Health for life

Joe Paduda of Managed Care Matters is hosting the latest "Streaming" Health Wonk Review.  If youre interested in technology, CMS, health orm, mainstream media and the influence of money, there is something here for you.

Enjoy!

Years ago, the Disease Management Care Blog tagged along as a minor player to a high level strategic meeting involving a pharmaceutical company and a provider organization. The senior leadership egos on display barely competed with the meeting rooms spacious view of the Manhattan skyline as our group was hosted over yummy pastries and coffee by a good looking, gregarious, gracious, intelligent and obviously "connected" pharma executive.

The meeting progressed quite nicely until a coffee break supervened and the DMCB found itself alone in an anteroom with the host. Caught up in the enthusiasm of the moment, the DMCB parroted one of the meetings nostrums about the internet. The executive turned and hissed at the DMCBs stupidity with dripping contempt, turned and walked out. Minutes later, the meeting restarted as if nothing happened.

That was just one of the DMCBs many encounters with an organizational psychopath. Unable to have experience any interpersonal "connection" with anyone, these soulless persons use the people around them to pursue the more tangible rewards of power, financial gain or amusement.  Excluded from the social web of human relationships, psychopaths cant access a moral compass.  As a result, they turn to social mimicry to charm, shame or bully anyone in the pursuit of their goals.  Everyone that surrounds them is a either a means to an end or,in the case of the DMCB, dirt.

While the more famous psychopaths are sadistic murderers, theyre the exception.  Most of them coldly calculate that they dont need violence to achieve their ends. Deceit, predation and manipulation are more than enough while they pursue their goals in the cubicles down the hall and the offices upstairs.  And as they click along, these Sandusky-esque time bombs are often recognized too late.

Heres the DMCBs four  rules on how deal with organizational psychopath:

1.  That ill-defined "feeling" that you have that somethings wrong with that person? You wonder if its bad parenting, drugs, mental illness, curious flattery or an inflated ego?  Trust your instincts and include psychopathy among the possibilities.

2. Dont be surprised when you uncover the extent of the dysfunction.  The prevalence is at least 1% and their toxicity can bring a team, a department and even an organization to its knees before you realize whats happening.

3. The infamous Milgram experiments found that persons in positions of power can lead decent people to do awful things.  Questioning authority is a good thing. If you do it, you deserve credit. If one of your reports does it, they deserve protection.

4. Stay away, contain and remove, perably the latter - even if it means you.  Warnings and counseling will not change their underlying motivation in any appreciable manner.

The DMCB is happy to report that the meeting didnt lead anywhere and that it was wiser for the experience. 

Thats why, years later, its skin crawled in a medical meeting hotel bar. 

Following a standing ovation for a plenary session presentation by the charismatic CEO of a very successful health care organization on the merits population health, the electronic record and systems integration, the DMCB found itself behind him and one of his minions trying to get a cappuccino. English was not the hapless servers primary language and she struggled with the baristas brewing details. The CEOs cold scorn and hateful disdain were radioactive while his companions nervous silence signalled that more than just impatience was at work.  The guy on stage just minutes before was an impostor.

Yes, it really did happen and yes, hes still out there.

Check out the three page article on "U.S. Health Cares Future" in the Marketplace section of the December 12 Wall Street Journal. Using personal stories of a doc, hospital CEO, insurance executive, human resources manager and a patient, the news piece portrays the blurring business lines between insurers, buyers and providers.  Mainstream readers of the Journal are likely to think the topic is both timely and novel.  Regular readers of the Disease Management Care Blog learned about his months ago.

Who are these five canaries in the health care coal mine, these bellwethers of the insurance business, these oracles of management and what are they telling us?

1. Dr. McCullough, a salaried physician with 28% of his income contingent on quality and satisfaction.  Some measures were imposed by the local Blues plan, which was passed through to the him by his employer.

Message: Purchaser and buyer control of physician reimbursement is already big and its growing.

2. Jim Taylor, a hospital CEO who cannot buy an electronic record system unless he merges with two other hospital systems.  If the merger is approved, the hospital will also be able to take on "warranty-style" payments from insurers.

Message: "Bigger is better" for capital-constrained hospitals.

3. Chris Day, an Aetna executive who got an Arizona health system to share insurance risk.  The main sticking point was the two-way mutual sharing of internal cost and contracting data.

Message: If insurers are willing to share internal pricing data, they must really mean it and think its an important success factor.

4.Robert Jacobs, the HR person, who linked about $10 per week of employees health insurance premiums to healthy behaviors (like tobacco) and quality test results (like blood cholesterol levels).

Message:  "Dont just stand there," say the employers, "do something."

5. Louis Kandor, an 86 year old man with advanced diabetes, who is being visited by a nurse who, in turn, is employed by a care management service provider under contract by his Medicare Advantage insurer.

Message: One key to mitigating risk for every insurer (except fee-for-service Medicare) is to use nurse-led care management.

While the Journal article doesnt spell it out, the DMCB believes the anecdotes can be distilled down into three useful insights:

1. Stakeholders are scrambling to demonstrate measurable outcomes to an increasingly educated and  skeptical public.  Thats the basis for physician pay-for-performance and premium surcharges.

2) Sharing proprietary insurance data is important.  Is information the secret ingredient that was lacking during the similar - and mostly unsuccessful - insurer-provider collaborations back in the 1990s?  Well see. 

3) For those hospitals that cannot or will not take risk, the next best answer is to merge.  That will mean economies of scale, access to capital and negotiating leverage.

The Disease Management Care Blog remembers when it was first introduced to an electronic health record (EHR).  After many days of learning how to document, link, retrieve, order, manage, view, bill, sign-off and close patient encounters, it asked about retrieving summary statistics on its patient population.  It wanted to know how many if its patients with high blood pressure were under control and how many of its patients with heart disease had low cholesterol levels. 
The practice administrator looked at the DMCB like it was crazy.

That was when the DMCB realized that the purpose of its EHR had less to do with quality, costs, coordination and everything to do with perpetuating the "hamster wheel" of one-on-one primary care.  Prior to the EHR, it averaged about 4-5 patient visits per hour.  After the EHR, that didnt change.  Neither did its HEDIS® measures, patient satisfaction rates or professional well-being.  The only thing that increased was its cumulative billing amounts.  No wonder the DMCB has been an unrepentant EHR skeptic.  It concluded that the purpose of the EHR is to perpetuate the dysfunctions of one-on-one care.

Articles like this, however, may change the DMCBs mind.  Jennifer Frankovich, Christopher Longhurst and Scott Sutherland describe how they tapped their local EHRs multi-year database to assess the outcomes of a cohort of patients that was similar to one of their own.  After analyzing how prior patients under similar circumstances fared, they decided that it would be a good idea to treat their patient with a blood thinner.  The patient ended up doing OK.

1.  Normally, a physicians expertise is built over the course of many patient encounters.  Thats called "clinical wisdom."  Being able to compact years of an institutions collective experience from an EHR into a spread sheet is not only a step in the right direction, its using the EHR to build an institutional body of wisdom.

2. This is another case study on the important distinctions between observational data bases (imperfect but locally relevant and readily available) and pristine evidence-based prospective randomized clinical trials (the gold standard for collecting evidence that is often lacking).  The latter is the standard of care and the enemy of the good; the former is quite useful and, as this case shows, often good enough.

3.  Last but not least, this is a good example of "applied" "population health management" in which a virtuous cycle of measurement can drive the local standard of care.  Its not only true for patients with obscure and rare diagnoses but for those with common, chronic and expensive conditions.  Want to reduce the burden of obesity?  Understand what really works for diabetes?  Tackle the costs associated with hypertension?  Assembling and using an electronic data base like this will make it possible.

The DMCB is looking forward to when future EHRs can perform at this level everywhere all the time.

Lets choose the health insurance channel!

A running joke among many managed care medical directors is that the typical enrollee spends hours comparing features and prices for their flat screen TVs and minutes selecting their health insurance.  Far too often, its after enrollees get sick that they discover that many of their assumptions arent meeting the reality of the provider network, coverage exclusions and out-of-pocket expenses that they chose. 

Whats more, juicy anecdotes of failed enrollee expectations (such as unproven cancer treatments in cute bald children) have fueled advocates demands for a generous version of orm (such as a single payer with a rich one-size-fits-all benefit design).

Thats why the Disease Management Care Blog found this Kaiser Health News report interesting.  It raises two issues.

1. The Merits of Consumer Shopping.

According to the KHN report, what were reading elsewhere isnt quite true because users of Massachesetts health insurance exchange (HIE) are being flummoxed by a thicket of multiple insurance options with premiums that vary according to provider tiers (some hospitals will cost you more), out of pocket expenses (a.k.a "skin in the game" stuff like co-pays and co-insurance) and exclusions (some things are not covered).  As a result, a shopper can expect to spend "six to eight hours" selecting a plan!

The DMCB is shocked, shocked by the specter of consumers having to spend as much time comparison-shopping for health insurance as the typical amount of time used checking out Consumer Reports, scanning the newspapers for sales, seeing if Amazon has a better deal and driving to several electronics stores for that best flat screen, Blu-Ray player or speaker system.  Dammit, says the DMCB, buying health insurance is important and it deserves that much time.  If an HIE forces consumers to finally pay attention, the DMCB says that is a good thing.

As an aside, the DMCB also points out that the art and science of HIEs are still evolving.  With better informatics and user-friendly on-screen interfaces, it should get better.  Given governments heavy hand, however, the DMCB predicts HIEs will never match the astonishing slickness of parallel on-line consumer purchasing aids, such as smart iPhone apps.  Taxpayer consumer expectations will continue to not be exceeded.  They will be eventually met, however.

That being said, however, the Massachusetts experience also speaks to the naive assumptions underlying the Affordable Care Acts HIE provisions.  If that remains problematic, consumers will always have the option of letting D.C.s Pete Stark, Max Baucus and Kathleen Sebelius save them time by arranging the details of their insurance for them.

2. Anecdotes and Framing

The underlying tone of the KHN piece vaguely suggests that consumerism and health insurance is a bad thing.  From the typical use of a selected negative anecdote, the skeptical visage of the person featured in the article, a "I could not figure it out" sub-headline, the sub-text portrayal of insurers as being intentionally opaque and the prominence given to saving money all paint a picture of a system that is failing. 

Good grief, HIEs have just gotten out of the crib and KHNs reporting suggests that the liberal and progressives still want to strangle this toddler.  Once again, the DMCB is shocked... shocked.

Testing for hidden early lung cancer

Remember this article on screening for lung cancer? 

More than 54,000 former and current tobacco users who looked like they were free of cancer were randomly assigned to a yearly cheapo chest x-ray vs. a yearly pricey low-radiation-dose CAT scan. Over 5 to 7 years of follow-up, the CAT scan was better at picking up early lung cancer (119 cases) which translated into a small but statistically significant survival advantage of 62 lives saved per 100,000 patient years.

Does this mean that Medicare, Medicaid and all commercial insurers should "cover" a baseline and yearly follow-up screening CAT scan for tobacco smokers at risk for lung cancer?  According to actuary Bruce Pyenson and colleagues writing in the latest issue of Health Affairs, the answer may be yes.

The Disease Management Care Blog thinks the answer may still be no. 

Is it being a heartless curmudgeon?  Read on and decide for yourself.......

In the Health Affairs article, the authors assumed current and former tobacco smokers comprise about 30% of persons aged 50-64 years.  They further assumed that about 50% of persons at risk would agree to the CAT screening exam.  Based on prior studies, they estimated that 21% of the baseline scans and 7% of the follow-up yearly scans would require additional testing and figured lung cancers would be present in 0.6% and 0.2% of the baseline and follow-up scans. They used a fee rate of $247 per screening for both the scan and included the cost of a counseling session on smoking cessation.  

Spread over a population, the cost of the screening would amount to 76 cents per member per month (PMPM). On a nationwide basis, there would be 130,000 additional lung cancer survivors.  The cost per life-year saved in 2012 dollars would range between $11,708 and $26,016.  To put things in perspective, it costs more per life-year saved to use current screening approaches to cervical cancer with pap smears (more than $50,000), colon cancer with colonoscopies ($18,000 to $29,000) and mammography ($31,000 to $51,000).

Much of the high costs of these other cancer screening procedures are the result of more persons being eligible for the testing.  In the Health Affairs study, the only persons getting the scan are smokers who are at high risk.

What did the DMCB learn?

One important lesson in this study is that cancer screening is not free.  Its too easy to assume that the early detection provided by mammography, colonoscopies and pap smears pays for itself.  Thats simply not true.  What is true is that cancer screening is good value, but itll still cost you for each life saved.

The second lesson is that good value still represents incremental cost.  As a result, the 76 cents PMPM is in addition to the money already being spent by health insurers.  While the extra pennies doesnt seem like a lot of money, the health insurance dollar is comprised of coverage of similarly priced goods and services, and all those pennies are continuing to add up.  The DMCB thinks were getting to the point where the U.S. would need to ask what coverage of which service should be cut to pay for lung cancer screening.

Both of these issues make it unlikely that insurers will willingly include coverage of screening CAT scans in their health insurer benefit.  They can also argue that it would be highly unusual to decide to cover a new screening procedure based on a single study that hasnt even been reviewed yet by the U.S. Preventive Health Services Task Force.

Last but not least, the DMCB is willing to bet that there wont be much consumer demand for coverage by insurers because of bias against the victims of tobacco-associated illnesses as well as the argument that smokers should self-pay based on the comparative cost of a years worth of cigarettes.

It remains to be seen if, under their ability to define a minimum insurance benefit as part of the Affordable Care Act, the Feds will require lung cancer screening.

Stay tuned!

Image from Wikipedia

Hi,

When I read the article at this link: http://www.drbenkim.com/articles-orthorexia.html#comment-10281 I just knew I had to share it. Enjoy!!

Ever been a nut about the specific things you eat? Been there. Done that. Maybe you did, too.

Read it!!  Good one!!

Love you,

Be back soon,

Marcia

The Disease Management Care Blog was shocked, shocked when it learned that Representative Pelosis political opponents have conspired to fund federal student loan subsidies by "tak[ing] it from their favorite target: womens health" (italics DMCB). The White House has chimed in about this political evildoing, noting defunding womens health could result in "hundreds of thousands of women" losing access to cancer screenings.

Alarmed by this unfair disenfranchisement of half of the U.S. population, the DMCB spouse and a number of future Secret Service agents, the DMCB decided to investigate.

As the DMCB understands it, the House Republicans propose to pay for the loan subsidies by defunding all or some the Sec 4002 of Affordable Care Acts Prevention and Public Health Fund (PPHF). 

Heres the key wording from the ACA:

SEC. 4002. PREVENTION AND PUBLIC HEALTH FUND ....to be administered through HHS, to provide for expanded and sustained national investment in prevention and public health programs to improve health and help restrain the rate of growth in private and public sector health care costs. FUNDING.—There are hereby authorized to be appropriated, and appropriated, to the Fund, out of any monies in the Treasury not otherwise appropriated—
(1) for fiscal year 2010, $500,000,000;
(2) for fiscal year 2011, $750,000,000;
(3) for fiscal year 2012, $1,000,000,000;
(4) for fiscal year 2013, $1,250,000,000;
(5) for fiscal year 2014, $1,500,000,000; and
(6) for fiscal year 2015, and each fiscal year thereafter, $2,000,000,000.
(c) USE OF FUND....for prevention, wellness, and public health activities including prevention research and health screenings, such as the Community Transformation grant program, the Education and Outreach Campaign for Preventive Benefits, and immunization programs.

Unable to find the words "womens health" in Sec. 4002 of the ACA, the DMCB next looked up the Community Transformation grant program and the Education and Outreach Campaign.  There is practically no mention of "womens health" there either.

With further research, the DMCB did find this insight on the mechanics of federal health grant funding in the unbiased and ereed policy journal Health Affairs.  According to Boston academic authors Mariana Arcaya and Xavier Briggs, the institutional complexity of overlapping committee and agency jurisdictions and budgets make it extremely difficult - absent innovation, reorganization and new support mechanisms - to coordinate grant programs like the PPHF and give the taxpayers their moneys worth.

The DMCBs conclusions?

1. Given the size of the U.S. governments deficit, its Congress job to make tough choices. Cancelling one program to fund another is one of them. The DMCB wishes that happened more often.

2. Trading a costly and questionably effective PPHF for a national investment in college education doesnt sound like a bad idea to the DMCB.

3. This is only the beginning. Those of us in the health care industry can look forward to the threat of funding cuts in other federally supported programs.

4. Even in this time of political discontent, Speaker Boehner has a point. Shame on Ms. Pelosi and her allies for their bombast and for the mainstream news media for failing to recognize it.

Image from Wikipedia

Getting ready for another announcement

Cornered by the politically inconvenient utterings of members of his Administration, President Obama threw election-year caution to the wind and stepped away from his "evolving" gay marriage perspective into an logorrheic gay marriage perspective: 

"At a certain point Ive just concluded that for me personally it is important for me to go ahead and affirm that I think same sex couples should be able to get married."

Sensing that wordiness may be that secret ingredient that turns feckless dodging into political determination, the public service-minded Disease Management Care Blog would like to offer the White House similarly crafted talking points in support of population health management.  These can be deployed by the President as the need arises at any time:

"After reading the science, Ive have reached a level of belief that warrants an individual decision to think that its important to conclude that population health management should be affirmed as a good thing."

"At a certain level, Ive just decided that for me, after regularly reading the Disease Management Care Blog, to support population health management and discern that the time has arrived in a manner that should prompt a level of commitment that Im willing to provide at this time."

"As the evidence reaches a degree of credibility that for population health management, I agree that a decision should be made in favor of incorporating this as a important option to consider as a worthwhile approach to care in the various programs supported in some manner by CMS."

Its the eve of Mr. Obamas State of the Union address (or, as the beltway cognoscenti apparently er to it, "SOTU").

What better way for the Disease Management Care Blog readers to mark this momentous occasion than by pretending that were in the Oval Office advising the President on the best way forward?

Here are some your options in helping our Chief Executive dispatch the problematic sequester, sustainable growth rate, Medicare and health orm.  Who knows, maybe someone from the White House is paying attention.....

Realizing that the sequester is both a bad deal for Medicare and a trap for the Democratic party, you recommend:

1. compromising,
2. changing the subject back to "evil insurers,"
3. a series of heartland speeches with nodding fawning accountants sharing the stage that explains to the American people the federal budget sequester and why you signed the enabling legislation in the first place,
4. hiring a Kardashian lawyer because hell know how to arrange a quickie divorce from the sequester deal.

To fix the SGR and prevent a physician flight from Medicare participation, you recommend:

1. compromising,
2. changing the subject to "oil companies,"
3. applying the vast anticipated 2016 savings from the "Medical Home" and ACOs to this years budget shortfall; if necessary add another zero or two,
4. re-tasking the controversial military drone program to drop freshly minted $100 bills on doctors offices.

You want mention Marilyn Tavenner, Acting Director for CMS, and ask that she confirmed by the Senate.  To make this happen, you advise the President to:

1. nominate her in the regular course of business and trust the Senate will do the right thing,
2. ask her to change the subject to the White House meme of "corporate jets,"
3. announce she will expand the care management program for FFS Medicare beneficiaries, ignoring, for the moment, that that is the largest insured population in the U.S. without that benefit,
4. fix the Chuck Hagel debacle by changing Ms. Taveneers nomination to Secretary of Defense

 Knowing that the President risks having his second-term being stymied by a defiant opposition party, you suggest Mr. Obama neutralize them by:

1. reaching out with Lincoln-esque "malice toward none and charity for all."
2. characterizing Republicans as "hateful munchkins"
3. recycling the "previous administration" blame strategy by reminding listeners it was Mr. Bush who kicked off the electronic health record mess in a previous State of the Union address and that its yet-unfulfilled promise is not your fault either.
4. suggesting everyone get out of their closed partisan information loops by regularly reading the Disease Management Care Blog.

Since 2014 promises to be the watershed year for Obamacare, you remind the President to:

1. avoid the subject because everyones projections are turning out to be wrong
2. decide now between the red pill and the blue pill
3.  announce that his White House advisors know more than any commercial health insurance executive about the underlying actuarial equivalence of an essential health benefit
4. in contrast to the 2010 SOTU, be respectful to the Supreme Court because they saved your Obamacare as*.

Changing opinion from right to left

Has marriage made the Disease Management Care Blog a better person?

While it and the spouse heartily agree on the ultimate answer, using hard numbers to prove it to a skeptical mother-in-law is a different matter. To definitively answer the question, the affable DMCB came up with some proposed measurement approaches, such as:

1. Pre vs. Post: comparing past beer guzzling to present-day chardonnay sipping;

2. Actuarial: actual vs. projected appreciation for the leather-clad vampire vixens of Underworld;

3. Comparison to a Control: the DMCBs willingness to take direction on shrubbery trimming, versus that of more docile hubbies;

4. Randomized and Prospective: (the DMCB has wisely opted to not go there).

While the DMCB continues to work on the complex methodology of marital outcomes, it is reminded of a key paradox: while we live in an "Information Age," other pressing questions - such as the extent of the Eurozones influence on GDP, the merits of vouchers in public education and the link between the Presidents approval rating and his governing by remote memo - likewise defy conclusive measurement.

Whats more, frustrated by our worlds complexity, we ironically want fewer answers. The DMCB suggests this search for simplicity partially explains the luster of a balanced budget amendment, laws on minimum medical loss ratios, Newts bombast, Obamas rhetoric, blanket coverage of birth control and, last but not least, single approaches to assessment of population-based programs.

Which brings the DMCB to Al Lewis $10,000 challenge, in which he dares anyone to come up with a more accurate approach to measuring disease management return on investment. 

Al is a luminary in the disease management firmament who leads the Disease Management Purchasing Consortium. He was there at the founding of the Disease Management Association of America, led the attack on the vendors past lazy outcomes reporting and has been instrumental in questioning the conclusions about North Carolinas Medical Home Program. He now claims to offer the only approach to accurately measuring the financial impact of disease and population health management.

Maybe, but the DMCB would like to humbly offer up an alternate perspective.

Check out this DMCB paper that simultaneously deployed three uncomplicated methodologies to assess the claims expense impact of a chronic heart failure disease management program. While all three gave different answers, they all pointed in the same direction.

That was enough for the DMCB boss to continue the programs funding.

This same overlapping and multi-layed approach also underlies the Care Continuum Alliances Outcomes Guidelines Reports, which recommend a suite of measurement approaches that pivot on important determinants such as population characteristics, the influence of confounders as well as bias and the resources available to answer the question.

None of this should be any surprise to seasoned and prudent health administrators, physician leaders, clinical program architects or DMCB readers. They know that good actuaries use complimentary and overlapping approaches to come up with the right premium. They understand that good medical researchers demand caution, skepticism and multiple research studies before reaching any conclusions.

In other words, there is no one-time and one-size fits all approach in outcomes assessment.

All this adds up to the fact that optimum outcomes measurement triangulates on the truth. The measurement approaches advocated by the DMCB, Care Continuum Alliance members and health system leaders have been around for years, are within the reach of standard statistical software, are familiar to researchers and are highly adaptable to the circumstances of 99.99% of disease management programs, not to mention the medical home and accountable care organizations.

The DMCB says that when multiple, competing, overlapping, repeated and adaptable measurement methodologies point in the same direction, thats when regulators, consumers, purchasers, buyers, providers and patients and mothers-in-law can be really confident that they have the answer they need.

Image from Wikipedia

I began using coffee a few months ago before soccer games (see Using Caffeine to Improve Athletic Performance) but have stepped up using it recently as I read about its health benefits. The review below of research on those benefits leaves be wondering why I did not start much earlier, and inspires me to step it up now:

Update:

Coffee consumption reduces risk of liver cancer

Coffee consumption reduces risk of hepatocellular carcinoma (HCC), the most common type of liver cancer, by about 40 percent, according to an up-to-date meta-analysis published in Clinical Gastroenterology and Hepatology, the official clinical practice journal of the American Gastroenterological Association. Further, some data indicate that three cups of coffee per day reduce liver cancer risk by more than 50 percent.

Coffee may help lower stroke risk

Green tea and coffee may help lower your risk of having a stroke, especially when both are a regular part of your diet, according to research published in Stroke: Journal of the American Heart Association.

People who drank at least one cup of coffee daily had about a 20 percent lower risk of stroke compared to those who rarely drank it.

As coffee drinking increased, the risk of death decreased

A large study of nearly half a million older adults followed for about 12 years revealed a clear trend: as coffee drinking increased, the risk of death decreased. Study author Neal Freedman, PhD, MPH, National Cancer Institute, discusses the significance of these findings and the potential links between coffee drinking, caffeine consumption, and various specific causes of disease in an interview in Journal of Caffeine Research, a peer-reviewed journal from Mary Ann Liebert, Inc., publishers. The article is available on the Journal of Caffeine Research website.

"Epidemiology of Caffeine Consumption and Association of Coffee Drinking with Total and Cause-specific Mortality" presents an in-depth interview exploring the many factors that could contribute to the association between coffee, disease, and mortality.

Four or more cups of coffee a day may keep prostate cancer recurrence and progression away

Consuming Coffee = Lower Risk of Liver Disease

Coffee may help prevent breast cancer returning


Caffeinated coffee may reduce the risk of oral cancers


Moderate coffee consumption may reduce risk of diabetes by up to 25 percent

Original report:

Coffee consumption lowers risk of most common form of skin cancer

Increasing the number of cups of caffeinated coffee you drink could lower your risk of developing the most common form of skin cancer, basal cell carcinoma, according to a study published in Cancer Research, a journal of the American Association for Cancer Research.

"Our data indicate that the more caffeinated coffee you consume, the lower your risk of developing basal cell carcinoma," said Jiali Han, Ph.D., associate professor at Brigham and Womens Hospital, Harvard Medical School in Boston and Harvard School of Public Health.

"I would not recommend increasing your coffee intake based on these data alone," said Han. "However, our results add basal cell carcinoma to a list of conditions for which risk is decreased with increasing coffee consumption. This list includes conditions with serious negative health consequences such as type 2 diabetes and Parkinsons disease."

Basal cell carcinoma is the form of skin cancer most commonly diagnosed in the United States. Even though it is slow-growing, it causes considerable morbidity and places a burden on health care systems.

"Given the large number of newly diagnosed cases, daily dietary changes having any protective effect may have an impact on public health," said Han.

Han and his colleagues generated their results by conducting a prospective analysis of data from the Nurses Health Study, a large and long-running study to aid in the investigation of factors influencing womens health, and the Health Professionals Follow-up Study, an analogous study for men.

Of the 112,897 participants included in the analyses, 22,786 developed basal cell carcinoma during the more than 20 years of follow-up in the two studies. An inverse association was observed between all coffee consumption and risk of basal cell carcinoma. Similarly, an inverse association was seen between intake of caffeine from all dietary sources (coffee, tea, cola and chocolate) and risk of basal cell carcinoma. However, consumption of decaffeinated coffee was not associated with a decreased risk of basal cell carcinoma.

Moderate coffee consumption offers protection against heart failure

While current American Heart Association heart failure prevention guidelines warn against habitual coffee consumption, some studies propose a protective benefit, and still others find no association at all. Amidst this conflicting information, research from Beth Israel Deaconess Medical Center attempts to shift the conversation from a definitive yes or no, to a question of how much.

"Our results did show a possible benefit, but like with so many other things we consume, it really depends on how much coffee you drink," says lead author Elizabeth Mostofsky, MPH, ScD, a post-doctoral fellow in the cardiovascular epidemiological unit at BIDMC. "And compared with no consumption, the strongest protection we observed was at about four European, or two eight-ounce American, servings of coffee per day."

The study published June 26 online in the Journal Circulation: Heart Failure, found that these moderate coffee drinkers were at 11 percent lower risk of heart failure.

Data was analyzed from five previous studies – four conducted in Sweden, one in Finland – that examined the association between coffee consumption and heart failure. The self-reported data came from 140,220 participants and involved 6,522 heart failure events.

In a summary of the published literature, the authors found a "statistically significant J-shaped relationship" between habitual coffee consumption and heart failure, where protective benefits begin to increase with consumption maxing out at two eight-ounce American servings a day. Protection slowly decreases the more coffee is consumed until at five cups, there is no benefit and at more than five cups a day, there may be potential for harm.

Its unclear why moderate coffee consumption provides protection from heart failure, but the researchers say part of the answer may lie in the intersection between regular coffee drinking and two of the strongest risk factors for heart failure – diabetes and elevated blood pressure.

"There is a good deal of research showing that drinking coffee lowers the risk for type 2 diabetes, says senior author Murray Mittleman, MD, DrPH, a physician in the Cardiovascular Institute at Beth Israel Deaconess Medical Center, an Associate Professor of Medicine at Harvard Medical School and director of BIDMCs cardiovascular epidemiological research program. "It stands to reason that if you lower the risk of diabetes, you also lower the risk of heart failure."

There may also be a blood pressure benefit. Studies have consistently shown that light coffee and caffeine consumption are known to raise blood pressure. "But at that moderate range of consumption, people tend to develop a tolerance where drinking coffee does not pose a risk and may even be protective against elevated blood pressure," says Mittleman.

This study was not able to assess the strength of the coffee, nor did it look at caffeinated versus non-caffeinated coffee.

"There is clearly more research to be done," says Mostofsky. "But in the short run, this data may warrant a change to the guidelines to lect that coffee consumption, in moderation, may provide some protection from heart failure."


High blood caffeine levels linked to avoidance of Alzheimers disease

Those cups of coffee that you drink every day to keep alert appear to have an extra perk – especially if youre an older adult. A recent study monitoring the memory and thinking processes of people older than 65 found that all those with higher blood caffeine levels avoided the onset of Alzheimers disease in the two-to-four years of study follow-up. Moreover, coffee appeared to be the major or only source of caffeine for these individuals.

Researchers from the University of South Florida (www.usf.edu) and the University of Miami (www.miami.edu)say the case control study provides the first direct evidence that caffeine/coffee intake is associated with a reduced risk of dementia or delayed onset. Their findings will appear in the online version of an article to be published June 5 in the Journal of Alzheimers Disease, published by IOS Press (http://health.usf.edu/nocms/publicaffairs/now/pdfs/JAD111781.pdf). The collaborative study involved 124 people, ages 65 to 88, in Tampa and Miami.

"These intriguing results suggest that older adults with mild memory impairment who drink moderate levels of coffee -- about 3 cups a day -- will not convert to Alzheimers disease -- or at least will experience a substantial delay before converting to Alzheimers," said study lead author Dr. Chuanhai Cao, a neuroscientist at the USF College of Pharmacy (http://health.usf.edu/nocms/pharmacy/) and the USF Health Byrd Alzheimers Institute (http://health.usf.edu/nocms/byrd/). "The results from this study, along with our earlier studies in Alzheimers mice, are very consistent in indicating that moderate daily caffeine/coffee intake throughout adulthood should appreciably protect against Alzheimers disease later in life."

The study shows this protection probably occurs even in older people with early signs of the disease, called mild cognitive impairment, or MCI. Patients with MCI already experience some short-term memory loss and initial Alzheimers pathology in their brains. Each year, about 15 percent of MCI patients progress to full-blown Alzheimers disease. The researchers focused on study participants with MCI, because many were destined to develop Alzheimers within a few years.

Blood caffeine levels at the studys onset were substantially lower (51 percent less) in participants diagnosed with MCI who progressed to dementia during the two-to-four year follow-up than in those whose mild cognitive impairment remained stable over the same period.

No one with MCI who later developed Alzheimers had initial blood caffeine levels above a critical level of 1200 ng/ml – equivalent to drinking several cups of coffee a few hours before the blood sample was drawn. In contrast, many with stable MCI had blood caffeine levels higher than this critical level.

"We found that 100 percent of the MCI patients with plasma caffeine levels above the critical level experienced no conversion to Alzheimers disease during the two-to-four year follow-up period," said study co-author Dr. Gary Arendash.

The researchers believe higher blood caffeine levels indicate habitually higher caffeine intake, most probably through coffee. Caffeinated coffee appeared to be the main, if not exclusive, source of caffeine in the memory-protected MCI patients, because they had the same profile of blood immune markers as Alzheimers mice given caffeinated coffee. Alzheimers mice given caffeine alone or decaffeinated coffee had a very different immune marker profile.

Since 2006, USFs Dr. Cao and Dr. Arendash have published several studies investigating the effects of caffeine/coffee administered to Alzheimers mice. Most recently, they reported that caffeine interacts with a yet unidentified component of coffee to boost blood levels of a critical growth factor that seems to fight off the Alzheimers disease process.

"We are not saying that moderate coffee consumption will completely protect people from Alzheimers disease," Dr. Cao cautioned. "However, we firmly believe that moderate coffee consumption can appreciably reduce your risk of Alzheimers or delay its onset."

Alzheimers pathology is a process in which plaques and tangles accumulate in the brain, killing nerve cells, destroying neural connections, and ultimately leading to progressive and irreversible memory loss. Since the neurodegenerative disease starts one or two decades before cognitive decline becomes apparent, the study authors point out, any intervention to cut the risk of Alzheimers should ideally begin that far in advance of symptoms.

"Moderate daily consumption of caffeinated coffee appears to be the best dietary option for long-term protection against Alzheimers memory loss," Dr. Arendash said. "Coffee is inexpensive, readily available, easily gets into the brain, and has few side-effects for most of us. Moreover, our studies show that caffeine and coffee appear to directly attack the Alzheimers disease process."

In addition to Alzheimers disease, moderate caffeine/coffee intake appears to reduce the risk of several other diseases of aging, including Parkinsons disease, stroke, Type II diabetes, and breast cancer. However, supporting studies for these benefits have all been observational (uncontrolled), and controlled clinical trials are needed to definitively demonstrate therapeutic value.

A study tracking the health and coffee consumption of more than 400,000 older adults for 13 years, and published earlier this year in the New England Journal of Medicine, found that coffee drinkers reduced their risk of dying from heart disease, lung disease, pneumonia, stroke, diabetes, infections, and even injuries and accidents.

With new Alzheimers diagnostic guidelines encompassing the full continuum of the disease, approximately 10 million Americans now fall within one of three developmental stages of Alzheimers disease -- Alzheimers disease brain pathology only, MCI, or diagnosed Alzheimers disease. That number is expected to climb even higher as the baby-boomer generation continues to enter older age, unless an effective and proven preventive measure is identified.

"If we could conduct a large cohort study to look into the mechanisms of how and why coffee and caffeine can delay or prevent Alzheimers disease, it might result in billions of dollars in savings each year in addition to improved quality of life," Dr. Cao said.

Coffee drinkers have lower risk of death

Older adults who drank coffee -- caffeinated or decaffeinated -- had a lower risk of death overall than others who did not drink coffee, according a study by researchers from the National Cancer Institute (NCI), part of the National Institutes of Health, and AARP.

Coffee drinkers were less likely to die from heart disease, respiratory disease, stroke, injuries and accidents, diabetes, and infections, although the association was not seen for cancer. These results from a large study of older adults were observed after adjustment for the effects of other risk factors on mortality, such as smoking and alcohol consumption. Researchers caution, however, that they can’t be sure whether these associations mean that drinking coffee actually makes people live longer. The results of the study were published in the May 17, 2012, edition of the New England Journal of Medicine.

Neal Freedman, Ph.D., Division of Cancer Epidemiology and Genetics, NCI, and his colleagues examined the association between coffee drinking and risk of death in 400,000 U.S. men and women ages 50 to 71 who participated in the NIH-AARP Diet and Health Study. Information about coffee intake was collected once by questionnaire at study entry in 1995-1996. The participants were followed until the date they died or Dec. 31, 2008, whichever came first.

The researchers found that the association between coffee and reduction in risk of death increased with the amount of coffee consumed. Relative to men and women who did not drink coffee, those who consumed three or more cups of coffee per day had approximately a 10 percent lower risk of death. Coffee drinking was not associated with cancer mortality among women, but there was a slight and only marginally statistically significant association of heavier coffee intake with increased risk of cancer death among men.

“Coffee is one of the most widely consumed beverages in America, but the association between coffee consumption and risk of death has been unclear. We found coffee consumption to be associated with lower risk of death overall, and of death from a number of different causes,’’ said Freedman. “Although we cannot infer a causal relationship between coffee drinking and lower risk of death, we believe these results do provide some reassurance that coffee drinking does not adversely affect health.”

The investigators caution that coffee intake was assessed by self-report at a single time point and theore might not lect long-term patterns of intake. Also, information was not available on how the coffee was prepared (espresso, boiled, filtered, etc.); the researchers consider it possible that preparation methods may affect the levels of any protective components in coffee.

“The mechanism by which coffee protects against risk of death -- if indeed the finding lects a causal relationship -- is not clear, because coffee contains more than 1,000 compounds that might potentially affect health,’’ said Freedman. ``The most studied compound is caffeine, although our findings were similar in those who reported the majority of their coffee intake to be caffeinated or decaffeinated.”

Caffeine consumption = decreased risk of liver disease

Caffeine consumption has long been associated with decreased risk of liver disease and reduced fibrosis in patients with chronic liver disease. Now, newly published research confirms that coffee caffeine consumption reduces the risk of advanced fibrosis in those with nonalcoholic fatty liver disease (NAFLD). Findings published in the February, 2012 issue of Hepatology, a journal of the American Association for the Study of Liver Diseases, show that increased coffee intake, specifically among patients with nonalcoholic steatohepatitis (NASH), decreases risk of hepatic fibrosis.

The steady increase in rates of diabetes, obesity, and metabolic syndrome over the past 20 years has given rise to greater prevalence of NAFLD. In fact, experts now believe NAFLD is the leading cause of chronic liver disease in the U.S., surpassing both hepatitis B and C. The majority of patients will have isolated fatty liver which has a very low likelihood of developing progressive liver disease. However, a subset of patients will have NASH, which is characterized by inflammation of the liver, destruction of liver cells, and possibly scarring of the liver. Progression to cirrhosis (advanced scarring of the liver) may occur in about 10-11% of NASH patients over a 15 year period, although this is highly variable.

To enhance understanding of the correlation between coffee consumption and the prevalence and severity of NAFLD, a team led by Dr. Stephen Harrison, Lieutenant Colonel, U.S. Army at Brooke Army Medical Center in Fort Sam Houston, Texas surveyed participants from a previous NAFLD study as well as NASH patients treated at the centers hepatology clinic. The 306 participants were asked about caffeine coffee consumption and categorized into four groups: patients with no sign of fibrosis on ultrasound (control), steatosis, NASH stage 0-1, and NASH stage 2-4.

Researchers found that the average milligrams in total caffeine consumption per day in the control, steatosis, Nash 0-1, and Nash 2-4 groups was 307, 229, 351 and 252; average milligrams of coffee intake per day was 228, 160, 255, and 152, respectively. There was a significant difference in caffeine consumption between patients in the steatosis group compared to those with NASH stage 0-1. Coffee consumption was significantly greater for patients with NASH stage 0-1, with 58% of caffeine intake from regular coffee, than with NASH stage 2-4 patients at only 36% of caffeine consumption from regular coffee.

Multiple analyses showed a negative correlation between coffee consumption and risk of hepatic fibrosis. "Our study is the first to demonstrate a histopatholgic relationship between fatty liver disease and estimated coffee intake," concludes Dr. Harrison. "Patients with NASH may benefit from moderate coffee consumption that decreases risk of advanced fibrosis. Further prospective research should examine the amount of coffee intake on clinical outcomes."


Coffee may protect against endometrial cancer

Long-term coffee consumption may be associated with a reduced risk for endometrial cancer, according to a recent study in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research.

Edward Giovannucci, M.D., Sc.D., professor of nutrition and epidemiology at the Harvard School of Public Health, said coffee is emerging as a protective agent in cancers that are linked to obesity, estrogen and insulin.

"Coffee has already been shown to be protective against diabetes due to its effect on insulin," said Giovannucci, a senior researcher on the study. "So we hypothesized that wed see a reduction in some cancers as well."

Giovannucci, along with Youjin Je, a doctoral candidate in his lab, and colleagues observed cumulative coffee intake in relation to endometrial cancer in 67,470 women who enrolled in the Nurses Health Study.

During the course of 26 years of follow-up, researchers documented 672 cases of endometrial cancer.

Drinking more than four cups of coffee per day was linked with a 25 percent reduced risk for endometrial cancer. Drinking between two and three cups per day was linked with a 7 percent reduced risk.

A similar link was seen in decaffeinated coffee, where drinking more than two cups per day was linked with a 22 percent reduced risk for endometrial cancer.

Giovannucci said he hopes this study will lead to further inquiries about the effect of coffee on cancer because in this and similar studies, coffee intake is self-selected and not randomized.

"Coffee has long been linked with smoking, and if you drink coffee and smoke, the positive effects of coffee are going to be more than outweighed by the negative effects of smoking," said Giovannucci. "However, laboratory testing has found that coffee has much more antioxidants than most vegetables and fruits."

Increased Caffeinated Coffee Consumption Associated With Decreased Risk of Depression in Women

The risk of depression appears to decrease for women with increasing consumption of caffeinated coffee, according to a report in the September 26, 2011 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

Caffeine is the most frequently used central nervous system stimulant in the world, and approximately 80 percent of consumption is in the form of coffee, according to background information in the article. Previous research, including one prospective study among men, has suggested an association between coffee consumption and depression risk. Because depression is a chronic and recurrent condition that affects twice as many women as men, including approximately one of every five U.S. women during their lifetime, “identification of risk factors for depression among women and the development of new preventive strategies are, theore, a public health priority,” write the authors. They sought to examine whether, in women, consumption of caffeine or certain caffeinated beverages is associated with the risk of depression.

Michel Lucas, Ph.D., R.D., from the Harvard School of Public Health, Boston, and colleagues studied 50,739 U.S. women who participated in the Nurses’ Health Study. Participants, who had a mean (average) age of 63, had no depression at the start of the study in 1996 and were prospectively followed up with through June 2006. Researchers measured caffeine consumption through questionnaires completed from May 1980 through April 2004, including the frequency that caffeinated and noncaffeinated coffee, nonherbal tea, caffeinated soft drinks (sugared or low-calorie colas), caffeine-free soft drinks (sugared or low-calorie caffeine-free colas or other carbonated beverages) and chocolate were usually consumed in the previous 12 months. The authors defined depression as reporting a new diagnosis of clinical depression and beginning regular use of antidepressants in the previous two years.

Analysis of the cumulative mean consumption included a two-year latency period; for example, data on caffeine consumption from 1980 through 1994 were used to predict episodes of clinical depression from 1996 through 1998; consumption from 1980 through 1998 were used for the 1998 through 2000 follow-up period; and so on. During the 10-year follow-up period from 1996 to 2006, researchers identified 2,607 incident (new-onset) cases of depression. When compared with women who consumed one cup of caffeinated coffee or less per week, those who consumed two to three cups per day had a 15 percent decrease in relative risk for depression, and those consuming four cups or more per day had a 20 percent decrease in relative risk. Compared with women in the lowest (less than 100 milligrams [mg] per day) categories of caffeine consumption, those in the highest category (550 mg per day or more) had a 20 percent decrease in relative risk of depression. No association was found between intake of decaffeinated coffee and depression risk.

“In this large prospective cohort of older women free of clinical depression or severe depressive symptoms at baseline, risk of depression decreased in a dose-dependent manner with increasing consumption of caffeinated coffee,” write the authors. They note that this observational study “cannot prove that caffeine or caffeinated coffee reduces the risk of depression but only suggests the possibility of such a protective effect.” The authors call for further investigations to confirm their results and to determine whether usual caffeinated coffee consumption could contribute to prevention or treatment of depre

Coffee Reduces Breast Cancer Risk

Recently published research shows that coffee drinkers enjoy not only the taste of their coffee but also a reduced risk of cancer with their cuppa. More detailed research published May 10, 2011 in BioMed Centrals open access journal Breast Cancer Research shows that drinking coffee specifically reduces the risk of antiestrogen-resistant estrogen-receptor (ER)-negative breast cancer.

Researchers from Sweden compared lifestyle factors and coffee consumption between women with breast cancer and age-matched women without. They found that coffee drinkers had a lower incidence of breast cancer than women who rarely drank coffee. However they also found that several lifestyle factors affected breast cancer rates, such as age at menopause, exercise, weight, education, and a family history of breast cancer. Once they had adjusted their data to account for these other factors they found that the protective effect of coffee on breast cancer was only measurable for ER-negative breast cancer.

The group from Karolinska Institutet explained that, "There is often conflicting information about the beneficial effects of coffee -- when we compared our results to that of a German study we discovered that their data showed the same trend, but the relationship was much weaker. We suggest that this may have something to do with the way the coffee was prepared, or the type of bean perred. It is unlikely that the protective effect is due to phytoestrogens present in coffee since there was no reduction in the incidence of ER-positive cancer in this study."

So while it is evident that coffee may have beneficial effects in protecting women from ER negative breast cancer the exact mechanism and compounds involved are not yet clear and not all types of coffee are the same.

New evidence that caffeine is a healthful antioxidant in coffee

Scientists are reporting an in-depth analysis of how the caffeine in coffee, tea, and other foods seems to protect against conditions such as Alzheimers disease and heart disease on the most fundamental levels. The report, which describes the chemistry behind caffeines antioxidant effects, appears in ACS The Journal of Physical Chemistry.

Annia Galano and Jorge Rafael León-Carmona describe evidence suggesting that coffee is one of the richest sources of healthful antioxidants in the average persons diet. Some of the newest research points to caffeine (also present in tea, cocoa, and other foods) as the source of powerful antioxidant effects that may help protect people from Alzheimers and other diseases. However, scientists know little about exactly how caffeine works in scavenging the so-called free radicals that have damaging effects in the body. And those few studies sometimes have reached contradictory conclusions.

In an effort to bolster scientific knowledge about caffeine, they present detailed theoretical calculations on caffeines interactions with free radicals. Their theoretical conclusions show "excellent" consistency with the results that other scientists have report from animal and other experiments, bolstering the likelihood that caffeine is, indeed, a source of healthful antioxidant activity in coffee.

Coffee protects against diabetes

Coffee, that morning elixir, may give us an early jump-start to the day, but numerous studies have shown that it also may be protective against type 2 diabetes. Yet no one has really understood why.

Now, researchers at UCLA have discovered a possible molecular mechanism behind coffees protective effect. A protein called sex hormone–binding globulin (SHBG) regulates the biological activity of the bodys sex hormones, testosterone and estrogen, which have long been thought to play a role in the development of type 2 diabetes. And coffee consumption, it turns out, increases plasma levels of SHBG.

Reporting with colleagues in the the journal Diabetes, first author Atsushi Goto, a UCLA doctoral student in epidemiology, and Dr. Simin Liu, a professor of epidemiology and medicine with joint appointments at the UCLA School of Public Health and the David Geffen School of Medicine at UCLA, show that women who drink at least four cups of coffee a day are less than half as likely to develop diabetes as non-coffee drinkers.

When the findings were adjusted for levels of SHBG, the researchers said, that protective effect disappeared.

The American Diabetes Association estimates that nearly 24 million children and adults in the U.S. — nearly 8 percent of the population — have diabetes. Type 2 diabetes is the most common form of the disease and accounts for about 90 to 95 percent of these cases.

Early studies have consistently shown that an "inverse association" exists between coffee consumption and risk for type 2 diabetes, Liu said. That is, the greater the consumption of coffee, the lesser the risk of diabetes. It was thought that coffee may improve the bodys tolerance to glucose by increasing metabolism or improving its tolerance to insulin.

"But exactly how is elusive," said Liu, "although we now know that this protein, SHBG, is critical as an early target for assessing the risk and prevention of the onset of diabetes."

Earlier work by Liu and his colleagues published in the New England Journal of Medicine had identified two mutations in the gene coding for SHBG and their effect on the risk of developing type 2 diabetes; one increases risk while the other decreases it, depending on the levels of SHBG in the blood.

A large body of clinical studies has implicated the important role of sex hormones in the development of type 2 diabetes, and its known that SHBG not only regulates the sex hormones that are biologically active but may also bind to receptors in a variety of cells, directly mediating the signaling of sex hormones.

"That genetic evidence significantly advanced the field," said Goto, "because it indicated that SHBG may indeed play a causal role in affecting risk for type 2 diabetes."

"It seems that SHBG in the blood does lect a genetic susceptibility to developing type 2 diabetes," Liu said. "But we now further show that this protein can be influenced by dietary factors such as coffee intake in affecting diabetes risk — the lower the levels of SHBG, the greater the risk beyond any known diabetes risk factors."

For the study, the researchers identified 359 new diabetes cases matched by age and race with 359 apparently healthy controls selected from among nearly 40,000 women enrolled in the Womens Health Study, a large-scale cardiovascular trial originally designed to evaluate the benefits and risks of low-dose aspirin and vitamin E in the primary prevention of cardiovascular disease and cancer.

They found that women who drank four cups of caffeinated coffee each day had significantly higher levels of SHBG than did non-drinkers and were 56 percent less likely to develop diabetes than were non-drinkers. And those who also carried the protective copy of the SHBG gene appeared to benefit the most from coffee consumption.

When the investigators controlled for blood SHBG levels, the decrease in risk associated with coffee consumption was not significant. This suggests that it is SHBG that mediates the decrease in risk of developing type 2 diabetes, Liu said.

And theres bad news for decaf lovers. "Consumption of decaffeinated coffee was not significantly associated with SHBG levels, nor diabetes risk," Goto said. "So you probably have to go for the octane!"

Coffee may protect against head and neck cancers

Data on the effects of coffee on cancer risk have been mixed. However, results of a recent study add to the brewing evidence that drinking coffee protects against cancer, this time against head and neck cancer.

Full study results are published online first in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research.

Using information from a pooled-analysis of nine studies collected by the International Head and Neck Cancer Epidemiology (INHANCE) consortium, participants who were regular coffee drinkers, that is, those who drank an estimated four or more cups a day, compared with those who were non-drinkers, had a 39 percent decreased risk of oral cavity and pharynx cancers combined.

Data on decaffeinated coffee was too sparse for detailed analysis, but indicated no increased risk. Tea intake was not associated with head and neck cancer risk.

The association is more reliable among those who are frequent, regular coffee drinkers, consuming more than four cups of coffee a day.

"Since coffee is so widely used and there is a relatively high incidence and low survival rate of these forms of cancers, our results have important public health implications that need to be further addressed," said lead researcher Mia Hashibe, Ph.D., assistant professor in the department of family and preventive medicine at the University of Utah, Salt Lake City, and a Huntsman Cancer Institute investigator.

"What makes our results so unique is that we had a very large sample size, and since we combined data across many studies, we had more statistical power to detect associations between cancer and coffee," she said.

At the AACR Frontiers in Cancer Prevention Research Conference last December, researchers from Harvard presented data that showed a strong inverse association between coffee consumption and the risk of lethal and advanced prostate cancers — men who drank the most coffee had a 60 percent lower risk of aggressive prostate cancer than men who did not drink any coffee.

More recently, results of another study published in the January issue of Cancer Epidemiology, Biomarkers & Prevention showed a decreased risk of gliomas, or brain tumors, associated with coffee. This association was found among those who drank five or more cups of coffee or tea a day, according the researchers from the Imperial College, London.

Cancer Epidemiology, Biomarkers & Prevention editorial board member Johanna W. Lampe, Ph.D., R.D., believes this current analysis by Hashibe and colleagues provides strong, additional evidence for an association between caffeinated coffee drinking and cancer risk.

"The fact that this was seen for oral and pharyngeal cancers, but not laryngeal cancers, provides some evidence as to a possible specificity of effect," said Lampe, who is a full member and associate division director in the division of public health sciences at Fred Hutchinson Cancer Research Center, Seattle., Wash.

"These findings provide further impetus to pursue research to understand the role of coffee in head and neck cancer prevention," she added. Lampe is not associated with this study.

Additional research is warranted to characterize the importance of timing and duration of exposure and possible mechanisms of action, according to Hashibe.

Coffee = Reduced Risk of Heart Rhythm Disturbances

Coffee drinkers may be less likely to be hospitalized for heart rhythm disturbances, according to a study by the Kaiser Permanente Division of Research in Oakland, Calif. The researchers note that the findings may be surprising because patients frequently report palpitations after drinking coffee.

While it has been established that very large doses of caffeine, the most active ingredient in coffee, can produce rhythm disturbances, there has been limited epidemiologic research about the caffeine doses people take. Previous data from a population study in Denmark compared heavy to light coffee drinkers with respect to risk of atrial fibrillation, the most common major rhythm disturbance, and found no statistically significant difference. This research presentation is believed to be the first large, multiethnic population study to look at all major types of heart rhythm disturbance, the researchers said.

The researchers followed 130,054 men and women and found that those who reported drinking four or more cups of coffee each day had an 18 percent lower risk of hospitalization for heart rhythm disturbances. Those who reported drinking one to three cups each day had a 7 percent reduction in risk, according to Arthur Klatsky, MD, the studys lead investigator and a senior consultant in cardiology at Kaiser Permanente Division of Research in Oakland, Calif.

"Coffee drinking is related to lower risk of hospitalization for rhythm problems, but the association does not prove cause and effect, or that coffee has a protective effect," Klasky said. Other explanations for the association might include other traits of coffee drinkers such as exercise or dietary habits. Additionally, some people with heart rhythm problems often are not hospitalized.

"However, these data might be reassuring to people who drink moderate amounts of coffee that their habit is not likely to cause a major rhythm disturbance," Klatsky said. While this report is not sufficient evidence to say that people should drink coffee to prevent rhythm problems, it supports the idea that people who are at risk for rhythm problems, or who have rhythm problems, do not necessarily need to abstain from coffee, emphasized Klatsky.

The long-term observational study involved 130,054 men and women, 18 to 90 years old, with the majority less than 50 years old. About 2 percent (3,317) were hospitalized for rhythm disturbances; 50 percent of those were for atrial fibrillation, the most common heart rhythm problem. The 18 percent reduction in risk was consistent among men and women, different ethnic groups, smokers and nonsmokers. It also was similar for various rhythm problems such as paroxysmal supraventricular tachycardia, atrial flutter, and atrial fibrillation.

Fourteen percent of the people in the study drank less than one cup of coffee a day; 42 percent drank one to three cups of coffee a day; and 17 percent reported drinking four cups or more each day. Only 27 percent of the people in the study were not coffee drinkers.

While emphasizing that these observational data do not establish causality and a protective mechanism is unclear, researchers speculate that moderate doses of caffeine may affect rhythm disturbances by antagonism of adenosine, a nucleoside compound widely distributed in the body. In the heart adenosine has several effects on conduction of electrical impulses, muscle cell energetics, and heart muscle cell recovery that might predispose to rhythm problems. Caffeine antagonizes adenosine effects by blocking its chemical sites of action.

The researchers examined hospitalization data by elapsed time after the initial examination. For hospitalization within 10 years, the reduction in hospitalizations for people who consumed four cups of coffee or more each day reached 28 percent.

The researchers also studied persons in the group with or without symptoms or history of heart and respiratory disease. For both groups, consuming four cups of coffee daily appeared to be associated with fewer hospitalizations for rhythm disturbances.

Coffee Consumption = Reduced Risk of Diabetes

Drinking more coffee (regular or decaffeinated) or tea appears to lower the risk of developing type 2 diabetes, according to an analysis of previous studies reported in the December 14/28 2009 issue of Archives of Internal Medicine, JAMA

By the year 2025, approximately 380 million individuals worldwide will be affected by type 2 diabetes (1).

Despite considerable research attention, the role of specific dietary and lifestyle factors remains uncertain, although obesity and physical inactivity have consistently been reported to raise the risk of diabetes mellitus. A previously published meta-analysis suggested drinking more coffee may be linked with a reduced risk, but the amount of available information has more than doubled since.

Rachel Huxley, D.Phil, of The George Institute for International Health, University of Sydney, Australia, and colleagues identified 18 studies involving 457,922 participants and assessing the association between coffee consumption and diabetes risk published between 1966 and 2009.

Six studies involving 225,516 individuals also included information about decaffeinated coffee, whereas seven studies with 286,701 participants reported on tea consumption.

When the authors combined and analyzed the data, they found that each additional cup of coffee consumed in a day was associated with a 7 percent reduction in the excess risk of diabetes.

Individuals who drank three to four cups per day had an approximately 25 percent lower risk than those who drank between zero and two cups per day.

In addition, in the studies that assessed decaffeinated coffee consumption, those who drank more than three to four cups per day had about a one-third lower risk of diabetes than those who drank none. Those who drank more than three to four cups of tea had a one-fifth lower risk than those who drank no tea.

That the apparent protective effect of tea and coffee consumption appears to be independent of a number of potential confounding variables raises the possibility of direct biological effects, the authors write. Because of the association between decaffeinated coffee and diabetes risk, the association is unlikely to be solely related to caffeine. Other compounds in coffee and tea including magnesium, antioxidants known as lignans or chlorogenic acids may be involved, the authors note.

If such beneficial effects were observed in interventional trials to be real, the implications for the millions of individuals who have diabetes mellitus, or who are at future risk of developing it, would be substantial, they conclude. For example, the identification of the active components of these beverages could open up therapeutic options for the primary prevention of diabetes mellitus. The findings also pose the question of whether patients most at risk for diabetes mellitus may in the future be advised to increase their consumption of tea and coffee in addition to increasing their levels of physical activity.

Spokesperson for the European Society of Cardiology, Professor Lars Rydén (Sweden), who is a diabetes specialist had the following advice: "This is a cautiously and caully conducted meta-analysis which means authors have caully conducted studies although each are too small to give an answer to the question although they indicate a positive correlation between the consumption of coffee and a decreasing occurrence of diabetes. So the principle is that if you drink coffee whether it is decaffeinated or not, you have less chance of developing diabetes. The data has been strengthened by bringing several studies together.

There are sometimes claims that coffee may do harm, that it may increase the propensity to Cardiovascular disease, but there is no evidence for this. The message is that people may drink coffee safely. Coffee from this point of view may actually be of benefit, as well as reducing the risk of getting diabetes – although the reduction is small (around 7%)."

However Prof Rydén warns that lifestyle changes far outweigh a regular coffee intake.

"Coffee helps, but other things are even more important. Those who are overweight should reduce their bodyweight by 5-10% - not too much - and include physical activity such as a brisk walk for 30 minutes a day. Then those people who are at risk of developing diabetes will reduce this risk by 40-50%.

It is interesting to consider why a beverage like coffee has a beneficial effect. It is obviously not the caffeine as decaffeinated coffee has the same efficiency as caffeinated coffee. Coffee may contain antioxidants but the studies have not measured the number of chemicals in the blood which is important."

Coffee Consumption Associated with Reduced Risk of Advanced Prostate Cancer

While it is too early for physicians to start advising their male patients to take up the habit of regular coffee drinking, data presented at the American Association for Cancer Research Frontiers in Cancer Prevention Research Conference revealed a strong inverse association between coffee consumption and the risk of lethal and advanced prostate cancers.

“Coffee has effects on insulin and glucose metabolism as well as sex hormone levels, all of which play a role in prostate cancer. It was plausible that there may be an association between coffee and prostate cancer,” said Kathryn M. Wilson, Ph.D., a postdoctoral fellow at the Channing Laboratory, Harvard Medical School and the Harvard School of Public Health.

In a prospective investigation, Wilson and colleagues found that men who drank the most coffee had a 60 percent lower risk of aggressive prostate cancer than men who did not drink any coffee. This is the first study of its kind to look at both overall risk of prostate cancer and risk of localized, advanced and lethal disease.

“Few studies have looked prospectively at this association, and none have looked at coffee and specific prostate cancer outcomes,” said Wilson. “We specifically looked at different types of prostate cancer, such as advanced vs. localized cancers or high-grade vs. low-grade cancers.”

Caffeine is actually not the key factor in this association, according to Wilson. The researchers are unsure which components of the beverage are most important, as coffee contains many biologically active compounds like antioxidants and minerals.

Using the Health Professionals’ Follow-Up Study, the researchers documented the regular and decaffeinated coffee intake of nearly 50,000 men every four years from 1986 to 2006; 4,975 of these men developed prostate cancer over that time. They also examined the cross-sectional association between coffee consumption and levels of circulating hormones in blood samples collected from a subset of men in the cohort.

“Very few lifestyle factors have been consistently associated with prostate cancer risk, especially with risk of aggressive disease, so it would be very exciting if this association is confirmed in other studies,” said Wilson. “Our results do suggest there is no reason to stop drinking coffee out of any concern about prostate cancer.”

This association might also help understand the biology of prostate cancer and possible chemoprevention measures.

Coffee W/O Milk Fights Bad Breath


We all know why Starbucks puts boxes of breath mints close to the cash register. Your morning latte can create a startling aroma in your mouth, strong enough to startle your co-workers too.

But intriguing research from Tel Aviv University by renowned breath specialist Prof. Mel Rosenberg of TAUs Sackler Faculty of Medicine finds that a coffee extract can inhibit the bacteria that lead to bad breath. laboratory tests have shown that the extract prevents malodorous bacteria from making their presence felt — or smelt.

"Everybody thinks that coffee causes bad breath," says Prof. Rosenberg, "and its often true, because coffee, which has a dehydrating effect in the mouth, becomes potent when mixed with milk, and can ferment into smelly substances."

But not always. "Contrary to our expectations, we found some components in coffee that actually inhibit bad breath," explains Prof. Rosenberg.

In the laboratory, the team monitored the bacterial odor production of coffee in saliva. In the study, three different brands of coffee were tested: the Israeli brand Elite coffee, Landwer Turkish coffee, and Tasters Choice. Prof. Rosenberg expected to demonstrate the malodor-causing effect of coffee in an in vitro saliva assay developed by Dr. Sarit Levitan in his laboratory. To his surprise, the extracts had the opposite effect.

"The lesson we learned here is one of humility," says Prof. Rosenberg. "We expected coffee would cause bad breath, but there is something inside this magic brew that has the opposite effect."

Prof. Rosenberg would love to isolate the bacterial-inhibiting molecule in order to reap the biggest anti-bacterial benefits from coffee. "Its not the raw extract we will use, he says, "but an active material within it." His latest discovery could be the foundation for an entirely class of mouthwash, breath mints and gum. Purified coffee extract can be added to a breath mint to stop bacteria from forming, stopping bad breath at its source, instead of masking the smell with a mint flavor.

Prof. Rosenberg is a successful scientist and inventor who has already developed a popular mouthwash sold widely in Europe, a pocket-based breath test, and an anti-odor chewing gum.


Caffeine reduces pain during exercise

Stopping to smell the coffee – and enjoy a cup of it – before your morning workout might do more than just get your juices flowing. It might keep you going for reasons you havent even considered.

As a former competitive cyclist, University of Illinois kinesiology and community health professor Robert Motl routinely met his teammates at a coffee shop to fuel up on caffeine prior to hitting the pavement on long-distance training rides.

"The notion was that caffeine was helping us train harder … to push ourselves a little harder," he said.

The cyclists didnt know why it helped, they just knew it was effective.

"I think intuitively a lot of people are taking caffeine before a workout and they dont realize the actual benefit theyre experiencing. That is, theyre experiencing less pain during the workout," Motl said.

He said its becoming increasingly common for athletes – before competing – to consume a variety of substances that include caffeine, motivated by "the notion that it will help you metabolize fat more readily."

"That research isnt actually very compelling," Motl said. "Whats going on in my mind is … people are doing it for that reason, but they actually take that substance that has caffeine and they can push themselves harder. It doesnt hurt as much."

The U. of I. professor has been investigating the relationship between caffeine and physical activity since taking a slight detour during his doctoral-student days, when his work initially was focused on exploring possible links between caffeine intake, spinal lexes and physical activity.

Seven years later, with several studies considering the relationship between physical activity and caffeine behind him, Motl has a much better understanding of why that cuppa Joe he used to consume before distance training and competing enhanced his cycling ability.

Early in his research, he became aware that "caffeine works on the adenosine neuromodulatory system in the brain and spinal cord, and this system is heavily involved in nociception and pain processing." Since Motl knew caffeine blocks adenosine from working, he speculated that it could reduce pain.

A number of studies by the U. of I. professor support that conclusion, including investigations considering such variables as exercise intensity, dose of caffeine, anxiety sensitivity and gender.

Motls latest published study on the effects of caffeine on pain during exercise appears in the April edition of the International Journal of Sport Nutrition and Exercise Metabolism.

"This study looks at the effects of caffeine on muscle pain during high-intensity exercise as a function of habitual caffeine use," he said. "No one has examined that before.

"What we saw is something we didnt expect: caffeine-naïve individuals and habitual users have the same amount of reduction in pain during exercise after caffeine (consumption)."

The studys 25 participants were fit, college-aged males divided into two distinct groups: subjects whose everyday caffeine consumption was extremely low to non-existent, and those with an average caffeine intake of about 400 milligrams a day, the equivalent of three to four cups of coffee.

After completing an initial exercise test in the lab on an ergometer, or stationary cycle, for determination of maximal oxygen consumption or aerobic power, subjects returned for two monitored high-intensity, 30-minute exercise sessions.

An hour prior to each session, cyclists – who had been instructed not to consume caffeine during the prior 24-hour period – were given a pill. On one occasion, it contained a dose of caffeine measuring 5 milligrams per kilogram of body weight (equivalent to two to three cups of coffee); the other time, they received a placebo.

During both exercise periods, subjects perceptions of quadriceps muscle pain was recorded at regular intervals, along with data on oxygen consumption, heart rate and work rate.

"Whats interesting," Motl said, "is that when we found that caffeine tolerance doesnt matter, we were perplexed at first. Then we looked at reviews of the literature relative to caffeine and tolerance effects across a variety of other stimuli. Sometimes you see them, sometimes you dont. That is, sometimes regular caffeine use is associated with a smaller response, whereas, other times, its not."

No ones been able to figure out the reason for the inconsistency, Motl said.

"Clearly, if you regularly consume caffeine, you have to have more to have that bigger, mental-energy effect. But the tolerance effect is not ubiquitous across all stimuli. Even brain metabolism doesnt show this tolerance-type effect. That is, with individuals who are habitual users versus non-habitual users, if you give them caffeine and do brain imaging, the activation is identical. Its really interesting why some processes show tolerance and others dont."

Regarding the outcome of the current research, he said, "it may just be that pain during exercise doesnt show tolerance effects to caffeine."

Motl said one of the next logical steps for his research team would be to conduct studies with rodents in order to better understand the biological mechanism for caffeine in reducing pain.

"If we can get at the biological mechanism, we can begin to understand why there may or may not be this kind of tolerance."

Motl said another research direction might be to determine caffeines effect on sport performance.

"Weve shown that caffeine reduces pain reliably, consistently during cycling, across different intensities, across different people, different characteristics. But does that reduction in pain translate into an improvement in sport performance?"

Meanwhile, the current research could prove encouraging for a range of people, including the average person who wants to become more physically active to realize the health benefits.

"One of the things that may be a practical application, is if you go to the gym and you exercise and it hurts, you may be prone to stop doing that because pain is an aversive stimulus that tells you to withdraw. So if we could give people a little caffeine and reduce the amount of pain theyre experiencing, maybe that would help them stick with that exercise.

"Maybe then theyll push a little harder as well … maybe get even better adaptations to the exercise."

Higher Coffee Consumption Associated with Lower Liver Cancer Risk

A large, prospective population-based study confirms an inverse relationship between coffee consumption and liver cancer risk. The study also found that higher levels of gamma-glutamyltransferase (GGT) in the blood were associated with an increased risk of developing the disease. These findings are published in the July issue of Hepatology, a journal published by John Wiley & Sons on behalf of the American Association for the Study of Liver Diseases (AASLD). The article and an accompanying editorial are also available online at Wiley Interscience (www.interscience.wiley.com).

Researchers led by Gang Hu at the University of Helsinki set out to examine the associations between coffee consumption and serum GGT with the risk of liver cancer in a large prospective cohort. Residents of Finland drink more coffee per capita than the Japanese, Americans, Italians, and other Europeans, so Hu and colleagues studied 60,323 Finnish participants ages 25 to 74 who were cancer-free at baseline. The Finns were included in seven independent cross-sectional population surveys conducted between 1972 and 2002 and followed up through June 2006.

The participants completed a mail-in questionnaire about their medical history, socioeconomic factors and dietary and lifestyle habits. For a subset of participants, clinical data was available, including serum levels of GGT. Data on subsequent cancer diagnoses was collected from the country-wide Finnish Cancer Registry.

Based on their answers to the question: “How many cups of coffee do you drink daily?” the participants were divided into five categories: 0-1 cup, 2-3 cups, 4-5 cups, 6-7 cups, and 8 or more cups per day. After a median follow-up period of 19.3 years, 128 participants were diagnosed with liver cancer.

The researchers noted a significant inverse association between coffee drinking and the risk of primary liver cancer. They found that the multivariable hazards ratio of liver cancer dropped for each group that drank more coffee. It fell from 1.00, to .66, to .44, to .38 to .32 respectively. “The biological mechanisms behind the association of coffee consumption with the risk of liver cancer are not known,” the authors point out.

They also found that high levels of serum GGT were associated with an increased risk of liver cancer. The hazard ratio of liver cancer for the highest vs. lowest quartile of serum GGT was 3.13. “Nevertheless,” they report, “the inverse association between coffee consumption and the risk of liver cancer was consistent in the subjects at any level of serum GGT.”

An accompanying editorial by Carlo La Vecchia of Milan says that Hu’s study solidly confirms the inverse relationship between coffee drinking and liver cancer risk, though we still don’t know if it is causal. “Furthermore, the study by Hu et al. provides original and important quantitative evidence that the levels of GGT are related to subsequent incidence of liver cancer, with an overall relative risk of 2.3,” he says.

La Vecchia notes, however, that, “It remains difficult, however, to translate the inverse relation between coffee drinking and liver cancer risk observed in epidemiological studies into potential implications for prevention of liver cancer by increasing coffee consumption.”


Coffee could protect against Alzheimers disease


A daily dose of caffeine blocks the disruptive effects of high cholesterol that scientists have linked to Alzheimers disease. A study in the open access publication, Journal of Neuroinflammation revealed that caffeine equivalent to just one cup of coffee a day could protect the blood-brain barrier (BBB) from damage that occurred with a high-fat diet.

The BBB protects the central nervous system from the rest of the bodys circulation, providing the brain with its own regulated microenvironment. Previous studies have shown that high levels of cholesterol break down the BBB which can then no longer protect the central nervous system from the damage caused by blood borne contamination. BBB leakage occurs in a variety of neurological disorders such as Alzheimers disease.

In this study, researchers from the University of North Dakota School of Medicine and Health Sciences gave rabbits 3 mg caffeine each day – the equivalent of a daily cup of coffee for an average-sized person. The rabbits were fed a cholesterol-enriched diet during this time.

After 12 weeks a number of laboratory tests showed that the BBB was significantly more intact in rabbits receiving a daily dose of caffeine.

“Caffeine appears to block several of the disruptive effects of cholesterol that make the blood-brain barrier leaky,” says Jonathan Geiger, University of North Dakota School of Medicine and Health Sciences. “High levels of cholesterol are a risk factor for Alzheimers disease, perhaps by compromising the protective nature of the blood-brain barrier. For the first time we have shown that chronic ingestion of caffeine protects the BBB from cholesterol-induced leakage.”

Caffeine appears to protect BBB breakdown by maintaining the expression levels of tight junction proteins. These proteins bind the cells of the BBB tightly to each other to stop unwanted molecules crossing into the central nervous system.

The findings confirm and extend results from other studies showing that caffeine intake protects against memory loss in aging and in Alzheimer’s disease.

“Caffeine is a safe and readily available drug and its ability to stabilise the blood-brain barrier means it could have an important part to play in therapies against neurological disorders,” says Geiger.

Coffee drinkers have slightly lower death rates than people who do not drink coffee


A study published in Annals of Internal Medicine has good news for coffee drinkers: Regular coffee drinking (up to 6 cups per day) is not associated with increased deaths in either men or women. In fact, both caffeinated and decaffeinated coffee consumption is associated with a somewhat smaller rate of death from heart disease.

"Coffee consumption has been linked to various beneficial and detrimental health effects, but data on its relation with death were lacking," says Esther Lopez-Garcia, PhD, the studys lead author. "Coffee consumption was not associated with a higher risk of mortality in middle-aged men and women. The possibility of a modest benefit of coffee consumption on heart disease, cancer, and other causes of death needs to be further investigated."

Women consuming two to three cups of caffeinated coffee per day had a 25 percent lower risk of death from heart disease during the follow-up period (which lasted from 1980 to 2004 and involved 84,214 women) as compared with non-consumers, and an 18 percent lower risk of death caused by something other than cancer or heart disease as compared with non-consumers during follow-up. For men, this level of consumption was associated with neither a higher nor a lower risk of death during the follow-up period (which lasted from 1986 to 2004 and involved 41,736 men).

The researchers analyzed data of 84,214 women who had participated in the Nurses Health Study and 41,736 men who had participated in the Health Professionals Follow-up Study. To be in the current study, participants had to have been free of cancer and heart disease at the start of those larger studies.

The study participants completed questionnaires every two to four years that included questions about how frequently they drank coffee, other diet habits, smoking, and health conditions. The researchers then compared the frequency of death from any cause, death due to heart disease, and death due to cancer among people with different coffee-drinking habits.

Among women, 2,368 deaths were due to heart disease, 5,011 were due to cancer, and 3,716 were due to another cause. Among men, 2,049 deaths were due to heart disease, 2,491 were due to cancer, and 2,348 were due to another cause.

While accounting for other risk factors, such as body size, smoking, diet, and specific diseases, the researchers found that people who drank more coffee were less likely to die during the follow-up period. This was mainly because of lower risk for heart disease deaths among coffee drinkers.

The researchers found no association between coffee drinking and cancer deaths. These relationships did not seem to be related to caffeine because people who drank decaffeinated coffee also had lower death rates than people who did not drink coffee.

The editors of Annals of Internal Medicine caution that the design of the study does not make it certain that coffee decreases the chances of dying sooner than expected. Something else about coffee drinkers might be protecting them. And some measurement error in the assessment of coffee consumption is inevitable because estimated consumption came from self-reports.


In women, caffeine may protect memory

Caffeine may help older women protect their thinking skills, according to a study published in the August 7, 2007, issue of Neurology, the medical journal of the American Academy of Neurology.

The study found that women age 65 and older who drank more than three cups of coffee (or the equivalent in tea) per day had less decline over time on tests of memory than women who drank one cup or less of coffee or tea per day. The results held up even after researchers adjusted for other factors that could affect memory abilities, such as age, education, disability, depression, high blood pressure, medications, cardiovascular disease, and other chronic illnesses.

“Caffeine is a psychostimulant which appears to reduce cognitive decline in women,” said study author Karen Ritchie,. “While we have some ideas as to how this works biologically, we need to have a better understanding of how caffeine affects the brain before we can start promoting caffeine intake as a way to reduce cognitive decline. But the results are interesting – caffeine use is already widespread and it has fewer side effects than other treatments for cognitive decline, and it requires a relatively small amount for a beneficial effect.”

The study involved 7,000 people whose cognitive abilities and caffeine consumption were evaluated over four years. Compared to women who drank one cup or less of coffee per day, those who drank over three cups were less likely to show as much decline in memory. Moreover, the benefits increased with age – coffee drinkers being 30 percent less likely to have memory decline at age 65 and rising to 70 percent less likely over age 80.
Caffeine consumers did not seem to have lower rates of dementia. “We really need a longer study to look at whether caffeine prevents dementia; it might be that caffeine could slow the dementia process rather than preventing it,” said Ritchie.

Ritchie said researchers aren’t sure why caffeine didn’t show the same result in men. “Women may be more sensitive to the effects of caffeine,” she said. “Their bodies may react differently to the stimulant, or they may metabolize caffeine differently.”


Caffeine may prevent heart disease death in elderly

Habitual intake of caffeinated beverages provides protection against heart disease mortality in the elderly, say researchers at SUNY Downstate Medical Center and Brooklyn College._

Using data from the first federal National Health and Nutrition Examination Survey Epidemiologic Follow-up Study, the researchers found that survey participants 65 or more years old with higher caffeinated beverage intake exhibited lower relative risk of coronary vascular disease and heart mortality than did participants with lower caffeinated beverage intake.__

John Kassotis, MD, associate professor of medicine at SUNY Downstate, said, "The protection against death from heart disease in the elderly afforded by caffeine is likely due to caffeines enhancement of blood pressure."_

The protective effect also was found to be dose-responsive: the higher the caffeine intake the stronger the protection. The protective effect was found only in participants who were not severely hypertensive. No significant protective effect was in patients below the age of 65.

Coffee consumption may lower blood uric acid levels

High uric acid levels in the blood are a precursor of gout, the most common inflammatory arthritis in adult men. It is believed that coffee and tea consumption may affect uric acid levels but only one study has been conducted to date. A large-scale study published in the June 2007 issue of Arthritis Care & Research (http://www.interscience.wiley.com/journal/arthritiscare) examined the relationship between coffee, tea, caffeine intake, and uric acid levels and found that coffee consumption is associated with lower uric acid levels but that this appears to be due to components other than caffeine.

Coffee is one of the most widely consumed beverages in the world; more than 50 percent of Americans drink it at the average rate of 2 cups per day. Because of this widespread consumption, its potential effects have important implications for public and individual health. Led by Hyon K. Choi, of the University of British Columbia in Vancouver, Canada, the current study was based on the U.S. Third National Health and Nutrition Examination Survey, conducted between 1988 and 1994. It included over 14,000 men and women at least 20 years old who consented to a medical exam in which blood and urine specimens were obtained. Coffee and tea consumption were determined based on responses to a food questionnaire that assessed intake over the previous month. Researchers estimated the amount of caffeine per cup of coffee or tea using data from the U.S. Department of Agriculture.

The results showed that levels of uric acid in the blood significantly decreased with increasing coffee intake, but not with tea intake. In addition, there was no association between total caffeine intake from beverages and uric acid levels. These results were similar to those found in the only previous study on the topic, which was conducted in Japan. Interestingly, there was an association between decaffeinated coffee consumption and uric acid levels. "These findings suggest that components of coffee other than caffeine contribute to the observed inverse association between coffee intake and uric acid levels," the researchers state.

A recent study found that coffee was associated lower C peptide levels (a marker of insulin levels). The researchers in the current study suggest that because there is a strong relationship between insulin resistance and elevated uric acid levels, the decreased insulin levels associated with coffee consumption may lead to lower uric acid levels. Coffee is also a major source of chlorogenic acid, a strong antioxidant, which may improve insulin sensitivity. Chlorogenic acid also helps inhibit glucose absorption in the intestine; in another study decaffeinated coffee seemed to delay intestinal absorption of glucose and increase concentrations of glucagon-like peptide 1, which is well known for its beneficial effects on insulin secretion and action. The researchers note further that their results could be due to an effect of non-caffeine components found in coffee, which would also explain why coffee affected uric acid levels but tea did not.

To examine how coffee consumption might aggravate or protect against this common and excruciatingly painful condition, researchers at the Arthritis Research Centre of Canada, University of British Columbia in Canada, Brigham and Women’s Hospital, Harvard Medical School, and Harvard School of Public Health in Boston conducted a prospective study on 45,869 men over age 40 with no history of gout at baseline. Over 12 years of follow-up, Hyon K. Choi, MD, DrPH, and his associates evaluated the relationship between the intake of coffee and the incidence of gout in this high risk population. Their findings, featured in the June 2007 issue of Arthritis & Rheumatism (http://www.interscience.wiley.com/journal/arthritis), provide compelling evidence that drinking 4 or more cups of coffee a day dramatically reduces the risk of gout for men.

Subjects were drawn from an ongoing study of some 50,000 male health professionals, 91 percent white, who were between 40 and 75 years of age in 1986 when the project was initiated. To assess coffee and total caffeine intake, Dr. Choi and his team used a food-frequency questionnaire, updated every 4 years. Participants chose from 9 frequency responses – ranging from never to 2 to 4 cups per week to 6 or more per day – to record their average consumption of coffee, decaffeinated coffee, tea, and other caffeine-containing comestibles, such as cola and chocolate.

Through another questionnaire, the researchers documented 757 newly diagnosed cases meeting the American College of Rheumatology criteria for gout during the follow-up period. Then, they determined the relative risk of incident gout for long-term coffee drinkers divided into 4 groups – less than 1 cup per day, 1 to 3 cups per day, 4 to 5 cups per day, and 6 or more cups per day – as well as for regular drinkers of decaffeinated coffee, tea, and other caffeinated beverages. They also evaluated the impact of other risk factors for gout – body mass index, history of hypertension, alcohol use, and a diet high in red meat and high-fat dairy foods among them – on the association between coffee consumption and gout among the study participants.

Most significantly, the data revealed that the risk for developing gout decreased with increasing coffee consumption. The risk of gout was 40 percent lower for men who drank 4 to 5 cups a day and 59 percent lower for men who drank 6 or more cups a day than for men who never drank coffee. There was also a modest inverse association with decaffeinated coffee consumption. These findings were independent of all other risk factors for gout. Tea drinking and total caffeine intake were both shown to have no effect on the incidence of gout among the subjects. On the mechanism of these findings, Dr. Choi speculates that components of coffee other than caffeine may be responsible for the beverage’s gout-prevention benefits. Among the possibilities, coffee contains the phenol chlorogenic acid, a strong antioxidant.

While not prescribing 4 or more cups a day, this study can help individuals make an informed choice regarding coffee consumption. "Our findings are most directly generalizable to men age 40 years and older, the most gout-prevalent population, with no history of gout," Dr. Choi notes. "Given the potential influence of female hormones on the risk of gout in women and an increased role of dietary impact on uric acid levels among patients with existing gout, prospective studies of these populations would be valuable."

Moderate coffee drinking reduces many risks

Although the American Society for Nutrition’s popular “controversy session” at Experimental Biology 2007 focuses on the health effects of coffee drinking, panel chair Dr. James Coughlin, a toxicology/safety consultant at Coughlin & Associates, says that recent advances in epidemiologic and experimental knowledge have transformed many of the negative health myths about coffee drinking into validated health benefits.

Indeed, panel co-chair Dan Steffen, who follows coffee and health issues in the Scientific and Regulatory Affairs group of Kraft Foods, note that the “controversy” is often to educate a wider audience about this transformation in understanding.

Coffee is among the most widely consumed beverages in the world, and Dr. Coughlin says that the preponderance of scientific evidence - some by the panelists - suggests that moderate coffee consumption (3-5 cups per day) may be associated with reduced risk of certain disease conditions, such as Parkinson’s disease. Some research in neuropharamacology suggests that one cup of coffee can halve the risk of Parkinson’s disease. Other studies have found it reduces the risk of Alzheimers disease, kidney stones, gallstones, depression and even suicide.

Dr. Coughlin and two distinguished researchers discussed some of the benefits - and a couple of the remaining increased risk factors (possible increase in blood pressure and plasma homocysteine) - on April 30 at the Experimental Biology meeting in Washington, DC.

Dr. Rob van Dam, an epidemiologist at the Harvard School of Public Health and the Harvard Medical School, studies the link between diet and the development of type 2 diabetes. Worldwide, an estimated 171 million persons have diabetes, mostly type 2 diabetes, and an alarming increase to 366 million persons is expected for the year 2030. While increased physical activity and restriction of energy intake can substantially reduce risk of type 2 diabetes, he believes insight into the role of other lifestyle factors may contribute to additional prevention strategies for type 2 diabetes.

In recent epidemiological studies in the U.S., Europe and Japan, persons who were heavy coffee consumers had a lower risk of type 2 diabetes than persons who consumed little coffee. Interestingly, he says, associations were similar for caffeinated and decaffeinated coffee, suggesting that coffee components other than caffeine may be beneficial for glucose metabolism.

Coffee contains hundreds of components including substantial amounts of chlorogenic acid, caffeine, magnesium, potassium, vitamin B3, trigonelline, and lignans. Limited evidence suggests that coffee may improve glucose metabolism by reducing the rate of intestinal glucose absorption and by stimulating the secretion of the gut hormone glucagon-like peptide-1 (GLP-1) that is beneficial for the secretion of insulin. However, most mechanistic research on coffee and glucose metabolism has been done in animals and in lab tubes and theore metabolic studies in humans are currently being conducted. Further research may lead to the development or selection of coffee types with improved health effects.

Dr. Lenore Arab, a nutritional epidemiologist in the David Geffen School of Medicine at UCLA, notes that the first coffee controversy dates back 430 years when in 1570 some monks petitioned the pope to condemn this drink, so popular among Muslims. Pope Clement VIII, liking how it kept the monks from falling sleep during mass, purportedly blessed it instead. The rest, including the United States’ wholesale conversion to coffee following the Boston Tea Party, is history.

In reviewing the latest epidemiologic literature on cancers and coffee, Dr. Arab has found there to be close to 400 studies of the associations between coffee consumption and cancers various at various sites. The earlier controversy with regard to colon cancer was based on flawed analyses, she says. More thorough analyses and the accumulation of evidence suggest no negative effect on the incidence of colon cancer, and possible protective effects for adenomas of the colon as well as for rectal cancer and liver cancer. Mechanisms which might contribute to a possible anticarcinogenic effect include reduction in cholesterol, bile acid and neutral sterol secretion in the colon, increased colonic motility and reduced exposure of epithelium to carcinogens, the ability of diterpenes to reduce genotoxicity of carcinogens, and lower DNA adduct formation, and the ability of caffeic acid and chlorogenic acid to decreased DNA methylation. In other cancers - breast, ovarian, and prostate - the evidence is not suggestive of either risk or protection. There are two areas, says Dr. Arab, in which there is some evidence of increased risk: leukemia and stomach cancer. The evidence for the former is intriguing, for the latter insubstantial. She concludes that a systematic review of the newer data for liver, rectal, stomach cancer and for childhood leukemia is due.

Study finds that caffeine cuts post-workout pain by nearly 50 percent

Although it’s too soon to recommend dropping by Starbucks before hitting the gym, a study suggests that caffeine can help reduce the post-workout soreness that discourages some people from exercising.

In a study published in the February 2007 issue of The Journal of Pain, a team of University of Georgia researchers finds that moderate doses of caffeine, roughly equivalent to two cups of coffee, cut post-workout muscle pain by up to 48 percent in a small sample of volunteers.

Lead author Victor Maridakis, a researcher in the department of kinesiology at the UGA College of Education, said the findings may be particularly relevant to people to exercise, since they tend to experience the most soreness.

“If you can use caffeine to reduce the pain, it may make it easier to transition from that first week into a much longer exercise program,” he said.

Maridakis and his colleagues studied nine female college students who were not regular caffeine users and did not engage in regular resistance training. One and two days after an exercise session that caused moderate muscle soreness, the volunteers took either caffeine or a placebo and performed two different quadriceps (thigh) exercises, one designed to produce a maximal force, the other designed to generate a sub-maximal force. Those that consumed caffeine one-hour before the maximum force test had a 48 percent reduction in pain compared to the placebo group, while those that took caffeine before the sub-maximal test reported a 26 percent reduction in pain.

Caffeine has long been known to increase alertness and endurance, and a 2003 study led by UGA professor Patrick O’Connor found that caffeine reduces thigh pain during moderate-intensity cycling. O’Connor, who along with professors Kevin McCully and the late Gary Dudley co-authored the current study, explained that caffeine likely works by blocking the body’s receptors for adenosine, a chemical released in response to inflammation.

Despite the positive findings in the study, the researchers say there are some caveats. First, the results may not be applicable to regular caffeine users, since they may be less sensitive to caffeine’s effect. The researchers chose to study women to get a definitive answer in at least one sex, but men may respond differently to caffeine. And the small sample size of nine volunteers means that the study will have to be replicated with a larger study.

O’Connor said that despite these limitations, caffeine appears to be more effective in relieving post-workout muscle pain than several commonly used drugs. Previous studies have found that the pain reliever naproxen (the active ingredient in Aleve) produced a 30 percent reduction in soreness. Aspirin produced a 25 percent reduction, and ibuprofen has produced inconsistent results.


“A lot of times what people use for muscle pain is aspirin or ibuprofen, but caffeine seems to work better than those drugs, at least among women whose daily caffeine consumption is low,” O’Connor said.


Still, the researchers recommend that people use caution when using caffeine before a workout. For some people, too much caffeine can produce side effects such as jitteriness, heart palpitations and sleep disturbances.

“It can reduce pain,” Maridakis said, “but you have to apply some common sense and not go overboard.”