REVIEW

The impact of caffeine on mood, cognitive function, performance and hydration: a review of benets and risks
C. H. S. Ruxton
Nutrition Communications, Cupar, UK

Summary

The reputed benets of moderate caffeine consumption include improvements in physical endurance, cognitive function, particularly alertness and vigilance, mood and perception of fatigue. In contrast, there are concerns that excessive intakes increase the risks of dehydration, anxiety, headache and sleep disturbances. This paper is a review of double-blind, placebo-controlled trials published over the past 15 years to establish what range of caffeine consumption would maximise benets and minimise risks for cognitive function, mood, physical performance and hydration. Of the 41 human studies meeting the inclusion criteria, the majority reported benets associated with low to moderate caffeine intakes (37.5 to 450 mg per day). The available studies on hydration found that caffeine intakes up to 400 mg per day did not produce dehydration, even in subjects undergoing exercise testing. It was concluded that the range of caffeine intake that appeared to maximise benet and minimise risk is 38 to 400 mg per day, equating to 1 to 8 cups of tea per day, or 0.3 to 4 cups of brewed coffee per day. The limitations of the current evidence base are discussed.
Keywords: caffeine, cognitive function, mood, performance, risk

Introduction
Caffeine (1,3,7-trimethylxanthine) is the most consumed psychoactive substance in the world. Although caffeine is naturally present in many plant-based foods, the main sources in the Western diet are coffee, tea, cocoa products and cola products. Table 1 provides typical caffeine levels found in standard portions of these. The wide variation in the caffeine content of tea and coffee can be explained by differences in the blend

Correspondence: Dr Carrie H. S. Ruxton, Freelance Dietitian, 6 Front Lebanon, Cupar KY15 4EA, UK. E-mail: carrie@nutrition-communications.com

and brewing times (FSA 2004). Caffeine is used as a stimulant in traditional South American and African communities via consumption of caffeine-rich plant products, such as cola nut and mat. It is also used in supplements and drinks designed for weight management, sports performance or energy boosting, and in some medicines (e.g. cold and u remedies). Most of the average UK caffeine intake of 4 mg per kg bodyweight originates from tea (Thomas 2003). Caffeine is rapidly absorbed from the gastrointestinal tract, with plasma levels peaking at 6090 minutes postingestion. Urine is a poor method of assessing caffeine exposure, as less than 6% of a caffeine dose is excreted (Thomas 2003). Instead, caffeine is metabolised, mostly

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Table 1 Caffeine content (mg/serving) of commonly consumed beverages

Beverage (serving size) Tea (190 ml) Instant coffee (190 ml) Ground coffee (190 ml) Hot chocolate (150 ml) Dark chocolate (bar) Cola (330 ml) Energy drink (250 ml) Range 190 21120 15254 16 1170 2787 Average 50 75 100 50* 40 80

Source: compiled from FSA (2004) and product information. Average values from FSA website. *Milk chocolate contains about half as much caffeine.

blind, placebo-controlled methodology was used. The focus on placebo-controlled experiments was important as regular caffeine consumers may be conditioned to anticipate cognitive effects from caffeinated products (Smit et al. 2006). Studies using combinations of caffeine and other substances (e.g. glucose, herbs and drugs) were excluded unless the results for caffeine vs. placebo could be extracted. The use of caffeinecontaining beverages as test products was allowed if similar non-caffeinated products were used as controls. However, it is acknowledged that decaffeinated tea and coffee are not actually caffeine-free and can contain up to 8 mg caffeine per cup (FSA 2004). Meta-analyses were included but were used only to support the discussion. Reference lists of acceptable papers were hand searched in an attempt to locate all relevant studies.

in the liver by the P45 enzyme system, producing a range of metabolites, including dimethylxanthine, monomethylxanthine and uric acid. The average half-life of caffeine is 2.5 to 4.5 hours but can vary from 1 to 10 hours in certain individuals (ANZFA 2000). The Food Standards Agency (FSA 2001) advises pregnant women to limit their caffeine intake to a maximum of 300 mg per day owing to concerns that excessive caffeine may cause miscarriage or low birthweight. There are no ofcial recommendations to limit caffeine consumption in non-pregnant consumers, although this has not prevented the assumption by media commentators and others that caffeine can be harmful. Specically, it is claimed that regular caffeine consumption, even at moderate levels, increases the risk of dehydration, anxiety and sleep disorders. While the published literature contains examples of high-dose caffeine studies where negative effects have been found (e.g. Smith 2002), there is also a considerable body of literature suggesting that natural caffeine-containing foods and beverages offer cognitive and performance-related benets, and may provide a source of polyphenols (Gardner et al. 2007). This review aims to examine and collate double-blind, placebo-controlled trials in order to investigate the risks and benets of regular caffeine consumption on mood, cognitive function, physical performance and hydration.

Mood and cognitive performance

Caffeine is believed to impact on mood and performance by inhibiting the binding of both adenosine and benzodiazepine receptor ligands to brain membranes. As these neurotransmitters are known to slow down brain activity, a blockade of their receptors lessens this effect. Caffeine intake also causes changes to a variety of other neurotransmitters, including noradrenaline, dopamine, serotonin, acetylcholine, glutamate and gamma-aminobutyric acid (Fredholm et al. 1999). Twenty-three studies were found and are summarised in Table 2. These considered a range of cognitive measures, such as memory, accuracy, vigilance and speed, as well as self-reported mood and perceived fatigue. A typical study would involve volunteers being given a placebo, or one or more doses of caffeine in drinks/ capsules. Mood and cognitive tests (often using computer software) would be undertaken at baseline and shortly after consumption of the placebo/caffeine. Before and after test results could then be compared to look for differences that may relate to caffeine consumption. Sixteen of the studies in Table 2 were on healthy, rested subjects and, of these, 14 reported benets relating to caffeine consumption, including improved alertness, short-term recall and reaction time. There were also consistent ndings for positive mood and lower perceived fatigue. The caffeine dose varied depending upon the study, with most using a single bolus of caffeine, ranging from 37.5 to 450 mg. A few studies considered caffeine intake over several days using doses of 1 to 6 mg per kg bodyweight, taken up to four times daily. The maximum caffeine dose for the longer studies, assuming a typical 70 kg person, was in the region of 450 mg. While the duration of most of the studies may

Methods
Medline was searched for English-language, peerreviewed studies published between 1992 and 2007. Search terms included caffeine in combination with mood, cognitive function, hydration, diuresis, performance and exercise. Inclusion criteria were that studies had to be on healthy adults and that a double-

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Table 2 Caffeine and mood/cognitive function

Caffeine test Outcome variables Results for caffeine vs. placebo*

Reference

Subjects

Not sleep-restricted Haskell et al. (2005) 75-, 150-mg bolus Cognitive performance, mood

Heatherley et al. (2005)

24 habitual caffeine users following 24-hour abstinence vs. 24 non-users 49 habitual caffeine users following 4-, 6- or 8-hour abstinence 1.2 mg/kg BW bolus Cognitive performance, psychomotor skills, mood Cognitive performance, thirst, mood 12.5-, 25-, 50-, 100-mg bolus

Smit & Rogers (2000)

Robelin & Rogers (1998)

23 habitual caffeine users following 24-hour abstinence. Within-person study 64 habitual caffeine users following 24-hour abstinence 1.2 mg/kg BW given t.i.d. in novel fruit drink 0 vs. 1 mg/kg BW bolus Psychomotor skills and mood tested after drink to assess cumulative effect Cognitive performance, alertness, mood

Yeomans et al. (2002)

Improvements in reaction time, vigilance, memory. Habitual users outperformed non-users Caffeine had short-term stimulant effects after 8-hour abstinence. Not all were positive Caffeine improved cognitive function at all doses. Regular caffeine users beneted more than low users Caffeine improved cognitive function after one exposure. No cumulative effect Performance improved after 1st dose of caffeine but not after 2nd

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Childs & de Wit (2006) 1.5 mg/kg BW bolus

50-, 150-, 450-mg bolus

Smith et al. (2005)

Memory, reaction time, vigilance, mood Cognitive performance, mood

Christopher et al. (2005)

2 mg/kg BW bolus

Cognitive performance, mood

Performance enhanced and mood improved in short-term Performance and mood improvements. Doseresponse. Intra-individual differences Performance and mood improvements Cognitive performance, mood Both regimes improved performance and increased reported anxiety

Brice & Smith (2002)

65 mg q.i.d. vs. 200-mg bolus

Hindmarch et al. (2000)

30 habitual caffeine users preloaded with 0,1 or 2 mg/kg bodyweight caffeine 102 light caffeine users. Within-person study 60 habitual caffeine users. Normal consumption maintained before trial 68 habitual caffeine users. Normal consumption maintained before trial 24 habitual caffeine users. Within-person study involving decaffeinated coffee + added caffeine 30 habitual caffeine users 37.5, 75, 100 mg q.i.d. to mimic tea/ coffee intake

Cognitive performance, sleep quality

Hindmarch et al. (1998)

Cognitive performance Blood pressure, mood, alertness

Quinlan et al. (2000)

19 habitual caffeine users. Within-person study 32 habitual caffeine users. Within-person study

100-mg bolus as tea, coffee or caffeinated water 25-, 50-, 75-, 100-, 200-mg bolus

Caffeine: a review of benets and risks

Smith et al. (2006)

25 habitual caffeine users following 24-hour abstinence vs. 25 non-users

2 mg/kg BW bolus

Cognitive performance, mood

Both regimes improved performance but higher doses of caffeine disrupted sleep Alertness maintained with caffeine. Tea and coffee had similar effects Caffeine increased blood pressure and elevated mood. No doseresponse Performance and mood improvements regardless of caffeine withdrawal

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Table 2 Continued
Caffeine test 1 mg/kg BW bolus Cognitive performance Outcome variables Results for caffeine vs. placebo*

Reference

Subjects

C.H.S. Ruxton

Hewlett & Smith (2006)

120 habitual caffeine users following 24-hour abstinence vs. 56 infrequent users

Judelson et al. (2005)

3 or 6 mg/kg BW/day for 5 days

Cognitive performance, psychomotor skills, mood Cognitive performance, alertness

Performance and mood improvements regardless of caffeine withdrawal. Caffeine users beneted more than infrequent users No effects

James (1998)

60 subjects after 3 day of caffeine equilibration (3 mg/kg bodyweight/ day) 36 habitual caffeine users 1- vs. 6-day exposure. 1.75 mg/kg BW t.i.d.

Acute improvements in alertness, not sustained over 6 days. No effect on cognitive performance

Sleep-restricted Lieberman et al. (2002) 100-, 200-, 300-mg bolus Vigilance, reaction time, marksmanship, alertness

68 sleep-deprived US Navy trainees

Deslandes et al. (2006) Rogers et al. (2005)

400-mg bolus 1.2 mg/kg BW bolus

Cognitive performance Cognitive performance, psychomotor skills

Improvements in all except marksmanship. Effects greatest one hour post consumption No effects No effects over and above withdrawal alleviation

James et al. (2005)

1.75 mg/kg BW bolus

Cognitive performance, psychomotor skills, mood

No effects over and above withdrawal alleviation

James & Gregg (2004)

1.75 mg/kg BW t.i.d.

Mood

Some subjects experienced poorer mood scores after caffeine

van Duinen et al. (2005) 600 mg

10 sleep-restricted subjects 17 habitual caffeine users following 3-week abstinence vs. 17 habitual caffeine users following 24-hour abstinence. Both groups sleep-restricted 96 habitual caffeine users alternating between 4-week caffeine use and 4-week placebo. Rested vs. sleep-restricted 48 habitual caffeine users alternating between 4-week caffeine use and 4-week placebo. Rested vs. sleep-restricted 23 fatigued subjects 3 mg/kg BW bolus

Cognitive performance Cognitive performance around shooting skills

Tikuisis et al. (2004)

20 military personnel. Control vs. sleep-deprived

Caffeine partly prevented fatigue-related cognitive decline All measures of performance declined with sleep deprivation. Caffeine restored some measures but not marksmanship

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*Only statistically signicant ndings reported. BW, bodyweight; q.i.d., four times a day; t.i.d., three times a day.

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appear short, it is worth bearing in mind that plasma caffeine levels peak at 6090 minutes post-ingestion. Thus, any cognitive effects would be expected to occur in the short-term. The issues of tolerance and dose response are addressed later in this review. Sleep deprivation is known to affect cognitive function and mood. Seven studies examined the impact of caffeine on sleep-restricted subjects, with only three nding that caffeine restored at least some measures of cognitive function. A single study by James and Gregg (2004) reported a negative impact of caffeine in sleeprestricted subjects. The dose of caffeine used in these studies ranged from 84 to 600 mg per day, usually taken as a single bolus. It has been argued that regular exposure to caffeine could increase tolerance to cognitive and mood effects (Childs & de Wit 2006). This point was addressed by a number of studies involving comparisons between habitual users of caffeine and low/non-users. In most of these, habitual users appeared to experience greater cognitive or mood effects compared with low/non-users, which is surprising as tolerance would be expected to blunt any effects. This was even the case when the caffeine was supplied as capsules, rather than tea or coffee, which could have raised expectations among regular consumers of these beverages. Smit and Rogers (2000) found that habitual caffeine users demonstrated tolerance to the thirst-inducing effects of caffeine but not to the performance-enhancing and mood effects. There is controversy about whether or not the cognitive effects associated with caffeine consumption are related to withdrawal alleviation. Supporters of this theory (e.g. Yeomans et al. 2002; James & Gregg 2004) suggest that caffeine withdrawal in habitual users worsens cognitive function while re-introduction of caffeine simply restores cognitive function to baseline levels, thus offering no additional benet (see Rogers 2007). Those in opposition to this theory (e.g. Smith et al. 2005; Childs & de Wit 2006) cite experimental examples where subjects, regardless of exposure to withdrawal, experience cognitive and mood enhancements with caffeine consumption. Among the studies collated for this review, opinion was evenly split, although it is worth noting that most of the studies supporting the withdrawal alleviation theory were carried out on sleep-deprived subjects, which may have inuenced the results. If it is assumed that caffeine does have a real impact on cognitive function, it is logical to consider whether a doseresponse exists. Of the 15 studies that compared different levels of caffeine intake, only two reported a doseresponse for cognitive performance (Lieberman

et al. 2002; Smith et al. 2005), while a further two found a doseresponse for blood pressure, heart rate or skin temperature (Hindmarch et al. 1998; 2000). In the latter study, coffee (moderate/high caffeine) adversely affected sleep onset and duration, while tea (low/ moderate caffeine) did not. It was clear that the majority of studies did not support a doseresponse argument and that the rst exposure to caffeine appeared to induce the cognitive and mood effects. Heatherley et al. (2005) simulated normal consumption of caffeinated beverages, nding that the second cup did not induce further cognitive or mood benets until at least 8 hours had elapsed. The level of caffeine intake at which cognitive effects were generated was fairly low in terms of normal daily consumption patterns. In the study by Smit and Rogers (2000), the lowest dose was 12.5 mg, which equates to one third of a cup of tea. This nding is backed up by other reviews (ANZFA 2000). In studies of caffeinated beverages, tea and coffee produced similar cognitive and mood effects, but differed in terms of other outcomes (e.g. sleep quality, heart rate, blood pressure). This could suggest that cognitive function is not inuenced by increasing caffeine dose, while other physiological systems are. It may also reect differences in the presence of other biologically active components in tea and coffee (e.g. avonoids, theophylline or theobromine). Indeed, some authors have noted that the cognitive/mood effects of tea and coffee are not fully explained by the caffeine content (Hindmarch et al. 1998; Quinlan et al. 2000).

Physical performance
Until 2004, the International Olympic Committee (IOC) restricted caffeine use during competition as it was believed to be an ergogenic (i.e. performance-enhancing) compound. The maximum permitted level was 12 mg caffeine per litre of urine (equivalent to around 5 cups of coffee). A review of the World Anti-doping Code in 2003 reversed the ban (World Anti-doping Agency 2003), although caffeine is still considered to be ergogenic even at levels below the former IOC threshold (Graham 2001; Schwenk & Costley 2002). Caffeine is thought to impact on physical and sporting performance via one or more modes of action. A commonly cited mechanism links caffeine consumption to increased free fatty acid oxidation, which would have the effect of sparing glycogen and prolonging the duration of exercise (Nehlig & Debry 1994; Paluska 2003). Certainly, caffeine ingestion has been found to increase plasma free fatty acids and promote insulin resistance (Norager et al. 2005). However, this proposed mecha-

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nism is disputed by some researchers (Graham 2001). Other mechanisms include enhancing muscle contractions via changes to sodium, calcium and potassium concentrations (Magkos & Kavouras 2005), and increased tolerance to fatigue via production of plasma catecholamines and inhibition of adenosine receptors (Nehlig & Debry 1994). Eleven studies were found that met our criteria, and these are summarised in Table 3. Five used trained subjects, while one was on active elderly people. The majority of studies found that caffeine consumption, at intakes of 2.5 to 6 mg per kg bodyweight, enhanced physical performance. Outcome measures included time to exhaustion, running/cycling performance, perception of fatigue and cycling power. In the two studies where a null effect was found, one gave 34 students 201 mg per day of caffeine for 8 weeks (Malek et al. 2006), while the other gave 8 trained cyclists 6 mg per kg bodyweight per day (Hunter et al. 2002). The latter authors wondered whether the lack of effect was due to the cyclists performing over a xed distance, rather than cycling to exhaustion, as this type of protocol would not have picked up any impact of caffeine consumption on endurance. It would appear, from the available evidence, that caffeine has ergogenic properties and, indeed, this is the view taken by two meta-analyses by the same authors. Doherty and Smith (2004) examined the evidence from 40 double-blind studies on exercise performance, nding that caffeine improved exercise test performance by 12%. The effect was more pronounced for endurance exercise than for graded or short-term exercise. The second meta-analysis (Doherty & Smith 2005) examined the impact of caffeine ingestion on perceived exertion using data from 21 studies. It was reported that the lower ratings of perceived exhaustion relating to caffeine ingestion accounted for 30% of the improvement in exercise performance. The authors proposed that the impact of caffeine on ratings of perceived exhaustion could partly explain its ergogenic effects. Habitual intake of caffeine does not appear to diminish any ergogenic properties (Paluska 2003).

Hydration
It is a common perception that caffeine-containing drinks cause a net loss in uid and may lead to dehydration. FSA advice (2007) states: Drinks that contain caffeine (such as tea, coffee and cola) can act as diuretics, which means they can make your body lose greater volumes of water than usual. So these drinks can lead to an increased need for water or other uids that dont have a diuretic effect. If this were the case, large

numbers of UK adults would be at risk from dehydration because 7097% are regular consumers of caffeinated beverages (Henderson et al. 2002; Heatherley et al. 2006). According to the National Drinks Survey (Taylor Nelson Sofres 2007), average intakes of tea and coffee in UK adults are 2.1 and 1.1 cups per day, respectively. Any risk of dehydration would be higher in elderly people, who, on average, consume 85% of daily nonfood uid from tea (Taylor Nelson Sofres 2003). In theory, caffeine could have an adverse effect on hydration as it increases blood ow to the kidneys and inhibits the re-absorption of sodium, calcium and magnesium, thus expelling more water (Birkner et al. 2006). There is also epidemiological evidence that caffeine consumption provokes the need to urinate by stimulating the bladders detrusor muscles (Arya et al. 2000), although this was not conrmed by a randomised controlled trial in women with detrusor overactivity (Swithinbank et al. 2005). However, the theory may not translate into practice because much of the research used high caffeine intakes in the form of capsules, rather than caffeinated beverages, and mechanistic studies were performed in rats. Despite the view that caffeine may act as a diuretic, there were surprisingly few studies in humans. Table 4 gives details on the eight studies found. In ve of these, a daily caffeine intake of 1.4 to 6 mg per kg bodyweight (98 to 420 mg per day for an average 70 kg person) did not have an adverse effect on hydration. Caffeine intakes were substantially higher in two studies that did nd evidence of dehydration. Wemple et al. (1997) used a dose of 8.75 mg per kg bodyweight, nding that urine output increased by 400 ml compared with the placebo condition when subjects (n = 8) were at rest. Interestingly, no signicant differences in hydration were seen when subjects performed a three hour cycle test, and the authors proposed that this may have been due to elevated catecholamine levels. Neuhauser-Berthold et al. (1997) compared six cups of coffee (providing 642 mg caffeine) with a water placebo in 12 non-exercising subjects who had been deprived of caffeine for ve days. Over the four hour trial, urine output increased in the caffeine group by 753 ml, and there was evidence of dehydration from bodyweight and body water estimates. Excretion of both sodium and potassium increased. A further study (Bird et al. 2005) reported increased urine output (360 ml) on day one, but not on days 2 or 3, of a trial of 5.6 mg caffeine per kg bodyweight. This suggests tolerance to the renal effects of caffeine after 48 hours. These studies taken together suggest that higher levels of caffeine can cause dehydration, particularly when subjects have abstained from the

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Table 3 Caffeine and physical performance

Caffeine test 201 mg/day for 8 weeks 5 mg/kg BW bolus 201 mg bolus 6 mg/kg BW bolus 3 mg/kg BW bolus 6 mg/kg BW bolus 600 mg taken over 7.5 hours 2.5, 5 mg/kg BW bolus Cycling speed and power Muscular endurance, anaerobic capability VO2 peak, running time to exhaustion No effect Outcome variables Results for caffeine vs. placebo*

Reference

Subjects

Malek et al. (2006)

Wiles et al. (2006) Beck et al. (2006)

34 students undergoing 8-week aerobic training 8 trained cyclists 37 resistance-trained men

Norager et al. (2005)

Speed and power improved Weight lifted in the one repetition bench press increased by 2 kg Endurance improved

Bridge & Jones (2006)

30 healthy elderly subjects. Within-person study. 48-hour abstention from caffeine 8 male distance runners. Cross-over design Simulation of rugby performance

Cycling and upper body endurance, walking speed 8-km run performance, blood lactate

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Stuart et al. (2005)

9 male rugby players. Cross-over design

McLellan et al. (2004)

Bell & McLellan (2003)

16 subjects after 28 hours of sleep deprivation in military-style setting 9 male caffeine users

Marching endurance, running time to exhaustion Cycling endurance 100-km cycling time trial

Hunter et al. (2002)

8 trained cyclists

Performance greater. Blood lactate levels higher 3 minutes after exercise Speed, power and passing accuracy improved. Perceived fatigue lower Perceived exertion lower during march. Time to exhaustion increased Time to exhaustion increased after both doses of caffeine No effect

Bell & McLellan (2002)

13 habitual caffeine users vs. 8 non-users

6 mg/kg BW preload followed by 0.33 mg/kg BW every 15 minutes during trial 5 mg/kg BW bolus taken 1, 3 or 6 hours prior to exercise 8.75 mg/kg BW taken over 4-hour period

Cycling endurance

Wemple et al. (1997)

6 trained cyclists. Cross-over design in resting condition and after 3-hour cycling

Maximal performance at 85% VO2 max

Time to exhaustion increased when caffeine taken 1 or 3 hours prior to exercise. Effects greater in non-users No impact

Caffeine: a review of benets and risks

*Only statistically signicant ndings reported. BW, bodyweight.

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Table 4 Caffeine and hydration

Subjects 8.75 mg/kg BW taken over 4-hour period Fluid-electrolyte balance Caffeine test Outcome variables Results for caffeine vs. placebo* Urine output 400 ml greater at rest. No differences during exercise

Reference

Wemple et al. (1997)

Fiala et al. (2004)

6 trained cyclists. Cross-over design in resting condition and following 3-hour cycling 10 partially heat-acclimated athletes Caffeinated (mean 244 mg/day) vs. caffeine-free cola 5-day test period of 3 or 6 mg/kg BW 3-day regime of 5.6 mg/kg BW/day

Armstrong et al. (2005)

No impact on hydration apart from urine colour (darker after caffeine) No impact on hydration

Bird et al. (2005)

Hydration following 2 x 2 hour exercise sessions Fluid-electrolyte balance, urine colour, body mass Fluid balance Thermoregulation, uid balance post exercise

Falk et al. (1990)

59 healthy men following 6-day equilibrium on 3 mg/kg BW 80 habitual caffeine users following 24-hour abstinence 7 trained male athletes. Cross-over design

Urine output 360 ml greater on day 1. No differences on days 2 and 3 No impact

Roti et al. (2006)

No impact

Grandjean et al. (2000)

Fluid-electrolyte balance, thermoregulation post exercise Fluid-electrolyte balance, body mass Fluid-electrolyte balance, BW, TBW (estimated by BIA)

Neuhauser-Berthold et al. (1997)

59 active male students following 6-day equilibrium on 3 mg/kg BW 18 healthy adult men. Cross-over design of 4 commercially-available test drinks 12 healthy volunteers after 5-day abstention from methylxanthines

5 mg/kg BW preload followed by 2.5 mg/kg BW 2 and 0.5 hours prior to exercise 5-day test period of 3 or 6 mg/kg BW with exercise test 1-day test periods of 111254 mg/day (1.43.1 mg/kg BW) 1-day test of 6 cups of coffee (642 mg caffeine/day)

No impact. BW reduced in all uid conditions 24-hour urine output increased by 753 ml. BW reduced by 0.7 kg. TBW reduced by 2.7%. Na and K urinary excretion increased

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*Only statistically signicant ndings reported. BIA, bioelectrical impedance analysis; BW, bodyweight; TBW, total body water.

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substance for a number of days. There is no evidence at present that low to moderate intakes of caffeine, even when consumed around extreme exercise, affect hydration in a negative way.

Limitations of the review

Many of the available studies had small sample sizes, although the body of evidence was considerable for mood and cognitive function. However, the use of differing cognitive and mood tests made some comparisons challenging. The issue of whether caffeine merely reverses withdrawal symptoms or confers a real cognitive benet remains controversial and is hard to resolve, because most people are now exposed to some dietary caffeine (Heatherley et al. 2006). Thus, studies need to be of sufcient duration to judge the long-term effects of caffeine, yet include caffeine consumers who have experienced sufcient abstinence to get beyond any impact of withdrawal alleviation. As mood and cognitive function are subjective variables, within-person comparisons are most appropriate. Finally, there are difculties in translating any caffeine ranges from experimental evidence to real life owing to differences in how tea and coffee, the main sources of caffeine in the UK diet, are prepared by individual consumers.

Safe limits and applications

In the studies reviewed here, different levels of caffeine had different effects. The maximum daily caffeine dose in the cognitive studies, assuming a typical 70 kg person, was in the region of 450 mg. Enhancements in mood and cognitive function were seen following daily caffeine intakes of 37.5 to 450 mg, although some disturbances to sleep were seen at around 400 mg per day. Turning to the physical performance data, intakes of 2.5 to 6 mg per kg bodyweight (equivalent to 175 to 420 mg per day for an average person) improved measures of endurance, power and tolerance of fatigue. Finally, the available studies on hydration found no ill effects of caffeine at intakes up to 400 mg per day, although it is acknowledged that these studies were relatively few in number. Thus, the range of caffeine intake that would appear to maximise benet while minimising risk, in relation to the topics covered by this review, seems to be 38 to 400 mg per day. This would be in the low to medium range according to an Australian/New Zealand expert group (ANZFA 2000). This group identied intakes of caffeine greater than 500 mg per day (>7 mg per kg bodyweight) as high. It is not known how many UK consumers exceed 400 mg per day, as data are currently unavailable. However, average caffeine intakes according to an ongoing study of 5870 adult consumers are 241 mg per day, with 97% of people identied as caffeine consumers (Heatherley et al. 2006). Given the average caffeine content of beverages (Table 1), a benecial range of caffeine consumption would equate to a tea intake of 1 to 8 cups per day, a brewed coffee intake of 0.3 to 4 cups per day or an energy drink intake of 5 cans. Average tea and coffee consumption in the UK is within this range, at 2.1 cups per day for tea, and 1.1 cups per day for coffee (Taylor Nelson Sofres 2007). Recommendations have been made by a few organisations to help groups of people gain benets from caffeine consumption. In the USA, military personnel are advised that 100 to 600 mg of caffeine can maintain cognitive performance during periods of sleep deprivation (Institute of Medicine 2001). The UK Department for Transport (2007) recommends that drivers consume two cups of coffee or another high-caffeine drink to help combat tiredness. There are no recommendations, as yet, for sports people.

Conclusions
From a review of double-blind, placebo-controlled studies published over the past 15 years, it would appear that the range of caffeine intake that could maximise benet and minimise risk in relation to mood, cognitive function, performance and hydration is 38 to 400 mg per day, equating to 1 to 8 cups of tea, or 0.3 to 4 cups of brewed coffee per day. Current levels of caffeine intake in the UK fall well within this range, suggesting that risk, for example from dehydration, is likely to be minimal.

Acknowledgements
This review was made possible by a grant from the Tea Council (UK), a condition of which was that Tea Council representatives and associates played no role in writing the review.

References
Armstrong LE, Pumerantz AC, Roti MW et al. (2005) Fluid, electrolyte, and renal indices of hydration during 11 days of controlled caffeine consumption. International Journal of Sports Nutrition and Exercise Metabolism 15: 25265. Arya LA, Myers DL & Jackson ND (2000) Dietary caffeine intake and the risk for detrusor instability: a case-control study. Obstetrics and Gynecology 96: 859. ANZFA (Australian New Zealand Food Authority) (2000) Report of the Expert Working Group on the Safety Aspects of Dietary Caffeine. ANZFA: Canberra/Wellington.

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