Cary, RN

Coffee Question

Question: Why does coffee make me poop?

Coffee!

We love coffee! It is often thought of as a guilty pleasure, or an every day addiction. You don’t need coffee to live, but coffee is a wonder drug. It can also cause adverse reactions in some people.

Scientists still argue about whether coffee is good or bad for us. There are check marks in both columns, but some of the old studies showing how awful caffeine and coffee are for people have been refuted in the last few years. That doesn’t mean it doesn’t have drawbacks. Coffee can raise your bad (LDL) cholesterol levels. It stimulates gastric acid production and can be hard on reflux, ulcers and other gastric issues.

Coffee stimulates peristalsis! That is why it makes you poop. In fact, some people rely on that effect and have to wean off coffee onto other methods to counteract constipation if they have depended on coffee to keep their bowels going. Coffee also has diuretic properties.

Do you have asthma? Caffeine is chemically related to theophylline, which is an asthma drug. People who drink caffeine have better lung function for up to four hours afterward. It is a weak bronchodilator and it reduces fatigue in the muscles you use to breathe (Caffeine For Asthma).  This does not mean it can replace your medication, but it can help you on a rough day.

Caffeine may have beneficial effects on liver function. That one is still being studied. In the past, coffee enemas were used to treat liver problems. I’m not saying I recommend coffee enemas. I like to drink mine the old fashioned way. Along the same lines, coffee seems to decrease progression of disease if you have Hepatitis C (Drinking Coffee Daily Linked to Lower Risk for Progression of Chronic Hepatitis C).

Coffee intake of more than four cups daily may decrease your risk of gout (Drinking 4 or More Cups of Coffee a Day May Help Prevent Gout). Of course, more than four cups daily may give you other problems. Recent studies have indicated that coffee consumption helps protect you against stroke. Contrary to popular belief, recent studies also show caffeine does not seem to raise blood pressure or cause arrhythmias in otherwise healthy people.

A study done in Japan (Coffee Consumption and the Risk of Oral, Pharyngeal, and Esophageal Cancers in Japan: The Miyagi Cohort Study) showed coffee decreased risk of oral, pharyngeal and esophageal cancers independent of diet or other factors. This is interesting considering coffee has an adverse effect on reflux and long time reflux is associated with esophageal cancer.

Many people who drink a lot of coffee also smoke. Smoking with coffee drinking changes everything. Nicotine and caffeine are both stimulants and complicated chemical compounds, but they work differently, and the two of them together have more adverse effects on your body than either of them alone. You should not smoke, but that is a different post. Just know these coffee facts are about coffee and healthy people.

Coffee drinking may decrease risk for prostate cancer (Coffee May Cut Risk of Prostate Cancer) and protect against diabetes (High Coffee/Decaf/Tea Intake Linked to Lower Diabetes Risk) as well. It seems that decaf worked as well as regular coffee in some of these studies. Coffee has an effect on insulin, glucose and sex hormone levels, and it doesn’t seem to be just caffeine related to these effects. There are many chemical compounds in coffee and it is uncertain exactly which of these contributes to the study results.

If you take medications for cardiac problems or allergies, you may have interactions when you add caffeine. Always tell your health care provider everything you take whether it is medication, herbal remedies, over the counter drugs or have a high caffeine intake. But if you are healthy and there are no contraindications, I say enjoy your coffee!

Other resources used for this post:

Charles W. Fetrow, PharmD, Juan R. Avila, PharmD. Complementary & Alternative Medicines.

Karch, Amy M. 2008 Lippincott’s Nursing Drug Guide.

Mitchell, William A., Jr. Plant Medicine in Practice.

Studies can be found on Medscape.

Ambien Question

I’ve had a couple of different medically trained people inform me that Ambien is only “designed for short term use” and is generally prescribed because insurance companies prefer it to be used based on cost.

I’m “lucky” that I had an adverse reaction to the drug so I was moved onto something “better”, however it makes me concerned that so many people take Ambien on what appears to be a long term basis.

What are your thoughts on the subject?

I am going to apologize now for what is most certainly going to become a miniature rant on medication.

Ambien is a non-benzodiazepine hypnotic, and is suggested for short-term use, just like every other hypnotic or sedative ever made. They are all recommended for short term because they all have potential for abuse, and many are thought to further disrupt your sleep cycle over time.

 As a newer drug, Ambien is actually more expensive than most of the old-line sleepers. One of the reasons it is prescribed a lot is because it is newer. Just like most people, doctors like to use the newest, shiniest, most promising things they find. This is, in my opinion, partly due to pharmaceutical companies beating us over the heads with their newest drugs, but also because the newer drugs tend to have fewer side effects, or at least they are presented that way. Another reason Ambien is popular is there is purported to be less risk of abuse compared to other sedatives and hypnotics. It is thought to be less addictive, and the odds of having to keep increasing your dose to get the same effect are lower than with things like Valium or Halcion.

Ambien does have weird side effects in some people. It can cause sleep-eating and other sleep behaviors that don’t typically occur in people who aren’t taking this type of medication. Sleep and insomnia are complicated, and not completely understood yet, so trying to fix problems with sleep can be pretty difficult. There are also reports that coming off of Ambien after taking it for an extended period can cause real problems in some people, including seizures if you don’t wean off and just suddenly discontinue.

Knowing all of the above, though, Ambien does have fewer potential problems than some of the older drugs, and many people have insomnia that just doesn’t respond to things like sleep hygiene or even “more natural” supplements like melatonin (see table below). Torturers use sleep deprivation as a tool, as do brain washers. Insomnia is a serious problem. So if you are one of the people who suffers from ongoing sleep issues, drugs like Ambien can be a real godsend.

I think the key is to work with your doctor and be honest about your situation. Try sleep hygiene first. Deal with any issues that can cause secondary sleep problems, such as chronic pain, depression, or anxiety. If you still have difficulty sleeping, Ambien is a decent drug for a lot of people. You have to be aware of its limitations as with any drug, and if it doesn’t work for you, try something else.

I can go on and on about this or any drug, but philosophically we have problems in the US related to medication use. We over prescribe, but we also demonize. Modern medicine and modern pharmaceuticals make our lives longer, healthier, and give us better quality of life. But we have this love/hate relationship with them. We think we should be able to muscle on without taking anything. We have this idea that drugs aren’t natural, and natural is better. But arsenic is natural, and so is suicide related to untreated depression and insomnia.

I don’t advocate unnecessarily taking medication, but I don’t think it helps when we develop unreasonable fear and hatred of meds, either. There are trade offs for everything in life, including nearly any medical treatment or lack thereof. Read up on any medication prescribed for you. Research every diagnosis you are given. You don’t have to be in health care to do this. Keep open communication with your health care providers and work as a partner in your own care. You owe it to yourself to be as informed as possible.

FDA-Approved Hypnotics for Insomnia

Duration    Agent    Trade Name    Dose    Half-life    Comments

Benzodiazepine

Long acting   

Flurazepam    Dalmane    15-30 mg    48-120 h    Do not use in older adults due to long half-life
Quazepam    Doral    7.5-15 mg    41 h    Do not use in older adults due to long half-life

Intermediate acting   

Estazolam    ProSom    1-2 mg    10-24 h    Sleep maintenance
Temazepam    Restoril    7.5-30 mg    3.5-18 h    Sleep maintenance
Lorazepam*    Ativan    0.5-4 mg; 1 mg in elderly    12-20 h    May be used if duration of action meets patients needs

Short acting   

Triazolam    Halcion    0.125-0.5 mg    1.5-5.5 h    Caution, rebound anxiety; not first-line agent

Nonbenzodiazepine
Intermediate acting   

Eszopiclone    Lunesta    2-3 mg; 1 mg in elderly and hepatic impairment    6 h    Sleep onset and maintenance

Short-to-intermediate   

Zolpidem    Ambien    5-10 mg; 5 mg in elderly or hepatic impairment    2.5 h    Primary use, sleep onset
Zolpidem ER    Ambien CR    12.5 mg; 6.25 mg in elderly or hepatic impairment    2.8 h    Primary use, sleep onset and maintenance

Short acting   

Zaleplon    Sonata    10 mg, 5 mg in elderly or hepatic impairment or use with cimetidine    0.9-1 h    Primary use, sleep onset; maintenance up to 4 h

Melatonin Receptor Agonist
Short acting   

Ramelteon    Rozerem    8 mg    1-2.6 h    Primary use, sleep onset

* Not FDA approved for sleep

Table from Primary Insomnia: Treatment and Medication on Medscape.

NOTE: Medscape requires a sign-in, but it is free and an excellent source of current, reputable medical information.