Caffeine

What is caffeine?

Caffeine is a bitter substance that occurs naturally in more than 60 plants including:

• Coffee beans
• Tea leaves
• Kola nuts, which are used to flavor soft drink colas
• Cacao pods, which are used to make chocolate products

There is also synthetic (man-made) caffeine, which is added to some medicines, foods, and drinks. For example, some pain relievers, cold medicines, and over-the-counter medicines for alertness contain synthetic caffeine. So do energy drinks and "energy-boosting" gums and snacks.

Most people consume caffeine from drinks. The amount of caffeine in different drinks can vary a lot, but it is generally:

• An 8-ounce cup of coffee: 95-200 mg
• A 12-ounce can of cola: 35-45 mg
• An 8-ounce energy drink: 70-100 mg
• An 8-ounce cup of tea: 14-60 mg

Caffeine has many effects on your body's metabolism. It:

• Stimulates your central nervous system, which can make you feel more awake and give you a boost of energy
• Is a diuretic, meaning that it helps your body get rid of extra salt and water by urinating more
• Increases the release of acid in your stomach, sometimes leading to an upset stomach or heartburn
• May interfere with the absorption of calcium in the body
• Increases your blood pressure

Within one hour of eating or drinking caffeine, it reaches its peak level in your blood. You may continue to feel the effects of caffeine for four to six hours.

For most people, it is not harmful to consume up to 400mg of caffeine a day. If you do eat or drink too much caffeine, it can cause health problems, such as:

• Restlessness and shakiness
• Insomnia
• Headaches
• Dizziness
• Fast heart rate
• Dehydration
• Anxiety
• Dependency, so you need to take more of it to get the same results

Some people are more sensitive to the effects of caffeine than others.

Energy drinks are beverages that have added caffeine. The amount of caffeine in energy drinks can vary widely, and sometimes the labels on the drinks do not give you the actual amount of caffeine in them. Energy drinks may also contain sugars, vitamins, herbs, and supplements.

Companies that make energy drinks claim that the drinks can increase alertness and improve physical and mental performance. This has helped make the drinks popular with American teens and young adults. There's limited data showing that energy drinks might temporarily improve alertness and physical endurance. There is not enough evidence to show that they enhance strength or power. But what we do know is that energy drinks can be dangerous because they have large amounts of caffeine. And since they have lots of sugar, they can contribute to weight gain and worsen diabetes.

Sometimes young people mix their energy drinks with alcohol. It is dangerous to combine alcohol and caffeine. Caffeine can interfere with your ability to recognize how drunk you are, which can lead you to drink more. This also makes you more likely to make bad decisions.

You should check with your health care provider about whether you should limit or avoid caffeine if you:

• Are pregnant, since caffeine passes through the placenta to your baby.
• Are breastfeeding, since a small amount of caffeine that you consume is passed along to your baby.
• Have sleep disorders, including insomnia.
• Have migraines or other chronic headaches.
• Have anxiety.
• Have GERD or ulcers.
• Have arrhythmia (a problem with the rate or rhythm of your heartbeat).
• Have high blood pressure.
• Take certain medicines or supplements, including stimulants, certain antibiotics, asthma medicines, and heart medicines. Check with your health care provider about whether there might be interactions between caffeine and any medicines and supplements that you take.
• Are a child or teen. Neither should have as much caffeine as adults. Children can be especially sensitive to the effects of caffeine.

If you have been consuming caffeine on a regular basis and then suddenly stop, you may have caffeine withdrawal. Symptoms can include:

• Headaches
• Drowsiness
• Irritability
• Nausea
• Trouble concentrating

These symptoms usually go away after a couple of days.

Carbohydrate Metabolism Disorders

Metabolism is the process your body uses to make energy from the food you eat. Food is made up of proteins, carbohydrates, and fats. Chemicals in your digestive system (enzymes) break the food parts down into sugars and acids, your body's fuel. Your body can use this fuel right away, or it can store the energy in your body tissues. If you have a metabolic disorder, something goes wrong with this process.

Carbohydrate metabolism disorders are a group of metabolic disorders. Normally your enzymes break carbohydrates down into glucose (a type of sugar). If you have one of these disorders, you may not have enough enzymes to break down the carbohydrates. Or the enzymes may not work properly. This causes a harmful amount of sugar to build up in your body. That can lead to health problems, some of which can be serious. Some of the disorders are fatal.

These disorders are inherited. Newborn babies get screened for many of them, using blood tests. If there is a family history of one of these disorders, parents can get genetic testing to see whether they carry the gene. Other genetic tests can tell whether the fetus has the disorder or carries the gene for the disorder.

Treatments may include special diets, supplements, and medicines. Some babies may also need additional treatments, if there are complications. For some disorders, there is no cure, but treatments may help with symptoms.

Cardiac Rehabilitation

Cardiac rehabilitation (rehab) is a medically supervised program to help people who have:

• A heart attack
• Angioplasty or coronary artery bypass grafting for coronary heart disease
• A heart valve repair or replacement
• A heart transplant or a lung transplant
• Angina
• Heart failure

The goal is to help you return to an active life, and to reduce the risk of further heart problems. A team of specialists will create a plan for you that includes exercise training, education on heart healthy living, and counseling to reduce stress. You will learn how to reduce your risk factors, such as high blood pressure, high blood cholesterol, depression, and diabetes. Being overweight, having obesity, smoking, and not exercising are other risk factors.

NIH: National Heart, Lung, and Blood Institute

Caregiver Health

What is a caregiver?

A caregiver gives care to someone who needs help taking care of themselves. The person who needs help may be a child, an adult, or an older adult. They may need help because of an injury, chronic illness, or disability.

Some caregivers are informal caregivers. They are usually family members or friends. Other caregivers are paid professionals. Caregivers may give care at home or in a hospital or other health care setting. Sometimes they are caregiving from a distance. The types of tasks that caregivers do may include:

• Helping with daily tasks like bathing, eating, or taking medicine
• Arranging activities and medical care
• Making health and financial decisions

Caregiving can be rewarding. It may help to strengthen connections to a loved one. You may feel fulfillment from helping someone else. But caregiving may also be stressful and sometimes even overwhelming. Caregiving may involve meeting complex demands without any training or help. You may also be working and have children or others to care for. To meet all of the demands, you might be putting your own needs and feelings aside. But that's not good for your long-term health. But you need to make sure that you are also taking care of yourself.

Many caregivers are affected by caregiver stress. This is the stress that comes from the emotional and physical strain of caregiving. The signs include:

• Feeling overwhelmed
• Feeling alone, isolated, or deserted by others
• Sleeping too much or too little
• Gaining or losing a lot of weight
• Feeling tired most of the time
• Losing interest in activities you used to enjoy
• Becoming easily irritated or angered
• Feeling worried or sad often
• Having headaches or body aches often
• Turning to unhealthy behaviors like smoking or drinking too much alcohol

Long-term caregiver stress may put you at risk for many different health problems. Some of these problems can be serious. They include:

• Depression and anxiety
• A weak immune system
• Excess weight and obesity
• Chronic diseases such as heart disease, cancer, diabetes, or arthritis. Depression and obesity can raise the risk of these diseases even more.
• Problems with short-term memory or paying attention

Taking steps to prevent or relieve caregiver stress may help prevent health problems. Remember that if you feel better, you can take better care of your loved one. It will also be easier to focus on the rewards of caregiving. Some ways to help yourself include:

• Learning better ways to help your loved one. For examples, hospitals offer classes that can teach you how to care for someone with an injury or illness.
• Finding caregiving resources in your community to help you. Many communities have adult daycare services or respite services. Using one of these can give you a break from your caregiving duties.
• Asking for and accepting help. Make a list of ways others can help you. Let helpers choose what they would like to do. For instance, someone might sit with the person you care for while you do an errand. Someone else might pick up groceries for you.
• Joining a support group for caregivers. A support group can allow you to share stories, pick up caregiving tips, and get support from others who face the same challenges as you do.
• Being organized to make caregiving more manageable. Make to-do lists and set a daily routine.
• Staying in touch with family and friends. It's important for you to have emotional support.
• Taking care of your own health. Try to find time to be physically active on most days of the week, choose healthy foods, and get enough sleep. Make sure that you keep up with your medical care such as regular checkups and screenings.
• Considering taking a break from your job, if you also work and are feeling overwhelmed. Under the federal Family and Medical Leave Act, eligible employees can take up to 12 weeks of unpaid leave per year to care for relatives. Check with your human resources office about your options.

Dept. of Health and Human Services Office on Women's Health

Carpal Tunnel Syndrome

What is carpal tunnel syndrome?

Carpal tunnel syndrome is the name for a group of problems that includes numbness, tingling, weakness, or pain in your wrist or hand. It's a very common condition that happens when a nerve in your wrist becomes squeezed.

The carpal tunnel is a narrow opening between the bones in your wrist and the ligament that holds them together. A nerve, called the median nerve, runs from your lower arm through the carpal tunnel and into your hand. This nerve provides feeling to your thumb and first three fingers. It also helps you move your thumb.

Tendons also run from your lower arm, through the carpal tunnel, and into your hand. The tendons connect your finger bones to muscles in your arm, so you can bend your fingers.

If the tendons become swollen or irritated inside the carpal tunnel, they may press on the nerve. The squeezed nerve may not work well, which can lead to numbness, weakness, and other symptoms of carpal tunnel syndrome.

In certain cases, the cause of carpal tunnel syndrome is unknown. But it usually happens from a combination of things that affect the structures in your wrist, such as:

• Injury to your wrist that causes swelling, such as a sprain or broken bone
• Health conditions that can affect your nerves, joints, or other parts of your wrist, for example:
  • Diabetes.
  • Rheumatoid arthritis.
  • A cyst or tumor in your wrist.
  • Changes in certain hormones, which may cause swelling from extra fluid in your body. Examples include an underactive thyroid gland (hypothyroidism), pregnancy and menopause.
  • Problems with the way your wrist is formed.
• Doing the same wrist and hand movements over and over, such as:
  • Assembly line work.
  • Carpentry or using tools that vibrate.
  • Knitting, gardening, or sports, such as golf.

Researchers aren't sure whether long-term typing or computer use leads to carpal tunnel syndrome.

Carpal tunnel syndrome usually happens only in adults. You're more likely to develop it if you:

• Are a woman. Women are three times more likely to have carpal tunnel syndrome than men.
• Have a health condition that may affect structures in your wrist.
• Do activities with repeated hand motions.
• Have had a wrist injury.
• Have a close relative who has had carpal tunnel syndrome, such as a parent, brother or sister.

You may feel numbness, tingling or burning in your fingers, especially in your thumb, index, and middle fingers. Symptoms often affect both hands.

In the early stages, symptoms usually:

• Start slowly in your dominant hand (the one you write with)
• Happen at night if you sleep with your wrists bent

As symptoms get worse, you may notice:

• Tingling, pain, or weakness with certain activities, such as driving or holding a phone
• Difficulty grasping or holding small things
• Feeling like your fingers are swollen when they're not

Without treatment, you could lose feeling in some fingers and have permanent weakness in your thumb. But early diagnosis and treatment can help prevent lasting damage.

To find out if you have carpal tunnel syndrome, your health care provider will:

• Ask about your medical history
• Ask about your family health history
• Do a physical exam
• Order tests if needed, such as:
  • Lab tests to look for diseases that may damage nerves
  • X-rays to look for broken bones or arthritis
  • Tests to measure the electrical activity in your nerves and muscles
  • Ultrasound to check the nerve in the carpal tunnel

It's easier to treat carpal tunnel syndrome early on, so you should start treatment as soon as possible. Your provider will first treat any health conditions you have that may cause your symptoms. The next step would be treatments for carpal tunnel syndrome. They may include:

• Wrist splints (usually worn at night).
• Rest.
• Medicines to reduce swelling and pain:
• Over-the-counter pain relievers, such as aspirin, ibuprofen, and naproxen sodium.
• Prescriptionsteroids, either pills or an injection (shot) into your wrist.
• Other therapies (complementary and integrative medicine). Research shows that yoga may help with pain and weakness. Some people may find acupuncture and chiropractic care helpful, but research hasn't shown that these therapies can improve carpal tunnel syndrome. If you want to try other therapies, talk with your provider first.
• Surgery to make more space in the carpal tunnel. Surgery may be an option if your symptoms are severe and other treatments don't work. It involves cutting the wrist ligament to take pressure off the nerve. Recovery may take months. Carpal tunnel syndrome rarely comes back after surgery, but mild symptoms may last.

You may help prevent carpal tunnel syndrome if you protect your wrists:

• Use good posture to keep your wrists in a natural position.
• Keep your hands warm to keep your muscles flexible. Fingerless gloves may help.
• Take work breaks and vary your tasks.
• Stretch and exercise your hands and wrists.
• Organize your workspace and tools to reduce strain on your hands and wrists.