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No one can understand the truth until he drinks of coffee’s frothy goodness.
—SHEIK ANSARI DJEZERI HANBALL ABD-AL-KADIR
IN BRIEF: The notion that coffee is unhealthy appears to be a myth. Moderate coffee drinking, up to three to five cups a day, can lower the chances of death from all causes, helps with a variety of specific ailments, and can increase quality of life. Try to sometimes stop using sugar and lots of cream in your coffee. Fresh-roasted, well-made coffee has rich flavors that cream and sugar may obscure.
A nomad named Kaldi was roaming the mountains of Ethiopia with his herd of goats, at a date and time lost to antiquity, when he made a discovery that would change the world forever: coffee.
Or rather, his goats did. According to legend, his goats began to munch on the bright red cherries growing on the mountainside. When they ate these cherries they became energetic and did something utterly un-goat-like—they began to dance. Those bright red cherries are the berries that now fuel the multibillion-dollar coffee industry.
Whether Kaldi’s story is true or not, by around the tenth century BC, the mountain people of Ethiopia were eating these cherries for their stimulating effect. The process of extracting the cherry’s immense flavors by drying, husking, and roasting the seeds to make a drink spread throughout the Arab world through Muslim Sufi mystics, who used coffee as an aid to concentrate as they chanted the name of God.
Today coffee is one of the world’s most traded commodities, with millions of cups consumed each day in the United States. And although “coffee will stunt your growth” is a refrain we’ve all heard over and over again, there’s about as much truth to it as there is flavor in most gas-station coffee. And that’s just one of the many negative misconceptions surrounding this falsely convicted “guilty” pleasure. A series of studies from the 1970s and ’80s tied the drink to higher rates of cancer and heart disease, but they failed to adjust for a participant’s cigarette habit or other unhealthy lifestyle choices. Not only does new research show coffee does not affect your growth, it also suggests that not drinking coffee just might stunt your health.
Beyond any other food, beverage, or lifestyle choice featured in this book, coffee is probably the least deserving of its reputation as a vice. Despite the fact that it is frequently blacklisted as a drink you should avoid or at least limit, a slew of studies have reported that moderate coffee drinking—three to five cups a day—could increase cardiovascular health and lower the risk of stroke and developing Parkinson’s disease, Alzheimer’s, and type 2 diabetes, as well as reduce the chance of death from all causes. Coffee has been linked to so many health benefits that coffee lovers should be dancing with the joy of Kaldi’s goats.
In a paper published by the American Heart Association in 2014, researchers conducted a systematic review of thirty-six studies with a combined sample size of more than 1,270,000 participants that looked at long-term consumption of coffee and its association with the risk of cardiovascular disease. These researchers found moderate coffee drinkers were at the lowest risk for problems.1 Previous studies found similar results and suggested coffee also decreases the likelihood of a stroke.2 Even excessive coffee guzzling (often defined as more than five cups a day) has been shown to have little or no adverse health side effects.3
Imagine if coffee were a new drug developed for a pharmaceutical company. Not only would it make billions, but also the advertising campaign associated with it might be big enough to move the Cialis and Viagra commercials out of prime time. After all, coffee has very few proven side effects and people love it.
So why does it have such a bad reputation?
The answer might be that coffee keeps some pretty unsavory company, most notably sugar. When we talk about the benefits of coffee, we can’t stress enough that we’re talking about straight black coffee, which generally has no calories, not the milk-shake-with-some-coffee-added beverages many people choose. Popular sugary coffee drinks at some major chains can have more than 400 calories. Even if we avoid the super-sugary drinks, coffee can pack something of a caloric wallop. An average-size coffee with cream and sugar has about 120 calories, while an average cappuccino has more than 100 calories.
In addition to its unhealthy stir-in ingredients, coffee often is paired with equally unhealthy practices and can serve as an enabler for bad habits like staying up too late or cramming for work or school. We turn to coffee to limit the effect of hangovers and to help us stay awake longer or get up earlier than we should.
The “magic” ingredient within coffee beans is caffeine, one of the world’s most consumed drugs. Caffeine interferes with the way the chemical adenosine works in our bodies. In normal conditions, adenosine acts as a central nervous system depressant, promoting sleep and suppressing arousal by slowing down nerve activity. But when caffeine is absorbed into our blood, nerve cell adenosine receptors mistake caffeine for adenosine, binding to it instead of adenosine. This gives us that wonderful “coffee high” and helps fuel the beverage’s benefits as a powerful antioxidant, a low-calorie natural brain stimulant, and a limiter of hyperglycemia. But if we abuse the drink, this delightful jolt of energy can backfire on us, causing anxiety and stress and temporarily raising blood pressure, all of which can be detrimental to our overall health.
All these negative secondary effects are easy to rectify. You can avoid sugar and high calories by drinking your coffee black. Few things on earth taste worse than poor-quality black coffee, but coffee aficionados often prefer black coffee because high-quality, consciously harvested Arabica coffee has rich, sweet flavors that are distinctly different depending on the region of the globe where the beans were grown. These flavors are almost entirely obscured by milk and sugar. All that being said, adding a little milk or cream still doesn’t negate coffee’s potential health benefits. For some people, adding a little cream to darker-roasted coffee can be a delightful treat. And a well-made cappuccino is truly a heavenly elixir.
You can also avoid making coffee a crutch for poor lifestyle choices by not treating it like a daily injection of energy. Although coffee is powered by the drug-like substance caffeine, it shouldn’t be consumed like an injected stimulant to jolt you awake first thing in the morning; instead, make it a high-quality delicious ritual that you enjoy and look forward to experiencing. Think of coffee’s ancient history and steep your drinking of the beverage in ritual. Coffeehouses have traditionally been spots where artists and scientists would meet to exchange ideas, and you should use the jolt of energy the drink affords to stimulate your intellect and creative side, not just to get through the day and manage stress. Take a few minutes with a newspaper or a good book with your morning coffee, or meet up with a friend or coworker.
In addition to coffee, black, white, and green teas have many well-known and accepted health benefits, and we and our patients drink tea often. We haven’t devoted a chapter to it because, well, other than at the Boston Tea Party, tea isn’t really considered a vice. Besides, since the American Revolution, coffee has been the American drink of choice. After all, it was coffee, not tea, that the settlers often took instead of more food on their wagon trains for the perilous journey west. Still, as mentioned, tea can be a very healthy drink. The average cup contains about a third of the caffeine of coffee and its methylxanthine theophylline has been used for decades as a bronchodilator and a treatment for asthma. So vice or not, go ahead and enjoy tea along with or instead of coffee.
Potentially more troubling to the health conscious are the coffee-like stains on the reputation of the beverage itself. But, as mentioned earlier, those studies from the 1970s and ’80s associating the drink with higher rates of cancer and heart disease had significant issues with their methodology, and those results have not been reproduced in decades. In fact, more recent, larger studies have suggested the opposite is true. One study saw a link between coffee and an overall decrease in cancer,4 and several recent meta-studies have found that drinking coffee was associated with a significantly reduced chance of death from all causes.5
In addition, some studies are equivocal if not downright perplexing. Data collected from the Singapore Chinese Health Study, which is a population-based prospective cohort that recruited 63,257 Chinese participants, age forty-five to seventy-four, who resided in Singapore from 1993 to 1998, found that “participants who drank less than 1 cup of coffee per week or more than 2 cups of coffee per day had a significant reduction in risk of hypertension compared to those who drank 1 cup per day.” Therefore, according to this study, someone with mild hypertension who drinks one cup of coffee a day might be better off either discontinuing most coffee or drinking a lot more.6
In 2016, a prestigious panel of twenty-three scientists convened by the International Agency for Research on Cancer (IARC), an agency of the World Health Organization (WHO), “found no conclusive evidence for a carcinogenic effect of drinking coffee,” though they noted drinking extremely hot beverages of any kind “probably causes cancer of the esophagus in humans.” The decision was a rare reversal by the panel, which had declared coffee a likely carcinogen in 1991. The new conclusions were reached after scientists on the panel reviewed more than one thousand studies on coffee.7
That all being said, drinking coffee on an empty stomach, particularly strong black coffee or even coffee with only a little bit of milk or cream, can sometimes precipitate digestive issues, and for some people it may be better to drink coffee a little later in the day. There also can be physical withdrawal symptoms, including severe headaches, when regular coffee drinkers abruptly stop drinking coffee.
Taken all together, the research is in coffee’s favor, suggesting it is a mostly harmless and potentially healthy drink. Not only will it not stunt your growth, coffee for adults in sugar-free moderation is an enjoyable practice with great health potential. We’re not likely to see commercials touting the health benefits of this wonderful “drug,” but it might be a good idea to talk to your doctor and see if coffee is right for you. The research suggests it probably is.