Coffee / Health Myths and Facts: Why We
Need a Risk-Benefit “Holistic” Approach
for Carcinogens”

James R. Coughlin, Ph.D....
Presentation Outline
 Coffee / Health Myths & Facts: 30+ Year History
 Acrylamide Background
– Animal Carcinogenicity
– ...
A 30+ Year Coffee/Health Perspective
…on Rats, Mice and Humans
…on “Good” and “Bad” Science
…on “Good” and “Bad” Media Cov...
Coffee / Health Conclusions:
1980 - 2013
… First 20 Years:
Mostly Bad News! Coffee and Caffeine
were linked to almost ever...
Why have Coffee/Caffeine been so maligned?
•

Dramatically increased interest in health and nutrition;
much consumer worry...
6
What Science Allowed the Bad Myths to
Happen and Why Do a Few Still Persist?
… Acute vs. Chronic effects:
 Partial / full...
Much Confusion over Coffee and Caffeine
“Perhaps no substance has been the subject of
more conflicting media and scientifi...
But since 2000 or so…
 The “Good News” is that almost all of the
earlier Bad News about Coffee was WRONG!
 Medical evide...
The “Maligning” Started in the Late 1970’s
and Ballooned in the 1980’s and Early 1990’s

•

Coffee and heart attacks

•

C...
11
Coffee and Pancreatic Cancer My Personal “Baptism by Fire”…
•

Dr. MacMahon (Harvard) study – New Engl J Med, 1981

•

Int...
13
Paracelsus (1493-1541)
THE basic
tenet of all
Toxicology:
“The dose
alone
makes the
poison.”
14
As we entered the 21st Century…
The preponderance of medical and scientific
evidence clearly supported the conclusion that...
Caffeine’s Beneficial Physiological Effects
•

Mild central nervous system (CNS) stimulant

•

Improves cognitive performa...
Cardiovascular Disease
•

Endpoints: heart attack, hypertension (with stress),  blood
cholesterol from boiled coffee, car...
Caffeine and Reproductive Effects
•

Began with birth defects in rats force-fed very high-doses
(FDA, 1978)

•

Then human...
Caffeine and Osteoporosis
•

Excess calcium loss & bone loss in post-menopausal
women causes millions of bone fractures (m...
Caffeine and “Addiction”

21
Caffeine and “Addiction”
•

Dependence, tolerance and withdrawal headache were cited in
many published studies (mostly amo...
Coffee and Cancer Risk
•

Coffee contains dozens of animal carcinogens, many
produced by the “Maillard Browning Reaction” ...
“FOR MOST CANCER SITES, THERE IS A SIGNIFICANT AMOUNT OF
EVIDENCE SHOWING NO DETRIMENTAL EFFECT OF CONSUMPTION
OF UP TO 6 ...
Conclusions on the “Bad” Health Effects
•

Long established history of safe global coffee
consumption

•

But more animal,...
26
“Risk Reductions” with Coffee Consumption

•

Some cancers (already reviewed)

•

Type 2 diabetes

•

Chronic liver diseas...
Coffee and Type 2 Diabetes
•

Diabetes “epidemic” in Western societies with links to
obesity and premature death

•

Human...
Liver Cancer and Liver Cirrhosis
•

Liver cancer is 5th most common cancer in the world,
and liver cirrhosis is a major ri...
Coffee Consumption and Reduced Risk of
Parkinson’s Disease (PD)
•

9 human studies found regular coffee consumers were
50-...
Coffee and Reduced Risk of Alzheimer’s
Disease (AD)
•

Several human cohort studies have shown that coffee
consumption is ...
Antioxidants (AOX) in Foods (Wine, Tea, Chocolate)
 Extensive media coverage of AOX health benefits in all these
other fo...
Coffee provides 64% of per capita AOXs from beverages
C
la
ck off
Te ee
a
(b
B
ag
ee
)
r
(L
ag
W
er
in
)
e
(
O
ra Re
G
d)
...
So with all this good news, why
are we still concerned?
~
Caffeine Issues [Congress / FDA]
Animal Carcinogens in Coffee
34
Caffeine
~
Summer of 2013

35
36
37
“Proposition 65”
A California Law

~
“Safe Drinking Water and Toxic
Enforcement Act of 1986”
- Right-to-Know Warnings
- Pr...
39
40
Acrylamide Snapshot
 Known for decades as an occupational neurotoxin
in humans; genotoxic / mutagenic in cell cultures
 ...
42
Food

Acrylamide Range (ppb)

Baby food/biscuits

ND - 442

Breads/bakery products

ND - 364

Cereals

11 - 1057

Chocolat...
Food
French fries

Acrylamide Range (ppb)
117 - 1325

Fruits/vegetables (canned)

ND - 83

Gravies/seasonings

ND - 151

I...
45
46
Annu. Rev. Food Sci. Technol. (2012) 3:15–35
47
Acrylamide Battleground under California Prop 65
 Listed in 1990 as a carcinogen with a very low “Safe Harbor” intake
lev...
Coffee/Acrylamide Battles under Prop 65


Private “bounty hunter” (CERT, R. Metzger) sued California
coffee shops in Apri...
50
Using a Benefit-Risk Approach
for Coffee…
The “Holistic” Approach

~
“Coffee - Cancer Paradox”
51
Benefit-Risk Evaluation to Assess the Safety of
Foods Containing Heat-produced Carcinogens
 Doing it the WRONG WAY for de...
“One by One” vs. the “Holistic” Approach
•

Foods and beverages contain huge numbers of
different chemical components that...
Use the Holistic “Risk-Benefit” Approach
•

The beneficial health effects of certain whole foods may
outweigh the effects ...
The “Coffee / Cancer Paradox”
 Coffee contains about 2,000 identified compounds (hundreds are
flavors and aromas), includ...
THE Health Beverage!

57
Thank You!
Questions?
Coffee / Health Myths and Facts: Why We Need a Risk-Benefit “Holistic” Approach for Carcinogens” Coughlin
Coffee / Health Myths and Facts: Why We Need a Risk-Benefit “Holistic” Approach for Carcinogens” Coughlin
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Coffee / Health Myths and Facts: Why We Need a Risk-Benefit “Holistic” Approach for Carcinogens” Coughlin

  1. 1. Coffee / Health Myths and Facts: Why We Need a Risk-Benefit “Holistic” Approach for Carcinogens” James R. Coughlin, Ph.D. President, Coughlin & Associates Aliso Viejo, California jrcoughlin@cox.net www.linkedin.com/in/jamescoughlin Pacific Coast Coffee Association 82nd Annual Convention Aptos, California September 20, 2013
  2. 2. Presentation Outline  Coffee / Health Myths & Facts: 30+ Year History  Acrylamide Background – Animal Carcinogenicity – Human Epidemiologic Evidence  Heat-produced Carcinogens in Foods  California Proposition 65 and Acrylamide  Benefit-Risk Evaluation of Coffee – The “Holistic Approach” – The “Coffee-Cancer Paradox” 2
  3. 3. A 30+ Year Coffee/Health Perspective …on Rats, Mice and Humans …on “Good” and “Bad” Science …on “Good” and “Bad” Media Coverage …on Coffee’s Beneficial Health Effects …on “Holistic” Risk-Benefit Evaluation 3
  4. 4. Coffee / Health Conclusions: 1980 - 2013 … First 20 Years: Mostly Bad News! Coffee and Caffeine were linked to almost every known animal and human disease! … Last 15 Years, a Big Turn Around: The “Good News” is that almost all of the Bad News was WRONG! 4
  5. 5. Why have Coffee/Caffeine been so maligned? • Dramatically increased interest in health and nutrition; much consumer worry about enjoying too much of a good thing! • What we eat…or don’t eat…is always being linked to disease, and there is so much Consumer Anxiety from dietary headlines • AVOID or REDUCE: salt, fat (fries and chips), red meat, carbs, soft drinks, coffee and caffeine!! 5
  6. 6. 6
  7. 7. What Science Allowed the Bad Myths to Happen and Why Do a Few Still Persist? … Acute vs. Chronic effects:  Partial / full tolerance to caffeine develops in humans consistently consuming caffeine and coffee daily … Most of the Myths and Fears are based on:  Acute effects testing of non-coffee consuming subjects  Massive doses of individual coffee chemicals fed to animals for a lifetime  Smaller poorly done human studies. 7
  8. 8. Much Confusion over Coffee and Caffeine “Perhaps no substance has been the subject of more conflicting media and scientific reports in recent years than caffeine. So, is a cup of coffee bad for you or not?” Los Angeles Times, September 11-13, 1994 risk series - But no one was even asking back then “So, is a cup of coffee good for you or not?” 8
  9. 9. But since 2000 or so…  The “Good News” is that almost all of the earlier Bad News about Coffee was WRONG!  Medical evidence has been building strongly that coffee may actually be GOOD for us!!!  Let’s briefly examine the evidence for some myths and facts… 9
  10. 10. The “Maligning” Started in the Late 1970’s and Ballooned in the 1980’s and Early 1990’s • Coffee and heart attacks • Coffee and bladder & pancreatic cancer • Caffeine and birth defects in rats (U.S. FDA, 1978) • Caffeine and osteoporosis • Caffeine “Addiction” 10
  11. 11. 11
  12. 12. Coffee and Pancreatic Cancer My Personal “Baptism by Fire”… • Dr. MacMahon (Harvard) study – New Engl J Med, 1981 • Intense media coverage and months of lost coffee sales • His methodology & results were severely criticized by university and industry scientists • MacMahon eventually retracted his conclusions almost completely in 1986, but only in a brief letter in the NEJM • This study’s limitations have become famous teaching points in human dietary epidemiology coursework. 12
  13. 13. 13
  14. 14. Paracelsus (1493-1541) THE basic tenet of all Toxicology: “The dose alone makes the poison.” 14
  15. 15. As we entered the 21st Century… The preponderance of medical and scientific evidence clearly supported the conclusion that moderate coffee consumption (3 - 4 cups per day), as part of a varied, balanced diet, was safe and was not associated with any adverse human health consequences. 15
  16. 16. Caffeine’s Beneficial Physiological Effects • Mild central nervous system (CNS) stimulant • Improves cognitive performance and mental processing; increases wakefulness; improves work performance and enhances mood • Increases capacity for physical work & exercise; improves muscular performance and endurance sports • Relaxes smooth muscle, especially bronchial (opens airways), and increases blood flow in heart and kidneys • Produces a slightly higher metabolic rate (some evidence of an ergogenic “fat burning” effect). 17
  17. 17. Cardiovascular Disease • Endpoints: heart attack, hypertension (with stress),  blood cholesterol from boiled coffee, cardiac arrhythmias • Andersen et al., 2006 – Iowa Women’s Health Study, decreased risk of cardiovascular death • Lopez-Garcia et al., 2006, 2008 (Harvard) – big cohort study in men & women, no increased risk seen, even modest benefit for all-cause and cardiovascular disease • Freedman et al., 2012 (NIH-AARP) – cohort study of over 400,000 men & women showed coffee consumption reduced total mortality and cause-specific mortality. 18
  18. 18. Caffeine and Reproductive Effects • Began with birth defects in rats force-fed very high-doses (FDA, 1978) • Then human studies followed: delayed conception; premature birth; low birth weight babies; fetal death; spontaneous abortion (miscarriage), congenital defects • But now there are more than 25 Published Reviews: • Peck, Leviton, Cowan (Food & Chemical Toxicology, October 2010): “The weight of evidence does not support a positive relationship between caffeine consumption and adverse reproductive or perinatal outcomes.” 19
  19. 19. Caffeine and Osteoporosis • Excess calcium loss & bone loss in post-menopausal women causes millions of bone fractures (mostly hip) • Earlier acute, 24-hour human studies on non-caffeine consuming subjects were originally misinterpreted • Many longer-term, human clinical studies have shown little excess calcium loss or bone loss and no increased risk of osteoporosis. 20
  20. 20. Caffeine and “Addiction” 21
  21. 21. Caffeine and “Addiction” • Dependence, tolerance and withdrawal headache were cited in many published studies (mostly among psychiatric patients) • Headlines since the late 1980’s: • • • “Caffeine Addiction More Than Just Java Jive -- Caffeine Junkies” “Study Finds Caffeine Has Qualities of Addictive Drug” Current view is very reassuring: • Caffeine is not classified as an addictive drug (APA, DSM-5 psychiatric “bible” May 2013) • Addiction over-warnings trivialize dangers of real drugs of abuse. 22
  22. 22. Coffee and Cancer Risk • Coffee contains dozens of animal carcinogens, many produced by the “Maillard Browning Reaction” in the presence of heat, including acrylamide • Over 500 human epidemiology studies have been published since the 1970’s on many human organs • But, after 3 decades of human research, most health authorities across the globe now agree that coffee drinking is NOT a cancer risk! 23
  23. 23. “FOR MOST CANCER SITES, THERE IS A SIGNIFICANT AMOUNT OF EVIDENCE SHOWING NO DETRIMENTAL EFFECT OF CONSUMPTION OF UP TO 6 CUPS OF COFFEE/DAY IN RELATION TO CANCER OCCURRENCE. IN FACT, SOME OF THE EVIDENCE…SUGGESTS THAT COFFEE MIGHT PREVENT SOME CANCERS.” [REVIEW BASED ON OVER 500 PUBLICATIONS] 24
  24. 24. Conclusions on the “Bad” Health Effects • Long established history of safe global coffee consumption • But more animal, clinical & epidemiologic studies and continued media attention are sure to come • More recent studies and re-examinations of older disease issues have been quite reassuring • Consumers can be assured that their health will not be adversely affected by the enjoyment of coffee and caffeine as currently consumed. 25
  25. 25. 26
  26. 26. “Risk Reductions” with Coffee Consumption • Some cancers (already reviewed) • Type 2 diabetes • Chronic liver disease • Parkinson’s Disease • Alzheimer’s Disease 27
  27. 27. Coffee and Type 2 Diabetes • Diabetes “epidemic” in Western societies with links to obesity and premature death • Human epidemiological studies have all shown a substantial reduction in risk with coffee consumption • Research is underway on promising coffee constituents, and longer term human clinical trials are needed • Identification of coffee constituents with beneficial effects on glucose metabolism may lead to the selection of coffees with more positive health effects. 28
  28. 28. Liver Cancer and Liver Cirrhosis • Liver cancer is 5th most common cancer in the world, and liver cirrhosis is a major risk factor for it • Coffee inhibits liver enzymes and produces a liverprotective effect that seems to reduce the risk of both cirrhosis and liver cancer by as much as 45% • This is coffee’s strongest cancer-protective effect • Physiological studies are also providing strong biological support. 29
  29. 29. Coffee Consumption and Reduced Risk of Parkinson’s Disease (PD) • 9 human studies found regular coffee consumers were 50-80% less likely to develop PD • In 2007, two large cohort studies also showed a graded decrease in risk with more cups consumed • Further studies on caffeine’s neuroprotective effects are required to demonstrate cause-effect conclusion. 30
  30. 30. Coffee and Reduced Risk of Alzheimer’s Disease (AD) • Several human cohort studies have shown that coffee consumption is associated with a reduced risk of AD • Caffeine has shown neuroprotective effects after chronic administration in animals, possibly via changes in neurotransmitter and receptor systems • Dr. Gary Arendash’s studies (U. of South Florida) in animals and humans continue to support this good news • Wouldn’t we all love to avoid this disease? 31
  31. 31. Antioxidants (AOX) in Foods (Wine, Tea, Chocolate)  Extensive media coverage of AOX health benefits in all these other foods and beverages, but coffee seems to get mentioned so much less  The media know that the positive health effects are mainly due to their polyphenol AOX content  However…Coffee is now known to be a much better source of AOX than all of the others combined!  Not just coffee’s naturally occurring polyphenols (the chlorogenic acids)  The brown melanoidin polymers are heat-produced AOX from the Maillard Browning Reaction. 32
  32. 32. Coffee provides 64% of per capita AOXs from beverages C la ck off Te ee a (b B ag ee ) r (L ag W er in ) e ( O ra Re G d) ra nge pe J Ju uic e ic e (R A pp ed ) G ra le pe Ju ic fr e ui C tJ ra nb ui ce er P in ry J ea u pp ice le Ju ic e B mg AOX/day BEVERAGE - PER CAPITA AOX’S 800 700 600 500 400 300 200 100 0 33
  33. 33. So with all this good news, why are we still concerned? ~ Caffeine Issues [Congress / FDA] Animal Carcinogens in Coffee 34
  34. 34. Caffeine ~ Summer of 2013 35
  35. 35. 36
  36. 36. 37
  37. 37. “Proposition 65” A California Law ~ “Safe Drinking Water and Toxic Enforcement Act of 1986” - Right-to-Know Warnings - Prohibition of Discharge 38
  38. 38. 39
  39. 39. 40
  40. 40. Acrylamide Snapshot  Known for decades as an occupational neurotoxin in humans; genotoxic / mutagenic in cell cultures  Known rat carcinogen, classified as a “probable human carcinogen” in the 1990’s  Discovered unexpectedly by the Swedes in 2002 in hundreds of heat-processed food products [including coffee] due to the Maillard Browning Reaction between sugars and amino acids. 40
  41. 41. 42
  42. 42. Food Acrylamide Range (ppb) Baby food/biscuits ND - 442 Breads/bakery products ND - 364 Cereals 11 - 1057 Chocolate products ND - 909 Coffee (roasted, not brewed) 37 - 374 Coffee (brewed) Cookies/crackers Dairy drinks Dried foods/mixes 5 - 11 26 - 1540 ND - 43 ND - 1184 43
  43. 43. Food French fries Acrylamide Range (ppb) 117 - 1325 Fruits/vegetables (canned) ND - 83 Gravies/seasonings ND - 151 Infant formulas ND Nuts/nut butters ND - 457 Potato chips 117 - 4080 Snacks (other salty) 12 - 1340 Olives 123 - 1925 Prune juice 53 - 326 44
  44. 44. 45
  45. 45. 46
  46. 46. Annu. Rev. Food Sci. Technol. (2012) 3:15–35 47
  47. 47. Acrylamide Battleground under California Prop 65  Listed in 1990 as a carcinogen with a very low “Safe Harbor” intake level = 0.2 micrograms/day; must stay below this level to avoid cancer warnings  French fries: Attorney General sued and settled a case (2008) against frozen fries/tater tots demanding a 50% reduction in levels; fast-food restaurant fries have had cancer warnings posted for years  Potato chips: AG settled a case (2008) against chip manufacturers; agreement to cut levels to 275 ppb by end of 2011 (20 - 85% reductions) to avoid warnings; no warnings are currently being given  Cereals: Private “bounty hunter” lawyers sued cereal manufacturers in 2009; case is still pending. 48
  48. 48. Coffee/Acrylamide Battles under Prop 65  Private “bounty hunter” (CERT, R. Metzger) sued California coffee shops in April 2010 for failure to provide cancer warnings (“brewed coffee” suit); in April 2011, the shops began posting 10 x 10 inch cancer warning placards covering coffee, baked goods and other browned products  CERT filed a related suit in May 2011 against coffee roasters, distributors and retailers, over 120 companies are now sued (“roasted coffee” suit)  Roasters are fighting hard to avoid cancer warning labels on packaged products; levels average only about 10 ppb in brewed coffee. 49
  49. 49. 50
  50. 50. Using a Benefit-Risk Approach for Coffee… The “Holistic” Approach ~ “Coffee - Cancer Paradox” 51
  51. 51. Benefit-Risk Evaluation to Assess the Safety of Foods Containing Heat-produced Carcinogens  Doing it the WRONG WAY for decades, by evaluating the risk of individual chemicals in a food one by one (like Prop 65 does!)  I believe the RIGHT WAY is to evaluate the safety of the whole food by comparing its risks vs. benefits  Use the “Holistic Approach”  “Benefit-Risk” evaluations have recently been published –  U.S. FDA’s 2009 “Draft Risk and Benefit Assessment of Fish” (Methyl mercury risks vs. Omega-3 fatty acid benefits) 52
  52. 52. “One by One” vs. the “Holistic” Approach • Foods and beverages contain huge numbers of different chemical components that can have directly opposite health effects • Assessing these chemicals “one by one” is highly likely to be misleading and overly conservative, especially for animal carcinogens produced in complex heated foods (no better example than coffee!) • I believe the correct way forward for complex heated foods and beverages requires the “Holistic” RiskBenefit approach, as opposed to the current “one by one” chemical assessments. 53
  53. 53. Use the Holistic “Risk-Benefit” Approach • The beneficial health effects of certain whole foods may outweigh the effects of trace levels of animal carcinogens and other toxicants – COFFEE is one of these foods! • We must press global health and regulatory authorities to: • Use improved toxicology & risk assessment methods on individual chemicals tested at high doses in animals • Do more research on qualitative and quantitative assessment of the benefits of whole foods • Consider the health benefits of protective compounds naturally occurring and produced by heating (coffee’s antioxidants) • Assess the safety and benefits of the whole food, not just individual food carcinogens & toxicants one by one. 54
  54. 54. The “Coffee / Cancer Paradox”  Coffee contains about 2,000 identified compounds (hundreds are flavors and aromas), including trace levels of many animal carcinogens  But global health and regulatory authorities now agree that coffee drinking is NOT causing any increased risk of human cancer  In fact, human studies show significant risk reductions for numerous cancers in spite of the presence of many animal carcinogens  How can this be?  Naturally occurring antioxidants (chlorogenic acids)  Heat-formed antioxidants (the brown melanoidin polymers)  Chemicals that induce detoxification enzymes So, here is the Paradox – Coffee is loaded with animal carcinogens but most likely reduces human cancer risk! 55
  55. 55. THE Health Beverage! 57
  56. 56. Thank You! Questions?

×