Monday 27 May 2013

Coffee addiction: Do people consume too much caffeine?

Coffee addiction: Do people consume too much caffeine?


Tea, coffee beans, energy drink, espresso maker, cans of energy drinks, coffee
US officials are investigating the safety of caffeine in snacks and energy drinks, worried about the "cumulative impact" of the stimulant - which is added to a growing number of products. Is our tea and coffee-fuelled society too dependent on the world's favourite drug?
The bubbling kettle, the aroma from the mug, the first bitter mouthful of the morning.
It's a ritual without which the working day would be, for millions of people, frankly horrifying.
Caffeine is, according to New Scientist, the planet's most popular "psychoactive drug." In the United States alone, more than 90% of adults are estimated to use it every day.
But now even the US - home of Coca-Cola, Starbucks and the 5-Hour Energy shot - is questioning the wisdom of adding it to everyday foodstuffs like waffles, sunflower seeds, trail mix and jelly beans.
In a statement, the Food and Drug Administration (FDA) highlighted the "unfortunate example" of Wrigley chewing gum producing packs of eight sticks which each contained as much caffeine as half a cup of coffee. Subsequently, Wrigley said it would "pause" production of the product.

How healthy is your coffee?

Coffee beans
"On the plus side, coffee is known to be packed full of antioxidants, which stop other molecules oxidising and producing free radicals.
"Women who drink two or more cups of coffee a day are less likely to get depressed, other research suggests.
"However previous studies have linked high caffeine intake to raised cholesterol and short-term high blood pressure."
The agency is also looking at highly-caffeinated energy drinks, and said it was concerned about the "cumulative impact" of adding stimulants to products.
According to the US Substance Abuse and Mental Health Services Administration, the number of people seeking emergency treatment after ingesting energy drinks doubled to more than 20,000 in 2011.
However, the energy drink industry says its products are safe and insists there is no proof of a link with any harmful reactions.
There have been documented cases of fatal overdoses caused by "caffeine toxicity", though these are very rare. Scientists at Johns Hopkins University, studying its addictive properties, found that withdrawal symptoms included tiredness, headaches, difficulty concentrating, muscle pain and nausea.
But there is far from any kind of scientific consensus that caffeine use is harmful. A recent study by the Harvard School of Public Health suggested that "coffee drinking doesn't have any serious detrimental health effects" and that drinking up to six cups a day was "not associated with increased risk of death from any cause".
In moderation, caffeine may have some positive effects. Research suggests it could be associated with a reduced risk of prostate cancer and breast cancer. A recent study linked drinking coffee and tea with a lower risk of type two diabetes.
As a result, the FDA has pledged to "determine what is a safe level" of caffeine use.
The agency's move has been welcomed by those who fear caffeine is already encroaching too much into our daily lives - often in products where it may not be expected.
"Many people just aren't aware of how much caffeine they are taking," says Lynn Goldman, dean of the George Washington University School of Public Health and Health Services.
As a result, she says, they could unwittingly create problems for themselves with insomnia, indigestion, or their blood pressure.
It's especially worrying for parents, who can find it hard to regulate their children's intake.
BeverageCaffeine (mg)Quantity
Coffee
77-150
6oz/170g
Tea
40-80
5oz/142g
Coca-Cola
34.5
12oz/340g
Pepsi
38
12oz/340g
Red Bull
80
8.3oz/235g
But challenging the hegemony of caffeine may be a difficult task on a planet that consumes 120,000 tonnes of the substance per annum.
In Finland, the world's most caffeinated country, the average adult consumes 400mg of the drug every day - equivalent to four or five cups of coffee a day, and equal to the maximum daily limit recommended by the UK Food Standards Agency.
"We think that, when used in moderation, caffeine doesn't pose a risk," says Sanna Kiuru, a senior officer at Evira, the Finnish food safety authority. "It's mainly adults who drink coffee, not children. For us the levels are quite moderate."
Even buzz-loving Finns have been troubled by the rise of stealth stimulants, however.
"We have been concerned about the rise in caffeine in different foods," says Kiuru. Highly-caffeinated energy drinks in Finland are obliged to carry warning labels - a practice that will be extended across the EU from 2014.
For most caffeine consumers, its chief benefit is that, by stimulating alertness, it helps you get more done.
This is a trait that makes it unusual among recreational substances, says Stephen Braun, author of Buzz: The Science and Lore of Alcohol and Caffeine.
Coffee-drinkers chart
"Its appeal is that it helps us earn more money," he adds.
"What makes it different from other drugs is that it's used as a productivity tool - not for pleasure, like cannabis, or as a relaxant, like alcohol."
Perhaps the closest analogy is with coca leaves, chewed by labourers to give them extra energy in countries like Peru and Bolivia.
It's no coincidence, Braun believes, that caffeine's popularity boomed in Europe at the dawn of the industrial revolution, when the race for ever-increased productivity accelerated.
Many of history's creative minds have also been associated with some truly epic feats of caffeine consumption.
According to one biographer, the French novelist and playwright Balzac drank as many as 50 cups of coffee a day. "Were it not for coffee one could not write, which is to say one could not live," he once insisted.
For seven years, the film-maker David Lynch ate at the same Los Angeles diner every day, drinking up to seven sweetened cups of coffee "with lots of sugar" in one sitting, which he said would guarantee that"lots of ideas" arrived.
Ludwig van Beethoven was said to have painstakingly counted out exactly 60 coffee beans per cup when he brewed coffee.
Perhaps the most well-publicised recent tales of caffeine excess featured the somewhat less critically revered singer Robbie Williams, whoreportedly consumed 36 double espressos and 20 cans of Red Bull a day.
It is the routine task itself, as much as the stimulant properties of caffeine, that makes the process so significant, Mason Currey, author of Daily Rituals: How Artists Work.
"A lot of artists use the process of making the coffee as a gateway to the creative process," he adds.
"You need to get into the right mindset to do that sort of work, and the preparation ritual provides a focus."
Cup of teaDoes the very ritual of preparing caffeinated drinks help minds focus?
But attempts to clamp down on the spread of the substance have historically proved futile.
In 1911, the US government sued the Coca-Cola Company, on the basis that the caffeine in its drink was "injurious to health", but Coca-Cola prevailed in the courts.
One problem with attempting to regulate the substance, says Braun, is that it affects everyone in differently - people's varying physiologies and metabolisms making it impossible to prescribe a "safe" limit that works for everyone.
"Ultimately, you have to become your own scientist - there isn't an alternative to careful self-experimentation," he says.
Most people are likely to have ascertained by adulthood how much, or little, tea or coffee they can tolerate at a time.
But critics say this doesn't apply to energy drinks and caffeinated foodstuffs, whose effects are arguably more difficult to judge.
However profitable these products may prove for their manufacturers though, Currey suspects they well never acquire the mystique of coffee and tea.
"There's something that's not quite as special and evocative about them," he says.
"Buying an 5-Hour Energy drink from the 7-Eleven [convenience store] doesn't have the ambience of brewing a cup of coffee. I can't imagine future biographers of great artists and writers describing this stuff in the same way."
Additional reporting by Mark Bosworth in Helsinki

Thursday 16 May 2013

A&E must change or face collapse, NHS warned


A&E must change or face collapse, NHS warned


Patients waiting to see a doctorPressures have been growing on A&E units for a number of years

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Urgent changes must be made to the way A&E units are run - or the system could collapse, doctors and managers say.
Both the College of Emergency Medicine and Foundation Trust Network have put forward proposals to overhaul the system.
Funding and staffing have been highlighted as key issues.
Health Secretary Jeremy Hunt said it was "very tough out there" and ministers would deal with it by "better joining up" health and social care.
The warnings come as fears grow over whether the NHS can continue to cope with rising demand.

Start Quote

Warnings don't come more serious than this”
Shadow health secretary Andy Burnham
Last week both ministers and the NHS regulator admitted the problems were a cause for concern.
A&E attendances have risen by 50% in a decade and this winter the NHS in England started missing its four-hour waiting time target.
Pressures have been noted in other parts of the UK too.
The review by the College of Emergency Medicine - based on feedback from more than half the A&E units in the UK - said the scale of the challenge was the biggest for a decade.
It said there were shortages in both middle-grade and senior doctors. As well as highlighting the workforce problem, the college also said more needed to be done to reduce unnecessary attendances.
It believes between 15% and 30% of patients do not need A&E care and instead could be treated in non-emergency settings.
Meanwhile, the Foundation Trust Network (FTN) highlighted the funding system in England which penalises A&E units seeing a rise in patients.
Funding concerns
Under rules designed to encourage the system to reduce A&E admissions, hospitals are only paid 30% of the normal fee for an emergency admission when the numbers rise above the levels that were seen in 2008-9.
But with the NHS failing to curb the rise in patients, that is costing some hospitals millions of pounds a year.
FTN chief executive Chris Hopson said: "Unless we can change the funding structure, the A&E system is going to fall over. We simply cannot carry on."

Why are A&E units getting busier?
Across the NHS more patients are being seen, but the upward trend is perhaps the greatest in A&E.
It is often said that the lack of out-of-hours GP care is the cause of rising demands on A&E.
That is certainly true. Since 2004 GPs have been able to opt out of providing night and weekend cover, leaving it to agencies to provide care.
A lack of confidence in the service has meant patients have to turn to A&E when they have not always needed emergency care.
This has been further compounded in recent months with the roll-out of the new 111 non-emergency phone line. Hospitals have reported rises in patients either because they cannot get through to 111 or have got poor advice and been told to go to their local A&E for trivial reasons.
But this does not tell the full story. The ageing population means there has been a rise in long-term conditions - about £7 in every £10 spent goes on patients with problems such as dementia and heart disease for which there is no cure.
When services are working properly in the community these patients can keep their conditions under control. But when that system fails - as it does too often - they can have crises and inevitably they end up at A&E.
He said the last winter was "very, very difficult" although with the weather now improving there were signs the system was stabilising.
But he added: "Unless we can make some really significant changes over the next six months I think it's pretty clear the system is in danger of falling over next winter."
NHS England has already agreed to plough some of the money it saves through these rules back into the system to support the most troubled A&E units in the short-term.
It has also ordered a review of emergency and urgent care, led by medical director Sir Bruce Keogh. The findings are expected to be published soon.
Shadow health secretary Andy Burnham said: "Warnings don't come any more serious than this.

Jeremy Hunt: "It's too difficult to access out of hours care"
"Too many hospitals around England are sailing dangerously close to the wind, operating way beyond safe bed occupancy levels."
He told BBC Radio 5 live the situation could be improved by "the full integration of health and social care - a national health and care service, if you like".
"As people get older, we've got to support them in their homes so they don't end up in hospital," he added.
"But we've also got to deal with the here and now and we can't have people waiting on trolleys in corridors and being treated in the back of ambulances.
"The government has got to get a grip on the situation and it's got to do it now."
Health Secretary Jeremy Hunt, meanwhile, told 5 live: "I've visited many, many A&E departments and staff are working extremely hard, you can see the lines on their eyes, people are very tired, they're obviously working hard, 24/7, and it's incredibly impressive what they're doing."
He said that, since the government came into power, the number of people using A&E had gone up by a million a year.
"There is that pressure and we have to do something about it," he said.
He admitted there was "a lack of joined-up thinking between health and social care system which we're sorting out".
He cited a care bill, set out in the Queen's Speech, which will introduce a cap on the cost of social care and give carers the legal right to support from their local council.
"That's also a very big problem because what you're finding in a typical hospital is maybe 100 beds are full of people who actually don't need to be in hospital but the doctors aren't able to discharge them into the social care system."
He said the government was putting £7.2bn into the social care system "to protect it against cuts".

A&Es under pressure

Figures for week ending 7 April 2013, to reflect period of higher demand during colder weather.
TrustA&E units% Patients seen in under 4 hours (target: 95%)
SOURCE: DEPARTMENT OF HEALTH

Sunday 12 May 2013


Ignorance of tick-borne Lyme disease 'costing lives'

Areas of woodland can harbour ticks
When Joanne Drayson regularly walked her dogs in the woodland near her home in Guildford, Surrey, she was unaware that a tick the size of a poppy seed would infect her with a serious and debilitating disease.
"I had this strange symptom, which I can only describe as whole body rigidness. It kept recurring," she says.
Her health deteriorated to such an extent that she was unable to lift her legs or arms. The pain in her hips meant she was unable to climb stairs in her own home.
In the end, she was retired on health grounds from her job in the civil service.
Mrs Drayson now realises what happened to trigger the extreme fatigue, joint pain and stiffness that plagued her for more than four years.

What is Lyme disease?

Tell tale 'bullseye' rash after being bitten by a Lyme-infected tick
  • Lyme disease is a bacterial infection that is spread to humans by infected ticks.
  • The ticks that cause the disease are commonly found in woodland and heath areas, because that is where tick-carrying animals, such as deer and mice, live.
  • The most common symptom of Lyme disease is a pink or red circular "bull's-eye" rash that develops around the area of the bite.
  • Flu-like symptoms and fatigue are often the first noticeable signs of infection.
  • Diagnosed cases of Lyme disease can be treated with antibiotics, but if left untreated neurological problems and joint pain can develop months or years later.
In 2003, she remembers finding a tick on her foot, which caused a rash. At the same time she had flu-like symptoms that lasted several weeks.
When Mrs Drayson was bitten again two years later, she developed symptoms similar to arthritis, but doctors still did not suspect that the ticks had infected her with Lyme disease.
"I had removed ticks from my dogs for over 30 years, but didn't really know much about them.
"There are probably thousands of people who could end up like me."
Devastating impact
It was 2007 before she was given a clinical diagnosis, after her GP prescribed antibiotics for a chest infection and they dramatically improved her symptoms.
This weekend, a group of individuals calling themselves Worldwide Lyme Protest UK is highlighting the devastating impact of Lyme and other tick-borne diseases when they are misdiagnosed.
Nicola Seal, from Aberdeen, who has co-ordinated the UK protest, says the disease is not understood by the vast majority of medical professionals, leaving thousands of patients without the appropriate treatment.
"We wanted to put our personal stories to the Department of Health to make them aware that people are dying because they are not getting diagnosed and treated properly."
She adds: "There is a lack of GP experience and knowledge - and when people are diagnosed with Lyme disease, we lack any professionals who understand it."

Start Quote

So many people are going undiagnosed because the tests are not foolproof”
Stella Huyshe-ShiresLyme Disease Action
The protest group is also urging the government to re-examine the current NHS test for Lyme, which it says misses as many as two-thirds of genuine cases.
Official estimates put the number of new UK cases each year at around 3,000, but Lyme disease charities say the figure could be as high as 15,000 annually because so many people do not have their condition diagnosed.
Stella Huyshe-Shires, who chairs the charity Lyme Disease Action, says that patients have not been listened to in the past and this has created a problem.
"So many people are going undiagnosed because the tests are not foolproof. The test relies on detecting antibodies which may take weeks to appear in some people.
Patients going abroad
"They may may not even develop the antibodies which the test looks for."
She says the NHS is not at fault. It is simply that the test is not perfect.
The result is that patients go abroad to private clinics to look for a test that will prove they have Lyme disease, spending a lot of money in the process.
At the Rare and Imported Pathogens Laboratory in Wiltshire, where tests for Lyme disease are carried out, a two-tier testing system recommended by American and European authorities is used.
Public Health England, which runs the lab, says the tests are sensitive enough to detect low levels of antibodies, occasionally producing a false positive result.
A deer tick which feeds on human blood and can cause Lyme DiseaseDeer ticks feed on human blood and can cause Lyme disease infection
It also acknowledges that the antibody response takes several weeks to reach a detectable level, so tests in the first few weeks of infection may be negative.
Dr Tim Brooks, head of the Rare and Imported Pathogens Laboratory, says they are always looking to improve their diagnostic systems.
"The laboratory is evaluating different diagnostic tests, and will be developing a specific set of guidance for the investigation and management of Lyme disease in the UK."
Yet there are still many uncertainties surrounding Lyme disease, says Mrs Huyshe-Shires.
By bringing clinicians and patients together, the charity has published a list of "unknowns" in the diagnosis and treatment of Lyme disease, which it hopes will inform any future research and guidance.
One controversial issue concerns the treatment of borreliosis, caused by the Borrelia burgdorferi bacterium, the agent of Lyme disease.

Where do ticks live?

Tick feeding on a human leg
  • Ticks can survive in many places, but prefer moist areas with dense vegetation or long grass.
  • Ticks are most active between spring and autumn.
  • Ticks prefer warm moist places on your body,
While most doctors agree that treatment of this type of infection with oral antibiotics in its early stages is often successful, there is far less agreement regarding the treatment of chronic Lyme disease, which keeps recurring because of a delayed diagnosis.
In these cases, a more lengthy course of intravenous antibiotics may be required. There is also the possibility that patients may relapse after a lengthy remission.
BADA UK, Borreliosis and Associated Diseases Awareness UK, says a full recovery is not certain.
"The length of time a person has been infected before treatment, whether the patient has been given sufficient treatment, and whether there are co-infections present, can all have a big impact on a patient's recovery," it says.
Much more study into the nature of the Borrelia bacterium needs to be done before a safe and reliable vaccine for all the strains can be created, BADA UK says.
Helpline for doctors
The Department of Health has been working closely with Public Health England and NHS England to raise awareness among doctors and nurses. It says it is using the latest world-class diagnostic tests to look for the disease in patients with symptoms.
There is now a Lyme disease helpline that doctors can call if they spot symptoms and are unsure about what to do.
Six years on from her diagnosis, Mrs Drayson's health has changed for the better after a long course of antibiotics.
"I've recovered my health and my life. I can now cycle and run upstairs."
But she says no two people react in the same way to Lyme disease.
"We have to acknowledge that people react in a different way to different treatments. There is no definitive treatment. We have to give patients the opportunity to have ongoing treatment if they need it."

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