The divine coffee: a healthy choice!

The author is an emergency physician, former head of the emergency medicine department of the Montreal Heart Institute. Full professor at the University of Montreal, he teaches, participates in research in emergency medicine and frequently intervenes on health issues.

Ah, the morning coffee, what happiness! If you drink it, you know how good it is and how good it feels. Although, I am aware, these are the words of a drug addict: offer a sip of coffee to a child and he will probably not appreciate its bitter taste. But the brain ends up convincing itself that the consumption of this hot drink corresponds to a moment of pleasure.

For my part, I give in the cappuccino, with freshly ground beans and a little heated milk, deposited in foam. I go moderately: one or two cups are enough for me, except on days when I teach. I can then put on three or four, just to stay dynamic all day.

Coffee fills its followers with happiness, but since I’m writing a medical column here, the most important thing is that it is, to my knowledge, the only drug that is widely beneficial to health – which is great . Not only does it cause no harm, but its effect is truly beneficial.

coffee and health

If you think coffee is a marginal topic in medicine, know that at the time of writing these lines, there have already been 570 new publications on its health effects since the beginning of 2022! And some enlighten us very well on its benefits.

Note in particular this vast study carried out in the United Kingdom with 468,629 people aged 56 on average, followed for 11 years. For a « dose » ranging from half a coffee to three cups a day, the researchers found an association with lower mortality and strokes. Concretely, this corresponds to one in eight fewer deaths from all causes combined, as well as one fewer in seven cardiac deaths and one fewer in five strokes. And when we talk about “cardiac death”, it usually means a heart attack.

It does not say that coffee is necessarily the cause of this drop, but it points in this direction, like many other studies of the genre.

This result is superior to those obtained with many drugs used to treat heart problems. But an even more astonishing and counter-intuitive revelation, however, concerns the favorable effect of coffee on heart rate found in various other studies.

Let’s see. The heart is an electric pump fed by the blood brought by the coronary arteries. With each pulse, it sends blood into the aorta which will then be distributed to all the organs.

Coffee is a stimulant that generally has the effect of accelerating the rate of the heart at rest, especially when consumed in large doses. For this reason, it can give the feeling that the heart tends to race after two or three espressos.

But what is paradoxical is that coffee is associated with a lower risk of arrhythmias – abnormal rhythms – by significantly reducing the incidence of some and having a neutral effect on others.

Reduced risk of atrial fibrillation

Coffee could indeed protect against one of the most frequent arrhythmias, called atrial fibrillation, a disorganization of the electricity of the atria (two of the four chambers of the heart) which causes an irregular acceleration of the heart and causes up to 20 % of strokes, because clots can then form in the atria.

Although this type of arrhythmia is sometimes found in younger people, it is mainly a problem usually associated with age, which in many cases requires the lifelong use of anticoagulants (to thin the blood and prevent clots) and other medicines to slow the heart.

However, we realized that drinking coffee, even if it is a stimulant, is associated with a marked reduction in the risk of suffering from atrial fibrillation. The effect would be proportional to the amount of caffeine, since the risk of fibrillation decreases from 1 in 10 people in general to 1 in 50 for consumers of increasingly strong “doses” of caffeine.

Other favorable effects

Coffee could also protect against Alzheimer’s disease and other dementias, at least in light to moderate consumption, not in excessive consumption (more than four cups per day).

In addition, caffeine is one of the substances that help dilate the bronchi, which could be beneficial for asthmatics. An analysis of the available data published a few years ago had shown a small favorable effect.

Coffee even has analgesic properties. Several studies have shown that adding caffeine to common pain relievers (medications like ibuprophen, for example) can decrease the pain experienced. However, its antimigraine effect is less certain.

Coffee could also act favorably on diabetes: it would protect the kidneys against their loss of function caused by this disease.

Other studies have revealed that its consumption could, among other things, prevent kidney stones and have a certain preventive effect against kidney cancer.

Risks ?

It goes without saying that those who do not tolerate coffee well should not force themselves to drink it.

In some people, this drink causes side effects, such as palpitations. Others will occasionally have digestive symptoms such as acid reflux, but the association is not clearly demonstrated.

In addition, we seem to have found a link between coffee consumption and rheumatoid arthritis, an extra cup of coffee a day can increase by some 6% the risk of suffering from this type of arthritis, which remains much rarer than the heart problems mentioned above.

If this figure frightens you, know that in absolute terms, this represents approximately 1 more case of arthritis for 16,666 coffee drinkers, while we are talking about 1 less death for 8 coffee consumers. In short, drinking coffee could be 2,000 times more likely to save your life than to give you rheumatoid arthritis.

This drink would also significantly reduce the risk of suffering from another problem often causing arthritis, gout. On the other hand, it could, in the event of excessive consumption, lead to a slight increase in the risk of hip fracture, but not of osteoporosis.

And while coffee consumption has long been thought to increase the risk of stomach cancer, a large analysis from 2022 does not seem to have found this effect… except perhaps in our southern neighbors, the only place where the risk was increased (on the order of one more cancer for every five stomach cancers). And with us? I couldn’t find any data. For my part, I do not drink « American coffee », even if nothing says that it is linked.

More generally, coffee consumption would not be linked to cancers, despite a probable protective effect for endometrial cancer in women and liver cancer.

A drug, and then?

Some believe that coffee is not a drug, since it poses few health risks and does not lead to severe withdrawal. Others, however, consider it so because it has several characteristics: it stimulates the nervous system, it is associated with a phenomenon of tolerance (gradual increase in doses to obtain the same effect), it can cause intoxication and it generates some withdrawal.

Several years ago, I abused it a bit, especially during my evening shifts in the emergency room, probably because I was working too hard and needed it to feel in top shape. Wanting to test life without coffee, I decided to stop drinking it at the start of my summer vacation.

Too bad I took it: for more than a week, I spun sideways, having a lot of headaches and a more gloomy mood than usual, like many people who suddenly stop drinking coffee.

Then things settled down and I noticed, when I got back from vacation, that working without coffee didn’t tire me as much anymore. So I persisted in my abstinence, very proud to tell left and right that I had succeeded in interrupting consumption. Better, my evening shifts were now going very well without this drink.

I was going to continue like this until, in 2017, I revised the scientific data on the question for the writing of my book Disorders. I then discovered with astonishment several of the virtues of coffee, and fell back into this (relative) addiction without any ulterior motive, now convinced that it was indeed a healthy choice.

Do we drink it or not?

Certainly, if you already drink light to moderate amounts of coffee, like me, you don’t have much reason to quit. You’re usually even better off continuing, because it could protect against the risks of serious and common problems such as cardiac arrhythmias, heart attacks, strokes, and dementia, in addition to preventing a host of other problems.

The side effects are limited, but let us mention all the same that if you are at risk for a hip fracture (low weight, immobility, family or personal history, fractures, etc.), it may be better to avoid coffee or at least not to drink too much.

As for the mechanisms of action, they remain uncertain, although several molecules present in coffee have antioxidant properties, which could explain a protective effect on several tissues by reducing the level of inflammation.

As for me, it will certainly not occur to me to stop my reasonable consumption of the divine drink, which I also suggest to my patients.

Who could say otherwise on a Sunday morning while sipping their first — or even their second — coffee? Not me anyway !