Caffeine and Exercise: Difference between revisions

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=  Introduction   =
=  Introduction   =


Caffeine is the most widely used stimulant in the world.&nbsp;This is because caffeine consumption is completely legal, socially acceptable, and is consumed daily by a large majority of the world population. Daily morning staples, such as coffee and tea, as well as soda pop and energy drinks contain caffeine. Ninety-percent of the adult population consider themselves daily coffee users drinking, on average, two cups of coffee daily.<ref name="Pesta">Pesta, H. D., Angadi, S. S., Burtscher, M., &amp;amp;amp; Roberts, K. C. (2013). The effects of caffeine, nicotine, ethanol, and tetrahydrocannabinol on exercise performance. Nutrition &amp;amp;amp; Metabolism. 10(71). doi: 10.1186/1743-7075-10-71</ref>&nbsp;&nbsp; Much research has been conducted to determine how caffeine consumption affects one’s body systems and processes during exercise. Many studies support the findings that caffeine enhances both physical and cognitive performances. Physically, caffeine specifically improves aerobic performance—<ref name="Duncan">Duncan, M. J., &amp;amp;amp; Hankey, J. (2013). The effect of a caffeinated energy drink on various psychological measures during submaximal cycling. Physiology &amp;amp;amp; Behavior, 116, 60-65.</ref> extending the time that an activity can be sustained prior to fatigue. Mixed results exist as to whether caffeine significantly improves performance in resistance training.<ref name="Duncan" /> Several mechanisms work on different systems of the body to produce the overall enhancement of exercise performance that caffeine causes.  
Caffeine is the most widely used stimulant in the world.&nbsp;This is because caffeine consumption is completely legal, socially acceptable, and is consumed daily by a large majority of the world population. Daily morning staples, such as coffee and tea, as well as soda pop and energy drinks contain caffeine. Ninety-percent of the adult population consider themselves daily coffee users drinking, on average, two cups of coffee daily.<ref name="Pesta">Pesta, H. D., Angadi, S. S., Burtscher, M., &amp;amp;amp;amp; Roberts, K. C. (2013). The effects of caffeine, nicotine, ethanol, and tetrahydrocannabinol on exercise performance. Nutrition &amp;amp;amp;amp; Metabolism. 10(71). doi: 10.1186/1743-7075-10-71</ref>&nbsp;&nbsp; Much research has been conducted to determine how caffeine consumption affects one’s body systems and processes during exercise. Many studies support the findings that caffeine enhances both physical and cognitive performances. Physically, caffeine specifically improves aerobic performance—<ref name="Duncan">Duncan, M. J., &amp;amp;amp;amp; Hankey, J. (2013). The effect of a caffeinated energy drink on various psychological measures during submaximal cycling. Physiology &amp;amp;amp;amp; Behavior, 116, 60-65.</ref> extending the time that an activity can be sustained prior to fatigue. Mixed results exist as to whether caffeine significantly improves performance in resistance training.<ref name="Duncan" /> Several mechanisms work on different systems of the body to produce the overall enhancement of exercise performance that caffeine causes.  


= Neuromuscular  =
= Neuromuscular  =
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A neuromuscular mechanism that aides in causing caffeine’s ergogenic effects is its influence on the ryanodine receptors in the sarcoplasmic reticulum of muscles.<ref name="Tarnopolsky">Tarnopolsky, M. (1994). Caffeine and Endurance Performance. Sports medicine, 18(2), 109-125. doi: 10.2165/00007256-199418020-00004</ref> The function of these receptors is to open to allow Ca<sup>2+</sup> to flow out of the sarcoplasmic reticulum. Ca<sup>2+</sup> facilitates the contraction of muscle fibers. Ca<sup>2+</sup> binds to troponin, which moves tropomyosin aside so that myosin can bind to the actin myofilaments and muscle contraction can occur. Therefore, the effect that caffeine has on this system is to make Ca<sup>2+</sup> more readily available, which allows for stronger contractions of muscles than is typical at a given level of stimulation.<br>  
A neuromuscular mechanism that aides in causing caffeine’s ergogenic effects is its influence on the ryanodine receptors in the sarcoplasmic reticulum of muscles.<ref name="Tarnopolsky">Tarnopolsky, M. (1994). Caffeine and Endurance Performance. Sports medicine, 18(2), 109-125. doi: 10.2165/00007256-199418020-00004</ref> The function of these receptors is to open to allow Ca<sup>2+</sup> to flow out of the sarcoplasmic reticulum. Ca<sup>2+</sup> facilitates the contraction of muscle fibers. Ca<sup>2+</sup> binds to troponin, which moves tropomyosin aside so that myosin can bind to the actin myofilaments and muscle contraction can occur. Therefore, the effect that caffeine has on this system is to make Ca<sup>2+</sup> more readily available, which allows for stronger contractions of muscles than is typical at a given level of stimulation.<br>  


Caffeine also acts on the nervous system. Specifically, it affects normal neurotransmitter release, increasing both the amount of noradrenaline (NA) and dopamine (DA) released in the brain during exercise.<ref name="Zheng">Zheng, X., Takatsu, S., Wang, H., &amp;amp;amp; Hasegawa, H. (2014). Acute intraperitoneal injection of caffeine improves endurance exercise performance in association with increasing brain dopamine release during exercise. Pharmacology Biochemistry and Behavior, 122, 136-143.</ref> Dopamine has widespread functions, but a few of these include influences on motivation, cognition, reward, motor control, and mood.<ref name="Zheng" /> Many studies have shown that an increase in DA release results in enhanced endurance.<ref name="Zheng" /> One such study showed that muscle pain perception and perceived exertion was much lower in a group that received caffeine prior to resistance training, as opposed to when those same subjects were administered a placebo on a separate date.<ref name="Duncan" /> When the individuals ingested the caffeine, they performed significantly more repetitions before failure than when they were given the placebo.<ref name="Duncan" /> Another study offered an explanation of the mechanism causing the reduced pain threshold. The researchers found that plasma ß-endorphin levels almost doubled after two hours of cycling with caffeine consumption, while the control group had no increase.<ref name="Tarnopolsky" /> Therefore, caffeine's effect to lower pain perception is beneficial to endurance exercise performance. <br>  
Caffeine also acts on the nervous system. Specifically, it affects normal neurotransmitter release, increasing both the amount of noradrenaline (NA) and dopamine (DA) released in the brain during exercise.<ref name="Zheng">Zheng, X., Takatsu, S., Wang, H., &amp;amp;amp;amp; Hasegawa, H. (2014). Acute intraperitoneal injection of caffeine improves endurance exercise performance in association with increasing brain dopamine release during exercise. Pharmacology Biochemistry and Behavior, 122, 136-143.</ref> Dopamine has widespread functions, but a few of these include influences on motivation, cognition, reward, motor control, and mood.<ref name="Zheng" /> Many studies have shown that an increase in DA release results in enhanced endurance.<ref name="Zheng" /> One such study showed that muscle pain perception and perceived exertion was much lower in a group that received caffeine prior to resistance training, as opposed to when those same subjects were administered a placebo on a separate date.<ref name="Duncan" /> When the individuals ingested the caffeine, they performed significantly more repetitions before failure than when they were given the placebo.<ref name="Duncan" /> Another study offered an explanation of the mechanism causing the reduced pain threshold. The researchers found that plasma ß-endorphin levels almost doubled after two hours of cycling with caffeine consumption, while the control group had no increase.<ref name="Tarnopolsky" /> Therefore, caffeine's effect to lower pain perception is beneficial to endurance exercise performance. <br>  


Although research supports the ergogenic effects of caffeine on endurance, it has been less conclusive as to whether caffeine has the same type of effects on resistance training. Data from several studies supports an increase in resistance training performance following caffeine ingestion; however, researchers have been unable to isolate the exact physiological mechanism responsible for this. Therefore, the increased performance could potentially be due only to the decreased pain &amp; exertion perception of the subject [as previously explained].<ref name="Duncan" />&nbsp;
Although research supports the ergogenic effects of caffeine on endurance, it has been less conclusive as to whether caffeine has the same type of effects on resistance training. Data from several studies supports an increase in resistance training performance following caffeine ingestion; however, researchers have been unable to isolate the exact physiological mechanism responsible for this. Therefore, the increased performance could potentially be due only to the decreased pain &amp; exertion perception of the subject [as previously explained].<ref name="Duncan" />&nbsp;  


= Cardiopulmonary  =
= Cardiopulmonary  =
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One other substantial mechanism by which caffeine positively effects athletic performance is by increasing the rate that lipolysis occurs.<ref name="Tarnopolsky" /> Lipolysis is the process human bodies use to break apart fats and produce ATP (our primary usable form of energy) to fuel our body. Each triglyceride (fat molecule) that is broken down produces approximately 300-400 ATP (depending on how many carbons form the specific fat being used). The increase in fats being used to produce energy results in a decrease in carbohydrates used for that same purpose. This greatly increases efficiency because carbohydrate molecules produce far fewer ATP than triglycerides.  
One other substantial mechanism by which caffeine positively effects athletic performance is by increasing the rate that lipolysis occurs.<ref name="Tarnopolsky" /> Lipolysis is the process human bodies use to break apart fats and produce ATP (our primary usable form of energy) to fuel our body. Each triglyceride (fat molecule) that is broken down produces approximately 300-400 ATP (depending on how many carbons form the specific fat being used). The increase in fats being used to produce energy results in a decrease in carbohydrates used for that same purpose. This greatly increases efficiency because carbohydrate molecules produce far fewer ATP than triglycerides.  


There are many factors in the methods of caffeine studies that cause confounded results. One factor that must be considered is the dose of caffeine administered. The many studies use different doses when investigating the effects that caffeine has on exercise. Researchers use doses of anywhere from 2-8 mg/kg, but the methods of most studies call for doses of 5-6 mg/kg.<ref name="Shearer">Shearer, J., &amp;amp;amp;amp; Graham, T. E. (2014). Performance effects and metabolic consequences of caffeine and caffeinated energy drink consumption on glucose disposal. Nutrition Reviews, 72(suppl 1), 121-136. doi: 10.1111/nure.12124</ref> Doses of 2-5 mg/kg improve athletic performance by approximately 3%, whereas doses of 5-7mg/kg improve performance by approximately 7%.<ref name="Shearer" /> Another factor that often confounds results is the form of caffeine used, because other ingredients in the caffeine source cause changes in the resulting physiological effects. Other factors include diet, time and intensity of exercise tested, and length of time prior to exercise that the caffeine is administered.<ref name="Shearer" /> These variables, in addition to many others, increase the complexity of research of caffeine and exercise performance.  
There are many factors in the methods of caffeine studies that cause confounded results. One factor that must be considered is the dose of caffeine administered. The many studies use different doses when investigating the effects that caffeine has on exercise. Researchers use doses of anywhere from 2-8 mg/kg, but the methods of most studies call for doses of 5-6 mg/kg.<ref name="Shearer">Shearer, J., &amp;amp;amp;amp;amp; Graham, T. E. (2014). Performance effects and metabolic consequences of caffeine and caffeinated energy drink consumption on glucose disposal. Nutrition Reviews, 72(suppl 1), 121-136. doi: 10.1111/nure.12124</ref> Doses of 2-5 mg/kg improve athletic performance by approximately 3%, whereas doses of 5-7mg/kg improve performance by approximately 7%.<ref name="Shearer" /> Another factor that often confounds results is the form of caffeine used, because other ingredients in the caffeine source cause changes in the resulting physiological effects. Other factors include diet, time and intensity of exercise tested, and length of time prior to exercise that the caffeine is administered.<ref name="Shearer" /> These variables, in addition to many others, increase the complexity of research of caffeine and exercise performance.  


The adverse effects of caffeine consumption in athletes who use it conservatively are minimal, if at all present. However, if the consumer is sedentary, or if the caffeine intake exceeds 7mg/kg, many negative side effects occur. In a sedentary person, caffeine interferes with the role of insulin (often resulting in hyperinsulinemia and hyperlipidemia),<ref name="Cavka" /> and therefore, also effects the metabolism of fats and carbohydrates.<ref name="Shearer" /> Most sources of caffeine are also high in glucose, which is a combination that leads to a decline in glucose disposal.<ref name="Cavka" /> Therefore, in the sedentary person, decreased glucose disposal often leads to obesity, which can cause many diseases, such as type 2 diabetes and metabolic syndrome. If caffeine intake exceeds 7mg/kg (even in the active individual), side effects such as nausea, jitters, headaches, and tachycardia present themselves. Additionally, these large doses do not improve athletic performance any more than the 7% improvement caused by doses of 5-7 mg/kg.<ref name="Shearer" />  
The adverse effects of caffeine consumption in athletes who use it conservatively are minimal, if at all present. However, if the consumer is sedentary, or if the caffeine intake exceeds 7mg/kg, many negative side effects occur. In a sedentary person, caffeine interferes with the role of insulin (often resulting in hyperinsulinemia and hyperlipidemia),<ref name="Cavka" /> and therefore, also effects the metabolism of fats and carbohydrates.<ref name="Shearer" /> Most sources of caffeine are also high in glucose, which is a combination that leads to a decline in glucose disposal.<ref name="Cavka" /> Therefore, in the sedentary person, decreased glucose disposal often leads to obesity, which can cause many diseases, such as type 2 diabetes and metabolic syndrome. If caffeine intake exceeds 7mg/kg (even in the active individual), side effects such as nausea, jitters, headaches, and tachycardia present themselves. Additionally, these large doses do not improve athletic performance any more than the 7% improvement caused by doses of 5-7 mg/kg.<ref name="Shearer" />  


Another negative side effect that can occur from caffeine intake is its effect on Polycystic Kidney Disease (PKD). PKD is the most common kidney disease in adults. It is an inherited disease that currently has no cure. Cysts are formed in the kidneys and grow in number and size over time. The disease can lead to many more health problems and eventually kidney failure.<ref>PKD Foundation. (2015). Learn about ADPKD. Retrieved from http://www.pkdcure.org/learn/adpkd/just-diagnosed-questions</ref> There has been suggestive research that caffeine plays a role in PKD. A nucleotide known as cAMP stimulates the growth of cysts and the secretion of cyst fluid. One study showed that caffeine promotes the accumulation of cAMP in the kindeys, which leads to an increase in the size and number of cysts. The study noted that caffeine has this effect on the kidneys in only those who have PKD. If a person has PKD, they should avoid drinks such as coffee, tea, soda, or pre-workout drinks that contain a high amount of caffeine.<ref name="Belibi">Belibi, F. A., Wallace, D. P., Yamaguchi, T., Christensen, M., Reif, G., &amp;amp;amp;amp; Grantham, J. J. (2002). The effect of caffeine on renal epithelial cells from patients with autosomal dominant polycystic kidney disease. Journal of the American Society of Nephrology, 13, 2723-2729.</ref> Water could work as a substitute and also gatorade after a workout to replenish their electrolytes. <br>  
Another negative side effect that can occur from caffeine intake is its effect on Polycystic Kidney Disease (PKD). PKD is the most common kidney disease in adults. It is an inherited disease that currently has no cure. Cysts are formed in the kidneys and grow in number and size over time. The disease can lead to many more health problems and eventually kidney failure.<ref>PKD Foundation. (2015). Learn about ADPKD. Retrieved from http://www.pkdcure.org/learn/adpkd/just-diagnosed-questions</ref> There has been suggestive research that caffeine plays a role in PKD. A nucleotide known as cAMP stimulates the growth of cysts and the secretion of cyst fluid. One study showed that caffeine promotes the accumulation of cAMP in the kindeys, which leads to an increase in the size and number of cysts. The study noted that caffeine has this effect on the kidneys in only those who have PKD. If a person has PKD, they should avoid drinks such as coffee, tea, soda, or pre-workout drinks that contain a high amount of caffeine.<ref name="Belibi">Belibi, F. A., Wallace, D. P., Yamaguchi, T., Christensen, M., Reif, G., &amp;amp;amp;amp;amp; Grantham, J. J. (2002). The effect of caffeine on renal epithelial cells from patients with autosomal dominant polycystic kidney disease. Journal of the American Society of Nephrology, 13, 2723-2729.</ref> Water could work as a substitute and also gatorade after a workout to replenish their electrolytes. <br>  


= Summary  =
= Summary  =


<br> Five mechanisms of action for caffeine: <ref name="Pesta" /><br>1. Antagonism of adenosine<br>2. Increased fatty acid oxidation<br>3. Caffeine acts as a nonselective competitive inhibitor of the phosphodiesterase enzymes<br>4. Increased post-exercise muscle glycogen accumulation<br>5. Mobilization of intracellular calcium<br> <br> = '''References''' = <references />
<br> Five mechanisms of action for caffeine: <ref name="Pesta" /><br>1. Antagonism of adenosine<br>2. Increased fatty acid oxidation<br>3. Caffeine acts as a nonselective competitive inhibitor of the phosphodiesterase enzymes<br>4. Increased post-exercise muscle glycogen accumulation<br>5. Mobilization of intracellular calcium<br> <br> = '''References''' = <references />

Revision as of 02:29, 2 December 2015

 Introduction [edit | edit source]

Caffeine is the most widely used stimulant in the world. This is because caffeine consumption is completely legal, socially acceptable, and is consumed daily by a large majority of the world population. Daily morning staples, such as coffee and tea, as well as soda pop and energy drinks contain caffeine. Ninety-percent of the adult population consider themselves daily coffee users drinking, on average, two cups of coffee daily.[1]   Much research has been conducted to determine how caffeine consumption affects one’s body systems and processes during exercise. Many studies support the findings that caffeine enhances both physical and cognitive performances. Physically, caffeine specifically improves aerobic performance—[2] extending the time that an activity can be sustained prior to fatigue. Mixed results exist as to whether caffeine significantly improves performance in resistance training.[2] Several mechanisms work on different systems of the body to produce the overall enhancement of exercise performance that caffeine causes.

Neuromuscular[edit | edit source]

A neuromuscular mechanism that aides in causing caffeine’s ergogenic effects is its influence on the ryanodine receptors in the sarcoplasmic reticulum of muscles.[3] The function of these receptors is to open to allow Ca2+ to flow out of the sarcoplasmic reticulum. Ca2+ facilitates the contraction of muscle fibers. Ca2+ binds to troponin, which moves tropomyosin aside so that myosin can bind to the actin myofilaments and muscle contraction can occur. Therefore, the effect that caffeine has on this system is to make Ca2+ more readily available, which allows for stronger contractions of muscles than is typical at a given level of stimulation.

Caffeine also acts on the nervous system. Specifically, it affects normal neurotransmitter release, increasing both the amount of noradrenaline (NA) and dopamine (DA) released in the brain during exercise.[4] Dopamine has widespread functions, but a few of these include influences on motivation, cognition, reward, motor control, and mood.[4] Many studies have shown that an increase in DA release results in enhanced endurance.[4] One such study showed that muscle pain perception and perceived exertion was much lower in a group that received caffeine prior to resistance training, as opposed to when those same subjects were administered a placebo on a separate date.[2] When the individuals ingested the caffeine, they performed significantly more repetitions before failure than when they were given the placebo.[2] Another study offered an explanation of the mechanism causing the reduced pain threshold. The researchers found that plasma ß-endorphin levels almost doubled after two hours of cycling with caffeine consumption, while the control group had no increase.[3] Therefore, caffeine's effect to lower pain perception is beneficial to endurance exercise performance.

Although research supports the ergogenic effects of caffeine on endurance, it has been less conclusive as to whether caffeine has the same type of effects on resistance training. Data from several studies supports an increase in resistance training performance following caffeine ingestion; however, researchers have been unable to isolate the exact physiological mechanism responsible for this. Therefore, the increased performance could potentially be due only to the decreased pain & exertion perception of the subject [as previously explained].[2] 

Cardiopulmonary[edit | edit source]

An additional performance enhancement provided to the endurance athlete by caffeine is related to the pulmonary system.  When researching cross-country runners, one randomized and double-blinded study found a significant difference in the measurement of tidal volume, alveolar ventilation, and rating of perceived exertion between those who were given caffeine before performing submaximal exercise and those who were not.[5]  Caffeine causes bronchodilation, which likely leads to the increase in tidal volume and alveolar ventilation.  As tidal volume and alveolar ventilation rise, an individual's respiration during exercise becomes more efficient and, therefore, less exertion is required and the perceived effort needed to complete the activity is reduced.[5]  Despite strong evidence indicating caffeine's positive effects on the pulmonary system (such as the aforementioned study), collectively the research remains inconclusive on the topic and, therefore, more experimental studies must be conducted.

One example of the conflicting evidence concerning the cardiovascular and pulmonary effects of caffeine is a study performed to specifically study the effects of Red Bull© on the systems of the body. Red Bull© contains glucuronoactone, taurine, B vitamins, and sugar in addition to caffeine. Results of the study showed significant increased arterial blood pressure (ABP), heart rate (HR), blood glucose levels, respiration rate, and respiratory flow rate (RFR) at rest and during exercise, as compared to the control group. Clearly, these physiological effects would have a negative impact on athletic performance. At various points before, during, and after energy drink consumption (500mL of Red Bull©), plasma adrenaline and noradrenaline levels were measured. The significant increase in these levels is a product of sympathetic nervous system activation. The study claimed that long term energy drink consumption could have detrimental cardiovascular and respiratory effects.[6]

Metabolism[edit | edit source]

One other substantial mechanism by which caffeine positively effects athletic performance is by increasing the rate that lipolysis occurs.[3] Lipolysis is the process human bodies use to break apart fats and produce ATP (our primary usable form of energy) to fuel our body. Each triglyceride (fat molecule) that is broken down produces approximately 300-400 ATP (depending on how many carbons form the specific fat being used). The increase in fats being used to produce energy results in a decrease in carbohydrates used for that same purpose. This greatly increases efficiency because carbohydrate molecules produce far fewer ATP than triglycerides.

There are many factors in the methods of caffeine studies that cause confounded results. One factor that must be considered is the dose of caffeine administered. The many studies use different doses when investigating the effects that caffeine has on exercise. Researchers use doses of anywhere from 2-8 mg/kg, but the methods of most studies call for doses of 5-6 mg/kg.[7] Doses of 2-5 mg/kg improve athletic performance by approximately 3%, whereas doses of 5-7mg/kg improve performance by approximately 7%.[7] Another factor that often confounds results is the form of caffeine used, because other ingredients in the caffeine source cause changes in the resulting physiological effects. Other factors include diet, time and intensity of exercise tested, and length of time prior to exercise that the caffeine is administered.[7] These variables, in addition to many others, increase the complexity of research of caffeine and exercise performance.

The adverse effects of caffeine consumption in athletes who use it conservatively are minimal, if at all present. However, if the consumer is sedentary, or if the caffeine intake exceeds 7mg/kg, many negative side effects occur. In a sedentary person, caffeine interferes with the role of insulin (often resulting in hyperinsulinemia and hyperlipidemia),[6] and therefore, also effects the metabolism of fats and carbohydrates.[7] Most sources of caffeine are also high in glucose, which is a combination that leads to a decline in glucose disposal.[6] Therefore, in the sedentary person, decreased glucose disposal often leads to obesity, which can cause many diseases, such as type 2 diabetes and metabolic syndrome. If caffeine intake exceeds 7mg/kg (even in the active individual), side effects such as nausea, jitters, headaches, and tachycardia present themselves. Additionally, these large doses do not improve athletic performance any more than the 7% improvement caused by doses of 5-7 mg/kg.[7]

Another negative side effect that can occur from caffeine intake is its effect on Polycystic Kidney Disease (PKD). PKD is the most common kidney disease in adults. It is an inherited disease that currently has no cure. Cysts are formed in the kidneys and grow in number and size over time. The disease can lead to many more health problems and eventually kidney failure.[8] There has been suggestive research that caffeine plays a role in PKD. A nucleotide known as cAMP stimulates the growth of cysts and the secretion of cyst fluid. One study showed that caffeine promotes the accumulation of cAMP in the kindeys, which leads to an increase in the size and number of cysts. The study noted that caffeine has this effect on the kidneys in only those who have PKD. If a person has PKD, they should avoid drinks such as coffee, tea, soda, or pre-workout drinks that contain a high amount of caffeine.[9] Water could work as a substitute and also gatorade after a workout to replenish their electrolytes.

Summary[edit | edit source]


Five mechanisms of action for caffeine: [1]
1. Antagonism of adenosine
2. Increased fatty acid oxidation
3. Caffeine acts as a nonselective competitive inhibitor of the phosphodiesterase enzymes
4. Increased post-exercise muscle glycogen accumulation
5. Mobilization of intracellular calcium

= References =

  1. 1.0 1.1 Pesta, H. D., Angadi, S. S., Burtscher, M., &amp;amp;amp; Roberts, K. C. (2013). The effects of caffeine, nicotine, ethanol, and tetrahydrocannabinol on exercise performance. Nutrition &amp;amp;amp; Metabolism. 10(71). doi: 10.1186/1743-7075-10-71
  2. 2.0 2.1 2.2 2.3 2.4 Duncan, M. J., &amp;amp;amp; Hankey, J. (2013). The effect of a caffeinated energy drink on various psychological measures during submaximal cycling. Physiology &amp;amp;amp; Behavior, 116, 60-65.
  3. 3.0 3.1 3.2 Tarnopolsky, M. (1994). Caffeine and Endurance Performance. Sports medicine, 18(2), 109-125. doi: 10.2165/00007256-199418020-00004
  4. 4.0 4.1 4.2 Zheng, X., Takatsu, S., Wang, H., &amp;amp;amp; Hasegawa, H. (2014). Acute intraperitoneal injection of caffeine improves endurance exercise performance in association with increasing brain dopamine release during exercise. Pharmacology Biochemistry and Behavior, 122, 136-143.
  5. 5.0 5.1 Birnbaum LJ, Herbst JD. Physiologic effects of caffeine on cross-country runners. Journal of Strength and Conditioning Research 2004;18(3):963-5.
  6. 6.0 6.1 6.2 Cavka A, Stupin M, Panduric A, Plazibat A, Cosic A, Rasic L, et al. Adrenergic system activation mediates changes in cardiovascular and psychomotoric reactions in young individuals after Red Bull© energy drink consumption. Int J Endocrinol. 2015;751530. http://doi.org/10.1155/2015/751530
  7. 7.0 7.1 7.2 7.3 7.4 Shearer, J., &amp;amp;amp;amp; Graham, T. E. (2014). Performance effects and metabolic consequences of caffeine and caffeinated energy drink consumption on glucose disposal. Nutrition Reviews, 72(suppl 1), 121-136. doi: 10.1111/nure.12124
  8. PKD Foundation. (2015). Learn about ADPKD. Retrieved from http://www.pkdcure.org/learn/adpkd/just-diagnosed-questions
  9. Belibi, F. A., Wallace, D. P., Yamaguchi, T., Christensen, M., Reif, G., &amp;amp;amp;amp; Grantham, J. J. (2002). The effect of caffeine on renal epithelial cells from patients with autosomal dominant polycystic kidney disease. Journal of the American Society of Nephrology, 13, 2723-2729.