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In praise of coffee

Some data point to coffee lowering colon, rectal and liver cancer rates.

MATTHEW EDLUND M.D.
Contributing Columnist
health@lbknews.com

For centuries coffee has been praised and vilified for its health and social benefits. Bach wrote a cantata depicting a young woman willing to give up most things in life for her very expensive, imported brew. That caffeine is addictive has been known for centuries. Yet now coffee is praised for 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 1970s, Dr. Brian MacMahon, chairman of the Epidemiology Department at the Harvard School of Public Health, reported disturbing findings. In his studies, coffee, particularly instant coffee, markedly increased rates of pancreatitis. Far worse, it increased the incidence of pancreatic cancer. Coffee might be causing a four-fold increase in one of medicine’s most untreatable cancers. Fortunately MacMahon was wrong. His research used as its control group patients with GI disease, an unfair comparison.

Further studies showed no increase in pancreatic cancer, nor pancreatitis, due to coffee. MacMahon’s research is a cautionary tale that should be remembered. Ours is a time when “new breakthroughs” are constantly trumpeted by a media obsessed by novelty and scandal. It reminds people 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.

In science, getting to know the truth takes time. When an “outrageous” result is reported, contrary to accepted fact, verify the result before you believe it. Many epidemiologists, as did my old teacher, Professor Olli Miettinen, apply their own “likelihood ratio” to any new data. They apply a probability coefficient from 0 to 1, from complete disbelief to fervent embrace, to any new research result they see.

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 resemble what arrives at your table in a restaurant. Italian espresso is different from what’s normally served in Finland, the world’s coffee drinking champion, where locals supposedly average nine cups a day (enjoy the Finnish climate a while and you may learn why). Yet when buying coffee, people may inherently respond to two major factors—taste and caffeine content.

Consider what you drink at a store or restaurant. Starbucks is very popular, but beware your waistline. Not only are the caffeine amounts often astronomic, but so are the calories. Some Starbucks’ Frappuccino and other concoctions push more than 700 calories into a single cup. Think of that sugar while happily remembering headlines about 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 be quite separate from its caffeine content. Decaffeinating coffee means you may lose some health benefits, but at this stage it’s hard to know what they are. If coffee really is providing half the antioxidants in the American diet, we’re in big trouble. Our processed foods are probably far away from any reasonable human design principles of sensible nutrition. Coffee may provide real health benefits.

If it holds up, the data on lowered insulin level should be important. Unfortunately, many drugs work on “risk factors,” but do not necessarily aid health. The recent history of the diabetes drug Avandia, where clinically “improved” glucose levels are associated with higher heart disease rates, demonstrates the risk of treating risk factors and not real, hard-end points, like death and disease. Association is not causality; lowering a risk factor does not mean you prevent a disease.

Caffeine can be used to keep shift workers up, to wake people up in the morning, to allow soldiers to remain sharp. Yet 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 no. 2 cancer killer in the United States, coffee might be providing an overall cancer 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 social progress and revolutions (including ours) since the 17th Century. Also neglected are the multiply useful effects of the kaffeklatsch. Recent uses of “coffee groups” include young mothers learning to overcome post-partum depression, while others are taught to become effective parents. Many a social, business and political meeting turns around people drinking coffee. The centuries-old network of coffee production and use will probably continue 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. Edlund practices sleep medicine and psychiatry in Sarasota. He can be reached at 365-4308, and by his Web site, www.doctoredlund.com.

Click here for more Staying Alive columns by Dr. Matthew Edlund.

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