CAVEATS ON COFFEE?

Should we or should we not drink coffee? What are the health benefits? What are the negatives?
—Felix N. Chien, DO, Newport Beach, Calif.

Coffee and tea are the most widely consumed beverages in the world, and caffeine is thought to be the most commonly used pharmacologically active substance (Gilbert RM. In: Spiller GA, ed. The Methylxanthine Beverages and Foods: Chemistry, Consumption and Health Effects. New York, N.Y.: Alan R. Liss;1984:185-214, and Amicis A, Viani R. In: Garattini S, ed. Caffeine, Coffee and Health. New York, N.Y.: Raven Press;1992:1-16). Caffeine, in general, and coffee specifically have been widely studied with regard to pharmacologic activity and purported health effects.

Large trials have been conducted in the areas of cardiovascular (CV) disease, diabetes, cancer, and even Parkinson’s disease. Unfortunately, in most areas, data appear to conflict, and effects, whether positive or negative, appear to be modest. Various publications regarding CV risk factors, for example, have shown small but significant rises in systolic BP following morning caffeine intake, which could theoretically translate to negative, long-term outcomes (Lancet. 1997;349:279-281). Yet larger longer-term trials, in the United States and Northern Europe, have failed to show any evidence for a positive association between coffee consumption and risk of subsequent CV disease (JAMA. 1996;275:458-462 and BMJ. 1996;312:544-545).

Using data from the Nurses’ Health Study and Health Professionals Follow-Up Study, other authors have shown an inverse relationship between long-term coffee consumption and the development of type 2 diabetes mellitus (Ann Intern Med. 2004;140:1-8). Furthermore, an inverse relationship between coffee consumption and Parkinson’s disease has also been proposed (JAMA. 2000;283:2674-2679). Reviews of the relationship between coffee and cancer suggest an inverse relationship with colon cancer and inconclusive but “largely reassuring” evidence with regard to other malignancies (Eur J Cancer Prev. 2000;9:241-256). Overall, it is premature to tell patients they can sip with impunity, but the weight of evidence seems to contrast with the supposition that coffee addiction is another bad habit.
—Christopher Ruser, MD (113-10)

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