Be Well - August 2011 Issue

Feature: Caffeine Dos and Don'ts

Feature: Caffeine Dos and Don'ts

Caffeine comes in many forms, some better than others. Beverages that combine caffeine with other ingredients — from stimulants in energy drinks to flavor shots in lattes—may have unwelcome side effects.

To find out how are you and your family are doing when it comes to the wise use of caffeine, Cleveland Clinic registered dietitians offer these dos and don'ts:

Don't get more energy than you bargained for.

Yes, energy drinks contain caffeine. But they also contain stimulants, additives and supplements, such as guarana, taurine and ginseng. Guarana (an herbal version of caffeine) is about 2.5 times stronger than caffeine and is released into the body more slowly, delivering a steady boost of energy.

"Combining guarana with caffeine and other stimulants may produce a synergistic effect that makes the effects more powerful — and that isn't necessarily a good thing," says Tara Harwood, MS, RD, CSP, LD. "You can develop heart palpitations, an increased heart rate and elevated blood pressure."

It's important to check the label on an energy drink before taking aspirin to avoid a medical emergency, says Ms. Harwood: "Guarana combined with ephedra and aspirin can cause stroke or death."

Registered dietitian Laura A. Jeffers, MEd, RD, LD, adds that "because substances like taurine and guanine mimic the effects of caffeine in the body, they should be considered when monitoring your daily caffeine intake." 

Do boost athletic performance the right way.

Energy drinks are often used to enhance sports performance. However, "the ingredients in energy drinks do not necessarily improve performance and can be hazardous to health," says Ms. Harwood.

For young athletes, the use of energy drinks is discouraged by the American Academy of Pediatrics because the effects of caffeine, stimulants and other additives on the developing heart and brain are unknown.

Choose sports drinks instead for strenuous workouts for the entire family. They'll replace the water, electrolytes and carbohydrates you'll lose through sweating and fueling the body. Drink cold water before and after exercise.

"Sports drinks are safe and encouraged for athletes who exercise outside in the heat for 60 minutes or longer or who engage in 30 minutes of intense start-and-stop activities, as in basketball," says Ms. Harwood.

For light activities, forgo the sports drinks — they only add unwanted calories and sodium to your diet, she says. And speaking of diet, remind active young athletes that they need three meals and two to three nutritious snacks per day.

Don't supersize your coffee.

When you grab your morning coffee, remember that size matters—as do strength and sweetness. "Portion sizes are a major problem; as size increases, so does the amount of caffeine," says Ms. Jeffers.

The 100 to 145 milligrams of caffeine per standard 8-ounce cup of brewed coffee can climb much higher, depending upon brand and brewing method. You get a whopping 400 milligrams of caffeine in certain drinks from your favorite coffee shop. "Some people may drink two to three of these per day," says Ms. Harwood.

"Caffeine in large doses can cause abdominal pain, increased anxiety and heart palpitations or arrhythmias," she cautions. "At that level, caffeine tolerance can also develop, and withdrawal symptoms such as headache, drowsiness, and difficulty concentrating can occur."

Weight gain can be another unwanted side effect of visiting coffee shops. "Coffee drinks made with milk and flavored syrups, and topped with whipped cream, add calories and fat that can sabotage the diet," says Ms. Jeffers.

Do use caution with combinations.

Young adults going clubbing often order alcohol mixed with stimulant-containing energy drinks "to enjoy social drinking without getting sleepy," says Ms. Harwood. 

Caffeine and other ingredients in energy drinks produce a powerful stimulant effect that fights alcohol, which is a depressant. "This confuses the nervous system, which can trigger heart palpitations and abnormal heart rhythms," she adds. The combination is especially dangerous for young adults with undiagnosed heart problems.

Because alcohol causes dehydration, it's important to get plenty of water on a night out. "Try rotating alcoholic beverages with water to control the amount of alcohol you're drinking and to rehydrate your body," says Ms. Harwood.

Before trying an energy drink with alcohol at the bar, "always try the energy drink during the day, without alcohol, to see how your body responds to it," Ms. Harwood advises. "Then, if you feel you need a stimulant when you're out, show moderation by having only one of these drinks."

The best ways to improve energy levels are to get plenty of sleep each night, to exercise during the day and to eat nutrient-dense foods, she says.

Do consider going green.

Making green tea your morning beverage of choice can do wonders for your health. It contains just 15 to 30 milligrams of caffeine per cup. Ms. Jeffers notes that green tea:

  • Contains anti-oxidants to promote healthy aging and possibly fight cancer
  • Produces lipid-lowering and blood-pressure-lowering effects for heart health
  • Promotes anti-inflammatory effects that reduce risks of heart disease, arthritis and other illnesses

In addition, "Research suggests that regular green tea consumption may stimulate fat burning without increasing heart rate, as many caffeine-containing diet pills do," says Ms. Harwood.

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Tip: Protect Eyes as well as Skin From Sun

When spending time in the sun, always wear sunglasses to protect your eyes from damaging UV rays. Research shows that in combination with sun exposure, low levels of zeaxanthin, vitamin E and vitamin C can cause vision loss. Combat this by eating leafy greens, egg yolks, nuts, whole grains, zucchini, bell peppers and citrus fruits.

Be Well – August 2011 Issue

Feature: Heart Disease Research Points to the Gut

The choline connection

Cleveland Clinic researchers have shed new light on the way heart disease develops — and hope it leads to new screening and prevention strategies.

It's a given that eating a high-fat diet and having a family history of heart disease contribute to our risks for cardiovascular disease. Now it appears that the way healthy gut bacteria digests animal products may contribute to risks as well.

Metabolism matters

"When two people both eat a similar diet but one gets heart disease and the other doesn't, we currently think the cardiac disease develops because of their genetic differences. Our studies show that is only part of the equation," says lead investigator Stanley Hazen, MD, PhD.

Dr. Hazen is Head of the Section of Preventive Cardiology and Rehabilitation and a member of the Department of Cell Biology. "Gut flora is a filter for our largest environmental exposure—what we eat," he explains. "Differences in gut flora metabolism from one person to another appear to have a big effect on whether one develops heart disease."

In his National Institutes of Health-funded research, Dr. Hazen and team studied data from 1,875 Cleveland Clinic patients referred for cardiac testing and conducted laboratory research on mice.

Choline over cholesterol

Choline is a natural B-complex vitamin found in a common dietary lipid called lecithin. The researchers found that patients with the highest levels of three metabolites of lecithin — choline and two other lecithin byproducts, TMAO and betaine —were most likely to have heart disease, peripheral artery disease or a history of heart attack.

"The metabolite that was strongest at predicting cardiac risks, TMAO, is formed in the intestines when bacteria, or gut flora, digest lecithin," explains Dr. Hazen. Mice that had gut flora and were fed higher amounts of lecithin and choline developed higher levels of TMAO and fatty plaque deposits in the arteries (atherosclerosis). However, when germ-free mice that lacked gut flora were fed the same diet, formation of TMAO and atherosclerosis was completely blocked.

To the team's surprise, high levels of TMAO were 10 times more likely than high levels of cholesterol to predict heart disease risk. For this reason, screening for TMAO may identify patients at high risk for heart disease who might otherwise be missed, they believe.

Choline and lecithin in your diet

Fruits, vegetables and fatty fish contain healthy amounts of choline. Animal products —eggs, cheese and other dairy products, liver and other meats, and fish and shellfish — contain higher amounts.

The fact that lecithin and choline are commonly added to vitamins and dietary supplements marketed to promote brain health, weight loss and muscle mass is alarming, says Dr. Hazen.

"Over the past few years we have seen a huge increase in the addition of choline into multivitamins — even in those marketed to our children. Yet it is the same substance that our study shows the gut flora can convert into something that has a direct, negative impact on heart disease risk," says Dr. Hazen.

He recommends avoiding all vitamins and supplements containing choline and simply eating a balanced diet with plenty of fruits, vegetables and fiber.

In the future, preventive treatment may go the dietary route to positively influence gut metabolism. "These studies suggest we can intelligently design a heart-healthy yogurt or other form of probiotic for preventing heart disease," says Dr. Hazen.

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Be Well – August 2011 Issue

Free Guide: Infertility

The human reproductive system is so intricate that it's no surprise that about one in six couples is unable to conceive after trying for a full year. Learn how the latest diagnostic and treatment options for infertility can help.

Recipe: Healthy Zucchini Bread

Made With Applesauce and Flaxseed

This zucchini bread recipe is lower in fat and cholesterol than other recipes and is safe for those with egg allergies. The ground flaxseed and water mixture serves as an egg substitute, and the applesauce replaces the oil.


2 tablespoons ground flaxseed
6 tablespoons water
1½ cups whole wheat flour
2 teaspoons baking powder
½ teaspoon baking soda
½ teaspoon salt
¼ teaspoon ground ginger
¼ teaspoon ground cinnamon
⅛ teaspoon ground nutmeg
¾ cup white sugar
½ cup unsweetened applesauce
2 cups grated zucchini

  1. Heat oven to 350 degrees. Spray a standard glass bread baking pan with non-stick cooking spray.
  2. Whisk together ground flaxseed and water in a large bowl. Allow to sit five minutes.
  3. Meanwhile, combine flour, baking powder, baking soda, salt and spices in a separate bowl. Set aside.
  4. Add sugar and applesauce to flaxseed mixture; beat for one minute. Stir in grated zucchini. Add dry ingredients, stirring just until moistened. Pour into prepared baking pan.
  5. Baked in preheated oven for 40 to 45 minutes or until inserted toothpick comes out clean. Cool 15 minutes in pan, then turn out on cooling rack and allow to cool completely.

Serves 16

Per serving:
Calories: 84
Fat: 0.5 g
Saturated Fat: 0 g
Protein: 1.9 g
Carbohydrate: 19 g
Sugar: 10 g
Fiber: 2 g
Cholesterol: 0 mg
Sodium: 144 mg
Potassium: 89 mg

Recipe from our Children’s Hospital Pediatric Nutrition Support Team

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Be Well – August 2011 Issue

Let's Move It! Mondays at Progressive Field

Your last chance to enjoy free, exclusive access to Progressive Field in downtown Cleveland is Monday, Aug. 15, between 11:30 a.m. and 1:30 p.m. Invite your friends to walk the warning track with you over the lunch hour — and stop by our booth for free giveaways and health information.