The Rationale of Caffeine Consumption and Its Symptoms During Preparatory and Non-preparatory Days : A Study among Medical Students

Published by Oriental Scientific Publishing Company © 2018 This is an Open Access article licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License (https://creativecommons.org/licenses/by-nc-sa/4.0/ ), which permits unrestricted Non Commercial use, distribution and reproduction in any medium, provided the original work is properly cited. The Rationale of Caffeine Consumption and Its Symptoms During Preparatory and Non-preparatory Days: A Study among Medical Students

Human curiosity has lead way for the discovery of coffee around 850AD by Goatherder name Khaldi in Abyssinia located in Upper Egypt.Through the ages the delight search for stimulants has been rewarded by the discovery of coffee bean (Coffea aabica) in Arabia, the tea leaf (Thea sineusis) in China, the Kola nut (Theo-bromo cacoa) in Mexico and other plant source of caffeine 1 .
Caffeine is the widely used pharmacologically active substance in the world 2 .Caffeine is consumed in different forms such as tea, coffee, soft drink and energy drinks.Caffeine consumption is popular among people because of its unique ability to enhance mood and alteress 3 , to increase exercise capacity, to increase wakefulness and mental alterness 4 .Medical student's life begins with regular tests, internal exam preparation and all throughout medical course the students are subjected to excessive stress, majorly due to sleepless working hours.Medical students have to put forth extra effort beyond their mental threshold and physical stress to show progress in their exams.The consumption of caffeinated drinks is one of the coping strategies used by medical students to manage their academic stress 5 .Study among first and second year students at the university of Puerto Rico Medical Sciences campus reported that 49% of them believed caffeinated products where useful for coping up with academic stress 6 .
Although caffeine consumption is related to psychiatric and substance use disorders, studies have showed that their associations were not casual 7 .On contrary one study showed a near causal relationship between the use of energy drink and hospitalisation among patient with mental illness 8 .Caffeine causes high anxiety level among moderate and high level caffeine consumers 9 whereas the positive effect of caffeine was shown by low level consumers like they reduced anxiety and elevated the mood 10,11,12 .
However there are adequate studies and data's to give pharmacological information about the source of caffeine and their consumption modalities, little is known in regard to symptoms faced by caffeine consuming medical students and their belief about their conventions.

Aims and Objectives
The study was postulated to obtain: 1) The different categories of caffeine intake 2) The reason and circumstances of caffeine intake 3) Symptoms experienced due to caffeine

Study design
It is a cross-sectional study.Inclusion criteria: III, IV and V semester medical students, male and female.
The fresher's were excluded from the study as they were exposed to multiple environmental factors like new friends, home-sick, sudden lack of parental guidance, new cuisine style,..etc.Hence their reason and circumstances for caffeine consumption may be in aspects high lightening the environmental factors.Clinical students are excluded as they are facing more stress and workload.They have to promisingly balance the knowledge on both theoretical and clinical skills.The interns, residents, physicians, nurses and technicians were excluded as they may be more pressurised due to hectic duty hours and their personal family issues.Thus in order to study the effect of caffeine in mediocre type of students; III, IV and V semester medical students were selected.Procedure About 150 medical students participated in the study (n=150).A brief introductory presentation was given to students about the rationale and implementation of the study.All the students who were willing to participate were included in the study.The data was collected by self-assessment questionnaire available in English.In order to avoid any bias students were asked to fill the questionnaire after fourth semester examination during Pharmacology session.The participating students were allowed to ask questions on matters those were unclear.Yousif et al and Josue et al studies were used as a prototype for analysing and framing the questions in the questionnaire.
The questionnaire was divided into four sections: a) Questions 1-5: represented the demographic data section which included the age, sex and location of the students b) Questions 6: perceived the amount of caffeine consumed, in accord to the frequency and type of caffeinated drinks consumed daily.c) Questions 7-8: indicated the reasons and circumstances of caffeine intake.There were about 12 choices for the reason and various

Data collection
The data's were collected from the questionnaire and recorded manually.Data analysis was performed using IBM statistical package for social science (SPSS) software version 21.

RESULTS
A total of 150 students participated in the study.The age ranged from19 to 23 years with the mean age of 21 years.Among the 150 students about 147(98%) were caffeine consumers and 3(2%) were non consumers of caffeine.
On categorising the students on the amount of caffeine consumption about 72 %( 106) of them were low consumers, 23.33 %( 35) were moderate consumers and 2.67 %( 4) were high consumers during routine days.During exam days about 58% (87) were low consumers, 34 %( 51) were moderate consumers and 4 %( 6) were high consumers.

Reason behind caffeine consumption
The result showed that 70(62.50%) of students consumed caffeine as they believed it makes them more alert and about 59 (52.68%) to keep them awake in the morning.The least number of students believed that caffeine helped them to control weight 3(2.65%) and to deal with depression 4(3.57%).

Circumstances for caffeine intake
The result showed that "studying for exam" were the commonest circumstance for caffeine intake about 78 (69.6%), the second common circumstance for caffeine consumption was to allay headache 63(56.3%)and "outing with friends" was about 50 (44.6%).

Symptoms
The results showed the various symptoms they faced during normal days and examination days.(i)Normal days and regular holidays: the most common symptoms faced by students due to caffeine intake was loss of sleep 30(26.8%)and gastritis 15(13.4%).ii) During exam days and study holiday: The most common symptoms present among caffeine consumers were nervousness 54(48.21%),loss of sleep 47(41.96%),palpitation 41(36.61%),confusion 29(25.89%)and gastritis 18(16.07%).

DISCUSSION
Age old tradition and our assumption has made consumption of coffee, tea, energy dinks and soft drinks as a part of our meal system, whether the consumption assist the nutritional benefit or worsen the life state of individual is yet to be scrutinized.The general lack of research relating to the role of caffeinated drinks on the day to day activities among medical students is an area that the current paper will try to discuss.
Participation of female students outnumbered the male student with the ratio of 2.6:1.0.In the study the caffeine consumption system by students were divided into four sessions as: (a) consumption on regular days (b) consumption on regular holidays (c) consumption on study holidays and (d) consumption during examinations.Depending on the quantity of caffeine consumed the U.S Food and Drug administration (FDA) and American Medical Association has categories it into three different category (1) Low intake: consumption up to 199mg/d (2) Moderate intake: consumption of about 200-399mg/d (3) High intake: consumption more than 400mg/d.The study showed that majority of the students where in category I (low in takers) during the session of regular days and holidays.During session of study holidays and exam days the students fell more into category II (moderate in takers) and few in category III (high in takers).Study by Kaplan et al showed that 250mg caffeine can cause elation in healthy volunteers and doses more than 400mg/d can increase irritability 13 .Evidences show that moderate doses of caffeine impair motor skills and may not be an adequate substitute for memory enhancement or to allay sleep 14 .At higher concentration caffeine acts as a diuretic agent and excess consumption can cause dehydration, headache and severe fatigue 15 .High caffeine consumers are subjected to decrease nutrient absorption and a slow rate of fluid absorption 16 .
The present study showed that the main reason behind caffeine consumption among students was to keep them more alert 62.5% and to keep them awake 52.68%.Caffeine has a special property of increasing the neurotransmission of mesopontine cholinergic neurons thus increasing alertness and reducing fatigue 17 .Adenosine inhibits cholinergic neurons resulting in a coupling mechanism that correlates caffeine and arousal; thus acting as a proof for the role of caffeine in arousal mechanism.
T h e c o m m o n c i r c u m s t a n c e f o r consumption of caffeine among students was "during exams" and "to reduce headache".Other circumstances were outing with friends and at restaurants, most of the circumstances the students 18 or even general population are left out without significant options.The commonly available drinks during outing or restaurants visit are coffee, tea, or ready to have caffeinated drinks like coco cola, pepsi.etcwith caffeine as main ingredient 19 .The social scenario and narrow profitable marketing has diverted us towards the consumption of caffeinated drinks leaving behind the footprints of various hazards in the health of individuals 20 .
The common symptoms presented were loss of sleep during normal days which drastically heightened during exam days.As the symptoms "loss of sleep" was presented during both normal days and exam days, exam related stress cannot be the substantiating reason behind the above symptoms.The study finding is similar to the study by Zeoyghnizen et al which showed that caffeine increases sleep latency 16 .Hicks et al study proved that caffeine reduces sleep duration 17 .Caffeine induced insomnia was suggested as research model for insomnia 21 .The other symptoms which peaked during examination days where nervousness, palpitation and confusion.From the study these symptoms are positively correlated to the increased frequency of caffeine consumption during exam days and to a greater extent can also be related to examination related stress.Study done by Haskell et al and Smith et al showed that lower dose of caffeine reduces anxiety and elevate mood 22,23 .Another study by Smith et al proved that lower doses of caffeine can reduce risk of depression when compared to non-consumption population 24 .Whereas high intake of caffeine can lead to a condition called as "caffeinism".Study by Lara et al showed that symptoms like anxiety, nervousness, dysphoria, restlessness, agitation, rambling of thoughts and speech caused by caffeine intake are considered to mimic the clinical features of "mixed mood state" 25 .Further study by Caykoylu et al and Dratcu et al supported the above finding and showed that caffeine interferes with patient recovery from bipolar disorder and manic type mood episodes 26,27 .
The future healthcare clearly relies on today's medical students who are in a responsible position to provide complete education to the community about the consequences of consuming caffeine drinks.For which the students should be aware of caffeine's implication on one's health.
The future healthcare clearly relies on today's medical students who are in a responsible position to provide complete education to the community about the consequences of consuming caffeine drinks.For which the students should be aware of caffeine's implication on one's health.
As medical students are posed to tremendous stress they should be sensitized with stress management workshops and awareness programs about alternative nutrients filled diet for their long lasting health benefits.

CONCLUSION
The study showed that consumption of caffeine among medical students was mainly to keep them alert in order to combat heavy working hours.The medical students were low consumers of caffeine.Whereas during the preparatory days consumption of caffeine ranged from moderate to high category.Though the high consumers represent a small percentage they should try to minimize the daily caffeine use.

Fig
Fig. 2. Circumstances For Caffeine Intake