Caffeine and homoeopathy

Dr Pratibha Raturi¹, Dr Shweta Singh¹, Dr Farazi Mirza¹, Dr Such Sushil¹

INTRODUCTION
Caffeine is the most widely used mood-altering drug. Today, caffeine use remains ubiquitous. In fact, caffeine ingestion is woven so intricately into social customs and daily rituals that it is often not perceived as a drug, despite its well-documented pharmacologic effects. Caffeine occurs naturally in a variety of plant-based products including coffee, tea, cocoa, kola nut, guarana. Caffeine is generally considered to be safe relative to classic drugs of dependence. However, caffeine is not a completely innocuous drug. Caffeine can produce tolerance and a characteristic withdrawal syndrome, and heavy use (>400 mg per day) is associated with increased risk for various health problems. Caffeine can cause discrete psychopathology (e.g., caffeine intoxication, caffeine induced anxiety disorder), exacerbate existing psychopathology (e.g., anxiety, insomnia), and interfere with the efficacy of some medications (e.g., benzodiazepines).

HISTORY
Caffeine was first isolated from coffee in 1820 and tea in 1827, and its chemical structure was first characterized in 1875. Tea was first cultivated in China, coffee in Ethiopia, guarana, cocoa, and maté in South America. The word coffee is believed to have been derived from the Arabic word “qahwa,” which historically referred to wine. According to legend, coffee was discovered after an Arabian goatherd observed his goats eating berries and subsequently behaving in an energetic manner. The technique of roasting and grinding coffee beans for beverage preparation was developed in Arabia by the fourteenth century. Soft drink consumption has increased steadily over the last century and has become a significant source of caffeine use among individuals of all ages.

THERAPEUTIC USES
As a mild central nervous stimulant, caffeine is commonly taken as an energy and alertness enhancer. Studies clearly demonstrate that caffeine is effective at restoring performance that has been degraded by fatigue. Caffeine is also used to enhance athletic performance because of its ergogenic effects. There is evidence to suggest that caffeine functions as an analgesic adjuvant, and it is added to a wide variety of over-the-counter and prescription analgesics used to treat various types of pain including headache. Caffeine, a cerebral vasoconstrictor, is the most effective treatment for caffeine withdrawal headaches, which are likely caused by rebound cerebral vasodilation in response to the absence of caffeine. Likewise, prophylactic administration of caffeine prevents postsurgical caffeine-withdrawal headaches.

PHARMACOKINETICS
After oral consumption, caffeine is rapidly and completely absorbed. Caffeine enters the brain rapidly, which accounts for the quick onset of mood-altering effects Peak caffeine blood levels are generally reached in 30- 45 minutes, but can be delayed by recent food consumption. Caffeine is highly lipid soluble and is widely distributed throughout all body tissues and fluids, including amniotic fluid, breast milk, and semen. The primary metabolic pathways involve the P450 liver enzyme system, which carries out the demethylation of caffeine to three pharmacologically active dimethylxanthines: paraxanthine, theophylline, and theobromine. The half-life of caffeine is typically 4 to 6 hours; however,the rate of caffeine metabolism is quite variable among individuals and can vary more than tenfold in healthy adults. Tobacco smoking increases the metabolism of caffeine as a consequence of stimulation of liver enzymes,with smokers metabolizing caffeine about twice as fast as nonsmokers. Caffeine metabolism is slowed in pregnant women and in individuals with liver disease. The liver enzyme systems of infants are not fully developed until about 6 months of age and thus caffeine metabolism in infants is very slow, with a half-life of 80 to 100 hours.

PHYSIOLOGIC EFFECTS
Caffeine produces effects on a wide variety of organ systems. At moderate dietary doses, caffeine increases blood pressure and tends to have no effect or to reduce heart rate.

SUBJECTIVE AND DISCRIMINATIVE STIMULUS EFFECTS
Acute doses of caffeine in the typical dietary dose range (i.e., 20 mg to 200 mg) produce a number of positive subjective effects, including increased well-being, happiness energy, alertness, and sociability.

CAFFEINE AND ANXIETY
Acute doses of caffeine generally greater than 200 mg have been shown to increase anxiety ratings in nonclinical populations, with higher doses sometimes inducing panic attacks. Individuals with anxiety disorders tend to be particularly sensitive to the effects of caffeine. Experimental studies demonstrate that caffeine exacerbates anxiety symptoms in individuals with panic disorder and generalized anxiety disorder to a greater extent than healthy control subjects. Interestingly, individuals with high caffeine consumption have greater rates of minor tranquilizer use (e.g., benzodiazepines) relative to those persons with low to moderate caffeine consumption, although the mechanism underlying this association has not been established. Caffeine-induced anxiety disorder is characterized by prominent anxiety, panic attacks, obsessions, or compulsions etiologically related to caffeine use.

CAFFEINE AND SLEEP
It is well documented that caffeine increases wakefulness and inhibits sleep onset. Perhaps the most widely accepted therapeutic use of caffeine, which has been widely studied, is that caffeine increases wakefulness and decreases performance decrements produced by sleep deprivation. Of course, caffeine also has detrimental effects on planned sleep (i.e., insomnia). Caffeine ingested throughout the day or before bedtime has been shown to interfere with sleep onset, total time slept, sleep quality, and sleep stages.

CAFFEINE AND HEALTH
The possibility that caffeine may pose health risks is of great interest to the general public and scientific community, and has been the focus of numerous studies There is no evidence for nonreversible pathologic consequences of caffeine use (e.g., cancer, heart disease, congenital malformations). In general, there is a lack of evidence to support the conclusion that moderate caffeine use causes significant health risk in healthy adults. However, some groups may be considered at risk for poten- tial adverse health effects of caffeine including individ- uals with generalized anxiety disorder, panic disorder, primary insomnia, hypertension, and urinary inconti- nence; women who are pregnant or trying to become preg- nant; and caffeine users who consume inadequate amounts of calcium. In addition, as discussed in more detail throughout this chapter, caffeine use can be associated with several distinct psychiatric syndromes: caffeine intoxica- tion, caffeine withdrawal, caffeine dependence, caffeine- induced sleep disorder, and caffeine-induced anxiety disorder.

CAFFEINE AND BLOOD PRESSURE
Role of caffeine in case of blood pressure increase is very evident. It is very common among general people to drink coffee to elevate their blood pressure for a sudden drop in it. The majority of medical professionals recommend for their blood pressure checked before having caffeinated beverages. This conventional wisdom stems from the idea that caffeine elevates blood pressure to the point where it tampers with an accurate reading. However, medical research has been ambiguous, few of them relates it to hypertension while some of them not.¹
Younger people are more sensitive to coffee, and it does elevate blood pressure in those who are not used to it, but not in frequent coffee consumers. Furthermore, components other than caffeine appear to be responsible for coffee’s hypertensive effects. Normal coffee users get adjusted to these components and experience an abrupt increase in pressure after consuming normal or decaf; nevertheless, those who aren’t accustomed to coffee are likely to experience a transient rise in pressure after consuming either type of coffee.¹

CAFFEINE AND BLOOD SUGAR
There are multiple studies that suggest that caffeine intake is somehow related to glucose metabolism. Coffee consumption has many good or bad effects on various chronic diseases. In a Research, published in PubMed they have studied the effect of coffee consumption on glucose metabolism and they have found some good relation between them. Research indicates that having three to four cups of coffee a day is linked to a roughly 25% decreased risk of type 2 diabetes when compared to not drinking any coffee at all or fewer than two cups. Furthermore, in the four years that followed the risk of T2DM decreased by 11% for those who increased their coffee use. Individuals who reduced their daily coffee consumption by more than one cup were shown to have a 17% increased risk of type 2 diabetes within four years.²

CAFFEINE AND THYROID FUNCTIONING
There are numerous evidences that can tell us regarding the alteration in blood pressure and blood sugar levels after caffeine consumption, but we barely find any clear relation between caffeine and thyroid functioning. We have found a pilot study on caffeine and thyroid functioning and this study tells us that those who drank two to four cups of coffee a day showed noticeably lower TSH levels than those who abstained from coffee use. Furthermore, there was no correlation found between coffee consumption and the incidence of hypo- and hyperthyroidism.³

REPERTORIAL APPROACH WITH KENT REPERTORY

• [Kent ] [Mind]Irritability (see anger): Coffee,after: 1:Calc-p
• [Kent ] [Mind]Sensitive, oversensitive:Coffee,after: 3:Cham
• [Kent ] [Vertigo] Coffee:Amel: 1: Cann-i
• [Kent ] [Head]Congestion hyperaemia: Coffee, from 2: Cact  2:Rumx
• [Kent ] [Head]Heaviness pressing): Coffee,strong amel: 1:Corn
• [Kent ] [Head]general:Coffee: From: 2: Bell: Bry: Cham: Cocc: Guare: Ign: Nux-v:Puls
• [Kent ] [Head]Weakness: Coffee,after: 2:Cham
• [Kent ] [Ear]Heat:Afternoon:After coffee: 1:Nat-m
• [Kent ] [Nose]Odors,imaginary and real:Coffee,of: 1:Puls
• [Kent ] [Face]Pain(aching,prosopalgia,etc.):Coffee:After abuse of: 2:Nux-v
• [Kent ] [Face]Pain (aching,prosopalgia,etc.):Tearing:Coffee,after abuse of: 2:Nux-v
• [Kent ] [Mouth]Taste:Bitter:Coffee:After: 2:Cham 1:Puls
• [Kent ] [Mouth]Taste:Wanting tastelessness of :Coffee: 1:Nux-v
• [Kent ] [Teeth] Pain,toothache in general:Coffee,from: 3:Cham
• [Kent ] [Stomach] Aversion:Coffee: 3:Calc  3:Nux-v
• [Kent ] [Stomach] Desires: Coffee: 3:Ang
• [Kent ] [Stomach]Nausea:Coffee:Smellof: 1:Arg-n
• [Kent ] [Stomach]Pain:Coffee,after: 3:Cham
• [Kent ] [Stomach]Pain:Cramping,griping,constricting:Coffee drinkers,in: 2:Cham 2:Nux-v
• [Kent] [Stomach]Pain:Pressing:Coffee,after: 2:Cham
• [Kent ] [Stomach] Vomiting:Coffee, after: 2:Cham
• [Kent] [Stomach] Vomiting: Bitter:Coffee,after: 2:Cham 
• [Kent ] [Stomach] Vomiting: Brownish: Evening,after :Coffee:  1:Verat
• [Kent ] [Stomach] Vomiting:Coffee grounds,like: 3:Cadm  3:Phos
• [Kent] [Stomach] Vomiting:Mucus:Morning: After coffee: 2:Cham
• [Kent ] [Stomach] Vomiting: Mucus:Evening: Coffee,after:  1:Verat
• [Kent] [Stomach] Vomiting:Mucus:Coffee,after:  2:Cham
• [Kent ] [Abdomen] Fullness,sensationof:Coffee,after: 1:Canth
• [Kent ] [Abdomen]Pain:Aching,dull pain (see Boring,Gnawing,etc.):Coffee:Amel: 3:Coloc
• [Kent ] [Abdomen] Pain:Aching,dull pain (seeBoring, Gnawing,etc.):Sides:Coffee,after: 2:Cham
• [Kent ] [Rectum]Constipation (see inactivity):Coffee,after: 2:Mosch
• [Kent ] [Rectum] Diarrhoea:Coffee:Smell of,after: 1:Sul-ac
• [Kent ] [Rectum]Diarrhoea:Coffee:Amel: 2:Coloc
• [Kent] [Rectum]Pain:Tenesmus:Coffee,after: 2:Nat-m
• [Kent ] [Rectum] Urging,desire (see tenesmus):Coffee, after: 1:Nat-m
• [Kent ] [Urine]Sediment: Coffee grounds,like: 3:Apis  3:Hell
• [Kent ] [Respiration] Difficult:Coffee,from: 2:Bell  2:Cham
• [Kent ] [Respiration] Impeded, obstructed: Coffee, after: 2:Cham
• [Kent ] [Cough] Coffee :Odour of: 1:Sul-ac
• [Kent] [Chest]Palpitation, heart:Coffee,after: 3:Nux-v
• [Kent ] [Back]Pain:Coffee agg: 2:Cham
• [Kent ] [Chill]Chilliness (see generalities,cold):Coffee,abuse of: 2:Cham  2:Nux-v
• [Kent ] [Generalities]Food:Coffee :Amel:  3:Cham
• [Kent ] [Generalities]Food:Coffee :Odour of,agg: 1:Sul-ac

HOMOEOPATHIC THERAPEUTICS RELATED TO CAFFEINE:

• Angustura vera- Irresistible desire for coffee. Pain from navel to sternum
• Coca- Longing for alcoholic liquors and tobacco, for the accustomed stimulants. Was first used as a tobacco antidote.
• Cyclamen europaeum- Diarrhoea after every cup of coffee; hiccough.
• Cantharis vesicatoria- Aggravation from drinking coffee; drinking the smallest quantity increases pain in the bladder and is vomited.
• Cadmium sulphuratum- Coffee ground vomiting (hematemesis). carcinoma, helps persistent vomiting. Burning and cutting pain in stomach.
• Chamomilla- oversensitive from use or abuse of coffee or narcotics. Toothache if anything warm is taken, from coffee.
• Cannabis indica- worse, morning; from coffee, liquor and tobacco; lying on right side.
• Guarana- sick headaches in people who have used tea and coffee in excess.
• Ignatia amara- aggravation- from tobacco, coffee, brandy, strong odors. Toothache worse after drinking coffee and smoking
• Nux vomica- bad effects of coffee, tobacco, alcoholic stimulats; highly spiced or seasoned food.
• Oxalic acid- Stitches in liver. colic. Diarrhoea from coffee. burning in small spots in the abdomen.
• Sulphuric acid- Aversion to the smell of coffee. sour vomiting.

REFERENCES:

	Coffee and your blood pressure [Internet]. Harvard Health. 2022 [cited 2024 Mar 22]. Available from: https://www.health.harvard.edu/heart-health/coffee_and_your_blood_pressure
	Reis CEG, Dórea JG, da Costa THM. Effects of coffee consumption on glucose metabolism: A systematic review of clinical trials. J Tradit Complement Med [Internet]. 2019 [cited 2024 Mar 22];9(3):184–91. Available from: http://dx.doi.org/10.1016/j.jtcme.2018.01.001
	Zhao G, Wang Z, Ji J, Cui R. Effect of coffee consumption on thyroid function: NHANES 2007-2012 and Mendelian randomization. Front Endocrinol (Lausanne) [Internet]. 2023 [cited 2024 Mar 21];14. Available from: http://dx.doi.org/10.3389/fendo.2023.1188547 Arnaud M.J. Metabolism of caffeine and other components of coffee. In: Garattini S., editon Caffeine, coffee and health. New York: Raven Press; 1993. pp. 43-95. Fredholm B.B., Bättig K., Holmén J., Nehlig A., Zvartau E.E. Actions of caffeine in the brain with special reference to factors that contribute to its widespread use. Pharmacol. Rev. 1999;51 (1):83-133. Lee R.A. Balick M.J. Rx: Caffeine, Explore (NX), 2006;2 (1):55-59. doi: 10.1016/1.explore.2005.10.012. Repertory of  Homoeopathic Materia Medica —  J T KENT. Boericke W. New Manual of Homoeopathic Materia Medica with Repertory. 3rd revised and augmented ed. Based on 9th ed. New Delhi: B Jain Publishers (P) Ltd; 2007.

AUTHOR DETAILS:

• Dr Pratibha Raturi, PG scholar, Batch 2020-23, Department of Homoeopathic Materia Medica, Bakson Homoeopathic Medical College & Hospital. pratibharaturi3094@gmail.com
• Dr Shweta Singh, PG scholar, Batch 2020-23, Department of Repertory, Bakson Homoeopathic Medical College & Hospital.
• Dr Farazi Mirza, PG scholar, Batch 2020-23, Department of Practice of Medicine, Bakson Homoeopathic Medical College & Hospital. fmirza260@gmail.com
• Dr Such Sushil, PG scholar, Batch 2020-23, Department of Homoeopathic Materia Medica, Bakson Homoeopathic Medical College & Hospital. suchsushil@gmail.com