CAFFEINE
Soon
after settling in Wisconsin, I was introduced to real coffee drinking. A Norwegian patient asked me if he could
drink coffee. He thought I was joking
when I told him “Sure, just hold it to less than 17 cups per day”. His face fell because he drank almost twice
that much. Then there was a barber who
complained of headaches every Thursday for ten years. After a rather extensive get acquainted conversation, the cause
of this unusual complaint was revealed.
He had not been a coffee drinker prior to marriage and finishing barber
school. Thursday was his day off and
there was no business partner or wife to offer coffee. He followed my advice to carry 2 thermoses of
coffee everywhere he went on his day off.
His Thursday headaches ceased.
Headache
as the withdrawal symptom of caffeine addiction is not sufficiently known. For instance, the mother of a teenage
daughter brought the young lady in because of sudden onset of severe headache. The crucial information: the mother had
recently told the daughter that she would have to buy her own soft drinks but
this child’s allowance was insufficient to support her habit. Neither of them was aware of the
connection. The headache of caffeine
withdrawal is not relieved by morphine in doses adequate to relieve the pain of
war wounds. This is illustrated by a
lady with pancreatitis causing severe abdominal pain relieved by large doses of
morphine. The second day of intravenous
feeding and nothing by mouth, she got a severe headache not relieved by the large
doses of morphine. She was not a coffee
drinker, but a few more questions revealed that she drank a gallon of iced tea
per day. Some caffeine injected into
her IV tubing relieved her headache before the injection was complete.
When
people state that only Anacin and Excedrin relieve their headaches, this
usually means caffeine withdrawal headaches.
Some of them take their caffeine containing pills in anticipation of
trouble. This results in the caffeine
in the headache pills becoming part of their drug requirement. Ironically, the aspirin or other ingredients
also present may proceed to cause stomach pain, a potential “foot in the door”
for Christian Science.
So
caffeine has a stereotyped withdrawal syndrome (the headache), a characteristic
of addiction. The withdrawal syndrome
of narcotics is goose bumps, sweating and diarrhea. Quitting “cold turkey” refers to the goose bumps similar to the
appearance of leftover turkey skin.
Much of slang originated in drug and criminal circles. Another characteristic of addiction is that
former addicts, even years after stopping the drug use, become re-addicted on
fewer, smaller doses than naive users (users without prior drug
experience). I became aware of this
after returning from 2 years in Asia where I drank tea, even though I do not
like it, in order to get boiled water and avoid dysentery. I could easily wean off but I would get
withdrawal headaches in late afternoon after 3 to 4 days of a cup of coffee for
lunch, a much smaller dose than would produce this result in someone who had
not been severely addicted. I had been
such a person prior to the 2 years in Asia.
Remember, I did not even like tea.
My addiction was purely physical, not psychological.
Caffeine
demonstrates that drug addiction does not necessarily cause health problems or
social problems. These depend on the
toxicity of the drug and the consequences of attempts at prohibition.
Chairman,
Monroe City Council Board of Health, May 1, 2001
Addendum, July, 2002: Not long after I started thinking about poisons, herbs and drugs derived from natural sources in terms of chemical warfare between plants and animals, it occurred to me that caffeine is so low in toxicity it is hard to explain why plants bother to make it. This month I ran into an item in Nature, the British science journal, reporting that a very small concentration of caffeine kills slugs and snails. .