Stephen Cherniske: Caffeine Blues, Esquire 5/2023 "Is it Time to Quit Coffee for Good?" J McDermott

The Caffeine Confusion: Stephen Cherniske, MS clarifies the issue.
Natalie Kather, MD: I'm here with Stephen Cherniske, biochemist and author of Caffeine Blues. Stephen, we hear such conflicting information about caffeine as illustrated in your May 2, 2023 interview in Esquire magazine.
https://www.esquire.com/lifestyle/hea...

Stephen Cherniske, MS: the conflicting information comes from two factors: 1. A foundational principle of science is “Everything is dose related.” In my research, I couldn't find any evidence that a cup or 2 of coffee early in the day will be harmful. Of course, a “cup” here is defined as 6 oz, containing about 100 mg of caffeine. Think of the amount in a teacup. This big mug is what most people call a cup of coffee, which is really three cups. The most commonly ordered size at Starbucks – Called a Grande, is 16 oz, and that delivers almost 270mg of caffeine. And this BIG GULP mug is just ridiculous!
N: I know people who have that have 16 oz on their way to work and another mid-morning,
S: and maybe a Red Bull or Monster “energy Drink” later when the brain fog rolls in.
N: So yes, clearly Everything is dose-related. What’s factor # 2?
S: Genetics. You see, caffeine is a drug, and like all drugs it has to be detoxified by your liver. This is accomplished by a remarkable enzyme system that breaks caffeine down to less stimulating compounds like methylxanthines. Now, this enzyme system called CYP 450 is highly variable. In fact, we now know that about 50% of people detoxify caffeine rapidly meaning that the specific CYP 450 enzyme that breaks down caffeine is very active. Again, this is genetic; you inherit this gene variant from your parents. Now here's the important point: the other 50% of people; Roughly half of everyone you know, are slow metabolizers meaning that with repeated doses of caffeine, the stimulant effects will tend to accumulate. Let me illustrate: in a rapid metabolizer the stimulant effect of caffeine including the production of stress hormones like epinephrine and cortisol will go like this. While in a slow metabolizer it will look like this. Thus with repeated doses, stress hormones can stay elevated, Causing or contributing to insomnia, anxiety, panic attacks, hypertension and increased risk for cardiovascular disease. This is well documented in the medical literature but poorly reported in the popular press where everything tends to be simplified to all good or all bad.
N: Please explain how people know if they’re a rapid or slow metabolizer.
S: There’s a genetic test, which can be expensive; so an easy way to test is to be sensitive to changes in your heart rate, blood pressure and mood after ingesting any form of caffeine. Also, carefully look at your sleep quality. Do you fall asleep quickly, or toss and turn? And do you feel rested in the morning? Slow metabolizers often fall into a vicious cycle, where they don’t sleep well, wake up feeling exhausted and then turn to – guess what, COFFEE to get going, which only makes it worse.
N: Thank you Stephen. Any closing comments?
Stephen: Yes. Remember this, No one is tired due to a caffeine deficiency.