Drinking up to 5 cups of coffee a day could reduce heart risk | This Month in Health Ep. 25

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[00:00:06]>> Welcome back to This Month in Health.

[00:00:08]I'm Liz Ortiz. Coffee drinkers, you may not need to feel guilty about reaching for another cup. The American Heart Association issued a scientific statement saying that consuming five cups of caffeinated coffee is generally safe and may be linked to a lower risk of cardiovascular conditions. That's according to recent studies. Joining me now is Dr. Dr. Manesh Patel, chief of the division of cardiology at Duke University School of Medicine and the newly named American Heart Association president. Dr. Patel, thank you so much for your time today.

[00:00:36]>> Yeah, thanks for having me.

[00:00:37]>> Absolutely. So, let's start with the takeaways. Talk to me more about this statement and what really stands out to you.

[00:00:44]>> Well, first, you know, I think I this is one of the more common conversations I have in my clinic. Um, you know, patients often want to know what are they doing that could be helpful or harmful to themselves. And this is a scientific statement from the American Heart Association that highlights a few things. Once one first is, you know, caffeine and coffee is one of the most commonly consumed things in the world.

[00:01:03]And most of the data we have and the studies we've had on them are largely observational, meaning we've sort of seen people who consume that and see how they um have health benefits or not. And that's often we call it confounding.

[00:01:16]Other factors may interfere with what we see in the scientific results. More recently, we've had some randomized trials investigating the effects of caffeine on cardiovascular health, and we need more. But the big findings from this scientific statement are that in general, we've been worried that caffeine, certainly caffeine from coffee, might lead to um adverse cardiovascular events. And what we see is that generally it seems to be safe and sometimes potentially beneficial.

[00:01:42]and talk to me about some of those benefits that that you saw in doing in looking at the research and putting together this statement.

[00:01:49]>> Well, you know what what what we thought and this is understandable that you know caffeine itself is something that's absorbed by the liver and then it it leads to binding to these receptors that can have transit increases in blood pressure, heart rate and alertness. And so we all know when you have a little bit of caffeine or coffee you can feel a little bit more clear or you might even feel a little jolt of energy. Um those studies made us worry that might be increases in heart failure, hypertension um and and actually arrhythmias, irregular heartbeats. And some of the studies we now have which randomly assigned people to caffeine after they got a cardio version for some of those irregular heartbeats showed that patients were if anything less likely to go into some of those irregular heartbeats for the top part of the heart or atrial arhythmias. Um atrial fibrillation being the most common of those arhythmias. There are a few more PVCs, premature beats in the bottom part of the heart. So, I don't want to say it's not without some potential increase in feeling your heart skips some beats, but it's important to recognize at least up to three to four cups of coffee. It's um not seen that we could see that kind of risk that we had thought about in the past.

[00:02:53]>> And as a coffee lover, I start my day with coffee. I don't even know if that's the right choice, but that's another conversation. Uh but to hear five cups of coffee, it's like, okay, great. I can I can drink more. Were you surprised to hear five cups? Uh what were your thoughts on on the on the number of cups that that is generally safe?

[00:03:10]>> I guess I would say you know I want to I want to modify that a bit up to five cups and you know what we would say is it's low to moderate caffeine consumption. It's associated with lower risk of a lot of the cardiovascular events. I want to be specific that observationally we saw a lower risk of heart failure. Excessive coffee consumption greater than four drinks sometimes five especially in people with heart failure could increase that risk and we have to be careful there. And it and I would say for people, you know, having a few cups of coffee is important to recognize that that's hard for us sometimes to disentangle all the other things that are in some of these um drinks such as um coffee or tea. That is separate from extrapolating what I've just talked about to caffeinated energy drinks. You know, we have case reports that have shown potentially increased in arhythmias with energy drink consumption and much more research is needed there.

[00:03:58]So I just want to be specific not to take the information or the best science we have today and extrapolate it to very high energy drinks.

[00:04:06]>> Would you say though that based on the findings here it is encouraging to hear about the cardiovascular benefits when it comes to caffeine and coffee?

[00:04:14]>> Yeah I want to be really specific. You know, the best available data when we were worried about this having an adverse effect on our health is that the majority of these studies investigating the relationship between caffeine often through coffee and cardiovascular health in natural substances like coffee seemed to show um really um safety if not some beneficial effects. Observationally, the consumption was associated with a reduced risk of type 2 diabetes. The risk of recurrent atrial fibrillation seemed to be less. Although as I noted there's some more increase in premature ventricular contractions. Um you know there are important messages around um moderate coffee consumption was associated with a lower risk of coronary artery disease and stroke and as I spoke about less than four cups or so um seem to also potentially have lower observational risk with heart failure.

[00:05:05]The you know the answers aren't out fully because it's hard to do randomized studies with caffeine. A lot of people don't want to give up drinking coffee, but the observations we have and some of the randomized trial data would tell us the best available science would say it's not as much risk as we might have thought. So, it's a generally a good news story. I just want to make sure people don't take it too far, if you will.

[00:05:25]>> And you touched on it, too. It It's hard to give up coffee or say want to drink less. What What is it about coffee? I'm just curious because so many people rely on it. I know I do. Family members, friends, so many people that I know.

[00:05:38]What is it about the coffee that's just so addicting?

[00:05:40]>> As somebody who also likes caffeine and I think going through the medical uh training and others, I'm sure a lot of my colleagues have had it. You know, it's important to recognize, as I said, it's primarily metabolized caffeine or coffee, and I want to be specific, there's a variety of natural substances in some of these drinks we have. They are absorbed and metabolized by the liver to lead to binding something called adenosine receptor that makes you feel like you have an increase in energy, heart rate, and alertness. So, you know, it's really obviously how people feel when they have a cup of coffee and how they feel about it. Um, and for a long time, we've said, you know, be really careful. People have had questions and at least this scientific statement for us today tells us the best available evidence is that in general, it's not only likely safe. It in some conditions it might be beneficial.

[00:06:25]>> Perfect. Well, Dr. Vetel, we're going to take a quick break right there. We'll come back and talk more about who should be more cautious when it comes to caffeine. And stay with us.

[00:06:39]Welcome back to this month in health. So Dr. Patel, we're talking about caffeine and the new scientific statement that came out. Talk to us though about who should be more careful when it comes to caffeine. I know this can vary from person to person. So talk to us more about that.

[00:06:53]>> Well, certainly we want to think about people that have underlying other problems where significant caffeine may at least make them at risk for some of the things that we worry about. So some examples are people who already have something we call ventricular arhythmias or abnormal heart rhythms for the bottom part of the heart that can sometimes lead them to get very laded or actually have pretty dangerous rhythms. And often we'll put implantable defibrillators in some of these patients. Highdose caffeine uh certainly in its purified form and again this talks maybe not to some mild or moderate coffee consumption. We'd be worried about that in those patients. In patients with significant blood pressure that despite on several medications is staying high.

[00:07:33]I think it's still quite reasonable if they haven't been on uh drinking a lot of coffee to first I don't advise them to drink more coffee and I certainly would say you have to be careful in those people that are having significant blood pressure issues. And finally uh we talked a little bit about heart failure.

[00:07:46]I'll just remind our audience that heart failure is a condition where your heart isn't providing enough blood flow for your body and it's either because it's weak or it's thickened and can't relax.

[00:07:56]And so often in patients with heart failure that's tied to blood pressure problems or very weak function, we're a little bit more cautious about recommending uh significant caffeine or coffee consumption.

[00:08:08]>> And in general, how much caffeine is considered too much? Yeah, it's a it's a really important conversation and com uh comp uh question and uh evidence that we see in our in our practice. I just highlight for our our audience that coffee and tea and other compounds we have, you know, we'll see on the labels milligrams per deciliter of caffeine in those in those compounds or drinks that we have. We know that at least on a general regular coffee um what was studied and observed somewhere between 2 to four cups seems to be pretty safe and reasonable. that may be a cup or more of tea because tea doesn't have as much caffeine that would not be uh clearly associated with some of the I'll call it purified caffeine compounds which haven't been studied. So, you know, my advice to most patients has been um it's it's reasonable to have a cup of coffee.

[00:08:57]It's reasonable to have a couple of cups of coffee. It's when people start to have a whole pot, they're having over three, four, five cups that I start to get a little worried. if they have some of the conditions we've talked about, this science would say it's in line with what we're what we've been advising.

[00:09:10]>> Yeah. Important to know that, too. And we did touch on this before, but the the difference between energy drinks themselves and when we talk about caffeine and coffee. Can you talk more about that difference and and why maybe energy drinks aren't as advised when we talk about the toque?

[00:09:25]>> Yeah. I think first and foremost, you know, we've got so much more data um on I'll just say uh caffeine that's consumed in coffee or tea for generations. Uh even from the Mayans and to all kinds of cultures, we've seen people who have been drinking coffee like compounds and drinks for a while.

[00:09:45]the purified or caffeinated products that people are getting in energy drinks or in those areas have been less studied and and there have been case reports of harm and primarily arrhythmias with significantly high doses of energy consumption. So there's quite a bit more research needed there. I can't say as clearly as we've been talking that the science would say it's safe um as we are with coffee or tea to have these highdosese energy drinks. In fact, there's some potential risk Are there any symptoms you would say that people should watch for that would point to maybe they are drinking too much caffeine and potentially should step back a little bit?

[00:10:24]>> Yeah, just to walk through uh how how caffeine is is done. And there probably genetic differences in individuals. You know, we all have people that we'll sit at at dinner with and they'll order a cup of coffee late at night and we'll go, "Oh my gosh, I I can't imagine you're having a cup of coffee now. I if I had a cup of coffee, I wouldn't be able to sleep." And so there are people that we know are fast and slow metabolizers of caffeine. And there's a an enzyme in your liver called your SIP 1A2 that breaks down caffeine. And depending on your genetics, you may have a differential way in how you break down that caffeine. And as I said, that caffeine often binds adenosine receptors that can lead to something we call sympathetic activity almost feeling like adrenaline that increases blood pressure, heart rate, and alertness. And so, you know, if you're drinking so much coffee that you're in a constant state of jitteriness, your blood pressure spiking, you have a lot of I'll call it sometimes withdrawal symptoms, but just inability to function with daily activities or even simple tasks, I worry that you're having way too much caffeine. And in fact, what we've seen is people that have in the case reports of people that have had very high doses of caffeine will have arrhythmias where their heart's skipping and beating and fast very fast, their blood pressure spiking. Um they're having inability to control some of their temperature and other things. And so I would say if you have any of those symptoms, you have to be really cautious about caffeine and you should seek medical attention if you have any concerns that we've talked about.

[00:11:46]>> And let's talk about what we put in our coffee, right? Because of course there's the sugar and the milk and the creamer and there's a lot of sugar and things in that in itself. What should we be putting in our coffee? What should we try to avoid or at least use minimal of?

[00:12:02]>> Yeah. You know, I I guess we've got um rigorous studies have yet not determined whether these additives might influence the health effects of commonly consumed caffeinated drinks, but it's not unreasonable in my opinion to extrapolate from um the extent of data in other settings that added sugars and flavored syrups probably don't help. Um you know, interestingly, the majority of observational research demonstrating the potential benefits of caffeinated coffee tend to be among people consuming their drinks as they normally would. So, it might suggest that there that there is either some potential benefits, but I would say uh despite all of that, um added sweeteners, creamers, um I'm not sure that they add much health benefits, and I'd always be a little bit cautious about a variety of I'll call it non-natural substances you're putting into your coffee.

[00:12:48]>> Yeah, it's hard to reduce the sugar when you're so used to it. Guilty of that.

[00:12:51]Well, >> yeah. And how about, and you touched on this before, the time of when you drink the coffee, right? If you drink it too late, maybe it'll keep you up at night, but everyone's different. Would you suggest a certain time frame to consume coffee in a day?

[00:13:04]>> There's limited evidence on on the timing of of caffeine intake. Um, we all know that a lot of people in the morning will have a coffin a caffeinated drink like a coffee or two. um what what I suggested in patients and then the science available says that the observations are when people were drinking in usual life and because of probably these effects that we've talked about most of the studies have people consuming coffee um early to midday but not very late in the day. It doesn't mean you couldn't. It's just what we know available in science. So we've sort of followed what human behavior has been and said this is what happens when you have that sort of activity. um there haven't been randomized studies or even great observational studies about what happens if you drink coffee in the morning versus the evening. We have done that for blood pressure pills and other things that helps us advise patients. So in general in practice and from this scientific statement we've we've highlighted for people that this is the usual sort of practice we've observed of people drinking coffee and what it might be.

[00:13:59]>> Perfect. Well, Dr. Battel, one more quick break and we'll come back and talk a little bit more about coffee and the practical takeaways. Stay with us.

[00:14:13]Welcome back, Dr. Battel. So, let's talk about filtered coffee and unfiltered coffee. There are some findings with that as well.

[00:14:20]>> Yeah, you know, I think important to recognize that consumption of unfiltered coffee can raise your cholesterol concentration as a result of a compound in coffee capsol. Uh that's C AF E S T O L. And what actually we found in in in uh double blinded placebo control randomized trial where capsules of this compound but not caffeinated capsules increased LDL cholesterol conver uh concentration. So we believe it's that component of unfiltered coffee that's present in coffees that some of our listeners might be um actually um drinking. French press, Greek or Turkish coffees have a higher amount of that.

[00:15:00]So, um, what we would say is certainly having caffeine and coffee in filtered way seems to have some of those health benefits, but unfiltered coffee might increase your LDL cholesterol and over time that might be important for people.

[00:15:13]>> Very interesting. And how about diabetes as well? Um, people who have diabetes, they drink coffee and sort of how that affects them over time.

[00:15:22]>> Yeah. Well, there's two two big findings I think uh from the observational data.

[00:15:26]Again, these are observational studies.

[00:15:28]though we we look at a lot of habitual coffee drinkers and non- coffee drinkers and sort of follow them for a while. Uh in this scientific statement there was a review of 28 prospective cohort studies and they noted that there was about a 20 to 30% decrease in the risk of developing type 2 diabetes among people who on average had again three and a half to four cups of coffee u a day respectively. And then there's other studies where they were able to actually look and see that there are uh lots of people who are having coffee who are potentially not having the same rates in other parts of the world including studies in Japan. And when you say well why is that? Is that because they've curbed their appetite? Is there something else going on? It's not fully clear. There are multiple postulations but we observe that fewer people are having diabetes and there are potential constituents of coffee. And there's something called chlorogenic acid that might improve our metabolism of glucose and some other ways in which maybe your insulin sensitivity might change. But the big picture is that it certainly doesn't seem to be harmful for people who might have diabetes. And so those also drinking coffee, they may have a lower risk of diabetes.

[00:16:37]>> And would you say based on this statement for someone who does drink coffee every day or or frequently, should this or does this change how they think about it, should they think about coffee differently?

[00:16:48]Well, I think there's some really important things about the scientific statement put out by the American Heart Association. First is it's tackling something that's really important to a lot of us and it's looking at something that there's the best available science on today and that science is evolving from observational studies where we were studying people and just watching how they did with coffee to actually now randomly assigning them as I told you a couple of those were components. another really creative uh investigator initiated and NIH funded studies around coffee drinkers who then undergo a cardio version to get out of a rhythm and then we randomly let them keep drinking coffee or not and we see that if anything those that kept drinking coffee might not have had more of those arhythmias.

[00:17:26]You know, I think the big picture for us from the scientific statement is that we need more science, especially in the high dose energy drinks and some of those areas where we see a lot of consumption, but the data would say it's safe for the coffee drinkers out there to keep drinking coffee as long as it's in moderation. And some would say even three to four cups isn't that moderation, but that's seems to be an an amount that seems to be safe, if not beneficial in some of the ways I've described. And would you say black coffee is the healthiest choice compared to say coffee with added sugar or added creamers and that sort of thing?

[00:17:59]>> Well, I think it is if you you know if you if you can tolerate the taste, if you like it, we would say that the best available >> I don't like it.

[00:18:06]>> Yeah, the best available science would say black coffee has the the most evidence for the kind of safety and nutritional benefits that we're talking about at least for the health benefits.

[00:18:16]>> Yeah, absolutely. Well, Dr. Battel, any final message to listeners when it comes to this statement with coffee and their heart health? Any big takeaway here for them?

[00:18:25]>> Well, I think the biggest takeaway is knowing your heart health. Uh, you know, we talked a lot about coffee today, but you know, unfortunately in our state and in our country, a significant number of people are at risk or have cardiovascular disease broadly, whether that's the heart, the arteries or blood pressure. So, you know, in the American Heart Association, we talk about life's essential a actions or knowing and I'd say to a lot of my patients, know your numbers. What's your blood pressure?

[00:18:47]What's your cholesterol, family history, your sugar, your weight? Those are key things to help you every day prevent adverse cardiovascular events.

[00:18:55]>> Yeah, important advice for all of us to know our numbers. Dr. Patel, thank you so much for your time today. We appreciate you giving us some more insight on this new statement.

[00:19:02]>> Hey, thanks for having me. I love to talk about coffee.

[00:19:05]>> Thank you. Me, too. Have a great day.

[00:19:07]Thank you.

[00:19:09]And thanks for joining us for this month in health. I'm Liz Ortiz.