Coffee: the good, the bad, and the ugly

Many of my new clients assume that a large part of my job as a naturopathic doctor is to convince people to completely eliminate coffee from their diet. This blog post is meant to clear up some of these questions and provide a quick review of some benefits and risks associated with regular coffee consumption.

We live in a fairly stressful world, and far too many are under-slept and overworked. So it’s no surprise that many of us rely on at least one coffee to make it through the day. Naturopathic doctors differ widely when it comes to their opinions on coffee, there are some of us that suggest no one should drink coffee, and other NDs that are habitual coffee drinkers. I would argue that both sides have value: there are benefits and drawbacks to that cup of coffee that may differ from person to person.

Benefits

Energizing

The most obvious benefit to drinking coffee is increased energy, alertness and mental performance; it makes us feel less tired.

Adenosine is a neurotransmitter (brain chemical) that has a roll in increasing our sleepiness and suppressing arousal. Caffeine is an adenosine antagonist, meaning it interferes with the brain chemical’s ability to act on the brain, thereby causing arousal and decreasing our sleepiness. In other words, Caffeine decreases the effect of our sleepy adenosine brain chemicals.

Helps you poop

Coffee is also a laxative, and can therefore help some people with constipation.

Antioxidants

Coffee is high in polyphenols, which are antioxidants that have been shown to have a role in cancer and cardiovascular disease prevention. However this conclusion needs to be taken with a grain of salt. Coffee can heighten our stress response, and stress is known to increase our risk of cancer and cardiovascular disease.

The aging brain

Some suggest that coffee (and not necessarily caffeine) in certain amounts may have cognitive and motor benefits in aging.

Alzheimer’s and Parkinson’s

Coffee’s role as a therapy for Alzheimer’s Disease (AD) as well as Parkinson’s (PD) has been well documented, and it’s action of improved cognitive function in AD and motor deficits in PD is largely attributed to it's effect on adenosine in the brain. Coffee consumption has even been shown to decrease the risk of AD and PD in the first place.

Risks

Coffee and the Stress Response

First of all, it is important to note that coffee is a mood-altering drug and should therefore be consumed with care. As a stimulant, coffee exerts its action by telling the body to release stress hormones. If you drink coffee your brain sends a message to the pituitary gland, which in turn sends out another signal to release those stress hormones from the adrenal glands: adrenaline and cortisol. If your HPA axis is in good shape, your adrenals will respond quickly and recover in good time. However if you experience a high level of stress and/or anxiety, you can overtax these adrenal glands and they may not fire as quickly or way less, and recovery time will be longer. Many of us drink coffee because we need to be "on" and alert when our body really needs more sleep and self-care. It can prolong exhaustion and burnout, making the inevitable crash worse.

Anxious? Coffee can make it worse.

Coffee is stimulating and increases our stress response and can therefore dramatically heighten our experience of anxiety. Whenever I can feel a more stressful or busy time of my life coming up, I make sure to completely cut coffee out of my diet for at least a week before. That way I don't have to worry about potential withdrawal headaches or fatigue during a more stressful time.

Osteoporosis: Fancy a break?

Coffee is acidic. Our bodies acidity level or "pH" is closely monitored, so that it doesn't get too high or drop too low, as many of the chemical reactions in our body rely on an environment of a certain pH. Calcium is a buffer in our bodies - meaning it has the ability (to a certain degree) to keep the pH within a certain range when something of a different pH is added to the mix. So, if we add acid to the mix, calcium is required as a buffer to neutralize the acid, and our bones happen to be a great source of calcium.

Looking at studies, however, I did not find the results I was expecting. It seems that although it is quite clear that coffee consumption in high amounts  (4 cups a day or more) is associated with a small decrease in BMD (bone mass density), it's effect on fracture risk is not as obvious. I am still looking for a study that shows coffee consumption increases the risk of fractures later on in life. However, I would still be careful with coffee consumption, especially for people with a personal or family history of osteoporosis, osteoarthritis, and fractures.

Coffee dependency

Sadly, coffee is substance that can create dependency. It increases the production of our feel-good chemical dopamine, which helps to maintain the dependency on this drug. Withdrawal symptoms are quite common and can include: headaches, lethargy and fatigue, irritability, constipation, lack of concentration, insomnia and changes in mood.

Your guts

Coffee can aggravate heartburn and stomach ulcers, as it increases gastric acid secretion. Cutting out coffee can dramatically improves digestive symptoms for some experiencing the effects of high levels of acid in their digestive tract.

Metabolism

Different people metabolize coffee at different rates. This means the time it takes for our bodies to break down caffeine differs from person to person. The rate at which you break down caffeine in your body has a dramatic effect on how sensitive you are to coffee. For those who metabolize it at a slower rate, it can severely aggravate insomnia, stress, and anxiety. I have a friend who rarely drinks coffee and can fall asleep after drinking a double espresso. On the other hand, I have friends who after a sip of coffee would feel extremely uncomfortable and may even have "the shakes" or tremors. Your sensitivity to coffee can change over time and drugs can interfere with how you metabolize coffee. Birth control, for example, is known to slow it down.

Coffee politics: choosing your bean

The farmers

When the market value for coffee is low, many farmers have no choice but to sell their coffee for less than the costs of production, causing a cycle of poverty and debt. A middleman often pays the farmer about half of the market price, about 30-50 cents a pound. These farmers and pickers tend to earn less than minimum wage, while working and living in very harsh conditions. Click here to read more from the Organic Consumers Association. 

The Environment and Sustainability

Coffee farming can be heavy in pesticides and can cause soil erosion, water pollution, and negatively effects biodiversity. Coffee farming currently threatens the extinction of certain songbirds due to mass deforestation.

Check out this quick guide (click here) for more information on the various certifications. 

What I suggest

For those who are habitual drinkers, have difficulty sleeping, or experience anxiety/tremors: I would consider cutting caffeine out for 10 to 14 days to see how you feel. Depending on your health and degree of dependency, you may need to do so under the supervision of a doctor or other health professional.

If this proves really difficult or you have severe withdrawal symptoms, start with a half caffeinated-half decaffeinated coffee for a week to prepare. Or switch to black tea for a few days. Consider consulting a naturopathic doctor for tips on how to help with the symptoms, or get some acupuncture for your headache and fatigue.

• Use coffee like an herbal medicine and use it wisely. Cutting it out a few times a year will lower your dependency, make it more effective, and you may even enjoy it more.

• Drink good quality, sustainable coffee. Toxic and cancer-causing substances are used in the production of non-organic coffee. We must also remember our actions and our behaviors of consumption have huge implications on the rest of the world.

• Buy whole beans and grind before making the coffee – beans go rancid fairly soon after they are ground.

• Make sure your diet is high in fruits and veg, coffee or no coffee. This will help keep your body less acidic and your bones will thank you for it.

• I would consider eliminating coffee altogether if you are concerned about bone density, osteoporosis, or osteoarthritis, or if you have heartburn or any digestive ulcers.

• And of course, avoid coffee in pregnancy

PLEASE NOTE: ALL MATERIAL AND INFORMATION CONTAINED IN THIS POST IS FOR EDUCATIONAL PURPOSES ONLY AND DOES NOT MEAN TO REPLACE OR AUGMENT ANY ADVICE OR CONSULTATION PROVIDED BY A LICENSED HEALTH CARE PRACTITIONER OR PHYSICIAN.

SOURCES

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Boekema, P, Samson, M, van Berge Henegouwn, G, & Smout A. (1999). Coffee and gastrointestinal function: facts and fiction. A review. Scandinavian Journal of Gastroenterology, 230, 35-9. PMID: 10499460.

Brice, C., & Smith, A. (2002). Effects of caffeine on mood and performance: a study of realistic consumption. Psychopharmacology, 164(2), 188-192. PMID: 12404081.

Chen, J., X, K., Petzer, J., … Schwarzschild, M. (2001). Neuroprotection by caffeine and A(2A) adenosine receptor inactivation in a model of Parkinson’s disease.  Journal of Neuroscience, 21(10), RC143. PMID: 11319241.

Eskelinen, M, & Kivipelto, M. (2010). Caffeine as a protective factor in dementia and Alzheimer’s disease, 20, S167-74. PMID: 20182054.

Hallstrom, H, Byberg, L, Glynn, A, Lemming, E, Wolk, A, & Michaelsson, K. (2013). Long-term coffee consumption in relation to fracture risk and bone mineral density in women. American Journal of Epidemiology, 178(6), 898-909. 

Hallstrom, H, Wolk, A, Glynn, A, & Michaelsson K. (2006). Coffee, tea and caffeine consupmtion in relation to osteoporotic fracture risk in a cohort of Swedish women. Osteoporosis International, 17(7), 1055-64.

History of the Global Exchange Coffee Campaign (n.d.). Organic Consumers Association. https://www.organicconsumers.org/old_articles/starbucks/coffeelabor.htm

Manach, C., Scalbert, A., Morand, C., Remesy, C., & Jimenez L. (2004). Polyphenols: food sources and bioavailability. American Journal of Clinical Nutrition 79(5), 727-747. PMID: 15113710.

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Shukitt-Hale, B., Miller M, Chy, YF, Lyle B, Joseph, J. (2013). Coffee, but not caffeine, has positive effects on cognition and psychomotor behaviours in aging. AGE, 35(6), 2183-92. PMID: 23344884.

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