Coffee – Pleasure and Pain
John McDougall, MD
www.drmcdougall.com
Quitting Is Better Than a Lifetime of Medications or
Worse
Of the world’s population, 80% consumes caffeinated
beverages – Coffee is the most widely consumed of all these stimulating
drinks. The user is seeking enhancements in mood, mental performance, and
physical activity. (Starbucks’ popularity can be directly tied to the
potency of their brew – 550 mg of caffeine per Coffee Grande.) Within
minutes of that first morning cup, people become keener, more alert, and
wide awake. Not only is the mind awakened but so are the bowels – a cup of
coffee starts the day right with a vigorous elimination. For some people,
coffee serves as a weight loss aid by suppressing appetite and increasing
metabolism (burning calories). If not for the side effects, this might be
the ideal legal, mind-altering, drug. But, as with all drugs, there are
prices to be paid.
Raise Your Cholesterol by 10%
Coffee contains several hundred different substances (in
addition to well-known caffeine) and many of these have powerful
pharmacological effects on the human body. Two cholesterol-raising
substances – cafestol and kahweol – are found in coffee beans. Not only do
they raise total cholesterol, but also “bad” LDL-cholesterol and
triglycerides, too.1 On average, cholesterol is increased by 10%; but very
potent boiled coffee can raise total cholesterol by as much as 23% (that
could mean a 50 mg/dl increase for someone starting with an average
cholesterol of 210 mg/dl). Triglycerides may be increased by a similar
amount.
The overall effect of elevated cholesterol could be a
higher risk of heart attacks and strokes. Heavy consumption – greater than
4 to 9 cups of regular coffee a day – does appear to actually translate
into an increased risk of heart attacks. In relevant numbers, a 10%
increase in cholesterol could boost your risk of death from heart disease
by 20% to 30%. Considering, that cholesterol-lowering medications (statins)
accomplish about a 10% reduction in cholesterol; you may decide to stop
this daily drink, rather than start daily drugs.
Fortunately, these substances lose their potency when
poured through a paper filter. Most coffeemakers in use today drip water
through coffee grounds held by a filter. The paper effectively traps the
cafestol and kahweol; and as a result, a person’s cholesterol and
triglyceride levels are little affected by this filtered beverage. Instant
coffee is almost devoid of cafestol and kahweol, and would also be a good
choice for someone only concerned about the cholesterol-raising effects of
coffee.
Decaffeination does not reduce the levels of cafestol
and kahweol; you can expect similar raises (10%) in your cholesterol and
triglycerides with decaf coffee, just as you would with unfiltered regular
coffee. But switching to decaf can be expected to reduce nervousness and
insomnia from the caffeine.
You may be able to negate the cholesterol-raising
effects of coffee with a paper filter, but not the other heart disease-
and stroke-producing consequences of this beverage, such as an elevation
in blood pressure.
Raises Blood Pressure
Coffee causes the blood vessels to constrict and the
heart to beat stronger, resulting in an elevated blood pressure for most
people. Within minutes of drinking this concoction of invigorating
chemicals, the systolic blood pressure (top number) can rise 5 to 15 mmHg
and the diastolic (bottom number), 5 to 10 mmHg.2 One 5-ounce (150 ml) cup
of regular coffee contains 150 mg of caffeine – a substance known to raise
blood pressure. However, decaffeinated coffee also increases blood
pressure; therefore, ingredients found in the coffee bean other than
caffeine also have pressure-raising effects.3
The first sips of coffee cause the greatest amount of
stimulation. As more is consumed though out the day (past the second cup)
the elevations in blood pressure from subsequent cups are less than those
caused by the initial doses.2 After an overnight abstinence the
sensitivity to that initial morning cup of coffee is fully restored.
Contrary to popular belief, with continued use (habitual coffee drinkers)
people do not become tolerant (develop immunity) to these blood pressure
raising effects.2
The overall effect of coffee consumption for an average
population (i.e., people in the USA) is about 2 to 4 mmHg elevation of
blood pressure. Lowering blood pressure by 2 to 3 mmHg by using commonly
prescribed medications is believed to produce a lifesaving benefit. For
example, a 2 mmHg reduction in systolic blood pressure would translate
into a 7% decrease in heart disease and 10% decrease in strokes (according
to some research). This could be interpreted to mean population-wide
cessation of the use of coffee would lead to a decrease in premature death
from heart attacks by 14% and strokes by 20%.2
Burns Your Stomach
Coffee is upsetting to the stomach. Every serious coffee
drinker keeps a bottle of Tums handy. Both regular and decaffeinated
coffees cause indigestion by reducing the function of the lower esophageal
sphincter – a valve that prevents the stomach acid from refluxing up into
and burning the esophagus.4-6 Regular coffee and decaffeinated coffee both
stimulate acid production in the stomach by similar amounts.7-8 Therefore,
caffeine is not the cause of either of these effects – other substances in
the coffee are creating the heartburn and reflux. Therefore, for relief,
coffee drinkers must switch beverages to something like herbal tea or
water. Fortunately, even though there is considerably more indigestion
among coffee drinkers, there is no increase in the risk of stomach or
duodenal ulcers.9
Other Reasons to Quit
Irregular heart beats (arrhythmias), nervous tremor,
headaches, anxiety, teeth-grinding, jaw-clenching, insomnia, frequent
urination, elevated eye pressure (glaucoma), diarrhea, osteoporosis and
periodontal diseases may be other reasons to add to your list for
quitting. When the fear of future health problems, like heart attacks, and
the suffering from anxiety, indigestion, and the urge to urinate every few
minutes becomes sufficiently troubling, you then may decide life would be
better without this upsetting drug.
How to Quit
Coffee consumption causes physical dependence – you are
addicted – making quitting difficult and painful. Headaches, fatigue,
depression, and sleepiness can be expected when use is suddenly stopped.
Withdrawal symptoms begin within 12 to 16 hours and peak at 24 to 48
hours. This process may last as long as one week.
There are two ways to quit; first and best is to simply
stop the coffee and suffer the withdrawal. Some of the symptoms, such as
the headache, can be effectively relieved with common analgesics, such as
aspirin or Tylenol. There are also immediate rewards, such as almost
overnight relief of the indigestion and urinary frequency, which should
keep you motivated.
A less painful way to quit coffee is by substitution
with another source of caffeine, such as black or green tea. Teas have
fewer side effects (and maybe a few health benefits from their
antioxidants and other phytochemicals), but they still offer a lift in the
morning. (There is some evidence that caffeinated teas can also raise
blood pressure, but not cholesterol.10) Then, over time, you can reduce
the dosage of caffeine by making your beverage weaker – eventually
switching to a non-caffeinated, herbal tea. You’ll be glad you did.
Here is one more example of how powerful you can be over
your present state of health and well-being, and in control of your
destiny by being informed and acting on this cost-free information.
References:
1) Urgert R, Katan MB. The cholesterol-raising factor from coffee
beans. Annu Rev Nutr. 1997;17:305-24.
2) James JE. . Critical review of dietary caffeine and blood pressure:
a relationship that should be taken more seriously. Psychosom Med. 2004
Jan-Feb;66(1):63-71.
3) Corti R, Binggeli C, Sudano I, Spieker L, Hanseler E, Ruschitzka F,
Chaplin WF, Luscher TF, Noll G. Coffee acutely increases sympathetic nerve
activity and blood pressure independently of caffeine content: role of
habitual versus nonhabitual drinking. Circulation. 2002 Dec
3;106(23):2935-40.
4) Van Deventer G. Lower esophageal sphincter pressure, acid secretion,
and blood gastrin after coffee consumption. Dig Dis Sci. 1992
Apr;37(4):558-69.
5) Wendl B. Effect of decaffeination of coffee or tea on gastro-oesophageal
reflux. Aliment Pharmacol Ther 1994 Jun;8(3):283-7.
6) Pehl C. The effect of decaffeination of coffee on gastro-oesophageal
reflux in patients with reflux disease. Aliment Pharmacol Ther. 1997
Jun;11(3):483-6.
7) Cohen S. Gastric acid secretion and lower-esophageal-sphincter
pressure in response to coffee and caffeine. N Engl J Med. 1975 Oct
30;293(18):897-9.
8) Cohen S. Pathogenesis of coffee-induced gastrointestinal symptoms.
N Engl J Med. 1980 Jul 17;303(3):122-4.
9) Elta GH Comparison of coffee intake and coffee-induced symptoms in
patients with duodenal ulcer, nonulcer dyspepsia, and normal controls. Am
J Gastroenterol. 1990 Oct;85(10):1339-42.
10) Quinlan PT, Lane J, Moore KL, Aspen J, Rycroft JA, O'Brien DC. The
acute physiological and mood effects of tea and coffee: the role of
caffeine level. Pharmacol Biochem Behav. 2000 May;66(1):19-28.
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