DEAR DR. ROACH: I’m a psychotherapist with an expertise in working with adults who experienced childhood trauma. I know that early trauma can lead to later mental health challenges and see this in my practice. The ACES (Adverse Childhood Experiences Study), conducted in the mid-’90s, reveals that trauma and other adverse experiences in childhood (abuse, neglect, parental abandonment and addictions, etc.) can lead to later chronic physical issues as well, such as heart disease and obesity. Will you please address how early trauma and chronic childhood stress affect our immune system and physical health later in life, and what steps people can take to optimize their health? — D.P.

ANSWER: The ACE Study showed that 67% of adults — volunteers from Kaiser Permanente from 1995-1997, average age 57 at the time — had at least one adverse event, e.g., abuse, neglect or household dysfunction, such as substance abuse or a mother who was treated violently. The more adverse events, the worse the outcomes in health and well-being. Adverse outcomes included cigarette smoking and obesity. These in turn increase the risk for heart disease and cancer. Other poor choices made by people with more childhood experiences included more unsafe sex practices leading to higher risk of HIV and other sexually transmitted infections. There was a higher risk of illicit and injection drugs and lower levels of recreational exercise.

The links to ill health go beyond poor lifestyle choices. There was an increased risk for depression and attempted suicide among those with more adverse experiences in childhood. The authors postulate that these traumas lead to social, emotional and cognitive impairment, which then lead to adopting bad behaviors as coping devices.

Two-thirds of adults have had adverse experiences in childhood as defined by the study. Everyone needs to work on making good choices, especially getting regular exercise, avoiding smoking and illicit drugs, as well as excess alcohol use; having meaningful relationships and practicing safer sex. People with more childhood trauma need to be aware of their increased risk for depression and seek attention for symptoms of depression quickly.

The other part of this is to stop the cycle of trauma by having children only when you are emotionally and financially ready, and for parents to seek help themselves if they are overwhelmed by the demands of a family and at risk for not taking the best care of their spouse and children.

DEAR DR. ROACH: I am very sensitive to caffeine. I usually have two cups of coffee in the morning but don’t consume anything with caffeine in it after about noon. If I do drink tea or soda, or eat chocolate after that time, I’ll be wide awake and my heartbeat will be racing by 2 a.m. Is there anything that I can take to counteract this effect of caffeine? — B.H.

ANSWER: People differ widely in their ability to metabolize caffeine. Some people have minimal effects from large amounts of coffee, but others, like you, are much more sensitive. This may have to do with different types of detoxifying enzymes (especially CYP1A2) in the liver, but this is only part of the approximately 40-fold difference in caffeine sensitivity among individuals.

In theory, substances that enhance the activity of the enzyme CYP1A2 should help metabolize caffeine faster. Cruciferous vegetables like broccoli or brussels sprouts do so, but I’m not sure how clinically relevant that effect is.

You can always switch to decaffeinated coffee/tea (or mix caffeinated and decaf to the amount of caffeine you want).

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.