Imagine a world without coffee
Guess what would be the average productivity in our countries if people had to start the day without having their cup of coffee first: it would probably look like a remake of Zombieland in most companies and organizations. Some people need that first java cup before they are able to say a single word. Some others are less addicted to coffee but it is still part of their morning routine and they probably underestimate the effects that a cup of Joe has for their body and mind. And we don’t even mention the java cup or two which fortunately prevent most offices to look like dormitories in the afternoon.
This sort of nightmare scenario refers of course to the physiological effects of coffee which are well-known, coffee being one of the most consumed beverages around the world and studied since years in thousands of medical studies, analyzing the risks and benefits for adults and even children. Then, why this buzz around coffee these last weeks? Simply because a recent study, published in May 2012 by the New England Journal of Medicine, concluded after 13 years of follow-up of almost 230,000 men and 175,000 women that coffee consumption decreased all-cause mortality by more than 10%.
We have a special interest in this topic for several reasons:
- Caffeine is an alkaloid, this fascinating family that we have described through the example of ephedrine.
- From a scientific point of view, it is interesting to see how coffee has been perceived in terms of risks and benefits for health: doctors used to tell us that coffee was bad us and now they say it’s good, what should we believe?
We will go through these risks and benefits based on the latest studies, reflecting the current point of view of the medical community. Then we will detail what belongs to caffeine, based on studies which compared the effects of coffee and caffeinated coffee.
Benefits of your daily java cups
Based on a serious body of research, there is today a strong evidence that coffee consumption plays a positive role in the following conditions:
Cardiovascular and cerebrovascular diseases
The counter-intuitive result of studies shows that coffee can reduce heart rhythm problems and lower the risk of stroke up to 20%      
Coffee drinkers have fewer cases of cancers such as head and neck  , basal cell carcinoma , breast cancer , endometrial cancer , oral, esophageal and pharyngeal cancer , aggressive men’s prostate cancer  and colorectal cancer . This is most probably due to the antioxidant and antimutagenic properties of coffee. 
A Harvard study found that women who drink four or more cups of coffee daily have a 20% lower risk of depression. 
Negative effects of coffee
While recent studies add to the list of benefits associated to a reasonable coffee consumption, many health professionals keep drawing attention on the risks linked to an excessive number of coffee cups per day. Some of the following conditions are still a matter of debate between medical experts, due to contradictory results of the concerned studies. In that case, further research is needed but meanwhile it is safe to consider that people who drink too much coffee may be exposed to these risks:
Heart rhythm problems (cardiac arrhythmias due to vasoconstriction) may occur in case of heavy coffee drinking habits. 
Blood pressure and risk of hypertension: this point is unclear, as different studies presented contradictory results, the latest ones show no relation between coffee drinking and clinical hypertension. 
Cholesterol levels may go up in case of excessive consumption of unfiltered coffee. 
Pregnancy: the excess of coffee (more than 7 cups) is suspected to raise the risk of low birth rate, miscarriage, premature birth and stillbirth . It is recommended to pregnant women to have a moderate coffee consumption.
Heartburn results from the acidic nature of coffee, but it has been found that espresso and dark-roasted coffee may contain a substance that limits the production of acid by the stomach. 
Sleep disorders (insomnia, nervousness, anxiety) : depending on individual sensitivity, these side effects can occur until caffeine is totally processed by the liver (half live of 5 to 7 hours).
Addiction: considered as low by most experts, due to the quick development of a tolerance to caffeine. The main symptoms of withdrawal include headache, irritability and fatigue. 
Coffee or caffeine?
Some might be surprised by this question but it makes sense: caffeine is naturally the important ingredient in coffee but other compounds such as antioxidants play also an important role in the above mentioned health benefits. This is why several studies found the same effects for coffee and decaffeinated coffee. In fact, you can have coffee without caffeine, but also you might take caffeine without coffee: during the decaffeination process, may it be through water extraction or by chemical solvents, caffeine is recovered by manufacturers and sold alone as tablets. Thus three intake possibilities exist: coffee, decaffeinated coffee or caffeine alone. We will detail in our next article the effects of caffeine combined to ephedrine in EC stacks for weight loss purpose, in this section we would like to review the main differences found by medical studies between the consumption of coffee and decaffeinated coffee.
- Caffeine has been identified as the probable key factor for the risk reduction in several conditions, thereof breast cancer, skin cancer, gallstones and gallbladder disease, mental sharpness especially by older people, because people who drank decaffeinated coffee did not experience the same benefits.
- On the other hand, one study found that people who had 2 cups of decaf coffee per day had half the risk of rectal cancer, compared with people drinking normal coffee.
- All other benefits mentioned in the previous section appear for both coffee and decaffeinated coffee: prevention of diabetes and strokes, reduction in endometrial or prostate cancer among others.
The researchers explain it by the fact that both coffee and decaffeinated coffee share protective components such as minerals and antioxidants, methylpyridinium for instance, which lower inflammation and protect cells from oxygen-free radicals.
Is coffee good or bad for us? Based on their current knowledge, today medical experts say that they have few proven benefits but a growing list of potential benefits, especially in case of a moderate coffee consumption.
Regarding decaffeinated coffee, it appears that coffee with caffeine has more health benefits, as it brings the full range of effects and not only those associated with antioxidants properties.
Why is decaffeinated coffee so popular then, or in other words, why are so many people deliberately avoiding caffeine? We will give our own answers in the next article.
Why Do People Drink Decaffeinated Coffee?
Knowing the benefits of a moderate coffee consumption, we can legitimately raise the question. In this post we analyze medical studies’ methodology (observational versus interventional studies) explaining why doctors were lacking scientific evidence of health benefits of coffee and caffeine.
1. Salazar-Martinez E, Willett WC, et al. “Coffee consumption and risk for type 2 diabetes mellitus“. Ann Intern Med. 2004 Jan 6;140(1):1-8.
2. van Dam RM, Willett WC, et al. “Coffee, caffeine, and risk of type 2 diabetes: a prospective cohort study in younger and middle-aged U.S. women“. Diabetes Care. 2006 Feb;29(2):398-403.
3. Huxley R, Lee CM, et al. “Coffee, decaffeinated coffee, and tea consumption in relation to incident type 2 diabetes mellitus: a systematic review with meta-analysis“. Arch Intern Med. 2009 Dec 14;169(22):2053-63.
4. Floegel A, Pischon T, et al. “Coffee consumption and risk of chronic disease in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Germany study“. Am J Clin Nutr. 2012 Apr;95(4):901-8.
5. Benedetti MD, Bower JH, et al. “Smoking, alcohol, and coffee consumption preceding Parkinson’s disease: a case-control study“. Neurology. 2000 Nov 14;55(9):1350-8.
6. Ross GW, Abbott RD, et al. “Association of coffee and caffeine intake with the risk of Parkinson disease“. JAMA. 2000 May 24-31;283(20):2674-9.
7. Maia L, de Mendonça A. “Does caffeine intake protect from Alzheimer’s disease?“. Eur J Neurol. 2002 Jul;9(4):377-82.
8. Lindsay J, Laurin D, et al. (2002). “Risk factors for Alzheimer’s disease: a prospective analysis from the Canadian Study of Health and Aging“. Am J Epidemiol. 2002 Sep 1;156(5):445-53.
9. Cao C, Loewenstein DA, et al. “High Blood caffeine levels in MCI linked to lack of progression to dementia“. J Alzheimers Dis. 2012;30(3):559-72.
10. Mineharu Y, Koizumi A, et al. “Coffee, green tea, black tea and oolong tea consumption and risk of mortality from cardiovascular disease in Japanese men and women“. J Epidemiol Community Health. 2011 Mar;65(3):230-40.
11. Larsson SC, Orsini N. “Coffee consumption and risk of stroke: a dose-response meta-analysis of prospective studies“. Am J Epidemiol. 2011 Nov 1;174(9):993-1001.
12. Lopez-Garcia E, van Dam RM, et al. “The relationship of coffee consumption with mortality“. Ann Intern Med. 2008 Jun 17;148(12):904-14.
13. Matsuura H, Mure K, et al. “Relationship between coffee consumption and prevalence of metabolic syndrome among Japanese civil servants“. J Epidemiol. 2012 Mar 5;22(2):160-6.
14. Montagnana M, Favaloro EJ, Lippi G. “Coffee intake and cardiovascular disease: virtue does not take center stage“. Semin Thromb Hemost. 2012 Mar;38(2):164-77.
15. Wu JN, Ho SC, et al. “Coffee consumption and risk of coronary heart diseases: a meta-analysis of 21 prospective cohort studies“. Int J Cardiol. 2009 Nov 12;137(3):216-25.
16. Galeone C, Tavani A, et al. “Coffee and tea intake and risk of head and neck cancer: pooled analysis in the international head and neck cancer epidemiology consortium“. Cancer Epidemiol Biomarkers Prev. 2010 Jul;19(7):1723-36.
17. Turati F, Galeone C, et al. “Coffee and cancers of the upper digestive and respiratory tracts: meta-analyses of observational studies“. Ann Oncol. 2011 Mar;22(3):536-44.
18. Song F, Qureshi AA, Han J. “Increased caffeine intake is associated with reduced risk of basal cell carcinoma of the skin“. Cancer Res. 2012 Jul 1;72(13):3282-9.
19. Ganmaa D, Willett WC, et al. “Coffee, tea, caffeine and risk of breast cancer: a 22-year follow-up“. Int J Cancer. 2008 May 1;122(9):2071-6.
20. Je Y, Hankinson SE, et al. “A prospective cohort study of coffee consumption and risk of endometrial cancer over a 26-year follow-up“. Cancer Epidemiol Biomarkers Prev. 2011 Dec;20(12):2487-95.
21. Rodriguez T, Altieri A, et al. “Risk factors for oral and pharyngeal cancer in young adults“. Oral Oncol. 2004 Feb;40(2):207-13.
22. Wilson KM, Kasperzyk JL, et al. “Coffee consumption and prostate cancer risk and progression in the Health Professionals Follow-up Study“. J Natl Cancer Inst. 2011 Jun 8;103(11):876-84.
23. Arab L. “Epidemiologic evidence on coffee and cancer“. Nutr Cancer. 2010;62(3):271-83.
24. Chu YF, Brown PH, et al. “Roasted coffees high in lipophilic antioxidants and chlorogenic acid lactones are more neuroprotective than green coffees“. J Agric Food Chem. 2009 Oct 28;57(20):9801-8.
25. Lucas M, Mirzaei F, et al. “Coffee, caffeine, and risk of depression among women“. Arch Intern Med. 2011 Sep 26;171(17):1571-8.
26. Klatsky AL, Morton C, et al. “Coffee, cirrhosis, and transaminase enzymes“. Arch Intern Med. 2006 Jun 12;166(11):1190-5.
27. Inoue M, Yoshimi I, et al. “Influence of coffee drinking on subsequent risk of hepatocellular carcinoma: a prospective study in Japan“. J Natl Cancer Inst. 2005 Feb 16;97(4):293-300.
28. Leitzmann MF, Willett WC, et al. “A prospective study of coffee consumption and the risk of symptomatic gallstone disease in men“. JAMA. 1999 Jun 9;281(22):2106-12.
29. Leitzmann MF, Stampfer MJ, et al. “Coffee intake is associated with lower risk of symptomatic gallstone disease in women“. Gastroenterology. 2002 Dec;123(6):1823-30.
30. Choi HK, Willett W, Curhan G. “Coffee consumption and risk of incident gout in men: a prospective study“. Arthritis Rheum. 2007 Jun;56(6):2049-55.
31. Diamond S, Balm TK, Freitag FG. “Ibuprofen plus caffeine in the treatment of tension-type headache“. Clin Pharmacol Ther. 2000 Sep;68(3):312-9.
32. Arita R, Yanagi Y, et al. “Caffeine increases tear volume depending on polymorphisms within the adenosine A2a receptor gene and cytochrome P450 1A2“. Ophthalmology. 2012 May;119(5):972-8.
33. Touger-Decker R, van Loveren C. “Sugars and dental caries“. Am J Clin Nutr. 2003 Oct;78(4):881S-892S.
34. Lopez-Garcia E, van Dam RM, et al. “Coffee consumption and coronary heart disease in men and women: a prospective cohort study“. Circulation. 2006 May 2;113(17):2045-53.
35. Winkelmayer WC, Stampfer MJ, et al. “Habitual caffeine intake and the risk of hypertension in women“. JAMA. 2005 Nov 9;294(18):2330-5.
36. Ricketts ML, Boekschoten MV, et al. “The cholesterol-raising factor from coffee beans, cafestol, as an agonist ligand for the farnesoid and pregnane X receptors“. Mol Endocrinol. 2007 Jul;21(7):1603-16.
37. Wisborg K, Kesmodel U, et al. “Maternal consumption of coffee during pregnancy and stillbirth and infant death in first year of life: prospective study“. BMJ. 2003 Feb 22;326(7386):420.
38. Rubach M, Lang R, et al. “Multi-parametric approach to identify coffee components that regulate mechanisms of gastric acid secretion“. Mol Nutr Food Res. 2012 Feb;56(2):325-35.
39. Griffiths RR, Chausmer AL. “Caffeine as a model drug of dependence: recent developments in understanding caffeine withdrawal, the caffeine dependence syndrome, and caffeine negative reinforcement“. Nihon Shinkei Seishin Yakurigaku Zasshi. 2000 Nov;20(5):223-31.
40. Smith, A. “Effects of caffeine on human behavior“. Food Chem Toxicol. 2002 Sep;40(9):1243-55.
By Mike Budd.