Caffeine

[Crayola227]

It's great if someone can discuss their caffeine pill usage as you do. For many people, it's just a way to take in more caffeine than they could ever manage if they actually had to drink that much coffee. Which really might be saying something for a lot of people.

I can drink about 8 cups of tea in a day before I literally can't drink anymore (that's starting around 8-10 am and ending around 4 pm).

The amount of coffee or tea you can consume "absent-mindedly" vs pills? cmon now

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[Crayola227]

Caffeine: How much is too much?

Mayo suggests 400 mg caffeine, or about 4 cups, of coffee is safe for most adults.

So when I tell my patients 1-2 cups I guess I'm being pretty conservative. Which is fine because whatever a doctor tells you people will figure 1 or 2 more can't really hurt. I guess in this case that would generally be true.

I think also maybe because 1-2 also matches the recommendations on alcohol use for most people.

We all know what "more than a couple" is and why that gets to be problematic in counting.

 

[Crayola227]

Caffeine content for coffee, tea, soda and more

 

[Crayola227]

I keep seeing different exact numbers around, but it seems that a standard 8 oz cup of coffee is ~ 100 mg, and for black tea it's ~ 40 mg.

Only what I call "heavy" coffee drinkers are usually having more than 4 cups or 400 mg in a day by these measures.

And I was not wrong that my 8 cups of tea are closer to 4 cups (actually less!) of coffee.

 

[THEBACKANDFORTH]

Currently an MS1 and i had to stop caffeine completely during first semester due to bigeminal PVCs that was noted during our EKG lab during Cardio block. Went through the entire cardiac workup. Three different cardiologists all told me the same advice:

No caffeine pills
No caffeine from cans or bottles like energy drinks or 5 hour shots. Just natural occurring (coffee, tea, espresso)
No caffeine after a set time, each day. They mentioned noon or 2 pm.

It was either that or start a beta-blocker. No thanks to the beta-blocker

That’s too bad. My philosophy is that you won’t find what you don’t look for. 400-600mg a day.

 

[Crayola227]

That’s too bad. My philosophy is that you won’t find what you don’t look for. 400-600mg a day.

Good thinking class of 2022. I mean, why listen to the cardiologists. They only know about hearts.

 

[mehc012]

Pills vs coffee makes no difference for tolerance. Can you see why?

I'm not entirely sure why the cardiologists would have said no to caffeine pills. If I have to guess, it might have to do with speed of administration, peak plasma concentration and the area under the curve, or just that frankly, cups of liquid ARE actually more rate-limiting than pills. This effect is similar when you look at beer drinkers vs those who drink spirits only. I also wonder what if any role the various flavenoids and whatnot in coffee/tea do to the absorption or metabolism of caffeine as well.

When I advise patients, I tell them the amount of caffeine in 1-2 cups of regular coffee, would be the ideal. I don't think I'm very helpful in translating that to various teas, espressos, pills, 5 hour shots, etc.

I'll bust out Google for some patients, but plenty of them, hey, here's something you can pull out Google for if you want to play Dr. Google.

If you press me, I would say I think 2 shots of espresso are like 2 cups of coffee. I think 3 cups of black tea is probably similar. If you really want to split hairs on mg, than I think you need to bust out a conversion calc or maybe rethink your usage.

I disagree, not because of physiologic reasons, but rather because most people I know who drink coffee have additional psychological motivation for coffee usage. That is, they drink it not only when they want caffeine, but because it is a part of their morning routine, it is a comfort ritual (warm beverage), or they simply enjoy the taste/experience. To me, these sorts of non-pharmacological motivations increase baseline usage and are exactly why I prefer to keep caffeine in a format that has no benefit beyond the pharm effect.

As for the conversion, espresso actually has less caffeine content than a cup of drip, and light roast has mre caffeine than dark (even though dark 'tastes stronger'). You are usually better off having a double or triple shot of espresso than you are having a medium cup of drip, especially at Starbucks where they tend to have higher caffeine contents. Tea is more analogous to espresso or a soft drink...notably less than coffee but not nothing. A small Starbucks Pike Place (the one I looked up whenever it was I researched caffeine levels, because whatever else they have, they almost always have that, which I only even know because my mom hates it and bitches about it every time) has close to 200mg of caffeine in it (equivalent to one standard caffeine tab), whereas a shot of espresso is closer to 60 or 70. Tea varies by blend, but standard black tea is closer to 50 or 60. Sodas also vary a lot, but they're more in the tea/espresso range than the coffee range, Mountain Dew and supersized drinks excepted. 5hr energy has mg right on the label, but it's usually equivalent to the standard caffeine pills (200mg) unless labelled extra strength or whatnot. Tabs are easier to split in half, though.

So it's closer to 2-3 tea ≈ 2-3 espresso ≈ 1 small-med drip, depending on roast, with soda varying widely in serving size and composition.

**values approximate and based off of whatever nutitional charts Starbucks had online when I was in college and curious about this crap**


The only reason I can think of is that most people sip coffee, as opposed to downing all 200mg in one swallow, so peak is probably lower. Otherwise, my experience has been that it seems largely psych effect (i.e. people who "can't deal with caffeine" but don't know relative caffeine ratios, and always seem to have these super jittery effects from drinks they describe as 'really strong', like an espresso drink, but no issue with a large black drip, and pale at the idea of a caffeine pill or 5hr).

 

[Crayola227]

I disagree, not because of physiologic reasons, but rather because most people I know who drink coffee have additional psychological motivation for coffee usage. That is, they drink it not only when they want caffeine, but because it is a part of their morning routine, it is a comfort ritual (warm beverage), or they simply enjoy the taste/experience. To me, these sorts of non-pharmacological motivations increase baseline usage and are exactly why I prefer to keep caffeine in a format that has no benefit beyond the pharm effect.

As for the conversion, espresso actually has less caffeine content than a cup of drip, and light roast has mre caffeine than dark (even though dark 'tastes stronger'). You are usually better off having a double or triple shot of espresso than you are having a medium cup of drip, especially at Starbucks where they tend to have higher caffeine contents. Tea is more analogous to espresso or a soft drink...notably less than coffee but not nothing. A small Starbucks Pike Place (the one I looked up whenever it was I researched caffeine levels, because whatever else they have, they almost always have that, which I only even know because my mom hates it and bitches about it every time) has close to 200mg of caffeine in it (equivalent to one standard caffeine tab), whereas a shot of espresso is closer to 60 or 70. Tea varies by blend, but standard black tea is closer to 50 or 60. Sodas also vary a lot, but they're more in the tea/espresso range than the coffee range, Mountain Dew and supersized drinks excepted. 5hr energy has mg right on the label, but it's usually equivalent to the standard caffeine pills (200mg) unless labelled extra strength or whatnot. Tabs are easier to split in half, though.

So it's closer to 2-3 tea ≈ 2-3 espresso ≈ 1 small-med drip, depending on roast, with soda varying widely in serving size and composition.

**values approximate and based off of whatever nutitional charts Starbucks had online when I was in college and curious about this crap**


The only reason I can think of is that most people sip coffee, as opposed to downing all 200mg in one swallow, so peak is probably lower. Otherwise, my experience has been that it seems largely psych effect (i.e. people who "can't deal with caffeine" but don't know relative caffeine ratios, and always seem to have these super jittery effects from drinks they describe as 'really strong', like an espresso drink, but no issue with a large black drip, and pale at the idea of a caffeine pill or 5hr).

I'm not disagreeing with you about baseline usage. I'm not criticizing your use of caffeine pills. No offense, but I don't consider the use of them to be "social." Perhaps that is why a physician would recommend someone with a heart condition likely to be exacerbated by caffeine to stay clear of pills and stick to mild-moderate use of coffee/tea.

Keep in mind as well that compounds sold as supplements such as caffeine or gingko, etc, are not as tightly regulated as medications, and so there have been more issues with manufacturing and labeling.

Come to think of it, I think a friend of mine had an issue with the dosing of some energy or caffeine supplements they obtained online.

If you thought someone might go into a symptomatic or dangerous heart rhythm with the wrong dose of caffeine, you might suggest they stick with cups of brewed liquid from the plant than white powder in a pill.

I've had the same issue with supplements where I got 100 mg or 200 mg mixed up. Discovered I was inadvertantly taking twice the intended dose. If I was going for 400 mg caffeine, that would instead be 800 mg.

If you want to tell yourself that most coffee drinkers are some sort of all day sipping fiends that mindlessly guzzle more than 400 mg worth of caffeine in the form of coffee, espresso, or tea, fine.

My point isn't that people who pop caffeine pills are high dose addicts. But I would frankly be more concerned about inadvertent overdose.

Maybe that doesn't make sense to you so far. Fine.

 

[Crayola227]

I disagree, not because of physiologic reasons, but rather because most people I know who drink coffee have additional psychological motivation for coffee usage. That is, they drink it not only when they want caffeine, but because it is a part of their morning routine, it is a comfort ritual (warm beverage), or they simply enjoy the taste/experience. To me, these sorts of non-pharmacological motivations increase baseline usage and are exactly why I prefer to keep caffeine in a format that has no benefit beyond the pharm effect.

As for the conversion, espresso actually has less caffeine content than a cup of drip, and light roast has mre caffeine than dark (even though dark 'tastes stronger'). You are usually better off having a double or triple shot of espresso than you are having a medium cup of drip, especially at Starbucks where they tend to have higher caffeine contents. Tea is more analogous to espresso or a soft drink...notably less than coffee but not nothing. A small Starbucks Pike Place (the one I looked up whenever it was I researched caffeine levels, because whatever else they have, they almost always have that, which I only even know because my mom hates it and bitches about it every time) has close to 200mg of caffeine in it (equivalent to one standard caffeine tab), whereas a shot of espresso is closer to 60 or 70. Tea varies by blend, but standard black tea is closer to 50 or 60. Sodas also vary a lot, but they're more in the tea/espresso range than the coffee range, Mountain Dew and supersized drinks excepted. 5hr energy has mg right on the label, but it's usually equivalent to the standard caffeine pills (200mg) unless labelled extra strength or whatnot. Tabs are easier to split in half, though.

So it's closer to 2-3 tea ≈ 2-3 espresso ≈ 1 small-med drip, depending on roast, with soda varying widely in serving size and composition.

**values approximate and based off of whatever nutitional charts Starbucks had online when I was in college and curious about this crap**


The only reason I can think of is that most people sip coffee, as opposed to downing all 200mg in one swallow, so peak is probably lower. Otherwise, my experience has been that it seems largely psych effect (i.e. people who "can't deal with caffeine" but don't know relative caffeine ratios, and always seem to have these super jittery effects from drinks they describe as 'really strong', like an espresso drink, but no issue with a large black drip, and pale at the idea of a caffeine pill or 5hr).

As someone who has consumed caffeine in all sorts of forms, I will take you that the rate of administration makes a huge difference. As do the other additives like B vitamins in a lot of the energy drinks.

You can literally see the difference it makes on a patient when you push 1 mg IV dilaudid in a patient in 1 min vs over 5 min, even though that dose is going to last a few hours.

So taking a literal shot of espresso versus consuming that same shot over 10-15 minutes, absolutely makes a difference in terms of side effects and subjective experience.

This is true for a lot of other drugs. So maybe you need to open your mind a little about how you think of pharmacology. People forget that pharmacology is also describing the *qualitative* effects of drugs.

 

[mehc012]

As someone who has consumed caffeine in all sorts of forms, I will take you that the rate of administration makes a huge difference. As do the other additives like B vitamins in a lot of the energy drinks.

You can literally see the difference it makes on a patient when you push 1 mg IV dilaudid in a patient in 1 min vs over 5 min, even though that dose is going to last a few hours.

So taking a literal shot of espresso versus consuming that same shot over 10-15 minutes, absolutely makes a difference in terms of side effects and subjective experience.

This is true for a lot of other drugs. So maybe you need to open your mind a little about how you think of pharmacology. People forget that pharmacology is also describing the *qualitative* effects of drugs.

I'm not sure why you're assuming my mind is closed when I'm literally the one who brought up speed of consumption, the crazy niacin levels in 5hrs that make you feel flushed, and the fact that subjective experience was different. But most people drinking espresso are doing so in lattes and capps and other fancy drinks which they consume similarly slowly as drip coffee. I don't often see people order the literal shot by itself, and I don't think I've ever seen anyone take an espresso shot in one go. Personally, I can't think of much beyond the sugar rush and the context clues of the experience - including people's perceptions of espresso as a 'strong' drink - that would result in the frequent "Oh man, I sipped a double shot latte during my shift instead of my usual medium black drip coffee...oh man, now I'm wired from all of the caffeine" scenario.

At the end of the day, if they're alert and enjoyed their shift better, more power to them. I just ascribe that to psych/placebo rather than the caffeine, and that's great. If someone comes up with a better explanation for it, that's cool too. Not sure what's so close-minded about that?

 

[mehc012]

I'm not disagreeing with you about baseline usage. I'm not criticizing your use of caffeine pills. No offense, but I don't consider the use of them to be "social." Perhaps that is why a physician would recommend someone with a heart condition likely to be exacerbated by caffeine to stay clear of pills and stick to mild-moderate use of coffee/tea.

Keep in mind as well that compounds sold as supplements such as caffeine or gingko, etc, are not as tightly regulated as medications, and so there have been more issues with manufacturing and labeling.

Come to think of it, I think a friend of mine had an issue with the dosing of some energy or caffeine supplements they obtained online.

If you thought someone might go into a symptomatic or dangerous heart rhythm with the wrong dose of caffeine, you might suggest they stick with cups of brewed liquid from the plant than white powder in a pill.

I've had the same issue with supplements where I got 100 mg or 200 mg mixed up. Discovered I was inadvertantly taking twice the intended dose. If I was going for 400 mg caffeine, that would instead be 800 mg.

If you want to tell yourself that most coffee drinkers are some sort of all day sipping fiends that mindlessly guzzle more than 400 mg worth of caffeine in the form of coffee, espresso, or tea, fine.

My point isn't that people who pop caffeine pills are high dose addicts. But I would frankly be more concerned about inadvertent overdose.

Maybe that doesn't make sense to you so far. Fine.

I...I feel like we're arguing, but I have no idea about what. I don't recall disagreeing with you thus far in the thread. I also don't know what you mean when you talk about caffeine pills being 'social' or not...I certainly don't take offense, because I never claimed they were social or wanted them to be?

I don't think most coffee drinkers are caffeine fiends, I just think that most people would tend to underestimate how much caffeine they consume when they drink drip coffee. Like, I think most people's internal concept of the relative strengths of tea, coffee, espresso, energy drinks, tabs, etc., are not very accurate. And for the most part they don't have to be.

Anyway, I made that post back when you weren't so adamant on the natural over tab front, and so I wasn't trying to be defensive, just supply some comparisons.

Here's a link to Starbucks values, which is what I was using. As I said, their coffee tends to have more caffeine content, so the values and relative comparisons are closer to what I outlined in my post.
The Complete Guide to Starbucks Caffeine

 

[Crayola227]

I...I feel like we're arguing, but I have no idea about what. I don't recall disagreeing with you thus far in the thread. I also don't know what you mean when you talk about caffeine pills being 'social' or not...I certainly don't take offense, because I never claimed they were social or wanted them to be?

I don't think most coffee drinkers are caffeine fiends, I just think that most people would tend to underestimate how much caffeine they consume when they drink drip coffee. Like, I think most people's internal concept of the relative strengths of tea, coffee, espresso, energy drinks, tabs, etc., are not very accurate. And for the most part they don't have to be.

Anyway, I made that post back when you weren't so adamant on the natural over tab front, and so I wasn't trying to be defensive, just supply some comparisons.

Here's a link to Starbucks values, which is what I was using. As I said, their coffee tends to have more caffeine content, so the values and relative comparisons are closer to what I outlined in my post.
The Complete Guide to Starbucks Caffeine

Sorry, I think I just got peeved at why it seemed like it didn't make sense that a cardiologist would caution a patient against too much caffeine overall, and part of that might be to say, hey, stay away from caffeine pills, but some amount of "regular" coffee/tea usage is OK.

It came to me sorta late why pills might represent a greater danger for overdose. Which for the average person is probably less of a big deal than exposing certain known heart rhythms in some patients.

I absolutely agree that many people who are consuming caffeine in beverages as opposed to mindful dosing with pills, likely have no real idea how much they are consuming.

And yes, people are sorta going off of how they feel, which certainly has a psychosomatic element to it.

 

[mehc012]

Sorry, I think I just got peeved at why it seemed like it didn't make sense that a cardiologist would caution a patient against too much caffeine overall, and part of that might be to say, hey, stay away from caffeine pills, but some amount of "regular" coffee/tea usage is OK.

It came to me sorta late why pills might represent a greater danger for overdose. Which for the average person is probably less of a big deal than exposing certain known heart rhythms in some patients.

I absolutely agree that many people who are consuming caffeine in beverages as opposed to mindful dosing with pills, likely have no real idea how much they are consuming.

And yes, people are sorta going off of how they feel, which certainly has a psychosomatic element to it.

Fair enough! Happens on the internet, lol. I agree that in the cases where people just aren't thinking about it and haven't, it's easier to make take a wrong turn with a single energy shot (or, heck, several shots of espresso) or any other low-volume source than any source where you're drinking uncomfortable volumes. Same concepts as to where new drinkers and lightweights are well advised to stick to beer, shots are dangerous, and if alcohol came in pill form, sooooo many stupid teenagers would die.

 

[MD-2021]

I don't drink coffee, never developed the habit. The few times that I have drank it, I haven't really experienced any changes in alertness