Historical studies examining coffee’s impact on health have found that coffee consumption is linked to a lower risk of early death. However, the studies did not distinguish between coffee consumed with sugar (or artificial sweeteners) or unsweetened coffee.

Now we have some answers, courtesy of researchers from Southern Medical University in Guangzhou, China. The scientists used data from the United Kingdom Biobank study health behavior survey to analyze the associations between the consumption of sugar-containing, artificially sweetened, and unsweetened coffee on mortality.

“I’d rather take coffee than compliments just now.”
― Louisa May Alcott, Little Women

Coffee, sugar, and mortality

Researchers analyzed 171,000 subjects in the United Kingdom, with none of these participants having known cancer or heart disease. During seven years of follow-up, the participants answered health (including dietary) behavior questions.

Here are the study results:

Subjects who drank any amount of unsweetened coffee were up to one-fifth (16 to 21 percent) less likely to die during the follow-up period than those who did not consume coffee. Those who consumed 1.5 to 3.5 daily cups of coffee sweetened with sugar were nearly one-third less likely to die than non-drinkers.

The study authors observed that adults drinking sugar-sweetened coffee added an average of only about one teaspoon of sugar per cup of coffee. The results appeared inconclusive for participants who used artificial sweeteners in their coffee.

My take — Coffee, sugar, and mortality

You probably already know what I am about to tell you: Take any observational, non-randomized clinical trial with some skepticism. Perhaps more affluent folks (who have longer longevity) tend to consume more coffee at Seattle-based Starbucks.

In addition, the subjects self-reported data on coffee consumption (and some in the non-coffee group consumed tea). Still, as an occasional espresso consumer, the results are okay with me.

The results are consistent with prior studies of coffee intake but add information on sweeteners added to coffee. If you prefer unsweetened coffee (I am working my way there), moderate consumption of 2.5 to 3.5 cups daily appeared to be associated with a lower risk for cardiovascular disease compared to no coffee intake.

The benefits of sweetened coffee appeared attenuated when adjusted for possible confounding factors.

I hope you have a joy-filled day. And if you prefer tea, here’s a piece I recently wrote on my preferred beverage:

Step Aside, Coffee — The Health Benefits of Tea

WHILE TEA APPEARS TO HAVE HEALTH BENEFITS, most research investigations have been done in regions where green tea is…

medium.com

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Here is a picture of my family and me having afternoon tea at the Ritz in London last month:

Today we look at a prospective study of nearly half a million participants in the UK Biobank cohort. Researchers published the study online in the Annals of Internal Medicine.

Tea, health, and longevity

Before we get into the recent tea study, let’s set some definitions. In a recent Medium piece, I talked about lifespan, health span, and longevity.

• Lifespan. The duration of an individual’s existence.
• Healthspan. Healthspan is the period of life spent in good health, free from the chronic diseases and disabilities of aging. Healthspan is a length of chronological time beginning at birth and ending when an individual is no longer in good health or is suffering from diseases or disabilities of aging.
• Longevity. Longevity is a balance of lifespan (living longer) and health span (living better).

British researchers examined nearly 500,000 adults with an average age of 57 years.

Approximately 85 percent of the subjects reported drinking tea, 90 percent reported consuming black tea, and most drank at least two cups daily; most drank two to three cups (29 percent), four to five cups (26 percent), or six to seven cups (12 percent) per day.

Let’s get to the results after a median follow-up of 11.2 years:

Those who drank at least two cups of tea daily had a lower all-cause mortality risk. Adding milk or sugar did not take away the benefit, and the tea’s temperature did not influence the results.

Compared to those with no tea intake, one cup per day tea drinkers had a five percent lower risk of death, a 12 to 13 percent lower risk for those drinking two or seven cups, and about a 10 percent lower risk for those drinking eight or more cups each day.

In addition to lower all-cause mortality risk, tea drinkers also had a lower risk of suffering cardiovascular death, ischemic heart disease, and stroke (compared with individuals who did not drink tea).

Why is tea associated with better health?

We do not know why people who drink tea may live longer. The large study I presented does not prove a causal relationship between tea drinking and better health.

With that important caveat in mind, study author Maki Inoue-Choi, an epidemiologist at the National Cancer Institute, offers that tea is “very rich in bioactive compounds” that reduce stress and inflammation, including polyphenols and flavonoids.

In support of these observations, a 2020 study using the UK Biobank database discovered an association between higher consumption of green and black tea and biomarkers related to cardiometabolic health, including lower cholesterol levels. Tea is also associated with very small decreases in blood pressure.

Should you double up on your tea habit? While the research findings are encouraging, the British study is observational — the evidence is not from an experiment, and the researchers infer results. Perhaps we tea drinkers do better because we put aside soft drinks. I would love to see a randomized trial comparing tea drinking versus no tea drinking.

In addition, the gains associated with tea consumption appear small in magnitude. I am reassured that my tea habit may have health upsides, even though the study offers nothing to make me drink more than I currently do.

Tea — Frequently asked questions (FAQs)

Let’s turn to some frequently asked questions about tea.

1. Do all teas come from the same plant? Many define tea as the infusion of the plant camelia sinensis in water. So, in this sense, tea all comes from the same plant.
2. How many tea types are there? There are six general groups of tea, including 1) Black tea (red tea in Chinese), a fully oxidized tea. 2) Green tea, a form that is barely oxidized. Green tea undergoes a process to remove excess water. 3) White tea is the least processed type; simply dry the leaves. 4) ) Oolong (blue) tea refers to partially oxidized teas. 5) Yellow tea; and 6) Dark (black in Chinese) tea, ones that are post-fermented (they have good mold growing on them).

年茶 三年药 七年宝 (one-year tea, three years medicine, seven years treasure). Thank you for joining me today. Do you drink tea?

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But do you still get the health benefits of coffee consumption if you add a bit of sugar to your cup?

In the form of observational studies, we have lower-level evidence that coffee intake reduces the probability of premature death. Still, these studies did not distinguish between coffee consumed with sugar or artificial sweeteners and coffee consumed without such additives.

In this context, Chinese investigators sought to determine if we could destroy coffee’s life-lengthening properties if we added sweeteners.

Coffee is popular

Coffee is one of the most widely consumed beverages globally, with my medical office being no exception. You may wonder about the health upsides and perils of consuming it.

We Americans consume over half a billion cups of coffee daily, with two-thirds of us reporting consumption within the past day.

A 2017 study demonstrated an inverse association between coffee consumption and early mortality: High coffee consumers had lower all-cause mortality risks than non-consumers after adjustments and for covariates such as smoking.

The researchers in the historical study reported similar inverse associations for caffeinated and decaffeinated coffee consumption. However, among men, the association of caffeinated coffee with all-cause mortality appeared less pronounced than for decaffeinated coffee.

Coffee and early mortality

Researchers sought to evaluate the associations of consumption of sugar-sweetened, artificially sweetened, and unsweetened coffee with all-cause and cause-specific mortality.

They used data from the United Kingdom Biobank study to evaluate the associations of sugar-sweetened, artificially sweetened, and unsweetened coffee consumption with mortality.

Here are the findings after a seven-year follow-up period:

• Those who drank any amount of unsweetened coffee were up to one-fifth (16 to 21 percent) less likely to die prematurely than participants who did not drink coffee.
• Those who consumed 1.5 to 3.5 daily cups of coffee sweetened with sugar were nearly one-third (29 to 31 percent) less likely to die than participants who did not drink coffee. On average, adults drinking sugar-sweetened coffee added only about one teaspoon of sugar per coffee.
• Results appeared inconclusive for participants who used artificial sweeteners in their coffee.

Coffee and longevity: My take

Coffee contains numerous substances that make health benefits possible. Observational studies have the problem of controlling for confounding variables, including diet, socioeconomic status, and other lifestyle characteristics.

Please note that the amount of daily sugar per cup of coffee is, on average, much lower than specialty drinks at your local popular coffee chain (no names offered by this Seattle resident).

Still, it is heartening to know that I can keep my single cup of espresso in my diet, but I will continue to be careful with high-calorie specialty coffees. I will also continue to dodge sugary drinks such as soda.

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Type 2 diabetes is a chronic disease associated with high rates of health problems and early death. More specifically, diabetes is several diseases that center on problems with the hormone insulin.

The pancreas is an organ situated at the top part of your abdomen. Typically, the pancreas releases the hormone insulin to help us store and use the sugar and fat from the food we consume. Diabetes can happen when the pancreas makes very little or no insulin; alternatively, the body may not respond appropriately to insulin.

Currently, there is no cure for diabetes. Those with the condition need to manage the chronic disease to optimize health.

Diabetes is common

The incidence of type 2 diabetes is increasing worldwide and is estimated to reach 366 million by 2030, from 171 million in 2000. The prevalence is rising more rapidly in low- and middle-income countries.

The prevalence of diabetes worldwide was approximately 2.8 percent in 2000 and may rise to 4.4 percent by 2030.

For those with type 2 diabetes, the risk of blindness, kidney disease, and amputation is 20 to 40 times higher than that of those without diabetes. I addition, those with the disease have a two to five times higher risk of heart attack and a two to three times higher risk of stroke.

Diabetes symptoms

Early diagnosis may occur through relatively inexpensive testing of blood sugar. Here are some symptoms associated with type 2 diabetes:

• Hunger and fatigue. If you don’t make enough insulin (or your cells resist the insulin you make), the glucose cannot get into the cells, and your energy drops. These phenomena can make you feel hungrier and more tired.
• Peeing more often and being thirstier.
• Itchy skin and dry mouth. As your body is using fluids to create extra pee, you have less moisture for other things and can become dehydrated.
• Blurred vision. With changes in your body’s fluid levels, the lenses of your eyes can swell. This swelling causes a change in shape and trouble focusing.
• Yeast infections. Yeast thrives on glucose. Both men and women can get fungal infections in any moist, warm fold of skin (for example, under the breasts, in and around sex organs, and between the fingers and toes).
• Slow-healing sores or cuts. High blood glucose (sugar) can affect your blood flow and cause nerve damage. This damage can make wound healing more challenging.
• Leg or feet pain or numbness as a product of nerve damage.
• Impotence or erectile dysfunction.

With this significant disease burden, we need to identify and pursue modifiable lifestyle factors for type 2 diabetes.

Diabetes risk reduction

The World Health Organization (WHO) explains that “simple lifestyle measures may prevent or delay the onset of type 2 diabetes. Such interventions include:

• Achieve and maintain healthy body weight.
• Eat a healthy diet, avoiding sugars and saturated fats.
• Move — do at least 30 minutes of regular, moderate-intensity activity on most days. You will likely need more activity for weight control.
• Avoid tobacco.

And what about coffee? Back to our recent study. Consuming six cups daily is associated with a one-third (33 percent) reduction in the risk for type 2 diabetes.

There is a seven percent drop in excess risk for type 2 diabetes for every additional cup of coffee consumed daily. On the other hand, decreasing consumption is associated with higher disease risk. Even decaffeinated coffee provides a risk reduction.

Coffee: The catch

Boiled coffee is not as beneficial as filtered coffee. Boiled coffee is made with coarsely ground coffee beans. You may have had Greek or Turkish coffee or espresso-based drinks.

Thank you for joining me today. If you consume coffee, do you have a favorite type?

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• A. Habitual coffee drinking increases your risk of atrial fibrillation, a condition marked by an irregular and often very rapid heart rhythm (arrhythmia) that can lead to blood clots in the heart, stroke, heart failure, and more.
• B. All coffee types have been associated with improved cholesterol, including lower “bad” LDL and increased “good” HDL cholesterol.
• C. Middle-age coffee drinking improves heart volumes and is associated with improvements in risk of death from cardiovascular diseases such as heart attack and stroke.

If you guessed “C,” it’s a bingo! Today we look at a few recent studies examining the health effects of coffee consumption.

We start with the encouraging findings of a recent study. Presenting at the virtual European Society of Cardiology Congress 2021, Dr. Judit Simon offered this observation: Drinking as many as three cups of coffee daily appeared associated with a one-fifth (21 percent) lower stroke risk.

In addition, middle-aged coffee consumers had a one-sixth (17 percent) drop in cardiovascular disease mortality and a 12 percent reduction in the risk of death from all causes. Finally, the coffee drinkers had more favorable heart imaging (magnetic resonance imaging or MRI) findings.

These reductions are compared with non-drinkers (that is, consumers of less than half a cup of coffee per day). Researchers followed half of the subjects for more than 11 years.

For the participants who had heart MRI imaging, coffee consumption appeared associated with significant increases in heart mass (in an area known as the left ventricle). The clinical significance of such findings is unclear.

“It is inhumane, in my opinion, to force people who have a genuine medical need for coffee to wait in line behind people who view it as some kind of recreational activity.”
― Dave Barry

Coffee and heart rhythm problems

The short answer is no: In general, coffee does not heighten your risk for heart arrhythmias. Scientists examined 300,000 individuals and recently reported their findings.

Coffee lowered the risk of experiencing an incident of arrhythmia after researchers adjusted for other lifestyle habits, health problems, and demographics. After an average follow-up of 4.5 years, habitual coffee drinking did not appear associated with a higher risk of cardiac rhythm problems.

There is a caveat: Transient and undiagnosed arrhythmias. Nevertheless, recent evidence suggests that coffee doesn’t increase the risk of persistent, diagnosed arrhythmias.

Moreover, coffee drinking does not appear to affect blood pressure significantly. Some studies suggest coffee may lower high blood pressure risk.

Coffee and cholesterol

Does coffee drinking improve cholesterol levels? It depends. A 2020 research study from the United Kingdom biobank showed that coffee type is important. For example, unfiltered express coffees (such as French press) result in higher levels of “bad” low-density lipoprotein (LDL) cholesterol levels. The standard ground of instant coffee does not appear to have this adverse effect.

The European Society of Cardiology Congress 2021 study did not identify an optimal coffee volume. It showed that, compared with not drinking coffee, drinking instant coffee appeared linked to a lower risk of early death (but not cardiovascular mortality or stroke).

Filtered coffee also lowered the risk of early death, but there was no improvement in the heart attack risk. Finally (this one applied to me), drinking decaffeinated coffee appeared associated with a lower probability of all-cause and cardiovascular disease mortality.

Coffee — Takeaway messages

It is heartening that the extensive studies presented showed no signals pointing to harm from coffee consumption. Instead, low-to-moderate coffee intake in midlife is associated with cardiovascular benefits. Thank you for joining me today.

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ARE YOU A PERSON who may have uttered this quote? — “The most dangerous drinking game is seeing how long I can go without coffee.” If so, I have some good news for you.

Today, we turn to the effects of coffee consumption on the risk of a heart condition known as atrial fibrillation. Atrial fibrillation (Afib) is one of the most common forms of serious heart rhythm problems and has recently increased incidence.

A new study sheds some light on the relationship between coffee and Afib. First, a primer on atrial fibrillation.

Atrial fibrillation — The facts

The authors of a study of trends over the last 50 years believe the increase in the incidence of atrial fibrillation in the community is probably partly due to enhanced surveillance. The US Centers for Disease Control and Prevention offers these observations:

About 9 percent of those older than 65 (and two percent of people under 65 years) live with atrial fibrillation in the United States.

Did you know that individuals of European descent are more likely to have atrial fibrillation than are African Americans? Or that the incidence of the condition increases with age? Given that women generally live longer than men, more women than men experience atrial fibrillation.

Atrial fibrillation — What is it?

Your heart typically contracts and relaxes to a reasonably regular beat. The sinus node in your heart is a natural pacemaker — it creates electrical signals that cause the heart to squeeze and pump blood. Your care team may use an electrocardiogram (ECG) to record and evaluate these electrical signals.

In atrial fibrillation (Afib), the heart’s two small upper chambers (atria) beat irregularly and too quickly. The heart quivers rather than making a nice muscular contraction. As a result, some blood may not be pumped efficiently from the atria into the ventricles during atrial fibrillation. The blood that is left behind can pool in the atria and form dangerous blood clots.

Symptoms

How do you know if you have atrial fibrillation? Sometimes there are no symptoms, but signs may include:

• a fast and irregular heartbeat
• heart palpitations (a “fluttering sensation” in the chest
• light-headedness or fainting
• chest pressure or pain
• shortness of breath, especially when you are lying down
• Tiring more easily

If left undetected or untreated, atrial fibrillation can lead to serious medical problems, including heart attack, heart failure, a stroke, or sudden cardiac arrest. The American Heart Association offers this frightening statistic:

The risk of stroke is about five times higher in people with atrial fibrillation. This risk increases because blood can pool in the atria, and blood clots can form.

Fortunately, there are often effective management tools. Some options may include one or more of these:

1. Medications to slow your heart rate (such as digoxin, beta-blockers, or certain calcium channel blockers);
2. Medication to bring back a regular heart rhythm (antiarrhythmics or beta-blockers);
3. Procedures to control the electrical impulses causing the atrial fibrillation (electrical cardioversion or catheter ablation);
4. “Blood thinners” (anticoagulants or antiplatelet medicines) to reduce clot risk;
5. Placement of a pacemaker (or other surgery).

Let’s get back to coffee. We already know many risk factors for atrial fibrillation, high blood pressure, diabetes, heart valve disease, heart failure, obesity, hyperthyroidism, and ischemic heart disease. Unfortunately, few studies have looked at the role of dietary habits on atrial fibrillation risk.

We know that coffee promotes the release of adrenal-like substances and increases the sensitivity of heart muscle to calcium. Such changes can affect your heart rhythm.

The available clinical literature does not provide a clear answer. For example, the Women’s Health Study showed an increased risk of Afib with two to three cups of caffeinated coffee daily. On the other hand, an analysis of a collection of studies (meta-analysis) showed no significant impact of coffee on men.

Recognizing these discordant results and the widespread consumption of coffee worldwide, researchers took another look at whether coffee is associated with atrial fibrillation risk among men.

The Coffee and Real-time Atrial and Ventricular Ectopy (CRAVE) trial used digital health tools to look at the effect of caffeine consumption on heart rhythm disorders in 100 healthy participants.

Here’s the innovative study design: Participants drank as much coffee as they wanted for one day and avoided all caffeine the next day, alternating this pattern in two-day blocks over two weeks. The subjects got daily coffee assignments via a smartphone app. They wore a continuous recording heart monitor, a continuous blood sugar monitor, and a Fitbit Flex 2 (to record sleep duration and step counts).

The participants pushed a button to record each coffee drink consumed. The researchers reimbursed the participants for their coffee purchases and used smartphone geolocation to track coffee shop visits.

The results? Coffee does not appear to play a role in developing atrial fibrillation or increasing problematic heart rhythms’ frequency (or severity).

Here’s the take of expert coffee researcher Chip Lavie, MD: “Unless coffee consumption is excessive, such as over 5 cups per day in young people, all of the evidence points to coffee and caffeine being safe.

My take

While the study is well-done, I look forward to follow-up research involving more subjects over a longer time period to see the long-term impact of coffee consumption. I would also note that the study participants were young and healthy, with an average age of 38 and an average body mass index.

In this context, if you are concerned about the effects of coffee on your health, you know the drill: Please check in with your healthcare provider. Finally, the researchers have not yet published their study in a peer-reviewed journal.

Interestingly, while the coffee tended to rob folks of sleep, the subjects took about 1,000 more steps than they typically would for every additional cup of coffee consumed. Don’t know if they were walking to the coffee shop or simply caffeine-fueled!

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