coffeestomach, intestines and liver
ColophonPublishersCoffee and Health Information BureauDesign and printingStimio Consultants, Drukwerk & Design, TielCopyri...
‘Coffee, stomach, intestines and liver’ – Contents                                                                        ...
4   |
IntroductionIn the Netherlands in total we drink some 6.5 million litres of coffee a day(VNKT, 2007). This makes coffee an...
If after reading this brochure you still have questions or comments, we will be        pleased to hear from you. You can a...
1 Coffee and the stomach1 Is there a relationship between coffee consumption  and dyspepsia (stomach complaints)?Dyspepsia...
Functional dyspepsia        Sensitive stomach or stomach complaints is a collective name for all sorts of        symptoms ...
Clinical research into gastroesophageal reflux is (very) difficult to carry out as ittakes place by introducing a catheter i...
Production of stomach acid         Approximately 1.5 litres of gastric juice is produced in the stomach every day:        ...
6 Is decaffeinated coffee better in the case of GERD?There is one study in which it was found that decaffeinated coffee at...
8 Can people with gastritis (inflamed stomach lining) continue           to enjoy drinking coffee?         Gastritis is a (...
ReferencesAldoori WH et al. (1997). A Prospective Study of Alcohol, Smoking, Caffeine, and the Risk of DuodenalUlcer in Me...
16   |
2 Coffee and the intestines1 Is there a relationship between coffee and ulcus duodeni  (duodenal ulcer)?In a large-scale p...
2 May patients with duodenal ulcers still drink coffee?         There was not found to be any difference in the daily patt...
(1.000 kcal) (Rao, 1998). The effect of caffeinated coffee was found to be assubstantial as that of a complete meal, and w...
6 What is the effect of coffee on bowel movements?         In healthy people coffee can have a stimulating effect on the l...
(Naganuma, 2007). On the other hand in a prospective cohort study (among50.139 women and 46.023 men) Lee et al. (2007) did...
22   |
ReferencesAldoori WH et al. (1997). A Prospective Study of Alcohol, Smoking, Caffeine, and the Risk of DuodenalUlcer in Me...
24   |
3 Coffee, liver and gall1 Does coffee affect the liver?Various studies show that the consumption of coffee is associated w...
when compared with people who never drink coffee (Bravi, 2007).         These results indicate that coffee consumption is ...
over time. Men who drank four or more cups of coffee a day were found tohave 40% less risk of gallstones than men who did ...
5 Can you still drink coffee if you no longer have a gall bladder?         Yes, this makes no difference. The bile duct ta...
Coffee, stomach, intestines and liver   |   29
References         Basso L et al. (1992). A descriptive study of pregnant women with gallstones. Relation to dietary and  ...
Leitzmann MF et al. (2002). Coffee intake is associated with lower risk of symptomatic gallstone diseasein women. Gastroen...
32   |
Study of coffee and healthEvery type of research has its own evidential value and limitations.Most of the studies reported...
5.   Patient-control study: In the case of this type of study the differences in              coffee consumption patterns ...
coffee intestines and liver  stomach,    KO F F I E E N G E Z O N D H E I D   www.koffieengezondheid.nl
Coffee stomach intestines and liver
Coffee stomach intestines and liver
Coffee stomach intestines and liver
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Dyspepsia means literally poor digestion. Symptoms of dyspepsia include pain or discomfort such as a bloated feeling in the upper part of the stomach. Other symptoms are early satiation, nausea, burping, a heavy feeling in the stomach or vomiting. Consumers regularly associate coffee with these stomach complaints.

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Coffee stomach intestines and liver

  1. 1. coffeestomach, intestines and liver
  2. 2. ColophonPublishersCoffee and Health Information BureauDesign and printingStimio Consultants, Drukwerk & Design, TielCopyright© January 2009, Coffee and Health Information Bureau, Rijswijk, NetherlandsAvailabilityThe brochure ‘Coffee, stomach, intestines and liver’ (or additional quantities ofthe brochure) can be ordered free of charge from Coffee and Health InformationBureau. The brochure ‘Coffee, heart and blood vessels’ from 2007 can alsobe requested here. You can also register for the digital newsletter atwww.koffieengezondheid.nl. This free Dutch newsletter keeps you abreastof the most recent scientific information about coffee and health and ispublished 4-5 times a year.Voorlichtingsbureau voor Koffie en GezondheidPostbus 161, 2280 AD RijswijkNetherlandsTel: +31 (0)70 – 3365163Fax: +31 (0)70 – 3365167E-mail: info@koffieengezondheid.nlWebsite: www.koffieengezondheid.nl
  3. 3. ‘Coffee, stomach, intestines and liver’ – Contents PageIntroduction 51 Coffee and stomach Dyspepsia (stomach complaints) 7-8 Gastroesophageal reflux (heartburn) 8-12 Making coffee, decaffeinated coffee 12-13 Peptic ulcer (stomach ulcer) 13 Gastritis (inflamed stomach lining) 14 Stomach operation 14 References 152 Coffee and the intestines Ulcus duodeni (duodenal ulcer) 17-18 Fluid excretion bowel movement 18-20 Irritable bowel 19 Colon cancer 20-21 References 233 Coffee, liver and gall Effect on liver 25-26 Gall bladder, gallstones 26-28 Pancreatitis (inflammation of the pancreas) 28 References 30-31Study of coffee and health 33-34 Coffee, stomach, intestines and liver | 3
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  5. 5. IntroductionIn the Netherlands in total we drink some 6.5 million litres of coffee a day(VNKT, 2007). This makes coffee an important source of fluid in our diets. In thisrespect it goes without saying that one wonders what the effects of coffee onhealth might be. This brochure deals with common questions about coffee inrelation to the stomach, intestines and liver. The questions have been drawn up incollaboration with the Dutch Association of Stomach Intestine and Liver Nurses.Questions have also been included that were asked as a result of an appeal in theemail newsletter published by the Dutch Coffee and Health Information Bureau.Two stomach, intestine and liver physicians and two dieticians working on behalfof the Dutch Association of Dieticians assisted with answering the questions:- Dr. Paul Boekema (stomach, intestine and liver physician, Máxima Medisch Centrum, Eindhoven)- Drs. Marco Becx (stomach, intestine and liver physician, Mesos Medisch Centrum, Utrecht)- Joan Rentzing (stomach, intestine and liver dietician, St. Antonius Ziekenhuis, Nieuwegein)- Gertien Hiemstra (stomach, intestine and liver dietician, UMC Utrecht)It was possible to provide sound answers to many of the questions asked on thebasis of various scientific studies. However, there were some questions that remainunanswered. On one hand because the body of research is not yet sufficient, andon the other hand because some aspects are very difficult to examine. Clinicalresearch into the effect of nutrition on gastroesophageal reflux for instance isdifficult to carry out as it requires a catheter to be introduced into the oesophagus,which can be rather uncomfortable. In addition to coffee, many other foods anddrinks are consumed, which does not make it any simpler to link the complaintto the right food. Coffee, stomach, intestines and liver | 5
  6. 6. If after reading this brochure you still have questions or comments, we will be pleased to hear from you. You can also order Dutch copies of the brochure free of charge or download it at www.koffieengezondheid.nl. Naturally we will continue to monitor scientific developments closely and should views change, they will be shown on our website and in our email newsletter. Coffee and Health Information Bureau (Voorlichtingsbureau voor Koffie en Gezondheid) Literature Vereniging van Nederlandse Koffiebranders en Theepakkers (VNKT), Annual Report 2007.6 |
  7. 7. 1 Coffee and the stomach1 Is there a relationship between coffee consumption and dyspepsia (stomach complaints)?Dyspepsia means literally poor digestion. Symptoms of dyspepsia include painor discomfort such as a bloated feeling in the upper part of the stomach. Othersymptoms are early satiation, nausea, burping, a heavy feeling in the stomach orvomiting. Consumers regularly associate coffee with these stomach complaints.In order to discover the extent to which dyspepsia occurs in the Netherlandsand in order to determine the relationship with alcohol, coffee and tea,500 people were approached by means of a telephone sample survey. Ofthese people 428 were willing to take part in an interview about the presenceof gastro-intestinal complaints and the use of alcohol, coffee and smoking(Boekema, 2001). Of those questioned 14% indicated that they suffered fromstomach complaints. No association was shown between coffee and dyspepsia,nor between alcohol and dyspepsia. Smoking and having stopped smoking,however, were strongly associated with stomach complaints. An earlierNorwegian study similarly found no relationship between coffee and dyspepsia(Haug, 1995). An Australian cross-sectional survey of 592 people also found norelationship between coffee drinking and dyspepsia (Nandurkar, 1998).Dyspepsia was found to be related to smoking and use of aspirin. A largecross-sectional survey of 8.407 adults in the UK showed a significant relationshipbetween the presence of Helicobacter pylori and dyspepsia. There was norelationship with coffee consumption (Moayyedi, 2000).The scientific studies available show no relationship between coffee consumptionand dyspepsia. Coffee, stomach, intestines and liver | 7
  8. 8. Functional dyspepsia Sensitive stomach or stomach complaints is a collective name for all sorts of symptoms such as stomach pain, nausea, vomiting and a heavy or bloated feeling in the stomach area. If no explanatory abnormalities or specific clinical picture are identified during examination of the complaints, the diagnosis ‘functional dyspepsia’ is made. 2 If you have dyspepsia (stomach complaints) may you still drink coffee? Based on the available scientific studies no relationship can be demonstrated between coffee consumption and dyspepsia (Boekema, 2001; Haug, 1995; Nandurkar, 1998; Moayyedi, 2000). Of the people with dyspepsia 38% assumed that coffee consumption was related to their complaints, although their pattern of coffee consumption was no different from that of people who did not assume a relationship with coffee (Boekema, 2001). There are no proven arguments for advising against coffee in the case of dyspeptic complaints, other than personal preference. 3 Is there a relationship between gastroesophageal reflux disease (GERD) and coffee? People with reflux complaints regard spicy food, fatty food and overeating as the most important nutritional factors affecting the complaints (Bolin, 2000). Stress is also frequently named. Coffee is named to a lesser extent in relation to acid reflux (see table on page 10).8 |
  9. 9. Clinical research into gastroesophageal reflux is (very) difficult to carry out as ittakes place by introducing a catheter into the oesophagus and can therefore beaggravating. Nevertheless Dutch researchers succeeded in carrying out such asurvey. This survey included an examination of the effects of drinking coffee onthe lower oesophageal sphincter (constrictor) and exposure to acid in the oeso-phagus during normal activities in eight healthy people and in seven patients withgastroesophageal reflux disease (Boekema, 1999b). Only if coffee was drunk onan empty stomach was there an increase in the exposure to acid in the oesopha-gus in the case of patients with GERD. This effect was smaller than the effect ofa meal. Coffee was found not to affect any other reflux parameters, such as themotility of the oesophagus body and the lower oesophageal sphincter.It was concluded that coffee has no significant effect on gastroesophageal refluxin patients and no effect whatsoever in the case of healthy volunteers.In an extensive patient control study in Norway among 3.153 people with refluxcomplaints and 40.210 controls, the relationship was examined between refluxand various lifestyle factors (Nilsson, 2004). Smoking scored most unfavourably,followed by high salt consumption. Coffee consumption, high-fibre bread andregular physical movement on the other hand were found to lower the risk ofreflux. In an Italian study coffee was found to have no relationship with GERD(Dore, 2007).A study of the relationship between lifestyle factors and gastroesophageal refluxcomplaints in identical twins, BMI, smoking and heavy physical activity duringwork were found to be risk factors for frequent GERD symptoms, while physicalactivity during leisure time appeared to have a protective effect (Zheng, 2007).After correction for these factors none of the nutritional factors (includingcoffee) was found to show a relationship to the complaints. In the case of menit was found that consumption of high amounts of coffee (more than seven cupsa day) was accompanied by a lower risk. Coffee, stomach, intestines and liver | 9
  10. 10. Production of stomach acid Approximately 1.5 litres of gastric juice is produced in the stomach every day: pepsin (protein-splitting enzymes), stomach acid (hydrochloric acid) and the so-called intrinsic factor. All foodstuffs (solid and liquid) increase the production of stomach acid. Hence also coffee, water, a meal or a biscuit. This is a normal, physiological reaction of the digestive system, which is no cause for complaints. It only becomes clinically relevant if stomach acid regularly flows back into the oesophagus. 5 What is the influence of the method of preparing coffee? The gastrointestinal tract can be stimulated by foodstuffs with a substantial calorie content, acidity, osmolarity or volume (Boekema, 1999a). Coffee’s acidity is virtually neutral (pH 5-6), which makes a pH effect very improbable. Coffee contains virtually no energy. The method of roasting the coffee beans (conduction or convection) does not appear to make any difference (DiBaise, 2003). No research has been undertaken into the effect of the different brewing methods. Nor is any research known in which the physiological effects on coffee of the addition of milk are examined. The addition of milk or evaporated milk does affect the taste and may mask any bitterness. As a result, the coffee is generally perceived as milder, which may also give the idea that the effect of the coffee on the stomach would also be milder. However, this cannot be confirmed by scientific research.12 |
  11. 11. 6 Is decaffeinated coffee better in the case of GERD?There is one study in which it was found that decaffeinated coffee at breakfastgave less reflux (Pehl, 1997). However, the relationship between drinking coffeeand the occurrence of reflux complaints could not be confirmed in otherstudies (Boekema, 1999b; Nilsson, 2004; Dore, 2007; Zheng, 2007). Thereare insufficient indications to conclude that decaffeinated coffee is better thanregular (caffeinated) coffee.7 Is there a relationship between coffee consumption and the risk of peptic ulcers (stomach ulcers)?In the past coffee has been associated with the development of stomach ulcers.However, since the identification of Helicobacter pylori, understanding of thepathogenesis of peptic ulcers has changed radically, as a result of which coffeehas ceased to be of interest as a possible causal factor (Boekema, 1999a).In a Danish cohort study among 2.416 Danish adults into risk factors for stomachulcers Helicobacter pylori infection, smoking and the use of tranquillisers wereidentified as the most important factors. Coffee was found not to be a risk factor(Rosenstock, 2003).There are no indications that coffee forms a risk for the development ofa stomach ulcer. Coffee, stomach, intestines and liver | 13
  12. 12. 8 Can people with gastritis (inflamed stomach lining) continue to enjoy drinking coffee? Gastritis is a (slight) inflammation of the stomach lining as a result for example of an infection with Helicobacter pylori. This generally does not result in com- plaints and is usually a coincidental finding during an endoscopic examination (gastroscopy). If the gastritis is more serious and results in sores or ulcers in the mucous membrane, this can explain complaints (see also page 17). In a prospective cohort study among 47.806 men, after six years there were found to be 138 new cases of ulcus duodeni (duodenal ulcer). No relationship was found with smoking, alcohol or caffeine intake (Aldoori, 1997). Coffee has no influence on the development of this disorder but it may influence the complaints. Patients themselves often already avoid such drinks or foodstuffs if they experience discomfort after consumption. Advice is generally not necessary. 9 May one drink coffee again soon after a stomach operation? Coffee has no special effects different from those of other drinks or food in this respect. Therefore as soon as eating and drinking are permitted after the operation, this can include drinking coffee if the patient feels like it.14 |
  13. 13. ReferencesAldoori WH et al. (1997). A Prospective Study of Alcohol, Smoking, Caffeine, and the Risk of DuodenalUlcer in Men. Epidemiology, 8: 420-424.Boekema PJ et al. (2001). Functional bowel symptoms in a general Dutch population and associationswith common stimulans. Neth J Med, 59(1): 23-30.Boekema PJ et al. (1999a). Chapter 4: Prevalence of functional bowel symptoms in a general Dutchpopulation and associations with use of alcohol, coffee and smoking. Coffee and upper gastrointestinalmotor and sensory functions, Zeist (the Netherlands).Boekema PJ et al. (1999b). Effect of coffee on gastroesophageal reflux in patients with reflux disease andhealthy controls. Eur J Gastroenterol Hepatol, 11: 1271-1276.Bolin TD et al. (2000). Esophagogastroduodenal Diseases and Pathophysiology, Heartburn: Communityperceptions. J Gastroenterol Hepatol, 15: 35-39.DiBaise JK (2003). A Randomized, Double-Blind Comparison of Two Different Coffee-Roasting Processeson Development of Heartburn and Dyspepsia in Coffee-Sensitive Individuals. Dig Dis Sci, 4(48): 652-656.Dore MP et al. (2007). Diet, Lifestyle and Gender in Gastro-Esophageal Reflux Disease. Dig Dis Sci, 53(8):2027-2032.Haug TT et al. (1995). What Are the Real Problems for Patients with Functional Dyspepsia?Scan J Gastroenterol, 30(2): 97-100.Kaltenbach T et al. (2006). Review: sparse evidence supports lifestyle modifications for reducingsymptoms of gastroesophageal reflux disease. Arch Intern Med, 166: 965-971.Moayyedi P et al. (2000). The Proportion of Upper Gastrointestinal Symptoms in the communityAssociated With Helicobacter pylori, Lifestyle Factors, and Nonsteroidal Anti-inflammatory Drugs.Am J Gastroenterol, 95(6): 1448-1455.Nandurkar S et al. (1998). Dyspepsia in the community is linked to smoking and aspirin use but not toHelicobacter pylori infection. Arch Intern Med, 158(13): 1427-1433.Nilsson M et al. (2004). Lifestyle related risk factors in the aetiology of gastroesophageal reflux.Gut, 53: 1730-1735.Pehl C et al. (1997). The effect of decaffeination of coffee on gastroesophageal reflux in patients withreflux disease. Alim Pharm Ther, 11: 483-486.Rosenstock S et al. (2003). Risk factors for peptic ulcer disease: a population based prospective cohortstudy comprising 2,416 Danish adults. Gut, 52: 186-193.Zheng Z et al. (2007). Lifestyle factors and Risks for Symptomatic Gastroeosophageal Reflux in Monozy-gotic Twins. Gastroenterology, 132: 87-95. Coffee, stomach, intestines and liver | 15
  14. 14. 16 |
  15. 15. 2 Coffee and the intestines1 Is there a relationship between coffee and ulcus duodeni (duodenal ulcer)?In a large-scale prospective cohort study of 47.806 American men (Aldoori, 1997)the relationship between alcohol, smoking, caffeine and the risk of an ulcus duodeni(duodenal ulcer) was examined. None of the factors examined were found to beassociated with a substantial increase of the risk. This result confirms the outcome ofan earlier study (Kato, 1992), in which similarly no connection could be establishedbetween coffee consumption and the risk of ulcus duodeni. There was found to beno difference in the daily pattern of coffee consumption between people with ulcusduodeni, dyspepsia and healthy controls (Elta, 1990). Similarly there was found to beno difference in the pattern of complaints after drinking coffee between patients withulcus duodeni and healthy controls. The available scientific studies show no relation-ship between coffee consumption and the risk of ulcus duodeni.Ulcus duodeniUlcus duodeni is the general medical term for duodenal ulcer. The duodenum isthe first part of the small intestine after the stomach. In addition to the stomach(see page 12), this part of the intestine is also exposed to stomach acid. Thestomach and duodenum produce mucus to protect themselves against the acid.Infection with Helicobacter pylori or the use of painkillers or anti-inflammatories(Non Steroidal Anti-Inflammatory Drugs NSAID) can slow the process of main-tenance of the mucous membrane, which can result in inflammation of themucous membrane. In the case of a minority of people infected by Helicobacterpylori or using NSAID, ulcers may arise, which can cause pain in the epigastrium. Coffee, stomach, intestines and liver | 17
  16. 16. 2 May patients with duodenal ulcers still drink coffee? There was not found to be any difference in the daily pattern of coffee consump- tion between people with ulcus duodeni, dyspepsia and healthy controls (Elta, 1990). Similarly there was not found to be any difference in the pattern of complaints after drinking coffee between patients with ulcus duodeni and healthy controls. There are also no indications that coffee influences the course of various intestinal disorders, such as diverticulitis, Crohn’s disease or colitis ulcerosa. People who feel ill often modify their feeding pattern of their own accord, in particular eating less fat, and drinking less coffee. This is a natural response in order to avoid stimulation of the intestinal system as much as possible. 3 Does coffee affect fluid discharge in the intestines? Approximately 9 litres of all sorts of digestive juices are added daily to the first part of the gastrointestinal tract, which are virtually entirely re-absorbed into the body further on in the intestinal system. A foodstuff has to have a very strong effect on the secretion of digestive juices to be capable of causing any relevant change. There are no indications that coffee affects fluid secretion in the intestines. 4 Does coffee have a stimulating effect on the large intestine? In some people coffee has a stimulating effect on the peristalsis of the large intestine. Results of a survey among 99 people (aged 17-27) concerning bowel movement indicate that in 29% of the people coffee stimulated bowel move- ment (Brown, 1990). The effect of regular (caffeinated) coffee (240 ml of coffee with 150 mg of caffeine) and decaffeinated coffee (240 ml) on intestinal motility was compared with that of the same amount of hot water or a complete meal18 |
  17. 17. (1.000 kcal) (Rao, 1998). The effect of caffeinated coffee was found to be assubstantial as that of a complete meal, and was 60% stronger than water and23% stronger than decaffeinated coffee. In a study by Sloots et al. (2005) strongcoffee (280 ml) and hot water were both found to have a significant effect onbowel movement.5 Is there a relationship between coffee consumption and irritable bowels (IBS)?Patients with Irritable Bowel Syndrome (IBS) have symptoms that cannot berelated to a clear clinical picture. It is regarded as a chronic disturbance of thefunctioning of the intestinal system. The symptoms, such as abnormal bowelmotions (constipation or diarrhoea) and stomach pain or an uncomfortablefeeling in the stomach, can also occur after consumption of food by peoplewithout IBS (Dapoigny, 2003). Almost everyone has intestinal complaints oncein a while. In the Netherlands during a screening exercise 5.8% of the adultswere found to be suffering from IBS, which is surprisingly low compared withother countries (Boekema, 2001). No association with coffee consumption wasfound. In a Swedish survey it was found that 63% of patients with IBS assumethat their symptoms are related to meals (Simren, 2001). In particular foodstuffsthat are rich in carbohydrates and fat were associated with complaints.Coffee was associated by 10% of the patients with serious complaints (dyspepsia,stomach pain and thin faeces). No general nutritional advice can be givento people with IBS. People often avoid foodstuffs that they themselves alreadyassociate with their complaints. Coffee, stomach, intestines and liver | 19
  18. 18. 6 What is the effect of coffee on bowel movements? In healthy people coffee can have a stimulating effect on the large intestine, which can have a positive effect on bowel movements. The same amount of hot water or a meal have a comparable effect (see question 4). The possible relevance of this effect for people who are troubled by constipation will differ individually and will depend among other things on the seriousness of the constipation. There are no indications that coffee causes diarrhoea in healthy people. A small percentage of patients with IBS associate coffee with thin faeces (see question 5). They will often already modify their pattern of consumption themselves. 7 Is there a relationship between coffee and colon cancer? Three cohort studies and nine case-control studies published between 1990 and 2003 showed no significant relationship between coffee consumption and colon cancer (cancer of the large intestine) (Tavani, 2004). Three cohort studies and four case-control studies also showed no relationship with cancer of the rectum (Tavani, 2004). In a meta-analysis, in which the results from five cohort studies and 12 case-control studies were combined, people who consumed four or more cups of coffee daily were found to have a 24% lower risk of colon cancer compared with people who did not drink any coffee (Tavani, 2004). In an extensive, prospective cohort study no relationship was observed between coffee and colon cancer. Consumption of two or more cups of decaffeinated coffee a day was found to be associated with a significantly lower risk of colon cancer (Michels, 2005). In two large Swedish prospective cohort studies of 61.433 women and 45.306 men no relationship was found between coffee and colon cancer (Larsson, 2006), as well as in a prospective Japanese cohort study20 |
  19. 19. (Naganuma, 2007). On the other hand in a prospective cohort study (among50.139 women and 46.023 men) Lee et al. (2007) did find a halving of the riskof colon cancer in the case of women who consumed three or more cups ofcoffee a day, and no relationship in the case of men. For cancer of the rectumno relationship was found with coffee consumption in either women or men.Based on the studies mentioned above it can be concluded that coffee con-sumption is not related to a heightened risk of cancer of the colon or rectum.The possibly protective effect of coffee with respect to cancer of the colondeserves further investigation.How much caffeine per day?The caffeine in coffee has a slightly stimulating effect on the central nervous system.As a result, coffee can increase alertness and concentration. In the case of somepeople it takes longer before they fall asleep after drinking coffee. In that casedecaffeinated coffee offers a solution. The amount of caffeine at which someonefeels comfortable can vary widely. This depends among other things on bodyweight and possibly nicotine consumption. In general 400 mg of caffeine a day(4 to 5 cups of coffee) is regarded as a safe and comfortable amount. Pregnantwomen are advised to limit the amount of caffeine to a maximum of 300 mg daily.In some countries e.g. the UK, the upper recommended limit is 200mg. Coffee, stomach, intestines and liver | 21
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  21. 21. ReferencesAldoori WH et al. (1997). A Prospective Study of Alcohol, Smoking, Caffeine, and the Risk of DuodenalUlcer in Men. Epidemiology, 4(8): 420-424.Boekema PJ et al. (2001). Functional bowel symptoms in a general Dutch population and associationswith common stimulans. Neth J Med, 59(1): 23-30.Brown SR et al. (1990). Effect of coffee on distal colon function. Gut, 31: 450-453.Dapoigny M et al. (2003). Role of Alimentation in Irritable Bowel Syndrome. Digestion, 67: 225-233.Elta GH et al. (1990). Comparison of coffee intake and coffee-induced symptoms in patients withduodenal ulcer, nonulcer dyspepsia, and normal controls. Am J Gastroenterol, 85:1339-1342.Kato I et al. ( 1992). A prospective study of gastric and duodenal ulcer and its relation to smoking,alcohol, and diet. Am J Epidemiol, 135(5): 521-530.Larsson SC et al. (2006). Coffee consumption and incidence of colorectal cancer in two prospectivecohort studies of Swedish women and men. Am J Epidemiol, 163(7): 638-644.Lee KJ et al. (2007). Coffee consumption and risk of colorectal cancer in a population-basedprospective cohort of Japanese men and women. Int J Cancer,121(6): 1312-1318.Michels KB et al. (2005). Coffee, tea, and caffeine consumption and incidence of colonand rectal cancer.J Natl Cancer Inst, 97(4): 282-292.Naganuma T et al. (2007). Coffee consumption and the risk of colorectal cancer: a prospective cohortstudy in Japan. Int J Cancer, 120(7): 1542-1547.Rao SSC et al. (1998). Is coffee a colonic stimulant. Eur J Gastroenterol Hepatol, 10: 113-118.Simren M et al. (2001). Food-Related Gastrointestinal Symptoms in the Irritable Bowel Syndrome.Digestion, 63: 108-115.Sloots CEJ et al. (2005). Stimulation of defecation: Effects of coffee use and nicotine on rectal toneand visceral sensitivity. Scan J Gastroenterol, 40: 808-813.Tavani A and La Vecchia C (2004). Coffee, decaffeinated coffee, tea and cancer of the colon andrectum: a review of epidemiological studies, 1990-2003. Cancer Causes and Control,15: 743-757. Coffee, stomach, intestines and liver | 23
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  23. 23. 3 Coffee, liver and gall1 Does coffee affect the liver?Various studies show that the consumption of coffee is associated with a lower riskof various disorders of the liver, particularly in people who have a heightened riskof such disorders as in the case of excessive alcohol consumption, viral hepatitis,overweight and a reduced glucose metabolism (Ruhl, 2005b; La Vecchia, 2005;Cadden, 2007).At the start of the 1990s in a large prospective epidemiological study of128.934 adults it was demonstrated that four or more cups of coffee a day canreduce the risk of alcoholic liver cirrhosis by 80% and the risk of death from livercirrhosis by 23% (Klatsky, 1992, 1993). This result was confirmed in a Norwegianstudy of 51.306 adults, in which coffee consumption was similarly found to berelated to lower mortality as a result of liver cirrhosis, both alcoholic and non-alcoholic liver cirrhosis (Tverdal, 2003).In various retrospective and cohort studies, too, an inverse relationship is foundbetween liver cirrhosis and consumption of coffee (Corrao, 1994, 2001; Gallus, 2002;Klatsky, 2006). The effect was only found for coffee and not for other caffeinecontaining drinks (Corrao, 2001).Increased activity of liver enzymes (alanine aminotransferase (ALT), aspartateaminotransferase (AST), gamma glutamyl transferase (␥GT)) forms an indicatorof liver damage and a heightened risk of liver cirrhosis. In various studies a linkhas been found between coffee consumption and reduced enzyme activity(Honjo, 2001; Nakanishi, 2000; Ruhl, 2005a; Klatsky, 2006). In a meta-analysisbased on six patient control studies and four cohort studies it was found thatcoffee drinkers have a 41% lower risk of hepatocellular carcinoma (liver cancer) Coffee, stomach, intestines and liver | 25
  24. 24. when compared with people who never drink coffee (Bravi, 2007). These results indicate that coffee consumption is associated with a reduced risk of (serious) liver disease. Various components in coffee are associated with this, such as caffeine, kahweol and cafestol (components in coffee oil) and anti- oxidants. However, more research is needed in order to demonstrate a possible mechanism. It is also still too early to attach a consumption recommendation to this, though the results give no cause to discourage coffee consumption. 2 May people with functional liver disorders drink coffee? There are no indications that coffee consumption has an adverse effect on the liver functions. The results of various major studies point in fact to an association between a reduced risk of (serious) liver disease and coffee consumption. It is as yet too early to attach preventive consumption advice to this. However, the results do not constitute a reason to advice against coffee consumption. 3 What is the effect of coffee on the gall bladder? Coffee can stimulate contraction of the gall bladder (Douglas, 1990; Lindaman, 2002). As a result, coffee may possibly contribute to a lower risk of gallstones (Lindaman, 2002). A number of older epidemiological studies of the relationship between gallstones and coffee consumption found no relationship (Jorgensen, 1989; Basso, 1992; Kratzer, 1997; Pastides, 1990; La Vecchia, 1991; Sahi, 1998) or a significant inverse relationship (Misciagna, 1996). Leitzmann et al (1999) monitored 46.008 men in the age range from 40 to 7426 |
  25. 25. over time. Men who drank four or more cups of coffee a day were found tohave 40% less risk of gallstones than men who did not drink coffee regularly.Decaffeinated coffee was not found to be associated with a lower risk. In acomparable study of 80.898 women in the age range from 30 to 55, who weremonitored for a period of 20 years, a significantly lower risk of cholecystectomy(removal of the gall bladder) was found (Leitzmann, 2002). Cholecystectomyis regarded as a measure of colelithiasis (gallstones). Decaffeinated coffee wasfound to have no effect. In a smaller Japanese study no relationship was foundbetween coffee, green tea and caffeine consumption and colelithiasis among7.167 men (Ishizuk, 2003).Further research will be needed to show whether coffee consumption can havea preventive effect on the development of gallstones.4 Can someone with gall or gallstone problems continue to drink coffee?In the case of gallstone complaints people are often advised to avoid fatty mealsin order to avoid the attacks. Although the effect is less, coffee can also affectthe contraction of the gallbladder and therefore will be avoided by a lot ofpeople suffering from gallstone complaints. This is supported by the fact thatcoffee consumption (just like consumption of a fat-rich meal) is followed by acontraction of the gallbladder (Douglas, 1990). If a gallbladder compresses butcannot empty itself as the result of a blocking gallstone, the pressure and walltension will increase. This stimulates the stretching and pain nerves and cantherefore be very painful. Not all gallstones cause complaints. Most gallstonesremain asymptomatic. Complaints occur in 20-25% of people with gallstones(symptomatic gallstones). Mostly in the case of clear gallstone attacks treatment(operative or otherwise) will be suggested. Coffee, stomach, intestines and liver | 27
  26. 26. 5 Can you still drink coffee if you no longer have a gall bladder? Yes, this makes no difference. The bile duct takes over part of the gallbladder’s reservoir function. 6 Do caffeinated and decaffeinated coffee differ in their effect on the bile? There are indications that caffeinated coffee stimulates a contraction of the gallbladder but an effect of decaffeinated coffee cannot be excluded. Adding milk is primarily a question of taste; there are no indications that this influences the effect. 7 Is there a relationship between coffee consumption and pancreatitis? In a study among 129.000 people into the effect of smoking and coffee con- sumption on pancreatitis (inflammation of the pancreas) it has been found that coffee consumption is related to a lower risk of alcohol-associated pancreatitis, while smoking is associated with a higher risk (Morton, 2004). There is also no relationship between coffee consumption and carcinoma of the pancreas (Tavani, 2000).28 |
  27. 27. Coffee, stomach, intestines and liver | 29
  28. 28. References Basso L et al. (1992). A descriptive study of pregnant women with gallstones. Relation to dietary and social habits, education, physical activity, height, and weight. Eur J Epid, 8: 629-633. Bravi F et al. (2007). Coffee Drinking and Hepatocellular Carcinoma Risk: A Meta-Analysis. Hepatology, 46(2): 430-436. Cadden ISH et al. (2007). Review article: possible beneficial effects of coffee on liver disease and function. Alim Pharm Ther, 26: 1-7. Corrao G et al. (1994). The effect of drinking coffee and smoking cigarettes on the risk of cirrhosis associated with alcohol consumption: a case-control study. Eur J Epid, 10: 657-664. Corrao G et al. (2001). Coffee, Caffeine, and the Risk of Liver Cirrhosis. Ann Epid, 11: 458-465. Douglas BR et al. (1990). Coffee stimulation of cholecystokinin release and gallbladder contraction in humans. Am J Clin Nutr, 52: 553-556. Gallus S et al. (2002). Does Coffee Protect Against Liver Cirrhosis? Ann Epid, 12: 202-205. Honjo S et al. (2001). Coffee consumption and serum aminotransferases in middle-aged Japanese men. J Clin Epidemiol, 54: 823-829. Ishizuk H et al. (2003). Relation of coffee, green tea, and caffeine intake to gallstone disease in middleaged Japanese men. Eur J Epidemiol, 18(5): 401-405. Jorgensen T et al. (1989). Gallstones in a Danish population. Relation to weight, physical activity, smoking, coffee consumption, and diabetes mellitus. Gut, 30: 528-534. Klatsky AL and Armstrong MA (1992). Alcohol, smoking, coffee and cirrhosis. Am J Epidemiol, 136(10): 1248-1257. Klatsky AL et al. (1993). Coffee, tea, and mortality. Ann Epidemiol, 3: 375-381. Klatsky AL et al. (2006). Coffee, Cirrhosis, and Transaminase Enzymes. Arch Intern Med, 166: 1190-1195. Kratzer W et al. (1997). Gallstone Prevalence in Relation to Smoking, Alcohol, Coffee Consumption, and Nutrition. The Ulm Gallstone Study. Scan J Gastroenterol, 32(9): 953-958. La Vecchia C et al. (1991). Risk Factors for Gallstone Disease Requiring Surgery. Int J Epidemiol, 20: 209-215. La Vecchia C (2005). Coffee, liver enzymes, cirrhosis and liver cancer. J Hepatol, 42: 444-446. Leitzmann MF et al. (1999). A prospective Study of Coffee Consumption and the Risk of Symptomatic Gallstone Disease in Men. JAMA, 281: 2106-2112.30 |
  29. 29. Leitzmann MF et al. (2002). Coffee intake is associated with lower risk of symptomatic gallstone diseasein women. Gastroenterology, 123: 1823-1830.Lindaman BA et al. (2002). The Effect of Phosphodiesterase Inhibition on Gallbladder Motility In Vitro.J Surg Res, 105: 102-108.Misciagna G et al. (1996). Epidemiology of cholelithiasis in southern Italy. Part II: Risk factors.Eur J Gastroenterol Hepatol, 8: 585-593.Morton C et al. (2004). Smoking, coffee and pancreatitis. Am J Gastroenterol, 99(4): 731-738.Nakanishi N et al. (2000). Coffee consumption and decreased gamma-glutamyltransferase: a studyof middle-aged Japanese men. Eur J Epidemiol, 16: 419-423.Pastides H et al. (1990). A case-control study of the relationship between smoking, diet,and gallbladder disease. Arch Int Med, 150: 1409-1412.Ruhl CE and Everhart JE (2005a). Clinical-liver, pancreas, and biliary tract. Coffee and CaffeineConsumption Reduce the Risk of Elevated Serum Alanine Aminotransferase Activity in the United States.Gastroenterology, 128: 24-32.Ruhl CE and Everhart JE (2005b). Clinical-liver, pancreas, and biliary tract. Coffee and Tea ConsumptionAre Associated With a Lower Incidence of Chronic Liver Disease in the United States. Gastroenterology,129: 1928-1936.Sahi T et al. (1998). Body Mass Index, Cigarette Smoking, and Other Characteristics as Predictors ofSelf-Reported, Physician-Diagnosed Gallbladder Disease in Male College Alumni. Am J Epidemiol,147: 644-651.Tavani A and La Vecchia C (2000). Coffee and Cancer: a review of epidemiological studies, 1990-1999.Eur J Cancer Prev, 9: 241-256.Tverdal A and Skurtveit S (2003). Coffee intake and mortality from liver cirrhosis. Ann Epidemiol,13(6): 419-423. Coffee, stomach, intestines and liver | 31
  30. 30. 32 |
  31. 31. Study of coffee and healthEvery type of research has its own evidential value and limitations.Most of the studies reported in this brochure can be differentiated into:1. Meta-analysis: A literature study of various studies (intervention studies, cohort studies and/or patent control studies) of the relationship between coffee consumption behaviour and a biomarker or (medical) condition, with the aim of obtaining a more precise outcome.2. Cohort study (prospective): In this type of research people in a certain age category (the cohort) are monitored over a longer period. Participants have been selected before the outcome (for example a particular (medical) condition) occurred. At the start of the research an examination has been made of exposure, for example coffee consumption, which can be related afterwards to the outcome. The pattern of coffee consumption of the participants has therefore not been influenced by the condition.3. Cross-sectional study: This is a study in which one monitors simultaneously (smaller) cohorts which follow each other in time. For example a group in the age range 31-45 and a group in the age range 45-60 are then examined simultaneously. In this case at the start of the study differences in coffee consumption have been examined between people who did and people who did not acquire the (medical) condition during the study. In this manner a good picture can be obtained of the association between for example coffee consumption and the development of a condition between the ages of 30 and 60.4. Clinical study: This type of study is carried out in a hospital or clinic under the supervision of a physician. The effect of the substance or nutrient to be examined is measured in patients and possibly also in a control group. Studies in the area of coffee research are mostly of limited scope and short duration. Coffee, stomach, intestines and liver | 33
  32. 32. 5. Patient-control study: In the case of this type of study the differences in coffee consumption patterns are investigated in groups of people who have and have not developed a (medical) condition. In this case therefore questions are asked after the event about previous coffee consumption behaviour. A disadvantage of this type of study may be that the coffee consumption pattern of the people who have that condition has been modified or is assessed differently than in the case of people who do not have the condition. 6. Telephone interview: In this brochure in this type of study relatively small groups of people are interviewed by telephone at a particular moment. An examination is made of differences in the pattern of coffee consumption in groups of people who have or have not developed a particular disorder. These people are asked retrospectively about their consumption behaviour. A disadvantage of this type of study can be that the pattern of coffee consumption of people with the disorder has been changed or is assessed differently than that of people who have not developed the illness.34 |
  33. 33. coffee intestines and liver stomach, KO F F I E E N G E Z O N D H E I D www.koffieengezondheid.nl

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