Coffee: Our Saint or Sinner

It's one of the most used brain-active substances while being the world’s second most traded commodity. It's used to treat human maladies from “stem to stern.” Used as a solid, liquid, or a vapor, it is a “seed” for imagination and “bloom” of industry. Coffee is said to have been brewed by the angel Gabriel for monks of Europe to stay awake during nightly prayers, or for the prophet Mohammed to stave off death the night before a battle, it's known as a “bitter invention of Satan,” associated with the “penny universities,” and called the “wine of Araby.” About 80 percent of the population consumes a volume strong enough to influence brain activity, where its use directly affects the same areas of the brain as cocaine. Last, it's deliciously frozen, cold, or hot; at full strength or minimized as a decaffeinated drink. It's caffeine, generally consumed as coffee, and it’s one of the world’s most beloved and feared drinks. How does it impact our history, health, and well-being?

The legend of coffee or qahwah began among goat keepers of Ethiopia who observed the reactions of their herds to eating certain berry seeds. Local monasteries boiled the berries and their seeds to drink, but it was the original response of the goats, this ‘excitement,’ that made coffee both hero and villain throughout time. It spread along the paths of ancient trading routes to India and Western Europe and remains a valued commodity today, costing as much as $80.00 US per cup for a ‘special processing’ of the bean by a civet (please look up, I don’t want to spoil the fun of research).

The average cup of coffee has about 95 milligrams (mg) of caffeine per cup (with a range of 80 – 160 mg with decaffeinated coffee rumored to have 3 mg) as well as potassium, magnesium, and niacin. Caffeine affects tissues from the brain to blood vessels and muscles. Though results vary based upon the target tissue, the overall result is excitatory due to the increased release of stimulating hormones, and suppression of the more calming ones. Based on these effects, coffee influenced the Industrial Revolution (energizing workers) and the French Revolution (causing the flourishing of free-thinking conversations). American soldiers in both World Wars used coffee to maintain their mental awareness and motivation on the battlefield, due to the response of norepinephrine found in the caffeine of coffee and chocolates

Norepinephrine, or noradrenaline, initiates the human ‘fight-or-flight’ response by energizing the brain for action, energy, and alertness, decreasing reaction time, and increasing the rate and force of muscles. Importantly. Coffee blocks the body’s uptake of adenosine and its effect of inducing sleep and slowing the heart’s activity. While increasing blood flow to the body's musculature, coffee decreases blood flow to the brain. When the drink is stopped for a period of time, those same vessels expand within a limited area, the brain, and cause the ‘coffee withdrawal’ headache.

Caffeine has been used to minimize headaches for centuries. Studies support this use and show an effect alone or in combination with other pain-controlling medicines like aspirin, ibuprofen, or acetaminophen. It can be more effective for tension and migraine headaches than other agents because of restricted blood flow to the head, neck, and shoulders. Additionally, caffeine stimulates the smooth muscles of our digestive and urinary systems. It increases the urge to urinate by stimulating bladder lining cells and increasing bowel contractions. Regular coffee drinking is associated with less constipation and the stopping of new episodes without using ‘medications.’

Coffee also decreases liver disease and slows the progression of hepatitis C. It has been used as an enema to increase energy, remove body toxins and improve the release of stool. The coffee enema was popularized in the 1930s by Dr. Max Gershon and was advertised as an alternative treatment to cure cancer using a simple mixture of brewed coffee and water to saturate one’s colon. Other touted effects include boosting immunity, controlling pain and chronic depression. However, due to the risks of dehydration, inflammation of the rectum and colon, electrolyte imbalance (particularly potassium), pain, infection, and rectal tears if done improperly, the practice of using coffee as a colonic detoxifying or cleansing agent to promote wellbeing is not recommended.

One of the negative effects of coffee ingestion can be irregular heartbeats. Studies show that the standard amount of 4 cups or 400 mg of caffeine in a 24-hour period does not provoke abnormal rhythms for many. Nevertheless, some may have a heightened response to coffee and have palpitations with intake. Thus, patients experiencing irregular heartbeats commonly should avoid large quantities of coffee; though regular amounts appear to be safe. Coffee increases blood pressure in many; though the degree of influence depends on the amount, frequency, and one’s baseline health. Ingesting more than four cups of coffee a day (amount) by those who are not regular users (frequency), coffee results in a limited rise in blood pressure.

This effect heightens stressful situations, such as confrontations and traffic; our modern ‘fight or flight’ events. The brief elevation in blood pressure is more pronounced in patients already diagnosed with hypertension (baseline health) who are twice as likely to show increases in blood pressure. In the elderly hypertensive patient, whose vessels are less compliant or flexible, the effect is more intense and longer-lasting. This appears to happen with the ingestion of more than four cups of coffee specifically. By comparison, the drinking of tea does not have result in a similar effect. Studies on tea ingestion show unchanged pressures at four weeks. In those whose blood pressure is difficult to manage, stopping coffee drops blood pressure over time.

Caffeine in teas, coffee, and chocolates, results in fluid loss or diuresis. One review suggests that the ingestion of greater than three cups results in an increase in urine output as well as bladder spasms. However, in those who regularly ‘use’ caffeine at lower doses, less than 3 cups or 300 mg of caffeine, over time tolerance develops, and diuresis is decreased. Coffee is a drink of the ancients and modernity. It replaced beer and wine as our morning fuel and treats diseases from head to toe.

Once thought descended from angels, it was endorsed by Pope Clementine VIII to disprove it as Satan’s drink and is the living embodiment of C. Nolan’s quote from The Dark Knight, “(y)ou either die a hero or you live long enough to see yourself become the villain.” The most used brain chemical in the world, caffeine has a weight of evidence supporting its use, for many. While some have a heightened response to its use and should therefore control their intake, in general, and in the absence of sugary additives, coffee is a healthy choice made by approximately 90% of the world’s population.

Now, I’m going to have a cup; before it again becomes a villain.

Thank you,

Keith Hopkins, MD

Internal Medicine

Sacramento, California

A local coffee shop