Good Morning Joe

July 09, 2012

Good Morning Joe 

 References:  NEJM and Circulation 

 Get out of bed in the morning and have a cuppa…Joe.  Coffee is about as American as we can be.  And the questions rage back and forth about whether it is good for us or not.  Seems like the answer is beginning to congeal around the concept that it is just fine.  Two cups a day keeps the doctor away. 

 This study, in the journal Circulation, looked at 5 meta-analysis studies (combining the results of many studies) that involved over 140,000 people.  What they were looking at was heart failure and the affect of coffee on that.  Heart failure is a reasonably good surrogate marker for diabetes and high blood pressure, which are all part of the metabolic syndrome package.  About 4 cups a day seemed to be the sweet spot with an 11% benefit in reduction of risk for heart failure.  After that, benefit started to fade and harm starts showing up.  

The research was done in Scandinavian countries, known for their strong coffee but the researchers did not look at whether it was decaf or fully loaded high test caffeine. But this study comes on the tail of the New England Journal study last month that said that drinking two cups of coffee a day was associated with longer life.  In that study, 400,000 folks were followed for 13 years and found to have a pretty strong association with longer life.  They had to adjust the numbers for other habits like smoking that make things worse, but when all was well and done, women who drank two cups a day had a 13% benefit, 4 cups a day had a 16% benefit.  Men only had a total of 10% benefit.  

Longer life is likely a benefit based on very fundamental physiology. There have been many, many studies on coffee that show good effects like it does not raise blood pressure.  There have been some that show that it decreases brain blood flow when you get to 5-6 cups a day, as much as 27% in one study.   The question remains, is it the caffeine or any of the several thousand other chemicals found in coffee that make it so beneficial? What’s the mechanism?  We don’t know but here is my conjecture.  Caffeine is a methylxanthine that is a chemical that looks like adenosine.  

Adenosine is what we make ATP from.  Now, when we eat a ton of fructose, we force our liver to get exhausted and use up our ATP and thereby raise our blood uric acid level.  That uric acid in our blood wipes out our nitric oxide, leading to hypertension.  There is good research that shows that one sugared soda a day will raise your blood pressure 1 mm Hg in one month.  We do believe that caffeine as a general rule lowers your uric acid, though there is no real solid evidence that it reduces gout.  But I believe coffee, or caffeine, blocks that process ever so slightly and raises our blood nitric oxide level.  But only at 2-4 cups a day.  Blood vessels with more nitric oxide are happy, mellow blood vessels. 

 WWW.  What will work for me?  I drink tea. Coffee makes me too jittery after which I crash and fall asleep.   There are other ways to affect my nitric oxide level in my blood.  One is to eat less sugar and the other is to supplement myself with arginine, the amino acid that we make nitric oxide from.  NO (nitric oxide) makes my blood vessels mellow.  I think that’s the unifying hypothesis.  And I’m sticking with it.  “Morning, Joe!” to the rest of you.  Drink and enjoy.

Written by John E Whitcomb, MD Brookfield Longevity and Healthy Living Clinic 17585 W North Ave, Suite 160, Brookfield, WI 53045 262-784-5300 Archives at