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Nervous: Treating coffee abuse by Paul Bergner Medical Herbalism 3(2):1,4-5 Coffee may be the most frequently used herbal decoction in the U.S., and the most commonly abused. Coffee is, of course, an effective stimulant, but its chronic use leads to exhaustion, and the vicious cycle of stimulant abuse. The side effects of coffee may include insomnia, irritability, anxiety, heart palpitations, muscle tension, heartburn, “biliousness,” gastritis, flatulence and diarrhea. Coffee abusers typically come to the practitioner complaining of anxiety, insomnia, extreme fatigue, muscle tension, or digestive complaints, and all patients with such complaints should be screened for coffee abuse. They will often be unaware of the relationship of coffee to their complaint, especially with muscle tension or digestive problems. Coffee has all the characteristics of a classically addictive drug. Users develop a tolerance over time, requiring larger amounts to receive the same level of stimulation. It has both physical and psychological withdrawal symptoms, including headaches, drowsiness, constipation, and feelings of emotional and mental disorientation which can last anywhere from two to six weeks. Users continue to use it even when they are aware of the adverse effects, and many who try to stop cannot. Some coffee users who stop suddenly find their work performance disrupted, and the practitioner should be aware that such complaints are legitimate. A patient withdrawing from coffee may not be able to adequately perform their job function, for instance. Low Potassium A low-potassium syndrome may be involved with some of the symptoms associated with coffee abuse or withdrawal. Significant serum potassium drops occur at doses of 180 mg of caffeine, the equivalent of three average cups, or one or two strong cups. (Passmore). The average cup of coffee has 60 mg caffeine, with the range from 14-333 mg (Gilbert). One patient with a 20-cup-a-day habit was hospitalized for severe potassium depletion apparently due only to the coffee (Rudy). The average daily intake of caffeine by American adults (including cola drinks) is 200 mg; 20-30% consume more than 300 mg., and 10% consume more than 1 g/day, the equivalent of sixteen cups of coffee (Greden). The low potassium is due to a combination of the effects of caffeine and the diuretic effect of coffee drinking. Drinkers at the high end of the scale take in as much as a gallon of liquid a day, which alone is sufficient to cause potassium depletion through diuresis. Low potassium is associated with fatigue, heart palpitations, nervousness, cloudy thinking, muscle weakness, and irregular heartbeat, all characteristic of coffee abuse and withdrawal symptoms.

Treatment Treatment for coffee abuse will depend on the chief presenting complaint, but in all cases coffee must be eliminated. If anxiety or nervous symptoms are predominant, nervine herbs such as valerian, passiflora, or hops may be prescribed, and appropriate exercise should be maintained or introduced. Dietary counseling and supplementation with multiple vitamins alone can reduce anxiety significantly (Abbey). See the accompanying table for a listing of insomnia remedies. Decaffeinated coffee may be continued while new habits are being established. Many psychological and physical disasters are created when medical doctors fail to screen for coffee abuse before prescribing benzodiazepine drugs (Valium, Dalmane) to patients complaining of anxiety or insomnia. The cause of the problem is mistakenly identified with the psyche or defective physiology of the patient, and the true cause is then not removed. The patient must also then experience the side effects and potential addictive properties of the new drug as well. Gastrointestinal complaints For gastric, hepatic, or other digestive complaints, all coffee, including decaffeinated beverages must be discontinued (caffeine is not the culprit here), and the appropriate treatments administered. A full discussion of treatments for gastrointestinal disorders is beyond the scope of this article, but soothing, cooling herbs such as slippery elm or marshmallow may be important, along with anti-inflammatory herbs such as licorice or chamomile. Fatigue For extreme fatigue, tonic herbs such as ginseng may be appropriate, but care must be taken that strong individuals do not abuse the herbs the same way they did the coffee, and also that coffee be completely eliminated. A “ginseng abuse syndrome” has been observed in people taking ginseng along with caffeine. Codonopsis (Chinese: Dang shen) is milder than ginseng, and often used as a substitute for it in China. It has less potential for abuse. It might be combined with licorice, taraxacum, and a warming synergist for a good formula. Muscle Tension Coffee abusers with muscle tension or other musculoskeletal complaints may not improve as expected with normal treatment. Stubborn, coffee-related muscle tension may be seen in patients taking as little as two or three cups of coffee a day, and sometimes the problems will clear completely simply by removing the coffee. Caution on withdrawal? An Eclectic medical textbook says that coffee “should never be completely withheld in acute illnesses when it has been a factor in the patient’s daily diet.” (Felter) this is in reference to debilitating feverish illnesses, not those due to coffee abuse.

Diet In all cases where coffee is discontinued, foods high in potassium should be consumed. Apricots, garbanzo beans, avocado, orange juice, figs, beet greens, adjuki beans, dried prunes, pumpkin seeds, tomato puree, rice bran, potato flour and soy flour are all unusually high in potassium. Perhaps the easiest food “prescription” is several glasses of orange juice a day. Each glass of orange juice contains about 500 mg of potassium. Tomato juice may also be suggested, but it is unusually high in sodium as well, and should not be used when sodium is being avoided. Bitters Some people with a coffee habit may be unconsciously self-medicating, using the beverage as a bitter herbal tonic. They may need to consciously increase bitter foods in their diet when stopping coffee. Bitter is one of five important flavors in Chinese medicine. It activates the Chinese heart principle, is cooling and drying in nature, and stimulates digestion. Note that bitter cordials are used in European culture as digestive aids. Mildly bitter herb tea substitutes, such as dandelion or chamomile (be sure not to sweeten it!) or foods such as bitter greens may be introduced. Stronger bitter herbs should be administered with caution unless one is sure that the patient’s problems (such as dryness or coldness) are not due to an excess of bitter principles in the coffee. Strong bitters (including coffee) are also contraindicated with gastrointestinal inflammation. Increasing the liquid intake may also reduce the craving for coffee in individuals who have come to depend on coffee for their daily liquid intake. Increasing orange juice or water can be helpful. Finally, coffee has a laxative effect, and withdrawal can cause rebound constipation. Introducing or maintaining a high fiber diet may be important. Case Study In this case, a patient with recurring headaches was not willing to stop drinking coffee. The headache was treated with herbs and diet, and the above strategy was applied and he spontaneously reduced coffee intake by about 25%. Patient Successful artist (painter). Age 38. Wt. 152. Height 5’8". Exercise moderate-regular light biking, hiking walking. Diet Fruits, raw vegetables, sandwiches (Salami, cheese), dinner varies, often in Chinese or Mexican restaurants. Four to six cups of coffee daily.

Chief complaint Debilitating headache, off and on for two days’ duration. Awakened by the pain in the middle of the night. He feels it is different from a coffee headache, with which he is familiar. Other symptoms Gas—thought it might have been from bad food. Stool slightly watery and slightly more often than usual. Fatigue—stayed in bed half a day one day last week, and not feeling quite up to par since. Mild nausea. Anger and resentment (“victim of the past”). Old issues plaguing him. Lungs OK. Sleep OK. Frequent urination, attributes to the coffee. Feels alternating hot and cold. History Recovering alcoholic—sober for six years. Family history of diabetes, but no personal history of it. Depressed lately, around Christmas holidays. Recently moved to new town (five months ago)—ambivalent about staying, misses old friends—career anxiety (positive stress, gallery just accepted his art work). Heightened emotional anxiety since moving. Headache behind eyes for five months, since first moving, once a week “like clockwork” except for one brief period. Always accompanied by “woozy” feeling like very mild motion sickness. Examination Strong robust constitution. Temperature 98.4. Pulse: 78. Pulse qualities: broad and strong, hands feel warm. Chinese liver pulse is tight and wiry. Chinese Kidney pulses normal. Treatment Dandelion Root. One ounce of root in a pint jar, cover with boiling water, put lid on and let stand till cool. Take by the shotglass four times a day for three weeks. Chamomile solid extract. Take one or two tablets at night one half hour before sleep. Milk thistle extract. Two tablets a day for one month. Introduce a large serving of collard greens or other bitter greens each day at lunchtime (patient says he likes them). Drink one cup of water along with each cup of coffee, immediately following. Drink two cups of orange juice a day, in addition to current fruits and vegetable. See physician for diabetes check (Note frequency of urination and family history.) Follow up: Thirty-six hours. Reports “miracle cure”—"especially after eating the greens"—"entire emotional outlook changed"—"like something being lifted."

Follow up: Two weeks. Spontaneously reduced coffee by about 25%. Still not willing to make efforts to quit. Follow up Two months. Incorporated the dietary changes into his life. Takes dandelion tea occasionally. No headaches since first treatment. Coffee consumption back up to previous levels. Practitioner’s comment Although he made no attempt to reduce his coffee, the treatment approach helped reduce his consumption in the early phase. I gave the chamomile as a solid extract only because I had some lying around. Normally I would prescribe it in the same form as the dandelion. I chose it over other sedatives because of its bitter principles and anti-inflammatory properties, as it seemed the headaches might have an inflammatory component. I gave the milk thistle because of the history of alcoholism, even though the liver probably would have healed after six years. The case seemed to break with the greens for lunch. I learned in this case that you can get a lot more bitter herbs into someone with a plate of greens than with tincture drops or teas. References Abbey, LV. “Agoraphobia” J. Orthomol. Psychiat. 11:243-259, 1982. Rudy DR, Lee S. “Coffee and hypokalemia” J Fam Fract. 1988 26(6):679-680. Felter, HW. The Eclectic Materia Medica, Pharmacology, and Therapeutics. 1922. Reprinted 1985. Eclectic Medical Publications. Portland, Oregon. Gilbert RM, Marshman JA, Schwieder M., Berg R. “Caffeine content of beverages as consumed” Can Med Assn J. 1976; 114:205-208 Greden JF. “Coffee, tea, and you.” The Sciences. 1979;19;6-11. Passmore AP, Kondowe GB, Johnston GD. “Caffeine in hypokalemia” Ann Int Med 1986. 105(3):468 [letter].

Copyright 2001 Paul Bergner

