I get a lot of calls from people who are seeking help with stress and anxiety. If you are feeling stressed, anxious, or irritable beyond what seems appropriate for the situations you are in, it might pay to look at your caffeine consumption. Although some homeopathic practitioners advocate complete abstinence from coffee, my more realistic expectation is that we should weigh the effects before throwing out the baby with the bath water.

I love good coffee and, in general, America is a nation of coffee drinkers. Starting twenty-five years ago, I always noticed that drinking coffee was mentioned or depicted in almost every American film. That's one trend that has not changed in our culture. People who are totally unconscious about their diet as well as health conscious people consume coffee on a regular basis. The preparation and serving of coffee has risen to an art form in the USA - and a very expensive one at that.

Although I don't advocate stopping coffee or other caffeine completely, it is a good idea to find out what your tolerance level is. Most people know when they've had too much due to a jumpy, uncomfortable feeling. I think there's also a level where we've had too much caffeine but don't realize that's what's causing our problems.

Caffeine has a structure that is very similar to adenosine, so it binds to the adenosine receptors instead. This causes two things. (1) The activity in your cells does not decrease; it increases. (2) The blood vessels in your brain constrict. Your body sees all this increased activity, and it thinks that it's in danger. So the pituitary gland sends messages to the adrenaline gland to produce adrenaline. The adrenaline causes your heart rate to increase and your liver to release more sugar into your bloodstream so that you have more energy.

This process brings up a lot of questions as to whether caffeine consumption adds to adrenal exhaustion, problems with sugar metabolism, and increased heartbeat. If your caffeine consumption caused your heart to beat 2 beats a minute faster averaged throughout the day, that's only 120 beats extra an hour. Unfortunately that small increase adds up to 2,880 beats extra a day, 20,160 beats a week, 86,400 beats a month, or 1,051,200 beats a year. That's quite a bit of extra work for the old ticker.

Medical doctors now acknowledge the association between caffeine and breast lumps. If you have fibrocystic breasts, it pays to cut down or cut out caffeine to see if the condition will get better. Many women that I work with report that PMS symptoms are reduced as they reduce their caffeine. Stress or urge incontinence can be dramatically worsened by caffeine. Chronic headaches can be caused by too much caffeine and many headache sufferers will tell you that a hot cup of coffee at the onset of a headache will often stop a headache in its tracks. At the opposite end of the spectrum, if you are used to having caffeine every day, rapidly withdrawing can cause a bad headache.

My suggestion is to use caffeine consciously. Enjoy it but also be aware that it is essentially a drug and when you are using it, it pays to watch its effects. The fact that it is used widely and without much thought, doesn't mean that you can handle it well. If your stress is too high, look first at your caffeine consumption and adjust it accordingly.

On the back page is a list of the caffeine content in many things that you may be using. Check the list to get an idea of how much caffeine you are using a day. Don't forget that foods, drinks, and medications can all contain caffeine. I was interested to see how many things with caffeine I had allowed my young children to have without realizing the caffeine content.

Shall we plan to have a cup of coffee together soon? Please remember that as spring arrives, it's a good time to think about getting a real constitutional follow-up. Especially for those of you who just check in with me on an intermittent basis, it may be time to take a half hour to take a more structured look at your health. If you suffer from seasonal allergies, it makes a lot of sense to get constitutional care before allergy season is in full swing. Call me or e-mail me to set up a day or night appointment.

Product	Serving Size	Caffeine (mg.)
NoDoz, maximum strength; Vivarin	1 tablet	200
Excedrin	2 tablets	130
NoDoz, regular strength	1 tablet	100
Anacin	2 tablets	64
Midol	1 tablet	64
Darvon	1 tablet	40
Tylenol and Aspirin	1 tablet	0

Product	Serving Size	Caffeine (mg.)
General Foods International Coffee, Orange Cappuccino	8 oz.	135
General Foods International Coffee, Cafe Vienna	8 oz.	102
Maxwell House Cappuccino, Mocha	8 oz.	65
General Foods International Coffee, Swiss Mocha	8 oz.	55
Maxwell House Cappuccino, French Vanilla or Irish Cream	8 oz.	50
Maxwell House Cappuccino, Amaretto	8 oz.	30
General Foods International Coffee, Viennese Chocolate	8 oz.	26
Maxwell House Cappuccino, decaffeinated	8 oz.	6
Coffee, decaffeinated	8 oz.	5

Product	Serving Size	Caffeine (mg.)
Celestial Seasonings, Iced Lemon Ginseng	16 oz.	100
Bigelow, Raspberry Royale	8 oz.	83
Tea, leaf or bag	8 oz.	50
Snapple Ice Tea, all varieties	16 oz.	48
Lipton Natural Brew Ice Tea Mix, unsweetened	8 oz.	45
Lipton Tea	8 oz.	40
Lipton Ice Tea, assorted varieties	16 oz.	40
Lipton Natural Brew Ice Tea Mix, sweetened	8 oz.	35
Nestea Pure Sweetened Ice Tea	16 oz.	34
Tea, Green	8 oz.	30
Arizona Ice Tea, assorted varieties	16 oz.	30
Lipton Soothing Moments Blackberry	8 oz.	25
Nestea Pure Lemon Sweetened Ice Tea	16 oz.	22
Tea, Instant	8 oz.	15
Lipton Natural Brew Ice Tea Mix, Diet	8 oz	15
Lipton Natural Brew Ice Tea Mix, decaffeinated	8 oz.	15
Celestial Seasonings Herbal Tea, all varieties	8 oz.	0
Celestial Seasonings Herbal Ice Tea, bottled	16 oz.	0
Lipton Soothing Moments Peppermint Tea	8 oz.	0

Product	Serving Size	Caffeine (mg.)
Mountain Dew	12 oz.	55
Surge	12 oz.	51
Diet Coke	12 oz.	47
Coca Cola	12 oz.	45
Dr Pepper, regular or diet	12 oz.	41
Sunkist Orange	12 oz.	40
Pepsi Cola	12 oz.	37
Barq's Root Beer	12 oz.	23
7-Up, regular or diet	12 oz.	0
Barq's Diet Root Beer	12 oz.	0
Minute Maid Orange	12 oz.	0
Mug Root Beer	12 oz.	0
Sprite, regular or diet	12 oz.	0

Product	Serving Size	Caffeine (mg.)
Hershey's Dark Chocolate Bar	1.5 oz.	31
Hershey's Milk Chocolate Bar	1.5 oz.	10
Hot chocolate or cocoa	8 oz.	5