Coffee & MTX… what are your experiences?

It is thought that one of the mechanisms by which MTX works for RA at low dose, in addition to disrupting the fast multiplication of marauding T cells, is also by stimulating all cells to release adenosine. This is a powerful anti-inflammatory that blunts RA. Adenosine locks on to adenosine receptors and tones down the inflammation. But it also causes drowsiness.

Now… here’s an interesting article I read about caffeine and it’s impact on adenosine…

“Coffee doesn’t perk you up - it just staves off drowsy feelings

By Xantha Leatham, Deputy Science Editor

WHEN it comes to waking up in the morning, many of us rely on a cup of coffee to give us the kickstart we need.

But your flat white, americano or latte won’t actually give you extra energy - it borrows it, according to an expert.

Dr Emma Beckett, a molecular nutritionist from the University of Newcastle, said this ‘loan’ of feeling awake will eventually need to be repaid with sleep.

She explained that caffeine keeps away drowsiness by temporarily blocking a chemical called adenosine. This chemical helps regulate our sleep and wake cycle.

Eventually adenosine binds to its receptor - part of the cells that receive signals - which tells the cells to slow down, making us feel drowsy and sleepy. Caffeine can help us feel awake by binding to the adenosine receptor and preventing the chemical from triggering the sleepy feeling.

‘But there is a catch,’ Dr Beckett wrote on The Conversation website. ‘While it feels energising, this little caffeine intervention is more a loan of the awake feeling rather than a creation of any new energy.

‘This is because the caffeine won’t bind for ever and the adenosine that it blocks doesn’t go away. So eventually the caffeine breaks down, let’s go of the receptors and all that adenosine that has been waiting and building up latches on and the drowsy feeling comes back - sometimes all at once. So, the debt you owe the caffeine always eventually needs to be repaid, and the only real way to repay it is to sleep.’

-DailyMail Feb 2023

This makes sense to me and explains why when I have my regular cappuccino on my MTX day, the efficacy of MTX is much reduced, but I don’t get MTX nausea or drowsiness or brain fog. If I take MTX with no caffeine, empty stomach at night, I get nausea, drowsiness and brain fog until lunchtime the next day, but my joints are ever so happy that week!

Counter to that, the RA resumes if I have an excess of fruit, my guess is it’s the fructose, as ordinary sugar does not trigger my RA.

Any one else with interesting experiences with different food? Or notice different levels of RA attack?

BTW I am on 25mg MTX tabs.


  • frogmorton
    frogmorton Member Posts: 29,032


    That was interesting @Arthuritis

    I see some possible sense there I only drink decaf. Will need to experiment with actual full-fat coffee!

    Sadly although I have spent the whole times since diagnosis looking at my eating I haven't found any triggers yet. I am trying to eat 'better' though it's not always easy. I am already vegan, but not the healthiest vegan in the world sadly.

    Will pay attentions to fruit now you've mentioned it 🤔

    Take care

    Toni x

  • stickywicket
    stickywicket Member Posts: 27,608

    Interesting. But I'm a tea drinker.

    Is it fruit or citrus fruit? I think some people find their inflammatory arthritis reacts badly to tart things ie lemon juice, picled onions.

    I'm fairly sure that those of us on methotrexate are not supposed to eat grapefŕuit or, maybe, oranges. I forget why. I don't much. Cherries and mangos do it for me.

    The only thing I founď, in food and drink, that did badly affect my RA wàs the wonderful whisky. Nothing to do with the DMARDS as I discovered that sad fact long before I was offered DMARDS.

    If at first you don't succeed, then skydiving definitely isn't for you.
    Steven Wright
  • Arthuritis
    Arthuritis Member Posts: 413

    @stickywicket @frogmorton

    Well spotted @stickywicket … oranges are the fastest trigger with even a single orange able to do it, however it depends on how long since MTX. Nothing happens first 2 days after MTX if I have oranges, but by day 3 my orange tolerance is down to 1 per day and on day 4 onwards zero.

    I tried it with black currants, same but I need a lot more. Not tried it with bananas, mangoes or pineapple but will do. Baked beans also triggers it, but I think it’s for different reasons, (lectins & leaky gut - something currently under NHS research).

    So it maybe that citrus is a no no, but others may still be ok. I will have to research why oranges. Grapefruit is well known for interfering with a lot of medications but I hoped oranges would be ok! I quite like them!

    I am now a once a mid week coffee drinker, other days it’s Earl Grey! I suspect once adenosine has saturated all your inflammation control receptors any further free floating excess adenosine just makes you miserable, so like folic acid, if you take it a day or 2 after MTX, it will make you feel better and be excreted before your next MTX dose. I will test both caffeine & oranges vs other fruits theory!

    BTW, not sure if I mentioned this, but my veggie smoothies come out a lot better if the veg is frozen at -22C. This makes it brittle and pulverises a lot finer in the bag even before going in the blender, particularly leafy greens like spinach and rocket. This allows for a nice smoothie without lumpy bits. Also as spinach contains a lot of oxalates (kidney stone & gall stone causing), I recommend having the juice with a piece of your fav cheese. The calcium in the cheese combines with the oxalates and makes it unabsorbable (precipitated). I guess the Mediterranean dish of spinach with ricotta cheese was a smart combination!

    Shame about the oranges. I really like Tesco Emperor oranges.

  • Arthuritis
    Arthuritis Member Posts: 413

    @stickywicket What are your thoughts on this?

    There’s mention of anecdotal reports and myths, plus the absence of evidence linking diet to cause, however in my view absence of evidence linking the two is not evidence of absence of a link… just evidence that no proper research has been carried out to test those that report this. Perhaps there’s a double blind controlled trial of possible triggers, but I’ve not seen one. I’d never had problems with oranges until RA, and if it’s allergies (too much of an easy answer) then something like anti-histamine should suppress it…and easily testable if it were being rigorously researched…