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 it 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 it, great controversy and misconception persists. The purpose of this column will be to discuss the “current wisdom” and present the truth about it.
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. It 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.
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. It can also be produced synthetically and added to food, beverages, supplements, and medications. Consumption of 130 to 300 mg of it 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 consumption among Americans is about 280 mg/day and 20% to 30% consume more than 600 mg/day. It's contents in some of the more popular forms are:
Caffeine can be habit-forming, but it is not addictive. The American Journal of Drug and Alcohol Abuse states that it 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 it 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 use can enhance your mood and improve focus and alertness. The American Dietetic Association suggests limiting intake to 200mg to 300mg (2- 3 cups of coffee) per day.
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 intake with generous use of water and sports drinks should suffice.
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 it. 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.
While studies show that moderate amounts (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 it can work like Ritalin and improves focus in children with attention disorders.
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 it is used in moderation, no evidence of bone loss exists.
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 it 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.
Source: www.LifeScript.com
EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog
EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy
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: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!
Antibiotic resistance occurs when bacteria no longer respond to the drugs designed to kill them. For more than a decade, the Centers for Disease Control along with other national and international agencies has supported an initiative called “Antibiotic Stewardship” the hallmark of which is the judicious, appropriate use of antimicrobials.
It’s told in some sobering statistics from the CDC, World Health Organization, and Food and Drug Administration:
Patients and providers must take equal responsibility. When we get sick, we often feel we need an antibiotic right away. In fact, we often demand one. A study published in the New England Journal of Medicine in 2018 found that to achieve a patient satisfaction rating in the 90th percentile physicians needed to prescribe antibiotics 75% of the time. Is this the correct approach to therapy? Are we using antibiotics too readily? What are the consequences of profuse antibiotic use?
In which of the following situations are antibiotics warranted?
A. Cold symptoms (runny nose, sore throat, headache) with a fever of 101F for 2 days
B. Cold symptoms lasting 12 days with persistent stuffiness and headache
C. Cold symptoms for 3 days with yellow-green mucous discharge
D. all of the above
The correct answer is B. Let’s discuss the reasons. Symptoms experienced as part of the common cold can include green/yellow sputum, cough, runny nose, stuffiness, sore throat, headache, fever, and mild muscle aches. This illness is caused by a virus, most likely a rhinovirus. Currently, 160 identified strains of rhinovirus are know.
Antibiotics work to destroy bacteria, not viruses since they have no activity against viruses. Antibiotics target specific bacterial structures or functions. Common bacterial targets for antibiotics include the cell wall (amoxicillin), ribosome activity (azithromycin), and bacterial DNA (levofloxacin). All of those are lacking in the very primitive structure of a virus. So, you could sit in a bathtub full of penicillin and not cure your cold with an antibiotic because there is simply nothing for the antibiotic to destroy in the viral structure.
Why are antibiotics appropriate after 10 days with cold symptoms? The typical common cold lasts between five and ten days with symptoms peaking around three or four days and waning at day six. If symptoms are consistent or regress and then become worse it is likely a sign of bacterial superinfections (super = on top of).
Usually, we carry certain bacteria with us as part of our “normal flora”. The mouth, nasal passages, large intestines, and skin host the most bacteria in the body. These bacteria work with our body and provide various “services” including protection against other more dangerous bacteria, digestion of food, and production of vitamins. A viral infection disturbs the normal balance of bacteria, allowing for proliferation and subsequent bacterial infection.
Why should we be careful about antibiotic use?
Antibiotics are not innocuous substances. They have significant side effect profiles. Adverse drug reactions associated with antibiotics can be less severe and consist of mild rash or nausea. More serious reactions include heart arrhythmias, tendon rupture, Stevens Johnson Syndrome (severe skin rash resembling thermal burns), and liver and kidney damage. Remember – every drug – not only antibiotics – has the potential to cause unpredictable adverse reactions
The most compelling reason to be careful about antibiotic use is resistance. Each time bacteria are exposed to an antibiotic, some are destroyed but others adapt to resist the antibiotic and live to see another day (remember Darwin’s Survival of the Fittest?). Antibiotics are unique in that the more they are used, the less effective they become. When antibiotics are used inappropriately – not taking them on schedule, for the right duration, taking them for a viral illness – bacteria have a chance to adapt to overcome the antibiotic activity. The resistant bacteria may go on to set up a resistant infection in you or that bacteria may be transmitted to others.
There are several ways we can combat this problem according to the Joint Commission on Healthcare Accreditation 2020 Standards. It is important to identify the causative agent if possible.
For example, a sore throat should not be treated with antibiotics until a throat culture or rapid strep test is obtained and a bacterial cause is identified. According to the Infectious Disease Society of America, 90 percent of adult sore throats have a viral cause, not bacterial. Avoid unneeded clinic or urgent care visits and utilize OTC and non-drug measures to manage non-bacterial infection symptoms.
Mislabeled allergy status leads to more expensive, less optimal antibiotic choices, more complex administration, increased resistance rates, and more treatment failures. The most common listed drug allergy in the US is Penicillin. According to the CDC, 10% percent of patients reports an allergy, however, < 1% of patients have a true allergy precluding penicillin or penicillin-like agents (the biggest class of antibiotic agents).
Vaccines may prevent bacterial infections or prevent viral infections which will avert a bacterial superinfection. Here are two examples of where vaccines can lower antibiotic use. The pneumococcal “pneumonia” vaccine protects against the bacterium Streptococcus pneumoniae. Following the current guidelines for vaccination during childhood and adulthood decreases pneumococcal infections. According to the CDC, this vaccine has reduced pneumococcal infections by more than 90% in children. In addition, antibiotic-resistant pneumococcal infections have decreased in the United States since the pneumococcal vaccine was introduced.
The shingles vaccine also minimizes antibiotic use. The shingles vaccine “Shingrix”, is currently approved for individuals 50 years old (and older) as a two-dose series. Not only does it effectively prevent the occurrence of shingles, a painful, debilitating re-emergence of the chickenpox virus, but also reduces the risk of a potential secondary bacterial skin superinfection. Vaccine prevention of viral illness may subsequently eliminate antibiotic use.
Educating patients and prescribers will lead to the proper use of antibiotics to curb antibiotic resistance.
Guest Author: Dr. Gretchen Welby, PharmD, MHA
Dr. Welby received degrees from Keystone College and Philadelphia College of Pharmacy and Science. She received a Master of Health Administration Degree from the University of Scranton and a Doctor of Pharmacy degree from Temple University. She is currently the Academic Director of the Physician Assistant Program at Marywood University where she teaches Anatomy, Physiology, Pathophysiology, and Pharmacology.
EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog
EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy
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: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!
