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Most of us are all too familiar with someone in our family or workplace that can be
described as a hyperactive or high energy person. I am sure members of my family or
coworkers in my office are thinking that this statement is a self-description.
Consequently, based on doctor’s advice, it is best to limit me to one cup of coffee or pay
the price when I become a hyperactive taskmaster. Now, after further research on this
topic, I have concluded that it may be that I may be hyperactive by nature, regardless of
my caffeine intake. While many of you may find the following facts hard to believe, and
the effects of caffeine may vary for everyone, the facts are still the facts.


Approximately 80% of the world's population consumes caffeine on a daily basis. While
research is constantly being done on health benefits and side-effects of caffeine, great
controversy and misconception persists. The purpose of this column will be to discuss the
“current wisdom” and present the truth about caffeine.
Caffeine is completely absorbed within 30 to 45 minutes of ingestion and its effects
linger for about three hours. Eventually it is excreted and there is no accumulation in the
body. Caffeine has been shown to affect mood, stamina, the blood vessels in the brain, as
well as stomach and intestinal activity. However, for most people, when used in
moderation (200 to 300mg or 2-3 cups), caffeine use is perfectly safe and may offer some
health benefits.

Sources of Caffeine

Caffeine is a natural substance found in certain leaves, seeds, and fruits of over 60 plants
worldwide. In our culture, the most common sources in our diet are coffee, tea leaves,
cocoa beans, cola, and energy drinks. Caffeine can also be produced synthetically and
added to food, beverages, supplements, and medications. Consumption of 130 to 300 mg
of caffeine per day is considered minimal to moderate. Amounts exceeding 500 mg are
moderate to heavy and more than 1000 mg/day is excessive. The average daily caffeine
consumption among Americans is about 280 mg/day and 20% to 30% consume more
than 600 mg/day.

Caffeine contents in some of the more popular forms are:


Caffeine is Not Addictive

Caffeine can be habit-forming, but it is not addictive. The American Journal of Drug and Alcohol Abuse states that caffeine is a mild stimulant but does not have the qualities of addictive stimulants like cocaine and amphetamines. However, sudden abstinence from caffeine can produce mild withdrawal symptoms such as headache, restlessness, and irritability. Therefore, it is recommended to slowly wean off caffeine over a week or two to lessen these symptoms.

The need to eliminate caffeine from your diet is not supported in the literature. In fact, studies show that moderate caffeine use can enhance your mood and improve focus and alertness. The American Dietetic Association suggests limiting caffeine intake to 200mg to 300mg (2- 3 cups of coffee) per day.

Caffeine Does Not Necessarily Cause Dehydration

While caffeine is a diuretic, its effects are very mild. However, like all diuretics, it will cause you to urinate more often and therefore, lose fluids. The more fluids you lose, the greater the chance for dehydration, especially if you are at risk due to health issues. Also, long distance runners and athletes performing in conditions of extreme heat must use caution. Minimal to moderate caffeine intake with generous use of water and sports drinks should suffice.

Caffeine Does Not Contribute to Heart Disease

A study conducted at the University of Madrid of more than 126,000 people found that women who drank 2-3 cups of caffeinated coffee per day had a 25% lower risk of heart disease. Also, a 33-yearlong study of more than 1,000 participants at Johns Hopkins University found that coffee had no significant effect on the risk of hypertension. Moderation seemed to be the key component in these studies. Interestingly, caffeinated colas did increase the risk of hypertension; however, it was believed to be due to the high amounts of sugars and other ingredients in the drink.

However, for many reasons, physicians tell their cardiac patients, especially those with high blood pressure or abnormal heart rhythms, to avoid caffeine. This matter should be discussed in more detail with your physician before using caffeine. Tea, especially black and green, contains a much smaller amount of caffeine than coffee, is often recommended for the health benefits of antioxidants.

Caffeine Does Not Cause Hyperactivity in Children

While studies show that moderate caffeine (40 – 200mg) in children does not make them hyperactive, others demonstrate that a 12 oz can of cola with only 35 mg of caffeine makes them bounce off the walls. It has been concluded that it is the sugar and other ingredients in the soda that makes them hyperactive. In fact, some studies show that small amounts of caffeine can work like Ritalin and improves focus in children with attention disorders.

Caffeine Does Not Cause Bone Loss

Caffeine has been shown to increase calcium excretion when taken in large amounts. Unless a child drinks caffeinated coffee in place of milk, there is no scientific evidence that bone loss will occur. When caffeine is used in moderation, no evidence of bone loss exists.

Caffeine Does Not Cause Fibrocystic Breast Disease

There is no scientific evidence to support the claim that caffeine causes fibrocystic breast disease or breast cancer. Confusion may lie with the fact that caffeine is associated with increased breast pain during monthly hormonal changes. If so, women are well advised to reduce the intake of caffeine during this time.


NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email:

Read Dr. Mackarey's articles at:

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.

Part I of II

Difficulty sleeping during the COVID-19 quarantine has become a common problem and can be manifested in a variety of ways; insomnia, fragmented sleep and nightmares. National prescription providers have reported a 21% increase in anti-insomnia, anti-anxiety and antidepressant medications since March of 2020. The next two weeks in Health & Exercise Forum” will be dedicated to sleep wellness.

Everyone Needs Sleep!

We do it every night, hopefully. Children are doing it. Our grandparents are doing it. Teenagers do it all the time. We sleep of course. These hours in which we slumber are vital to our ability to function during the day and to our health overall. It does not appear evolutionarily advantageous for us to be unconscious for extended periods of time. Modern science tells us that much of our body’s restoration, strengthening, and processing occurs while we sleep. Our brains consolidate the information they have learned throughout the day and enhance our memory. Additionally, sleep restores sugar storage in our brains and improves the functioning of our immune system. But science does not illuminate why we need such a prolonged period other than the fact that we just seem to get sleepy after a long day.

How much Sleep Do I Need?

Sleep is crucial to us as a species, but it is not always easily attained. For many individuals across the globe, this author included, sleeping properly can be a challenge. The trial and tribulations of the human experience can lead to restless nights and early morning risings without adequate sleep. But what is considered “adequate” sleep? The answer depends on your age. As we grow older, our sleeping requirements change drastically from infancy to elderdom. Infants are learning and processing so much information of this new world they now inhabit. Thus, their brains need enough time to analyze and consolidate the data, necessitating 12 to 15 hours of sleep. As we advance into adulthood, our sleep requirements drop to approximately 7 to 9 hours with some variability from person to person. Good indications of a restful night’s sleep include waking up feeling refreshed, functioning with enough energy for your daily tasks, and having continuous sleep- meaning there are not extended periods of time of wakefulness when we are supposed to be sleeping.

You are not alone, roughly 100 million people suffer from insomnia at some point each year!

This seems easy enough to say, but significantly more difficult to do. Current reports demonstrate that roughly 100 million people suffer from insomnia at some point each year, with 25% progressing to long-term chronic sleep insufficiency. Insomnia is described as difficulty falling asleep or staying asleep for three nights per week for at least two consecutive weeks in a three-month period. There are a lot of unhealthy sleeping habits permeating the country. We measure the quality of sleep in two different dimensions duration (quantity) and depth (quality). The duration is straightforward enough. Do you sleep for the recommended 7 to 9 hours per night? The quality is a little more difficult to quantitate. Some individuals may sleep for the proper duration of time, but the depth is not adequate. Sleep quality is determined by the number of arousals or awakenings in a given night.  As few as 5 arousals in a night can result in daytime sleepiness and performance deficits. In addition, how long we remain in certain phases of sleep also determines the quality of our sleep. There are four stages of sleep: N1, N2, N3, and REM with N3 being the most restful of the stages. When we fall asleep, we go through a predictable descent into sleep. We repeat the cycle of N1 to N2 to N3 to REM sleep every 60 to 90 minutes. The more time we remain in the restful stages, N3 and REM, the better our sleep is. As we age, we inevitably spend less and less time in restful sleep.

What causes poor sleep and why are so many Americans suffering from insomnia?

There are many factors that influence how we sleep. Everything from what we drink to the type of curtains we have can impact those crucial hours of sleep. Some of the more common culprits that disrupt our sleep are:

For More Informations:




Read Dr. Mackarey’s Health & Exercise Forum – every Monday. Next Week Read, Sleep and Wellness Part II.

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email:

Paul J. Mackarey PT, DHSc, OCS is a Doctor  in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine.

Read all of Dr. Mackarey's articles in our health and exercise forum:

Guest Columnist: Timothy Farrell, MD3

Tim Farrell is a third year medical student at Geisinger Commonwealth School of Medicine. Originally from Clarks Summit, Pennsylvania, Tim received his bachelor’s degree from Loyola University Maryland in Baltimore, MD. Currently a 2nd Lieutenant in the US Army, he enjoys listening to music, running, and spending time with his two dogs. He volunteers with the Cody Barrasse Foundation in the Organ Transplant Assistance Program, where he helps patients receive grant funding as they await their transplant surgery. He hopes to pursue a career in General Surgery.