Caffeine-containing herbs and supplements are consumed around the world. Of these, coffee is the most popular. The caffeine in coffee increases alertness and decreases fatigue, as anyone who enjoys a morning cup of coffee is well aware. Despite widespread caffeine use, no rigorous, well designed study has evaluated caffeine-containing substances in people with MS.
One study was published examining a therapy known as Prokarin in people with MS. Prokarin contains caffeine as well as histamine, which makes the results of this study difficult to interpret. Further information on Prokarin is available in the Prokarin section of this site (see Prokarin page).
Coffee has been studied in the general population. These studies suggest that coffee improves mental, but not physical, fatigue. Coffee increases mental alertness, but not physical power or endurance. Timing and dose for maximal benefit for MS-related fatigue has not been determined.
Caffeine is known to alter the immune system, an issue of possible relevance to people with MS. Some research suggests caffeine decreases the activity of immune system cells known as lymphocytes. Theoretically, these alterations in immune system function could be beneficial for people with MS.
Caffeine can also be found in many other herbal sources. Tea contains caffeine. Black and green teas are both derived from Camellia sinensis. Chocolate and other products derived from the cacao plant contain caffeine. Guarana, another caffeine-containing herb, may be consumed in tablet form or as a tea. Maté (yerba maté) and cola nut (bissy nut) also contain caffeine. Caffeine itself may also be consumed in tablet form; it is available as a dietary supplement.
Caffeine-containing herbs, including coffee, are considered to be generally safe. However, caffeine may have effects on a developing fetus, so the FDA recommends that pregnant women limit their use. Also, maté is believed to increase the risk of certain forms of cancer. Therefore, the FDA has classified two forms of mate, Ilex cassine and Ilex vomitoria, to be unsafe.
People with MS may be especially prone to some caffeine side effects. MS may increase osteoporosis risk, and caffeine may increase this osteoporosis risk further. Caffeine also increases urination and may cause irritation of the urinary tract, thus possibly exacerbating MS-associated bladder problems.
High doses of caffeine may produce insomnia, heart palpitations, anxiety, nausea, vomiting, increased blood pressure, muscle twitching, tremors, and increased cholesterol levels. Chronic use of high doses of caffeine can lead to tolerance, which causes the body to need larger doses in order to produce the same effect. When these high doses are stopped, withdrawal symptoms may be experienced, including irritability, dizziness, headache, and anxiety. Usually, the suggested maximum daily dose is between 250 to 300 mg. This is approximately four to five cups of tea or two to three cups of coffee.
References and Additional Reading
Bowling AC. Complementary and Alternative Medicine and Multiple Sclerosis. New York: Demos Medical Publishing, 2007.
Bowling AC, Stewart TS. Dietary Supplements and Multiple Sclerosis: A Health Professional’s Guide. New York: Demos Medical Publishing, 2004.
Jellin JM, Batz F, Hitchens K, et al. Natural Medicines Comprehensive Database. Stockton, CA: Therapeutic Research Faculty, 2009.
Ulbricht CE, Basch EM, eds. Natural Standard Herb and Supplement Reference: Evidence-Based Clinical Reviews. St. Louis: Elsevier-Mosby, 2005.