Maggie McKay (Host): Do you know anyone who doesn't drink coffee or tea daily? Most Americans consume some amount of caffeine and it does impact your health. But how? Today we'll find out with Dr. T. Glenn Pait, Director of the Jackson T. Stevens Spine and Neurosciences Institute. Welcome to UAMS Health Talk, a podcast from University of Arkansas for Medical Sciences. I'm Maggie McKay. Dr. Pait, thank you so much for being here.

Thomas Glenn Pait, MD: Well, we're delighted to have the opportunity to join you, Maggie.

Host: Doctor, many people combine alcohol and caffeine at the same time when, say they're eating dinner, whether it's an Irish coffee, espresso, martini, or a mixed drink. Is that a popular thing to do? And is it safe to mix alcohol and coffee?

Thomas Glenn Pait, MD: Maggie, it is indeed a popular thing nowadays to do, but it can be kind of dangerous. You got to be careful with doing that. We've all been around somebody that, well, will have an espresso martini. And they drink it very quickly. And then the next thing you know, they lean over to you and they say, Hey, you know, I don't think they put a whole lot of alcohol in there. I'm going to have to have another one. Have you ever had somebody do that, Maggie?

Host: Thankfully, no, but I know people do.

Thomas Glenn Pait, MD: Yeah, they're skimping on the alcohol and it can be a dangerous thing to do. And here's the reason why. When you combine alcohol and coffee, and because it has caffeine in it, the caffeine is a stimulant, and it's going to mask the depressive effects of the alcohol.

And that's going to make you feel, well, a little bit brighter than you should. You're more alert. And you can say, well, they're just not putting enough alcohol into my drink, so I'm going to have another one. So it's very important that you do not underestimate the effects of alcohol and caffeine or coffee mixed together.

Because one thing you must remember; putting caffeine or coffee in a drink, you still cannot drive when you're drinking. All righty? And also, you keep on drinking those things, you can wind up with something called alcohol poisoning, and then also something else, risky sexual behavior. So be careful about the caffeine and alcohol combinations.

Host: Definitely. So a lot of people believe drinking caffeine after alcohol will help to sober them up. Is that true?

Thomas Glenn Pait, MD: Absolutely not. It's not going to help you out. Again, the only thing that's going to happen is that the caffeine in the coffee will mask some of the depressive effects of the alcohol. But you're still going to have the alcohol on board. So, be careful. Don't drink and drive, even with alcohol and coffee.

Host: Right. And a lot of people are mixing energy drinks with alcohol. How do you feel about mixing those two?

Thomas Glenn Pait, MD: Well, I'm going to tell you, Maggie, not very much. It's more common among young people. Now, according to the Centers for Disease Control, take a listen to this; 10 percent of students in grades 8, 10, and 12, and then some 30 percent of adults will say that they consume alcohol mixed with an energy drink.

They're going to get that good feeling and as well as that little boost from the caffeine. Not a good thing to do at all. One of the things we worry about those things, besides you don't want to drink and drive when doing that, is that you can get dehydrated very quickly. Because remember, caffeine and alcohol are both diuretics.

So next thing you know, you're dehydrated. You're going to have a big thirst. And your mouth is going to become dry. You're going to pass dark urine. It's a real good sign that you're dehydrated. And then you're going to be a little light headed. Be very cautious combining alcohol and caffeine. It's not a good thing to do.

Host: And what about coffee? Does it have an impact on cardiovascular disease?

Thomas Glenn Pait, MD: There are so many studies going on about the benefits of coffee on your heart. One study looked at this, I'm going to tell you about, and it talked about the habitual coffee drinker, the everyday coffee drinker, and will that help with cardiovascular disease. Now, cardiovascular disease, we're talking about coronary artery disease and cardiac failure and some arrhythmias and stroke. Now, Maggie, did you ever think about what subtype of coffee you drink?

Host: No.

Thomas Glenn Pait, MD: No, you just drink your coffee, right?

Host: I don't drink coffee, but I do drink a lot of iced tea.

Thomas Glenn Pait, MD: What do you mean? Everybody in the world drinks coffee but Maggie.

Host: I know. I know. I drink iced tea. Close.

Thomas Glenn Pait, MD: That's got some caffeine in it. That's got some caffeine in it. Well, coffee comes in subtypes. There's your decaf coffee and then your ground and regular and instant. And it appears that if you drink about two to three cups of coffee every day, it's associated with some reduction in cardiovascular disease and mortality.

So drinking the right type of coffee is what we call is a modifiable lifestyle risk factor. So it appears that in many studies, coffee can help out the old heart.

Host: So I better start drinking coffee. That's what you're telling me?

Thomas Glenn Pait, MD: Yeah Maggie, you got to, you got to go get some coffee right after this show is over.

Host: I think I will uh, but not decaf, right? Not decaf.

Thomas Glenn Pait, MD: Yeah, try the regular stuff first okay.

Host: Okay. I like coffee ice cream for sure. Okay. So it, can lengthen one's life, true?

Thomas Glenn Pait, MD: Well what do you think? What do you think? You think it's going to help you out?

Host: It sounds like it.

Thomas Glenn Pait, MD: Well, it may. Um, you know, we all want to live longer. And we want a pill that's going to do it. But we all know that exercise and the right diet and sleep are the way we should go. We're talking about coffee here, and it appears that if you drink about one and a half to three and a half cups of coffee every day, you may live a little bit longer, according to some studies.

In fact, you're 30 percent less likely to die than those who do not drink coffee. Hint, hint, Maggie. Hint, hint. How about that?

Host: I'm on it. I'm on it. I'm headed to starbucks right after this.

Thomas Glenn Pait, MD: Now Maggie, now Maggie, if you drink more than four and a half or five cups, it seems to taper off the effects. But did you get that 30 percent less likely, Maggie?

Host: I heard it loud and clear.

Thomas Glenn Pait, MD: Now, I'm to tell you one more thing, Maggie, about this thing. It's living longer with coffee, is that coffee has some social benefits. Right? It's going to foster the social interactions, and it's going to provide some sense of community, and that's going to help you live longer as well.

Host: Right, I have that.

Thomas Glenn Pait, MD: Have you ever been to a gathering where there's not coffee?

Host: No, no, never, you're right. A lot of coffee drinkers complain that their cup in the morning no longer gives them that giddy up that they need. Is there a reason for this lack of stimulation from their morning cup?

Thomas Glenn Pait, MD: Well, yes, and in fact, many people will need to drink more and more coffee to get that giddy up and go you're talking about, and there's no doubt that coffee will increase energy and the focus that, that we need to have throughout the day. But this is only going to work on the amount of coffee you're drinking if you have a caffeine reset. Now that's an interesting way to talk about it, right? A caffeine reset. And this is what happens. Over the course of the day, you're going to get sleepy because there's a molecule, adenosine, and it will bind with receptors in the brain. And when this happens, you're going to get muscle relaxation, and you want to take a nap, and you're going to get a little bit sleepy.

And caffeine may block that receptor. That's why when you drink it, oh, I get that jolt of being awake because it's going to block those receptors. And throughout the day, you're going to get more adenosine, whether you have physical work or you're sitting at a computer. That's brain work. You're still going to build up adenosine.

So if you block it, you're going to stay awake, but you develop a tolerance for it. And you're going to need more and more coffee to get the same buzz, or as you said, the giddy up.

Host: A reset is like a detox. How long does it take to detox from coffee?

Yeah.

Thomas Glenn Pait, MD: Oh, that's it's not going to be easy to reset. Once you get there, the reset or the detox is about seven days. And that's referred to as the coffee one week rule. And interesting enough, now Maggie, I'm going to warn you, some people can develop a caffeine tolerance by just drinking one to two cups of coffee about three times a week.

Now, before you stop drinking coffee to reset yourself and decrease the tolerance of the caffeine, you got to be careful. You got to tell your family and friends, hey, look, I'm going to stop drinking some coffee. That's because you're going to get tired. You're going to be grumpy, you're going to be irritated, and you don't want to be around people, and you're going to get a bad headache.

So you got to tell people, hey, I'm going to detoxify, I'm going to have that coffee one week rule, and it's going to start right now, so I will get rid of my tolerance.

Host: So, when we're talking about detox, does that mean you're giving it up altogether forever or just for that week and then you go back to maybe having one cup instead of four?

Thomas Glenn Pait, MD: Yeah, you should take a break from coffee for about two weeks. So you take a break from coffee, readjust your system somewhat, and then you can go back to drinking. And some people will only drink one to two cups, maybe three cups of coffee a week to try to avoid that tolerance of the caffeine.

Host: Mm hmm.

Thomas Glenn Pait, MD: But it's good. You need to stay away, Maggie. Stay away from the caffeine for about two weeks.

Host: Do you know, I hate to admit it, but I used to drink a lot of straight Coca Cola, and I gave it up a few months back, I don't know, like four months. It was so hard. I imagine it's the same for coffee, and I was cranky, and I did get headaches, just all these things you're saying, and I did warn everyone in the house but I did not go back to it because it's not worth it, the sugar and all that.

Thomas Glenn Pait, MD: No, it isn't. No, you know, I had a fellow come up to me and he said, Hey, look doc, I heard you talking about that, those headaches after you stopped coffee. It never happened to me. I'm totally immune to any type of withdrawal symptoms. And you know what, Maggie, in his hand was a soda can with a lot of caffeine in it, right? So, so I said, so if you do this thing, you can't cheat, okay?

Host: Right. Okay. So how long should it take for a cup of coffee to have its greatest benefits?

Thomas Glenn Pait, MD: It's readily absorbed in your small intestines, and it's going to take about 45 minutes to about an hour to travel to the brain. And that's when you're going to get the peak level and you're going to feel good with it. Because caffeine is not only going to give you that boost, but it's also going to release some feel good hormone, the dopamine.

So you're talking about 15 minutes to about two hours to get a benefit for it. Now I got to warn you, if you drink your coffee in the morning, particularly if you have some fiber with it, it's going to take it a little bit longer to get to the brain. It's going to delay how caffeine is absorbed.

So if you drink on an empty stomach, you're going to get the jolt much quicker, but be careful if you have any stomach problems like GERD, gastroesophageal reflux disease, you got to eat it and drink it with some food. If you smoke, everybody should quit smoking. Smoking is going to speed up the breakdown of caffeine, and if you're pregnant, it's going to slow down caffeine. So keep those two things in mind, okay?

Host: I thought you're supposed to give up caffeine when you're pregnant. Is that wrong?

Thomas Glenn Pait, MD: Yeah, yeah, some physicians will say yes, and it's probably because it's going to slow it down.

Host: Okay. And now speaking of that when it comes to children and caffeine, I remember when my son was about, I don't know, 10, 11, all his friends started drinking coffee. And I said, that's fine. They can, you're not. I just thought uh, I just thought it was too young. I don't even know why I had nothing to back it up. But thankfully now he just has like cold brew now and again, but he's not like a coffee addict. When should you offer a cup of coffee to your child, 12 years old, 15, 10?

Thomas Glenn Pait, MD: Well, that's a really good question. And the impact that coffee has on the child, the nervous system particularly, is not fully known. But it's becoming more popular that people are saying, Hey, look, have a cup of coffee, and the child is quite young. But here's the thing I think you should keep in mind.

Children under the age of 12, I wouldn't give them any, any coffee, and be careful with how much is consumed in other drinks, like tea and cola, okay? And the adolescents, and we're talking about 12 years and older about 100 milligrams a day, that comes out to about 2 to 3, 12 ounce cans of soda.

But remember, the sodas with all that sugar aren't good

as well. So I'd be very careful. And the reason you don't want to do it, one, we're still trying to understand the impact that it will have on the developing nervous system. Also, it can cause anxiety, and that can lead to all kinds of sleep disturbances.

And also anxiety can bring about stress, and that can cause acne.

So I'd probably tell you stay away from it with children, okay?

Host: Absolutely. Dr. Pait, why is caffeine added to some medications?

Thomas Glenn Pait, MD: Well, because it can help out, it can actually benefit, and the medication that it's added to the most are the migraine medication for migraine headaches. That's because when you get a migraine headache the blood vessels of the brain are enlarged, they're inflamed, and this will cause headache pain. So the caffeine and the coffee, also other beverages can help to reduce that dilation of the blood vessels and bring about some alleviation of the headache.

Host: Yet when you give it up, you get headaches.

Thomas Glenn Pait, MD: have So, if you have a bad headache, a migraine, it may help out a little bit. And here's the other thing. When you're using coffee, as a medication, make sure you tell your doctor about it. In fact, a lot of people don't even think that coffee and caffeine is anything at all. It's not medication, but it's a good idea when you see your practitioner or your clinician to tell him or her well, I'm drinking 12 cups of coffee a day. It's a good idea to tell them that.

Host: Oh, wow. That's a lot. Is coffee good for your hair? Someone said it will help prevent hair loss. Is that true?

Thomas Glenn Pait, MD: Well, you see ads about that nowadays. What do you think, Maggie? You think you think not? Well, you don't drink coffee, so you may not know, you know. You may start drinking and say, Oh my gosh, look at my beautiful hair.

Host: Well, you have very nice hair and you probably drink coffee. So maybe it is true. I don't know.

Thomas Glenn Pait, MD: Well, here's the thought behind it is that coffee has caffeine and that's a stimulant. So you're going to stimulate your follicles to wake up and grow hair. Nah, that's not true. I spoke to some dermatologists about this and not a single one told me that they would recommend drinking coffee for hair loss.

Host: Okay, good. But will it prevent hair loss?

Thomas Glenn Pait, MD: No, don't think so.

Host: I don't either. All right. Well, finally, Dr. Pait, you know that expression, good to the last drop, it was a slogan of one of the, I don't know if it was Maxwell House or what, is that attributed to Theodore Roosevelt?

Thomas Glenn Pait, MD: Well, that's an often asked question. And many people will say that Theodore Roosevelt indeed said that. Well, here's the story behind it. Joel Creek, he was a traveling salesman throughout Kentucky and Tennessee, and he began to experiment with coffee in his kitchen. So in Tennessee, he went to a Nashville hotel, and the name of the Nashville hotel was Maxwell House Hotel.

How about that? The Maxwell Hotel. And so, Joel Creek convinced the owners of the hotel, well, will you try my coffee? It's really good coffee. And so he tried it and other people tried it at the hotel, and they liked it a lot. And when they stopped serving it, people said, Hey, look, where's that Maxwell House coffee you got?

And so it came back. And one day, Theodore Roosevelt, his friends called him T. R., of course, came visiting Nashville, and he sat down, and he had a cup of coffee at the Maxwell Hotel. And he said, by God, this coffee, it's good to the last drop. And remember, Theodore Roosevelt, they often said they should put wheels on a bathtub, and just push it around.

He was really a coffee drinker. So when the president said, good to the last drop, years went by, and Maxwell House Coffee needed a slogan, so they said, good to the last drop. But that's not true, Maggie, that's not true.

No, Theodore Roosevelt probably never said that. Maxwell House didn't use the slogan until about 1920. Here's a little bit of trivia about coffee for you. Coca Cola actually said good to the last drop in 1908 to describe its beverage. So Theodore Roosevelt, T. R., probably did not say it. But it's a good story, isn't it? Because he was such a he would drink so much coffee. He would drink a bathtub of coffee every day. So they said, well, the president must have said, good to the last drop. There you go.

Host: Thank you so much for joining us. This has been a lot of fun and invaluable information that I'm sure a lot of people can use.

Thomas Glenn Pait, MD: It's been a pleasure, Maggie. Stay healthy and stay well.

Host: Thank you. You too. Again, that's Dr. T. Glenn Pait. For more general, medical information from Dr. Pait, visit news.uams.edu/category/here'stoyourhealth. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you.

Thanks for listening. I'm Maggie McKay. This is UAMS Health Talk.