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Caffeine for the Sustainment
of Mental Task Performance
Formulations for Military
Operations
Committee on Military Nutntion Research
Food and Nutntion Board
INSTITUTE OF MEDICINE
NATIONAL ACADEMY PRESS
Washington, D.C.
OCR for page R2
NATIONAL ACADEMY PRESS · 2101 Constitution Avenue, NW · Washington, DC 20418
NOTICE: The project that is the subject of this report was approved by the
Governing Board of the National Research Council, whose members are drawn
from the councils of the National Academy of Sciences, the National Academy
of Engineering, and the Institute of Medicine. The members of the committee
responsible for the report were chosen for their special competences and with
regard for appropriate balance.
Support for this project was provided by the U.S. Department of the Army,
Army Medical Research and Materiel Command through grant No. DAMD17-
94-J-4046 and grant No. DAMD17-99-1-9478. The U.S. Anny Medical
Research Acquisition Activity, 820 Chandler Street, Fort Detrick, MD 21702-
5014, is the awarding and administering acquisition office. The views presented
in this publication are those of the Committee on Military Nutrition Research
and do not necessarily reflect the position or policy of the government, and no
official endorsement should be inferred.
International Standard Book Number 0-309-08258-7
Library of Congress Control Number 2001097708
This report is available for sale from the National Academy Press, 2101
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6242 or (202) 334-3313 (in the Washington metropolitan area), or visit the
NAP's on-line bookstore at http://www.nap.edu.
For more information about the Institute of Medicine and the Food and Nutrition
Board, visit the IOM and FNB home pages at http://www.iom/ and
http://www.iom/fnb/.
Copyright 2001 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America.
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Knowing Is not enough; we must apply.
Miffing is not enough; we must To.
Goethe
,, 11'
_
/
/
INSTITUTE OF MEDICINE
Shaping the Future for Health
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National Acaclemy Of Sciences
National Acaclemy Of Engineering
Institute of Medicine
National Research Council
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of
distinguished scholars engaged in scientific and engineering research, dedicated to the
furtherance of science and technology and to their use for the general welfare. Upon the
authority of the charter granted to it by the Congress in 1863, the Academy has a mandate
that requires it to advise the federal government on scientific and technical matters. Dr.
Bruce M. Alberts is president of the National Academy of Sciences.
The National Academy of Engineering was established in 1964, under the charter of the
National Academy of Sciences, as a parallel organization of outstanding engineers. It is
autonomous in its administration and in the selection of its members, sharing with the
National Academy of Sciences the responsibility for advising the federal government.
The National Academy of Engineering also sponsors engineering programs aimed at
meeting national needs, encourages education and research, and recognizes the superior
achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of
~ . .
cngmeermg.
The Institute of Medicine was established in 1970 by the National Academy of Sciences
to secure the services of eminent members of appropriate professions in the examination
of policy matters pertaining to the health of the public. The Institute acts under the
responsibility given to the National Academy of Sciences by its congressional charter to
be an adviser to the federal government and, upon its own initiative, to identify issues of
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Medicine.
The National Research Council was organized by the National Academy of Sciences in
1916 to associate the broad community of science and technology with the Academy's
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the principal operating agency of both the National Academy of Sciences and the
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and the scientific and engineering communities. Me Council is administered jointly by
both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. Wm. A.
Wulf are chairman and vice chairman, respectively, of the National Research Council.
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COMMITTEE ON MILITARY NUTRITION RESEARCH
JOHN E. VANDERVEEN (Chair), San Antonio, Texas
LAWRENCE E. ARMSTRONG, Departments of Physiology and Neurobiol-
ogy, and Exercise Science, University of Connecticut, Storrs
GAIL E. BUTTERFIELD (deceasedJ, Nutrition Studies, Palo Alto Veterans
Affairs Health Care System and Program in Human Biology, Stanford Uni-
versity, Palo Alto, California
WANDA L. CHENOWETH, Department of Food Science and Human Nutri-
tion, Michigan State University, East Lansing
JOHANNA T. DWYER, Frances Stern Nutrition Center, New England Medical
Center Hospital and Departments of Medicine and Community Health,
Tufts Medical School and School of Nutrition Science and Policy, Boston,
Massachusetts
JOHN D. FERNSTROM, Depa~l~ent of Psychiatry, Pharmacology, and Neu-
roscience, University of Pittsburgh School of Medicine, Pennsylvania
ROBIN B. KANAREK, Depa~l~ent of Psychology, Tufts University, Boston,
Massachusetts
ORVILLE A. LEVANDER, Nutrient Requirements and Functions Laboratory,
U.S. Depardnent of Agriculture Beltsville Human Nutrition Research Cen-
ter, Beltsville, Maryland
ESTHER M. STERNBERG, Neuroendocrine Immunology and Behavior
Section, National Institute of Mental Health, Bethesda, Maryland
U.S. Army Grant Representative
LTC KARL E. FRIEDL, U.S. Army, Military Operational Medicine Research
Program, U.S. Army Medical Research and Materiel Command, Fort
Detrick, Frederick, Maryland
Staff
MARY I. POOS, Study Director
TAZIMA A. DAVIS, Senior Project Assistant (from September 18, 2000)
KARAH NAZOR, Project Assistant (through July 28, 2000)
v
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FOOD AND NUTRITION BOARD
CUTBERTO GARZA (Chair), Division of Nutrition, Cornell University,
Ithaca, New York
LARRY R. BEUCHAT, Center for Food Safety and Quality Enhancement
University of Georgia, Griffin
BENJAMIN CABALLERO, Center for Human Nutrition, The Johns Hopkins
School of Hygiene and Public Health, Baltimore, Maryland
ROBERT J. COUSINS, Center for Nutritional Sciences, University of Florida,
Gainesville
SHIRIKI KUMANYIKA, Center for Clinical Epidemiology and Biostatistics,
University of Pennsylvania School of Medicine, Philadelphia
ALFRED H. MERRILL, JR., Department of Biochemistry, Emory Center for
Nutrition and Health Sciences, Emory University, Atlanta, Georgia
LYNN PARKER, Child Nutrition Programs and Nutrition Policy, Food Re-
search and Action Center, Washington, D.C.
ROSS L. PRENTICE, Division of Public Health Sciences, Fred Hutchinson
Cancer Research Center, Seattle, Washington
A. CATHERINE ROSS, Nutrition Department, The Pennsylvania State Un
versity, University Park
ROBERT M. RUSSELL, Jean Mayer U.S. Department of Agriculture Human
Nutrition Research Center on Aging, Tufts University, Boston, Massachu-
setts
BARBARA O. SCHNEEMAN, Department of Nutrition, University of Cali-
fornia at Davis
ROBERT E. SMITII, R.E. Smith Consulting, Inc., Newport, Vermont
VIRGINIA A. STALLINGS, Division of Gastroenterology and Nutrition, The
Children's Hospital of Philadelphia, Pennsylvania
STEVE L. TAYLOR, Department of Food Science and Technology and Food
Processing Center, University of Nebraska, Lincoln
BARRY L. ZOUMAS, Department of Agricultural Economics and Rural Soci-
ology, The Pennsylvania State University, University Park
Stay
ALLISON A. YATES, Director
LINDA MEYERS, Deputy Director
GAIL SPEARS, Staff Editor
GEORGE YORK, Administrative Assistant
GARY WALKER, Financial Associate
V1
it_
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Dectication
The Committee on Military Nutrition Research
dedicates this report to the late Gail Butterfield, a
diligent and enthusiastic member of the committee
who made invaluable contributions to this study and
numerous other studies during her six years of
service. Her unique background in nutrition and
physiology was a special asset to the committee's
work. She was dedicated to contributing to the health
and nutritional well-being of America's military
personnel, both active-duty members and veterans.
. .
V11
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Reviewers
This report has been reviewed in draft form by individuals chosen for their
diverse perspectives and technical expertise, in accordance with procedures
approved by the National Research Council's Report Review Committee. The
purpose of this independent review is to provide candid and critical comments
that will assist the institution in making its published report as sound as possible
and to ensure that the report meets institutional standards for objectivity, evi-
dence, and responsiveness to the study charge. The review comments and draft
manuscript remain confidential to protect the integrity of the deliberative proc-
ess. We wish to thank the following individuals for their review of this report:
E. Wayne Askew, University of Utah
Fergus M. Clydesdale, University of Massachusetts
Joseph T. Coyle, Harvard Medical School
David Dinges, University of Pennsylvania School of Medicine
Harold Goforth, Point Lorna College
Steven R. Hursh, Science Applications International Corporation
Although the reviewers listed above have provided many constructive
comments and suggestions, they were not asked to endorse the conclusions or
recommendations nor did they see the final draft of the report before its release.
The review of this report was overseen by Catherine E. Woteki, University of
Maryland at College Park, appointed by the Institute of Medicine, who was
responsible for making certain that an independent examination of this report
was carried out in accordance with institutional procedures and that all review
comments were carefully considered. Responsibility for the final content of this
report rests entirely with the authoring committee and the institution.
. . .
vail
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Preface
This publication is the latest in a series of reports prepared by the Commit-
tee on Military Nutrition Research (CMNR) of the Food and Nutrition Board
(FNB), Institute of Medicine, National Academies. Other reports in the series
have included such issues as food components to enhance performance; nutri-
tional needs in hot, cold, and high-altitude environments; body composition and
physical performance; nutrition and physical performance; cognitive testing
methodology; fluid replacement and heat stress; and antioxidants and oxidative
stress. These reports are part of the response that the CMNR provides to the
commander of the U.S. Army Medical Research and Materiel Command
(USAMRMC) regarding issues brought to the committee by the Military Opera-
tional Medicine Research Program at Fort Detrick, Maryland, and the Military
Nutrition Division of the U.S. Army Research Institute of Environmental Medi-
cine at Natick, Massachusetts. Typically, reports in this series review the scien-
tific background of an issue, and provide direct responses to questions posed by
USAMRMC and specific recommendations from CMNR.
HISTORY OF THE COMMITTEE
The CMNR was established in October 1982, following a request by the as-
sistant surgeon general of the Army that the Board on Military Supplies of the
National Academy of Sciences set up a special committee. The purpose of this
committee was to advise the U.S. Depa~l~ent of Defense on the need for and
conduct of nutrition research and related issues. The CMNR was transferred to
the FNB in 1983. The CMNR's current tasks are as follows:
· to identify nutritional factors that may critically influence the physical and
mental performance of military personnel under all environmental extremes;
· to identify deficiencies in the existing database;
1X
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x
CAFFEINE FOR MENTAL TASK PERFORMANCE
· to recommend research to remedy these deficiencies as well as approaches
for studying the relationship of diet to physical and mental performance; and
· to review and advise on standards for military feeding systems.
Within this context, the CMNR was asked to focus on nutrient requirements
for performance during operational missions rather than requirements for m~li-
tary personnel in garrison (the latter were judged to be not significantly different
O ~ —~ . . - , ~ hi,=
from those of the civilian population).
Although the membership of the committee has changed periodically, the
disciplines represented consistently have included human nutrition, nutritional
biochemistry, performance physiology, food science, and psychology. For issues
that require broader expertise than exists within the committee, the CMNR has
convened workshops or utilized consultants. The workshops provide additional
state-of-the-art scientific information and informed opinion for the consideration
of the cornm~ttee.
ORGANIZATION OF THIS REPORT
Chapter 1 of this report provides background information on the military
interest in caffeine and the history of its use, and Chapter 2 briefly reviews caf-
feine metabolism and pharmacology. Chapters 3 through 6 review the recent
scientific literature organized around the Army's task questions of efficacy,
safety, formulations, dosage, ethical considerations, and alternatives. The
CMNR's summary responses to questions, conclusions, and recommendations
are presented in Chapter 7. The workshop agenda and abstracts are presented in
Appendix A. Appendix B contains CMNR recommendations concerning caf-
feine from the report, Food Components to Enhance Performance (IOM, 1994~.
Biographical sketches of CMNR members and the workshop speakers are given
in Appendix C. Speakers invited to the workshop were also requested to submit
a brief list of selected background papers. Their recommended readings, relevant
citations collected by CMNR staff prior to the workshop, and citations from
each chapter are included in the references.
ACKNOWLEDGMENTS
It is my pleasure as chairman of the CMNR to acknowledge the contribu-
tions of the FNB staff. Their dedication in the planning and organization of the
workshop and in editing this report made it possible for the committee to pro-
vide an in-depth response to the Army's request. In particular, I wish to ac-
knowledge the superior efforts of Mary I. Poos, the staff officer for the CMNR.
She worked diligently with committee members in securing the expert panel of
speakers and organizing the program for the workshop into coherent sessions.
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PREFACE
X1
She also conducted extensive reviews and summaries of the scientific literature
and performed major edits of the report to ensure clarity and accuracy.
I also wish to commend the workshop speakers for their excellent contribu-
tions in preparing abstracts and participating through their presentations and
discussions at the workshop. Their willingness to take time from very busy
schedules to prepare and deliver outstanding presentations made it possible for
the committee to conduct the review and prepare this report. Their thoughtful
responses to CMNR members' and workshop participants' questions also con-
tributed immeasurably to the quality of the review. It would be neglectful not to
mention the many experts who attended this open meeting at their own initiative
and expense. Their questions and comments contributed in no small measure to
broadening the exchange of scientific information.
I express my deepest appreciation to the members of the CMNR who par-
ticipated extensively during the workshop and in discussions and preparation of
the summary and recommendations in this report. I continue to be stimulated by
the committee's dedication and willing contribution of time and expertise to the
activities of the CMNR. I thank all of you for your continuing contributions to
this program.
JOHN E. VANDERVEEN, Chair
Committee on Military Nutrition Research
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. .
X11
PREFACE
I express my deepest appreciation to the members of the CMNR who participated extensively
during the workshop and in discussions and preparation of the summary and recommendations in
this report. ~ continue to be stimulated by the committee's dedication and willing contribution of
time and expertise to the activities of the CMNR. ~ thank all of you for your continuing
contributions to this program.
JOHN E. VANDERVEEN, Chair
Committee on Military Nutrition Research
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Contents
EXECUTIVE SUMMARY.........
Background, 2
The Committee's Task, 2
Methods, 3
Caffeine Use, 4
Caffeine Metabolism, 4
Response to Military Questions, 6
1
1 BASIC CONCEPTS 17
Military Interest in Caffeine, 17
History of Caffeine Use, 19
The Committee's Task, 20
PHARMACOLOGY OF CAFFEINE.....................................................
Absorption, Distribution, and Metabolism, 26
Factors Affecting Caffeine Metabolism, 28
Physiological Effects, 29
Summary, 3 1
EFFICACY OF CAFFErNE ...................................................................
Physical Performance, 33
Cognitive Function and Alertness, 37
Compensation of Sleep Deprivation Impairments, 40
Summary, 44
SAFETY OF CAFFEINE USAGE .~
Caffeine and Cardiovascular Disease Risk, 49
Caffeine Effects on Reproduction, 52
Caffeine Effects on Bone Mineral Density, 54
Caffeine Effects on Fluid Homeostasis, 55
X111
25
33
47
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XIV
6
CAFFEINE FOR MENTAL TASK PERFORMANCE
Detrimental Effects of High Doses of Caffeine, 56
Summary, 59
DOSES AND DELIVERY MECHANISMS 61
Optimum Caffeine Dosage, 61
Caffeine Delivery Mechanisms, 63
Summary, 65
SPECIAL CONSIDERATIONS 67
Education and Training Issues, 68
Labeling, 68
Ethical Considerations, 69
Alternatives to Caffeine for Maintenance of Cognitive
Performance, 69
Summary, 77
7 RESPONSE TO MILITARY QUESTIONS, CONCLUSIONS,
AND RECOMMENDATIONS 79
Additional Research Recommendations, 96
REFERENCES .
APPENDIXES
97
A Workshop Agenda and Abstracts, 115
B Previous Recommendations on Caffeine from the Committee on
Military Nutrition Research, 143
Biographical Sketches, 147
