Wednesday, January 12, 2011

The Good, The Bad & The Coffee (Part 2)

Now the Good

Remember, most of the health benefits I'm going to talk about refer to MODERATE consumption of coffee! We all know that drinking coffee increases alertness and wakefulness, but less well known is this: people who drink coffee in moderation are less likely to have Type 2 Diabetes, Alzheimer's Disease, Parkinson's Disease, heart arrhythmias, stroke, liver disease and certain cancers. Coffee can also help treat asthma and headaches and can help with weight management and enhance athletic performance. Caffeine wakes us up because it blocks adenosine receptors in the brain. Adenosine causes reduced arousal and sleepiness because it inhibits excitatory neurotransmitters in the brain. By blocking adenosine receptors, caffeine keeps the excitatory neurotransmitters working which increases mental alertness, decreases reaction time (we're faster), and improves information processing.

There are more than 15 published studies that establish that coffee consumption may help prevent Type 2 Diabetes—some research indicates that decaf helps just as much as caffeinated coffee. In this instance alone, increased coffee consumption showed greater protection (compared people who drink fewer than 2 "cups" of coffee per day, people who drank 4-5 cups a day had a 28% reduction in risk vs. 35% reduction in those who drank 6-7+ cups a day). Personally, I'd go with decaf if I were to add coffee-as-diabetes-prevention into my lifestyle. Coffee also is high in antioxidants and contains some magnesium and chromium—all of which help manage blood sugar and insulin.

There is a lot of research linking coffee consumption to decreased risk of Parkinson's disease. The benefit here seems to come from the caffeine content, though the mechanism isn't clear. A 2009 study from Finland and Sweden showed than, out of 1,400 people followed fro about 20 years, those who reported drinking 3-5 cups of cofee daily were 65% less likely to develop dementia and Alzheimer's disease, compared with nondrinkers or occasional coffee drinkers.

The reduced risk of heart disease and stroke observed with moderate coffee consumption comes from reduction in Type 2 Diabetes (a risk factor for heart disease) as well as a decrease in heart arrhythmias in men and women who drink 1-3 cups of coffee a day. Women who drink 2 or more cups of coffee a day are 20% less likely to have a stroke than women who drink none.

Moderate coffee consumption has very definitively been found to decrease risk of liver cancer and cirrhosis but the mechanism isn't fully understood. Some research indicates that coffee consumption decreases your risk of developing gall stones. The evidence isn't as strong for coffee's protection from other cancers, but is fairly consistently showing benefit in ovarian, endometrial, and colorectal cancer.

The health benefits in regard to asthma, headache, and exercise can be attributed to coffee's caffeine content. Caffeine is very similar to theophylline, an anti-asthma drug. Caffeine is also often included in migraine medication because it constricts blood vessels (this is helpful for people who get vasodilatory migraines but can make things worse for vasoconstrictive headaches). In relation to athletic performance, caffeine improves muscular work performance in all types of activities, though the mechanism is not fully understood. In a 2004 review of 39 previously published trials, Doherty et al. found that caffeine improved performance by 12.4%. Low amounts of caffeine (the equivalent of 1-2 "cups" of coffee) consumed pre-workout can help you to perform longer before tiring. In last week's post, I cautioned about the risks of dehydration from excess coffee consumption. Recent research shows that drinking 3-4 cups of coffee (300 milligrams of caffeine) does not have any adverse effect on hydration and in fact coffee can contribute toward your daily fluid intake.

My current relationship with coffee is as it always has been—love and hate. But now the tables have turned; I love coffee, but it doesn't love me back. A few years ago I did a food allergy test and found out that the main reason for all of my horrible digestive symptoms was an allergy to coffee. After 2 years avoiding each other, I think coffee and I are working things out. I now drink coffee once or twice a week and it doesn't give me any trouble. So for me, I'll have to miss out on most of the health benefits, but I can still enjoy my relationship with coffee. As for you, I'll tell you what I usually tell my patients when they guiltily admit to drinking coffee: if you NEED coffee in order to make it through your day or you don't handle stress well, then you may need to give up coffee for a while and focus on getting your adrenals in better shape. If you are just friendly with coffee, rather than codependent, keep your coffee consumption to no more than 16 ounces a day, preferably filtered and drink the good stuff!

Wednesday, January 5, 2011

The Good, the Bad & the Coffee (Part 1)

Throughout my adult life, I have had a love and hate relationship with coffee. When I was in my teens, I really couldn't stand the stuff; my stepfather drank coffee every morning out of a really nice crockery pitcher and filter set that he kept warm on the stove over a burner diffuser. He liked his coffee with honey and half & half. I gave it a try and found it terribly bitter (he made his coffee really strong) and I didn't care for it at all. Later, I discovered lattes and mochas and these were much more appealing to me. What's not to like about a creamy, sweet drink topped with whipped cream? I liked these because I got the caffeine boost and didn't even taste the coffee! I still enjoy a caramel latte, but I've learned to appreciate a good cup of drip coffee (though I still can't drink it black).

While I was in Naturopathic medical school, I found that many naturopathic physicians have a poor opinion of coffee and I made it my mission to discover as many health benefits to coffee as I could. Yes, part of me wanted to justify my coffee consumption, but I also didn't like the statement "coffee is bad for you" because it went against one of the most fundamental concepts of Naturopathic medicine: everyone is unique. Sure, coffee is "bad" for some people, but most people can drink moderate amounts of coffee with no problems at all; and drinking moderate amounts of coffee can even be good for you! So let's take a look at the good and the bad of coffee.

First the Bad
Like everything, coffee in excess is not good for you. A cup of coffee (and a standard "cup" is approximately 6 ounces) contains 50-100 milligrams or so of caffeine. The amount varies depending on the beans used, how fine they are ground and what method is used to prepare them. Looking at the research, moderate consumption of caffeine means less than 300 milligrams per day—so, 18 ounces of Stumptown to 36 ounces of Folgers. Drinking more than this can contribute to dehydration because caffeine is a diuretic, making you lose water. In excess, coffee can contribute to constipation because of the diuretic effect but it can also cause diarrhea due to increasing peristalsis in the colon.

Too much caffeine can also wreak havoc on your adrenal glands and this is the primary reason that Naturopathic physicians tell their patients to stop drinking coffee. Caffeine stimulates the release adrenaline in your body—so drinking caffeinated beverages puts your body into a state of fight-or-flight. For people in good adrenal health, the body manages the surge in cortisol and epinephrine and helps you return to a "rest and digest" state. But for those with adrenal gland dysfunction—and this is probably the majority of people—caffeine can overstimulate an already overworked pair of adrenal glands. Your adrenal glands sit on top of your kidneys and, among other things, are responsible for moderating your stress response by releasing cortisol, epinephrine (adrenaline) and norepinephrine. I say that a majority of people have some level of adrenal gland dysfunction because, as a culture, we live a high stress lifestyle. In the earlier stages of adrenal dysfunction, with prolonged exposure to stress, you are pumping out way too much cortisol (this causes an increase in belly fat, among other things). In later stages of adrenal dysfunction, exposure to stress creates a situation of trying to wring out a dry sponge—your body is so depleted that it can no longer respond to the stress signal (such as caffeine). So, coffee in a way is liquid stress. The difference between drinking a moderate amount of coffee and coffee in excess is like the difference between the good stress of workout and being chased by lions.

Coffee (because of its caffeine content) can also aggravate insomnia, worsen anxiety, and increase symptoms of PMS and fibrocystic breast pain. Excess caffeine consumption can contribute to high blood pressure and osteoporosis. A compound in coffee called cafestol can increase cholesterol levels (filtering your coffee removes most of the cafestol).

Coffee consumption can drastically affect fertility: women consuming more than 300 milligrams of caffeine each day are 2 1/2 times more likely to have delayed conception than women consuming less. Some research suggests that excess caffeine consumption during pregnancy can contribute to low birth weight and miscarriage, but most research shows that consumption of less than 200 milligrams of caffeine per day is safe in pregnancy. But enough about the bad stuff, what's good about coffee? Well, for that, you'll have to wait for next week!

(For more detailed information about adrenal dysfunction, please check out my colleage, Dr. Jason Barker's, blog post Adrenal Fatigue on The Natural Athlete's Clinic site.)