By: Heather K. Mackie, MS, RD, LD Coffee Crunch By: Heather K. Mackie, MS, RD, LD What is the deal with coffee? Is it good for us? Bad for us? Okay? What types of coffee are best to choose? Is it safe for bariatric patients? Sponsored by:

Coffee & Health Growing body of research showing coffee drinkers compared to nondrinkers are less likely to have: Type 2 diabetes Parkinson’s disease Dementia Fewer cases of certain cases Heart rhythm problems Strokes Many people will agree coffee tastes great and helps to start the day, but is it good for our health? In 2009, the average American consumed 416 8-ounce cups of coffee! Why the change in what the research says? Earlier studies did not account for known high-risk behaviors, such as smoking, level of physical activity, etc.

You know there has to be some bad news with good news! BUT… You know there has to be some bad news with good news!

Coffee & Health While there may be fewer cases of the aforementioned diseases/conditions, coffee has not been shown to prevent these diseases/conditions. However, the research does have its limitations They follow the habits of individuals, not randomized. Do coffee drinkers eat better? Are coffee drinkers more physically active? Do coffee drinkers have protective genes? Researchers are not asking people to drink or not drink coffee for the sake of the study, but are simply asking about individual’s habits. Because of this, these studies cannot show cause & effect. As in any study, there is always the possibility that coffee drinkers may eat more healthy, be more active, or have genes that protect against chronic disease.

1 cup of coffee = 8 oz Keep in Mind!!! Portion distortion has also hit our coffee craze. Most people report, “I only drink one cup of coffee per day.” But how big is that one cup. For the purpose of the presentation (and how you should talk to your surgeon, dietitian, nursing staff, etc.), one cup should refer to only 8 oz.

Disease Specifics There is no solid proof for or against coffee drinker. There may be a few health perks AND cautions. Let’s take a look….

Type 2 Diabetes Vast majority of studies have shown a benefit of coffee consumption in regards to the prevention of type 2 diabetes. Decaffeinated coffee may have the same benefit as regular coffee based on newer research. Review published in 2005 of more than 193,000 people who reported drinking more than 6-7 cups per day were 35% less likely to have type 2 diabetes than those people who drank fewer than 2 cups per day. Those who drank 4-6 cups per day had an additional 28% lower risk. Data is considered pretty solid. Based on about 15 published studies. This review reported the findings regardless of sex, weight, or geographic location (Europe & U.S.).

Type 2 Diabetes, cont. Another review of 18 studies of nearly 458,000 people found a 7% decrease in the odds of having type 2 diabetes for every additional cup of coffee consumed daily. Similar risk reductions for those that consumed decaf coffee and tea. Review of 18 studies – researchers cautioned that data from some of the smaller studies included in the review may be less reliable. So there may be an overestimation of the strength of the link between heavy coffee drinkers and diabetes.

Mechanism of Action: Type 2 Diabetes How might coffee reduce the risk of diabetes? High in antioxidants – nutrients that assist in preventing tissue damage caused by molecules called oxygen-free radicals. Minerals: magnesium & chromium – these minerals help the body to use the hormone insulin which controls blood sugar. As we know, in type 2 diabetes, individuals lose the ability to use and insulin and regulate blood sugar effectively. Most likely not the caffeine due to seeing similar results from studies examining decaf coffee.

Heart Disease & Stroke Coffee has been linked to lower risk for heart rhythm disturbances (another risk factor for heart diseases and stroke). One study of 130,000 people who reported consuming 1-3 cups of coffee per day revealed they were 20% less likely to be hospitalized for abnormal heart rhythms than nondrinkers. A study in 2009 of 83,700 nurses showed a 20% lower risk of stroke in those who reported drinking two or more cups of coffee daily compared to woman who drank less coffee or none at all. Another study found that two or more cups of coffee per day, may increase the risk of heart disease in a specific (and common) group of people with a genetic mutation that slows the breakdown of caffeine in the body. Reducing the risk of type 2 diabetes, in itself, reduces the risk of heart disease and stroke. Study of 130,000 persons – the results were found regardless of other risk factors. Study of 83,700 nurses – this pattern was found whether the woman had high blood pressure, high cholesterol, and type 2 diabetes.

Parkinson’s & Alzheimer’s Diseases Data has been mostly consistent for Parkinson’s disease: Higher consumption of coffee is associated with decreased risk of Parkinson’s disease. Coffee has been linked to a lower risk of dementia, including Alzheimer’s disease. 2009 study followed 1,400 people for 20 years who reported drinking 3-5 cups of coffee daily were 65% less likely to develop dementia and Alzheimer’s disease, compared with nondrinkers and occasional coffee drinkers.

Cancer All studies have shown that high coffee consumption is associated with decreased risk of liver cirrhosis and liver cancer. No clear mechanism of action at this time. Research shows possible association, but does not show cause and effect. Evidence for cancer protection effect of coffee is weaker than the evidence for the protection effect of type 2 diabetes. Liver cancer data is much more consistent.

Pregnancy In August 2010, the American College of Obstetricians and Gynecologists stated moderate caffeine drinking (less than 200 mg/day) doesn’t appear to have any major effects on causing miscarriage, premature delivery, or fetal growth. The effects of larger caffeine doses are not known. Other research has shown that pregnant women who drink several cups of coffee daily may be at a greater risk for miscarriage than nondrinkers or moderate drinkers. Although, it is not clear if coffee is responsible for this. 200 mg/day = about 12 oz of home-brewed coffee (not starbucks).

Cholesterol Levels High consumption of unfiltered coffee is associated with mild elevations in cholesterol levels.

Calories, Heartburn, and Urine Coffee is low calorie, until you start adding all the fixings. This refers to regular brewed coffee with nothing added to it (no sugar, cream, syrups, etc.). Regular and decaf coffee both contain acids that can make heartburn worse. Caffeine is a mild diuretic. For example, some “coffee” drinks at the popular coffee houses may have as much as 800+ calories per serving! Diuretic = you will have to urinate more frequently. Decaf coffee has about the same effect on urine production as water.

Specifics to Bariatrics Coffee contains caffeine, which is a diuretic. Dehydration is a common issue post-operatively. Coffee contains acid, which may increase your risk of ulcers post-operatively. Depending upon the coffee beverage of choice, it might be high in calories (due to sugar, high-fat milk/creamers, and syrups). Most importantly, talk to your surgeon, dietitian, nurse, and/or program about consuming caffeine and/or coffee following your bariatric procedure.

Hold the Caffeine?!? There is no solid proof for or against coffee drinking. There may be a few health perks AND cautions. Let’s take a look….

Hold the Caffeine? While coffee contains some beneficial items, it does not necessarily mean it is good for you. No evidence showing coffee drinking leads to an increased level of antioxidants in the blood stream even though we know freshly brewed coffee is high in antioxidants. Caffeine can raise blood pressure and blood levels of the hormone epinephrine (the fight or flight hormone also termed adrenaline). High levels of caffeine (4-7 cups per day) can cause problems such as restlessness, anxiety, irritability, sleeplessness, particular in susceptible individuals. Ultimately, you have to decide what is right for you, your medical conditions, current state of health, and what your physician and healthcare team recommend.

Caffeine Levels Type of Coffee Serving Size Caffeine Content (mg) Brewed coffee (generic) 8 oz 133 mg Brewed coffee (Starbucks) 12 oz (tall) 240 mg Instant coffee 93 mg Espresso (generic) 1 oz 40 mg Espresso (Starbucks) 1 oz (solo) 75 mg Decaf coffee or espresso Any size ~ 4-5 mg Caffeine level of your beverage depends on number of factors: Variety of coffee bean Brewing method Usually, the longer the grounds are in contact with water and the finer the grind, the more caffeine is extracted. Generally, espresso contains more caffeine than drip coffee, whereas instant coffee has the least amount of caffeine. Although it is true that espresso contains the most caffeine (ounce per ounce), lattes and cappuccinos do not have as much caffeine (in general) than an 8-oz cup of drip coffee (b/c only made with 2-3 shots or 2-3 oz. of espresso).

Calorie Levels Drink (12 oz or Commonly Termed a Tall) Calories Fat (g) Brewed drip coffee with Half & Half Cream (2 tbsp) + Sugar (2 tbsp) 72 3.5 Brewed drip coffee with skim milk (2 tbsp) 23 0.2 Latte, regular (1 oz espresso + whole milk) 204 10.5 Latte, nonfat (1 oz espresso + skim milk) 100 Cappuccino, regular (1 oz espresso + equal parts whole milk and milk foam) 110 6 Cappuccino, nonfat (1 oz espresso + equal parts skim milk and milk foam) 60 Americano Misto, regular (1 oz espresso + equal parts water and whole milk) 102 5.6 Americano Misto, nonfat (1 oz espresso + equal parts water and skim milk) 62 0.5 Caramel Macchiato, regular (1 oz espresso + whole milk + vanilla syrup + caramel sauce) 7.8 Caramel Macchiato, nonfat (1 oz espresso + skim milk + vanilla syrup + caramel sauce) 140 1 There are many more examples, but you can see it is important to choose non-fat and also ask for sugar-free options (non-nutritive sweetener and/or sugar-free syrups). The other item that will drive the calories up is the proportion of milk to coffee to water.

Coffee Crunch: Bottom Line If allowed, coffee in moderation is possibly safe. May depend on stage post-op. Be aware of caffeine and calorie levels. Don’t be afraid to ask questions and customize your drink. Some websites help to breakdown nutritional information and you can make changes online to determine best match for your calorie needs. Stay clear of 3-in-1 or specialty coffee mixes – too much sugar and hydrogenated oils (bad fats).

Fancy & Healthy Avoid whipped cream! Go low! Although this may seem obvious, many people think of having specialty coffee as a treat, but the problem is it is most likely a habit and not on occasion. Consuming the whipped cream, adds 110-140 extra calories and 9-13 extra grams of fat for a 16 oz drink. Go low! Choose low-fat and low-calorie versions. Most drinks are made with whole milk at coffee shops, but they can easily substitute skim milk or even sometimes light soy milk to cut as much as 105 calories and more than 12 g fat in a 16 oz drink. Here are a few tips to make your fancy coffee healthier…

Fancy & Healthy, cont. Cut the syrup! Order sugar-free! Most coffee beverages are too sweet anyway, so ask for half the syrup to save about 20 calories and 5 g sugar for every pump. Order sugar-free! You can also ask for sugar-free syrup to save about 80-120 calories and 20-25 g sugar for a 16 oz drink. Portion distortion! If you usually order a large (or venti) drink, consider cutting it down to a medium or even a small to save calories, fat, sugar, and caffeine intake. Cut the syrup – besides most weight loss surgery patients think foods (and beverages) taste sweet post-operatively as well.

Fancy & Healthy, cont. Protein power! Tea time! Consider increasing protein intake by increasing milk (or soy milk) and decreasing coffee. Ensure it is light soy milk or skim milk. You can order a café au lait (half coffee and half steamed milk). This increases protein and calcium intake. You can also add protein powder to coffee, but ensure the temperature is less than 130oF (if higher than 130oF, then protein breaks down). Tea time! Opt for a cup of tea once per week. Teas generally do not have as much caffeine as coffee and offer many beneficial antioxidants. These are just a few modifications to make your coffee healthier. Remember, most of the large coffee chains have nutritional info online. Look up your favorite drink(s) – that may be an eye opener! For example, Starbuck’s Double Chocolate Chip Frappuccino Blended Crème is 580 calories and 22 g fat (and that is not even the large). This is more than half of the calories of most average post-op bariatric patient’s daily calories.

Everything in Moderation! Remember… Everything in Moderation! Also, keep in mind, while coffee may appear “safe” to consume, if someone replaces coffee for other beverages, such as low-fat milk and juice, they are missing out on other key nutrients (vitamin D, vitamin C, vitamin A, calcium, etc.). Coffee accompaniments, such as cream and sugar add fat and calories.

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