Written by Joseph Gallab
Caffeine contributes to the work-flow lifestyle and aspects of socialization commonly found within postsecondary institutions. This attachment is rooted in the early development of caffeine dependence through frequent consumption of beverages or foods containing this substance. Given that caffeine is deemed to ameliorate vigilance and cognitive function, it has become a staple in the student diet. In several studies, it is observed that safe caffeine consumption is not associated with adverse effects to the mental, physical and social health of university students. In fact, caffeine intake has shown inverse associations with depression and respiratory health. However, elevated caffeine consumption ( < 2.5 mg/kg/day) poses the possibility of harmful effects to current or at-risk students with pre-existing psychiatric, cardiovascular or respiratory conditions. Frequent consumption of energy drinks align with increased alcohol and drug use, which may also harm mental and physical health. Long-term use of caffeine has not been found to increase the likelihood of developing cardiovascular or respiratory diseases in university student populations. Further studies must be conducted to garner causal associations between health and caffeine consumption in university populations.
Caffeine is the most commonly used drug in the world.1 Market trends show that Scandinavian countries consume the most coffee per capita in the world, while North American countries consume the most energy drinks per capita.2 Caffeine can be found in many beverages or foods––including coffee, tea, kola nuts, and chocolate––and may inadvertently be a prominent feature in the diets of many.3Indeed, the mean daily caffeine consumption for university students was found to be 173 mg/day among caffeine users.3 Health Canada reports that excess of 2.5 mg/kg/day of caffeine can cause adverse health effects.4 Surveys have found that caffeine products are consumed by 92% of university students, with coffee serving as the primary mode of intake, followed by soft drinks and tea.5 Additionally, it is found that students, especially those that identify as female, consume more caffeine than the general population of individuals aged 19–30 years.3 Caffeine has amassed its popularity because of its association with productivity, and the promise of benefits such as increased attentiveness and alertness, increased work performance, enhanced vigilance, elevated mood, and delayed onset of sleep.6 Thus, certain student cohorts are more likely to consume caffeine than others, including athletes, who use the substance to enhance physical performance, as well as medical students and residents, to diminish fatigue and increase alertness.7,8 Caffeine has proven itself to be a major component of one’s routine; however, there is a paucity of research investigating its lifestyle effects. In the realm of mental health, caffeine has been found to diminish the quality of sleep, and one study found an increase in likelihood of anxiety, particularly in those with pre-existing psychopathology.9It should be noted that caffeine is not a typical drug of dependence and many of its withdrawal effects appear to be weak or transient. However, while the physiological effects of caffeine have been extensively studied, it has been shown that its physical dependence has been poorly characterized in laboratory animals and only moderately well-characterized in humans.10 Overall, evidence shows that levels of caffeine consumed by most people have largely positive effects on behavior.11In regards to its physiological effects, caffeine is found to significantly increase blood pressure, produce feelings of arousal and positive mood, but impair performance on memory tasks.11In terms of social health, caffeine may serve as a gateway to consuming other drugs, as well as enhancing the subjective effects of other substances.12
THE IMPLICATIONS TO MENTAL HEALTH
Caffeine provides enhancements typically sought after by university students––this includes increasing alertness, attention, cognitive function and elevation of mood.13In fact, moderate caffeine intake (< 6 cups/day) has been associated with less depressive symptoms, fewer cognitive failures, and lower risk of suicide.13In a longitudinal study investigating the association between caffeine and depression in a total of 50,739 US women, it was found that the risk of depression decreased with increasing caffeinated coffee consumption.14 A similar study conducted with Finnish men found that there is a significant inverse association between coffee drinking and depression, but no association with tea or other caffeinated beverages.15 Such longitudinal studies reveal the potential therapeutic benefit of coffee in relieving the risk of depression prior to onset, but its effects in individuals already diagnosed with depression is unclear.
The effect of caffeine on other forms of mental health disorders such as anxiety have also been investigated in several studies. Patients who are predisposed to panic disorders or social anxiety disorder seem to be particularly sensitive to the anxiogenic effects of caffeine.16 In a study conducted with 21 patients meeting the DSM-III criteria for agoraphobia with panic attacks or panic disorder, it was found that 71% of the patients reported that the behavioral effects of caffeine were similar to those experienced during panic attacks; moreover, caffeine produced significantly greater increases in subject-rated anxiety, nervousness and fear.16 This study reveals the consequences of caffeine to those with agoraphobia, but other forms of anxiety were not investigated in association to caffeine consumption. In contrast, preliminary data from other investigations suggest that caffeine may be effective in reducing symptoms for patients with obsessive compulsive disorder.13, 17
RISK AND BENEFITS TO PHYSICAL HEALTH
Caffeine intake usually begins in childhood, most often in the form of chocolate and soda.18 As children become adolescents, the consumption of beverages with greater caffeine content increases, such as coffee and energy drinks.18 Average caffeine intakes progress from about 50 mg/day in childhood (aged 2–11 years) to 180 mg/day in adulthood.19 There is no clear-cut evidence suggesting that longitudinal consumption of caffeine can cause physiologically harmful effects to health; however, studies have uncovered that caffeine intake can lead to various cardiovascular and respiratory disorders.
The effects of caffeine on the heart are primarily stimulatory and result in increased coronary blood flow; therefore, caffeine is contraindicated for individuals who suffer from cardiovascular conditions such as hypertension or tachycardia. In fact, caffeine stimulates the increase of blood pressure through the release of neuroendocrine substances such as epinephrine, norepinephrine, and renin, which in turn increase serum calcium levels and promote the sensitization of dopamine receptors.20 One study suggests that coffee intake is associated with an increased risk of non-fatal myocardial infarction among individuals with slow caffeine metabolism.21 The metabolism of caffeine is governed by the cytochrome P450 1A2 (CYP1A2) enzyme. Individuals who are homozygous for the CYP1A2*1A allele are “rapid” caffeine metabolizers, whereas carriers of the variant CYP1A2*1F are “slow” caffeine metabolizers.21 Therefore, the degree of caffeine metabolism is dependent on genetic variability. In regards to respiratory health, one case-control study found a higher risk of chronic obstructive pulmonary disease with coffee consumption in Japanese adults; however, no other studies have corroborated this finding.22In fact, other prospective cohort studies have found that coffee consumption is a component of a healthy lifestyle and reduced respiratory morbidity; as caffeine induces smooth muscle relaxation and bronchial dilatation, it may yield antiasthmatic effects.23It is important to consider that younger cohorts are not properly represented in the patient populations of the aforementioned studies; such findings may be more applicable for middle-aged or elderly populations who are more likely to possess cardiovascular and respiratory disorders.
CAFFEINE AS A MEDIATOR TO SOCIAL HEALTH
Coffee tends to be the caffeinated beverage of choice amongst students.3 Some studies have revealed that coffee’s popularity is not entirely rooted in reaping its physiological effects, but rather factors such as social gatherings, the enjoyment of coffee’s taste, or image enhancement.3In a study which explored the associations of demographics, health, and risk behaviors of young adults (aged 19-30 years) who drink energy drinks and coffee beverages, it was found that 39% of students consumed caffeine for social reasons.3 Another study found that tea consumption was more motivated by socialization than coffee.24 A suggestion for this finding was that tea may not provide motivation by nature of its caffeine content, but the socialization aspect comes from the brewing process in a pot, which has the capacity to serve multiple people and generate conversation.24 The results of this study may not be entirely generalizable, as the study population consisted of students from South Korea, whereby such results may only account for neighbouring regions. Besides the aforementioned study, there have not been any other indicative motivations to consuming caffeinated beverages for social purposes. However one study in rats observed quite the opposite presentation being antisocial behavior.25 Rats who were administered the highest dose of caffeine (60 mg/kg) had significantly reduced social interaction and motor activity, as the duration and frequency of avoidance-irritability behavior was dose-dependently increased by caffeine.25 Furthermore, besides coffee and tea, energy drinks also play a major role in caffeine usage amongst university students. One study found that the reason for its popularity lies with its “better taste” compared to other caffeinated beverage choices, but it has been found that coffee remains the healthier option.26 One study observed that high-end energy drink consumers reported increased drug and alcohol use, engagement of risky behaviour, sleep disturbances, and higher frequency of mental illness diagnoses than those who consumed fewer energy drinks, in an American private college.27 Results from this study suggest that university students who frequently consume energy drinks may be more likely to engage in riskier activities that may seemingly increase social acclaim among fellow students, yet pose an equal or greater risk to mental and physical health.
Caffeine consumption is widespread amongst university students. Findings from aforementioned studies show that coffee is the most popular caffeinated beverage, and caffeine consumption at certain levels may induce adverse effects to current or at-risk individuals with psychiatric, cardiovascular or respiratory disorders. As well, consumption of excess levels of caffeine (above health guidelines) pose serious or fatal effects to dimensional health. University students who frequently consume high doses of caffeinated energy drinks are likelier to exhibit riskier behaviour which can elicit harm to mental and physical health likewise. Ultimately, literature asserts that safe consumption of caffeine can provide more benefits than harm to mental, physical, and social health to healthy university students.
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