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. 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. 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. 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. 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

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. 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. 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. 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

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

14. Paracelsus (1493-1541)
THE basic
tenet of all
Toxicology:
“The dose
alone
makes the
poison.”
14

16. 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

17. 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

18. 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

19. 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

20. 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

21. Caffeine and “Addiction”
21

22. 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

23. 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

24. “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

25. 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

26. 26

27. “Risk Reductions” with Coffee Consumption
•
Some cancers (already reviewed)
•
Type 2 diabetes
•
Chronic liver disease
•
Parkinson’s Disease
•
Alzheimer’s Disease
27

28. 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

29. 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

30. 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

31. 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

32. 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

33. Coffee provides 64% of per capita AOXs from beverages
C
la
ck off
Te ee
a
(b
B
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P
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mg AOX/day
BEVERAGE - PER CAPITA AOX’S
800
700
600
500
400
300
200
100
0
33

34. So with all this good news, why
are we still concerned?
~
Caffeine Issues [Congress / FDA]
Animal Carcinogens in Coffee
34

35. Caffeine
~
Summer of 2013
35

36. 36

37. 37

38. “Proposition 65”
A California Law
~
“Safe Drinking Water and Toxic
Enforcement Act of 1986”
- Right-to-Know Warnings
- Prohibition of Discharge
38

39. 39

40. 40

41. 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

42. 42

43. 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

44. 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

45. 45

46. 46

47. Annu. Rev. Food Sci. Technol. (2012) 3:15–35
47

48. 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

49. 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

50. 50

51. Using a Benefit-Risk Approach
for Coffee…
The “Holistic” Approach
~
“Coffee - Cancer Paradox”
51

52. 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

53. “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

54. 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

55. 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

57. THE Health Beverage!
57

58. Thank You!
Questions?