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Coffee advice from and for doctors

Help your patients get a bigger health boost from their coffee

A large majority of adults consume caffeine daily and depend on a steaming cup of coffee to get their day started on the right foot. But does drinking that daily cup of joe offer health benefits for patients? It does pack some surprising health benefits depending on the amount consumed.

With consumption of up to four cups of coffee—compared with nondrinkers—there is a 29% reduced risk of all-cause mortality over a seven-year period and a 15% reduction in all cardiovascular disease. There is even a 29% reduction in risk of developing type 2 diabetes by the highest consumers of coffee, compared with those who don’t drink it at all, according to Stephen Devries, MD, a preventive cardiologist and executive director of the educational nonprofit Gaples Institute in Chicago.

The Gaples Institute is widely recognized for its four-credit condensed nutrition CME course, which is required learning in six leading medical schools and is available to AMA members at a discount through the AMA Ed Hub™.

“Many people—myself included—consider themselves to be coffee lovers. And fortunately, coffee loves us right back,” said Dr. Devries on the podcast, “Coffee Science: A Clinician's Guide to a Beloved Bean.”  

“Caffeine is one of the contributors to the health benefits. It’s in the methylxanthine family—like theophylline—and it’s an adenosine-receptor antagonist,” said Dr. Devries, an AMA member. “But beyond caffeine, coffee and tea … have a really wide range of polyphenols. These are plant-derived chemicals that act both as anti-inflammatories and antioxidants.

“Perhaps the best of all studied in coffee is chlorogenic acid. It’s a potent anti-inflammatory and antioxidant also found in peaches and eggplants,” he added in the podcast, which is hosted on AMA Ed Hub.

Here is how to help your patients get the most out of their coffee.

Standard drip coffee with a paper filter “is good to go,” Dr. Devries explained, noting that unfiltered coffee—such as espresso or coffee made with a French press—is “associated with a small, but still significant increase in blood levels of LDL cholesterol.”

“The filtering of coffee removes a lot of a particular chemical called cafestol,” he said. “This cafestol is a compound that's naturally found in coffee that raises blood cholesterol, but fortunately is largely removed by paper filters.”

The Food and Drug Administration “cites 400 milligrams as the daily maximum for caffeine for non-pregnant adults, but of course we need to acknowledge that many people are especially sensitive to caffeine,” Dr. Devries said. For those people, “much lower intake than 400 milligrams may be needed to avoid some of the adverse effects, which can be nervousness and anxiety, and—of course—difficulty sleeping.”

Caffeine level also depends on the type of coffee and how it is made. For example, a small drip coffee that is 8 ounces has anywhere from 90 to 150 milligrams of caffeine. An extra-large 16-ounce drip coffee from a popular national coffee chain has up to 310 milligrams of caffeine. A single shot of espresso only has 75 milligrams of caffeine.

But what about mochas, pumpkin spice lattes and other coffee-shop creations? Think twice about those.

“If the drink is described by more than five words, probably not a good idea,” said Dr. Devries, noting that “a lot of these coffee-shop creations are just loaded with extra sugar. In fact, a 16-ounce drink of many of these … can top out at over 400 calories.”

There are definite benefits of drinking decaffeinated coffee, and the data is clear on that, said Dr. Devries. It “supports the idea that it’s not only caffeine that is responsible for the health benefits, but it’s this wide range of polyphenols.”

“Fortunately, the polyphenols in decaf are present almost as concentrated as in fully caffeinated coffee,” he added. “Decaf is still on target for good health benefits.”

It’s important to limit caffeine to less than 200 milligrams a day if pregnant. That means about one to two small cups a day.

But more recent data suggests that even 200 milligrams “may be associated with an increased risk of an adverse outcome in pregnancy,” Dr. Devries said, noting it’s best to switch to decaf during pregnancy, but “patients should seek guidance from their obstetrician.”

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