COMMENTARY

Should You Recommend Coffee Drinking to Your Patients?

Arthur L. Caplan, PhD

Disclosures

October 02, 2017

Hi. I'm Art Caplan, and I'm at the Division of Medical Ethics at the School of Medicine at NYU.

How many of you drink tea? It's a ridiculously horrible beverage. No one should be drinking tea. It's effete. It's obviously a drink that anyone with any sense wouldn't imbibe.

I'm just kidding. It's a joke. My wife drinks tea. I, on the other hand, happen to drink coffee. I love coffee, always have. I'm not a tea drinker.

A recent study published in a very prominent journal, Annals of Internal Medicine, said that coffee drinking seemed to lengthen life.[1] Coffee drinking seems to be good. Patients undoubtedly will ask about this and say, should I start drinking coffee? Should I drink more coffee? Does it matter if I drink coffee with cream in it? I'm assuming the tea drinkers might even take an envious look over in this direction and wonder whether they should drink a little bit more coffee too.

The big study is very interesting. It was studied with a lot of subjects, so it powered up very strongly. Still, I'm a little reluctant to say, in all honesty, that the tea drinkers should abandon their beverage.

Coffee may be something that helps you live longer. I'm going to wait for a few more studies to try and replicate these findings. It seems that every week, somebody says, "Red wine is good for you, asparagus is bad for you, and coffee is going to extend your life."

I think we have to tell patients that there are no real breakthrough studies; there are suggestive studies. They only become breakthroughs when they get replicated. We haven't really had a lot of replication that even I, as a coffee drinker, have to admit, about the information that says this beverage makes you live longer.

Remember too, it's hard to get real solid information, even with large numbers of people, because you're not controlling for lots of variables: how much people exercise, their sleep habits, on and on. There are all kinds of things they're doing differently. Even if you control for age, race/ethnicity, and gender, you're not capturing all of the other differences in lifestyle that might contribute to a longer life.

I'm still going to drink my coffee. Studies make me feel, so far, that there's nothing obviously bad about it. It's probably okay to keep drinking tea as well, I have to confess.

When patients ask, let's tell them there's something suggestive. It's interesting. I'm not sure I would change my habits yet, but pay attention, watch for the confirmation, and stay tuned for more data to come in.

I'm Art Caplan at the Division of Medical Ethics at NYU, and thank you for watching.

Talking Points

Issues to Consider: Can Drinking Coffee Prolong Life?

  • Coffee consumption has been linked to cancer risk or incidence in virtually every tissue type in the body, with the most commonly reported subsites being colorectal, bladder/urinary tract, pancreatic, and female-specific and breast cancers. A total of 352 (27.6%) studies have reported links between coffee consumption and cancer, and these are typically observational. [2]

  • A total of 273 (21.4%) studies have reported links between coffee consumption and cardiovascular disease. These are mainly observational studies, although some evidence from intervention studies is reported, particularly for hyperlipidemias, hypercholesterolemia, and blood pressure.[2]

  • Such studies have reported on several different outcomes or disease endpoints, ranging from mechanistic studies focusing on individual risk factors (or causes of such) to those reporting adverse events, such as myocardial infarction, heart failure, or stroke.[2]

  • High consumption of unfiltered coffee (boiled or espresso) has been associated with mild elevations in cholesterol levels. Some studies found that two or more cups of coffee a day can increase the risk for heart disease in people with a specific, and fairly common, genetic mutation that slows the breakdown of caffeine in the body. Therefore, how quickly you metabolize coffee may affect your health risk.[3]

  • A study by the Harvard T.H. Chan School of Public Health found that people who drink about three to five cups of coffee a day may be less likely to die prematurely of some illnesses than those who don't drink coffee or drink less coffee. People who drank both caffeinated and decaffeinated coffee had benefits, including a lower risk for death from cardiovascular disease, neurologic diseases, type 2 diabetes, and suicide.[4]

  • In the study cited above, the researchers analyzed health data from participants in three large ongoing studies: 74,890 women in the Nurses' Health Study, 93,054 women in the Nurses' Health Study 2, and 40,557 men in the Health Professionals Follow-up Study. Coffee drinking was assessed using validated food questionnaires every 4 years over about 30 years. During the study period, 19,524 women and 12,432 men died of a range of causes.[4]

  • In the whole study population, moderate coffee consumption was associated with reduced risk for death from cardiovascular disease; diabetes; neurologic diseases, such as Parkinson disease; and suicide. Coffee consumption was not associated with cancer deaths. The analyses took into consideration potential confounding factors, such as smoking, body mass index, physical activity, alcohol consumption, and other dietary factors.[4]

  • In a letter to the editor of Circulation regarding the Harvard Chan study, the authors raised concern that coffee consumption has been reported to have a hypercholesterolemic effect, leading to adverse cardiovascular outcomes. Cafestol and kahweol occur naturally in coffee beans and have been identified as hypercholesterolemic compounds.[5]

  • The authors of the letter to the editor of Circulation also noted that effects of coffee on serum lipoprotein concentrations are largely dependent on the method of its preparation. For example, cafestol and kahweol are not present in regular coffee made with drip coffee makers because they are largely trapped by the use of a paper filter. Espresso, which is made with high-pressure hot water through a column of coffee in a percolator, has a different composition.[5]

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