Researchers generated caffeine-consumption guidance using the open-access tool 2B-Alert Web 2.0


A web-based caffeine optimization tool successfully designs effective strategies to maximize alertness while avoiding excessive caffeine consumption, according to preliminary results from a new study.

Using multiple sleep-deprivation and shift-work scenarios, the researchers generated caffeine-consumption guidance using the open-access tool 2B-Alert Web 2.0, and then they compared the results with the U.S. Army guidelines.

Their analysis found that the solutions suggested by the quantitative caffeine optimization tool either required on average 40% less caffeine or enhanced alertness by an additional 40%.

“Our 2B-Alert Web tool allows an individual, in our case our service members, to optimize the beneficial effects of caffeine while minimizing its consumption,” said principal investigator Jaques Reifman, Ph.D., a Department of the Army Senior Research Scientist for Advanced Medical Technology, serving at the U.S. Army Medical Research and Development Command at Ft. Detrick, Maryland.

According to the authors, caffeine is the most widely consumed stimulant to counter the effects of sleep deprivation on alertness.

However, to be safe and most effective, the right amount must be consumed at the right time.

Last year at SLEEP 2018 in Baltimore, Reifman presented data comparing the algorithm with the caffeine dosing strategies of four previously published experimental studies of sleep loss.

The current study extended his team’s previous work by incorporating the automated caffeine-guidance algorithm in an open-access tool so that users can input several factors: the desirable peak-alertness periods within a sleep/wake schedule, the minimum desirable level of alertness, and the maximum tolerable daily caffeine intake.

With this added capability, the 2B-Alert Web 2.0 tool now allows users to predict the alertness of an “average” individual as a function of his or her sleep/wake schedule and caffeine schedule.

It also enables users to automatically obtain optimal caffeine timing and doses to achieve peak alertness at the desired times.

This freely available tool will have practical applications that extend beyond the realms of the military and the research lab, noted Reifman.

“For example, if you pull an all-nighter, need to be at peak alertness between, say, 9 a.m. and 5 p.m., and desire to consume as little caffeine as possible, when and how much caffeine should you consume?” he said.

“This is the type of question 2B-Alert was designed to answer.”

The research abstract was published recently in an online supplement of the journal Sleep and will be presented Wednesday, June 12, in San Antonio at SLEEP 2019, the 33rd annual meeting of the Associated Professional Sleep Societies LLC (APSS), which is a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society.

Caffeine is the most widely consumed psychoactive drug in the world (1) and one of the most comprehensively studied ingredients in the food supply.

It occurs naturally in the leaves and seeds of many plants and has a taste bitter enough to deter pests (2).

Natural sources of dietary caffeine include coffee, tea, and chocolate. Synthetic caffeine is also added to products to enhance their stimulant properties.

Historically, this addition was limited to soda-type beverages, but over the past decade, caffeine has been added to a diverse variety of foods and non-food items to promote arousal, alertness, energy, and elevated mood (35).

This recent increase in caffeine-containing food products, as well as changes in patterns of consumption of the more traditional sources of caffeine, has increased scrutiny by health authorities and regulatory bodies of the overall consumption of caffeine and its potential cumulative effects on behavior and physiology.

Of particular concern is the rate of caffeine intake among populations potentially vulnerable to its negative effects. Health and regulatory authorities have recently highlighted the risk of consumption among pregnant and lactating women, children, adolescents, young adults, and people with underlying heart and other health conditions.

In light of these concerns, we conducted a comprehensive review of all relevant published clinical and intervention trials, observational studies, systematic reviews, meta-analyses, and expert reviews on the use and safety of caffeine in humans, complemented where needed (e.g., for aspects of safety or mechanisms of action) with evidence from animal studies.

We evaluated the strengths and limitations of the evidence on the safety of ingested caffeine, specifically focusing on the safety of caffeine-containing foods (e.g., beverages and solid foods). We summarize here what is known and what remains to be learned about caffeine intake and safety in healthy and vulnerable populations and highlight needed research.

Dietary Sources of Caffeine

Adults commonly consume caffeine in coffee and tea, both of which contain natural caffeine in their leaves or beans (6).

Energy drinks often contain caffeine from natural products such as extracts from guarana leaves.

In addition to coffee, tea, and energy drinks, caffeine is also naturally present in cocoa beans and thus in chocolate.

The amount of caffeine in chocolate varies by the percentage of cocoa it contains, with 100% cocoa chocolate (unsweetened baking chocolate) containing around 240 mg caffeine/100 g, 55% cocoa (bittersweet) containing 124 mg caffeine/100 g, and 33% cocoa (milk chocolate) containing 45 mg caffeine/100 g (7).

Synthetic caffeine is also added to soda and energy drinks (8), which are commonly consumed by children and adolescents worldwide, and to other food and non-food products with niche markets for subsets of consumers, such as juice, chewing gum, water, cookies, hot sauce, candy, beef jerky, mints, syrup, waffles, shampoo, soap, lip balm, eye cream, body scrub, and body lotion. These products are primarily marketed with claims that they provide energy, alertness, or are “age-defying.”

Last year, the FDA announced that it will begin investigating the safety of caffeine added to food products, with a special emphasis on children and adolescents.1

Caffeine is a constituent of many over-the-counter pain relievers and prescription drugs because the vasoconstricting and anti-inflammatory effects of caffeine act as a compliment to analgesics, in some cases increasing the effectiveness of pain relievers by up to 40% (914).

Caffeine is used for general pain relief in medications such as Midol™ and Vanquis™, which contain doses ranging from 33 to 60 mg.

It is used therapeutically in combination with ergotamine to treat migraine headaches and in combination with non-steroidal anti-inflammatory analgesics.

Anacin™, Excedrin™, Goody’s™ headache powder, and pain reliever plus contain between 32 and 65 mg of caffeine, and prescription headache medications, including Fiorinal, Orphenadrine, and Synalgos, contain between 30 and 60 mg of caffeine.

Alone, caffeine is used as a somnolytic to counteract drowsiness (e.g., NoDoze™ and Vivarin™ each contain 200 mg of caffeine), to enhance seizure duration in electroconvulsive therapy, and to treat respiratory depression in neonates, postprandial hypotension, and obesity (1518).

Similar synergistic additive effects of caffeine and medications also occur in treatments for asthma and gall bladder disease, attention deficit-hyperactivity disorder, shortness-of-breath in newborns, low blood pressure, and weight loss (1924). Between 50 and 200 mg of caffeine is added to some weight-loss supplements (Dexatrim™, Hydroxycut™, and Nutrisystem™ Energi-Zing Shake) for its purported effects on appetite suppression and increased metabolism (25).

Estimates of Caffeine Consumption

Recent estimates in adults suggest that more than 85% of adults in the U.S. regularly consume caffeine, with an average daily intake of about 180 mg/day, about the amount of caffeine in up to two cups of coffee (626).

Among children and adolescents, caffeine use appears to be either stable or slightly decreasing over time, despite the influx of new caffeine-containing products on the market. For example, a study by Ahluwalia and Herrick using NHANES data reports that about 75% of U.S. children between 6 and 19 years old consume caffeine, with an average consumption of 25 mg/day in children 2–11 years old and 50 mg/day in children 12–17 years old (8).

Another study also using the NHANES dataset reports average caffeine consumption in children and adolescents as 35 mg/day, with 4–8 years old consuming 15 mg/day, 9–13 years old consuming 26 mg/day, and 14–19 years old consuming 61 mg/day (27).

Coffee consumption varies worldwide: Finland and Norway are at the top of the list, with averages of 9.6 and 7.2 kg of coffee consumed per capita per year.

The U.S. ranks 22nd, with 3.1 kg. A 1984 study showed that Canada and the U.S. had per capita rates of caffeine consumption that were triple the worldwide average but that were still half of what was consumed in countries such as Sweden and the United Kingdom (U.K.) (28).

A more recent study from the Canadian Community Health Survey found that coffee was the second most popular drink among Canadian adults, with water being the first (29).

The U.K.’s National Diet and Nutrition Survey also collected information on caffeine consumption through foods and beverages from adults and children.

These data show that, on average, adults in the U.K. consume about 130 mg/day of caffeine and that children consume about 35 mg/day (30).

A study from Japan using 4-day food diaries reported average daily caffeine consumption as about 260 mg/day in adults (31). Finally, people in Finland, Norway, the Netherlands, and Sweden are consistently reported to drink the most caffeine, primarily from coffee. However, these estimates are derived from sales of coffee and not from surveys of individual intake.

Trends in Caffeine Consumption

Trends in caffeine consumption have been stable among adults for the past two decades (6). Among children aged 2–19 years old, caffeine consumption increased significantly from the 1970s through the 1990s (532).

This increase was also marked by a decrease in dairy consumption and an increase in soda consumption (32). More recent data suggest that caffeine consumption has remained stable among this age group since the 1990s (833), a finding similar to that in adults. This stability is somewhat surprising, given the marked increase in the number, variety, and availability of caffeinated beverages introduced in the past decade.

Some researchers speculate that this stability reflects a lag in data collection or in consumption trends from when products are introduced to the market to when data are collected (for example, the most recent NHANES data on caffeine consumption are from 2011).

Another potential explanation is that a possible decline in consumption among younger children has been offset by increased consumption among older adolescents and young adults attracted to the increasing number of new caffeine-containing products.

Targeted marketing strategies seem to support this explanation.

Advertisements for caffeinated energy drinks, the fastest growing segment of the beverage market (3435), are specifically aimed at adolescent and young adult males (3637). Given the popularity and prevalence of energy drinks, caffeine consumption could reasonably be expected to increase quickly among children and adolescents.

Caffeine intake usually begins in childhood, most often in the form of chocolate, soda, and chocolate milk (8).

As children become adolescents, they increase consumption of soda and begin to add beverages with greater caffeine content, such as coffee and energy drinks (8).

Average caffeine intakes increase from about 50 mg/day in childhood (aged 2–11 years) to 180 mg/day in adulthood (6).

This amount is about 2 mg/kg/day in children, 2.4 mg/kg/day in women, and 2.0 mg/kg/day in men.

This shift in absolute caffeine intake from childhood to adulthood is related to changes in the pattern of consumption, with adults adopting a more regular, daily pattern of consumption relative to children (6).

In addition, the dietary sources of caffeine shift over the lifespan: adults primarily consume coffee and tea, whereas children and adolescents consume primarily soda and chocolate, which contain much lower amounts of caffeine.

The pattern of caffeine use changes across the lifespan has not been studied, but tolerance to the effects of caffeine has been speculated to increase the desire for larger doses to reverse the impact of overnight caffeine withdrawal (38).

In addition, once caffeine intake is great enough to disrupt sleep, or if sleep duration is shortened by other factors, caffeine is often used to promote morning arousal, which can further disrupt sleep, creating a pattern in which caffeine is both the cause and the cure for too little sleep (3839). Variations in caffeine sensitivity and consumption may relate to polymorphisms in enzymes that degrade caffeine and in adenosine receptors, which are the primary targets of caffeine (40).

More information: Kamal Kumar et al, 0324 2B-Alert Web 2.0: An Open-access Tool to Determine Caffeine Doses That Optimize Alertness, Sleep(2019). DOI: 10.1093/sleep/zsz067.323

Open access web tool: 2B-Alert Web 2.0

Journal information: Sleep
Provided by American Academy of Sleep Medicine


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