Category Archives: Tea/Coffee/Caffeine

It’s National Coffee Day-Let’s Celebrate The Health Benefits Of Java!

The skeptical cardiologist admits to being a coffee snob and addict. For the last 10 years I’ve been using the Chemex system to brew my morning cup of Java. Once I consistently partook of Chemex pour-over coffee made from freshly ground, recently roasted quality coffee beans it was hard for me to enjoy any other kind. I find Starbucks coffee particularly loathsome.

Although numerous studies have established that coffee consumption is safe (assuming you are not adding  titanium dioxide to your cup), the belief that it is bad for you persists in the majority of patients that I see.

Since today is National Coffee Day let me take this opportunity to reassure my patients and readers who consume the good brew that they are not harming their hearts.

While it is possible to adulterate coffee into an unhealthy concotion (see my post on “How Starbucks Is Making Heart Healthy Coffee Into a Stealth Dessert”) overall coffee is heart-healthy.

In fact a recent study (Coffee Consumption and Coronary Artery Calcium Score: Cross‐Sectional Results of ELSA‐Brasil (Brazilian Longitudinal Study of Adult Health)) showed that coffee consumption is associated with less subclinical atherosclerosis as measured by coronary artery calcification (CAC).

The intro to this paper summarizes information known about coffee and cardiovascular disease (CVD). Although early observational studies suggested coffee could increase risks:

More recent meta‐analysis of prospective studies showed that moderate coffee consumption was associated with decreased CVD risk, all‐cause mortality, and mortality attributed to CVD and neurologic disease in the overall population. High coffee consumption (>5 cups/d) was neither related to CVD risk nor to risk of mortality.12, To corroborate this evidence, the 2015–2020 Dietary Guidelines for Americans show that consumption of 3 to 5 cups/d of coffee is associated with reduced risk of type 2 diabetes mellitus and CVD in adults. Consequently, moderate coffee consumption can be incorporated into a healthy dietary pattern, along with other healthful behaviors. Although coffee consumption has been studied in relation to various risk factors of CVD, only 4 studies have investigated the association between coffee intake and subclinical atherosclerosis, and the data available were limited and inconsistent.

Coffee is rich in phenolic compounds which have demonstrated anti-inflammatory, antioxidant and antithrombotic properties which could lower cardiovascular risks. However, unfiltered coffee is rich in cholesterol‐raising compounds (diterpenes, kahweol, and cafestol) that can  increase total cholesterol, low‐density lipoprotein cholesterol, and triglycerides.which could worsen cardiovascular risk.

Consumption of filtered coffee however does not effect lipid levels adversely- presumably those nasty diterpenes are retained by my Chemex filter.

The Brazilian Longitudinal study looked at 4426 residents of Sao Paulo, Brazil who underwent a CAC measurement.  Information on coffee consumption was obtained from a food frequency questionnairre.

Those who reported high coffee consumption (>3 cups per day) had one-third the chance of a CAC>100 than nondrinkers. More coffee=less plaque build up in the coronary arteries. Less atherosclerotic plaque should = less heart attacks and strokes.

Scientific Consensus On The Healthiness of Coffee Consumption

In contrast to what the public believes, the scientific evidence very consistently suggests that drinking coffee is associated with living longer and having less heart attacks and strokes. Multiple publications in major cardiology journals in the last few  years have confirmed this.

You can read the details here and here. The bottom line is that higher levels of coffee consumption (>1 cup per day in the US and >2 cups per day in Europe) are NOT associated with:

  • Hypertension (if you are a habitual consumer)
  • Higher total or bad cholesterol  (unless you consume unfiltered coffee like Turkish, Greek or French Press types, which allow a fair amount of the cholesterol-raising diterpenesinto the brew)
  • Increase in dangerous (atrial fibrillation/ventricular tachycardia) or benign (premature ventricular or supra-ventricular contractions) irregularities in heart rhythm

Higher levels of coffee consumption compared to no or lower levels IS associated with:

  • lower risk of Type 2 Diabetes
  • lower risk of dying, more specifically lower mortality from cardiovascular disease
  • Lower risk of stroke

So, if you like coffee and it makes you feel good, drink it without guilt, there is nothing to suggest it is hurting your cardiovascular health. It’s a real food. These tend to be good for you.

Nonpoikilothermically Yours,

-ACP

N.B. The Chemex Coffeemaker was invented in 1941 by Dr. Peter Schlumbohm PhD. Made simply from non-porous, borosilicate glass and fastened with a wood collar and tie, it brews coffee without imparting any flavors of its own. On permanent display at MOMA NY and other fine museums, it is truly a work of art.

Despite Kaldi’s gastronomic abomination I’m still predominantly using their coffee beans.

The Brailian coffee study has numerous flaws like all observational dietary studies.

The caffeine in coffee can bring on palpitations. If you feel palpitations or other symptoms after consuming coffee you should lower the caffeine content or amount until you no longer experience troubling symptoms. Be guided by how you feel.

The Bad Food Bible: A Well-Written, Sensible and Science-Based Approach To Diet

The skeptical cardiologist has been searching for some time for a book on diet that he can recommend to his patients. While I can find books which have a lot of useful content, usually the books mix in some totally unsubstantiated advice with which I disagree.

I recently discovered a food/diet/nutrition book which with I almost completely agree. The author is Aaron Carroll,  a pediatrician, blogger on health care research (The incidental Economist) and a Professor of Pediatrics and Associate Dean for Research Mentoring at Indiana University School of Medicine.

He writes a regular column for the New York Times and covers various topics in health care. His articles are interesting,  very well written and researched and he often challenges accepted dogma.

Like the skeptical cardiologist, he approaches his topics from an unbiased perspective and utilizes a good understanding of the scientific technique along with a research background to bring fresh perspective to health-related topics.

Last last year he wrote a column, within which I found the following:

Studies of diets show that many of them succeed at first. But results slow, and often reverse over time. No one diet substantially outperforms another. The evidence does not favor any one greatly over any other.

That has not slowed experts from declaring otherwise. Doctors, weight-loss gurus, personal trainers and bloggers all push radically different opinions about what we should be eating, and why. We should eat the way cave men did. We should avoid gluten completely. We should eat only organic. No dairy. No fats. No meat. These different waves of advice push us in one direction, then another. More often than not, we end up right where we started, but with thinner wallets and thicker waistlines.

I couldn’t agree more with this assessment and as I surveyed the top diet books on Amazon recently, I saw one gimmicky, pseudoscientific  diet after another. From the Whole30 approach (which illogically  completely eliminates any beans and legumes, dairy products,  alcohol, all grains, and starchy vegetables like potatoes (see how absurd this diet is here)) to Dr. Gundry’s Plant Paradox (aka lectin is the new gluten (see here for James Hambling’s wonderful Atlantic article on the huckster’s latest attempt to scare you into buying his useless supplements).

It turns out Carroll published a useful book recently, The Bad Food Bible which critically examines diet and I agree with the vast majority of what is in it.

The first three chapters are on butter, meat, eggs and salt. His conclusions on how we should approach these 4 are similar to ones I have reached and written about on this site (see here for dairy, here for meat, here for eggs and here for salt).  Essentially, the message is that the dangers of these four foods have been exaggerated or nonexistent, and that consuming them in moderation is fine.

The remaining chapters cover topics I have pondered extensively,  but have not written about: including gluten, GMOs, alcohol, coffee, diet-soda and non-organic foods.

I agree with his assessments on these topics. Below, I’ll present his viewpoint along with some of my own thoughts in these areas.

Gluten

Carroll does a good job of providing a scientific, but lay-person friendly background to understanding the infrequent (1 of 141 Americans), but quite serious gluten-related disorder, celiac disease.

However, surveys show that up to one-third of Americans, the vast majority of whom don’t have celiac disease, are seeking “gluten-free” foods, convinced that this is a healthier way of eating. Carroll points out that there is little scientific support for this; there are some individuals who are sensitive to wheat/gluten, but these are rare.

He concludes:

“If you have celiac disease, you need to be on a gluten-free diet. If you have a proven wheat allergy, you need to avoid wheat. But if you think you have gluten sensitivity? You’d probably be better off putting your energy and your dollars toward a different diet. Simply put, most people who think they have gluten sensitivity just don’t.

I do agree with him that the “gluten-free” explosion of foods (gluten-free sales have doubled from 2010 to 2014) is not justified.

However, I must point out that my 92 year old father has recently discovered that he has something that resembles gluten sensitivity. About a year ago, he noted that about one hour after eating a sandwich he would feel very weak and develop abdominal discomfort/bloating. He began suspecting these symptoms were due to the bread and experimented with different bread types without any symptom relief.

Finally, he tried gluten-free bread and the symptoms resolved.

If you have engaged in this type of observation and experimentation on your self, and noted improved symptoms when not consuming gluten, then I think you’re justified in diagnosing gluten sensitivity, and by all means consider minimizing/avoiding wheat.

GMOS

Carroll begins his chapter on genetically modified organisms (GMOs) with a description of the droughts that plagued India in the 1960s and the efforts of Norman Borlaug to breed strains of wheat that were resistant to fungus and yielded more grain. By crossbreeding various strains of wheat he was able to develop a “semi-dwarf” strain that increased what was produced in Mexico by six-fold.

Despite the fact that numerous scientific and health organizations around the world have examined the evidence regarding the safety of genetically modified organisms (GMOs) and found them to be completely safe, there remains a public controversy on this topic. In fact a Pew Poll found that while 88% of AAAS scientists believe that GMOs are safe for human consumption, only 37% of the public do – a 51% gap, the largest in the survey.

This gap is largely due to an aggressive anti-GMO propaganda campaign by certain environmental groups and the organic food industry, a competitor which stands to profit from anti-GMO sentiments. There is also a certain amount of generic discomfort with a new and complex technology involving our food.

The National Academy of Sciences analyzed in detail the health effects of GMOs in 2016. Their report concludes:

While recognizing the inherent difficulty of detecting subtle or long-term effects in health or the environment, the study committee found no substantiated evidence of a difference in risks to human health between currently commercialized genetically engi-neered (GE) crops and conventionally bred crops, nor did it find conclusive cause-and-effect evidence of environmental problems from the GE crops. GE crops have generally had favorable economic outcomes for producers in early years of adoption, but enduring and widespread gains will depend on institutional support and access to profitable local and global markets, especially for resource-poor farmers

Carroll does a good job of looking at the GMO issue from all sides. He touches on environmental downsides related to herbicide-resistant GMO crops and the problems created by patenting GMO seeds, but asserts that “these are the result of imperfect farming and the laws that regular agribusiness, not of GMOS themselves.”

Ultimately, despite these concerns, I agree with Carroll’s conclusion that:

“Foods that contain GMOs aren’t inherently unhealthy, any more are  than foods that don’t contain them. The companies that are trying to see you foods by declaring them ‘GMO-free” are using the absence of GMOs to their advantage–not yours.”

Alcohol, Coffee, and Diet-Soda

Carroll does a good job of summarizing and analyzing the research for these three topics and reaches the same conclusions I have reached in regard to coffee, alcohol and diet-soda:

-alcohol in moderation lowers your risk of  dying, primarily by reducing cardiovascular death

-coffee, although widely perceived as unhealthy, is actually good for the vast majority of people

For those seeking more details a few quotes


on alcohol:

“Taken together, all of this evidence points to a few conclusions. First, the majority of the research suggests that moderate alcohol consumption is associated with decreased rates of cardiovascular disease, diabetes, and death. Second, it also seems to be associated with increased rates of some cancers (especially breast cancer), cirrhosis, chronic pancreatitis, and accidents, although this negative impact from alcohol seems to be smaller than its positive impact on cardiovascular health. Indeed, the gains in cardiovascular disease seem to outweigh the losses in all the other diseases combined. The most recent report of the USDA Scientific Advisory Panel agrees that “moderate alcohol consumption can be incorporated into the calorie limits of most healthy eating patterns.”

Keep in mind that moderate consumption is up to one drink per day for women, and two drinks for men (my apologies to women in general and the Eternal Fiancee’ of the Skeptical Cardiologist in particular) and be aware of what constitutes “one drink.”

Also keep in mind that any alcohol consumption raises the risk of atrial fibrillation (see here) and that if you have a cardiomyopathy caused by alcohol you should avoid it altogether.


on coffee:

“It’s time people stopped viewing coffee as something to be limited or avoided. It’s a completely reasonable part of a healthy diet, and it appears to have more potential benefits than almost any other beverage we consume.
Coffee is more than my favorite breakfast drink; it’s usually my breakfast, period. And I feel better about that now than ever before. It’s time we started treating coffee as the wonderful elixir it is, not the witch’s brew that C. W. Post made it out to be.”

Strangely enough, coffee is usually my breakfast as well (although I recommend against adding titanium oxide to your morning java).  Why am I not compelled to consume food in the morning?  Because breakfast is not the most important meal of the day and I don’t eat until I’m hungry.


on diet-soda:

Carroll notes that many Americans are convinced that artificial sweeteners are highly toxic:

“no article I’ve written has been met with as much anger and vitriol as the first piece I wrote on this subject for the New York Times, in July 2015, in which I admitted, “My wife and I limit our children’s consumption of soda to around four to five times a week. When we let them have soda, it’s . . . almost always sugar-free.”

He notes, as I have done, that added sugar is the real public enemy number one in our diets. He reviews the scientific studies that look at toxicity of the various artificial sweeteners and finds that they don’t convincingly prove any significant health effects in humans.

Some believe that artificial sweeteners contribute to obesity, but the only evidence supporting this idea comes from observational studies. For many reasons, we should not highly value observational studies but one factor, “reverse causation,” is highly likely to be present in studies of diet sodas. If diet soda consumption is associated with obesity, is it the cause, or do those who are obese tend to drink diet soda. Observational studies cannot answer this question but randomized studies can.

Carroll points out that:

the randomized controlled trials (which are almost always better and can show causality) showed that diet drinks significantly reduced weight, BMI, fat, and waist circumference.”

Simple Rules For Healthy Eating

Carroll concludes with some overall advice for healthy eating:

-Get as much of your nutrition as possible from a variety of completely unprocessed foods

-Eat lightly processed foods less often

-Eat heavily processed foods even less often

-Eat as much home-cooked food as possible, preparing it according to rules 1, 2, and 3

-Use salt and fats, including butter and oil, as needed in food preparation

-When you do eat out, try to eat at restaurants that follow the same rules

-Drink mostly water, but some alcohol, coffee, and other beverages are fine

-Treat all calorie-containing beverages as you would alcohol

-Eat with other people, especially people you care about, as often as possible

These are solid, albeit not shocking or book-selling, rules that  correspond closely to what I have adopted in my own diet.

In comparison to the bizarre advice from nutrition books which dominate the best-selling diet books, I found The Bad Food Bible to be a consistent, well-written, extensively researched, scientifically-based, unbiased guide to diet and can highly recommend it to my readers and patients.

Semibiblically Yours,

-ACP

Is Green Tea Better For Your Heart Than Black Tea?

Coffee is the  caffeinated beverage most consumed by Americans and the skeptical cardiologist. It is good for the heart (unless adulterated by titanium dioxide or lots of sugar, a horror that Starbucks likes to promote).

coffee_teaWorldwide, however, as this cool graphic demonstrates (interactive at the Economist)  tea dominates over coffee in lots of places.

Tea in general and particularly green tea is perceived by many to be incredibly healthy: fighting cancer, dementia, obesity and heart disease. But is this perception justified?

The Green Tea Superfood Hype

If you Google search the health benefits of green tea you might conclude that it is a panacea for all that ails modern civilization. However, bad nutritional advice is the norm on the internet and even  websites like Web MD, which you might consider to be reliable, spread inaccurate, misleading and poorly researched information regularly.

WebMD has an article on green tea that starts off

“Green tea is so good for you that it’s even got some researchers raving.“It’s the healthiest thing I can think of to drink,” says Christopher Ochner, PhD. He’s a research scientist in nutrition at the Icahn School of Medicine at Mount Sinai Hospital.”

Who is Chris Ochner and why is he “raving” about the health benefits of green tea you might ask? That’s certainly what I wanted to know, particularly since this same quote or variations on it are all over the internet on sites like “Herbal Republic” which ups the green tea ante with the title “”Green Tea is Beyond a Superfood”-Dr. Christopher Ochner”  (by the way, any source of nutritional information that uses the term superfood should be considered bogus.)

ochnerAlthough no source is provided for this quote from Dr. Ochner, there is a Christopher Ochner, Ph.D listed on the Icahn Medical School Staff. His Ph. D. is in psychology and he works in the areas of adolescent obesity (perhaps he pushes green tea on his obese adolescents).  I can find no publications by him on the topic of green tea and no evidence that he made these comments. I have sent him an email asking for clarification and edification.

The website,  juicing for health.com lists “5 scientifically proven reasons to drink green tea” (by the way, I consider articles with headlines that start with a number, i.e.  “3 health foods that are actually killing you from the inside”,  “5 veggies that kill stomach fat”, and “35 celebs who’ve aged horribly” are worthless and should be ignored and avoided at all costs)

Green Tea and Catechins: Magical Weight Loss elixir?

It’s hard to find good studies on green tea that aren’t somehow funded by the tea, nutraceutical or food industry.  For example, one “S Wolfram” has written extensively on the benefits of green tea in marginal scientific journals. He works for DSM Nutritional Products, LTd., a Swiss food conglomerate.(“DSM Nutritional Products is the world’s largest nutritional ingredient supplier to producers of foods, beverages, dietary supplements, feed and personal care products” says one DSM PR release”).

DSM developed a highly concentrated extract of  a catechin called Epigallocatechin Gallate (EGCG) in green tea that had been identified as having potential health benefits for humans.

In one recent “review” Wolfram wrote  in somewhat vague but highly optimistic terms

“Dose-response relationships observed in several epidemiological studies have indicated that pronounced cardiovascular and metabolic health benefits can be obtained by regular consumption of 5-6 or more cups of green tea per day. Furthermore, intervention studies using similar amounts of green tea, containing 200-300 mg of EGCG, have demonstrated its usefulness for maintaining cardiovascular and metabolic health. Additionally, there are numerous in vivo studies demonstrating that green tea and EGCG exert cardiovascular and metabolic benefits in these model systems.”

I’m not sure what “model systems” he is referring to but it is certainly not humans. He may be talking about rodents, because in 2005  Wolfram published  a paper entitled:

“TEAVIGO (epigallocatechin gallate) supplementation prevents obesity in rodents by reducing adipose tissue mass”

In the conclusions of this “landmark” study performed in mice and rats he wrote

“Thus, dietary supplementation with EGCG should be considered as a valuable natural treatment option for obesity.”

Voila! From a few experiments in rodents and a few short-term, small studies in humans performed by heavily biased scientists, DSM’s version of EGCG emerged as a leading nutraceutical (I prefer the term, snakeoil) and now you can buy this online from a host of bogus supplement/nutraceutical sites as Teavigo.

The production and marketing of TeaVigo is a classic example of how the cynical food/supplement/nutraceutical industry creates a product that has a thin veneer of scientific credibility for health promotion but is considered “natural” (despite being manufactured)

teavigo
It’s Really Pure…. and Really Useless!

and therefore appeals to Americans who are seeking “natural” ways to prevent or treat the common  chronic  diseases of Western civilization.

Because there is no good scientific evidence supporting a role for green tea extracts or ECGC in preventing any specific disease, there is no FDA scrutiny of

Screen Shot 2015-12-27 at 7.51.35 AM
Teavigo: Good for everything that ails you plus can be put in anything you would like to consume and spread on your face! The perfect nutraceutical!

the drug for efficacy and safety. This is fine for nutraceutical manufacturers as they have been granted the ability to  sell their useless products without any regulatory or FDA approval.

Companies like DSM avoid making any specific health claims for their supplements (such as this drug reduces your chances of having a heart attack or stroke) because the FDA can then go after them.
Instead, the Teavigo website makes vague but optimistic statements such as
“Green tea has long been used for health benefits and Teavigo® is the purest and most natural form of the most active substance in green tea – Epigallocatechin Gallate (EGCG). EGCG contains potent natural antioxidants and efficient free-radical scavengers (free radicals being the highly reactive compounds that cause cellular damage).
Notice the key marketing buzzwords in this statement
-Purest
-Natural
-Active
-Antioxidants
-Efficient
-Free-Radical Scavengers
-Cellular Damage
Who wouldn’t want to take a pill that is pure and natural and full of those wonderful antioxidants that stop those nasty free-radicals  from causing cellular damage?
Unfortunately, any time a proposed powerful “anti-oxidant” ( b-carotene, vitamin E, vitamin C, selenium, retinol, zinc, riboflavin, and molybdenum ) has been studied in a well done scientific trial for prevention of cancer or cardiovascular disease it has failed.
We don’ know if this is because the wrong anti-oxidants have  been chosen (for example in green tea  there are hundreds of potential beneficial chemicals)  or because extracting a single chemical from its milieu in a complex food/beverage makes it inactive or if the whole idea of stopping free-radical damage is misguided.
Why take the time to actually brew and drink green tea the website points out after all:
“To get the optimal benefits from ordinary green tea would take an intake of four to eight cups of green tea a day. With Teavigo® you get the same pure, natural and healthy effects, with more convenience and without the caffeine.”
Finally, consumers of Teavigo can be reassured because it is produced using
“A patented and unique production process with constant product quality”
Let me see here, Teavigo is natural but it is made by a “production process” with “constant product quality”.  Isn’t natural production process an oxymoron?
I have asked the Teavigo people to tell me their “production process” but so far I’ve gotten no response. Your guess is as good as mine as to what chemicals or other potentially damaging processes tea undergoes to reach the colorless and tasteless powder that is Teavigo.
 Green Tea Reality

The evidence supporting tea and green tea health benefits  is weak, coming from observational studies.  A recent review of all these observational studies (supported in part by the tea industry) concluded that

Although the evidence appears to be stronger for green tea than for black tea, which differ greatly in their flavonoid profiles, it is difficult to compare this evidence because the populations and their baseline risks of cardiovascular disease differ greatly between the individual studies on these 2 types of tea, and few studies of green tea provide evidence in non-Asian populations.

Whereas there is reasonable observational evidence that high tea consumption is associated with lower cardiovascular risk, the evidence for green tea being healthier is mostly marketing hype.

If you like green tea by all means drink it in whatever quantity you desire. It’s not bad for you. Weak observational data suggests it may reduce your stroke risk, especially if you are Asian.
On the other hand, if you like black tea or oolong tea you can feel very comfortable that it is not bad for you.  It might also reduce your risk of stroke.
There is nothing to suggest tea is healthier than coffee.
Don’t add sugar or titanium dioxide to your tea but feel free to add cream or full fat milk.
Don’t worry about caffeine unless it makes you jittery or brings on palpitations. Common sense should tell you what amount you can tolerate.
Please don’t buy or consume green tea extracts or Teavigo or any other nutraceutical.
The makers of these products are cynically preying on consumer desire for “natural” treatments, selling chemicals which have not been proven either safe or effective, and employing  misleading marketing and promotional material that implies “scientific” support that is either nonexistent or comes from very weak studies, often run by researchers employed by the industry.
 I guarantea this post was unbiased
-ACP