Joey Wahler (Host): It's a staple in many of our lives, but at what cost? We're discussing caffeine pros and cons. Our guest, Dr. Elise LeBel. She's an Internal Medicine Physician with PRISMA Health. This is Flourish, a podcast from PRISMA Health. Thanks for listening. I'm Joey Wahler. Hi, Dr. LeBel. Thanks for joining us.

Elise LeBel, MD: Thanks for having

Host: Great to have you. So first in a nutshell, what effect does caffeine for most of us typically have on the body?

Elise LeBel, MD: Well, caffeine is a stimulant, so it revs things up. Most of us drink it, for example, to be more awake. But by revving up, you can get palpitations, you can get restlessness, you can get headaches, insomnia.

Host: So how do we know where the line is in terms of how much is too much caffeine?

Elise LeBel, MD: First, everybody has a different threshold also, which can be very different. There's some arbitrary guidelines out there, like 400 milligrams of caffeine a day for an adult. And so, you can take a look at what caffeinated substances you're drinking and sort of get a clue from there. You know, if you drink 200 mg of caffeine a day and you're having an irregular heartbeat or chest pain, then it would probably be too much for you.

Host: Now, we all know of course about the caffeine in coffee, which so many people drink and many drink a lot of. Which foods or drinks besides coffee contain the highest levels of caffeine?

Elise LeBel, MD: Sodas can contain a lot of caffeine, energy drinks probably contain the most. Green tea, contains caffeine, and some of the green tea products I've seen are actually clear, and so you don't necessarily even think that caffeine is in them. Chocolate contains caffeine, that's why we're supposed to keep it away from our pets. Some people actually have chocolate on top of espresso beans, so that'll give you a lot of caffeine.

Host: So is it possible for the average person, because you said of course it does differ individual to individual, what would be a quote unquote acceptable amount of coffee in a day, let's say based on cups. Is it two? Is it three? Any kind of a guideline there?

Elise LeBel, MD: Four cups of coffee, two energy drinks, ten cans of soda a day are sort of ballparks.

Host: 10 cans of soda a day? I try to keep it under 10 a week.

Elise LeBel, MD: Well, I'm not, you're asking only about from the caffeine perspective. You know, there are a lot of reasons you shouldn't have 10 cans of soda a day, the sugar, and there's a huge amount of variety because some of the brands have a lot more caffeine than others.

Host: Right, I'll tell you, I used to be a huge soda drinker and then I went off of it for a while and when I brought it back, not too long ago, I kind of made a deal with myself. I'm going to have it once a day, if that, only with dinner, and I limit myself to one can, and I find that if I do it by the can as opposed to by the bottle, it's easier to kind of regulate myself.

 Meanwhile, you touched on it a little bit earlier, but what would you say is the biggest danger for those that overdo it in the caffeine department from a health standpoint? What's the worst thing that could happen to us?

Elise LeBel, MD: Well, really the worst one, especially for certain subgroups like heart patients, is that caffeine, even in the 400 milligrams a day, can cause sharp increases in blood pressure. And if your blood pressure is poorly controlled at baseline, you know, that could get you to stroke level, heart attack level.

Host: How about in terms of mood, in terms of getting people in some cases from too much caffeine too keyed up that type of thing?

Elise LeBel, MD: Well, it definitely can cause anxiety and restlessness and headaches. And then, you know, sort of as the after effect, like for your example of the soda at dinner, a lot of times if it's a caffeinated soda at dinner, people will get insomnia and then even when the caffeine has worn off, the lack of sleep will cause them to have even more anxiousness the following day and more difficulties with their mood.

Host: And that leads me to my next question, which is what about cutting off caffeine at a certain hour of the day? How good an idea is that?

Elise LeBel, MD: Cutting off caffeine at a certain hour of the day makes sense for a lot of us, though it's very interesting because a lot of people with attention deficit disorder can drink as much caffeine as they'd like, as late as they'd like, and it doesn't appear to impact them, but for the rest of us, even caffeine with dinner can impact your sleep.

Host: And you mentioned earlier that there's caffeine in chocolate, which I did not know. And the people are therefore advised to keep chocolate away from their pets. One of several reasons, I would imagine. How about the impact of caffeine on kids, on children?

Elise LeBel, MD: I found it very interesting because I'm an internist, so I'm an adult doctor, but it turns out that there's no level of acceptable caffeine for children under the age of 12, and even teenagers should at most have a hundred milligrams a day, which would be just one cup of coffee. So it definitely has a lot more impact on children. And that's also one of the reasons we discourage breastfeeding mothers from significant amounts of caffeine.

Host: So if you're thinking it would be a fun or quote unquote grown up thing to do to give your 10, 11, 12 year old a cup of coffee, figuring what's the harm in that, probably not the best idea, right?

Elise LeBel, MD: Probably not. And one you should talk to the pediatrician about.

Host: Gotcha. How about besides kids? Are there any other people you mentioned earlier, of course heart patients, any others who should stay away from caffeine for the most part?

Elise LeBel, MD: Caffeine can impact pregnant women more so than other adults. So they are advised usually to avoid it. Sometimes people with epilepsy or glaucoma can run into problems with caffeine and I usually encourage them to speak with their specialists about it.

Host: Getting back to coffee, Doctor, is decaf coffee healthier than caffeinated?

Elise LeBel, MD: So it appears to be healthier than caffeinated in that it gives you a lot of the pleasure of drinking caffeine without the stimulant side effects.

Host: So would you advise that for those that can handle whatever the taste difference might be?

Elise LeBel, MD: Yes.

Host: A few other things. Does the way you brew your coffee make a difference in a caffeine scenario?

Elise LeBel, MD: It definitely can because, for example, a cup of espresso, which is quite small, has more caffeine than the average drip brew. But as far as the details of that, I'm not sure on the specifics.

Host: Now we've been pretty hard on caffeine these last few minutes, so I think it's only fair to ask, Doc, does caffeine have any health benefits at all?

Elise LeBel, MD: It's sort of interesting because most of the time we're talking about the downside. But for reasons that aren't clear, those who drink caffeine tend to live longer. They're less likely to get type 2 diabetes. They're less likely to have heart failure and colon cancer, stroke and Parkinson's. Though none of the studies have been big enough for us to know the exact connection.

Host: So I have two reactions to what you just said. One is, in the interest of fairness, you certainly provided some objective information there to balance things out here, but then along with that, I'm wondering based on everything we just talked about and you just pointed out, doesn't what you just said, kind of surprise you?

Elise LeBel, MD: It does. But there was one small study I found that showed that dark roast coffee decreased DNA strand breakage, which I thought was sort of fascinating. You know, most of the stimulant problems are more like with palpitations and blood pressure. But you know, maybe you would live longer if your DNA didn't break down as much.

Host: Okay. I was going to ask you what you meant by that. And so just two other things. One being many people who try quitting caffeine altogether wind up suffering withdrawal. So for those interested in going that route, does anything reduce that withdrawal effect?

Elise LeBel, MD: Especially if you're a heavy caffeine drinker, I would recommend tapering it off because you're going to have less side effects. As much as caffeine can cause headache, definitely stopping caffeine cold turkey will give you nasty headaches. So, you know, I would encourage people to maybe go to a 50/50 split of caffeinated decaffeinated and then a quarter. And, you know, you didn't start drinking coffee or soda or some combination of those overnight. So why not plan to quit over a few weeks?

Host: And then finally, in summary here, what's your overall recommendation to the average person listening when it comes to caffeine intake? What's sort of the best general rule of thumb just based on good old fashioned common sense?

Elise LeBel, MD: Diet is about moderation and I think most of us would probably do well to moderate our caffeine consumption to about 200 milligrams a day.

Host: All right, well folks, we trust you're now more familiar with the pros and cons of caffeine. Dr. Elise LeBel, thanks so much again.

Elise LeBel, MD: Thank you for having me.

Host: And for more information, please visit prismahealth.org/flourish. Again that's prismahealth.org/flourish. Now if you found this podcast helpful, please share it on your social media. I'm Joey Wahler. And thanks again for listening to Flourish, a podcast from PRISMA Health.