How Much Coffee Is Too Much?
Java lovers will rejoice over proposed new guidelines
Coffee lovers have every reason to feel pumped about the proposed new Dietary Guidelines for Americans, due to be updated later this year. (The guidelines are revised just once every five years.) Recently a panel of experts, tasked with updating advice on what to eat and drink, zeroed in on coffee, among other things. (One of those other things is cholesterol, which the proposed changes remove from the list of “nutrients of concern.”) The experts say they can find no evidence of harm for healthy adult Americans who drink three to five cups of Joe a day.
Here’s what the proposed new guidelines say — and one internist’s advice on how to interpret them.
What the proposed guidelines say
After scouring the medical literature, the panel made this conclusion statement about coffee: "Strong and consistent evidence shows that consumption of coffee within the moderate range (3 to 5 cups/d or up to 400 mg/d caffeine) is not associated with increased risk of major chronic diseases, such as cardiovascular disease (CVD) and cancer and premature death in healthy adults."
It gave the overall statement a ''strong'' grade, meaning there is strong evidence to back up the recommendation. Not only does coffee appear to cause most healthy Americans no harm, studies suggest those with a coffee habit have a reduced risk of:
- Premature death
- Type 2 diabetes
- Cardiovascular disease
- Cancers, including liver and endometrial cancer
Among the caveats:
- The advice is only for adults, and healthy ones.
- The panel wasn’t referring to the high-caffeine energy drinks that have been sending teens to the emergency department.
- Other links between coffee and health were less strong, such as coffee’s purported ability to reduce the risk of Parkinson's disease (the panel says evidence there was moderate).
- The evidence about coffee lowering the risk of cognitive decline with age is limited, according to the panel.
- Coffee drinking during pregnancy needs more study, the experts say.
Who should still limit their coffee intake?
The recommendations, by and large, make sense for healthy people, says Peter Galier, MD, an internist at UCLA Medical Center, Santa Monica, and former chief of staff there. He did not take part in updating the recommendations but often fields questions about coffee from his patients. And he's been known to drink a cup or five a day himself.
People with certain health problems should think twice about drinking coffee, he says. "You don't want people who have a weak bladder or chronic prostate symptoms" drinking a lot of coffee, he says. "Coffee acts on the bladder and is a weak diuretic."
People with weak or overactive bladders already visit the bathroom more than they would like to, as do men with an enlarged prostate, he says.
Who else should pass up that coffee house line? "People who are already tense or stressed and who are prone to palpitation," he says. Those who get acid reflux after eating spicy foods should take it easy on coffee if that's a trigger.
People with high blood pressure that’s well controlled on medication and who can drink coffee without a bad effect on their blood pressure are probably fine, he says. On the other hand, "people who have touchy blood pressure, people who might have anxiety or insomnia after drinking'' should not go overboard, he says.
The guidelines are just that, says Galier. The experts aren't saying you should have five cups. Rather, he says, they seem to saying to those who are healthy: "For people who drink coffee and enjoy their coffee who don't seem to have a problem with the caffeine, up to three to five cups daily has been shown to be OK."
Coffee and calories
No matter how many cups you decide to drink, Galier has another bit of advice that applies to every coffee drinker. "Be mindful of the calories if the coffee isn't black,'' he says. With so many options at coffee houses, such as adding caramel and other flavors, choosing high-fat milks and topping it all with whipped cream, coffee can be a fat and calorie trap.
Treat yourself too much, and that blended concoction with extras like chocolate or caramel can weigh in at 300 calories or more. For five-cup-a-day folks, that's the equivalent of a couple meals.
Related: Should You Say Sayonara to Sugar?