The Big Five
Five Simple Things You Can Do to Live a Longer, Healthier Life
By Sanjiv Chopra, David Fisher
St. Martin's Press Copyright © 2016 Sanjiv Chopra, M.D., and David Fisher
All rights reserved.
Coffee — A Cup of Health
Americans love coffee. We drink about 400 million cups of coffee a day, making us the leading coffee-consuming nation in the world. An estimated 83 percent of American adults drink coffee. The average cup of coffee is nine ounces, and we drink about three cups every day. American coffee drinkers spend an average of $1,100 a year on coffee. Coffee is considered the ultimate energy drink. Most people drink it in the morning to get them going and in the afternoon to give them the necessary pick-up-up-up-up. "In Seattle," according to Amazon founder and CEO Jeff Bezos, "you haven't had enough coffee until you can thread a sewing machine while it's running."
Americans also drink it because we love its taste: about a third of all the coffee we buy is considered gourmet coffee, meaning it is espresso-based or otherwise a specialty drink.
We're not the only people who love coffee. Worldwide, an estimated 2.25 billion cups of coffee are consumed every day. Mostly we drink coffee because we love its taste and because it provides an instant energy boost. Former late-night host David Lettermen once admitted, "If it wasn't for coffee, I'd have no identifiable personality whatsoever."
With the meteoric rise of Starbucks and America's estimated 25,000 other coffee shops, the availability of various special preparations and blends of coffee, and the ease of one-cup coffeemakers, the once-bland world of coffee has been transformed into one of the fastest-growing food and beverage industries in the county. Business has discovered that coffee is indeed the multi-billion-dollar bean. Few people look forward to their daily stop at the local coffee shop more than I do. In addition to getting my coffee, I'm going to meet friends there, and we'll sit together for a few minutes enjoying our coffee and the joy of companionship.
But few people drink it for the most important reason: Coffee is really good for you. I make that statement as a physician and liver specialist. In fact, coffee actually may well be the healthiest beverage you can drink. Many people don't believe that. When I make that statement they sometimes look at me like I've told the beginning of a joke and they are waiting for the punch line. Often when I'm giving a lecture on a liver disorder, I will ask everyone in the audience who drinks at least two cups of coffee to raise their hands. Most hands, both of men and women, go up. "Good," I tell them, then ask, "How many of you drink at least four cups a day?" Fewer hands are raised, and I notice that people look around the room nervously to see who is drinking that much coffee. Finally I ask my audience, "How many of you average six or more cups of coffee a day?" In response there is always some sort of nervous laughter and then a few brave people gingerly raise their hands, as though they were doing something wrong. That's when I say to the audience, "You know what? It's good for you! You're really doing yourself a big favor."
In fact, instead of believing coffee is good for you, most people believe it can be harmful. In the past drinking too much coffee supposedly had been linked to a variety of health problems including heart attacks, birth defects, pancreatic cancer, osteoporosis, weight gain, hypertension, and miscarriage. We do know that in some instances coffee can cause insomnia, tremors, raise blood pressure a tad, and worsen heartburn, and it certainly increases urination. For those reasons people usually limit the amount of coffee they drink and often decide that for health reasons they shouldn't have that extra cup of coffee they are craving. I often hear this common refrain: "Dr. Chopra, I used to drink two cups of coffee a day. Now I hardly drink it. Isn't caffeine bad for you?"
The evidence that they are misinformed is overwhelming, and more of it is being reported practically every day. While many people read those stories, they still don't believe them. Few people consider coffee a health drink. In fact, most people don't even know how effective coffee appears to be in preventing a variety of very serious illnesses, or, when they learn the facts, they remain quite dubious. They ask incredulously, "You're saying coffee is probably better for me than tea? Coffee really can reduce the risk of developing a number of common cancers? It can decrease the risk of developing gallstones and tooth decay? It decreases the risk of developing cirrhosis of the liver? It can even decrease the risk of developing dementia? Dr. Chopra, are you nuts?"
I have become a true advocate of the health benefits of coffee, so much so that many of my medical colleagues are amused by my passion for coffee. For years I spent four weeks attending on the in-patient hepatology service at Beth Israel Deaconess Medical Center, a major teaching affiliate of Harvard Medical School. To satisfy my own curiosity I instructed the students, interns, residents, and fellows to ask all the patients admitted with severe liver disease one additional question: How much coffee do you drink? The answer I always got was that none of our patients with severe liver disease regularly drank coffee. It's quite uncanny and quite remarkable how consistent this answer had been, week after week, for years. But a couple of years ago, as I was about to start teaching rounds, a resident approached me smiling broadly and said, "Dr. Chopra, we finally have a patient on our liver service who drinks four cups of coffee every day!"
Oh, well, that caught my attention. I said, "Tell me more about him."
The resident responded, "He's a fifty-three-year-old patient who was admitted yesterday with severe cellulitis."
I told the house staff, "When we go and see him at rounds, I will take my own history. He may well be the exception to the rule. The studies are epidemiological and may not be iron-clad, even though there are some reasonable mechanistic explanations."
When I met this patient I took a detailed history. In addition to the questions about alcohol and over-the-counter medications, I said to him, "Please tell me about tea and coffee. Do you drink any?"
"I don't drink tea at all," he said, shaking his head. "But I love coffee."
I asked him if he drank regular or decaf, since most studies had shown that it is regular coffee that confers major protection against liver disease.
"Only regular," he said, smiling, "If you're going to drink coffee you might as well drink the real thing."
I asked him how many cups of coffee he drank every day.
"At least four," he said, "sometimes more."
"What size?" I inquired.
He pointed to a large paper cup on his bedside table and said, "That size."
I asked one final question, "How long have you been drinking regular coffee?"
And matter-of-factly he responded, "Ever since my liver transplant." He then turned to me and asked, "Should I stop? Is it bad for me?"
"No, it's not," I said, repressing a laugh. "Keep drinking it, it's very good for you.
No wonder coffee hadn't prevented his disease. I asked him, "Did someone tell you to drink coffee after your transplant?"
He shook his head again. "It's really strange. I never used to like coffee, but after my transplant I suddenly had this incredible craving for coffee!" The facts are indisputable; coffee appears to offer a great variety of benefits, including substantial protection against liver cirrhosis, type 2 diabetes, heart disease, Parkinson's disease, cognitive decline and dementia, gallstones, tooth decay, and a host of common cancers, including prostate, colon, endometrial, and skin cancer. There also is a lower rate of suicide among coffee drinkers.
Incredible as it may seem, coffee also appears to make you smarter, can improve physical performance — major league baseball players may drink as many as six cups of coffee during a game to increase focus and response time — and even helps burn fat. It can be used to treat headaches, and, contrary to conventional wisdom, it appears to lower the risk of being hospitalized for arrhythmia.
But perhaps the single most startling conclusion that has emerged from the more than 19,000 studies concerning the impact of coffee on health is that people who drink a lot of coffee appear to live longer than people who drink little or no coffee. That's an incredible statement, but there are several good studies that support it. A National Institutes of Health study published in the New England Journal of Medicine in 2012 analyzed data collected from 400,000 participants over a fourteen-year period and concluded that the overall mortality rate for people who drank between two and six cups of coffee a day was about 10 percent lower for men and about 15 percent lower for women. The study found that the more coffee participants drank, the more they cut their risk of death, with the greatest benefit seen in people who enjoyed four or five cups. Interestingly, women benefitted slightly more than men.
A Johns Hopkins Bloomberg School of Public Health review of twenty-one studies conducted between 1966 and 2013 that included almost a million participants concluded that people who drank as many as four cups of coffee daily reduced mortality by 16 percent.
There is one caveat though: Studies also show that coffee consumption often is linked with known health risks (e.g., coffee drinkers tend to smoke), which tends to skew the results.
Considering the myriad of potential health benefits to be gained from drinking coffee, it is somewhat surprising how little most Americans know about them. I am also surprised that an overwhelming number of physicians are not aware of the many benefits of coffee. If a patient says to his primary care physician, "I heard coffee has lots of health benefits," the response they often hear is, "These studies come and go. Everything in moderation is okay." In reality, this is inaccurate. Scores and scores of well-conducted studies have been published in prestigious, peer-reviewed medical journals. There appears to be a dose-dependent effect — in other words, the more coffee an individual consumes on a daily basis, the greater the benefit or the risk reduction in many of the common medical ailments mentioned above.
While many people can rhapsodize for hours about the nuances of wines, the craft of creating beers, and the history and variations of teas, few people know much about coffee beyond how they order it each morning. But coffee has a rich and bold history and has helped shaped the world as much as any other substance.
Coffee does grow on trees. It is a very hearty plant that can grow in a great variety of conditions, which is why it is such an important economic crop. It is grown around the world. It takes three or four years for a coffee tree to bear fruit. That fruit, the coffee cherry, actually is a bright, deep red color. Rather than a bean, it is a seed, and if it is planted rather than processed it will grow into a tree. Most often these cherries are picked by hand, and in most countries there is a single annual harvest. It takes about two thousand cherries to produce one pound of roasted coffee. After the coffee is dried it is prepared for export, which can be done several different ways. An estimated seven million tons of this "green coffee," as it is now called, are shipped each year. This green coffee is finally roasted at about 550° into the aromatic brown beans that most of us recognize as coffee, then sold to the consumer while still fresh.
The legend is that the virtues of coffee were first discovered in the ninth century by a shepherd named Kaldi, who observed while tending his goats in the Ethiopian highlands that his flock became unusually active after eating the red berries from certain trees. Supposedly he told the abbot of the local monastery about this curious discovery. According to this story the abbot frowned upon this magical power and angrily threw the berries into the fire. The enticing aroma that arose from the burning beans attracted other residents of the monastery. These roasted beans were brewed into a drink and the monks discovered that it kept them awake and alert throughout the long hours of evening prayer. They shared this knowledge with other monks, and slowly stories about the powers of these red berries to create a vibrant consciousness began spreading throughout the world.
Other legends attribute the discovery of coffee to a Yeminite Sufi mystic who noticed, during his travels through Ethopia, that birds feasting on these red berries seemed more energetic, and when he chewed the berry he enjoyed a similar response. While the truth will never be known, it is generally accepted that the properties of the coffee bean were discovered in Ethopia and exported to Yemen. For hundreds of years coffee remained popular throughout the Islamic world. By the sixteenth century it had spread throughout the Middle East. The word "coffee," in fact, can be traced to the Arabic qahwa, a slang term meaning "wine of the bean." Turks translated that to be kahve, which the Dutch called koffie and which entered the English language as "coffee" in 1582.
In many places this qahwa was greeted with suspicion. What kind of strange brew causes such disruptions of the spirit? In 1511 imams in Mecca banned its use, but that ban was overturned a decade later by the Ottoman Turkish sultan. In 1532 it was outlawed in Cairo, and coffee storehouses were reduced to rubble. As it turned out though, it wasn't only Muslim clerics who tried to prevent the spread of this powerful and seemingly dangerous stimulant.
It was the globe-traveling merchants of Venice who introduced coffee to Europe, where it became known as "the Muslim drink." It created quite a ... stir. The possible medicinal attributes of coffee were first noted in 1583, when German physician Leonhard Rauwolf, after returning from an exploration of the Near East, described "[a] beverage as black as ink, useful against numerous illnesses, particularly those of the stomach. ... It is composed of water and the fruit from a bush called bunnu." Almost instantly there was a debate within the Catholic Church as to whether it would be permitted or banned; there is considerable dispute as to precisely which church leader eventually made the decision. Some credit Pope Clement VIII, while others believe it was Pope Vincent III, but the story goes that the pope demanded to taste it before rendering his decision and that, after doing so, rather than banning it he proclaimed, "Why, this Satan's drink is so delicious that it would be a pity to let the infidels have exclusive use of it. We shall cheat Satan by baptizing it."
At that time nations often tried to control the market for certain goods. While the Dutch attempts to prevent other nations from growing tulips is well known, there were similar efforts by coffee-growing regions to prevent the spread of the coffee tree. Nations guarded their coffee trees. In 1670 a smuggler strapped seven beans from Yemen onto his chest and carried them to India. When French King Louis XIV turned down a request for coffee tree clippings from a young naval officer from the colony of Martinique, that officer stole them and hid them aboard his ship. His voyage home was perilous, the ship was becalmed and the crew and passengers went without water for days — so he shared his precious allotment of these seeds. They survived the journey, and within half a century 18 million trees had been planted on Martinique and the coffee trade became a thriving industry.
Brazil grew to become the world's largest coffee exporter after dispatching a colonel to French Guiana purportedly to mediate a border dispute. In fact, he won the affections of the governor's wife, who handed him a bouquet of flowers at his farewell dinner — with coffee seeds hidden in the bouquet.
Among the prizes of war won by Austria after defeating the Turkish army in a 1683 battle were sacks of coffee beans. The Austrians created their own blend of coffee to be served with a cake called kipfel, which was shaped to resemble the crescent moon on the flag of the defeated Turkish army — and eventually became known by its French name, the croissant.
Proving that history repeats itself, for centuries most coffee was consumed in coffeehouses — historic versions of Starbucks — which served as centers of social and political activity. The first known coffeehouse opened in Istanbul in 1471. Europe's first coffeehouse opened its doors in Italy in 1645. In these "penny universities," as they became known in England because the cost of a cup was one penny, people could listen to music, play chess, watch performers, conduct business, and debate the issues of the day. Relationships that changed history were conducted in those meeting places; for example Lloyd's of London grew out of Lloyd's Coffee House. In some nations the political and religious discussions that became commonplace made governments wary, fearing rebellion was being plotted. England's Charles II tried to close down the estimated three thousand coffeehouses in that nation in December 1675, issuing a proclamation that read, in part, "Whereas it is most apparent that the multitude of Coffee Houses of late years set up and kept within this kingdom ... and the great resort of idle and disaffected person to them, have produced very evil and dangerous effects ... (and that) in such houses divers, false, malitious, and scandalous reports are devised and spread abroad to the ... Disturbance of the Peace and Quiet of the Realm ... said Coffee Houses be (for the future) put down and surpressed. ..." Two weeks later, after widespread protests, the ban was rescinded. (Continues...)
Excerpted from The Big Five by Sanjiv Chopra, David Fisher. Copyright © 2016 Sanjiv Chopra, M.D., and David Fisher. Excerpted by permission of St. Martin's Press.
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