Women who suffer from the side effects of caffeine or find that it aggravates preexisting health conditions should cut down their caffeine intake substantially or eliminate it entirely from their diet. Habitual coffee, tea, cola, or cocoa drinkers should reduce their daily intake to one cup (or glass) per day or even less.

Unfortunately, women may find that going "cold turkey" with coffee and eliminating it abruptly causes unpleasant withdrawal symptoms such as headaches, depression, and fatigue I have asked patients to abruptly stop caffeine usage on the weekends, when they were more relaxed and did not require the stimulation that caffeine provided. However, severe withdrawal headaches often ruined the leisure time activities they planned on their days off.

To avoid uncomfortable withdrawal symptoms, it is better to cut down caffeine intake gradually. The best strategy is to decrease amounts slowly for one to several months. At the same time, other beverages can be substituted. Many of these substitutes either provide the taste or "look" of coffee. Certain beverages can even produce a similar pick me up without causing caffeine's deleterious effects. If you like the flavor of coffee, water process decaffeinated coffee is often the easiest substitute to start with. However, if you do use "decaf," be sure to buy a product prepared by steam distillation or the "Swiss water process" to remove the caffeine. Otherwise, you may be exposed to residues of dangerous chemicals like methyl chloride that are used in other methods of processing. Grain based coffee substitutes, such as Pero, Postum, and Caffix, are even better. Ginger tea is a stimulant that can actually be therapeutic for women since it has a vitalizing and energizing effect. Many of my patients make ginger tea by simply grating a few teaspoons of raw ginger root into a pot of water. It has a pleasant, spicy taste that many people enjoy. In addition, vitamins and mineral supplements and regular exercise can boost your energy levels without the use of coffee.

If you tend to be nervous and edgy in the morning, you might want to start the day with an herbal tea like chamomile or hops. These teas have a pleasant, relaxing, and calming effect.

(listed in order of caffeine content)

Side Effects of Caffeine Use

• Anxiety, irritability, nervousness
  
• Chronic fatigue
  
• Depletion of potassium, magnesium, zinc, vitamin C, anad vitamin B
  
• Diarrhea
  
• Dizziness
  
• Frequent urination
  
• Headaches
  
• Heartburn
  
• Insomnia, restlessness
  
• Less absorption of iron and calcium
  
• Rapid and irregular heartbeats

• Adrenal exhaustion
  
• Anxiety
  
• Chronic fatigue
  
• Fibrocystic breast disease
  
• Gastritis and ulcers
  
• Hypertension
  
• Insomnia
  
• Interstitial cystitis
  
• Menopausal symptoms
  
• Osteoporosis
  
• PMS

Alcohol
Alcoholic beverages are available in a wide variety of types and potencies. They are produced either by the fermentation of grains and fruits or the distillation of grains and starches. Alcohol has been taken for thousands of years, both as a social and commercial beverage. Today, there are over 100 million consumers of alcoholic beverages in the United States alone. Next to caffeine, alcoholic is the most abused legal drug of choice for people wishing to alter their energy level and their mood.

Alcohol is a central nervous system depressant. Though it relaxes the drinker and has a mild tranquilizing effect, it also slows down physical processes. In addition, mental alertness and acuity are decreased when drinking alcohol. It is often difficult (if not impossible) for many people to perform demanding intellectual work after imbibing alcoholic beverages. Physical coordination and reflexes are also impaired when drinking, which is one reason why it is so dangerous to drive after drinking.

On the plus side, the relaxant effect of alcohol can remove inhibitions and improve congeniality at parties and other social gatherings. This is why people often socialize with a beer or a glass of wine in their hands. When consumed in small amounts, alcohol can promote a relaxed state of mind for people after a hard day of work, or enhance pleasure when they are socializing. An added benefit is that alcohol stimulates the appetite and increases the enjoyment of dining. There are even possible health benefits with moderate use. Alcohol improves blood circulation by dilating blood vessels and causes a mild increase in the beneficial HDL cholesterol, which is thought to decrease the risk of heart attacks.

Unfortunately, many people take alcohol in amounts far beyond that which is needed to produce the social or health benefits. In fact, 10 percent of all alcohol consumers in this country (10 million people) cannot limit their amount of alcohol use and are diagnosed as alcoholics. Many people abuse alcohol because they are trying to suppress strong emotions. Often, people increase their alcohol intake to unhealthy levels as an attempt to dull emotional pain and anxiety. It is also thought that alcoholics may have a genetic proclivity towards abuse, and it is true that alcoholism runs in families.

Some people may crave alcohol because they are allergic to the grains, grapes, or yeast from which the beverages are made. As with other food allergies, the sufferer may crave the food to which he or she is allergic. Thus, alcohol abuse in some people may be a manifestation of an underlying medical problem.

Alcohol, itself, has no particular nutritive value. It contains almost twice the calories of protein and carbohydrate foods (7 calories per gram versus 4 calories per gram, respectively). Unfortunately, these are empty calories. Alcohol is readily digested and easily absorbed from the digestive tract so it rapidly affects the blood sugar level after ingestion. Once absorbed, it is metabolized by the liver and used immediately as energy or stored as fat in the liver. Unfortunately, alcohol cannot be converted to storage forms of carbohydrate, which would be much more beneficial.

The excessive use of alcohol can significantly worsen a number of common female health problems, including PMS, menopausal symptoms, anxiety states, depression, heavy menstrual bleeding, fibroid tumors of the uterus, fibrocystic breast disease, and endometriosis.

Women with moderate to severe anxiety, mood swings, and depression due to PMS, menopause, or emotional causes, should avoid alcohol entirely or limit its use to occasional small amounts. Alcohol, like a simple sugar, is rapidly absorbed by the body. Like other sugars, alcohol increases hypoglycemia symptoms; excessive use can increase anxiety and mood swings. This can be particularly pronounced in women with PMS related hypoglycemia.

As mentioned earlier, once alcohol has been absorbed and assimilated, it is metabolized primarily by the liver. This is a complex process requiring much work. Excessive intake of alcohol can overwhelm the liver's ability to process it, leading to toxic byproducts that can themselves affect mood. Too much alcohol can also impede the body's ability to detoxify other chemicals including drugs, hormones such as estrogen, and pesticides that we take into our bodies by choice or through environmental contact. As a result, toxic levels of these chemicals can build up in the body, worsening anxiety.

The liver metabolizes estrogen, thus playing an important role in regulating estrogen levels in the body. Normally, the liver can metabolize estradiol, the main type of estrogen secreted by the ovaries, to less potent forms of estrogen as it passes through the hepatic circulation. When liver function is healthy, it will convert estradiol to estrone and estriol the much weaker and less potent forms of estrogen. In the liver, estrogen is also inactivated by binding it to sulfates and gluccoronates. From there, the inactivated and weaker forms of estrogen are secreted into the bile and, finally, the intestinal tract. Much of the estrogen is then excreted from the body with the bowel movements.

When liver function is compromised by alcohol, estrogen levels can become elevated. This can be a risk factor for the aggravation of many common female problems such as heavy menstrual bleeding, fibroid tumors of the uterus, endometriosis, fibrocystic breast disease, and PMS.

During midlife and beyond, alcohol can actually intensify almost every type of menopause symptom. As a result, I recommend that women with active symptoms limit their intake or avoid alcoholic beverages entirely. The list of menopause symptoms affected by alcohol intake includes hot flashes and mood swings. Unlike caffeine, alcohol is a central nervous system depressant, so its intake can worsen menopausal fatigue and depression. This is particularly pronounced in women with night sweats and insomnia whose sleep quality is already poor. In addition, alcohol has a diuretic effect on the body. Estrogen helps keep the skin and other tissues plump by causing fluid and salt retention in the body. So, excessive intake of alcohol can further dehydrate the skin and tissues, including the vaginal and bladder mucosa, already at risk for dehydration because of estrogen deficiency. Alcohol's diuretic effect also causes the loss of excessive amounts of essential minerals through the urinary tract. These include minerals needed for healthy bones, such as calcium, magnesium, and zinc. Women who are addicted to alcohol may also have a negative calcium balance because of poor nutritional habits. Alcoholics often eat less calcium rich food and ignore their intake of other essential nutrients, preferring the empty, nonnutritive calories of alcohol.