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Coffee: The Good News, The Bad News, and How Much is Too Much

This article is a transcribed edited summary of a video Bob and Brad recorded in November of 2020 . For the original video go to https://www.youtube.com/watch?v=x9c0MWX3x_4

Brad: Hi I’m Brad Heineck, physical therapist.

Chris: Hi, I’m Chris, the pharmacist.

Brad: We are here today to do a video on coffee! The good news, the bad news and how much is too much? All from recent research. We are very happy to have Chris the pharmacist here to take how caffeine and coffee and how it works with our bodies and give us the most updated recent research. You’ve done a lot of homework on this, haven’t you Chris?

Chris: Little bit, little bit.

Brad: Yeah, his little bit, believe me it’s complete. Bob is on a coffee break today. Ha-ha, just kidding.

Chris: That guy.

Brad: Coffee, first of all, it is one of the most widely consumed drinks throughout the whole world. It’s right up there in the top 5.

Chris: It’s up there, everybody drinks it. 80% of the planet, so you got 7.8 billion times that by 80%, that’s a large number of people. About 60-65% of Americans drink it on a regular basis.

Brad: If you haven’t noticed, Chris is a numbers person. He knows his stats. Which is also nice.

Chris: It’s alright, I’m a nerd.

Brad: The history of coffee, very briefly, has it been around for a couple hundred years?

Chris: It’s been around for thousands of years. Basically, there’s a fancy cute little story about a goat herder, his name was Kaldi. The story goes that he was watching his goats and basically these goats were eating these berries and he observed that they just wouldn’t sleep at night. They were jumping around and all crazy. He figured out what they were eating, brought it home to his wife. His wife took some and was like, oh my gosh, this stuff really jacks me up. To the point, they were like, we should probably tell somebody. So, what do you do in Ethiopia in 850AD? You take it to the monastery, so they had a monk try it. Basically, at first, they kind of scoffed at it. Then they were like, well, maybe it’s not so bad. It kept me awake during my prayer session. This is a good thing. So, that’s the story of how they essentially came up with coffee. Realistically, the Persians, Ottoman Empire, Ethiopia, all those areas seem to have had all around the same time been trading coffee. Went to the 1500’s, and then it was more or less started to expand towards Europe. In the 1600’s, brought to the United States and here you go.

Brad: We have Folgers and everything.

Chris: The whole nine yards!

Brad: We’re going to refer to one cup of coffee. We’re going to talk about the good news, and the bad news. Let’s start with the good news. When we refer to a cup, let’s define what that is, according to most studies.

Chris: Yeah, coffee ranges all over the map. That’s one of the problems is nobody knows what they’re getting in a cup of coffee. So, to standardize it, we’ll assume that one cup of coffee, which we’ll call it eight ounces, contains 100-milligrams of caffeine.

Brad: Okay, eight ounces, and I’m not even sure if this is exactly eight?

Chris: That looks more like six, you know. If we pour it out, we could get a volumetric measure.

Brad: We’ll hold on that.

Chris: Yeah, I mean, so the average cup of coffee and again, it’s going to vary, we’ll just assume 100-milligrams.

Brad: 100-milligrams of?

Chris: Caffeine in the coffee. Caffeine in a lot of cases is the simulant that causes a lot of the effects. But not always. I mean, maybe we have to ask what’s in coffee. Coffee’s got a lot of good stuff in there. It’s going to have some essential vitamins, a few of your B vitamins, like B6, pantothenic acid/B5. It’s also going to have a little magnesium, potassium and of course the flavonoids, chlorogenic acids. There’s a lot of fancy stuff in coffee that does a lot of good things for a body. As we get into some of the health things that it helps, we’ll kind of break it down.

Brad: So, the big thing everyone is aware of, the caffeine. So, caffeine has good effects and maybe some bad effects?

Chris: Good and bad. That’s one of those things that you want to kind of be aware of with your doctor, guys. It’s one of those things where, if you have a heart condition, an anxiety condition, probably not the best thing to be taking. Because of what caffeine does, it’s got kind of an adrenergic effect, it’s kind of jacks you up a little bit. We do have to be kind of careful with that, for our friends that maybe shouldn’t be on it. Always check with your doctor.

Brad: I think we were talking before, typically the symptoms that are bad are oftentimes, you’ll know it. You’re jumpy, you don’t feel right. If you’re that person, you just stay off of it. Or stay away from it. The other thing I was going to say is, now I can’t remember what I was going to say Chris!

Chris: That’s okay. The interesting thing is there’s probably a genetic predisposition to people that actually drink coffee.

Brad: That’s where I was going.

Chris: It’s metabolized by a specific enzyme in our livers, so if you’re playing score at home it’s the C1A2, which will glaze everybody over. That particular pathway in our bodies and in our liver, when people drink coffee and aren’t really bothered by it; we all have those friends that can drink a cup of coffee and then go right to sleep. I’m not that guy. People don’t like me on caffeine. It’s a bad thing. So, there are other people that it metabolizes a lot longer. From that standpoint, they naturally tend to avoid it. They recognize the symptoms of taking too much coffee makes them jittery, makes them jumpy, raises the heart rate, makes them anxious. It’s one of those things where we want to try to avoid it. They know how to avoid it. Although there’s actually more and more accidental caffeine overdoses being seen in the ER’s.

Brad: From coffee?

Chris: Coffee and/or more likely energy drinks. We’ll sidebar that for another day. But if we’re sticking with coffee at hand, I mean, those are the negatives.

Brad: Let’s get back to some of the good things. That’s what I wanted to get in to. I sidetracked things. So, we talked about fitness. People who are marathon runners, people who are doing some aggressive things.

Chris: Yup, cyclers, swimmers, rowers.

Brad: They are actually, taking caffeine in what form?

Chris: Yeah, well usually just a cup of coffee. And basically, when coffee hits your lips, into the system, you’re going to start to feel the effects within about 15 minutes, maximum response, about 45 minutes to an hour, and then it lasts for about 4-5 hours in your system.

Brad: We are talking about that rush, that buzz, from the caffeine? How does that relate to making you faster?

Chris: Well, it’s kind of interesting. They’ve done a lot of studies on endurance athletes. Cyclists, marathon runners particular, but they’ve also look at swimmers and we’ll talk a little bit about team sports. Marathoners and cyclists in particular, caffeine when you take it before a race, tends to increase your metabolism. In fact, cyclists have been putting out more power, so they test their muscles. You could probably speak to that a lot more effectively than I could. They’re putting out about 17% more power on caffeine. Some of the studies show like 200 mg before, 400 mg before, 100 mg before.

Brad: So that’s like, 1-4 cups of coffee?

Chris: Yes. That’s kind of that safety range that we’ll talk as we get into the health benefits. It’s that range of 1-4. We aren’t really going to exceed that. Beyond that, it gets to be too much. To get the aerobic output, and for a swimmer, a bicyclist, or a marathoner, you’re definitely going to improve your times. They’ve done studies with guys that were trained, and they improved their mile time. They’ve improved their cycling times; they’ve improved their marathon times.

Brad: You know what I’m thinking Chris?

Chris: That we should take it before a race.

Brad: Well, that but I’m thinking there’s going to have to be potty breaks because that’s an issue.

Chris: Well, yeah, it is a mild diuretic. For a lot of people though, it’s kind of interesting, if you’re a seasoned coffee drinker, that effect tends to go away. Kind of looked at that a little bit, because you’re putting liquid in, but you’re also putting liquid out. The effect seems to negate itself. So, dehydration, what was once believed to be a big issue with coffee drinking, is not so much because coffee’s mostly water. It’s just beans, and filtered water. That’s how it works, it’s pretty slick. So, it’s not as bad as we think, but if you’re going to use it before a race, you want to save it for race days in most cases, because caffeine that’s in coffee, you develop a tolerance. You will lose some of the benefit from it if you’re doing it every day to train. Test it before you take a race. Some people, you go out and you could have a bad day if you miscalculate the dose or what have you. Find what works best for you but then save it for race day. It is going to help you to improve your performance. That’s almost guaranteed.

Brad: Another thing I understand, coffee can actually compliment that caffeine can compliment some pharmaceutical meds. Is that accurate?

Chris: Yes. There are actually several prescription medications that do get affected by coffee, so we have to be really careful with that. Your pharmacist certainly, if you’re a coffee drinker, you should let them know up front. Then they can kind of tailor make something. There’s certain muscle relaxant where all of a sudden, if you’re having coffee with that, it actually competes with how the drug is actually metabolized, raising the drug level and you’re just putty.

Brad: So, you want to avoid caffeine with muscle relaxers?

Chris: Yeah, the one that I’m talking about is tizanidine, so you would know if you were on it. You might have to be really careful with that. There’s certain antibiotics, it actually goes the other direction. So, the quinolones, things like Cipro. It’s used commonly for a lot of people.

Brad: So, it’s good to combine that, or no it’s not?

Chris: No, these are things that are bad. Basically, if you take Ciprofloxacin and you had a cup of coffee, it can really amplify the caffeine effects of the coffee itself.

Brad: And these are antibiotics?

Chris: Yes, for certain infections. Again, I think the biggest thing is when you’re talking to your doctor, you go in, you’re sick, you’re not doing well and you think you’re going to get something, let him know if you’re somebody that actually uses coffee or caffeine. Because certain drugs can affect how it is used. There are certain anti-depressants, certain medications used for arthritis, that we have to be careful with.

Brad: What about the other side, are there some medications that are helped if you take coffee or caffeine?

Chris: There’s disease states that are helped by having coffee. Because there’s the good things in coffee; they have the flavonoids, and the magnesium, the B vitamins and so it’s interesting that there’s a litany of different health conditions that can actually be improved. There’s a wide variety of studies, like almost half a million people study, much likely to analyze which shows coffee makes you live longer. Really, when we look at it for its overall health benefits. Most people when you look at diet aids, the number one ingredient in most diet aids is caffeine.

Brad: You’re talking about diet pills?

Chris: Yes. People can lose weight on coffee though. There’s a thermogenic effect from caffeine that’s in the coffee itself.

Brad: So, thermogenic, you’re going to get hotter?

Chris: Nope, not quite, it helps your body burn more calories. Basically, unlocks your ability to break down fat cells, and actually covert it to energy. Which conversely when we’re talking about improving our physical performance, they think that it’s carbohydrate sparing. What happens is you break down your fat cells for your energy first, and then your carbohydrates later. That’s why marathoners and cyclists seem to do better when they have caffeine, which is kind of the opposite of what a lot of us were taught a long time ago. We want to carbo-load before a race, because that’s our quick energy reserves. Well, it seems like caffeine seems to spare that. That’s why those endurance runners and endurance athletes tend to perform better when they have coffee before a race. Kind of interesting. Going back to the weight loss aspects. That one’s a little iffy, because what happens with a lot of us that drink coffee, is the tolerance does develop after about 90 days. It’s one of those kinds of a quick hitter. When they’re a quick hitter, basically what happens is the effect kind of loses itself after 90 days, and over the course of a year all of a sudden, those weight loss gains kind of gradually comes back. It’s not to say that you don’t still get some of that thermogenic effect, but if you’re not changing your diet and you’re not exercising the way you should, that weight loss balance kind of goes away.

Brad: Now, before you mentioned there’s some disease processes that studies have shown it

actually helps. Can we talk about a couple of those?

Chris: Yeah, so diabetes type II, that’s the one that’s non-insulin dependent, although some people can use insulin with type II diabetes.

Brad: Is that the one you get with age or you’re born with?

Chris: That’s the one that we get with age. That’s the one we develop when we let things slide. We’re not eating as well as we should, we’re not exercising as well as we should. It’s one of those things where it shows pretty eloquently that it can reduce the risk by about 7% if you’re a regular coffee drinker. Again, what’s regular? 1-4 cups a day. Know yourself because too much can be too much. Too little is not enough. We have to be careful with that. You never want to go over four cups. That’s that 400 mg threshold of caffeine, and that’s where it can get pretty jumpy for people’s hearts or anxiety levels. It does seem to help you to process sugars more efficiently, it helps with insulin resistance. It does seem to do a very good thing for diabetics, for the most part. So, talk to the doctor, but if you’re going to be using coffee, but it’s certainly something that could have a preventative effect on type II diabetes.

Brad: So, the big thing is, again, I want to emphasize, if you are on meds, or you’re going to be put on meds, make sure you talk to your doctor. If you say, “Oh, I forgot to tell my doctor that I drink three cups of caffeine a day, is that going to affect things?” When you go to the pharmacist, make sure you mention it too, because that’s part of the pharmacist’s job to double check and make sure that there isn’t something missed.

Chris: Yes, there’s lots of stuff that could get by the goalie, so to speak, if we’re not told. If you don’t tell us, we don’t know. Same thing with your doctor or your nurse practitioner. Anybody that sees you. Want to share, sharing is good.

Brad: What about things like Alzheimer’s or Parkinson’s?

Chris: They are two of the biggest neurological problems that people face. The studies show there’s coffee and decaffeinated coffee. In Alzheimer’s, which is the one where we kind of get forgetful and we kind of lose things. It’s a very sad, debilitating neurological disease. Drinking coffee, interestingly, seems to have a strongly preventative effect with Alzheimer’s. That 1-4 cups of coffee range, can lower the effects quite a bit.

Brad: This is from studies?

Chris: Studies over hundreds of thousands of people, retroactively. The proof is there. It does show it. So, it seems to unlock certain nerve pathways in the brain. With some of the neurotransmitters it involves.

Brad: So, it’s a prevention thing, or once you have it, it lessens?

Chris: It’s more preventative. I mean, I would say you probably would want to be starting to drink coffee at an earlier age. When we’re 70 and also, we start cranking down the cup of Joe to try and reverse our Alzheimer’s is probably not going to work. It seems like, these are people that have been lifelong studies and they’ve done studies from 30-50. That’s kind of where that sweet spot for a lot of these studies have been picked out which is why they end to look for diabetes, Alzheimer’s, Parkinson’s, liver disease. These are all things that coffee is very beneficial for. Jumping back to Alzheimer’s and Parkinson’s, Parkinson’s interestingly enough, you heard me say decaf and regular caffeinated coffee. In Alzheimer’s decaffeinated coffee will still actually help you. So, the flavonoids and other things that are in there seem to work with the brain chemistry to help to work with those pathways that are associated with memory. Whereas in Parkinson’s, which is kind of a motor disorder, where we can get those shakes where muscles don’t quite work the way we want them to. It’s contingent upon the caffeine to help with that. People that drink coffee, they will notice to a lesser degree that their symptoms will be alleviated when they have Parkinson’s. Usually at that point, its too far gone. Parkinson’s probably starts 30 years before you figure out you have it. Again, as a preventative measure, you’d want to be drinking coffee well before the problem starts. Without genetic testing, you really wouldn’t know that.

Brad: I just do want to emphasize those people with personalities kind of like mine, well if 1 or 4 cups of coffee is good maybe 8 cups a day is even better!

Chris: There’s a lot of us that subscribe if some is good, more is better. And that’s, again, the exact opposite. The upper limits of coffee or coffee intoxication, which is really caffeine intoxication, can be quite dangerous. It can put you in the hospital, ER visits. You’ll see them more with energy drinks, and usually kids, but it still can happen with adults. So, you do have to be mindful of that.

Brad: And that’s because the energy drinks have a more concentrated …

Chris: Much more concentrated across the board. So, I mean, the fatal dose of caffeine is 10 grams. So that’d be like drinking a hundred cups of coffee. You on your best day could never do that. That’s the interesting thing with coffee drinking, it’s generally self-limiting. At some point, you’re like, “ooh, I’ve had too much.” You just naturally tend to stop because it’s uncomfortable for your heart. That’s one of the first thing you notice. Your heart starts racing, really pounding and you get a little jumpy. Somebody comes through the door; you’re willing to jump. Be afraid or something to that effect so usually we’re going to back off.

Brad: So, let’s say, because I notice that with myself, I can have one, two cups and then it doesn’t taste so good anymore and it’s like, why am I even drinking this anymore and I’m done with it for the day. But how long does that caffeine stay in your system?

Chris: The law of averages unless you’re on certain medications, it’s going to be about 4 ½ to 5 hours. Then it starts to peter off. For a lot of people, insomnia is kind of a big thing. I mean, we have a sleep deprived nation. So probably cut off the coffee around two or three in the afternoon, if you’re trying to be in bed at a reasonable time. That’ll certainly help, so it’s kind of peters off and runs out of gas.

Brad: Well, I know like my mother, she’s been drinking coffee all of her life and she’s 84 now. She could drink a cup of coffee at 10:00 o’clock at night and go to bed, “It doesn’t bother me a bit.” Again, that’s because she’s been drinking it for so long.

Chris: There’s definitely a tolerance. She may just have the genetic structure that says that hey, I can handle this. Maybe she’s just used to it because she’s been drinking it for 50, 60 years.

Brad: I’m hoping that that’s not a bad thing, for her.

Chris: No, no it shouldn’t be. If anything, it might actually, you know you said 84, that’s some serious longevity, so it may be adding to it.

Brad: 84 and ½ now. She’s doing well. All she takes is a little high blood pressure medication. She’s an incredible woman.

Chris: Yes, she is, yup, I know June. I do think, and a lot of the other studies show, that actually helps you live longer. I think it’s pretty safe to say that unless your doctor directly tells you no, or if you’re on certain medications that could create a problem with caffeine, I think it’s okay to drink a cup or two a day. I think it’s pretty reasonable. Couple withstanding medical conditions, of course would have us avoid it.

Brad: Well, boy, there isn’t too much bad news and if it is bad you should know it by your symptoms.

Chris: You just naturally kind of quit. You’re just like, “Eh, it’s not for me.”

Brad: What about people that have a-fib?

Chris: A-fib, that’s actually a no-no. That’s going to be one of the ones that we do have to be careful with. That’s one of the cardiac conditions.

Brad: So atrial fibrillation, we’re talking about.

Chris: Atrial fib, tachycardia, I mean these are things that are heart problems. A lot of the heart problems I would tell you probably to avoid it. Although, it’s interesting, people that have mildly elevated blood pressure or hypertension, studies used to say, “Oh we have to avoid coffee at all costs.” We are actually finding that it only raises if you’re a tolerance coffee drinker. It only raises your blood pressure by about two to three points, which is really insignificant.

Brad: So, that’s different, the blood pressure versus heart rate?

Chris: Blood pressure versus yeah, so if you’re talking like A-fib, that’s an absolute hard pass. You are not going to do that. We’re going to put the breaks on that one.

Brad: Alright, I’ll tell you what, I have to get a cup of coffee, we’re going to have to cut this off.

Chris: Alright, drink up everyone!

Brad: Thank you everyone and hope you learned something. Well, whatever, just get some coffee.

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