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For some reason, coffee reduces the pressure on this valve so that the highly acidic contents of the stomach are allowed to pass up into the esophagus.102
Obviously, there are cofactors. Overeating increases one’s risk to GERD, as does obesity, maldigestion, and lying down after eating. But the coffee factor is quite significant, as demonstrated by the fact that you can stimulate heartburn in a sizeable percent of perfectly healthy people just by giving them coffee.103
It was once thought that coffee-induced heartburn resulted from a hypersecretion of stomach acid, but it appears that the coffee-induced valve defect is the primary cause. Heartburn sufferers, in fact, have been found to produce less stomach acid when given coffee.104 I mention this in order to point out the folly of treating coffee-induced heartburn with antacids. Notwithstanding drug company hype, people don’t get heartburn due to an antacid deficiency.
The prudent approach to eliminating the problem (and not just masking the symptom) is to quit drinking coffee.
Of course, the coffee industry does its best to downplay the heartburn issue, and once again, the reasoning is along the lines of, “If coffee caused heartburn, everybody would be suffering.” But the truth is that, for unknown reasons, some people are just more sensitive than others. In addition, certain types of coffee appear to create more severe symptoms.105
IRRITABLE BOWEL SYNDROME
(IBS)
IBS is a common condition affecting approximately 20 percent of Americans.106
The complaints are constipation (perhaps alternating with diarrhea), abdominal pain (dull or crampy), bloating, abdominal rumbling, and flatulence. Now you might think with symptoms this common, researchers would have discovered the cause, but, once again, the picture is only now coming into focus. Brand-new evidence suggests strongly that there is a coffee connection involving two factors.
First is a group of rather caustic acids found in coffee. These acids, actually present at a higher level in decaf coffee, can irritate the GI tract directly, causing cramps, discomfort, and diarrhea. Second, there is GABA. Our last discussion of GABA (gamma amino butyric acid) focused on this biochemical’s role in mind, mood, and behavior, and how it acts as a natural stress reducer in the brain. “We now know that GABA is also produced in the gastrointestinal tract, for much the same purpose.
The GI tract is essentially a tubular muscle with a variety of bulges, twists, and turns. Material is moved from the stomach to the small intestine and on to the large intestine through a series of rhythmic contractions known as peristalsis.
Laxatives work by irritating the sensitive intestinal tissue, which triggers accelerated contractions. Actually, anything that irritates the GI tract will tend to have a laxative effect, and that includes anxiety. We all know the “gutwrenching” feeling of stress.
So nature placed in this system a large number of cells to manufacture GABA, as well as receptors for GABA that would calm the GI tract.107–108, 109
From Chapter 4, we know that caffeine interferes with GABA metabolism,110
and this explains why people with IBS experience a worsening of symptoms when they drink coffee, as well as the widely variable effects of coffee from person to person.
Scientists are now referring to the complex network of immune and nervous
system cells within the intestinal tract as the “brain of the gut.”111 Stress is perceived differently by different people, and its effects throughout the body reflect this difference. What you must know is that coffee lowers the stress threshold in your GI tract just as it does elsewhere in your body and mind.
GABA is the neurochemical that is supposed to keep your GI tract functioning at “normal,” and the combination of stress and caffeine overrides that GABA message, creating the symptoms of IBS and possibly much worse. Colitis has been positively linked to anxiety and stress,112 and animal research has found that the GABA receptors are a first-line defense against colon cancer.113
THE ULCER STORY
You’ve probably heard that caffeine and stress don’t really cause ulcers, that the real cause is a bacteria known as Helicobacter pylori (H. pylori). Here’s an intriguing fact: H. pylori is an extremely common bacteria. Millions of Americans test positive for this organism, and by age seventy,80 percent of the population has been infected, yet only 10 percent develop ulcers.114
Obviously, there must be other risk factors, and any investigation will quickly identify stress, caffeine, and coffee. Coffee contributes to ulcer formation in a number of ways. The harsh acids are a direct factor and, as mentioned, these acids are higher in decaf coffee. But caffeine itself is a problem because it stimulates acid secretion in the stomach and interferes with the protective action of GABA. In fact, coffee, tea, and soft drinks have all been shown to stimulate acid secretion, especially when consumed on an empty stomach.115, 116
We also know that caffeine and chronic stress elevate blood levels of cortisol, which suppresses a number of immune functions, including production of secretory IgA. As we have learned, slgA is a powerful antimicrobial agent, especially effective against guess what? H. pylori!117 That means that when IgA levels are low, H. pylori is allowed to proliferate and cause ulcers. When IgA levels are high, H. pylori and other pathogens in the mouth, throat, and gastrointestinal tract are quickly destroyed. When viewed in this way, H. pylori is actually a secondary risk factor. Stress, caffeine, elevated cortisol, and suppressed IgA production are the primary factors contributing to ulcer risk.
Unfortunately, the modern drug-oriented approach to ulcers is simply a course of antibiotics and acid inhibitors. They may help in the short run, but if nothing is done to reduce cortisol and restore IgA production, the condition will
recur. This is just one more example of “Band-Aid” health care ignoring the underlying cause of disease. Consider that in research predicting the incidence of ulcers in a large population, stress is the most significant factor.118 And in research evaluating the drug-oriented approach to ulcer healing, the single most predictive factor for successful healing is the patient’s anxiety level. In one study, those experiencing high levels of anxiety had a 400 percent increased risk for incomplete healing compared to those with low stress.119
It’s an amazing but all-too-familiar scenario: Joe Executive goes to his doctor for his yearly physical. Joe’s blood pressure is increasing, he’s not sleeping well, and he has lots of discomfort after meals, and he uses antacids almost daily for the resulting heartburn. Caffeine is a known factor in all of these conditions, but his doctor doesn’t even ask how much coffee Joe is drinking. There are two reasons for this: (1) It would involve a discussion, and today the average office visit with a primary care physician is twelve minutes and (2) the doctor is drinking four cups of coffee a day himself. He or she hasn’t read the medical literature regarding caffeine and doesn’t believe it’s really doing anyone harm.
Six months later, Joe returns. His intestinal pain has increased, and he reports sharp stomach pain that gets slightly better when he eats. The doctor springs into action, writing prescriptions for a drug that will prevent Joe’s stomach from producing digestive acid, and an antibiotic to kill H. pylori. Joe leaves the office thinking that he has received health care. But the fact is that Joe’s suffering was not caused by a deficiency of ranitidine, sucralfate, amoxicillin, omeprazole, tetracycline, azithromycin, metronidazole, or any of the other drugs currently in use. All of these medications have side effects, and there is even evidence that chronic suppression of acid secretion can increase one’s risk for gastric cancer.
(Remember that stomach acid is an important part of gastrointestinal immunity.) Please understand that I am not suggesting that one ignore an H. pylori infection. But evidence clearly indicates that drug treatment alone is frequently ineffective, precisely because it does not deal with the root problem. In fact, if dietary and lifestyle issues are not addressed, research shows that reinfection can be as high as 73 percent.120 To get an idea of how shortsighted the drug-on
ly approach is, imagine that Joe went to a fortune-teller before his first physical: Fortune-teller: “You are suffering from severe indigestion and heartburn.”
Joe: “That’s right, I am.”
Fortune-teller: “This is caused by stress, poor eating habits, and excessive coffee consumption. But your doctor will overlook these factors. Instead he will wait for your symptoms to become worse. In the meantime, a pathogenic
bacteria will grow within your body and begin to eat away at your insides. This will cause open wounds in the extremely sensitive tissue of your intestinal tract, resulting in internal bleeding and acute pain. You will try to dull that pain with antacids, but it will become so bad you will return to the doctor, who will give you drugs. The therapy will include anywhere from two to four different drugs and the rate of success with this approach can be as low as fifty-three percent.”121
Joe: “Wait a minute. That means I have nearly a fifty percent chance of not killing this bacteria?”
Fortune-teller: “That’s right, and if the first course of drugs does not work, your doctor will try a second treatment plan using more powerful drugs at a higher dose. Of course, it is almost a certainty that the bacteria will have developed antibiotic resistance after the first course, so your chance of success grows smaller with each additional trial.”
Joe: “Isn’t there anything I can do?”
Fortune-teller: “Sure there is. Stop drinking coffee, tea, and soft drinks. Eat slowly and chew well. Eat smaller, more frequent meals, start an exercise program and make it a regular habit, learn a stress management technique and take some time off, sign up for a yoga class and learn the breathing exercises.
Make sure to get at least eight hours of sleep a night, and slow down! Life’s too short to suffer with internal bleeding from a perforated intestinal tract.”
A FINAL NOTE CONCERNING ULCERS
Coffee promoters have done a good job of whitewashing the ulcer issue, often relying on the argument, “If coffee caused ulcers, everyone who drinks coffee would get one.” The fact of the matter is that coffee doesn’t “cause” ulcers, but once again, there is a continuum of gastrointestinal health with optimal function on one end, all the way to heartburn, irritable bowel, colitis, ulcers, and colon and rectal cancer at the other extreme. Where are you now and where do you want to be? Do you experience stomach or digestive problems more than a few times a month? If so, and if you are a coffee drinker, you may be heading for trouble. Keep in mind also that when coffee is administered to laboratory animals, in moderate but repeated doses similar to what humans consume, it produces “pathological changes in the gastrointestinal tract and ultimately ulcer formation.”122
OTHER GASTROINTESTINAL RISK FACTORS
Temperature
Most people drink their coffee piping hot, and the resulting increase in gastrointestinal temperature has been shown to contribute to upper GI tract disorders.123
Food Allergy or Intolerance
Some individuals appear to be allergic to coffee (or possibly the chemicals it is treated with), and this can increase the adverse effects associated with the beverage.124
The Melatonin Connection: Intriguing New Research
In Chapter 3, I described the critical role played by melatonin in regulating immunity and sleep. I presented evidence that caffeine and coffee, especially when combined with other stressors, significantly reduce melatonin levels.125
In addition to being a primary neurohormone produced by the brain, melatonin is manufactured by a large number of cells in the gastrointestinal tract —another facet of the “brain of the gut.” And melatonin’s effect on the GI tract is more than calming. Researchers believe that melatonin’s principal role in the GI tract is to promote healing and boost immune defense. New studies show that melatonin is particularly effect against stress-induced injury to the sensitive lining of the intestinal tract and stomach.126 Not only is melatonin essential for the protection of this tissue, but it has also been shown to enhance tissue DNA synthesis, indicating that it is also an agent for repair and cancer prevention.127
We are finally understanding that the gastrointestinal tract is an incredibly complex and sensitive environment. So much of our health depends upon maintaining the right balance of acids, enzymes, and hormones. Moreover, this biochemical balance must be matched by the proper mechanical function of valves, muscles, and organs.
When we eat natural foods (the foods this system was designed for) and consume these foods in reasonable quantity at a reasonable pace, things tend to go quite well. But today’s diet presents a level of digestive challenge unknown in human history. For eons, the only beverage humans consumed was water.
in human history. For eons, the only beverage humans consumed was water.
Today, Americans consume more soft drinks than any other liquid, and most of that is caffeinated. What’s more, we consume coffee and tea in prodigious amounts, and then wonder why we don’t feel well.
Of course, I’m not saying that everyone who drinks coffee is going to suffer with gastrointestinal problems, but many people do, and they usually don’t make the connection. In clinical practice, I saw hundreds of patients whose irritable bowel syndrome, colitis, food allergy, gastritis, heartburn, bloating, and abdominal pain improved or healed completely once they got off coffee. I concur with the advice given by Dr. Henry D. Janowitz, author of Good Food for Bad Stomachs: “People with stomach ailments should avoid coffee and other caffeinated products.”128
Oh My Aching Back (and Wrist and Shoulders and …)
For years I had a practice in a comprehensive medical group that included physicians, chiropractors, psychotherapists, and massage therapists. Usually I could tell by looking at a patient’s chart if he or she needed to be referred to massage therapy. Experience told me that habitual caffeine users were very likely to be holding enough tension in their muscles to cause a significant amount of discomfort and pain. And I was right 95 percent of the time, even when pain was not one of the patient’s listed complaints.
I am still amazed at the amount of pain that people become accustomed to living with. After a while, we just sort of get used to it, assuming that it is an inevitable part of growing older. Therapeutic massage, of course, brings pain and tension to the “surface” of our awareness, and often prompts us finally to take steps to alleviate this suffering. Many, however, simply keep returning to the massage table instead of eliminating the underlying cause.
The first step I recommend for someone experiencing chronic muscular tension is to get off caffeine. Massage therapists, chiropractors, and physical therapists—anyone who works physically with a patient’s body—can always tell a difference when the patient gets off caffeine. For many, that step alone will reduce pain to a remarkable degree. Others need bodywork or yoga to release the deep level of tension that we all tend to accumulate as we go through the trials and challenges of life.
It helps to understand that tension is simply part of the stress response left over from Paleolithic days when stress meant imminent peril. When faced with a fightor-flight situation, tension helped to steel the body against injury. But it’s
fightor-flight situation, tension helped to steel the body against injury. But it’s no longer a survival asset. Tension today destroys our sense of ease. It creates a level of pain that may flare up or smolder, but either way, it diminishes the quality of life.
If you suffer from chronic pain and your physician has not recommended you stop drinking caffeine, it’s probably because he or she has been told caffeine is a muscle relaxant. That is partly true, in that certain muscles in the body do relax in response to caffeine, but these are only the smooth muscles, such as those lining the airways. The vast majority of skeletal muscles contract in response to caffeine, and those are the ones that ultimately produce tension-derived pain.
Very often, muscle tension combines with other factors, such as inflammation, to cause pain. Such is the case with a common condition known as carpal tunne
l syndrome (CTS) in which pain is produced by a narrowing of the nerve channel in the wrist. CTS sufferers wear wrist splints, take painkillers, often resort to surgery, and frequently none of those treatments is effective.
That’s because the underlying muscular tension must be reduced, and that won’t happen as long as the individual is drinking caffeine.
In a study of nearly 1,500 office workers, caffeine use was found to be a primary risk factor for CTS. In fact the correlation of caffeine use and this affliction held in both directions. In other words, people who did not use caffeine had very low risk for CTS and those who used caffeine had the highest risk.
Since cigarette smoking is associated with caffeine use (and could confuse the issue), the researchers removed from the data anyone who smoked. Even then, caffeine remained a primary risk factor.129
Other research with chronic back pain illustrates the same association. In one study, individuals with chronic back pain were found to be consuming an average of nearly 400 milligrams of caffeine per day, while matched controls (people the same age and occupation without back pain) averaged less than half that amount.130 Of course, this does not prove that caffeine causes the pain. It is possible that pain sufferers turn to caffeine to help manage pain.
To clear up that possibility, researchers administered caffeine to volunteers and found that in fact, caffeine produced head and neck pain in a significant percent of volunteers.131 This would tend to confirm that caffeine is a contributing cause of pain syndromes from carpal tunnel to neck, shoulder, and back pain.
