Category Archives: Dr. Croft’s Blog

Being In Control

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High blood pressure (hypertension) is one of the leading contributors to death here in the United States.  According to the CDC, about 75 million people, or one out of three adults have hypertension.  Unfortunately, only about half of the population with hypertension have their high blood pressure under control.  If your blood pressure is not controlled, you are four times more likely to die from a stroke and three times more likely to die from heart disease.  In fact, 69% of people who have their first heart attack, 77% who have their first stroke and 74% with chronic heart failure all have high blood pressure.  As well, hypertension is not just an “old folks” disease.  An American Academy of Pediatrics study shows that up to 15% of teenagers may have either elevated blood pressures or outright hypertension.

Blood pressure measures the force of your blood inside your arteries. The top number (systolic) is the pressure when your heart contracts, and the bottom number (diastolic) is the pressure when relaxed.  If your systolic measures 120 and diastolic measures 80, the reading is “120 over 80”, or written, 120/80 mmHg.  The CDC guidelines provide “normal” blood pressure as systolic less than 120 and diastolic less than 80, “pre-hypertension” (at risk for hypertension) as systolic 120-139 and diastolic 80-89, and “high” as systolic 140 or higher and diastolic as 90 or higher.

Lifestyle choices may have significant influence on blood pressure.  A diet that is too high in sodium or low in potassium may put you at risk.  Sodium is the element in table salt that raises your pressure and commonly comes from processed and restaurant food.  About half of individuals who limit their salt intake may see a positive response in their blood pressure.  Those low in potassium intake may want to include bananas, beans, yogurt and potatoes in their daily diet.  Individuals who are overweight may likely see an increase of their blood pressure as their weight goes up.  Increasing physical activity has many benefits, and weight loss can be one of them.  However, losing weight may not guarantee lower blood pressure, as there are people who are not overweight who have hypertension.  Drinking too much alcohol can raise blood pressure, and the CDC recommends women to have no more than one drink per day and men no more than two.  Nicotine use includes cigarette smoking, chewing tobacco and vaping, all which increase heart rate and blood pressure as well as restrict blood flow to the heart, significantly increasing cardiovascular risk.    

Hypertension is known as the “silent killer”, as you rarely feel the presence of high blood pressure.  However, the effects of high pressure over time can damage circulation resulting in stroke, heart attack, heart failure, and kidney failure.  Controlling blood pressure may include the previously mentioned lifestyle changes such as diet modifications, increasing activity/exercise levels and not smoking as first line therapies. Many of us will need the addition of some medication to reach adequate levels of control. 

As February is American Heart Month, it is a good time to see if you are at risk.  A simple blood pressure check is the first step to determine your risk.  Your doctor’s office should readily be able to check your blood pressure on request.  The health kiosks commonly seen at your pharmacy and grocery store are usually accurate for screening purposes.  And most fire departments will be happy to check your blood pressure, as they are trained professionals and have the proper equipment to do so.  Even if you have a normal blood pressure with one reading, do not stop there.  Blood pressure will vary throughout the day, so additional checks at different times are important for consistent accuracy of screenings.  The tendency is for blood pressure to increase as we age.  Ongoing regular screenings provide early detection and the opportunity for early intervention, limiting the risk of developing hypertension in the future.  Do your heart a favor and check your blood pressure.


Bradford Croft, DO

East Flagstaff Family Medicine

Dollars and Sense

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As we enter the new year of 2019, you may get a call out of the blue from your doctor’s office, a care management program like an ACO, or possibly your health insurance company.  One likely reason would be to schedule your annual wellness exam.  Other reasons could be to schedule an age based recommended mammogram, colonoscopy or Pap smear.  Perhaps it is to remind you of procedures like an eye exam for diabetics or labs that are scheduled or otherwise due.  For those patients with chronic diseases, it is critical to receive preventive and proactive care, as most problems will otherwise just get worse – and more expensive to treat.

The concept is called Population Health Management, and comes as both public and private payers focus on “value-based care”.  If we are able to be preemptive in providing timely care, we may be able to prevent or better control common diseases.  Primary care has been tasked by insurance companies with the challenge of tracking and coordination of a person’s care.  Communication between primary, specialty and hospital care may prevent duplication of services or tests, thus keeps cost down.  Awareness and reconciliation of medications provided to patients among these entities may also minimize the risk of dangerous drug interactions. 

The challenge of primary care providing population health can be difficult but not impossible.  It is necessary to identify those chronic disease patients who may benefit from outreach programs.  To do so requires electronic health records to compile and organize this data.  As a rule, a health care team manages the scheduling, tests and outcome records to assure that no patient is overlooked.  Such a program provides an opportunity for improvement, and truly does help patient care.

My first visualization of population health was that of my patients becoming rows and columns on a spreadsheet.  I would no longer be caring for my patients, but be asked to treat all of the “red” cells on the form.  But now, seeing the benefits of this organized data, we can easily find a patient who is due for timely lab or coming due for a visit and contact them accordingly.  It also allows reporting, for example, that our diabetics are achieving their treatment goals, or that routine preventive care has been provided.     

Care Management Services (CMS) is already providing financial payments or penalties to physicians for their Medicare patients who are meeting the guidelines or not.  Private payers may determine their continued contracting with your doctor depending on practices meeting the performance measures designed by the carrier.  As these programs expand and develop, we should have better data and better processes to gain markedly improved outcomes.

Health care costs continue to rise despite the Affordable Care Act.  We still have an uninsured and underinsured population.  The United States continues to spend the most money per capita of any country in the world, costing almost half again the Scandinavian countries who provide universal care to their entire populace.  If we are to curb our exploding cost of care, we need to embrace better accountability of health care and outcomes.  When asked to schedule your annual wellness exam, get medical testing, or follow up for your chronic health care, I encourage your compliance.  Ask your provider if they are participating in Population Management, as this may be the best means yet to improve health care, compliance, costs and outcomes.


Bradford Croft, DO

East Flagstaff Family Medicine

Too Bad, so SAD?

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When the days are getting shorter and the temperature colder, do you find yourself getting a little more irritable?  Have a little less energy?  Feel a little more moody?  And if you find that this pattern is consistent year after year, starting every fall and disappearing each spring, you may be suffering from Seasonal Affective Disorder, or SAD.

Seasonal Affective Disorder is a subset of major depression, and may have general characteristics of daylong depression and low energy.  Feelings of hopelessness or worthlessness, as well as no interest in activities that once were enjoyable are common.  Poor sleep patterns, difficulty concentrating, changes of appetite or weight and feelings of agitation are also frequent.  Specific to SAD include craving starches and subsequent weight gain, heavy feelings of the arms and legs, as well as trouble with interpersonal relationships including hypersensitivity to rejection and problems getting along with others.

Although the specific cause is not known, some factors are likely contributing to the development of the disease.  It is season specific, commonly starting as days get shorter and diminishing as longer days return.  The decrease in sunlight may disrupt your circadian rhythm or “bio clock” which sets your wake/sleep cycle.  Disruption of this cycle may lead to depression.  Reduced sunlight can also cause a drop of serotonin which is known to affect mood and contribute to depression.   Melatonin, another neurotransmitter, can be disrupted by a shrinking photo period and will affect sleep patterns and mood.

Females seem to be more likely to suffer from SAD, but males may experience greater severity of symptoms.  Younger individuals are at greater risk for SAD, however the risk does decrease with increasing age.  Those with a personal history of depression or family history of Seasonal Affective Disorder are also more likely to have SAD.  The greater the swing of day/night intervals, the greater likelihood of this disorder as well.

The diagnosis of Seasonal Affective Disorder may be difficult to make.  Health problems and lab tests that contribute to depression need to be investigated.  Additional types of depression may muddy the picture as well and need be considered.  There are some factors that do support the SAD diagnosis if present for over two years.  These include depression that begins during a specific season every year, and ends during another specific season annually, there are no episodes of depression during seasons of normal mood, and there are more seasons of depression than seasons without depression over time.

There are treatments for Seasonal Affective Disorder, but must be used with caution if there is a concern for additional underlying bipolar depression.  Light therapy (phototherapy) involves exposure to a special type of light.  The light source mimics the natural light of the outdoors and seems to influence the brain chemicals linked to mood.  After days to weeks of consistent periods of exposure, this treatment seems to have a positive effect with most people suffering from SAD.  Consult your doctor regarding light therapy treatment, as you need to assure the proper equipment for efficacy and safety.  A common medication for preventing SAD is bupropion, an antidepressant.  This may be considered for severe SAD, and is usually started every year before the onset of symptoms and continued beyond the usual seasonal recovery time before stopping the prescription.  Psychotherapy can help control negative thoughts and behavior as well as assist developing healthy coping skills and stress management.  Of course, should you identify with these symptoms, please consult your health care provider as soon as possible.

Bradford Croft, DO

East Flagstaff Family Medicine

 A Head of Trauma – TBI

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Traumatic brain injury (TBI) is caused by an acute bump, blow or penetrating head injury that disrupts the normal brain function.   If you ever “saw stars” as a result of head trauma, even without loss of consciousness, you may have experienced a mild concussion.  The source of the experience is due to the physical bruising of the brain against the inside of the skull.  Likely, you recovered without a problem.

Not every blow to the head results in TBI.  Those that do may have a wide range of severity from mild, a brief change in consciousness or thought process, to severe, a prolonged period of unconsciousness or coma.  The lasting effects of TBI are also quite variable, lasting from days or weeks in many cases to prolonged, causing lifelong consequences.

TBI contributes to one third of all trauma related deaths.  Although three out of four TBIs are mild, there are 153 people who die every day from sustaining a severe TBI.

According to the CDC, the leading cause of TBI resulting in ED visits, hospitalization and death is from falls, accounting for almost half of all reported cases.  The young, up to age 14, and the elderly, those over 65, are a greater risk than the general population, accounting for fifty-four and seventy-nine percent of all TBI cases respectively.  The sources of TBI related trauma that result in death are the greatest in ages 65 and older from falls, 25 to 64 years old from intentional self-harm, 5 to 24 years old from motor vehicle accidents, and 0 to 4 years old from assault.

There are four categories of concussion symptoms.  “Thinking and remembering” may present as difficulty with reasoning, feeling slow mentally, difficulty concentrating and difficulty remembering new information.   “Physical effects” may include fuzzy or blurry vision and headache, nausea and vomiting, sensitivity to noise and light, dizziness, balance problems and feeling tired and no energy.  “Sleep patterns” may include sleeping more than usual, less than usual or difficulty falling asleep. “Emotional and mood changes” may include irritability, sadness, emotional liability and nervousness or anxiety.  Some symptoms may be noticed immediately, whereas others may not show up for weeks to months after the incident.  If presenting symptoms are subtle, they may initially be overlooked by family, physicians and even the patient.

Those with a history of previous concussion are at greater risk to have another, and may also find it takes longer to recover with repeated incidents.  With the recent attention from the NFL, it is also known that repeated brain trauma may lead to Chronic Traumatic Encephalopathy (CTE), a disease with progressive development of any of the concussion symptoms previously discussed.

Those who experience milder forms of TBI should consult their health care provider as soon as possible.  It is important to get adequate rest and limit activity.  Protection from additional trauma is critical.  Physical activity may need to be restricted for a period of time.  Medications should be reviewed, and alcohol should be avoided.  Severe TBI which may include loss of consciousness should be evaluated emergently.  It should also be treated after the acute phase with a formal rehabilitation program to improve the likelihood of better long term outcomes.  More information is available at this link:

Bradford Croft, DO

East Flagstaff Family Medicine

Flu Season 2018-2019 – It’s that Time of Year Again

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2017-2018 was a record epidemic season for influenza in almost ten years.  One infamous record was that deaths attributed to flu were above the epidemic threshold for sixteen consecutive weeks nation-wide.  Last year was also the first season ever to be classified as high severity over all age groups since the current classification system had been instituted sixteen years ago.  Here is some seasonal information that you should be aware.

Influenza is a respiratory infection that causes fever, cough, sore throat and nasal congestion.  Additional symptoms include headaches, muscle aches and fatigue.  As these complaints sound similar to the signs of the common cold, the severity commonly is much worse.  Not only can the intensity be serious enough to cause weeks of lost work or school, but the infectiousness can be so powerful as to infect the majority of a workplace or school from a single source.  Influenza can evolve into complications which kills thousands of Americans every year, more commonly those with chronic health problems, the elderly and very young.  However anyone can suffer a complication of this illness, sometimes requiring hospitalization with significant lost time from daily routines, or even resulting in death.

A severe outbreak may commonly last up to eight weeks regionally, and can possibly expect to infect one out of every three people in a community.  Hand washing and hygiene are always important, but the single best prevention of influenza is the seasonal immunization.  Appropriate for almost everyone six months or older, it is especially important for those with any chronic disease such as asthma, COPD, diabetes, heart, kidney or liver disease, and any kind of cancer.  Also, those who are overweight or 50 and older are at a significant risk as well.

The influenza immunization recommendations from the CDC for the 2018-2019 season again include quadrivalent injectable vaccines.  This year vaccines have been updated to better match the circulating viruses, and should most commonly be provided as the flu shot (inactivated influenza vaccine or IIV) and the recombinant influenza vaccine (RIV).  The nasal spray / live flu vaccines which were not effective in seasons past have also been updated.  The CDC now does recommend them as an alternative choice for most non-pregnant individuals ages 2-49 this year.

For those interested, the protection for this year’s likely infections is recommended to include:

A/Michigan/45/2015 (HINI) pdm09-like virus

A/Singapore/INFIMH-16-0019/2016A (H3N2)-like virus (changed from A/Hong Kong)

B/Colorado/06/2017-like (Victoria lineage) virus (changed from B/Brisbane)

B/Phuket/3073/2013-like virus (B/Yamagata lineage)

Annual flu vaccines are commonly covered by most health insurance programs at no cost to patients.  These immunizations are readily available at county health clinics, most retail pharmacies and many family doctor offices.  Nobody knows when the flu will show up in the community.  Of course, the sooner the administration, the more effective the immunization.  It can take up to two full weeks to acquire immunity from the shot.  Now is the time to prevent the flu!  Immunize, and don’t let the flu get YOU!

Bradford Croft, DO

East Flagstaff Family Medicine

In Memory of Rachel

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There was a recent motor vehicle accident in the greater Phoenix area this July.  It only involved one car.  The driver died at the scene.  It was reported in the police investigation to likely be the result of distracted driving.  She was the daughter of a friend of mine.  She was only twenty-two.

Over 90% of automobile accidents involve human error.  Distracted driving injured 391,000 and claimed the lives of 3,450 people nationally in 2016. The US Department of Transportation reports that ten percent of fatal injuries and fifteen percent of injury accidents were distraction related, although the National Safety Council attributes up to 27% of crashes a result of cell phone distraction.  The Insurance Institute for Highway Safety reports that the fatal crash rate for teens is three times greater than for drivers age 20 and over.  As well, driver distraction is responsible for more than 58% of teen crashes according to the AAA Foundation for Traffic Safety.

Distractions are categorized as three types:  manual, visual and cognitive.  Manual distractions are when your hands are removed from the steering wheel.  Visual are when you focus your eyes away from the road.  Cognitive are when your mind wanders away from the task of driving.  Some examples of manual and visual distraction include reaching for objects, eating or drinking while driving, adjusting the radio or stereo, smoking or vaping, and putting on makeup.  Carrying on a conversation with passengers can serve as a cognitive distraction.  Texting involves all three categories.

A study at the University of Utah reports that people are as impaired when they drive talking on a cell phone as when they drive intoxicated at the legal blood alcohol limit of .08%.  It also reports cell phone users are 5.36 times more likely to get into an accident than an undistracted driver.   Text messaging increases the likelihood of a crash or near crash by 23 times.  The National Highway Traffic Safety Administration reports that sending or reading a text message takes your eyes off the road for about five seconds which, at a speed of 55 mph, is the equivalent of driving the length of a football field without looking.

Arizona is one of only three states that do not have a statewide ‘texting while driving’ law.  There is, however, A.R.S. 28-701 providing for a “speed that is reasonable and prudent for the circumstances” that may deter people from using cell phones while driving.    In July 2014, the Flagstaff City Council passed the local ordinance 9-01-001-0013 – “Use of wireless communications device while vehicle or bicycle is in motion prohibited”.   If you drive around our fair city, you may notice that many drivers are either not aware or choose not to obey these laws.  You can, nonetheless, make the right choice – be a good role model, obey the law, make sensible choices, and not become a statistic.  The call or text you make or receive while driving is likely not a matter of life and death, but the distraction of your action certainly is.

Bradford Croft, DO

East Flagstaff Family Medicine


When Is a Shot “shot”?

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When we talk about immunizations, many of us think of “baby shots” and childhood immunizations.  As vaccines are required by law for children to attend public schools, records are generally available through the educational institution and the pediatrician.  However, there are a number of adult updates and new vaccinations we all should consider. As August is ‘Immunization Awareness Month’, do you know what you need and when you are due?

Meningococcal B vaccine should be considered for adolescent ages 16-18 going to college or other dormitory type environments.  The close quarters of dorm living may put these individuals at risk of Meningitis B.

The human papilloma virus (HPV) is the most common sexually transmitted in the United States affecting both men and women.  Historically, the significant concern of this disease is known for its role in the development of cervical cancer.  It is also recognized as responsible for genital warts and multiple other cancers of both men and women.  This immunization is recommended for people up to 26 years old.

The tetanus booster is a shot that typically contains an additional component to prevent diphtheria (Td). Once childhood dosing is completed, this should routinely be repeated at least every ten years.  If the person suffers a puncture or other wound, the tetanus should be updated promptly if it has been five years or more since their last shot. There is also a tetanus vaccine that immunizes against pertussis, otherwise called whooping cough (Tdap).   For adults who have not had a preliminary Tdap, it should be done as soon as possible.  This is particularly important for those individuals having contact with younger children, such as grandparents or those in a child care setting.

Flu shots (influenza) are an annual immunization.  Because this shot does not last longer than a year, it should be administered before the flu season every year.   And, as the upcoming flu season may have different strains of viruses from the prior year, the vaccine may change from year to year.  Typically, this shot is given as early as the end of August through October, but can be administered at any time throughout the season.  The nasal sprays are no longer recommended.

As we age, our immune systems weaken over time.  At age 50 or older, the recommendation has been for everyone to get a shingles vaccine.   The recent release of Shingrix is now the currently recommended vaccine.  It is far superior to the older Zostavax that many have already received.  This population is encouraged by the CDC to be re-immunized with Shingrix as soon as possible, and those otherwise due should receive it as well.

There are two recommended pneumonia vaccines available at and after 65 years old.  The Prevnar 13 is generally given first, and the Pneumovax 23 is provided one year later to complete the series.  These vaccines help prevent community acquired pneumonias which become much more likely as well as potentially lethal in the elderly.

These vaccines may have different recommendations of timing and dosing for patients with chronic diseases as well as during pregnancy.  There may be other immunizations appropriate for you individually in addition to these general recommendations.  It is an easy process to catch up on your immune status and maintain your protection against these nasty diseases.  Consider this month what your immunization status may be.  You can receive assistance through the Coconino County Health Department or consult your family physician.  Immunization schedules can be found at


Bradford Croft, DO

East Flagstaff Family Medicine

Dragging Your Anchor

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Anemia is a condition of having a lower than normal amount of circulating red blood cells (RBC). This can be due to either your body not making adequate RBCs, having a source of bleeding that surpasses the body’s ability to replenish them or that your body is destroying RBCs. All of these conditions result in the oxygen carrying component of circulation being compromised. If anemia is present, symptoms may include headache, fatigue and exhaustion. There may be shortness of breath or irregular heartbeats. As anemia worsens, there may be pain and or pallor or paleness to the skin. Long term presence of anemia may damage systems such as the brain, heart and other organs. Severe anemia may lead to death.
Iron deficiency anemia is the most common form worldwide. As iron stores are depleted or inadequate in the body, the bone marrow cannot make hemoglobin, the oxygen carrying component of the RBC. The most common reason for low iron is that of blood loss. This is usually caused by bleeding in the digestive or urinary tract, surgery, trauma, heavy menstrual periods or cancer.
Vitamin deficiency anemia is from inadequate levels of folate and vitamin B-12. These substances are also needed in addition to iron to produce healthy RBCs. This anemia is typically due to dietary deficiencies. Some individuals may have a problem with B-12. Although they may be consuming proper amounts, their body cannot properly process the vitamin. This is known as pernicious anemia.
Anemia of chronic disease may be a sign of underlying problems such as cancer, HIV and AIDS, rheumatoid arthritis, kidney disease, Crohn’s disease or other inflammatory diseases. Obviously, other than treating the anemia itself, it is necessary to discover the source of the problem and treat the root cause.
There are a group of hemolytic anemias that cause RBCs to be destroyed faster than they can be replaced. These diseases include thalassemia, sickle cell disease, G6PD deficiency, malaria, and acquired and immune hemolytic anemias, to name a few.
Prevention is not possible for many types of anemia. A vitamin rich diet may minimize the development of the diet-deficient anemias. This would include foods or supplements including iron, folate, B-12 and Vitamin C. Treatments, depending on the type of anemia, may range from simple iron supplements to transfusions, medication, marrow transplants and possibly surgical intervention.
As fatigue is a common complaint for many people, there are also many causes and contributions to having this symptom. If you have other chronic issues or illnesses, it is important to keep anemia in mind as a possible effect of these diseases. Your primary care provider can start the screening process when it is appropriate by ordering some simple blood tests as the first step to diagnosis and treatment.
More info:

Bradford Croft, DO
East Flagstaff Family Medicine

Keeping Afloat

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Gatorade. Propel. Powerade.  Body Armor.  Vitamin Water. These are some names you may know.  As the list of sports drinks continues to expand, so does the revenue spent.  Estimated to be more than twenty-eight billion dollars spent on these beverages in the global market of 2017, sport drinks are a popular supplement for many who exercise. These beverages are designed to help athletes replace water, electrolytes and energy before, during or after training or competition.  The right drink used for the right purposes at the right time can help to postpone fatigue and stabilize blood sugar.

Physical exercise may elicit high sweat rates potentially resulting in substantial water and electrolyte losses.   There is significant variability of dehydration among people – men and women, slender to stocky, fit to deconditioned, even from different levels of exertion by the same individual.  Additional influences that also increase water loss include higher ambient temperature and humidity as well as the exercise apparel worn.  Adequate hydration prior to exercise is important.   One should start with a “full tank” as opposed to catching up during or once exercise is completed.  A simple hydration barometer is the color of your urine.  A straw color or pale yellow tint usually indicates satisfactory hydration.  Increasing intensity of yellow coloration indicates increasing levels of dehydration.

Hydration is better sustained throughout performance or exercise periods rather than waiting until your session is completed.   The best balance is to minimize fluid loss during exertion by drinking small quantities of liquids at regular intervals during exercise.  It is important to maintain less than 2% of body weight loss during exertion, as that is the level when significant electrolyte and carbohydrate deficit may start to become evident.   The serious athlete may want to evaluate his hydration needs by calculating total body weight loss during a typical and maximal training effort.  If the two percent limit is reached or surpassed, it is essential that the glucose and electrolyte losses be remedied routinely with sports drink rehydration after training and competition.

Gatorade, the original sport drink, was initially designed for the elite college athlete.  A reasonable sport drink should be about six to eight percent carbs with a small amount of sodium and potassium. However not everyone may need sport drink rehydration.  One estimate is that it may take up to ninety minutes of vigorous exercise or three hours of sustained lower level exertion to require carb and salt replacement.   Plain water with a normal carbohydrate based meal may be adequate to replenish deficits post exertion.  Beware of unnecessary calories in a lot of these drinks, as the energy consumption of many of our exercise regimens may not warrant the caloric cost.  A number of us, given an hour in the gym, on the court or out the door, may be adequately restored with just water alone.

Bradford Croft, DO

East Flagstaff Family Medicine


What’s the Buzz?

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Many folks start their day with a cup of coffee.  In fact, according to the Food and Drug Administration, about 80% of us consume caffeine on a daily basis.  Most people are aware of the stimulating effects of caffeine, but a lot of us do not know the other impacts of caffeinated beverages.

Caffeine is the most commonly used psychoactive drug worldwide.  Coffee, tea and sodas are typical sources of the caffeine we ingest, for many of us regularly.  But foods, nutritional supplements and medications may also be sources.  For healthy adults, a moderate intake of up to 300mg per daily intake is considered “generally safe” by the FDA.  The Dietary Guidelines of America recommends, however, women who are pregnant and those breast feeding consult their health care providers for advice on caffeine consumption.  For children and adolescents, the American Academy of Pediatrics takes the stance that there is “no place for stimulant-containing energy drinks” for this population.

Federal guidelines require that the presence of caffeine in beverages or foods be listed as an ingredient.  However, the amount of caffeine does not.  To give you an idea as to how much caffeine is present, here are some common listings from based on an eight ounce serving:

Brewed coffee                   102-200mg.            Brewed decaf                    3-12mg.

Expresso (1 oz.)                  30-90mg.              Brewed black tea              40-70mg.

Brewed green tea              40-120mg.              Cold brew coffee            110-200mg.

The following sodas contain the following based on a twelve ounce serving:

Pepsi One                              57mg.                        Pepsi                                     39mg.

Diet Pepsi                              37mg.                        Coke Zero                             36mg.

Coca-Cola                              34mg.                        Diet Coke                              46mg.

Mountain Dew                     54mg.                           Dr. Pepper                           41mg.

IBC Root Beer                         0mg                          Orange Crush                        0mg.

A Monster Energy Drink contains 80mg caffeine in an eight ounce serving and has 27gm of sugar.

Many non-prescription medications that treat drowsiness, headaches and migraines will commonly have caffeine, from 60 to 200mg per dose.


The most commonly anticipated effect of caffeine is to stimulate the brain.  Within minutes, there is increased alertness, and there may be a buffering of drowsiness and fatigue – our morning “wake-up”.  Other positives include a decreased suicide risk as well as developing Alzheimer’s and dementia for those who consume caffeine on a regular basis. In addition is a reported decreased risk of oral and throat cancer.


According to the Mayo Clinic, there may be some negative effects may occur after 400mg of caffeine is consumed routinely (about four cups of coffee).  If the brain is over-stimulated, there may be side effects of restlessness, anxiety, headaches or insomnia.  Urine output is increased, producing a diuretic effect.  There may be an increase of symptoms from those already suffering from bladder problems.  Gastrointestinal stimulation may produce heartburn and diarrhea, with nausea and vomiting developing at higher doses of ingestion.  Calcium absorption into the bones is decreased, increasing the risk of developing osteoporosis and fracture.  The cardiac effects of caffeine increase heart rate, blood pressure and contribute to skipping beats.


Over time, your body becomes more tolerant to your daily dose.  Should you develop adverse effects from your caffeine consumption or just be concerned to the long term effects as listed, you should taper down gradually.  Headaches are the most common presentation of caffeine withdrawal.  There are websites available providing information about caffeine from the FDA and Mayo Clinic, among others.  How much caffeine are you consuming?


Bradford Croft, DO

East Flagstaff Family Medicine