Dr. John Day, Cardiologist

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Is Caffeine Safe for the Heart?

New research reports that caffeine does not cause an irregular heart beat, palpitations, or heart arrhythmias.  Can we really believe the results of this new study?  Read on to see my answer to the question, is caffeine safe for the heart?

Mark’s Experience

Mark was a 46 year old man who came to see me for palpitations and a rapid heart beat.  Mark was tired all of the time.  The only thing that could get him through the long work day was Red Bull and Monster energy drinks.

He typically started off the day with a Red Bull.  In the afternoon, when energy levels were at the lowest, he would switch to Monster.  Sometimes, if he was really tired, he might add in a third energy drink or even a cup of coffee.

To identify the cause of his palpitations and rapid heart beat, I had him wear a heart monitor.  After just a few days it was obvious what was going on.

His palpitations clearly correlated with premature heart beats arising from his ventricles or PVCs.  The rapid heart beat coincided to short episodes of a heart arrhythmia called atrial fibrillation.

Fortunately, Mark’s stress echocardiogram and other tests were completely normal.

Knowing about the reported possible heart dangers of energy drinks, I asked him to stop the energy drinks.  I also encouraged him to eat healthier, exercise every day, and make sleep a priority.

When he came back to see me a month later, he reported that his energy levels were much better.  His symptoms were also completely gone.

Initially, I suspected it was the eliminating the caffeine from the energy drinks that did the trick.  I was surprised to find out that while he no longer drank energy drinks, he was now eating dark chocolate on most days.  With this new information, it became clear to me that perhaps caffeine was not the cause of his heart troubles.

Latest Study on Caffeine and Abnormal Heart Rhythms

This past week, a new study was published by my colleagues at the University of California, San Francisco  (UCSF) on the effects of caffeine to the heart’s rhythm.  As might be expected, as soon as this study was published, headlines around the world reported “Caffeine May Not Cause Palpitations.”

In this study, UCSF cardiologists recruited 1,388 participants in this study.  As part of this study, participants reported their coffee, tea, and chocolate intake.

To measure the effect of coffee, tea, and chocolate on the heart, participants also wore heart monitors to record every heart beat.  When UCSF cardiologists reviewed their heart monitors, they found no correlation between the number of irregular heart beats and caffeine intake.  In other words, regardless of their caffeine intake, it did not seem to affect how many premature atrial contractions (PACs) or premature ventricular contractions (PVCs) study participants had.

Limitations of this Caffeine Arrhythmia Study

Does this study mean that people who suffer from heart arrhythmias can have all the caffeine they want?  Not so fast.  This study leaves many questions unasnwered.  In my opinion, there are three big limitations of this study.

1. This was an observational study.

As an observational study we can’t conclusively say that caffeine from coffee, tea, or chocolate doesn’t cause heart arrhythmias.  All we can say is that, for whatever reason, the amount of caffeine consumed from coffee, tea, and chocolate in this study, did not seem to affect the number of irregular heart beats.

There could be other reasons why these study participants were not affected by caffeine.  Perhaps these people practiced mindfulness techniques, like meditation or yoga, to control stress and keep irregular heart beats at bay with increasing doses of caffeine.

2. This study did not include caffeine from other sources.

Study participants were only asked about coffee, tea, and chocolate consumption.  They were not asked about caffeine from other sources.  For example, researchers had no idea if study participants were also drinking Diet Coke or Red Bull.

3. This study did not compare fast versus slow caffeine metabolizers.

It is possible that most of the study participants were fast caffeine metabolizers.  For fast caffeine metabolizers, caffeine consumption has little affect on the heart.

Fast vs. Slow Caffeine Metabolizers

Does caffeine make it hard for you to sleep at night?  If so, then chances are that you are part of the 50% of people who have a genetic variant to your CYP1A2 gene.

Variations in the CYPA12 gene can cause you to metabolize caffeine more slowly.  Indeed, based on your genetics, there can be up to a 40-fold difference in how fast caffeine is metabolized in your body.

These genetic differences may explain why some studies report that caffeine may be dangerous to your heart and other studies, like the one discussed in this artice, report that caffeine is safe.  Indeed, other studies report that caffeine slow metabolizers can have up to a 64% increased risk of a heart attack depending on their caffeine dose.

Fortunately, less than 100 mg/day appears to be safe, even for caffeine slow metabolizers.  How much is 100 mg of caffeine?  A 100 mg dose of caffeine is approximately the equivalent of one cup of coffee, two cups of tea, three 12-ounce cans of soda pop, or four ounces of dark chocolate.

Why does medical science seem to be “flip flopping” on issues like coffee and caffeine?  This is likely because we have not taken into account genetic differences.  Just as everyone responds differently to medications, everyone responds differently to caffeine.

When it comes to caffeine metabolism, I am a slow metabolizer.  Fortunately, dark chocolate does not cause palpitations or arrhythmias for me.  While I love my dark chocolate, as a slow caffeine metabolizer, I must eat it first thing in the morning or I will have troubles sleeping at night.

The Big Picture

In the big picture of things, if you suffer from palpitations, arrhythmias, or heart problems should you or shouldn’t you consume caffeine?  Fortunately, this study suggests that if your caffeine source is coffee, tea, or chocolate you may be just fine.

One important thing to remember is that this study was just an average of 1,388 people.  I’m sure that of these 1,388 people, there were some whose heart’s were very sensitive to caffeine.  Perhaps these were the caffeine slow metabolizers?

While you could certainly have your genes tested to find out, as I described in a previous blog, perhaps an easier solution would be to just monitor how caffeine affects your body.  If caffeine causes palpitations or heart arrhythmias it would be best to avoid caffeine.  In contrast, if it doesn’t seem to bother you then it is probably OK unless your doctor tells you otherwise.

If you have heart problems or insomnia, try cutting out caffeine, or even setting a caffeine curfew of say 12 pm in the afternoon, to see if it makes a difference.  Perhaps you are like me in that caffeine is fine first thing in the morning.

How does caffeine affect you?  Please leave your comments below.  Also, if you have any questions about this article, please leave your questions below.  I will try to answer every question.

These chewy oatmeal bars make a yummy breakfast or a healthy snack–great for after school or on the go.  They can be made with or without sweeteners.  The bars are delicious plain, or can be adapted by adding any number of your favorite ingredients such as coconut, mashed ripe banana, almonds, pecans or walnuts (we love sprinkling the nuts on top to toast as the bars bake), peanut butter or almond butter, seeds, chopped dried fruit, dark chocolate chips, or anything else you’d like!

BASIC RECIPE (we use organic ingredients, when possible)

3 cups thick rolled oats

2 tsp. baking powder

1/2-1 tsp. salt

1 tsp. cinnamon (or more)

1 tbl. flax or chia seeds (or more)

1/2 c unsweetened applesauce

1 cup milk (we like almond or cow milk)

2 eggs beaten

1-2 tbl honey or agave or stevia to taste (if desired)

OPTIONAL ADD-INS:

Coconut

Mashed ripe banana

Pumpkin purée

Pumpkin spice or other spices

Almonds, pecans or walnuts (we love sprinkling nuts on top)

Seeds

Peanut butter or almond butter

Chopped dried fruit

Dark chocolate chips

DIRECTIONS:

Mix all ingredients together in a bowl with a spoon and pour into a greased 9×9 baking pan. Bake at 350 degrees for 35-40 minutes.

Chewy Oatmeal Bars

These chewy oatmeal bars make a yummy breakfast or a healthy snack--great for after school or on the go. The bars can be adapted by adding any number of your favorite ingredients.

Print Recipe Pin Recipe

Prep Time 10 minutes mins

Cook Time 35 minutes mins

Total Time 45 minutes mins

Servings 9 bars

Ingredients

  

• 3 cups thick rolled oats
• 2 tsp baking powder
• 1 tsp salt
• 1 tsp cinnamon
• 1 tbsp flax or chia seeds
• 1/2 cup unsweetened apple sauce
• 1 cup milk we like almond or cow milk
• 2 eggs
• 1-2 tbl honey or agave (if desired)
• or stevia to taste (if desired)

Instructions

 

• Mix all ingredients together and pour into a greased 9x9 baking pan. Bake at 350 degrees for 35-40 minutes.
• OPTIONAL ADD-INS: Coconut, mashed ripe banana, almonds, pecans or walnuts (we love sprinkling nuts on top), seeds, peanut butter or almond butter, chopped dried fruit or anything else you'd like to try!

Notes

<strong>BASIC RECIPE</strong> (we use organic ingredients, when possible)

3 cups thick rolled oats

2 tsp. baking powder

1/2-1 tsp. salt

1 tsp. cinnamon (or more)

1 tbl. flax or chia seeds (or more)

1/2 c unsweetened applesauce

1 cup milk (we like almond or cow milk)

2 eggs beaten

1-2 tbl honey or agave or stevia to taste (if desired)

<strong>OPTIONAL ADD-INS:</strong>

Coconut

Mashed ripe banana

Pumpkin purée

Pumpkin spice or other spices

Almonds, pecans or walnuts (we love sprinkling nuts on top)

Seeds

Peanut butter or almond butter

Chopped dried fruit

Dark chocolate chips

<strong>DIRECTIONS:</strong>

Mix all ingredients together in a bowl with a spoon and pour into a greased 9x9 baking pan. Bake at 350 degrees for 35-40 minutes.

I can find all sorts of reasons to eat. I don’t even need to be hungry!

Just this afternoon, I finished a very healthy and satisfying lunch, and it was time to go back to work. My first thought was, “I’m going to head out to the garage freezer and see if we have any chocolate out there.”

Having quite a bit of experience with this faulty thought process, I caught myself and asked, “Jane, are you really hungry?”

The answer: “No.”

“What do you really need right now?”

The answer: “I am tired but I feel I need to get back to work. I have so much to do. Instead of giving myself permission to rest for a few minutes, which is what I really need, I thought I’d try eating some chocolate and keep going.”

Aha! The truth!

I decided that I would honor my real need to rest for 20 minutes before I went back to work and assured myself that I could eat the chocolate later, if I still wanted it.

Rejuvenated, I went back to work, and made it through the rest of the day without feeling any pull from the chocolate.

This week, in our seminar, we explored the false promises of these sugary and fake foods.  They tell us that they will meet our needs, when really they just make us want more of them and less of what our minds and bodies really need.

When we look beyond the confusion of the labels and marketing of fake food products, it’s crystal clear that simply eating real food when we are hungry is the way to nourish our bodies.

So, why can’t we implement this knowledge and eat only real food only when we’re hungry?

Why are we lured in by these fake food products, often when we’re not even hungry?

The Top Ten Reasons We Eat

Here are ten of our favorite reasons to eat.  Do any of these sound familiar to you?

1. I am tired

“I am tired, so I think I’ll eat something.”

2. I am procrastinating

“I don’t want to do this, so I think I’ll eat something.”

3. I am happy

“I am happy! Let’s eat!”

4. I am sad

“I don’t want to deal with these feelings, so I think I’ll eat something”

5. I am thirsty and need water

“My body is sending me a signal that it needs something, I’d better eat.”

6. I am with people

“Here we all are with all this great food! Let’s eat!

7. I am alone

“I am alone—no one will see me eat this.”

-OR-

“I am lonely, maybe eating something will make me feel better.

8. I feel stuck

“I don’t see any other way to meet my needs right now, what can I eat to feel better?”

9. I see food

“Oh, that looks good! I wasn’t even hungry, but I think I’ll have just one.”

Our seminar participants came up with many more favorites, including: I’m bored, It’s family tradition, I’m stressed, I’m rewarding myself….

But, here’s the one real reason to eat that will actually meet our needs:

10. I am hungry

“I am looking forward to a nutritious, satisfying meal.”

Separating the Truth from the Lies

Here’s the lie in the first nine (or so) reasons to eat:

I can fix the problems in my life or make the good things better in my life by eating.

We can eat and eat and eat until we feel stuffed, but are never satisfied. Eating for these reasons can never satisfy us because we are not addressing the real issues.

Here’s the truth in the last reason, number 10–eating because we are hungry:

“My body is ready for nourishment. I am going to honor it and give it what it needs. I am going to be satisfied because I am eating for true hunger and giving it real food.”

When I eat for any reason other than hunger, more often than not, I turn to the fake and sugary foods which lie to my brain and lie to my body that they can meet my needs and that what I really need is more of these “foods.”

How to Interrupt the Cycle

The key to interrupting this cycle and developing healthier behaviors is to become aware of the cues that precede our reach for the unhealthy/unnecessary stuff, insert ourselves by asking a few questions, and provide ourselves with a different option that satisfies our true needs.

The last chapter of Charles Duhigg’s book, The Power of Habit offers a helpful formula. I highly recommend this fascinating collection of stories and case studies, which illuminates how habits develop and the enormous consequences that can result.

I also highly recommend Susan Albers’ Eating Mindfully for an in-depth exploration of the habits that trap us in emotional eating cycles and strategies to return to mindful eating.

Here are the three questions I’ve learned to ask myself when I feel the urge to grab something to eat:

1. Am I hungry–do I feel like eating real food?

If I am thinking about eating fake sugary food items, and I can’t think of something healthy and nourishing that I want to eat, the chances are high that I am looking to eat for reasons other than true hunger.

2. What do I need right now?

If I can’t think of something nourishing that I want to eat, I can ask myself what I am actually feeling and needing. More often than not, I am feeling tired or procrastinating doing something I know I need to do but don’t want to do.

3. What options can I give myself?

When I want to reach for junk food, I am usually in a situation where I feel I can’t meet my needs otherwise—usually at work. But there is always something I can do to interrupt this cycle. If I am tired, I can close my eyes and breath for a few moments and commit to giving myself time to rest or meditate when I finish a project. If I am looking for distraction, I can set a time for 5 minutes, go on a walk, listen to a podcast, call a friend, etc..

In each case, I can interrupt the cue-reward cycle with a question and an option. Then, I can invite myself to wait until I am actually hungry to eat and offer myself real food first.

Taking a minute to check in by asking myself these questions and giving myself other options dissolves the seeming desperate urge to eat foods I don’t need and enables the overall health and well-being I desire–one mindful choice at a time.

Please share with us! What have you found to be most helpful as you strive to eat mindfully?

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The Top 10 Benefits of Dark Chocolate

Did you know that chocolate could improve your cognitive function and increase your chances of winning a Nobel Prize?  Sounds strange, but these were the conclusions of a study published in the most prestigious medical journal, the New England Journal of Medicine.

As a recovering sugar addict, my new vice is dark chocolate.  I especially like it with almonds; the darker the chocolate the better.  Fortunately for me and for those of you who share this love of dark chocolate, there are literally hundreds and hundreds of medical studies supporting the idea that dark chocolate, in moderation, can be a healthy vice.

In this article I will discuss the pros and cons of dark chocolate and health.

Which dark chocolate is best? 

The higher the percentage of cacao the better.  To have any health benefits, dark chocolate needs to be at least 60% cacao (ideally 70% or higher).

Unfortunately, milk chocolate is not good for you as the cacao percentage is low and it contains mostly sugar.  Likewise, there are no health benefits from white chocolate.

Remember that chocolate is high in calories and even dark chocolate has added sugar.  Read the dark chocolate labels closely as the World Health Organization has recommended that the safe daily intake of sugar is approximately 25 grams each day.  The key is to only eat dark chocolate in moderation.

If you eat dark chocolate with carmel and other candy-like ingredients then it really just becomes candy and you are doing more harm than good.  Again, check the labels of dark chocolate with peanut butter or other fillings as they may contain transfats which can be deadly to the heart.  If you are going to eat dark chocolate, eat a pure form of it.

What quantity of dark chocolate is considered “moderate?”

One square of a bar, or about one ounce per day (definitely not the whole bar!), seems to be “moderate.”  In fact, in a study of nearly 20,000 people, there was a 39% reduction in heart attacks and strokes with dark chocolate consumption.  In this study, participants ate an average of about one square of a dark chocolate bar each day.

Naturally, the question arises: “What other factors may have been adjusted in this study population that could have contributed to this outcome?” This is always the challenge of doing clinical research.

For now, I’m hoping that the dark chocolate was a central factor.  If you want to read more about this study, click here.

If you like dark chocolate covered almonds, one ounce of dark chocolate is somewhere in the range of 8-12 pieces per day.  This is where I struggle. It is a challenge for me to stay within the framework that I need to.

The thing that keeps me honest is a food journal.  I record each chocolate almond I eat.  Otherwise, I’d be likely to eat the whole bag.

Is Dark Chocolate Healthy?

This study, which links dark chocolate consumption to heart attack and stroke reduction, adds to a growing body of evidence that dark chocolate, in moderate quantities, may indeed be heart healthy.  Below are additional benefits of dark chocolate based on medical studies.

1. Dark chocolate decreases your chance of cardiovascular disease by 39% as already discussed in this article.

2. Dark chocolate decreases your blood pressure by 1-3 mmHg.

3. Dark chocolate is high in antioxidants.

4. Dark chocolate improves arterial blood flow and may help to prevent plaque build up in the arteries.

5. Dark chocolate has a mild beneficial effect on cholesterol.

6 .Dark chocolate has a reasonable amount of protein, fiber, magnesium, iron, and zinc.

7. Dark chocolate may enhance mood, cognitive function, and memory.

8. Dark chocolate may help to keep your weight in check.

9. Dark chocolate may be anti-inflammatory.

10. Dark chocolate may increase your happiness.

Should you start eating dark chocolate for health reasons?

I would not recommend eating dark chocolate just for its health benefits.  For example, fruits and vegetables are packed with much more nutrition than dark chocolate.

However, if you have a sweet tooth or are a chocoholic, then having some dark chocolate in moderation can be a relatively guilt-free treat. Because I still experience strong sugar cravings, and am surrounded by sugary treats everywhere, eating dark chocolate is a compromise that helps me avoid giving in to less healthy alternatives.

This is a work in progress, and I’m sharing openly with you that this is where I currently am in my journey of sugar addiction recovery. I am finding the healthiest ways to make this work in my current daily environment.

My goal is to eliminate these cravings all together.  If I could give up any form of sugar, including dark chocolate, I know I could release the cravings all together.

I experienced this freedom from cravings when I lived in Asian communities such as Taiwan in the late 1980s and China’s Longevity Village in 2012 and 2013, where I did not have access to any “treats” of any kind.

What are the risks of dark chocolate?

Unfortunately, dark chocolate is not risk free.  Despite the benefits of dark chocolate, here is my list of potential health concerns with dark chocolate.

1. Dark chocolate is high in calories and contains added sugar.

2. Dark chocolate, or any form of chocolate, is highly addictive.

3. Caffeine.

For many of my patients, caffeine can trigger palpitations or other heart rhythm problems.  If caffeine triggers palpitations for you, you should avoid this. Also, the caffeine from dark chocolate can impair your sleep quality.

I have a strict rule that I never have any dark chocolate after 12 pm each day.  As long as I never have any dark chocolate after 12 pm I seem to sleep just fine at night.

It takes 4-6 hours for half of the caffeine to get out of your body.  Thus, if your bedtime is 10 pm, like mine, and you have some dark chocolate at 12 pm then about 25% of the caffeine will still be in your body when it is time to sleep (2 half lives).

4. Increased risk of kidney stones

5. Increased risk of acid reflux

If you suffer from kidney stones or acid reflux it would be best to minimize or avoid dark chocolate as well.

My Three Dark Chocolate Rules:

To help me “manage” dark chocolate, let me share with you my three rules.  Many of my patients have found these rules to be very helpful.

1. Limit the amount.

As dark chocolate is so addictive, it is absolutely critical to eat this in moderation.  Read the labels carefully.  In general, if you ensure that you never take in more than 25 grams of added sugar from any source, then your dark chocolate consumption will probably be reasonable.

2. The darker the better

Go for the real dark chocolate.  The higher the percentage of cacao the better.  My favorite is 80%.

3. Use dark chocolate to replace unhealthy sweets in your diet 

Probably the best use of dark chocolate is when it is used to replace unhealthy sweets in your diet.  Dark chocolate can be particularly effective when you are in a situation where you are surrounded by tasty sweets.  A little bit of dark chocolate can enable you to resist other foods that are more harmful to your body.