Coffee is Good for You
Whether America runs on Dunkin’ or Starbucks can be debated. But there is no question that many Americans start their day with coffee. There are plenty of marketing campaigns aimed at getting us to consume the stuff – “The best part of waking up is Folger’s in your cup.” Once again, the brand aside, for many it probably does feel like the best part of the morning because of all coffee contains.
We don’t yet understand the precise role of all of the ingredients in terms of health benefits. What we do know is that coffee contains numerous substances and it has been associated with health benefits, e.g., reducing depression, prostate cancer, stroke, and Type 2 Diabetes. What we don’t know for sure is exactly which of the substances are related to which benefits, and if any of the short-term changes like increases in blood pressure, insulin, and homocysteine are problematic. But let’s look at a little of what we do know about coffee. Just what is in that cup of Joe?
First, coffee contains caffeine which is a powerful psychoactive drug that helps many of us see coffee as the best part of waking up. An average eight ounce cup contains around 100 mg of caffeine. Caffeine can increase attention, wakefulness, and overall performance. Of course if the levels become too high it can decrease performance, and cause or exacerbate all kinds of problems like anxiety, irritability, and insomnia.
Caffeine is a stimulant and coffee consumption is where the majority of Americans get their caffeine. There are of course other beverages that contain caffeine like tea and the growing number of “energy drinks.” The caffeine in coffee, like other stimulants, is likely the culprit for raising blood pressure soon after coffee consumption. But, for regular coffee drinkers this effect likely diminishes. And as we will see, coffee has been associated with benefits that reduce cardiovascular risk factors. Even decaffeinated coffee has been found to improve some health outcomes, which indicates other substances in coffee may be of interest to healthy minded individuals.
Diterpines are typically known for their anti-inflammatory properties. Normally I encourage my healthy patients to eat or do anything that reduces inflammation and regularly incorporate it into their lifestyle program (of course if there is a medical issue, I make sure they know to run it past the appropriate physician). Coffee’s diterpines may present ambivalence for some medical professionals. Cafestol and kahweol are two diterpines found in coffee. These two may be responsible for findings that coffee can reduce problems with liver disease. Paper filters (and there is some evidence mesh screens as well) remove the majority of these diterpines. So the effect of cafestol and kahweol will be for unfiltered coffees. If research on their impact on liver disease becomes more conclusive that could be a reason to drink more unfiltered coffee, especially if liver disease is something you may be at risk for developing. But a study in the American Journal of Epidemiology indicates that unfiltered coffee increases LDL (low-density lipoproteins). While there is debate about the count, size, or LDL at all as a predictor of heart disease, it is not settled science. So if you are a coffee drinker and have concerns about liver disease and/or your LDL, having a conversation with your physician may be a logical step. You may simply want to begin using or doing away with your paper filters which soak up most of the cafestol and kahweol depending on whether you are targeting liver disease or LDL.
Coffee also contains an important antioxidant, chlorogenic acid. Antioxidants stop the damaging effects of free radicals that put us at risk for certain cancers. So in general antioxidants are good for increasing the quality and lengths of our lives. But chlorogenic acid has also been associated with inhibiting glucose absorption and stabilizing insulin levels. This antioxidant may be responsible, at least in part, for the dramatic findings that coffee may prevent Type 2 Diabetes. Once again there may be a caveat. It has also been associated with raising the levels of something correlated with heart disease, homocysteine. But as we see later on, the effect may not have a significant impact.
Cup of Joe or No Joe?
Caffeine, diterpines, and chlorogenic acid have all been associated with some negative markers, e.g., increased blood pressure, homocysteine levels. Given that, it certainly makes sense to speak to your physician about his or her take on the relative risks and benefits of coffee given your particular genetics (some of us metabolize coffee differently), risk-factors, and lifestyle.
With that said, what may be more critical for your physician and you to discuss than the associated markers, are findings from larger scale prospective disease studies. While markers may be important- the reason we use them at all is in hopes of discovering how they are linked to endpoints like disease or quality of life. Studies conducted in the U.S., Europe, and Japan have all indicated that coffee appears to reduce the risk of Type 2 diabetes- which is one of the fastest growing health problems facing Americans and people worldwide. Diabetes also puts your heart health in jeopardy- so doing what we can to prevent it has to be a health priority. Heart disease is the number one killer of men and women. These studies followed thousands of individuals over years and controlled for many confounding variables that earlier studies had not included, e.g., alcohol consumption, cigarette smoking, and a sedentary lifestyle. The support for coffee’s role in Type 2 diabetes appears to be quite significant.
Preliminary evidence indicates that coffee may even help prevent the development of Alzheimer’s disease, depression, some breast cancers and prostate cancers, endometrial cancer, and Parkinson’s disease. And even though certain markers commonly associated with cardiovascular risk-factors are increased by coffee (blood pressure and homocysteine) at least in the short-term, moderate coffee consumption is associated with decreased risks of heart attacks and stroke for those regularly consuming it (as a stimulant it for those infrequently drinking coffee it may increase stroke risk right after consumption).
While it would be easier to remove all scientific details and nuance from health recommendations, coffee doesn’t quite allow for that yet. What I hope this brief overview does is provide a starting point for you to become an informed advocate about your health with your trusted physician and other health care providers. There is a great deal of research studying coffee and the hundreds of substances it contains. While it is not easy to parse out all of the findings, for those at risk for diabetes and heart disease having a candid conversation about all of your lifestyle habits, including coffee is an important step. Overall behavioral health has to include an ongoing assessment of your nutrition- and for many of us, coffee is one of the more frequent items on our nutrition log.