February 11, 2007

What Is The Best and Healthiest Coffee To Drink?

A short digression on my fourth favorite subject.

Does coffee raise blood pressure?  Does coffee elevate cholesterol?  Does coffee hurt your liver?  Does coffee taste delicious?

At the outset, you need to know that not all coffee preparations are the same.   The diterpenes cafestol and kahweol are the alleged cuplrits in the negative effects of coffee, especially raising cholesterol and increasing risk of coronoary artery disease.  However, these are lipid soluble and are almost entirely filtered out by paper filters. Mix coffee grounds and water in a pot, and boil.  Pour off the cofffee into a glass.  Drink.  Now look at the glass.  That oily residue is-- well, oily residue.  You don't get that with a filter.

For example, here is the breakdown of lipids in coffee: filtered coffee: 7mg/cup.  Boiled and  unfiltered (Turkish): 60-160mg/cup.  Metal screener (french press): 50mg/cup.  The types of lipids in each were the same (no selectivity in lipid filtration.)   So how you make your coffee matters.

Blood pressure: as long as you're a regular drinker, don't worry.

Reports of coffee elevating blood pressure are misleading, because they aren't done they way we drink coffee: daily.  Going from nothing to a triple espresso raises blood pressure; but chronic coffee drinking eventually allows for normalized blood pressure.

For example, the much repeated finding "unfiltered boiled coffee causes a significant elevation in blood pressure, especially in women" is misleading:  the study actually found that if you switch exclusively to boiled unfltered coffee from filtered coffe, your systolic blood pressure rises about 4mm Hg.  However, switching from filtered coffee to abstinence did not have any effect on blood pressure or heart rate.  Another study found a trivial change in blood pressure (-3.4mm Hg) after two months of abstinence (afgter 5 cups/d.)

Interestingly, a metaanalysis of 16 studies found that chronic caffeine (400mg/d) raised systolic blood pressure by 4 mm Hg. while 5 cups coffee/d (>500mg caffeine ) only raised it 1.2mm Hg.)  This was corroborated by another study finding >5 cups lead to 1.35mm Hg increase.

 

Cholesterol: raised slightly by unfiltered coffee, and possibly with filtered. 

Initial reports had found that drinking unfiltered coffee was associated with higher triglycerides and cholesterol levels than filtered coffee, because the filter removed almost all (80%) of the causative substance.  Another study found unfiltered caused higher cholesterol (but not TG) than filtered; filtered coffee had no effect on lipids over no coffee at all.

These findings were slightly contradicted in a recent study: Abstaining after 4 cups/d reduced cholesterol by about 12mg/dl.  Drinking filtered coffee raised cholesterol by about 11 mg/dL.  For perspective, 4 cups/d of whole milk would raise cholesterol by about 14mg/dL.

The question t ask here would be, how good was the paper filter? 

Coronary/heart disease: no. 

Retrospective analyses find that >4 cups/d, but not <2/d, had almost double the risk of coronary disease;  however, prospective studies found no increased risk.

A review identified possible explanations for an increased risk of heart disease in coffee drinkers  including a genetic predisposition to slower caffeine metabolism in some people, and the presence of diterpenes (which raise cholesterol) in unfiltered coffee .  However, the same review found several studies indicating a protective effect of moderate coffee drinking, which they conclude is related to the  antioxidants.

One study found heart attacks more frequent in coffee drinking women than abstainers: but was only usefully relevant at <7 cups/d, which doubled the heart attack risk.   However, a gigantic 85000 middle aged women prospective 10 year study found no effect of 6 or more cups coffee/d on coronary heart disease. 

For what it's worth, unfiltered coffee seems to be associated with higher rates of heart attacks than filtered. 

But it pays to wait: a week after I initially posted this, an 8 year  prospective study in the elderly found a dose dependent (i.e. greatest >4 servings) protective effect of caffeine in cardivascular mortality (reduced by 50%) (but, oddly, no effect on cerebrovascular mortality).  Importantly, these were normotensive individuals.

 

Suicide: Opposite of smoking: drink up.

Gigantic 10 year prospective study of 86626 female middle aged nurses:  suicide rate was reduced by 60-70% in those who drank more than 3 coffees/d, all other factors controlled.

A Finnish study of 43000 people over 14 years-- 216 suicides-- found that 2-5 cups/d moderately (30%) reduces suicide risk, while >8cups increases risk 1.5 times.  (For reference: "heavy drinking" (weirdly: 2 drinks/d) or smoking had about the same risk.)

A 1993 study looking at death from any cause found a reduction in suicide risk (RR 0.87 per cup) with increasing coffee. 

Liver cancer and cirrhosis: can't hurt, may help, especially if you're an alcoholic. 

The same 1993 study above also found a lower risk of cirrhosis (RR 0.77/cup).  The same authors, in a more recent study, again find such a reduction in risk, and find lower levels of liver enzymes ALT and AST. An Italian study found coffee reduced the risk of hepatocellular carcinoma from any cause (Hep B, C, alcohol, etc); same in the Japanese, and in the Japanese in a prosepctive trial.  And in Americans chronic liver disease rates were half in 2 cups/d drinkers.

Recent evidence suggests that this may be partly due to caffeine, but also to phenolic acid antioxidants which are not present in tea.  The authors cite reports of such ingredients' protective effect sagainst various forms of liver damage (including Tylenol.)  

So if you're going to drink coffee, there are two prudent things to do.  1) drink filtered coffee, made with a good filter.  2) drink medium roast, not dark roast.  The roasting process burns off volatile chemicals such as caffeine and the antioxidants. 

For this reason, my vote for best, healthiest, and most delicious coffee to drink is Dunkin' Donuts.


 








Comments

Very interesting.M... (Below threshold)

February 12, 2007 11:21 AM | Posted by AK: | Reply

Very interesting.

My mother made our morning coffee using a Swedish method. She'd bring the water and coffee to a boil, then turn off the flame and threw in 2 or 3 crushed egg shells and added (?) about a quarter cup of a raw egg and water solution.

The egg proteins coagulated with the fine particulate matter and the coffee grounds, leaving clear strong coffee in the pot.

It would be interesting to find out if the egg proteins reduced the lipid content of the coffee or not.

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Mmmm...coffee...... (Below threshold)

February 12, 2007 1:16 PM | Posted by Anonymous: | Reply

Mmmm...coffee...

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is this just a shameless pl... (Below threshold)

February 12, 2007 1:49 PM | Posted by anonymous: | Reply

is this just a shameless plug to try to get sponsorship from Dunkin Donuts?

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What about expresso? How do... (Below threshold)

February 12, 2007 2:55 PM | Posted by Anonymous: | Reply

What about expresso? How do you filter that?

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Thank you for the article, ... (Below threshold)

February 12, 2007 5:47 PM | Posted by Coffee loving software guy: | Reply

Thank you for the article, doc! I shall switch to filtered coffee.

How can i find out the type of "roast" (medium roast vs. dark roast)?

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Thank you for the article, ... (Below threshold)

February 12, 2007 6:02 PM | Posted by Coffee loving software guy: | Reply

Thank you for the article, doc! I shall switch to filtered coffee.

How can i find out the type of "roast" (medium roast vs. dark roast)?

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I'm known to every Dunkin D... (Below threshold)

February 13, 2007 8:31 PM | Posted by ClinkShrink: | Reply

I'm known to every Dunkin Donuts franchise between my home and work. Doesn't everyone start the day with 32 ounces of hazelnut?

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Fun facts:Espresso... (Below threshold)

February 14, 2007 12:13 AM | Posted by Admin: | Reply

Fun facts:

Espresso is not filtered, so you're on your own. However, it is less coffee, so not as bad as, say Turkish. Also less caffeine than a regular cup (80mg vs. 120mg) because of the volume (1-2 oz vs. 8-10 oz.)

The roast description is on the packaging; importantly, it is not related to the bean, necessarily. For example, there is dark roast espresso and medium roast espresso.

The Swedish/scandanavian method is fascinating, I had not heard it before, I will investigate. My initial suspicion is it has more to do with the shells (calcium) than the egg. But I will research.

Americans got into coffee after the Boston Tea Party-- tea was taxed, so onto coffee we went. A similar thing happened to Americans with rum/whisky.

Robusta=cheaper/bitter, more caffeine than arabacia; but more espressos are made from quality robustas.

Maxwell House's "Good To the Last Drop" was originally said by Teddy Roosevelt, as he sipped coffee in the Maxwell House (a hotel).

There is no Mormon/CLDS prohibition on caffeine. Not sure where that came from.

I am semi-joking about DD coffee, it is no more healthy than any other filtered coffee, but I do like it best. But, for what it's worth, DD is going to take over the world. It is currently owned by the Carlyle Group.

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I found a another version o... (Below threshold)

February 15, 2007 11:06 PM | Posted by AK: | Reply

I found a another version of the swedish method in The Settlement Cookbook, 1947 edition.

There, it is referred to as 'Egg Coffee' and you stir in the egg and water mixture. No crushed eggshells.

This may just be a version of what has been called Navy coffee or Cowboy coffee--open kettle methods

There's a discussion of coffee and hot chocolate given in Brillat-Saverin's 1825 book, entitled 'The Physiology of Taste'.

Brillat-Savarin preferred drinking chocolate to coffee. He could not take coffee without suffering severe insomnia.

When he offered his friends a taste test, they preferred coffee pounded in a mortar, Turkish style, but prepared by an early form of the filtration method-the filter unit was made from silver.

Brillat-Saverin was a French judge who survived the Revolution, then kept his office during Napoleon, the 100 Days, and the Bourbon Restoration. He was fascinated by people, interested in medicine (he gives two chapters on how to lose weight and how to gain weight--back then, being skinny was considered ugly).

He describes how a young girl he knew feared that she was getting fat (her friends teased her). She dulled her appetite by drinking vinegar and her debilitation triggered a latent case of TB, which resulted in her early death. This happened in the 1770s, yet it sounds eerily modern.

The authors advice on how to lose weight is also modern and eminently practical. He advised exercise, and a prudent version of a nutritious, relatively high protein, low carbohydrate diet, and gives constructive advice on how to pick and choose when one is at a banquet.

He also describes how very difficult it is for people to make these lifestyle changes. Every health care provider will give a wry smile and sigh in commiseration when reading those chapters.

This man would have made an excellent physician. He had excellent powers of observation, had a warm heart, and was highly adaptable. (He spent time in the United States as a refugee, giving French lessons and playing violin in a theatre orchestra--and gives a take on what it was like to be in a new nation.)

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I drink, on average, a pot ... (Below threshold)

February 17, 2007 6:45 AM | Posted by Anonymous: | Reply

I drink, on average, a pot (10 cups) of coffee a day. My blood pressure continues to run low. I'm pleased to learn I have some damn good filters.

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Going from nothing to a ... (Below threshold)

February 17, 2007 11:37 PM | Posted by Holly: | Reply

Going from nothing to a triple espresso raises blood pressure; but chronic coffee drinking eventually allows for normalized blood pressure.

Good thing for me! I would be completely useless to the world if I dont have at least two cups everyday, and apparently I'm not the only one. My only real complaint is having to worry about my teeth turning yellow. :(

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If I use the Illy E.S.E. po... (Below threshold)

July 24, 2007 10:04 PM | Posted by Jeff Carpenter: | Reply

If I use the Illy E.S.E. pods to make my espresso, I am effectively getting filtered espresso through the paper pods? I love the espresso pods for their convenience so perhaps this is another reason to love them.

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I have read the article on ... (Below threshold)

September 18, 2007 11:16 AM | Posted by Jessica: | Reply

I have read the article on Ritalin and this article on coffee. Recently I have been prescribed Ritalin for excessive daytime sleepiness, which doesn't quite help. I am still very tired all day no matter how many hours I sleep, though I don't just pass out at my desk randomly as often. Some people have suggested I drink coffee to keep me up, but honestly (and I am sure many of you may think I am crazy) I really hate the taste of coffee. The only kind I have liked were macchiati when I was in Italy (American style is not quite so good) and Indian coffee (which is essentially just Nescafe mix). And I don't like the addictive properties of coffee. I had some concerns about the health risks of ingesting so much caffeine, but apparently there is not much of a risk. Sure I can focus better with the Ritalin, but I am so tired that I would rather just focus on keeping my eyes closed...not so good at work or while driving. Any suggestions on what I should try to stay awake and feel refreshed? Help with an explanation on how I should feel when taking Ritalin or drinking coffee?

Alone's response: Shot in the dark. Ritalin is fairly short acting. Chronic coffee (and Ritalin) makes you overall more tired. Your body accommodates to the increased energy of the stimulant while it's on board, but then misses it when it's gone. So you feel more tired. Read the post called "Worse Than the Flu" http://thelastpsychiatrist.com/2007/04/worse_than_the_flu.html

The symptom that clued me in was tiredness. the solution would be either less Ritalin, or longer acting form (Concerta) or splitting up the dose throughout the day. P.S. acidic beverages lower Ritalin levels.

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I have a question about tho... (Below threshold)

August 19, 2008 8:20 PM | Posted by joe: | Reply

I have a question about those permanent metal filters for drip coffee makers...is it the same thing as unfiltered then?

Alone's response: nearly yes. The paper filter holds the lipids, the holes in the metal filters are too big to retain them (though it does retain some.) Just use a paper filter. The best method seems to be to put coffee in a paper filter, then boil water separately in a pot and pour it over the grounds yourself.

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hi... (Below threshold)

November 12, 2008 6:26 PM | Posted by Anonymous: | Reply

hi

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The ubiquity of caffeine's ... (Below threshold)

April 15, 2009 1:03 PM | Posted by Anonymous: | Reply

The ubiquity of caffeine's biochemical effects on the body is both the reason scientists are constantly paranoid about coffee and also why it constantly seems to be either neutral or healthy for you.

cAMP is such a pervasive and likely ancient metabolic pathway that anything bad is equally compensated by something good.

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What are the effects of cof... (Below threshold)

October 1, 2009 1:31 PM | Posted by Anonymous: | Reply

What are the effects of coffee, in terms of Bipolar Disorder, Anxiety, Insomnia, Psychosis, etc.

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Dunkin Donuts Coffee is th... (Below threshold)

October 25, 2009 3:18 PM | Posted by LP: | Reply

Dunkin Donuts Coffee is the worst tasting coffee in the western hemisphere!

It's actually the reason why a lot of Canadians and Europeans make fun of American "Coffee" because it bears almost no resemblance to coffee found in the rest of the world.

Surely you kidding?

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If you are still struggling... (Below threshold)

March 2, 2010 5:19 AM | Posted, in reply to Jessica's comment, by Paige: | Reply

If you are still struggling with chronic fatigue, you should, first and foremost FIND ANOTHER DOCTOR! And do a little research of your own in regards to finding the source of your problem. Taking a medication like Ritalin for the rest of your life as a cure for fatigue is ridiculous. FIND THE SOURCE of the problem, don't just try to treat the symtoms.

In my case, I'd spent most of my life fighting the urge to sleep anywhere and everywhere. Beginning in early grammar school, it was a regular problem into my mid twenties. Over several years I'd had my thyroid tested many times and it was only after the 7th time that I was diagnosed with a thyroid disorder. I now take a tiny hormone pill daily and the fatigue, as well as a slew of other symptoms Ive suffered with since childhood, are about 85% better. And trust me, that's saying A LOT! I can't imagine if I had settled with taking meds to treat each of my symptoms! Do yourself a favor and find the source of your symptoms! Hope this info helps you and others :-)

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Science studies on coffee... (Below threshold)

June 16, 2010 3:59 PM | Posted by Harry Horton: | Reply

Science studies on coffee and its beneficial effects for diabetes prevention: "New Evidence that Drinking Coffee may reduce risk of Diabetes." Science Daily. June 2010 article from Science Daily. Excerpts: "Caffeine may be the ingredient highly responsible for this effect." End quote. Therapeutic effect of T2D prevention effect, is the effect referred to in this previous quote. Further excerpts from the article on results from Japaneese researchers.: "Caffeine also caused a cascade of other beneficial changes in fatty liver and inflammatory adipocytokines realted to reduced diabetes risk." end quote. Earlier quote: "prevented devlopment of high blood sugar improved insulin sensitivity." End quote. Article (2) "Role of Vitamin D and Calcium in Type 2 Diabetes. A systematic Review and Meta Analysis." Anastassios Pittas et al. Journal of Clinical ENdocrinology and Metabolism Vol 92 No. 6 2017-2019. (June 2007 edition). THe study found information that vitamin D and calcium vitamin supplementaion could very well prevent diabetes II development. And the two vitamins noramlize glycemia. Vitamin D and calcium meatbolism has major role in normalizing glucose metabolism and maintaining insulin sensitivity. Article (3): "Does Coffee Consumption Reduce the Risk of Type 2 Diabetes in Individuals with Impaired Glucose?" Diabetes Care,Bessa Smith et al. Quote excerpt: "This study confirms a striking protective effect of caffeinated coffee against diabetes and extends these findings to incident diabetes based on OGTT independent of multiple plausible cofounders." End quote.

Thoughts on the above three articles. The June 2010 Science Daily article related caffeine as the beneficial agent for diabetes ii prevention. One reason for this could be the fact that caffeine ahs always had a detrimental and deleterious effect on calcium metabolism. Calcium for strong bones and teeth, the saying goes when one drinks milk with enriched with vitmain D and calcium. Interestingly the adverse effect caffeine has on vitamin D and calcium ironcially in turn could have a strengthening and forifying effect on the vitamin D and calcium metabolism. And this strenghtening effect could be potent enought for preventing diabetes II. Thats only a theory but could be in the range of possibilities of being a true scientific fact. Like straining muscles in atheletic conditioning to gain eventual strength, one example to look at the coffee issue.

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