March 9th, 2015
The Coffee Conundrum – What Do You Say to Your Patient?
John Ryan, MD
This post continues our series “What Do You Say to Your Patient?” In this series, we ask members to share how they interpret a complex or controversial issue for patients. To review earlier posts, click
The following scenario stems from a recent study published in Heart, which finds that people who consume moderate amounts of coffee may be less likely to have atherosclerosis.
Your 55-year old female patient with hyperlipidemia and hypertension comes in for her annual follow up.
She is taking daily aspirin 81 mg and atorvastatin 20 mg, both for primary prevention. She also takes CoQ10, ginseng, and an herbal medication for her liver. She is not sure what the herbal medication contains but says it, “…keeps my liver healthy.” Her lipids are well controlled and she exercises for 20-25 minutes every day on an elliptical machine.
Your patient says she drinks two cups of coffee a day and adds cream and sugar to each cup.
She asks: “I recently heard that coffee could help prevent heart disease. Should I drink more per day?”
What do you tell your patient?
Do you advise her to alter the amount of coffee she drinks?
Do you discuss what she is adding to her coffee and how it might affect her risk?
4 Responses to “The Coffee Conundrum – What Do You Say to Your Patient?”
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Assuming she in general eats reasonable food in moderation, is physically active, and not morbidly obese, you ask her if she enjoys her coffee every day and if she does you say great and say you should only increase or decrease the amount if it is something you would enjoy. I recently did a lecture and a music video on nutrition where I discuss the evidence for food (including coffee) if it is of interest to anyone.
Nutrition – What we know (very little) and what we will likely never know (a lot) about nutrition – September 2014
http://youtu.be/awu09bSGTj0
Eat Mediterranean – December 2014
http://youtu.be/tfH6qSSTa90
I’ve published a considerable number of studies and a book on the effects of coffee and caffeine. The literature clearly shows that coffee, in reasonable amounts, has a number of health benefits, including a reduction in the probability of an MI. I would advise her to increase her coffee intake (to as much as 5 cups or so per day) if she is comfortable with that and the coffee does not produce an uncomfortable level of arousal. I would also advise her to try to gradually reduce the amounts of sugar and cream in the coffee, unless she feels that this would ultimately reduce her intake of coffee. Finally, if I were her physician, I would monitor her BP and suggest that she do so at home as well. Evidence shows that coffee can increase BP, and it would be important to determine that the increase does not result in hypertension.
What do you tell your patient?
I would tell her. The role of aspirin in primary prevention and more in women is controversial, probably is nor helping. Depending in the dyslipidemia classification, but in general the use of statins in primary prevention in women are very controversial. About the coffee don’t drink it for medicinal purposes. In the consumption level you have I don’t think is harmful. You could drink more if you don’t feel bad, or to much stimulated and you take in account you are adding more cream and sugar to your diet so you have to modify accordantly your diet. Take also in consideration the possibility of dependence associated with coffee.
Do you advise her to alter the amount of coffee she drinks?
No, if you want to drink more only for Heath reasons is not a good reason, it could cause dependence. If you are limiting the coffee consumption, because you think is bad, you could drink a little more but be careful with the sugar and cream and you I remind you it could develop tolerance and dependence to coffee.
Do you discuss what she is adding to her coffee and how it might affect her risk?
Yes.
I would tell her that is not necessary increase more only for healthy reasons but she can fell safe about reasonable consume. Healthy diet is a more complex topic, and she will not increase her life only for more coffee.It is the opportunity to discuss global diet, specially about salt consume and alcohol as risk factors in hypertension. Probably with two cups is not a problem in her hypertension, and we can negotiate with her , that she can have more coffee but less alcohol or salt.