THE SKINNY ON A CUP OF JOE

I’d just left my office for lunch, my last patient being a large man who’d come in for a follow-up visit and not very happy to have had to give up his daily habit of four (inhaled) cigars and four cups of Luzianne chicory coffee.  He’d recently had a three-way coronary artery bypass but it was the bright red blood in the urine that was the real motivator for him making the change.  He reminded me of a taxidermist I once saw who during his work day drank 10-12 mugs of chicory coffee and presented with bloody urine.  I told him I thought it was due to all the chicory.  He never came back.

Anyway, I was driving, thinking about the gentleman as I approached and stopped at the red light.  Looking across the street, I saw a young lady walking out of Starbucks holding what looked like a half-gallon container of coffee.
 
I wondered how much caffeine might be in that container or “cup” the size of which I learned later was 31 oz., which actually turns out to be a quart of coffee.  And whether she too might be on her way to a bloody-urine perdition.  Forget the cup.  We’ve got a quart today.  Does she drink this every morning or is this her “coffee day”?  Was this much coffee good?  How much caffeine is good?   

I later came across an update on these answers in a synopsis of the recent 15th Annual Cardiovascular Disease Comprehensive Symposium in Miami.

People drink coffee for the taste, but they probably drink it more for the effects.  Coffee is well-known to increase alertness, wakefulness, and produce feelings of energy.  It increases the ability to concentrate and focus attention while decreasing fatigue.  Coffee enhances physical motor skills, cognitive performance, and short-term memory (maybe helpful to NFL players).  It increases ability to problem-solve, reason, and make correct decisions (helpful to Supreme Court judges and Congressmen).  It increases the availability of energy and expenditure of energy during physical activity (helpful to stay-at-home Moms).

The new guidelines on coffee consumption, a healthy beverage, says that consumption should be limited to a caffeine intake of 400 mg/day (that’s 3-5 8 oz. cups/day or less than 200 mg/day if you’re pregnant).  Coffee DOES NOT increase the risk for premature death, cardiovascular disease, or chronic diseases.

What are its benefits?  Studies show coffee is of benefit in chronic disease like heart disease and type 2 diabetes, multiple sclerosis, Parkinson disease, melanoma, liver disease, Alzheimer disease, and depression.  A large prospective study found that drinking more than 6 cups coffee per day reduced mortality by 10% in men and 15% in women.  The Starbuck’s lady with her one quart of coffee has reduced her chance of dying by 15% (depending on what she puts in it).  And assuming she drinks it daily.  (Seems like a lot.)

Its effects on cholesterol: If you’ve heard or worried that it makes your cholesterol go up, then you are correct if you’re drinking it unfiltered (French press).  Drink it filtered and it won’t affect your cholesterol levels.

Its effects on blood pressure: 200-300 mg caffeine per day increases blood pressure for up to 3 hours after consumption.  But the increase diminishes after 2 weeks if you drink it regularly.

But before you start drinking cup after cup during the day one must be aware of the amount of caffeine consumed on a daily basis.  There’s 95 - 112 mg caffeine in one cup of Folgers or Maxwell House black coffee.  So four cups and you’re at your daily maximum allowable caffeine intake.  But if you get your coffee out and about then you will encounter variable levels of caffeine.  A researcher went around and measured the amount of caffeine in coffee drinks of same size in different shops and found the amount of caffeine varied greatly.  In fact, at the same Starbucks the caffeine varied from 250 to 564 mg for the same size of cup at the same Starbucks on different days.

And so the coffee itself is not so much a problem as what is added to it.  Sugar added is not good.    Flavored creamers are popular but are loaded with calories, sugar, artificial ingredients, and hydrogenated oils.  Non-dairy creamers contain similar components.  Sugar substitutes can increase one’s risk for metabolic syndrome, renal insufficiency, and disrupted blood-glucose metabolism.  The less of these added to your coffee the better.  If you’re going to make the change know that it takes 2 weeks for taste buds to change and acclimate. 

So enjoy your coffee, don’t overdo it, and watch what you add to it.