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Caffeine

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=Caffeine and Genetics=
There is some research indicating that there are genetic differences that change how caffeine effects people, but the research is a little unclear. However, it seems that having your genome tested could provide valuable information into how to use caffeine. The enzyme CYP1A2 metabolizes many drugs, and it's been shown to be responsible for over 95% of the metabolism of caffeine<ref name="BegasKouvaras2007"/>. The CYP1A2 enzyme is produced by the CYP1A2 gene, and a genetic change at rs762551 impacts how the enzyme is produced, with AA having greater activity than the AC or CC genotypes<ref name="snpe_rs76"/>. Sometimes the subjects with the AA variant are called "fast metabolizers". (I had my genome tested using 23andme.com which showed I have the AA variant of CYP1A2/rs762551.)
* A study of 101 recreationally competitive male athletes on a 10K cycling time trial with 2 or 4 mg/Kg caffeine, there was an improvement only in those with the AA variant of CYP1A2, with no effect on the AC and diminished performance for the CC<ref name="Guest-2018"/>.
* A study of 21 active subjects given 3 mg/Kg of caffeine and tested using a 30 second Wingate test showed performance improvements did not vary between AA and AC/CC variants, though AC/CC reported increased nervousness while the AA variants did not<ref name="Salinero-2017"/>.
* A study of 20 collage level tennis players showed that 6 mg/Kg caffeine improved intermittent treadmill performance with no differences between AA and C variants<ref name="KleinClawson2012"/>.
* Other factors beyond genetics impact CYP1A2 enzyme activity, with exercise, caffeine intake, broccoli all increasing it<ref name="Vistisen-1992"/>.
I had my genome tested using 23andmeIt seems rather counterintuitive to me that the faster you metabolize caffeine, the greater the benefit.com which showed I have It suggests that maybe it's a metabolite of caffeine that improves performance rather than the AA variant of CYP1A2/rs762551caffeine itself, but that's pure supposition on my part.
=Caffeine, Blood Pressure and Heart Rate=
Caffeine increases blood pressure at rest and under stress, including exercise stress. The effect of caffeine on heart rate is unclear, with both increases and decreases observed in studies. Generally caffeine decreases heart rate at rest and moderate intensity exercise, but increases it at maximal workloads.
Caffeine has a shorter duration of effect at high altitude, possibly due to increased blood flow to the liver, and withdrawal from caffeine would likely make altitude problems more severe<ref name="CafAltitude"/>.
=Caffeine clearance=
Caffeine is rapidly absorbed, and its clearance varies with multiple variables, including exercise. It seems that exercise might increase clearance, which in turn might increase the needed dosage for ultra-endurance events. * About 99% of consumed caffeine is absorbed within 45 minutes, with peak concentrations after about 30 minutes<ref name="NehligAlexander2018"/>.* Caffeine half-life is generally 2.5-5 hours with some dose dependency and individual variability<ref name="CamandolaPlick2018"/>.* A study found that lean subjects cleared caffeine faster than the obese, with the half life of 2.6 hours rather than 4.4 hours<ref name="Kamimori-1987"/>.* An hour's light exercise (30% [[VO2max|V̇O<sub>2</sub>max]]) reduced the half life from 4 hours to 2.3 hours in healthy subjects<ref name="Collomp-1991"/>.* A study of 14 active ([[VO2max|V̇O2max]] of 50) subjects (8 women) found no change in caffeine clearance with exercise<ref name="McLeanGraham2002"/>. Subjects exercised for 1.5 hours at 60-65% of [[VO2max|V̇O<sub>2</sub>max]], starting 1 hour after ingesting 6 mg/Kg of caffeine. Half life was ~6 hours. * The half-life of caffeine seems dose dependent<ref name="ChengMurphy1990"/>. In healthy subjects, the half-life at 70mg was 4.5 hours, at 200mg was 60 hours, and at 300mg was 6.4 hours. (Impaired liver function can dramatically increase the half-life to 25-30 hours.)* Caffeine is metabolized by the liver enzyme CYP1A2<ref name="KalowTang1993"/>, and the activity of this enzyme can be effected affected by drugs and diet, with tobacco and chargrilled meat increasing levels<ref name="Flockhart-2007"/>. Things may not be so simple, as about 85% of caffeine is metabolized to Paraxanthine <ref name="GuerreiroToulorge2008"/> and Paraxanthine in mice is a stronger stimulant than caffeine<ref name="Okuro-2010"/>, while similar in humans<ref name="BenowitzJacob1995"/>. Paraxanthine has a half-life of 3.1-4.1 hours<ref name="CamandolaPlick2018"/>, and levels become higher than caffeine after 8-10 hours<ref name="NehligAlexander2018"/> (There is a common genetic mutation in dogs that prevents the formation of CYP1A2, making these dogs unable to metabolize caffeine and some other substances<ref name="AretzGeyer2011"/>.)
=Glucose Absorption, Insulin Resistance and Glycemic index =
Caffeine changes the way glucose is absorbed, but this effect is different for those at rest compared with those exercising.
* A milk intake of 500 to 900 ml/day<ref name="CaffBabyMilk"/>
* The nursing mother's caffeine intake of 200mg/day (one double shot espresso),
We get a resulting caffeine concentration in the milk of 4ug/ml to 8ug/ml<ref name="Stavchansky-"/>, which is a total caffeine intake of between 2mg to 13mg, or 0.6 to 4 mg/Kg body weight. The upper end of that level is quite high. However, the baby's half-life for caffeine is 31-132 hours (average 82 hours)<ref name="Parsons-1981"/>, compared with an adult's 2-10 hour half-life, so the caffeine will build up over time. A 24 hour half live (which is easier to calculate) would result in about a 3mg to 26mg, which is 1 to 8 mg/Kg. I'm guessing that would result in the baby not sleeping well! Conversely, a baby whose mother takes caffeine during pregnancy and is then given formula milk may undergo caffeine withdrawal after birth<ref name="McGowan-1988"/>. Even if the mother breast feeds, the varying levels of caffeine may cause withdrawal symptoms<ref name="Martín-2007"/>. Also, caffeine has been shown to increase fetal [[Heart Rate]]<ref name="Buscicchio-2012"/>. There is research indicating that Caffeine may not reduce to subtherapeutic levels until around 11-12 days<ref name="Doyle-2016"/>.
=References=
<references>
<ref name="Doyle-2016">J. Doyle, D. Davidson, S. Katz, M. Varela, D. Demeglio, J. DeCristofaro, Apnea of prematurity and caffeine pharmacokinetics: potential impact on hospital discharge., J Perinatol, volume 36, issue 2, pages 141-4, Feb 2016, doi [http://dx.doi.org/10.1038/jp.2015.167 10.1038/jp.2015.167], PMID [http://www.ncbi.nlm.nih.gov/pubmed/26562367 26562367]</ref>
<ref name="Martín-2007">I. Martín, MA. López-Vílchez, A. Mur, O. García-Algar, S. Rossi, E. Marchei, S. Pichini, Neonatal withdrawal syndrome after chronic maternal drinking of mate., Ther Drug Monit, volume 29, issue 1, pages 127-9, Feb 2007, doi [http://dx.doi.org/10.1097/FTD.0b013e31803257ed 10.1097/FTD.0b013e31803257ed], PMID [http://www.ncbi.nlm.nih.gov/pubmed/17304161 17304161]</ref>
<ref name="McGowan-1988">JD. McGowan, RE. Altman, WP. Kanto, Neonatal withdrawal symptoms after chronic maternal ingestion of caffeine., South Med J, volume 81, issue 9, pages 1092-4, Sep 1988, PMID [http://www.ncbi.nlm.nih.gov/pubmed/3420441 3420441]</ref>
<ref name="Guest-2018">N. Guest, P. Corey, J. Vescovi, A. El-Sohemy, Caffeine, CYP1A2 Genotype, and Endurance Performance in Athletes., Med Sci Sports Exerc, volume 50, issue 8, pages 1570-1578, 08 2018, doi [http://dx.doi.org/10.1249/MSS.0000000000001596 10.1249/MSS.0000000000001596], PMID [http://www.ncbi.nlm.nih.gov/pubmed/29509641 29509641]</ref>
<ref name="snpe_rs76">rs762551 – SNPedia, snpedia.com !!work!!, 18 March 2019 !!access-date!!, [https://www.snpedia.com/index.php/Rs762551 https://www.snpedia.com/index.php/Rs762551]</ref>
<ref name="CamandolaPlick2018">Simonetta Camandola, Natalie Plick, Mark P. Mattson, Impact of Coffee and Cacao Purine Metabolites on Neuroplasticity and Neurodegenerative Disease, Neurochemical Research, volume 44, issue 1, 2018, pages 214–227, ISSN [http://www.worldcat.org/issn/0364-3190 0364-3190], doi [http://dx.doi.org/10.1007/s11064-018-2492-0 10.1007/s11064-018-2492-0]</ref>
<ref name="BenowitzJacob1995">Neal L. Benowitz, Peyton Jacob, Haim Mayan, Charles Denaro, Sympathomimetic effects of paraxanthine and caffeine in humans*, Clinical Pharmacology & Therapeutics, volume 58, issue 6, 1995, pages 684–691, ISSN [http://www.worldcat.org/issn/0009-9236 0009-9236], doi [http://dx.doi.org/10.1016/0009-9236(95)90025-X 10.1016/0009-9236(95)90025-X]</ref>
<ref name="Okuro-2010">M. Okuro, N. Fujiki, N. Kotorii, Y. Ishimaru, P. Sokoloff, S. Nishino, Effects of paraxanthine and caffeine on sleep, locomotor activity, and body temperature in orexin/ataxin-3 transgenic narcoleptic mice., Sleep, volume 33, issue 7, pages 930-42, Jul 2010, PMID [http://www.ncbi.nlm.nih.gov/pubmed/20614853 20614853]</ref>
<ref name="GuerreiroToulorge2008">S. Guerreiro, D. Toulorge, E. Hirsch, M. Marien, P. Sokoloff, P. P. Michel, Paraxanthine, the Primary Metabolite of Caffeine, Provides Protection against Dopaminergic Cell Death via Stimulation of Ryanodine Receptor Channels, Molecular Pharmacology, volume 74, issue 4, 2008, pages 980–989, ISSN [http://www.worldcat.org/issn/0026-895X 0026-895X], doi [http://dx.doi.org/10.1124/mol.108.048207 10.1124/mol.108.048207]</ref>
<ref name="NehligAlexander2018">Astrid Nehlig, Stephen P. H. Alexander, Interindividual Differences in Caffeine Metabolism and Factors Driving Caffeine Consumption, Pharmacological Reviews, volume 70, issue 2, 2018, pages 384–411, ISSN [http://www.worldcat.org/issn/0031-6997 0031-6997], doi [http://dx.doi.org/10.1124/pr.117.014407 10.1124/pr.117.014407]</ref>
<ref name="McLeanGraham2002">C. McLean, T. E. Graham, Effects of exercise and thermal stress on caffeine pharmacokinetics in men and eumenorrheic women, Journal of Applied Physiology, volume 93, issue 4, 2002, pages 1471–1478, ISSN [http://www.worldcat.org/issn/8750-7587 8750-7587], doi [http://dx.doi.org/10.1152/japplphysiol.00762.2000 10.1152/japplphysiol.00762.2000]</ref>
<ref name="Collomp-1991">K. Collomp, F. Anselme, M. Audran, JP. Gay, JL. Chanal, C. Prefaut, Effects of moderate exercise on the pharmacokinetics of caffeine., Eur J Clin Pharmacol, volume 40, issue 3, pages 279-82, 1991, PMID [http://www.ncbi.nlm.nih.gov/pubmed/2060565 2060565]</ref>
<ref name="Kamimori-1987">GH. Kamimori, SM. Somani, RG. Knowlton, RM. Perkins, The effects of obesity and exercise on the pharmacokinetics of caffeine in lean and obese volunteers., Eur J Clin Pharmacol, volume 31, issue 5, pages 595-600, 1987, PMID [http://www.ncbi.nlm.nih.gov/pubmed/3830245 3830245]</ref>
<ref name="ChengMurphy1990">Wendy S C Cheng, Therese L Murphy, Maree T Smith, W Graham E Cooksley, June W Halliday, Lawrie W Powell, Dose-dependent pharmacokinetics of caffeine in humans: Relevance as a test of quantitative liver function, Clinical Pharmacology and Therapeutics, volume 47, issue 4, 1990, pages 516–524, ISSN [http://www.worldcat.org/issn/0009-9236 0009-9236], doi [http://dx.doi.org/10.1038/clpt.1990.66 10.1038/clpt.1990.66]</ref>
</references>

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