Caffeine and PCOS
When we think of caffeine, we often think of coffee. However, caffeine is found in various beverages, from coffee, tea, energy drinks, pre workouts, but it is also found in chocolate.
Everyone enjoys a nice hot cup of coffee or tea in the morning before work (because no one functions without it, right?), or when we need that extra push before our workout or even to get you through the rest of the day. However, is this delicious hot beverage doing our PCOS and symptoms harm?
Caffeine and PCOS is a topic I am sure many women with PCOS are curious to know more about.
There is plenty of research for and against the consumption of caffeine if you suffer from PCOS. Often you may find that caffeine has health benefits, but then again it has health risks too.
But, what is the outcome, should you or shouldn't you?
A popular reason for avoiding caffeine is it's effect on fertility.
Many studies have been undertaken to establish the affect caffeine consumption has on fertility, however, no study is conclusive. All studies obtain different results and conclusions.
Pollack, Louis et al. (2010) (1) conducted a prospective cohort study assessing caffeine consumption during sensitive windows of development comprising women discontinuing contraception for the purpose of becoming pregnant.
The study found that caffeine consumption was not associated with an increased risk of miscarriage or with an increased hazard of miscarriage.
A study in the American Journal of Epidemiology (2) concluded it is the amount of caffeine consumed that may result in reduced fertility. The study found women who consumed five or more cups/day carried a significant risk of delayed conception (TCP >9.5 months).
Yet other studies found no associate between the amount of caffeine consumed.
Results from a large retrospective study in pregnant women reported no association between those who consumed >7,000 mg of caffeine per month compared with those who consumed ^500 mg per month. Furthermore, another study concluded that no decrease in fertility occurred among coffee consumers of more than three cups per day.
A further study conducted by Saleh, Doush et al. (3) found no associate between coffee or tea consumption on pregnancy rate. However, they reported that caffeine could reach the follicular fluid and therefore warrant further research as there is suggestive evidence that it may result in harmful consequences to the reproductive process.
Another study concluded that the association between caffeine intake and fertility differed by beverage type (4). However, the researchers outlined that while certain types of caffeinated beverages may have an effect on fertility, it is difficult to know for certain if caffeine truly affects fertility, or if there are other lifestyle factors clustered together which affect fertility. It may be that coupled with the caffeinated beverage they also have an unhealthy lifestyle that could affect fertility.
A recent study (5) conducted by researchers at the National Institutes of Health and Ohio State University found that women who consumed more than 2 cups of caffeine a day had a risk of miscarriage.
Furthermore, another key finding published in Fertility and Sterility found women who supplemented with a daily multi vitamin before conception and through early pregnancy were less likely to miscarry by 79%, even when their caffeine consumption was on the higher-side (not that this should give you a pass on the caffeine restrictions) than women who did not.
Research (6) suggests drinking between 1 to 2 cups of coffee a day is not expected to be a concern for fertility.
Studies have found that consumption of caffeine can enhance insulin sensitivity and lower the risk of Type 2 Diabetes.
A study (7) found that consuming at least three cups of coffee or tea per day may lower the risk of type 2 diabetes.
Furthermore, a study published in the Journal of Agricultural and Food Chemicals (8) found that while tea contains polyphenols, providing a whole range of health benefits from protection against oxidative damage, antibacterial, antiviral, anticarcinogenic, and antimutagenic activities, the polyphenols found in tea may also increase insulin activity.
Research (9) has found that participants who consumed a high amount of caffeine regularly, over a 4-week period, has been shown to impair insulin sensitivity in people with Type 2 Diabetes.
Although other studies (10) linked caffeine and coffee consumption with increased blood sugar levels and insulin resistance.
Furthermore, a study published in Diabetes Care (11) found that both caffeinated and decaffeinated coffee was associated with reduced diabetes risk. Therefore, it may not be the caffeine found in coffee that helps it is possibly simply the ingredients that make up coffee.
Coffee consumption can, in fact, reduce the risk of heart disease rather than increase it.
A study (12) found that a moderate coffee consumption was associated with lower CVD risk, with the lowest CVD risk at 3 to 5 cups per day of coffee consumption, and heavy coffee consumption was not associated with CVD risk.
Can slightly raise blood pressure in some people. However, this effect is small (3–4 mmHg) and tends to diminish when they consume coffee regularly and they build a tolerance to it.
Women with PCOS are about three times more likely to develop Endometrial Cancer (EC) compared with women without it.
A study (13) conducted by Zhou, Luo et al. (2015) found coffee and intake of caffeine might significantly reduce the incidence of EC.
Sex Hormone Binding Globulin is a protein made by your liver. It's role in the body is to bind together with three sex hormones; estrogen, testosterone and dihydrotestosterone (DHT).
Once SHBG is bound to these three hormones, it can carry them throughout your blood. However, if your SHBG levels are low, like many women with PCOS have, this, therefore, means there are more active estrogen and testosterone in the body than there should be, resulting in hormone imbalances.
By increasing SHBG levels, testosterone, DHT and estrogen levels will decrease in turn helping with PCOS and it's symptoms.
There have been several studies indicating that caffeine can help increase SHBG levels.
Research (14) has linked low levels of SHBG with insulin resistance.
Furthermore, some researchers suggest that an increase in coffee consumption can increase SHBG levels and in turn help prevent type 2 diabetes.
Caffeine is not the best for your adrenals. Drinking coffee stimulates the release of both cortisol and adrenaline. Your body switches to the 'fight or flight' mode. The burst of adrenaline is great for performance. However, the problem is that over the use of caffeine can cause you to burn out, which results in adrenal fatigue. Every time you drink caffeine you force your adrenal glands to secrete even when they do not really have much-left give. Eventually, your body crashes and over time, you begin to feel even more tired and fatigued.
Many recommend adding fat such as grass fed butter to your coffee and this can help with the release of caffeine. Therefore, in turn avoiding the spike in energy and then the crash. You will instead have a slow release of caffeine.
This is not to say that by simply drinking coffee (15) you will lose fat. What it means is, caffeine raises free fatty acids (FFA), it does this by boosting the lipolysis process (16). Often when people say when you workout you will be burning into the fat stores instead of using carbs as energy, this is how you do it. Research has also shown that caffeine also increases energy expenditure by 13%.
It is important to note that you cannot drink caffeine and sit around all day and expect to lose weight. Caffeine is not some magic source and weight loss does not work like that. In order to reap this benefit, you need to exercise. Caffeine will enhance your performance, through not only give you that extra push and energy but by also helping you continue working out through relatively pain-free. As mentioned previously, caffeine stimulates adrenaline and when that 'fight or flight' mode is activated you often don't feel pain until after, which is great when you are going through a difficult workout.
Anxiety and Depression
Women with PCOS have higher rates of anxiety and depression.
A study in the Journal of Alzheimer's disease (17) indicated that a moderate consumption of caffeine (< 6 cups/day) has been associated with less depressive symptoms, fewer cognitive failures, and lower risk of suicide. They note that supposed beneficial effects on depression and ADHD have been insufficiently studied.
Furthermore, they highlight high doses of caffeine can cause anxiety. The research indicates that patients with panic disorder and performance social anxiety disorder seem to be particularly sensitive to the anxiety effects caused by caffeine, however, prior research suggests that it may be effective for some patients with obsessive compulsive disorder (OCD).
Several studies have concluded that coffee consumption reduces the risk of depression. One study (18) found that the risk of depression decreased faster and the association became significant when the caffeine consumption was above 68 mg/day and below 509 mg/day.
Research has shown that caffeine produces insomnia. A study found that it reduces slow-wave sleep in the early part of the sleep cycle (19) and can reduce rapid eye movement (REM) sleep later in the cycle (20). Caffeine raises your cortisol levels and therefore it is recommended that you avoid drinking caffeine after 11 or 12 o'clock as this can have an effect on your sleep. Researchers found that consuming high doses late in the evening can increase the time taken to fall asleep.
Sleep disturbances were twice as common in women with PCOS compared with those without. Caffeine is a stimulant and therefore women who have PCOS already have trouble falling asleep as a result drinking caffeinated beverages may not help. However, it may depend on how much caffeine you drink and what time during the day you drink it.
Should women with PCOS avoid caffeine?
There is no clear yes or no answer. While caffeine may have some benefits, it also has some risks. Whether you should avoid caffeine is up to you. Each and everyone woman's PCOS is different, symptoms may vary from mild to severe, and your tolerance to caffeine may be high or low. It is, therefore, your decision. From the evidence, it suggested that the ideal amount of caffeine you should consume is 1-3 cups a day. Avoid drinking caffeine late in the evening. If you are trying to conceive try and avoid or limit to 2 cups.
When it comes to many things, it is all about moderation. There are also plenty of other, healthier, ways to improve blood sugar levels and prevent Type 2 Diabetes. Which includes; eating a balanced diet, made up of low glycemic index carbohydrates, healthy fats, lean protein and plenty of micronutrient dense fruits and vegetables. As well as regular exercise.
(1) Pollack, AZ., Louis, GM., Sundaram, R., Lum, KJ. (2010). Caffeine consumption and miscarriage: a prospective cohort study. Fertility and Sterility. 93(1), 304–306. Available from: http://www.fertstert.org/article/S0015-0282(09)02488-1/fulltext
(2) Bolumar, F., Olsen, J., Rebagliato, M., Bisanti, L. and the European Study Group on Infertility and Subfecundity. (1997). Caffeine Intake and Delayed Conception: A European Multicenter Study on Infertility and Subfecundity. American Journal of Epidemiology. 145 (4)., 324-334.
(4)Hatch, EE., Wise, LA., Mikkelsen, ME., Christensen,T., Riis, AH., Sørensen, vanHT., and Rothman KJ. (2010). Caffeinated Beverage and Soda Consumption and Time to Pregnancy. 23(3): 393–401. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3321066/
(14) Pihan-Le Bars, F., Gusto, G. (2017). Cross-sectional association of coffee and caffeine consumption with sex hormone-binding globulin in healthy
women. Clinical Endocrinology. Available from: http://onlinelibrary.wiley.com/doi/10.1111/cen.13411/full
(15) Effect of caffeine on the metabolic responses of lipolysis and activated sweat gland density in human during physical activity.Food Science and Biotechnology. 19(4), 1077–1081. Available from: https://link.springer.com/article/10.1007%2Fs10068-010-0151-6
(16) Acheson, KJ., Gremaud G., Meirim, I., Montigon, F. (2004). Metabolic effects of caffeine in humans: lipid oxidation or futile cycling? The American Journal of Clinical Nutrition. Available from: http://ajcn.nutrition.org/content/79/1/40.full
(17) Dokras A. (2012). Mood and anxiety disorders in women with PCOS. Steroids. 10;77(4):338-41. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22178257
(18) Wang L, Shen X, Wu Y, Zhang D. (2016). Coffee and caffeine consumption and depression: A meta-analysis of observational studies. The Australian and New Zealand Journal of Psychiatry. 50(3):228-42. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26339067
(19) Smith, A. (2002) Effect of Caffeine on Human Behaviour. Food and Chemical Toxicology. 40, 1243-1255.
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