The cardiac paradox of caffeine: Irritant or therapeutic stimulotonic?

“ CAFFEIN Caffein can irritate the heart and cause irregularity and tachycardia, especially in certain persons. In fact, some can never take a single cup of coffee without having an attack of palpitation, and many times when coffee and tea have been unsuspected by the patient as the cause of cardiac irritability, their removal from the diet has stopped the symptoms, and the heart has at once acted normally. ”

“ When used in considerable quantity, by young or old, it causes a nervous condition both distressing and dangerous, known as "tobacco heart."
Tea and coffee contain a drug, called caffeine, which acts upon the nervous system and which may, on this account, interfere with the proper control of the heart. In some individuals the taking of a very small amount of either tea or coffee is sufficient to cause irregularities in the action of the heart. Tea is considered the milder of the two liquids and the one less liable to injure. ”

“ Caffein: This should not be given or allowed, even in the form of tea or coffee, to patients who have valvular lesions with perfect compensation, as it is a nervous and cardiac stimulant and may cause a heart to become irritable. It raises the blood pressure slightly, acts as a diuretic, and hence is often of great value when used medicinally. It should be ranked as a stimulotonic to the heart. It increases its activity, but gives it a little more strength. It will rarely slow a rapid heart; it will often stimulate a sluggish, slow heart; it may increase the irritability of an irritable heart. ”

“ In civilized countries coffee is an article of prime necessity as a food; here we shall consider it therapeutically under two heads, as a tonic-stimulant and as an antiseptic. As caffeine is the principle that acts upon the heart we shall consider the cardiac properties of coffee under the head of that alkaloid, so important that it may best be studied separately.
There are two preparations of coffee, the decoction used by the Arabs and the infusion, used in Europe and adopted in the Philippines. ”

“ From this fact it is sometimes argued that stimulants must supply a physiological need. The same method of reasoning will apply with greater force to the use of condiments. Such conclusions appear to us to be scarcely warranted. If the extensive or even universal practice of a thing proves its necessity, then has there been justification, either now or in the past, for war, lying, avarice and other vices. It is strange that drugs differing so greatly in their immediate and obvious effects as, for example, alcohol and opium, or coffee and tobacco should be used. ”

“ Is it a waste? Is it possible that we throw all this away, year after year, in idle stimulation or sedation?
It is but too true, that the instinct, leading to the use of some form of stimulant, appears to be universal in the human race. We call it an instinct, since all men naturally search for stimulants, separately, independently, and unceasingly,—because use renders their demands as imperious as are those for food.
Next to alcohol and tobacco, coffee and tea have supplied more of the needed excitement to mankind than any other stimulants ”

“ Science almost always finds some foundation in fact for popular prejudices. For years, men have continued wasting their substance on coffee and tea, insisting that they strengthened as well as comforted them, in spite of the warnings of the sanitarian, who looked on them solely as stimulants or sedatives, and of the economist, who bewailed their extravagant cost. ”

“ Nothing was formerly more common with temperance people of the compromise school than to comfort converted drunkards with stimulating drugs and strong coffee, in the hope that the organism might somehow be induced to acquiesce in the quid pro quo. That hope is a delusion. The surrogate may bring a temporary relief, but it can not satisfy the thirst for the stronger tonic, and only serves to perpetuate the stimulant diathesis—the poison hunger which will sooner or later revert to the wonted object of its passion. ”

“ Hence the apparent paradox that drunkenness is most frequent among the most civilized nations. The tendency of every stimulant-habit is toward a stronger tonic. Claude Bernard, the famous French physiologist, noticed that the opium-vice recruits its female victims chiefly from the ranks of the veteran coffee-drinkers; in Savoy and the adjoining Swiss cantons kirsch-wasser prepares the way for arsenic; in London and St. Petersburg many ether-drinkers have relinquished high wines for a more concentrated poison ”

“ Therefore when a heart has serious lesions, whether of the myocardium or of the valves, with compensation only sufficient, the action of caffein in any form is contraindicated. The fact that it raises the blood pressure, thus increasing the force against which the heart must act, and that it irritates the heart muscle to more sturdy or irregular contraction, indicates that a patient with a heart lesion or with a nervously irritable heart should never drink tea and coffee or take caffein in any beverage. ”

“ The increase of the action of the heart may depend no doubt upon a foreign substance, which, mixed with the blood, alters and renders it more irritating; it may be owing to an affection of the substance of the organ which disposes it to be more irritable; but it is certainly very often sympathetic, and depends upon that unknown relation which connects all our organs, upon that consensus which links together all their actions, and places them in reciprocal dependance. ”

“ Drugs also should be employed and the aroma of strong coffee with the irritating effect of ammonia upon the nostrils should be employed. These act upon the vagus so as to stimulate the heart, but above all they act upon the mind, and nothing so stimulates the heart as reawakened hope. ”

“ Somewhere from 1 to 3 percent of the community are distinctly injured or poisoned by tea or coffee, even small amounts producing burning of the stomach, palpitation of the heart, headache, eruptions of the skin, sensations of extreme nervousness, and so on; though the remaining 97 percent are not injured by them in any appreciable way if consumed in moderation.
So, if one is personally satisfied that he belongs to the abnormal minority, and has not been argued by fallacious reasoning into his belief that coffee injures him, he should either reduce his consumption of coffee or let it alone. ”

“ But the heart behaves very differently in different subjects in the presence of flatulent distention of the stomach. It partakes of the general constitutional condition of the individual; in the strong, therefore, it is vigorous; in the weak it cannot be anything but weak.
Prognosis.—Nothing sends a young person sooner to a physician than this cardiac unrest and functional disturbance. He comes all a-tremble, as if to hear the worst. ”

“ A drastic, if not unconstitutional, measure is now being put thru in this country to prevent the consumption of alcohol and yet it is a positive fact that coffee, tea, tobacco, chewing gum and other stimulants, which are freely indulged in even at the tender age, are vastly more injurious to the national body, judging from the number of those who succumb. So, for instance, during my student years I gathered from the published necrologues in Vienna, the home of coffee drinkers, that deaths from heart trouble sometimes reached sixty-seven per cent of the total. ”

“ The patient should be taught that he should never rush upstairs, and that he should never run rapidly for a car or a train or for any other reason; he should not pump up a tire, or repeatedly attempt to crank a refractory engine; even the prolonged tension of steering a car for a long distance is inadvisable. He should be told that after a large meal he is less capacitated for exertion than a man who has not a damaged heart. It is better if he drinks no tea or coffee; it is much better if he absolutely refrains from tobacco and alcohol. ”

“ The curative treatment of functional derangement of the heart must have reference to the causes producing it. If it is in consequence of indigestion, the appetite and digestion should be improved by observing regularity in the time of taking the meals, and eating very easily-digested food. The use of strong tea, coffee, tobacco, and spirits, should be interdicted, and regular exercise, rest, and sleep should be enjoined. ”

“ Other frequent causes of more or less disturbance of the heart's action, often accompanied by pain, are overexertion, worry and mental anxiety, and intestinal toxemias due to too much protein or disturbed protein digestion. Frequent causes are tobacco, and the overuse of tea and coffee. Many a patient's pseudo-anginas are corrected by stopping tea and coffee. The effects of caffein and tobacco on the heart will be considered later when toxic disturbances are under discussion. ”

“ Good general elimination by catharsis, warm baths to increase the peripheral circulation, a low diet for a few days, abstinence from any toxin which could cause this cardiac irritation, extra physical and mental rest, sometimes nervous sedatives such as bromids, and perhaps a lowering of the blood pressure by nitroglycerin, if such is indicated, or an increase of the cardiac tone by digitalis if that is indicated, will generally remove the cardiac irritation and prevent the extrasystoles, and the heart will again become regular. ”

“ It would be curious and well worth while to follow out the peculiar connection between the use of coffee and the excretion of phosphorus, which has been before hinted at. Other experiments of Dr. Böcker prove sugar to be a great saver of the phosphates, and hence of bone,—which affords, at least, a very plausible reason for the instinctive fondness of children for sweets, during the building portion of their lives.
In exhausting labors, long-continued exposure, and to insure wakefulness, the uses of coffee and tea have long been practically recognized by all classes. ”

“ The best way to prevent the expenditure of superfluous energy on the part of the heart in the form of palpitation is to give it a fair amount of legitimate physiological work to do." Personally I have found that most of the cardiac tonics seem to do harm, in the sense of increasing the subjective symptoms, except in cases where the patient is run down in general health because of failure to take sufficient food, when strychnin seems to be of avail and in the shape of nux vomica acts as an appetizer as well as a heart tonic. ”

“ Alcohol is used in compounding most of our tinctures, but in remedies proper my experience has been that other stimulants, such as ammonia, strychnine, caffeine, kolafra, etc., answer the same purpose without alcohol’s dangerous effects. ”

“ One radical fallacy identifies the stimulant-habit in all its disguises: its victims mistake a process of irritation for a process of invigoration. The self-deception of the dyspeptic philosopher, who hopes to exorcise his blue-devils with the fumes of the weed that has caused his sick-headaches is absolutely analogous to that of the pot-house sot who tries to drown his care in the source of all his sorrows ”

“ The use of stimulants in aid of work is, perhaps, one of the commonest forms of collateral influence suspending the warning sense of exhaustion. When the laborious worker, overcome with fatigue, "rouses" himself with alcohol, coffee, tea, or any other agent which may chance to suit him, he does not add a unit of force to his stock of energy, he simply narcotizes the sense of weariness, and, the guard being drugged, he appropriates the reserve. ”

“ It may be set down as the unchangeable rule of physiology, that stimulating drinks deduct from the powers of the constitution in exactly the proportion in which they operate to produce temporary invigoration.
The second evil is the temptation which always attends the use of stimulants. Their effect on the system is so agreeable, and the evils resulting are so imperceptible and distant, that there is a constant tendency to increase such excitement both in frequency and power. ”

“ It is a mental stimulus of a high order, and one that is liable to great abuse. Through its fascinations the scholar burns the midnight oil, and too rapidly reduces his store of vital force. To some temperaments it may be called a poison. Carried to excess it produces abnormal wakefulness, indigestion, acidity, heartburn, tremors, debility, irritability of temper, trembling, irregular pulse, a kind of intoxication ending in delirium, and great injury to the spinal functions. Unfortunately, there are many coffee tipplers who depend upon it as a drunkard upon his dram. ”

“ Coffee is a beverage, prepared from the seeds of the coffee tree. The best known brands come from the Island of Java, Mocha, Rio de Janeiro, and Mexico.
Coffee is not a food. The active principle is caffein. This is an alkaloid and is a strong stimulant to the central nervous system. It quickens the heart action, and, unless the heart be weak, one does not need so strong a stimulant. The stimulating effect is so apparent with many, that they cannot sleep for several hours after drinking it. Others drink coffee to quicken mental activity and to keep them awake. ”

“ In some a little emotional excitement gives rise to palpitation, and a piece of bad news or the bang of a door seems to stop the heart altogether. There is in such subjects no form or degree of cardiac disease which may not he simulated. [Italics ours.] Add a touch of hysteria on the lookout for symptoms and for someone to give ear to the narration of the unparalleled agonies of the sufferer, and the difficulties of the heart, and it may be added of dealing with them, are complete. ”

“ A careful decision as to the size of the heart will often show that it has become slightly dilated and is a cause of the general symptoms of weakness, leg weariness, slight dyspnea, epigastric distress or actual chest pains. Many such cases are treated for gastric disturbance because there are some gastric symptoms. There is no question that gastric flatulence, or hyperacidity, or a large meal causing distention of the stomach may increase the cardiac disturbance, and the cardiac disturbance may be laid entirely to indigestion ”

“ Treatment.—The rôle of psychotherapy in this form of cardiac disturbance associated with gastro-intestinal affections is, after the differentiation of neurotic from serious organic conditions, to give the patient such reassurance as is justified by his condition. It is surprising how many people are worrying about their hearts because their stomachic and intestinal conditions give rise to heart palpitation, that is to such action of the heart as brings it into the sphere of their consciousness, sometimes with the complication of intermittency or even more marked irregularity. ”

“ Persons who have accustomed themselves to stimulants of any sort are completely depleted if they are unable to get the special form to which they have been accustomed. This holds true for tobacco, morphine, coffee, and many other forms of stimulants actually indulged in by many persons. If they are able to resist the temptation and deny themselves the stimulant, the period of exhaustion soon disappears and the subject may even lose all craving for that which formerly seemed essential to his very existence.
The quantity which we eat is partly a matter of habit. ”

“ A man who has never drunk tea, coffee or spirit, or one who has never chewed or smoked tobacco, is not at all affected by the counsel to discontinue their use; but they who have been accustomed to them miss them when they are deprived of them, and they want something to supply their place. I speak, now, not from my own experience, but from what I have heard others say on these things. There is a craving felt by parties when they discontinue the use of these stimulants, and they need variety. This variety must be supplied, and we must take steps to supply it. ”

“ Gradually, however, the blood regains its alkalinity and its acid-dissolving power and enough of the acid deposits are reabsorbed by the circulation to cause a return of the symptoms of collaemia. Then arises a craving for more alcohol, coffee, tea, nicotine or xanthine-producing foods in order to again obtain temporary relief and stimulation, and so on, ad infinitum.
The person addicted to the use of stimulants is never himself. His mental, moral and emotional equilibrium is always unbalanced. ”

“ Hence also the fallacy of the brewer’s argument that the use of lager beer would prevent the dissemination of the opium habit. No stimulant vice has ever prevented the introduction of worse poisons. Among the indirect causes of intemperance we must therefore include our mistaken toleration of the minor stimulant habits. The poison vice has become a many-headed hydra, defying one-sided attacks, and it is no paradox to say that we could simplify our work of expurgation by making it more thorough. ”

“ No human being ever relished the first taste of a "stimulant." To the palate of a healthy child, tea is insipid; the taste of coffee (unless disguised by milk or sugar) offensively bitter, laudanum acrid-caustic; alcohol as repulsive as corrosive sublimate. No tobacco-smoker ever forgets his horror at the first attempt, the seasick-like misery and headache—Nature's protest against the incipience of a health-destroying habit. ”

“ I was very fond of coffee, but I read that it was the strongest causative factor in the production of heart disease. In medicine advertisements in the newspapers I [Pg 64] saw men falling dead on the street as a result of heart failure—always the same man, it is true; but that made little difference to me. I cut out both tea and coffee and drank only milk and water. When I got to reading about tuberculous cows and the action of State Boards of Health and public sanitarians in the matter, I became afraid to continue drinking milk. ”

“ The experiments of physiologists all prove that stimulants are not needful to health, and that, as the general rule, they tend to debilitate the constitution. Is it right, then, for a parent to tempt a child to drink what is not needful, when there is a probability that it will prove, to some extent, an undermining drain on the constitution? Some constitutions can bear much less excitement than others ”