coffee stomach intestines and liver

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© January 2009, Coffee and Health Information Bureau, Rijswijk, Netherlands

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Tel: +31 (0)70 – 3365163

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‘Coffee, stomach, intestines and liver’ – Contents

Page

Introduction 5

1 Coffee and stomach

Dyspepsia (stomach complaints) 7-8

Gastroesophageal refl ux (heartburn) 8-12

Making coffee, decaffeinated coffee 12-13

Peptic ulcer (stomach ulcer) 13

Gastritis (infl amed stomach lining) 14

Stomach operation 14

References 15

2 Coffee and the intestines

Ulcus duodeni (duodenal ulcer) 17-18

Fluid excretion bowel movement 18-20

Irritable bowel 19

Colon cancer 20-21

References 23

3 Coffee, liver and gall

Effect on liver 25-26

Gall bladder, gallstones 26-28

Pancreatitis (infl ammation of the pancreas) 28

References 30-31

Study of coffee and health 33-34

Coffee, stomach, intestines and liver | 3

Introduction

In the Netherlands in total we drink some 6.5 million litres of coffee a day

(VNKT, 2007). This makes coffee an important source of fl uid in our diets. In this

respect it goes without saying that one wonders what the effects of coffee on

health might be. This brochure deals with common questions about coffee in

relation to the stomach, intestines and liver. The questions have been drawn up in

collaboration with the Dutch Association of Stomach Intestine and Liver Nurses.

Questions have also been included that were asked as a result of an appeal in the

email newsletter published by the Dutch Coffee and Health Information Bureau.

Two stomach, intestine and liver physicians and two dieticians working on behalf

of the Dutch Association of Dieticians assisted with answering the questions:

- Dr. Paul Boekema (stomach, intestine and liver physician, Máxima Medisch

Centrum, Eindhoven)

- Drs. Marco Becx (stomach, intestine and liver physician, Mesos Medisch

Centrum, Utrecht)

- Joan Rentzing (stomach, intestine and liver dietician, St. Antonius Ziekenhuis,

Nieuwegein)

- Gertien Hiemstra (stomach, intestine and liver dietician, UMC Utrecht)

It was possible to provide sound answers to many of the questions asked on the

basis of various scientifi c studies. However, there were some questions that remain

unanswered. On one hand because the body of research is not yet suffi cient, and

on the other hand because some aspects are very diffi cult to examine. Clinical

research into the effect of nutrition on gastroesophageal refl ux for instance is

diffi cult to carry out as it requires a catheter to be introduced into the oesophagus,

which can be rather uncomfortable. In addition to coffee, many other foods and

drinks are consumed, which does not make it any simpler to link the complaint

to the right food.


If after reading this brochure you still have questions or comments, we will be

pleased to hear from you. You can also order Dutch copies of the brochure free

of charge or download it at www.koffi eengezondheid.nl. Naturally we will

continue to monitor scientifi c developments closely and should views change,

they will be shown on our website and in our email newsletter.

Coffee and Health Information Bureau

(Voorlichtingsbureau voor Koffi e en Gezondheid)

Literature

Vereniging van Nederlandse Koffi ebranders en Theepakkers (VNKT), Annual Report 2007.

6 |


1 Coffee and the stomach

1 Is there a relationship between coffee consumption and dyspepsia (stomach complaints)?

Dyspepsia means literally poor digestion. Symptoms of dyspepsia include pain

or discomfort such as a bloated feeling in the upper part of the stomach. Other

symptoms are early satiation, nausea, burping, a heavy feeling in the stomach or

vomiting. Consumers regularly associate coffee with these stomach complaints.

In order to discover the extent to which dyspepsia occurs in the Netherlands

and in order to determine the relationship with alcohol, coffee and tea,

500 people were approached by means of a telephone sample survey. Of

these people 428 were willing to take part in an interview about the presence

of gastro-intestinal complaints and the use of alcohol, coffee and smoking

(Boekema, 2001). Of those questioned 14% indicated that they suffered from

stomach complaints. No association was shown between coffee and dyspepsia,

nor between alcohol and dyspepsia. Smoking and having stopped smoking,

however, were strongly associated with stomach complaints. An earlier

Norwegian study similarly found no relationship between coffee and dyspepsia

(Haug, 1995). An Australian cross-sectional survey of 592 people also found no

relationship between coffee drinking and dyspepsia (Nandurkar, 1998).

Dyspepsia was found to be related to smoking and use of aspirin. A large

cross-sectional survey of 8.407 adults in the UK showed a signifi cant relationship

between the presence of Helicobacter pylori and dyspepsia. There was no

relationship with coffee consumption (Moayyedi, 2000).

The scientifi c studies available show no relationship between coffee consumption

and dyspepsia.

8 |

Functional dyspepsia

Sensitive stomach or stomach complaints is a collective name for all sorts of

symptoms such as stomach pain, nausea, vomiting and a heavy or bloated

feeling in the stomach area. If no explanatory abnormalities or specifi c clinical

picture are identifi ed during examination of the complaints, the diagnosis

‘functional dyspepsia’ is made.

2 If you have dyspepsia (stomach complaints) may you still drink coffee?

Based on the available scientifi c studies no relationship can be demonstrated

between coffee consumption and dyspepsia (Boekema, 2001; Haug, 1995;

Nandurkar, 1998; Moayyedi, 2000). Of the people with dyspepsia 38% assumed

that coffee consumption was related to their complaints, although their pattern

of coffee consumption was no different from that of people who did not assume

a relationship with coffee (Boekema, 2001).

There are no proven arguments for advising against coffee in the case of

dyspeptic complaints, other than personal preference.

3 Is there a relationship between gastroesophageal refl ux disease (GERD) and coffee?

People with refl ux complaints regard spicy food, fatty food and overeating as

the most important nutritional factors affecting the complaints (Bolin, 2000).

Stress is also frequently named. Coffee is named to a lesser extent in relation to

acid refl ux (see table on page 10).


Clinical research into gastroesophageal refl ux is (very) diffi cult to carry out as it

takes place by introducing a catheter into the oesophagus and can therefore be

aggravating. Nevertheless Dutch researchers succeeded in carrying out such a

survey. This survey included an examination of the effects of drinking coffee on

the lower oesophageal sphincter (constrictor) and exposure to acid in the oeso-

phagus during normal activities in eight healthy people and in seven patients with

gastroesophageal refl ux disease (Boekema, 1999b). Only if coffee was drunk on

an empty stomach was there an increase in the exposure to acid in the oesopha-

gus in the case of patients with GERD. This effect was smaller than the effect of

a meal. Coffee was found not to affect any other refl ux parameters, such as the

motility of the oesophagus body and the lower oesophageal sphincter.

It was concluded that coffee has no signifi cant effect on gastroesophageal refl ux

in patients and no effect whatsoever in the case of healthy volunteers.

In an extensive patient control study in Norway among 3.153 people with refl ux

complaints and 40.210 controls, the relationship was examined between refl ux

and various lifestyle factors (Nilsson, 2004). Smoking scored most unfavourably,

followed by high salt consumption. Coffee consumption, high-fi bre bread and

regular physical movement on the other hand were found to lower the risk of

refl ux. In an Italian study coffee was found to have no relationship with GERD

(Dore, 2007).

A study of the relationship between lifestyle factors and gastroesophageal refl ux

complaints in identical twins, BMI, smoking and heavy physical activity during

work were found to be risk factors for frequent GERD symptoms, while physical

activity during leisure time appeared to have a protective effect (Zheng, 2007).

After correction for these factors none of the nutritional factors (including

coffee) was found to show a relationship to the complaints. In the case of men

it was found that consumption of high amounts of coffee (more than seven cups

a day) was accompanied by a lower risk.

12 |

Production of stomach acid

Approximately 1.5 litres of gastric juice is produced in the stomach every day:

pepsin (protein-splitting enzymes), stomach acid (hydrochloric acid) and the

so-called intrinsic factor. All foodstuffs (solid and liquid) increase the production

of stomach acid. Hence also coffee, water, a meal or a biscuit. This is a normal,

physiological reaction of the digestive system, which is no cause for complaints.

It only becomes clinically relevant if stomach acid regularly fl ows back into

the oesophagus.

5 What is the infl uence of the method of preparing coffee?

The gastrointestinal tract can be stimulated by foodstuffs with a substantial

calorie content, acidity, osmolarity or volume (Boekema, 1999a). Coffee’s acidity

is virtually neutral (pH 5-6), which makes a pH effect very improbable. Coffee

contains virtually no energy.

The method of roasting the coffee beans (conduction or convection) does not

appear to make any difference (DiBaise, 2003). No research has been undertaken

into the effect of the different brewing methods. Nor is any research known in

which the physiological effects on coffee of the addition of milk are examined.

The addition of milk or evaporated milk does affect the taste and may mask any

bitterness. As a result, the coffee is generally perceived as milder, which may also

give the idea that the effect of the coffee on the stomach would also be milder.

However, this cannot be confi rmed by scientifi c research.

6 Is decaffeinated coffee better in the case of GERD?

There is one study in which it was found that decaffeinated coffee at breakfast

gave less refl ux (Pehl, 1997). However, the relationship between drinking coffee

and the occurrence of refl ux complaints could not be confi rmed in other

studies (Boekema, 1999b; Nilsson, 2004; Dore, 2007; Zheng, 2007). There

are insuffi cient indications to conclude that decaffeinated coffee is better than

regular (caffeinated) coffee.

7 Is there a relationship between coffee consumption and the risk of peptic ulcers (stomach ulcers)?

In the past coffee has been associated with the development of stomach ulcers.

However, since the identifi cation of Helicobacter pylori, understanding of the

pathogenesis of peptic ulcers has changed radically, as a result of which coffee

has ceased to be of interest as a possible causal factor (Boekema, 1999a).

In a Danish cohort study among 2.416 Danish adults into risk factors for stomach

ulcers Helicobacter pylori infection, smoking and the use of tranquillisers were

identifi ed as the most important factors. Coffee was found not to be a risk factor

(Rosenstock, 2003).

There are no indications that coffee forms a risk for the development of

a stomach ulcer.


8 Can people with gastritis (infl amed stomach lining) continue to enjoy drinking coffee?

Gastritis is a (slight) infl ammation of the stomach lining as a result for example

of an infection with Helicobacter pylori. This generally does not result in com-

plaints and is usually a coincidental fi nding during an endoscopic examination

(gastroscopy).

If the gastritis is more serious and results in sores or ulcers in the mucous

membrane, this can explain complaints (see also page 17). In a prospective

cohort study among 47.806 men, after six years there were found to be

138 new cases of ulcus duodeni (duodenal ulcer). No relationship was found

with smoking, alcohol or caffeine intake (Aldoori, 1997).

Coffee has no infl uence on the development of this disorder but it may

infl uence the complaints. Patients themselves often already avoid such drinks

or foodstuffs if they experience discomfort after consumption.

Advice is generally not necessary.

9 May one drink coffee again soon after a stomach operation?

Coffee has no special effects different from those of other drinks or food in

this respect. Therefore as soon as eating and drinking are permitted after the

operation, this can include drinking coffee if the patient feels like it.

14 |


References

Aldoori WH et al. (1997). A Prospective Study of Alcohol, Smoking, Caffeine, and the Risk of Duodenal Ulcer in Men. Epidemiology, 8: 420-424.

Boekema PJ et al. (2001). Functional bowel symptoms in a general Dutch population and associations with common stimulans. Neth J Med, 59(1): 23-30.

Boekema PJ et al. (1999a). Chapter 4: Prevalence of functional bowel symptoms in a general Dutch population and associations with use of alcohol, coffee and smoking. Coffee and upper gastrointestinal motor and sensory functions, Zeist (the Netherlands).

Boekema PJ et al. (1999b). Effect of coffee on gastroesophageal refl ux in patients with refl ux disease and healthy controls. Eur J Gastroenterol Hepatol, 11: 1271-1276.

Bolin TD et al. (2000). Esophagogastroduodenal Diseases and Pathophysiology, Heartburn: Community perceptions. J Gastroenterol Hepatol, 15: 35-39.

DiBaise JK (2003). A Randomized, Double-Blind Comparison of Two Different Coffee-Roasting Processes on Development of Heartburn and Dyspepsia in Coffee-Sensitive Individuals. Dig Dis Sci, 4(48): 652-656.

Dore MP et al. (2007). Diet, Lifestyle and Gender in Gastro-Esophageal Refl ux Disease. Dig Dis Sci, 53(8): 2027-2032.

Haug TT et al. (1995). What Are the Real Problems for Patients with Functional Dyspepsia? Scan J Gastroenterol, 30(2): 97-100.

Kaltenbach T et al. (2006). Review: sparse evidence supports lifestyle modifi cations for reducing symptoms of gastroesophageal refl ux disease. Arch Intern Med, 166: 965-971.

Moayyedi P et al. (2000). The Proportion of Upper Gastrointestinal Symptoms in the community Associated With Helicobacter pylori, Lifestyle Factors, and Nonsteroidal Anti-infl ammatory Drugs. Am J Gastroenterol, 95(6): 1448-1455.

Nandurkar S et al. (1998). Dyspepsia in the community is linked to smoking and aspirin use but not to Helicobacter pylori infection. Arch Intern Med, 158(13): 1427-1433.

Nilsson M et al. (2004). Lifestyle related risk factors in the aetiology of gastroesophageal refl ux. Gut, 53: 1730-1735.

Pehl C et al. (1997). The effect of decaffeination of coffee on gastroesophageal refl ux in patients with refl ux disease. Alim Pharm Ther, 11: 483-486.

Rosenstock S et al. (2003). Risk factors for peptic ulcer disease: a population based prospective cohort study comprising 2,416 Danish adults. Gut, 52: 186-193.

Zheng Z et al. (2007). Lifestyle factors and Risks for Symptomatic Gastroeosophageal Refl ux in Monozy-gotic Twins. Gastroenterology, 132: 87-95.


2 Coffee and the intestines

1 Is there a relationship between coffee and ulcus duodeni (duodenal ulcer)?

In a large-scale prospective cohort study of 47.806 American men (Aldoori, 1997)

the relationship between alcohol, smoking, caffeine and the risk of an ulcus duodeni

(duodenal ulcer) was examined. None of the factors examined were found to be

associated with a substantial increase of the risk. This result confi rms the outcome of

an earlier study (Kato, 1992), in which similarly no connection could be established

between coffee consumption and the risk of ulcus duodeni. There was found to be

no difference in the daily pattern of coffee consumption between people with ulcus

duodeni, dyspepsia and healthy controls (Elta, 1990). Similarly there was found to be

no difference in the pattern of complaints after drinking coffee between patients with

ulcus duodeni and healthy controls. The available scientifi c studies show no relation-

ship between coffee consumption and the risk of ulcus duodeni.

Ulcus duodeni

Ulcus duodeni is the general medical term for duodenal ulcer. The duodenum is

the fi rst part of the small intestine after the stomach. In addition to the stomach

(see page 12), this part of the intestine is also exposed to stomach acid. The

stomach and duodenum produce mucus to protect themselves against the acid.

Infection with Helicobacter pylori or the use of painkillers or anti-infl ammatories

(Non Steroidal Anti-Infl ammatory Drugs NSAID) can slow the process of main-

tenance of the mucous membrane, which can result in infl ammation of the

mucous membrane. In the case of a minority of people infected by Helicobacter

pylori or using NSAID, ulcers may arise, which can cause pain in the epigastrium.

18 |

2 May patients with duodenal ulcers still drink coffee?

There was not found to be any difference in the daily pattern of coffee consump-

tion between people with ulcus duodeni, dyspepsia and healthy controls

(Elta, 1990). Similarly there was not found to be any difference in the pattern of

complaints after drinking coffee between patients with ulcus duodeni and healthy

controls. There are also no indications that coffee infl uences the course of various

intestinal disorders, such as diverticulitis, Crohn’s disease or colitis ulcerosa. People

who feel ill often modify their feeding pattern of their own accord, in particular

eating less fat, and drinking less coffee. This is a natural response in order to avoid

stimulation of the intestinal system as much as possible.

3 Does coffee affect fl uid discharge in the intestines?

Approximately 9 litres of all sorts of digestive juices are added daily to the fi rst part

of the gastrointestinal tract, which are virtually entirely re-absorbed into the body

further on in the intestinal system. A foodstuff has to have a very strong effect

on the secretion of digestive juices to be capable of causing any relevant change.

There are no indications that coffee affects fl uid secretion in the intestines.

4 Does coffee have a stimulating effect on the large intestine?

In some people coffee has a stimulating effect on the peristalsis of the large

intestine. Results of a survey among 99 people (aged 17-27) concerning bowel

movement indicate that in 29% of the people coffee stimulated bowel move-

ment (Brown, 1990). The effect of regular (caffeinated) coffee (240 ml of coffee

with 150 mg of caffeine) and decaffeinated coffee (240 ml) on intestinal motility

was compared with that of the same amount of hot water or a complete meal


(1.000 kcal) (Rao, 1998). The effect of caffeinated coffee was found to be as

substantial as that of a complete meal, and was 60% stronger than water and

23% stronger than decaffeinated coffee. In a study by Sloots et al. (2005) strong

coffee (280 ml) and hot water were both found to have a signifi cant effect on

bowel movement.

5 Is there a relationship between coffee consumption and irritable bowels (IBS)?

Patients with Irritable Bowel Syndrome (IBS) have symptoms that cannot be

related to a clear clinical picture. It is regarded as a chronic disturbance of the

functioning of the intestinal system. The symptoms, such as abnormal bowel

motions (constipation or diarrhoea) and stomach pain or an uncomfortable

feeling in the stomach, can also occur after consumption of food by people

without IBS (Dapoigny, 2003). Almost everyone has intestinal complaints once

in a while. In the Netherlands during a screening exercise 5.8% of the adults

were found to be suffering from IBS, which is surprisingly low compared with

other countries (Boekema, 2001). No association with coffee consumption was

found. In a Swedish survey it was found that 63% of patients with IBS assume

that their symptoms are related to meals (Simren, 2001). In particular foodstuffs

that are rich in carbohydrates and fat were associated with complaints.

Coffee was associated by 10% of the patients with serious complaints (dyspepsia,

stomach pain and thin faeces). No general nutritional advice can be given

to people with IBS. People often avoid foodstuffs that they themselves already

associate with their complaints.

20 |

6 What is the effect of coffee on bowel movements?

In healthy people coffee can have a stimulating effect on the large intestine,

which can have a positive effect on bowel movements. The same amount of hot

water or a meal have a comparable effect (see question 4). The possible relevance

of this effect for people who are troubled by constipation will differ individually

and will depend among other things on the seriousness of the constipation.

There are no indications that coffee causes diarrhoea in healthy people. A small

percentage of patients with IBS associate coffee with thin faeces (see question 5).

They will often already modify their pattern of consumption themselves.

7 Is there a relationship between coffee and colon cancer?

Three cohort studies and nine case-control studies published between 1990 and

2003 showed no signifi cant relationship between coffee consumption and colon

cancer (cancer of the large intestine) (Tavani, 2004). Three cohort studies and

four case-control studies also showed no relationship with cancer of the rectum

(Tavani, 2004). In a meta-analysis, in which the results from fi ve cohort studies

and 12 case-control studies were combined, people who consumed four or

more cups of coffee daily were found to have a 24% lower risk of colon cancer

compared with people who did not drink any coffee (Tavani, 2004).

In an extensive, prospective cohort study no relationship was observed between

coffee and colon cancer. Consumption of two or more cups of decaffeinated

coffee a day was found to be associated with a signifi cantly lower risk of colon

cancer (Michels, 2005). In two large Swedish prospective cohort studies of

61.433 women and 45.306 men no relationship was found between coffee and

colon cancer (Larsson, 2006), as well as in a prospective Japanese cohort study


(Naganuma, 2007). On the other hand in a prospective cohort study (among

50.139 women and 46.023 men) Lee et al. (2007) did fi nd a halving of the risk

of colon cancer in the case of women who consumed three or more cups of

coffee a day, and no relationship in the case of men. For cancer of the rectum

no relationship was found with coffee consumption in either women or men.

Based on the studies mentioned above it can be concluded that coffee con-

sumption is not related to a heightened risk of cancer of the colon or rectum.

The possibly protective effect of coffee with respect to cancer of the colon

deserves further investigation.

How much caffeine per day?

The caffeine in coffee has a slightly stimulating effect on the central nervous system.

As a result, coffee can increase alertness and concentration. In the case of some

people it takes longer before they fall asleep after drinking coffee. In that case

decaffeinated coffee offers a solution. The amount of caffeine at which someone

feels comfortable can vary widely. This depends among other things on body

weight and possibly nicotine consumption. In general 400 mg of caffeine a day

(4 to 5 cups of coffee) is regarded as a safe and comfortable amount. Pregnant

women are advised to limit the amount of caffeine to a maximum of 300 mg daily.

In some countries e.g. the UK, the upper recommended limit is 200mg.


References

Aldoori WH et al. (1997). A Prospective Study of Alcohol, Smoking, Caffeine, and the Risk of Duodenal Ulcer in Men. Epidemiology, 4(8): 420-424.

Boekema PJ et al. (2001). Functional bowel symptoms in a general Dutch population and associations with common stimulans. Neth J Med, 59(1): 23-30.

Brown SR et al. (1990). Effect of coffee on distal colon function. Gut, 31: 450-453.

Dapoigny M et al. (2003). Role of Alimentation in Irritable Bowel Syndrome. Digestion, 67: 225-233.

Elta GH et al. (1990). Comparison of coffee intake and coffee-induced symptoms in patients with duodenal ulcer, nonulcer dyspepsia, and normal controls. Am J Gastroenterol, 85:1339-1342.

Kato I et al. ( 1992). A prospective study of gastric and duodenal ulcer and its relation to smoking, alcohol, and diet. Am J Epidemiol, 135(5): 521-530.

Larsson SC et al. (2006). Coffee consumption and incidence of colorectal cancer in two prospectivecohort studies of Swedish women and men. Am J Epidemiol, 163(7): 638-644.

Lee KJ et al. (2007). Coffee consumption and risk of colorectal cancer in a population-based prospective cohort of Japanese men and women. Int J Cancer,121(6): 1312-1318.

Michels KB et al. (2005). Coffee, tea, and caffeine consumption and incidence of colon and rectal cancer.

J Natl Cancer Inst, 97(4): 282-292.

Naganuma T et al. (2007). Coffee consumption and the risk of colorectal cancer: a prospective cohort study in Japan. Int J Cancer, 120(7): 1542-1547.

Rao SSC et al. (1998). Is coffee a colonic stimulant. Eur J Gastroenterol Hepatol, 10: 113-118.

Simren M et al. (2001). Food-Related Gastrointestinal Symptoms in the Irritable Bowel Syndrome. Digestion, 63: 108-115.

Sloots CEJ et al. (2005). Stimulation of defecation: Effects of coffee use and nicotine on rectal tone and visceral sensitivity. Scan J Gastroenterol, 40: 808-813.

Tavani A and La Vecchia C (2004). Coffee, decaffeinated coffee, tea and cancer of the colon and rectum: a review of epidemiological studies, 1990-2003. Cancer Causes and Control,15: 743-757.


3 Coffee, liver and gall

1 Does coffee affect the liver?

Various studies show that the consumption of coffee is associated with a lower risk

of various disorders of the liver, particularly in people who have a heightened risk

of such disorders as in the case of excessive alcohol consumption, viral hepatitis,

overweight and a reduced glucose metabolism (Ruhl, 2005b; La Vecchia, 2005;

Cadden, 2007).

At the start of the 1990s in a large prospective epidemiological study of

128.934 adults it was demonstrated that four or more cups of coffee a day can

reduce the risk of alcoholic liver cirrhosis by 80% and the risk of death from liver

cirrhosis by 23% (Klatsky, 1992, 1993). This result was confi rmed in a Norwegian

study of 51.306 adults, in which coffee consumption was similarly found to be

related to lower mortality as a result of liver cirrhosis, both alcoholic and non-

alcoholic liver cirrhosis (Tverdal, 2003).

In various retrospective and cohort studies, too, an inverse relationship is found

between liver cirrhosis and consumption of coffee (Corrao, 1994, 2001; Gallus, 2002;

Klatsky, 2006). The effect was only found for coffee and not for other caffeine

containing drinks (Corrao, 2001).

Increased activity of liver enzymes (alanine aminotransferase (ALT), aspartate

aminotransferase (AST), gamma glutamyl transferase (�GT)) forms an indicator

of liver damage and a heightened risk of liver cirrhosis. In various studies a link

has been found between coffee consumption and reduced enzyme activity

(Honjo, 2001; Nakanishi, 2000; Ruhl, 2005a; Klatsky, 2006). In a meta-analysis

based on six patient control studies and four cohort studies it was found that

coffee drinkers have a 41% lower risk of hepatocellular carcinoma (liver cancer)

26 |

when compared with people who never drink coffee (Bravi, 2007).

These results indicate that coffee consumption is associated with a reduced risk

of (serious) liver disease. Various components in coffee are associated with this,

such as caffeine, kahweol and cafestol (components in coffee oil) and anti-

oxidants. However, more research is needed in order to demonstrate a possible

mechanism. It is also still too early to attach a consumption recommendation

to this, though the results give no cause to discourage coffee consumption.

2 May people with functional liver disorders drink coffee?

There are no indications that coffee consumption has an adverse effect on the

liver functions. The results of various major studies point in fact to an association

between a reduced risk of (serious) liver disease and coffee consumption.

It is as yet too early to attach preventive consumption advice to this. However,

the results do not constitute a reason to advice against coffee consumption.

3 What is the effect of coffee on the gall bladder?

Coffee can stimulate contraction of the gall bladder (Douglas, 1990; Lindaman,

2002). As a result, coffee may possibly contribute to a lower risk of gallstones

(Lindaman, 2002).

A number of older epidemiological studies of the relationship between gallstones

and coffee consumption found no relationship (Jorgensen, 1989; Basso, 1992;

Kratzer, 1997; Pastides, 1990; La Vecchia, 1991; Sahi, 1998) or a signifi cant inverse

relationship (Misciagna, 1996).

Leitzmann et al (1999) monitored 46.008 men in the age range from 40 to 74

over time. Men who drank four or more cups of coffee a day were found to

have 40% less risk of gallstones than men who did not drink coffee regularly.

Decaffeinated coffee was not found to be associated with a lower risk. In a

comparable study of 80.898 women in the age range from 30 to 55, who were

monitored for a period of 20 years, a signifi cantly lower risk of cholecystectomy

(removal of the gall bladder) was found (Leitzmann, 2002). Cholecystectomy

is regarded as a measure of colelithiasis (gallstones). Decaffeinated coffee was

found to have no effect. In a smaller Japanese study no relationship was found

between coffee, green tea and caffeine consumption and colelithiasis among

7.167 men (Ishizuk, 2003).

Further research will be needed to show whether coffee consumption can have

a preventive effect on the development of gallstones.

4 Can someone with gall or gallstone problems continue to drink coffee?

In the case of gallstone complaints people are often advised to avoid fatty meals

in order to avoid the attacks. Although the effect is less, coffee can also affect

the contraction of the gallbladder and therefore will be avoided by a lot of

people suffering from gallstone complaints. This is supported by the fact that

coffee consumption (just like consumption of a fat-rich meal) is followed by a

contraction of the gallbladder (Douglas, 1990). If a gallbladder compresses but

cannot empty itself as the result of a blocking gallstone, the pressure and wall

tension will increase. This stimulates the stretching and pain nerves and can

therefore be very painful. Not all gallstones cause complaints. Most gallstones

remain asymptomatic. Complaints occur in 20-25% of people with gallstones

(symptomatic gallstones). Mostly in the case of clear gallstone attacks treatment

(operative or otherwise) will be suggested.


28 |

5 Can you still drink coffee if you no longer have a gall bladder?

Yes, this makes no difference. The bile duct takes over part of the gallbladder’s

reservoir function.

6 Do caffeinated and decaffeinated coffee differ in their effect on the bile?

There are indications that caffeinated coffee stimulates a contraction of the

gallbladder but an effect of decaffeinated coffee cannot be excluded. Adding

milk is primarily a question of taste; there are no indications that this infl uences

the effect.

7 Is there a relationship between coffee consumption and pancreatitis?

In a study among 129.000 people into the effect of smoking and coffee con-

sumption on pancreatitis (infl ammation of the pancreas) it has been found that

coffee consumption is related to a lower risk of alcohol-associated pancreatitis,

while smoking is associated with a higher risk (Morton, 2004). There is also

no relationship between coffee consumption and carcinoma of the pancreas

(Tavani, 2000).

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References

Basso L et al. (1992). A descriptive study of pregnant women with gallstones. Relation to dietary and social habits, education, physical activity, height, and weight. Eur J Epid, 8: 629-633.

Bravi F et al. (2007). Coffee Drinking and Hepatocellular Carcinoma Risk: A Meta-Analysis. Hepatology, 46(2): 430-436.

Cadden ISH et al. (2007). Review article: possible benefi cial effects of coffee on liver disease and function. Alim Pharm Ther, 26: 1-7.

Corrao G et al. (1994). The effect of drinking coffee and smoking cigarettes on the risk of cirrhosis associated with alcohol consumption: a case-control study. Eur J Epid, 10: 657-664.

Corrao G et al. (2001). Coffee, Caffeine, and the Risk of Liver Cirrhosis. Ann Epid, 11: 458-465.

Douglas BR et al. (1990). Coffee stimulation of cholecystokinin release and gallbladder contraction in humans. Am J Clin Nutr, 52: 553-556.

Gallus S et al. (2002). Does Coffee Protect Against Liver Cirrhosis? Ann Epid, 12: 202-205.

Honjo S et al. (2001). Coffee consumption and serum aminotransferases in middle-aged Japanese men.J Clin Epidemiol, 54: 823-829.

Ishizuk H et al. (2003). Relation of coffee, green tea, and caffeine intake to gallstone disease in middleaged Japanese men. Eur J Epidemiol, 18(5): 401-405.

Jorgensen T et al. (1989). Gallstones in a Danish population. Relation to weight, physical activity, smoking, coffee consumption, and diabetes mellitus. Gut, 30: 528-534.

Klatsky AL and Armstrong MA (1992). Alcohol, smoking, coffee and cirrhosis. Am J Epidemiol, 136(10): 1248-1257.

Klatsky AL et al. (1993). Coffee, tea, and mortality. Ann Epidemiol, 3: 375-381.

Klatsky AL et al. (2006). Coffee, Cirrhosis, and Transaminase Enzymes. Arch Intern Med, 166: 1190-1195.

Kratzer W et al. (1997). Gallstone Prevalence in Relation to Smoking, Alcohol, Coffee Consumption, and Nutrition. The Ulm Gallstone Study. Scan J Gastroenterol, 32(9): 953-958.

La Vecchia C et al. (1991). Risk Factors for Gallstone Disease Requiring Surgery. Int J Epidemiol, 20: 209-215.

La Vecchia C (2005). Coffee, liver enzymes, cirrhosis and liver cancer. J Hepatol, 42: 444-446.

Leitzmann MF et al. (1999). A prospective Study of Coffee Consumption and the Risk of Symptomatic Gallstone Disease in Men. JAMA, 281: 2106-2112.


Leitzmann MF et al. (2002). Coffee intake is associated with lower risk of symptomatic gallstone diseasein women. Gastroenterology, 123: 1823-1830.

Lindaman BA et al. (2002). The Effect of Phosphodiesterase Inhibition on Gallbladder Motility In Vitro. J Surg Res, 105: 102-108.

Misciagna G et al. (1996). Epidemiology of cholelithiasis in southern Italy. Part II: Risk factors. Eur J Gastroenterol Hepatol, 8: 585-593.

Morton C et al. (2004). Smoking, coffee and pancreatitis. Am J Gastroenterol, 99(4): 731-738.

Nakanishi N et al. (2000). Coffee consumption and decreased gamma-glutamyltransferase: a study of middle-aged Japanese men. Eur J Epidemiol, 16: 419-423.

Pastides H et al. (1990). A case-control study of the relationship between smoking, diet, and gallbladder disease. Arch Int Med, 150: 1409-1412.

Ruhl CE and Everhart JE (2005a). Clinical-liver, pancreas, and biliary tract. Coffee and Caffeine Consumption Reduce the Risk of Elevated Serum Alanine Aminotransferase Activity in the United States. Gastroenterology, 128: 24-32.

Ruhl CE and Everhart JE (2005b). Clinical-liver, pancreas, and biliary tract. Coffee and Tea ConsumptionAre Associated With a Lower Incidence of Chronic Liver Disease in the United States. Gastroenterology, 129: 1928-1936.

Sahi T et al. (1998). Body Mass Index, Cigarette Smoking, and Other Characteristics as Predictors ofSelf-Reported, Physician-Diagnosed Gallbladder Disease in Male College Alumni. Am J Epidemiol, 147: 644-651.

Tavani A and La Vecchia C (2000). Coffee and Cancer: a review of epidemiological studies, 1990-1999.Eur J Cancer Prev, 9: 241-256.

Tverdal A and Skurtveit S (2003). Coffee intake and mortality from liver cirrhosis. Ann Epidemiol, 13(6): 419-423.

Study of coffee and health

Every type of research has its own evidential value and limitations.

Most of the studies reported in this brochure can be differentiated into:

1. Meta-analysis: A literature study of various studies (intervention studies,

cohort studies and/or patent control studies) of the relationship between

coffee consumption behaviour and a biomarker or (medical) condition,

with the aim of obtaining a more precise outcome.

2. Cohort study (prospective): In this type of research people in a certain age

category (the cohort) are monitored over a longer period. Participants have

been selected before the outcome (for example a particular (medical)

condition) occurred. At the start of the research an examination has been

made of exposure, for example coffee consumption, which can be related

afterwards to the outcome. The pattern of coffee consumption of the

participants has therefore not been infl uenced by the condition.

3. Cross-sectional study: This is a study in which one monitors simultaneously

(smaller) cohorts which follow each other in time. For example a group in

the age range 31-45 and a group in the age range 45-60 are then examined

simultaneously. In this case at the start of the study differences in coffee

consumption have been examined between people who did and people

who did not acquire the (medical) condition during the study. In this

manner a good picture can be obtained of the association between for

example coffee consumption and the development of a condition between

the ages of 30 and 60.

4. Clinical study: This type of study is carried out in a hospital or clinic under

the supervision of a physician. The effect of the substance or nutrient to be

examined is measured in patients and possibly also in a control group. Studies

in the area of coffee research are mostly of limited scope and short duration.


5. Patient-control study: In the case of this type of study the differences in

coffee consumption patterns are investigated in groups of people who have

and have not developed a (medical) condition. In this case therefore

questions are asked after the event about previous coffee consumption

behaviour. A disadvantage of this type of study may be that the coffee

consumption pattern of the people who have that condition has been

modifi ed or is assessed differently than in the case of people who do not

have the condition.

6. Telephone interview: In this brochure in this type of study relatively small

groups of people are interviewed by telephone at a particular moment.

An examination is made of differences in the pattern of coffee consumption

in groups of people who have or have not developed a particular disorder.

These people are asked retrospectively about their consumption behaviour.

A disadvantage of this type of study can be that the pattern of coffee

consumption of people with the disorder has been changed or is assessed

differently than that of people who have not developed the illness.

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