White Coat Underground

I visited a physician this week as a patient. The details of the meeting are in the TMI category, but the long a short of it was he gave me advice that the altmed folks wouldn’t believe. Surrounded by the most advanced diagnostic technology, armed with a nearly infinite pharmacopoeia, he made a single recommendation: stop caffeine.

Stop caffeine. Ugh. He said, “Stopping caffeine often solves the problem you’re having. You know, it’s a drug. You don’t need it. It’s like speed. Stop it, and I’ll see you in a month.”

Caffeine is my friend. In college I always wrote my papers in one, long sitting, drinking tea the whole time. I started drinking coffee just after college. My life doesn’t always include enough sleep, and my good friend caffeine lets me pretend I living a normal, healthy life.

Except when it doesn’t.

Recent literature suggests that much like other addictive drugs, once one is tolerant of caffeine, the boost one feels is really just the mitigation of the withdrawal syndrome. Caffeine, taken occasionally, increases alertness. Taken chronically, it simply helps prevent withdrawal.

And withdrawal sucks. I had some decaf today—my plan is to have a bit of caffeine for the next few days and then just enjoy decaf coffee, which is not completely devoid of caffeine, but the amount is pretty minimal. I love my coffee rituals—buying beans, grinding them, stirring them to evenly extract them. And I hate the lethargy and headache.

But I do enjoy even decaf, and I know the withdrawal syndrome will be over in a couple of days. Despite the fact that coffee does not appear to have serious risk in most people, it is definitely causing me some trouble, and I look forward to mitigating that.

And while I wait for the positive effects of quitting caffeine, I’m enjoying some of the benefits of being a dad on Fathers’ Day. This morning, in addition to my decaf, we had fresh bagels (because any other kind are useless), hand-sliced Nova lox, and the usual additions such as Muenster cheese, sliced onion, and of course hand-packed cream cheese. And I stayed up late last night making lockshen kugel and despite not having a recipe, it didn’t come out too bad. I’m stuffed. Another advantage to decaf: my dad usually drinks it, and there are few things I enjoy more than coffee with my dad.

And I’m with my kiddo. We’re being decadent. We’re hanging out in the guest room watching Disney while she snacks on edamame and I eat some leftover kugel. She has a room full of toys, and yet has entertained herself for the last hour-and-a-half playing with a pile of balloons and a couple pieces of styrofoam packing.

PalKid finished kindergarten last week, and we had to cut off four inches of her hair (which doesn’t really look any shorter). Tomorrow she starts day camp, which means our morning routine together is over for now. But I have time planned for us this summer, if all works out. I’m taking her up to Canada for my usual gig as a camp doctor, and we’ve talked my folks into going up north with us for a week. By the end, she’ll be good and tired of her daddy. And she’ll be a first-grader. Everyone says kids grow up fast, but you never believe it changing a diaper in the middle of the night.

But one of the advantages of decaf is that tonight, after I tuck her in, I can pour myself a cup of coffee, look at pictures of my family, and think about what is past, or passing, or to come.

Comments

#1 D. C. Sessions
June 20, 2010

Welcome to the decaf set. The only part I miss is that it’s hard to find good dark roasted decaf — which means I may have to start roasting my own. Damn.

I long ago noticed that caffeine wasn’t doing me any good, and might be interfering with sleep quality and might be pushing my BP a bit. So I quit buying it. Since I keep my beans in a large airtight cannister, I just started adding decaf beans to the cannister as space became available and over the course of a few weeks weaned myself off of the drug. No drama, and I don’t miss it a bit.

And yes, Father’s Day is awesome. Especially that part about your adult, employed, independent “children” taking you out for breakfast.
#2 Stella
June 20, 2010

Peet’s decaf Moca Java, if you like a rich, smooth, Pacific coffee.

I’ve found mixing one third regular with two thirds decaf for about two weeks is a gentle way to decaffeinate.
#3 PalMD
June 20, 2010

I never met a Peet’s i didn’t like.
#4 DaleP
June 20, 2010

Good luck with the de-caffination

When I did it 35 years ago, I found that some decaf’s gave me headaches similar to the withdrawal headaches. I suspected it was some of the other alkaloids in the beans. It seemed to be less with arabica beans than robusta. Finally, I just gave up coffee altogether – it was just more pain than pleasure – and this was during grad school, if you can believe it.

I have found that chocolate is a good substitute. The theobromine is milder than caffeine, and I don’t seem to be affected by the other alkaloids. I eat 65 % or greater, to keep my consumption of extra calories down, and the flavor experience up.
#5 Stella
June 20, 2010

Allow me to second the suggestion of real chocolate to perk one up a bit and mitigate the withdrawal headaches.

I’ve been roasting my own coffee for about ten years, and I’ve tried most of the available arabicas. It’s difficult to find a full-flavored decaf, but a little mixing of varieties can help.

I buy Peet’s coffees from time to time when I get lazy or when it’s too hot to roast. If I knew what you usually like, I might be able to offer some suggestions for mixing up a good decaf.
#6 Perky Skeptic
June 20, 2010

Ohnoooooooooo!!! *lol* I’ve had a friend who has been telling me to give up caffeine for years, but I dismissed her warnings as altmed propaganda. Is it really and truly *better* for me to give it up?
#7 D. C. Sessions
June 20, 2010

Is it really and truly *better* for me to give it up?

You in particular? Ask your PCP.

However, caffeine is a vasopressor, it has some adverse effects on sleep quality, and whatever it does that causes the withdrawal headaches (nasty, nassssssssty withdrawal headaches) doesn’t even seem to have any upside. Maybe there’s other downsides.

On the other hand, some people — even morning people — simply don’t function well without it. YMMV.
#8 Dr. O
June 21, 2010

Happy Father’s Day…sounds like it was a great one!

I started cutting my morning coffee with decaf about a year and a half ago in preparation for getting pregnant. I also cut out any caffeine after noon. But I was too weak to ever really rid the caffeine bug completely. Luckily, my single cup of weak coffee in the morning isn’t something my doctor feels I need to give up. Until another reason comes up, I’m holding on tightly to my wee bit of caffeine!
#9 Maryn
June 21, 2010

Eeek. I am sympathetic and impressed. Caffeine has been my performance-boosting drug since undergrad (as opposed to single malt, which is strictly for pleasure). Newsrooms run on it. I cut my consumption from 6 cups a day to 2 in the morning once I went freelance, since the water-cooler aspect of gathering at the pot was removed from my day, but the thought of giving it up … hmmm.
#10 lylebot
June 21, 2010

Yesterday I had a bad headache, nausea, and a zombie-like lethargy, and I am about 95% certain that it’s because the waiter at the place I went for breakfast brought decaf by mistake.

Coffee doesn’t give me any boost, and I only really enjoy the first cup of the day anymore, so why do I give it even a small chance of ruining my day? I should just quit and be done with it.
#11 Donna B.
June 21, 2010

All this talk of coffee, I had to go make a pot. That’s not something I do every day anymore. Somehow without even thinking about it, much less trying, I went from a two 10 cup pots a day to now not finishing what my 4 cup pot makes. And that’s if I think about making a pot. Like now.

I wish I knew how it happened. There are one or two things I’d like to apply the method to.
#12 Isis the Scientist
June 21, 2010

I wish you nothing but the best in your attempts, but I think drinking decaf tastes like licking one’s own ass. I have never had a tolerable cup of it.
#13 Ellen
June 21, 2010

Drooling at the thought of lockshen kugel, never mind the coffee which hurt my stomach so much I gave it up decades ago. Recipe for your kugel? Do you make it sweet, with raisins? Can I come over and have some?????
#14 PalMD
June 21, 2010

I had to make up a recipe cuz i couldn’t find mine or my mother in laws. No raisins!!!!!! Yes sweet, but i should have made it sweeter. A reasonable kugel recipe, which needs to be messed around with to get right is:

1 lb wide egg noodles, cooked.
Greased 9×13 baking pan.

Mix noodles with about 1 stick butter, 2 cups sour cream, 2 cups cottage cheese, prob a bit of cream cheese as well, like about a cup, 2 tsp vanilla
about 1.5 cups sugar, some honey, like a Tbsp and a bunch of eggs, around 8. Pour the mixture into the baking pan. Topping can be chunks of butter with cinnamon/sugar, or a mix of flake cereal with same.

Bake at 350 for about 1-1.25 hours.

Corrected…
Eat.
#15 Ellen
June 21, 2010

Gevalt, the cholesterol!!!! It sounds yummy, how could it not be with all that fat? Thanks.

(I LIKE raisins in kugel…)
#16 PalMD
June 21, 2010

I forgot a couple of things, corrected above.

NO RAISINS!!!!!
#17 Joe
June 21, 2010

A problem with decaf is knowing what one is getting when one buys a prepared cup. Quality assurance for a major manufacturer selling beans or ground coffee is easy; but there are too many opportunities to make a mistake (switch) when it is being prepared.
#18 Isis the Scientist
June 21, 2010

Can you make it with chocolate chips instead of raisins? Seems to me this recipe is missing chocolate.
#19 Kate from Iowa
June 21, 2010

I love coffee, always have. My grandmother used to get up and brew a pot of Chock Full ‘o Nuts and get her (first) cup and go sit out in the garden and watch the rabbits race around.

Some time later, when I was sure she was out of the kitchen (I was about six or so,) I’d go beg my grandfather for a cup of coffee. Which I got…sort of. It was mostly warm milk and sugar, with just enough coffee to tint it, but I felt very grown up and sophisticated…just like my grandmother.

I must be wierd or something, because the thing is…it dosen’t wake me up, but makes me sleepy. The most miserable 18 months of my life were the ones where I stopped drinking coffee…and completely stopped sleeping, it felt like. *shakes head* Oh well. I’ll keep happily drinking. (It’s not coffee unless it’s strong enough to pour itself and walk over to where you’re sitting, btw.)
#20 Karen
June 21, 2010

Ever since I was a teenager and worked in my dad’s office, I’ve loved coffee. Dad ran a small accounting firm, and the coffee they brewed there could dissolve spoons, but I loved it. Later I discovered really good coffee, and became a coffee fiend. But… the end has come.

I have Irritable Bowel Syndrome, which has been getting worse over the years. Coffee is a known irritant. So I gave it up, and noticed an abrupt change toward normalcy in my bowel performance.

I still drink tea to get some morning caffeine. But I miss coffee!
#21 Ellen
June 21, 2010

Ewwww, chocolate chips in kugel. I love chocolate, but that is just so wrong.

Golden raisins would be perfect. What’s wrong with raisins???

It’s been years, maybe I should make some, but my spouse would probably have to increase the statin dose.
#22 PalMD
June 21, 2010

Excellent point from the neurobiology perspective, Karen.
#23 SES
June 21, 2010

I made the decision to decaffeinate a few years ago. It took 3 weeks and I never got a headache. First week was 75% high-test and 25% decaf; then 50-50, 25-75 and finally 100% decaf. It did cut down on the ectopic beats.
#24 khan
June 21, 2010

I drink a cup of tea in the morning. Gave up coffee a while back, will occasionally have a half decaf. Once last year I had a straight cup of coffee around noon from a local shop; I was wired for 12 hours.
#25 gaiainc
June 22, 2010

No raisins in my food, please. Raisins alone, fine. However, none in my food and I mean it. I will pick them out if I have to. Do not put them into my food.

At one point I was dependent on caffeine, but that was a long time ago. I made it through my surgery rotation as an intern without coffee (just wasn’t time). I went to decaf when I was pregnant, but now that I’m not, I get one 16 ounce coffee drink. When I have to be awake and functional before 7 am, like I am now on service, it makes me bearable. I am not a morning person. Half my clinic thought I didn’t like them until they realized that I was much cheerier after 10 am.

I also can’t drink coffee black. I need the sweetness and the creaminess of either fake creamer or real half-and-half (or as some say, Boston style). I’ll do 2% in my lattes, but usually do skim… usually. However the latte really does taste better with the 2%. Oh well. For some reason, Noah’s Bagels Chelsea Blend coffee is my favorite. I think it’s the half-and-half I drink with it, though I do like the vanilla and hazelnut combination.
#26 JustaTech
June 22, 2010

Oh, gaiainc, I love the Chelsea coffee at Noah’s! It’s too bad that the only one near me is being run by idiots who decided to do away with all the good flavors of bagels and can’t follow simple instructions. So I can’t go there anymore.
#27 PalMD
June 22, 2010

There are very few flavors that should legitimately sold as bagels. In the old days, the bagel bakers union specified the exact weight of flower, salt, malt, and yeast.

Plain, poppy, egg, onion, salt, and…maybe raisin. Maybe. And maybe garlic. But that’s it.
#28 pear communication
June 22, 2010

You want confirmation it’s a drug, just have a cup after you’ve been caffiene-free for a couple of months. I loved coffee before I gave up for medical reasons, so was tempted once to have a coffee with a friend – that was at 2pm and I was still lying wide awake at 4am the next morning thinking, ‘Wow, I really had become totally desensitised to the stuff.’ I only drink boiled water now, which makes for some interesting comments when I meet friends ‘out for coffee’. But, I don’t miss the shakes, and I don’t miss the boom/bust caffeine cycle in my system anymore, either.
#29 LadyDay
June 22, 2010

I, personally, have found that stopping caffeine when one is horribly sick with a cold or flu makes it a lot easier to deal with the withdrawal symptoms of caffeine addiction. Usually, I feel like such crap for ~1-2 weeks, anyway, that a little withdrawal headache or 2 is nothing. So, if one wishes to rid oneself of a pesky caffeine addiction, it is definitely recommended that one take advantage of one’s head cold or flu when one has the opportunity. Also, if one is wondering how to acquire such a convenient illness, it is further recommended that one take a seat at a conference in front of Drs. McSneezysnot or Coughingupphlegmface.
#30 Anthropologist Underground
June 22, 2010

Inspired by this and by Steve Novella’s caffeine blasphemy at NeoroLogica, I have ordered some swiss water process decaf beans. My hope is that if I mix these in with the amazing, oily, dark, rich Mesa De Los Santos beans the resulting brew won’t make me speculate about how it tastes to lick ones own ass. I’ll let you know if it turns out well.

My FIL eats oatmeal for breakfast nearly every day. He adds black raisins. The raisins absorb the water and plump up into little black marbles that remind me of antelope feces. Then they explode in my mouth, sending slimy, watery vaguely raisin-flavored viscera everywhere. This experience does make me speculate about coprophagia. Just writing this makes me want to throw up a little. I’ll be sure to omit raisins when I make the kugel.
#31 Chris
June 23, 2010

By the hammer of Thor, you will only get my Norsk Petrol away from my cold dead hands! Or if my family doctor tells me to quit because of the blood pressure bit I inherited from my English descended father.

Fortunately that has not happened yet.

Raisins are evil for just the reason the Anthropologist Underground so poetically described. My brother and I both drove our mother crazy because we hated them in rice pudding. We were both delighted when it was served without raisins at a gathering at a Monterey Peninsula house of a Portuguese family. Sure, they served barnacles and other odd aquatic things… but they also had artichokes, crabs and raisinless rice pudding. Yay!
#32 Vicki
June 23, 2010

Pumpernickel!

One problem with all these johnny-come-lately bagel flavors (Asiago cheese?!) is that they tend to displace the pumpernickel bagel.
#33 Shasta
June 23, 2010

Great post. Your summer plans sound great.
I had to give up caffeine a couple years ago because even a cup in the morning was messing with my sleep. And, I was starting to hate the addiction/fear of the headache if I happened to be awake for an hour before I got my coffee.
I had a terrible headache for 2 weeks straight when I gave it up cold turkey (probably not too smart) .
But, I enjoy my herbal tea, homemade hot chocolate (from unsweeted, unprocessed cocoa powder) , or decaf coffee, just fine now.
The one downside for me to giving up caffeine was gaining about ten pounds. I guess it was keeping my metabolism artificially high? No clue, but the weight gain immediately followed.
#34 david
June 24, 2010

Wikipedia tells me that the SSRI antidepressent Fluvoxamine inhibits an enzyme CYP1A2, that metabolizes caffine. When taking Fluvoxamine I noticed my tendency to caffine dependency/withdrawal was significantly worse. Sadly the prescribing doctor does not seem to have been aware of this.

I gave up drinking coffee at work to avoid withdrawal headaches on weekend mornings when I was busy doing other things. Now I have hot dark drinking chocolate.
#35 gaiainc
June 24, 2010

PalMD may find this blasphemic, but I find that the only two good bagels at Noah’s are the chocolate chip and the pumpkin (when they have it and if my local Noah’s hasn’t already sold out before Halloween has even come). I do the whole grain to make myself feel good, but the other two are what I truly crave.

Coffee… had a cinnamon dolce latte at Starbucks today. Not as good as I remembered. I think I have go back to Noah’s and the Chelsea coffee.
#36 OleanderTea
June 24, 2010

I have chronic migraine and gave up all triggers I could identify — including nightclubs (b/c of noise and flashing lights), alcohol, sodas, perfume, over- or under-sleeping, movie theatres, and a dozen other things I can’t even remember.

Then my doc told me that “caffeine causes migraines!”. I quit coffee and had….Absolutely no change. None. I tried for three months, and literally no difference. Except one. I MISSED real coffee. I can live without soda or nightclubs, but I LOVE that cup of “Boston style” coffee (they do love their half and half up here! Bless them.).

So. I started drinking it again. A comparatively small amount, but I go for the good stuff. My colleage french-presses a pot of amazing Ruta Maya coffee every morning, and it’s my crack.
#37 ElevatedSteve
July 7, 2010

I never drank coffee or really even caffeine until about the age of 28 (I am 34 now). I went on a trip to Italy and discovered that coffee is actually good, and the stuff my Mom calls coffee is not!
I also used to suffer from bad headaches just about every day. I was diagnosed with tension headaches and migraine headaches. I was prescribed many different headache medicines throughout the years, including Vicodin and Immetrex, which never really seemed to help much.
Since I started drinking coffee every day, I rarely have headaches anymore. Once in a while, I’ll skip making coffee on weekends, and usually by Sunday night or Monday morning, my head will be hurting again, just like it used to. In this respect I feel that caffeine is a wonder drug! I really really really hope that I never have adverse affects from it. I don’t think I could stand the headaches again.