05/22/2018
Aaron CarrollA judge in California recently ruled that coffee would be required to carry a carcinogen warning label, since it contains acrylamide. Well, have the barista make you a double espresso with a shot of evidence, because that coffee probably isn’t going to give you cancer.
This episode was adapted from a column I wrote for The Upshot. Links to sources can be found there.
04/25/2018 Aaron CarrollThe following originally appeared on The Upshot (copyright 2018, The New York Times Company).
About two-thirds of smokers will die early from cigarette-based illnesses. Cigarettes are also very addictive. Because of this, it seems reasonable to place warnings on their labels.
If a Los Angeles Superior Court judge has his way, California businesses will have to put similar warnings on something else that can be addictive, coffee. His ruling, which is being challenged by coffee producers, is harder to justify in terms of health — if it can be justified at all.
California’s Proposition 65, enacted in 1986, mandates that businesses with more than 10 employees warn consumers if their products contain one of many chemicals that the state has ruled as carcinogenic. One of these chemicals is acrylamide. Like many other substances, acrylamide causes cancer in rats — when they are pumped full of huge doses in ways that don’t approximate real life.
In humans, the data are far less clear. The American Cancer Society(which does not shrink from saying things cause cancer) reports on its website that “there are currently no cancer types for which there is clearly an increased risk related to acrylamide intake.”
Other organizations, such as the International Agency for Research on Cancer, have warned that acrylamide is a “probable human carcinogen.” But this is based almost entirely on animal studies, and the agency has backpedaled in recent years. It’s also worth pointing out that of the nearly 1,000 substances the agency has classified, it has ruled almost none to be non-carcinogenic.
Regardless, acrylamide isn’t an industrial additive. It’s a chemical that is made almost any time you cook starches at temperatures above 250 degrees Fahrenheit. You can make acrylamide from frying, baking, broiling or roasting — essentially anything that isn’t boiling or microwaving.
Toasted bread contains acrylamide. So do fried and roasted potatoes. So do roasted coffee beans. Acrylamide formation occurs whether this cooking is done by a corporation or by you in your home. It’s made even when you cook organic food — there’s just not much of a way to avoid it. Acrylamide is found in about 40 percent of the calories consumed by people in the United States.
Some California businesses that serve food and drinks, unwilling to wage a legal fight against Proposition 65 or possibly hedging against fines, have already posted warnings about acrylamide over the years. A handful of makers of potato chips and fries also agreed to reduce their levels of acrylamide by 20 percent. There have been no studies showing this has made any difference in health, certainly not with respect to cancer.
Coffee has had acrylamide in it since humans started drinking it. The Food and Drug Administration, in its Guidance for Industry Acrylamide in Foods, reports that there is no viable commercial process for making coffee without producing at least some acrylamide.
06/15/2016 Aaron CarrollI kid. I’m glad they’re following the evidence:
An influential panel of experts convened by the World Health Organization concluded on Wednesday that regularly drinking coffee could help protect against some types of cancer, a decision that followed decades of research pointing to the beverage’s many health benefits.
Of course, this follows years of saying the opposite:
The announcement marked a rare reversal for the panel, which had previously described coffee as “possibly carcinogenic” in 1991 and linked it to bladder cancer. But since then a large body of research has portrayed coffee as a surprising elixir, finding lower rates of heart disease, Type 2 diabetes, neurological disorders and several cancers in those who drink it regularly.
Let this also serve as your daily reminder that of the 985 substances the WHO has weighed on for possible carcinogenicity, only ONE has been found by them “Probably not carcinogenic to humans“. I imagine that may now be two, although it sure took long enough.
For the record, here’s my Upshot column on coffee from a year ago. Here’s the Healthcare Triage video if you prefer watching to reading:
01/07/2016 Aaron CarrollWe’ve been leading up to this forever. No surprises for anyone who has been reading my many pieces on nutrition in the last year or two. Here are the Key recommendations:
Consume a healthy eating pattern that accounts for all foods and beverages within an appropriate calorie level.
A healthy eating pattern includes:
- A variety of vegetables from all of the subgroups—dark green, red and orange, legumes (beans and peas), starchy, and other
- Fruits, especially whole fruits
- Grains, at least half of which are whole grains
- Fat-free or low-fat dairy, including milk, yogurt, cheese, and/or fortified soy beverages
- A variety of protein foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), and nuts, seeds, and soy products
- Oils
A healthy eating pattern limits…
- Consume less than 10 percent of calories per day from added sugars
- Consume less than 10 percent of calories per day from saturated fats
- Consume less than 2,300 milligrams (mg) per day of sodium
- If alcohol is consumed, it should be consumed in moderation—up to one drink per day for women and up to two drinks per day for men—and only by adults of legal drinking age.
They also add:
- Meet the Physical Activity Guidelines for Americans.
This is the kind of thing that everyone will find some aspect to hate. They still don’t limit carbs (which many will scream about). They still attack saturated fats (which many will scream about) and red meat. Some will think the sodium restrictions are still too much; others will hyperventilate about them not being stringent enough. The milk emperor gets his tribute.
On the other hand, cholesterol gets fixed. Coffee gets more science based. Alcohol does, too.
I’m biased, but I still like my recommendations more.
07/06/2015 Aaron CarrollWhen I was a kid, my parents refused to let me drink coffee because they believed it would “stunt my growth”. It turns out, of course, this is a myth. Studies have failed, again and again, to show that coffee or caffeine consumption are related to reduced bone mass or how tall people are. But that’s just the tip of the iceberg. Break out your supersized cup of joe, cause coffee is the topic of this week’s Healthcare:
For those of you who want to read more, you can find all the supporting links at my Upshot piece on Coffee, from which this episode was adapted. There’s also a follow-up Q&A you might enjoy.
05/19/2015 Aaron CarrollThe following originally appeared on The Upshot (copyright 2015, The New York Times Company).
In [a recent] article, I reviewed the evidence behind coffee consumption and health in an effort to put to rest the idea that coffee is a “vice” or something we all need to cut back on.
We received many comments and questions from readers. In fact, we received so many that we thought it might be useful to respond to some of the most frequently discussed ones.
Are the same beneficial relationships seen with decaffeinated coffee?
Most studies did not include data on decaffeinated coffee, either because too few people drank it or because data were not available. The few studies that did, though, had differing results. With respect to cardiovascular disease, decaffeinated coffee did not seem to have the same protective effects as regular coffee. With respect to the one stroke meta-analysis, it seemed to be just as protective as regular coffee. In two breast canceranalyses, decaffeinated had the same nonrelationship as regular coffee. Decaffeinated coffee was also protective against lung cancer, not as protective against Parkinson’s disease, and protective against diabetes andoverall mortality, but perhaps to a lesser extent than regular coffee.
But for most studies, there just aren’t data available. The conclusion to take away: There’s less evidence overall for a potential benefit, but still, there’s no evidence of harmful associations.
What constitutes a cup of coffee?
Pretty much all studies defined a cup of coffee as an 8-ounce serving. That’s smaller than what I imagine most people drink. A grande-size coffeeat Starbucks (what is called simply “large” at most other coffee houses) is 16 ounces.
Are the same benefits seen with tea?
The literature on tea is about the same size as that for coffee, and reviewing it thoroughly would take more time than is appropriate for this column. However, a number of studies I reviewed did include tea in analyses, and those I can present here. People who drank more tea had a lower risk ofParkinson’s disease and of cognitive decline. Black tea had a potential protective effect against diabetes, but it was not statistically significant. Green tea had no relationship to the development of diabetes.
If we think there’s enough interest in tea, though, we could devote a future column to the evidence on that beverage.
Is the benefit from caffeine or from some other element in coffee?
It’s not known. I also don’t think it’s necessarily the same protective effect in each disease. I think that for many of the neurological issues, it could be caffeine acting as a stimulant in the brain. This hypothesis is supported by the fact that decaffeinated coffee doesn’t seem to be as protective, yet tea is. In some of the other diseases, though, the same benefits aren’t seen from other caffeine-containing beverages. No one is arguing that diet soda consumption is associated with less of a chance of getting cancer. Additionally, some protective effects are seen with decaffeinated coffee as well. It’s likely, therefore, that something else could be at work. We don’t know what, though.
What about high blood pressure or cholesterol?
A 2005 meta-analysis found that in randomized controlled trials caffeine was associated with an increase in blood pressure. When that caffeine was from coffee, however, the blood pressure effect was small. A 2011 studyfound that caffeine intake could raise blood pressure for at least three hours. Again, though, there wasn’t a significant relationship between long-term coffee consumption and higher blood pressure. A 2012 meta-analysisof 10 randomized controlled trials and five cohort studies could find no significant effect of coffee consumption on blood pressure or hypertension.
And, as has been reported in The New York Times, two studies have shownthat drinking unfiltered coffee, like Turkish coffee, can lead to increases in serum cholesterol and triglycerides. But coffee that’s been through a paper filter seems to have had the cholesterol-raising agent, known as cafestol, removed.
High blood pressure and high cholesterol would be of concern because they can lead to heart disease or death. Drinking coffee is associated with better outcomes in those areas, and that’s what really matters.
Some readers were upset that I neglected to mention some of the deleterious effects of caffeine. What about jitteriness and mood changes?
I want to reiterate that the point of the piece was not to tell people to drink coffee. As I said in my recent article on food recommendations, I don’t think there is much value in preaching or judging what others eat or drink. Moreover, this evidence is epidemiologic, that is, based on observations of patterns. I don’t want to fall prey to the mistake of recommending we change our eating behavior without evidence from randomized controlled trials.
The point of the article was to show that there’s no evidence that coffee is bad for the average person. Data do not support the idea that we are drinking “too much.” Coffee does not appear to be associated with poor health outcomes — the opposite is true. In light of this, we should stop telling everyone to avoid it, or judging others for drinking it. We should also stop feeling guilty or feel we need to consume less.
That is, unless it’s not making you feel well. As I also said before, individual trial and error is likely necessary when it comes to nutrition. Some people need to avoid caffeine for medical reasons, and they should. If coffee makes you feel bad, or makes it hard for you to sleep, or renders you a less likable person — then by all means feel free to cut back or stop.
But if you like it, then by all means enjoy it.
05/19/2015 Aaron CarrollThe following originally appeared on The Upshot (copyright 2015, The New York Times Company). I answer readers’ questions about this article in a follow-up here.
When I was a kid, my parents refused to let me drink coffee because they believed it would “stunt my growth.” It turns out, of course, that this is a myth. Studies have failed, again and again, to show that coffee or caffeine consumption are related to reduced bone mass or how tall people are.
Coffee has long had a reputation as being unhealthy. But in almost every single respect that reputation is backward. The potential health benefits are surprisingly large.
When I set out to look at the research on coffee and health, I thought I’d see it being associated with some good outcomes and some bad ones, mirroring the contradictory reports you can often find in the news media. This didn’t turn out to be the case.
Just last year, a systematic review and meta-analysis of studies looking at long-term consumption of coffee and the risk of cardiovascular disease was published. The researchers found 36 studies involving more than 1,270,000 participants. The combined data showed that those who consumed a moderate amount of coffee, about three to five cups a day, were at the lowest risk for problems. Those who consumed five or more cups a day had no higher risk than those who consumed none.
Of course, everything I’m saying here concerns coffee — black coffee. I am not talking about the mostly milk and sugar coffee-based beverages that lots of people consume. These could include, but aren’t limited to, things like a McDonald’s large mocha (500 calories, 17 grams of fat, 72 grams ofcarbohydrates), a Starbucks Venti White Chocolate Mocha (580 calories, 22 grams of fat, 79 grams of carbs), and a Large Dunkin’ Donuts frozen caramel coffee Coolatta (670 calories, 8 grams of fat, 144 grams of carbs).
I won’t even mention the Cold Stone Creamery Gotta-Have-It-Sized Lotta Caramel Latte (1,790 calories, 90 grams of fat, 223 grams of carbs).Regular brewed coffee has 5 or fewer calories and no fat or carbohydrates.
Back to the studies. Years earlier, a meta-analysis — a study of studies, in which data are pooled and analyzed together — was published looking at how coffee consumption might be associated with stroke. Eleven studies were found, including almost 480,000 participants. As with the prior studies, consumption of two to six cups of coffee a day was associated with a lower risk of disease, compared with those who drank none. Another meta-analysis published a year later confirmed these findings.
Rounding out concerns about the effect of coffee on your heart, another meta-analysis examined how drinking coffee might be associated with heart failure. Again, moderate consumption was associated with a lower risk, with the lowest risk among those who consumed four servings a day. Consumption had to get up to about 10 cups a day before any bad associations were seen.
No one is suggesting you drink more coffee for your health. But drinking moderate amounts of coffee is linked to lower rates of pretty much all cardiovascular disease, contrary to what many might have heard about the dangers of coffee or caffeine. Even consumers on the very high end of the spectrum appear to have minimal, if any, ill effects.
But let’s not cherry-pick. There are outcomes outside of heart health that matter. Many believe that coffee might be associated with an increased risk of cancer. Certainly, individual studies have found that to be the case, and these are sometimes highlighted by the news media. But in the aggregate, most of these negative outcomes disappear.
A meta-analysis published in 2007 found that increasing coffee consumption by two cups a day was associated with a lower relative risk of liver cancer by more than 40 percent. Two more recent studies confirmed these findings. Results from meta-analyses looking at prostate cancerfound that in the higher-quality studies, coffee consumption was not associated with negative outcomes.
The same holds true for breast cancer, where associations were statistically not significant. It’s true that the data on lung cancer shows an increased risk for more coffee consumed, but that’s only among people who smoke. Drinking coffee may be protective in those who don’t. Regardless, the authors of that study hedge their results and warn that they should be interpreted with caution because of the confounding (and most likely overwhelming) effects of smoking.
A study looking at all cancers suggested that it might be associated with reduced overall cancer incidence and that the more you drank, the more protection was seen.
Drinking coffee is associated with better laboratory values in those at risk for liver disease. In patients who already have liver disease, it’s associated with a decreased progression to cirrhosis. In patients who already have cirrhosis, it’s associated with a lower risk of death and a lower risk of developing liver cancer. It’s associated with improved responses to antiviral therapy in patients with hepatitis C and better outcomes in patients with nonalcoholic fatty liver disease. The authors of the systematic review argue that daily coffee consumption should be encouraged in patients with chronic liver disease.
The most recent meta-analyses on neurological disorders found that coffee intake was associated with lower risks of Parkinson’s disease, lowercognitive decline and a potential protective effect against Alzheimer’s disease (but certainly no harm).
A systematic review published in 2005 found that regular coffee consumption was associated with a significantly reduced risk of developingType 2 diabetes, with the lowest relative risks (about a third reduction) seen in those who drank at least six or seven cups a day. The latest study,published in 2014, used updated data and included 28 studies and more than 1.1 million participants. Again, the more coffee you drank, the less likely you were to have diabetes. This included both caffeinated and decaffeinated coffee.
Is coffee associated with the risk of death from all causes? There have been two meta-analyses published within the last year or so. The first reviewed 20 studies, including almost a million people, and the second included 17 studies containing more than a million people. Both found that drinking coffee was associated with a significantly reduced chance of death. I can’t think of any other product that has this much positive epidemiologic evidence going for it.
I grant you that pretty much none of the research I’m citing above contains randomized controlled trials. It’s important to remember that we usually conduct those trials to see if what we are observing in epidemiologic studies holds up. Most of us aren’t drinking coffee because we think it will protect us, though. Most of us are worrying that it might be hurting us. There’s almost no evidence for that at all.
If any other modifiable risk factor had these kind of positive associations across the board, the media would be all over it. We’d be pushing it on everyone. Whole interventions would be built up around it. For far too long, though, coffee has been considered a vice, not something that might be healthy.
That may change soon. The newest scientific report for the U.S.D.A. nutritional guidelines, which I’ve discussed before, says that coffee is not only O.K. — it agrees that it might be good for you. This was the first time the dietary guideline advisory committee reviewed the effects of coffee on health.
There’s always a danger in going too far in the other direction. I’m not suggesting that we start serving coffee to little kids. Caffeine still has a number of effects parents might want to avoid for their children. Some people don’t like the way caffeine can make them jittery. Guidelines also suggest that pregnant women not drink more than two cups a day.
I’m also not suggesting that people start drinking coffee by the gallon. Too much of anything can be bad. Finally, while the coffee may be healthy, that’s not necessarily true of the added sugar and fat that many people put into coffee-based beverages.
But it’s way past time that we stopped viewing coffee as something we all need to cut back on. It’s a completely reasonable addition to a healthy diet, with more potential benefits seen in research than almost any other beverage we’re consuming. It’s time we started treating it as such.
02/11/2014 Aaron CarrollIn the last episode of Healthcare Triage, I mentioned that my wife and I try to keep caffeine away from our kids. Why? Cause caffeine works. It affects your heart rate, your blood pressure, your mood, etc. In the last few years, the popularity of some energy drinks has raised concerns that kids are getting way more caffeine than they used to. Are they? There’s a new manuscript in Pediatrics that’s on point:
BACKGROUND AND OBJECTIVE: Physicians and policy makers are increasingly interested in caffeine intake among children and adolescents in the advent of increasing energy drink sales. However, there have been no recent descriptions of caffeine or energy drink intake in the United States. We aimed to describe trends in caffeine intake over the past decade among US children and adolescents.
METHODS: We assessed trends and demographic differences in mean caffeine intake among children and adolescents by using the 24-hour dietary recall data from the 1999–2010 NHANES. In addition, we described the proportion of caffeine consumption attributable to different beverages, including soda, energy drinks, and tea.
We’ve discussed NHANES before. These data cover 1999 through 2010. They found that about three quarters of kids and adolescents consume caffeine each day. The good news, though, is that there was no significant increase in the amount consumed over time. In fact, there was a decrease in caffeine consumption in 2 to 11 year olds.
And get this! While soda was the main way kids get caffeine, its contribution went down from 62% to 38%. Coffee, on the other hand, went from 10% in 1999 to 24% in 2010. Energy drinks – which everyone is panicked about – went from nothing in 1999 to 6% in 2010. Overall, daily caffeine consumed went down, from 77 mg to 58 mg.
So, yes, kids are drinking more coffee, and some proportion are drinking more energy drinks. But soda seems to be down. Overall caffeine consumption is down. The sky isn’t falling.
