small amounts, self-brewed, morning, shift work effective drug

         For centuries coffee has been praised and vilified for its health and social benefits.  Bach wrote a cantata depicting a young woman too fond of her very expensive, imported brew.  Caffeinism has been a recognized addiction for hundreds of years.  Presently, coffee has been praised as lowering insulin levels and decreasing uric acid levels. It’s said to provide the American population perhaps half the anti-oxidants in its diet.

         Not very long ago, research on coffee told a different story.

         In the late 1970’s, Dr. Brian MacMahon, chairman of the Epidemiology Department at the Harvard School of Public Health, reported very disturbing findings.  In his studies, coffee, particularly instant coffee, markedly increased rates of pancreatitis. Far worse, the rate of pancreatic cancer multiplied.  Coffee was causing a perhaps four-fold increase in one of medicine’s most untreatable cancers.

         Fortunately MacMahon was wrong.  He had used as his control group patients with GI disease, an unfair comparison.  Further studies showed no increase in pancreatic cancer, or pancreatitis, due to coffee drinking.

         It’s another cautionary tale that should be considered in a time when “new breakthroughs” are constantly trumpeted by a media obsessed by novelty and scandal.  It is reminiscent of the old adage taught in medical school – half of what we’re teaching you is true, half is false; the only problem is we don’t know which half.

         The truth takes time.  When an “outrageous” result is reported, contrary to previously accepted fact, it should be verified before that result is generally believed.  Many epidemiologists, as did my old teacher, Professor Olli Miettinen, apply their own “likelihood ratio” to any new data, effectively setting a personal probability of whether they think it correct.

Home Brew Versus Commercial

         Coffee varies a lot.  There are different beans from different regions, different brewing methods, different chemical fixes and additives.  What’s brewed at home may not at all resemble what arrives for you in a restaurant.

         Italian espresso is different from what’s normally  served in Finland, the world’s champion coffee drinking capital, where locals supposedly average nine cups a day (enjoy the Finnish climate and you may learn why.)  Yet when buying coffee, people tend to notice at least two things – taste and caffeine content.

         Both represent potential problems buying store or restaurant bought brews.  Starbucks is very popular, but beware your waistline.  Not only are the caffeine amounts sometimes astronomic, but so are the calories.  Some Starbucks’ brews push over 700 calories into one cup.  Think of all that sugar while happily considering the “insulin lowering” effects of caffeine.

Coffee and Caffeine

            Coffee can be caffeine rich or caffeine poor.  The difference is clinically important.

         Many of the “health effects” of coffee may well be divorced from caffeine. Decaffeinating coffee means you may lose some health benefits, but it’s hard to know what they are.  If coffee really is providing half the anti-oxidants in the American diet, we’re in trouble. Our processed foods are probably very far away from any reasonable human design principles for sensible nutrition.

         Coffee may provide other health benefits.  If it holds up, the data on lowered insulin level might be important.  Unfortunately, many drugs work on “risk factors”, but do not necessarily aid health.  The recent story of the diabetes drug avandia, where clinically decreased glucose levels are associated with higher heart disease rates, demonstrates the risk of treating risk factors and not hard end points of death and disease.  Association is not causality; lowering a risk factor does not mean a disease is prevented.

         Caffeine can be used to keep shift workers up, to wake people up in the morning, to allow soldiers to remain sharp. Too much caffeine can cause chronic insomnia, even for those who only drink coffee in the morning.  Caffeinism with its “speediness” and high levels of anxiety is a common syndrome in corporate life.
        
Coffee and Cancer

         Is coffee tumorigenic, or not?  This remains a very controversial area. Some data point to coffee lowering colon, rectal, and liver cancer rates.  With colon cancer the number two cancer killer in the US, that may represent a considerable public health benefit.  However, leukemia rates appear increased by coffee drinking.

Other Coffee Benefits

         The social elements of coffee receive too little comment.   Coffee houses have been major venues for fomenting and planning revolutions (including ours) and social progress since coffee made its first major inroads into 17th century Europe.  Neglected still are the useful effects of the kaffeklatsch.  Recent uses of “coffee groups” include young mothers overcoming post-partum depression and learn to parent more effectively.  Many a social, business, and political meeting still turns around people drinking coffee.

         The centuries old global network of coffee production and use will probably continue for a long time.  Coffee is a great enjoyment to billions of people.  If it prevents diabetes and gout, major tumors, and lifts alertness and spirit, so much the better. 

Dr. Matthew Edlund, M.D., M.O.H., director of The Center for Circadian Medicine, is an expert on applied public health, sleep medicine and psychiatry. A former professor at Brown and University of Texas medical schools, he can be reached via email to DocME@DoctorEdlund.com. And CLICK HERE to subscribe to our new Fitcast, via the iTunes Store.