I’ve gone mad for coffee in lockdown but will too much cause me harm?
Q
For the past year I’ve been working from home, and though I’ve been fairly well disciplined about not drinking too much alcohol or snacking on biscuits, I am drinking far more coffee than I used to. I know pregnant women shouldn’t drink a lot of it, but how harmful is it for someone in her mid-60s, like me?
A
The caffeine in coffee is a stimulant which can help to keep you alert and reduce tiredness. Numerous studies have shown that drinking it can lead to a short-term boost in brain function, improving mood, reaction time and general cognitive function. No wonder that so many people, stuck working from home, with none of the normal stimuli of working in the company of others, have turned to coffee to keep themselves awake when staring at the computer for hours on end. To add to the good news there is also some evidence that coffee drinking may help stop Parkinson’s disease and liver disease. Research has also shown that caffeine can reduce the risk of type 2 diabetes in those with normal blood glucose levels. On the other hand, it can cause blood glucose levels to rise slightly in diabetics. However, you can have too much of a good thing and excess caffeine can lead to anxiousness, nervousness and irritability, muscle twitches and tremors, headaches and – more worryingly – a fast and sometimes erratic heartbeat. Caffeine is also notorious for causing sleepless nights and, in post-menopausal women, some studies have indicated consuming more than 300mg a day of caffeine can speed up bone loss, increasing the risk of osteoporosis. As you say, in pregnant women heavy caffeine consumption is thought to increase the risk of a miscarriage and low birthweight babies, which is why the NHS recommends a limit of 200mg a day. People vary enormously in their sensitivity to caffeine and while some can consume large amounts with seemingly no ill effects, others find they are jittery after just one cup. The amount of caffeine in coffee depends on both the type and strength, with “real” coffee being much higher than instant. A cup from a capsule contains around 55 to 85mg, while a cup made with a teaspoon of instant granules will have between 25 and 35mg. Overall, there appears to be little harm in most people having 300 to 400mg a day of caffeine, but if you habitually have more than this you may get withdrawal effects, especially a thumping headache, if you go without for a day or more. A racing pulse, palpitations or being unable to sleep are also signs that you should cut your consumption down.
Q
I’m 45, and after six months of misery from hot flushes and sweats, blood tests confirmed I’m menopausal. My GP started me on HRT and the sweats have gone, but in the second half of each packet of pills I get spotty and feel bloated. I’m sure it’s the progesterone component, so I was wondering what else I could try.
My doctor has suggested a Mirena coil, but I’m concerned that will just give me side effects all the time, so I was wondering if I should try a progesterone cream instead?
A
HRT replaces the oestrogen that your ovaries no longer produce after the menopause, but this can cause a build-up in the womb lining, which can lead to erratic bleeding and, after many years, increase the risk of abnormal cells developing. This can be countered by the addition of a second hormone, progesterone, but certain types of this can cause the side effects you describe. The amount of progesterone absorbed from progesterone cream on the skin can be variable, and as this has not been confirmed to be a safe way of protecting the womb lining there are no creams available on NHS prescription and it is not something I would advise. You have been taking a synthetic form of progesterone so you may find that natural progesterone (the trade name is Utrogestan) suits you better, though you will have to take this separately rather than combined with your oestrogen tablets. The Mirena intrauterine device delivers the progesterone where it is needed – straight into the womb – and only a tiny amount goes to the rest of the body. Side effects, such as greasy skin, really are quite rare. So if other forms of progesterone do not suit you, I would encourage you to give it a try.
Q
I had Covid-19 in early January and compared to many people I seem to have recovered well. I feel a bit tired, but I haven’t been left with any other symptoms. However, I’m getting mouth ulcers. Is this a symptom of long Covid and, if so, is there anything I can do about them? Would vitamins help?
A
Along with skin rashes and changes in the tongue, mouth ulcers have been reported in people with Covid-19 infection and in some it does seem the changes take several weeks to clear up. However, mouth ulcers can also be caused by trauma, such as a jagged tooth edge, a rough filling or accidentally biting the inside of your lip and cheek. In older people they can also be caused by poorly fitting dentures. In some people recurrent mouth ulcers also appear to be triggered by stress and anxiety as well as eating foods such as chocolate, almonds, strawberries, cheese or tomatoes, so it may be worth keeping a food diary. They can also be linked with vitamin B12 or iron deficiency, coeliac disease and inflammation elsewhere in the intestine. Occasionally they may be caused by medications such as ibuprofen or beta blockers. Therefore it would be worth having a chat with your GP, who can arrange blood tests. If no other cause is found then you will probably have to assume long Covid is to blame.