Sensitivity to coffee and subjective health

Abstract

The question was whether health complaints are associated with coffee consumption and self reported sensitivity to coffee. Participants were 89 men and 107 women, all coffee drinkers. Questionnaires were used at 2 points of time with an interval of 3.7 years. The correlations among coffee consumption, sensitivity and health complaints were signifi-cant but were of low importance to health. Coffee consumption was significantly related to intestinal complaints (r=0.15) and sensitivity to coffee with sleep-wake complaints (r=0.30). An increase in sensitivity to coffee over almost 4 years went along with less health complaints. The interaction of coffee intake and sensitivity to coffee had no influence on subjective health. Since subjective sensitivity data were used, validation of the findings should be done with objectively measured sensitivity and caffeine levels. The main conclusion is that self-reported coffee intake is not related to subjective health, but claimed sensitivity is.

Full text

Act Nerv Super Rediviva 2009; 51(1-2): 61–68
ORIGINAL ARTICLE
Activitas Nervosa Superior Rediviva Volume 51 No. 1-2 2009
Sensitivity to coffee and subjective health
Jan S 1*, Lando L. J. K 2 , Jos W. T 3
1 Department of Psychology, University of Amsterdam, Roetersstraat 15, 1018 WB Amsterdam, The Netherlands.
2 Division of Work and Employment, TNO Quality of Life, Hoofddorp, The Netherlands. 3 EMGO Institute, VU
University Medical Center (VUMC), Amsterdam, The Netherlands.
Correspondence to: j.snel@uva.nl
Submitted: 2008-10-27 Accepted: 2009-01-10
Key words:
coffee consumption; subjective health; sensitivity; longitudinal
Act Nerv Super Rediviva 2009; 51(1-2): 61–68 PII: ANSR51129A04 © 2009 Act Nerv Super Rediviva
Abstract
The question was whether health complaints are associated with coffee consumption and
self reported sensitivity to coffee. Participants were 89 men and 107 women, all coffee
drinkers. Questionnaires were used at 2 points of time with an interval of 3.7 years. The
correlations among coffee consumption, sensitivity and health complaints were signifi-
cant but were of low importance to health. Coffee consumption was significantly related
to intestinal complaints (r=0.15) and sensitivity to coffee with sleep-wake complaints
(r=0.30). An increase in sensitivity to coffee over almost 4 years went along with less health
complaints. The interaction of coffee intake and sensitivity to coffee had no influence on
subjective health. Since subjective sensitivity data were used, validation of the findings
should be done with objectively measured sensitivity and caffeine levels.
The main conclusion is that self-reported coffee intake is not related to subjective health,
but claimed sensitivity is.
I
Blaming coffee for causing negative effects on health
and behaviour has been done for centuries. In 1674,
at the start of the coffee houses in England, an infa-
mous pamphlet “The women’s petition against coffee”
was distributed, worrying about the “...grand inconve-
niences … from the excessive use of that drying, enfee-
bling liquor”. The complaints focussed on impotency
due to coffee and an increased talkativeness (Knibbe
& De Haan 1998). In spite of these negative opinions
about coffee, coffee was highly appreciated, still we are
unsure about coffee’s effect on health. In a question-
naire, filled in by 405 civilians and 123 physicians,
there were 10 statements concerning coffee as causing
or worsening high blood pressure, heart infarct, cancer
of the bladder, gastro-intestinal tract and oesopha-
gus, increase of blood sugar and stroke (Heyden &
Escher 1973). Of the physicians 2–52% said the state-
ments were right or possibly right against 4–76% of
the laymen. The low percentage concerned coffee as
a cause of bladder disease and the high percentage for
seeing coffee as the cause of worsening high blood
pressure. Not much has changed since then. In 1994 a
Danish study among physicians and patients showed
that 42% of the patients and 39% of the physicians
believed that coffee played a causal role in peptic ulcer
disease (Christensen et al 1994). A survey among 292
customers of 10 pharmacies in Sweden revealed that
the most common perceived cause of gastrointestinal
symptoms after poor diet was coffee (Sihvo & Hem-
minki 1999). Boekema and co-workers (Boekema et
al 1999) however in their review found no association
between coffee consumption and the development of
peptic ulcer. Also coffee is not an important contribu-
tor to symptoms of bad health in patients with func-
tional dyspepsia (Richter 1991). More recently there is
still no consensus among health professionals on the
coffee-health relationship (Soroko et al 1996; VNKT
2006). Sixty-eight percent of Dutch dieticians and 82%
of physicians agreed with the statement that ‘coffee can
give stomach problems’, while 11% and 27% respec-
tively disagreed. The opinions on the statement ‘coffee
is bad for the heart’ diverged even more. Thirteen per-

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Jan Snel, Lando L. J. Koppes, Jos W. Twisk
cent of the dieticians agreed with it against 26% of the
physicians, while 46% of the dieticians disagreed with
it against 30% of the physicians. Different opinions on
coffee must have consequences for given health advice
to patients (Binns et al 2008).
Also among the general public differing opinions
on coffee are found. Page and Goldberg (1986; 1987)
studied the perceived consequences of drinking caffein-
ated beverages (coffee and or other caffeinated drinks)
among college students, who always or usually con-
sumed caffeinated beverages or who rarely or never did
so (Page & Goldberg 1986; Page 1987). Those who pre-
ferred caffeinated drinks were more likely to see these
drinks as positive, giving people more energy, helping
them to relax and to feel better. Those who never or
rarely chose caffeinated beverages were more likely
to believe that these drinks would make people more
irritated, nervous, anxious and jumpy and that ulcers,
headaches, kidney and bladder damage, upset stom-
achs and high blood pressure, cancer and other nega-
tive effects would result from them. Similar differences
were found by (Goldstein & Kaizer 1969; Goldstein et al
1969) in comparing coffee drinkers of >5 cups per day
with light users.
It is obvious that worries concerning the health
effects of coffee are counterproductive in establishing
coffee as a drink of which the caffeine has beneficial
effects on cognition (Bendlin et al 2007; Quintana et al
2007; Snel et al 2004; Tieges et al 2007), and ill health
such as Parkinson’ disease (Hu et al 2007; Saaksjarvi et
al 2007), diabetes type II (Cadden et al 2007; Williams
et al 2008), certain cancer types (Hu et al 2008; Larsson
& Wolk 2007; Shimazu et al 2008), mood (Ruxton 2008)
and fatigue (Lorist & Snel 2008). Obviously spending a
lot of time worrying about the appropriateness of one’s
coffee consumption detracts from the quality of life
(Rozin et al 2003). The opinion that coffee consumption
might have unwanted health effects is not only men-
tioned in the popular press but is also found in scientific
research as a part of an unhealthy or ‘risky life style’. In
such studies coffee use is seen as a part of an imprudent
lifestyle and similar as smoking, alcohol over consump-
tion, insufficient physical exercise and other unhealthy
habits (Hulshof et al 2003; Kawachi et al 1994; Klatsky et
al 1993; Rasch 2003). No surprise that in case of health
complaints people consider to abstain or reduce their
coffee consumption. Health professionals are easily
inclined to support this wish even if his request is irrel-
evant for the specific complaint (Knibbe & De Haan
1998). An example: a check on sleep hygiene rules across
7 studies, running from 1977 to 2003, revealed that
abstinence from coffee is always recommended as a rule
to follow (Stepanski & Wyatt 2003). In a survey among
nearly 700 physicians 75% recommended changes in
caffeine consumption to patients with common health
problems (Hughes et al 1988). When asked to evaluate
which factors may disturb sleep (Urponen et al 1988),
caffeine was seen as the most disturbing factor after
work-related causes in men and after relational prob-
lems in women. The physician’s advice to limit coffee
consumption is easily followed and feeds the patient’s
suspicion that coffee may have negative health effects
and confirms his decision to give up his coffee habit.
Most who curtail on coffee consumption do so on own
initiative, but only 10% on advice of a physician (Soroko
et al 1996).
This negative attitude towards coffee may be
expressed as worries and health complaints. Thirteen
per cent of 1,178 coffee consumers (16–70 years old)
perceived their coffee consumption as a personal worry
and moreover was negatively commented upon by their
partners (6.3%) and by others (2%) (Knibbe & De Haan
1998). Eleven per cent of these coffee drinkers reported
four of the five studied health complaints of too much
coffee consumption (stomach pain, failed attempts
to reduce coffee, not able to sleep, feeling sick, trem-
bling hands). One third reported one or more negative
consequences and 5.4% reported three or more conse-
quences of coffee consumption. Interesting, there only
was a difference of 8 cups in weekly coffee consumption
(33.0 cups/weeks) between those reporting one and
those with four or more complaints (41.2 cups/week).
Although experimental evidence shows that regular
coffee consumption is not associated with objectively
measured health hazards (Boekema et al 1999; Heyden
1993; Nawrot et al 2003; Nehlig & Debry 1996), the
belief that coffee is bad for health is ineradicable. In
other words: coffee may be a reason for subjective
health complaints.
The subject of this study was whether coffee con-
sumption was associated to health complaints and
whether self reported sensitivity to coffee plays a role
in this.
M
Participants
This study is part of the Amsterdam Growth and Health
Longitudinal Study (Kemper 1985; 1995; 2004). The
AGAHLS is approved by the local ethics committee,
and started in 1977 to measure the lifestyle, health and
psychological characteristics of almost 600 healthy 13
year-old boys and girls who were pupils from two sec-
ondary schools. The present analyses are based on the
99 men and 133 women (more than 95% Caucasian).
Complete longitudinal data was gathered on coffee con-
sumption and self-rated health measured at a mean age
of 32.4 yr (SD = .80) and 3.7 years later at the age of 36.1
years.
Measures
Data on coffee consumption (yes or no, and amount
of consumption for drinkers) were obtained from a
questionnaire. Amount of consumption was asked spe-
cifically for eight moments of the day, the sum of the 8
scores formed the usual number of cups per day. The

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Sensitivity to Coffee and Subjective Health
question ”are you sensitive for the effects of coffee?” was
answered on a 5-point rating scale: score 1 was abso-
lutely not sensitive and score 5 extremely sensitive.
A 13-item questionnaire asked for the presence or
absence of specific health complaints (dizziness, bad
stomach, trembling hands, listlessness, tiredness, short-
age of breath, chest or back pain, pain in muscles or
bones, and headache (Jansen & Sikkel 1981). Sleep-wake
complaints were assessed with a 15-item questionnaire
on problems with falling asleep, waking up during the
night, waking up too early, difficulty with waking up,
being tired when waking up, and being tired during the
day (Diest R. van et al 1989). General health experience
was assessed using the question “Taken altogether how
healthy are you” on a five-point scale, running from
‘very well’ to ‘bad’. The question on general intestinal
complaints was asked at the age of 32 years (10-point
scale), and questions on happiness “taken altogether,
how happy are you?” (4-point scale) and life satisfac-
tion (10-point scale) at the age of 36 years.1
Data Analysis
The cross-sectional data were used to investigate
whether subjects who differ on coffee consumption
(not on other caffeinated drinks) and on claimed
coffee sensitivity differ in reported subjective health.
The longitudinal data were used to examine whether
individual changes over the 3.7-year follow-up in coffee
consumption or in claimed sensitivity were related to
changes in subjective health. Both the cross-sectional
and longitudinal data were used to study the interac-
tion between coffee consumption and claimed sensitiv-
ity on subjective health characteristics. To analyze these
data tertiles were formed of the 6 cross-sectional and
3 longitudinal outcome variables. Multinomial logistic
regression analyses were then performed to investigate
1 In this study, ‘happiness’ and ‘life satisfaction’ are considered indica-
tors of subjective health.
whether a score-difference of ‘one cup’ on coffee, or on
claimed sensitivity was related to the chance to belong
to the highest tertile (33%) or to the lowest tertile of
each perceived health characteristic.
Because coffee non-consumers may be a specific
population, only the participants who reported to
consume coffee at both assessments are included in
the analyses, so that starters, stoppers, and stable non-
consumers are excluded.
R
Descriptive population data on coffee consumption are
shown in Ta bl e 1 and on reported sensitivity to coffee
in Ta b l e 2 . Because the subjects who did not consume
coffee were not asked to answer the question on sensi-
tivity, the numbers of subjects are smaller in Table 2. At
the age of 32 years, 8.1% of the men and 14.3% of the
women reported no coffee consumption, while respec-
tively 10.1% and 2.3% reported to consume at least 8
cups/day. Over the four years of follow-up, five coffee
drinkers stopped (one man), while four non-consum-
ers started to drink coffee (all women). In men, a sig-
nificant average increase of .75 cups per day was seen,
whereas women did not significantly change coffee
consumption. The average sensitivity to coffee did not
change significantly between men and women.
Ta bl e 3 shows the descriptive data on the subjective
health characteristics. On average, women reported
more health and sleep-wake complaints than men. No
gender differences were observed for the other variables
or for the 3.7-year changes.
Ta bl e 4 shows the gender-controlled correlation
coefficients among the central variables. No correlation
was observed between coffee consumption and claimed
sensitivity to coffee. The amount of coffee consumption
was correlated significantly with intestinal complaints,
while the reported sensitivity to coffee was related to
more sleep-wake complaints. All subjective health vari-
Table 1. Frequency distribution of coffee consumption (cups/
day) at age 32 years, and its change over 3.7-year
Men N = 91 Women N = 114
% 1-2 cups/day 25.2 26.4
% 3-4 cups/day 27.5 46.4
% 5-7 cups/day 36.2 24.5
% ≥ 8 cups/day 11.0 2.7
4-year change:
% Decrease >2 cups/day 3.0 5.3
% Decrease 1-2 cups/day 17.2 23.3
% No change 31.3 44.4
% Increase 1-2 cups/day 28.3 19.5
% Increase >2 cups/day 20.2 7.5
Table 2. Frequency distribution of the reported sensitivity to coffee
at age 32, and its change over 3.7-year
Men N = 89 Women N = 107
Sensitivity to coffee:
% Not at all 29.7 43.8
% A bit 52.7 42.0
% Quite 13.2 11.6
% Very / Extremely 4.4 2.7
4-year change in sensitivity:
% Decrease 22.5 18.7
% No change 64.0 66.4
% Increase 13.5 15.0

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Jan Snel, Lando L. J. Koppes, Jos W. Twisk
ables, except intestinal complaints showed significant
correlations.
In Ta b l e 5 , a significant negative correlation is
reported between changes in the sensitivity to coffee
and health complaints. The change in health complaints
was also significantly related to changes in sleep-wake
complaints and general health experience.
The logistic regression analyses using cross-sectional
data showed no significant relationships between the
amount of coffee consumed and any perceived health
characteristic (all ps > .10). For the reported sensitiv-
ity to coffee, significant relationships were found with
sleep-wake complaints and general health experience.
Participants with a coffee sensitivity rating that was one
value higher were 2.25 times more likely to be in the
highest tertile of sleep-wake complaints as compared
with the lowest, and they were more than two times less
likely (OR = .46) to be in the highest tertile of experi-
enced general health. In line with these findings were
the non-significant trends for more health complaints
and intestinal complaints in participants with a higher
reported sensitivity to coffee (p = .07 and .11, respec-
tively). Table 6.
The logistic regression analyses using longitudinal
data showed a significant relationship between the
change in reported sensitivity to coffee and the change
in reported health complaints (Tab l e 7 ). Participants
with a four-year increase of one on reported sensitiv-
ity to coffee were almost two times more likely to have
Table 3. Means (SD) of the subjective health characteristics
Men N = 99 Women N = 133
Health complaints Age 32 2.6 (3.2) 3.6 (3.2)
4-year change .1 (3.1) .1 (2.9)
Sleep-wake complaints Age 32 3.2 (3.1) 4.5 (3.4)
4-year change .5 (3.3) .6 (2.8)
General health experience Age 32 4.1 (0.6) 4.1 (0.7)
4-year change –.0 (0.7) –.1 (0.7)
General intestinal complaint Age 32 2.2 (1.8) 2.3 (1.9)
Happiness Age 36 3.3 (0.6) 3.3 (0.6)
Life satisfaction Age 36 7.6 (1.4) 7.8 (1.4)
Table 4. Partial correlations among central variables (cross-sectional data)
Sensi tivity Health com-
plaints
Sleep-wake
complaints
General
health
Intestinal
complaints Happi ness Life satisfac-
tion
Coffee –.02 .08 –.02 –.03 .15* –.11 –.14
Sensitivity .12 .30*** –.12 .06 –.05 –.08
Health complaints .45*** –.45*** .36*** –.24*** –.31***
Sleep-wake complaints –.31*** .25*** –.25*** –.33***
General health –.34*** .34*** .31***
Intestinal complaints –.01 –.06
Happiness .78***
*p ≤ .05
***p ≤ .001
Table 5. Partial correlations among central variables (longitudinal data)
Sensitivity Health complaints Sleep-wake
complaints
General health
experience
Coffee –.02 –.04 –.13 .13
Sensitivity –.16* .05 .06
Health complaints .23*** –.23***
Sleep-wake complaints –.09
*p ≤ .05
***p ≤ .001

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Sensitivity to Coffee and Subjective Health
decreased than increased the number of reported health
complaints (OR = .53).
The interaction between coffee and reported sensi-
tivity to coffee was significant for the longitudinal anal-
ysis of health complaints (Table 7; p = .04), indicating
that the non-significant inverse relationship between
coffee consumption and health complaints was stron-
ger (more inverse) in participants reporting an increase
in sensitivity, and likewise, that the significant inverse
relationship between reported sensitivity and health
complaints was stronger (more inverse) in participants
who had increased their coffee consumption. In all other
analyses, the amount of coffee consumption did not
interact with reported coffee sensitivity regarding their
relationships with the perceived health characteristics.
D
In the present study the cross-sectional data on amount
of coffee consumption was significantly correlated
(r=0.15) with intestinal complaints. The reported sen-
sitivity to coffee was related (r=0.30) to more sleep-
wake complaints. Although statistically significant,
the explained variance is low with 2% and 9% respec-
tively which points to other, unknown factors that are
involved. These findings are of low clinical signifi-
cance, which is supported by the finding that when the
highest tertile of health complaints is compared to the
lowest, an increase of the sensitivity to coffee with one
point did not result in an increase of health complaints
(Table 6).
Since coffee drinking is a regular habit for many
people, they are not likely to monitor exactly how many
units they consume. This may provoke underreport-
ing and over reporting. In representative samples of
the population caffeine consumption is systematically
underestimated with about 20–25% (Brown et al 2001;
Ferraroni et al 2004; Schreiber et al 1988; Wendte et al
2003). However, those who do have health complaints
may worry more about possible causes, so their recall
of prior coffee use could be more accurate (Ferraroni
et al 2004). If true, it might mean that healthy people
underreport while those with health complaints over
report their coffee consumption, which leads to spuri-
ous correlations between coffee intake and health prob-
lems. Worrying about one’s coffee consumption may
also result in an exaggeration of reported sensitivity.
The combination of worry and claimed oversensitivity
may form a chronic stress, the first signs of it could be
impaired sleep and gastrointestinal functioning (Kik-
kert et al 1996; Snel et al 2001; Snel, Hofman, & Van
Kuler 2001). Thus, the reported health symptoms may
represent the effect of mild chronic stress rather than
the effect of coffee consumption and sensitivity to it.
The finding based on longitudinal data that an
increase of reported sensitivity is associated with less
health complaints is unexpected. It could reflect a strat-
egy to enforce a supposedly healthier lifestyle. Shlon-
sky and co-workers (Shlonsky et al 2003) found that a
Table 6. Odds ratio (OR) and 95% Confidence interval (CI) for being in the upper as compared with the lower tertile of a
subjective health characteristic if coffee consumption is one cup/day higher, respectively, if reported sensitivity to coffee is
one point higher (cross-sectional analyses)
Coffee Sensitivity
OR 95% CI OR 95% CI
Health complaints 1.06 .93 – 1.21 1.55 .97 – 2.48
Sleep-wake complaints 1.00 .87 – 1.14 2.25 1.40 – 3.60
General intestinal complaint 1.10 .97 – 1.25 1.41 .93 – 2.16
General health experience 1.01 .83 – 1.22 .46 .25 – .86
Happiness .88 .75 – 1.04 .82 .43 – 1.55
Life satisfaction .96 .84 – 1.09 .74 .46 – 1.19
Table 7. Odds ratio (OR) and 95% Confidence Interval (CI) for being in the upper as compared with the lower tertile of the
3.7-year change of a subjective health characteristic if the change in coffee consumption is one cup/day, respectively, if the
change in reported sensitivity to coffee is one point higher (longitudinal analyses)
Coffee Sensitivity
OR 95% CI OR 95% CI
Health complaints .92 .76 – 1.11 .53 .32 – .83
Sleep-wake complaints .96 .80 – 1.15 1.01 .68 – 1.51
General health experience 1.23 .97 – 1.58 1.17 .68 – 2.03

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Jan Snel, Lando L. J. Koppes, Jos W. Twisk
large proportion of decaffeinated coffee drinkers not
only avoided caffeinated coffee but also other vehicles
containing caffeine and rigidly adhered to special diets,
vitamin pills and rigorous exercise. Eighty per cent
of coffee consumers who change from caffeinated to
decaffeinated coffee do so predominantly for health
reasons (Soroko et al 1996). The effort to change to such
healthier lifestyle could be helped by a claimed higher
sensitivity to caffeine, but also by reporting less health
problems. The wish to change one’s coffee consump-
tion may come from the view that coffee is still seen as
a ‘negative’ food item in spite of studies showing that
coffee is safe for objectively measured health (Binns et
al 2008; Cadden et al 2007; Driessen et al 2008; George
et al 2008; Klatsky et al 2008; Taylor & Demmig-Adams
2007).
Most people are unaware of taking caffeine, since
it is present in various beverages, chocolate, chocolate
flavoured products, baked goods, dairy products, soft
candies and certain medicaments. It means that also
strict non-coffee drinkers are not caffeine-naive, con-
tinuously ‘under influence’ which implies that true con-
trol subjects do not exist. The present study was done
on ‘coffee drinkers’, without knowing how many con-
sumed decaffeinated coffee and to which degree caf-
feine was taken from other sources. Possibly, those who
prefer decaffeinated coffee do so as a part of a healthy
lifestyle. Although some studies show that coffee users
have more subjective health complaints than decaffein-
ated coffee drinkers or abstainers (Shirlow & Mathers
1985), the reverse is also true. Health complaints may
lead to abstinence from coffee and to decaffeinated
products (Leviton & Allred 1994). The choice of decaf-
feinated coffee could be seen as a marker of fear for ill-
ness and for running a low risk on ill health. (Shlonsky
et al 2003) compared 4 groups: 4,400 regular caffeinated
coffee users, 1,545 only decaffeinated coffee drinkers,
3,307 subjects who consumed both coffee types and
2,837 non-users on medical history, current symptoms
and special diets. A composite of cardiovascular ail-
ments resulted in a decaffeinated-caffeinated OR of 1.5
(95% CI 1.3–1.7, p < .001) and a decaffeinated-absti-
nence OR of 1.3 (95% CI 1.2–1.6, p < .01). The gastro-
intestinal composite also showed an OR of 1.3 (95% CI
1.1–1.5) for the decaffeinated-caffeinated comparison,
but not for the decaffeinated/abstinence comparison.
The subjects were also questioned on sleep problems,
loss of libido, stomach pain, eye trouble, headache and
backache. On all these subjective health complaints the
ORs were significant, ranging from 1.2 to 1.4 and all
showed that decaffeinated coffee use went together with
more complaints in comparison with regular coffee.
However, decaffeinated coffee drinkers were less tired
or rundown (OR = 0.6, 95% CI 0.7–0.9 p = .008) than
non-coffee users and had more unexplained weight loss
(OR = 0.5, 95% CI 0.3–0.9 p = .04). It suggests an ener-
getic component in decaffeinated coffee compared with
abstinence from coffee that is not caffeine.
In sum decaffeinated coffee is either related to bad or
good health. Thus, the common view that caffeinated
coffee drinkers are worse off concerning their health
than decaffeinated coffee consumers or abstainers is
not warranted.
That health complaints could be related to self
reported sensitivity to coffee might be caused by dif-
ferences in experimental procedures. It most studies,
in the same session self-ratings of health are combined
with questions on diet and health behaviour, which sug-
gests an association among these variables and hence
may bias self-rating of health. This suggestion is even
stronger when a questionnaire is used which asks both
for coffee consumption and based on a description of
the pharmacological action of caffeine asks for somatic
symptoms (James et al 1989). In the present study, the
assessment of health, diet and coffee consumption
formed a minor part of a multitude of different physi-
cal, psychosocial and demographic measurements and
were distributed amply in time. Several questionnaires
were filled in at home at home; some weeks later mea-
surements were done in the laboratory (Kemper 1985;
1995; 2004).
We found that women reported more health and
sleep-wake complaints than men, although they did
not differ on sensitivity to coffee. Women in general
complain more about health, possibly because of its
acceptance in our culture to receive more social sup-
port (Verbrugge 1985; 1989). However, this difference
between men and women is not consistently found.
Male and female students (age 20–21 yr) were ques-
tioned on 30 typical complaints most associated with
poor health or uncomfortable physical states (headache,
difficulty sleeping, etc) (Gondola & Tuckman 1983)
and also on the consumption of 10 categories of food,
among them coffee. Men whose consumption of coffee
fell in the highest quartile reported on average almost 2
symptoms of physical discomfort more than those who
consumed less. In women coffee consumption and dis-
comfort were unrelated. It could mean that at each level
of coffee consumption women report health complaints.
Puzzling was that from the women, the heavy consum-
ers had a better health knowledge than those who drank
coffee moderately or not at all. That with a higher coffee
consumption more physical discomfort was reported is
consistent with the expectation that ingestion of certain
so-called ‘negative’ foods, such as coffee is related to
more discomfort.
A similar gender difference was found in a study
(Botella & Parra 2003) in which caffeinated coffee was
given to male and female healthy regular coffee drink-
ers. Thirty minutes after intake, coffee increased state
anxiety in a dose-dependent manner in males, but not
in females, which was ascribed to a possible lesser sen-
sitivity of females to caffeine. Since saliva caffeine levels
were similar in men and women, this gender difference
was not caused by the systemic availability of caffeine.
The authors interpreted this finding by suggesting that

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Sensitivity to Coffee and Subjective Health
oestrogens could have made the difference in making
the dopamine system less sensitive in females to coffee.
These interpretations do not help much to explain why
in the present study women had more health com-
plaints than man with similar coffee consumption and
sensitivity. Other factors could be involved as well such
as differences of lifestyle.
Differences in sensitivity to caffeine may imply
that healthy people differ in the amount of coffee they
habitually consume. If an optimal adjustment to their
sensitivity is the case, negative effects of coffee such as
feelings of being ‘high’, jitteriness, tenseness and physi-
cal symptoms such as headaches and stomach problems
should be absent. If people are not able to attune coffee
consumption to their sensitivity, it may lead to subjec-
tive health complaints. Although most people know
from experience not to surpass a certain amount of
coffee consumption to prevent unwanted side effects,
apparently not all people are aware or are able to attune
coffee intake to their sensitivity. There are several stud-
ies and casus descriptions that support this interpreta-
tion. A reduction of an excess of caffeine intake may
lead to improvement in anxiety, irritability, headache,
sleep complaints and hand instability (James & Crosbie
1987; Mackay & Rollins 1989; Shaul et al 1984; Smith
1988). An other reason for health complaints could be
that even if one knows the personal limit of coffee con-
sumption, social pressure could bring people to drink
more coffee than usual. In our culture coffee drinking
is ritualised to specific times of the day and to fixed
amounts, so refusing offered coffee could be seen as
impolite by the host.
C
In this study, the main finding is that self reported
coffee consumption is not related to subjective health
complaints. Also there was no correlation between
coffee consumption and claimed sensitivity to coffee.
The correlations among coffee consumption, sensitivity
to coffee, health complaints and satisfaction with life
showed two significant positive, but clinically insig-
nificant correlations. Amount of consumed coffee was
associated with intestinal complaints and sensitivity to
coffee with sleep-wake complaints. The interpretation
was that the stress of health concern and the ambiva-
lent attitude to coffee in our culture could possibly
have caused these associations. Underreporting and
over reporting of coffee consumption and sensitivity to
coffee could also have played a role.
Also an increase in sensitivity to coffee over almost
four years went along with less health complaints. Our
speculation is that the wish to attain a healthier lifestyle
and the effort it takes for those who reduce coffee intake
or change to decaffeinated results in reporting higher
sensitivity and less health complaints. The interaction
of coffee intake and sensitivity to coffee did not affect
subjective health. Subjective sensitivity might be the
crucial factor. Since no causality can be derived from
correlational data, the alternative conclusion could be
that subjective health has no influence on coffee con-
sumption, but may have on self reported sensitivity.
Acknowledgement
The Amsterdam Growth and Health Longitudinal
Study received financial support from the Netherlands
Heart Foundation in The Hage (NHS), the dutch Pre-
vention Fund in The Hague (currently ZONmw), the
Dutch Ministry of Well Being and Public Healthh in
The Hague (VWS), the Dairy Foundation on Nutrition
and Health in Zoetermeer (NZO), the Dutch Olym-
pic Committee/the Netherlands Sports Federation in
Arnhem (NOC*NSF), Heineken, Inc. In Zoetermeer,
Scientific board on Smoking and Health in The Hague
and the Committee on Physiological Effects of Coffee
(PEC) of the Institute on Scientific Information on
Coffee (ISIC) in Paris.
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