly that adults we're, we're not sleeping enough. End of the day. Right. Or it's restless sleep, it's not good deep sleep, all that kind of stuff. How much of a role do you think caffeine really plays in that for people?

Dr. John Card: Given our society, Dr. Mike, I think that we are caffeine users and it does affect our overall sleep as well. If we're not getting enough sleep yet, we still have an eight, 10, 12 hour day that's ahead of us. What are most of us probably doing? We're trying to get some caffeine in, in order to get us through that day, and then over time we're starting to add more because what we were using just isn't quite giving us the effect. Right.

Host: That's the dependence thing, right?

Dr. John Card: There, therefore, the dependence, the addiction part now comes in as well. So we keep encouraging our people and, and of course it's not just our people, but our organizations and companies, that we work with and work for. Just trying to be mindful of all of that as well.

We need to get a good at least six to eight hours of sleep a night, and it has to be restful sleep like you said. If you're drinking caffeine too late into the day, that could potentially affect your sleep and sleep patterns as well too. So try to cut that off again, really in the noon or midday type deal, especially depending on what time you're going to sleep at night.

Host: Yeah, I think most people kind of know their limit there. Like when I can so follow that. Because a lot of times you know it, but you still do it, like know where your limit is. It's do that. As an internal medicine specialist, you've been practicing a long time. What's your big takeaway here when it comes to caffeine consumption?

Dr. John Card: My big takeaway is it's okay to have some caffeine. It's okay. And in some studies, it may even be beneficial for us as well. We definitely see how it can benefit with alertness, awareness, it can help with memory. So there are some benefits to this as well, but always remember, like with most things, we have to do it in moderation.

Again, no more than really about one to two cups of coffee a day. If you need a little more, maybe switching to like a green tea or an herbal tea, caffeine-free may help us in those, instances as well. And there are even some other natural caffeinated sources right now that we're still learning about, but may want to consider. And that's like the matcha teas or the Yerba Mate teas, which are now available as well.

Host: Yeah. Do you like matcha?

Dr. John Card: Can I be real with you, Dr. Mike?

Host: Because I want to be real too. I have problem with matcha.

Dr. John Card: I do too.

Michael Smith, MD (Host): I know it's, I, I, I know people are, I, my son drinking, he loves it. And I'm just, I drink it. I'm like, I feel like I'm drinking leaves. Like, I don't know what, I don't know what I'm like, did you get this from the dirt outside? Like what?

Dr. John Card: Right, right, right.

Host: But that people love it though. And that, that's fine. That's just just me.

Dr. John Card: Right, And that's me with you. But yes.

Host: That's great. This has been fantastic. You gave some great, great advice, Dr. Card. I know a lot of people, uh, needed to hear this. They really do. I did. I think all of us do. So thank you so much for coming on today.

Dr. John Card: Thanks Dr. Mike. I really appreciate having this opportunity. Thank you to your fans out there as well, and hopefully we shared some great information with them today.

Host: Thank you so much. For more information, you can visit novanthealth.org. If you enjoyed this episode, please share it right, get it out there, and explore our podcast library for many, many other topics that we do cover. This has been Meaningful Medicine. I'm Dr. Mike. Thanks for listening.