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Medicine is an ever-changing science, and as new research or clinical experience increases our knowledge, it may change diagnosis and treatment. The authors have checked
with sources believed to be reliable in their efforts to provide information that is generally
in accord with the standards accepted at the time of publication. The information in this
book is not intended as a substitute for advice from your doctor. It is impossible to list every risk or benefit associated with diagnostic tests, medications, lifestyle changes, and
herbal and alternative medicines, and individual experiences may vary. Individual readers
are solely responsible for their own health care decisions; the authors and the publisher do
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whether directly or indirectly, from the information contained in this book.
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they may provide or recommendations they may make.
THOMAS DUNNE BOOKS.
An imprint of St. Martin’s Press.
LIVE BETTER, LIVE LONGER. Copyright © 2010 by Drs. Sanjiv Chopra and Alan Lotvin
with David Fisher. All rights reserved. Printed in the United States of America. For information, address St. Martin’s Press, 175 Fifth Avenue, New York, N.Y. 10010.
The Library of Congress has cataloged the hardcover edition as follows:
Doctor chopra says : medical facts and myths everyone should know / Sanjiv Chopra and
Alan Lotvin with David Fisher.—1st ed.
Includes bibliographical references and index.
1. Medicine, Popular. 2. Medicine—Miscellanea. 3. Medical misconceptions.
I. Lotvin, Alan. II. Fisher, David. III. Title.
ISBN 978-0-312-37693-2 (trade paperback)
Originally published under the title Doctor Chopra Says
First St. Martin’s Griffin Edition: March 2012
1. Is Coffee Truly
ften I begin my lectures by asking everyone in the audience who
has at least two cups of coffee most days to raise their hands.
Usually, the majority of people do so. Then I ask how many of them
have at least four cups a day, and fewer hands are raised. Finally I ask
how many of them average six or more cups of coffee a day. In response
there is always some ner vous laughter and rarely more than a few
hands raised. That’s when I surprise my audience: “Good for you,” I tell
those few people. “You’re doing your liver a big favor.”
Coming from me, a liver specialist, that is high praise indeed.
In the past, drinking too much coffee supposedly had been linked
to a variety of health problems including heart attacks, birth defects,
pancreatic cancer, osteoporosis, and miscarriages. We do know that
coffee can cause insomnia, tremors, and it can raise blood pressure and
increase urination. But more recent evidence indicates that rather than
being dangerous, coffee may also offer substantial benefits, including
protection against heart disease, Type 2 diabetes, liver cirrhosis, Parkinson’s disease, cavities, colon cancer, prostate cancer, and even suicide. It is known to bring relief for asthma, increase endurance and
concentration—some major league baseball players are known to drink
as many as six cups of coffee during a game—and increase the absorption of other medications. It can be used to treat headaches—popular
Food and Drink
over-the-counter pain medications contain as much caffeine per pill as a
large cup of joe. And contrary to conventional wisdom, it appears to lower
the risk of being hospitalized for an arWhat is most surprising is
rhythmia. What is most surprising is
that so few people realize how much
that so few people realize
value there is in a cup of coffee. Or,
how much value there is in a
in fact, several cups of coffee.
cup of coffee.
According to legend, in about
1000 a.d. the shepherd Kaldi from the province of Kaffa in Ethiopia
noticed that the sheep in one pasture were far more active than those
in the nearby herds. The cause of that, he determined, were the odd
“cherries” they were eating. He tried one himself—and felt its energizing effects. Soon the local monks were using this fruit to help them
stay awake at night. Eventually coffee was exported to Yemen and the
first known coffeehouse opened in Istanbul in 1471. Initially, the conservative religious leaders of the Middle East forbade it because of its
stimulating abilities, but eventually it spread throughout Europe and
became a popular and profitable beverage. By 1675 there were more
than 3,000 coffeehouses in England.
The health benefits of coffee have been debated for centuries. Coffee has been blamed for everything from infertility to causing rebellions.
In 1674, for example, English women complained that this “nauseous
Puddle-water . . . has Eunucht our Husbands . . . they are become as
impotent as Age.”
But while many people still believe coffee can be dangerous, numerous large studies indicate that drinking coffee actually provides
considerable protection against several serious diseases and—this is
Many people should be
even more remarkable—many people
drinking more coffee,
should be drinking more coffee, not
While most medical studies begin with a specific premise to be
tested, considerable information can be gleaned from statistical analysis of information collected with no specific goal. One of the largest of
Is Coffee Truly a Lifesaver?
those observational collections was compiled by the Kaiser Permanente Medical Care Program. KP had been founded during World War
II as a prepayment medical plan for employees of Kaiser Shipyards
and expanded coverage after the war. In the 1960s, according to cardiologist Dr. Arthur Klatsky, an investigator at that company’s research
division, “Kaiser Permanente began a study to determine which [medical] tests were worth doing and which tests were not. This involved
setting up a computerized database to store information from healthcheckup examinations. Although the computers were rudimentary,
the database made it possible to perform a study of heart attack predictors matching a wide diversity of known risk factors. The study was
conceived by Dr. Gary D. Friedman as basically a search for new heart
“Counting all history queries and measurements, there were about
500 items and some of them would prove predictive of heart attacks.
One was that abstinence from alcohol predicted a higher risk from
heart attacks compared to light or moderate drinkers. That was not a
pre-study hypothesis and it led us to further explore alcohol and
health. I was able to obtain grant money to create a new data base
about alcohol habits from 1978 to 1985. It consisted of about 129,000
people from a multi-ethnic group. We used that data base to look at
subsequent medical events—for example, hospitalization or death from
a specific cause, like heart disease or cancer. We published the
alcohol–heart attack study in 1974.”
Another study from the same database, first published in 1992 and
updated in 2006, reported an inverse relationship between coffee and
liver cirrhosis. Coffee lowered the blood level of liver enzymes; astonishingly, the study found that the more coffee people drank, the less
chance they would develop alcoholic cirrhosis. Each cup daily accounted for a 20 percent reduction in risk. For example, alcohol drinkers could reduce the chance of cirrhosis by 80 percent by drinking
four cups of coffee daily.
The reason for this is not known. “Epidemiology doesn’t determine
mechanisms,” explained Dr. Klatsky, “it usually shows only associations.
Food and Drink
I was surprised at the strength of the apparent protection. When you
see something that is reduced 60, 70, 80 percent, that is a very major
reduction risk. That’s what we found in the relationship between
heavy coffee drinking and the likelihood of developing cirrhosis. It’s
very important to mention that the best way to reduce the risk of alcoholic cirrhosis is to limit alcohol intake, not to cover heavy drinking by
“I wish we knew a lot more about the coffee-cirrhosis link. We wish
we knew what type of coffee people drink, whether they put cream or
sugar in it, whether they filter it, whether it’s caffeinated or decaffeinated, but all we know is the number of cups per day. We did a subsample of about 10,000 people, and people who drink a lot of coffee,
generally four or more cups a day, almost always drink caffeinated
Personally, Dr. Klatsky states, he has “two cups of coffee in the morning and sometimes a cup at noon, but otherwise it keeps me awake.
Three’s my maximum.”
The curious benefits of coffee reported in this study may possibly
extend to other diseases affecting the liver. In August 2007, the journal Hepatology reported that 10 different studies, conducted in
Europe and Japan, showed that people who drink coffee have a significantly reduced chance of developing liver cancer. The studies included about 240,000 people, including 2,260 suffering from liver
cancer, and showed that people who drank at least several cups of coffee every day had less than half the chance of being diagnosed with
liver cancer than study participants who drank no coffee—the odds
dropped by 23 percent with each daily cup. As in Dr. Klasky’s study,
there was no attempt made to determine the reason for this decline in
liver cancer, that’s the type of work done in laboratories by scientists,
though there is some speculation that coffee causes liver enzymes to
It has been my experience—and this is anecdotal evidence—that
coffee lowers liver enzymes, which is quite desirable, prevents liver fibrosis (scarring), reduces the rate of hospitalization from chronic liver
Is Coffee Truly a Lifesaver?
disease, and reduces the risk of eventually developing liver cancer. We
know that coffee is insulin sensitizing; there are people whose pancreas produces sufficient insulin but for some reason it does not have
its desired target effect. Coffee sensitizes cells to insulin so that it
does have the necessary effect. Another recent study from the Harvard School of Public Health, Beth Israel Deaconess Medical Center,
showed that coffee drinkers have high levels of plasma adiponectin—
that’s important because low levels of plasma adiponectin have been
linked with aggressive liver disease. And finally, four cups of coffee a
day has been shown to reduce the incidence of very painful gout by as
much as half.
This impact on insulin may have another vitally important benefit.
While previous studies had failed to find a link between coffee drinking and prostate cancer, a National Institutes of Health–funded study
published in 2009 followed 50,000 male health professionals for two
decades and found that men who drank six or more cups of caffeinated or decaffeinated coffee daily reduced their chances of developing
advanced prostate cancer by 60 percent, men who had four or five
cups saw a 25 percent reduction, and drinking up to three cups provided a 20 percent lower risk compared to people who did not drink
While the reasons for this impact are not known, one of the authors of the study, Harvard’s Kathryn Wilson, speculated, “Coffee has
effects on insulin and glucose metabolism as well as sex hormone levels, all of which play a role in prostate cancer.”
If that’s all it did it would still be remarkable, but there is a rapidly
growing body of evidence that it has other real benefits. No one can
patent coffee, not even Starbucks, so studies about the effects of coffee have to be conducted by large public-oriented groups. Researchers
at the Harvard School of Public Health and Brigham and Women’s
Hospital conducted their own 125,000-person study from 1980 to
1998, which revealed another impressive benefit of coffee: People who
drink coffee regularly can significantly reduce their risk of Type 2 or
adult-onset diabetes. The results were impressive: Men who drank six
Food and Drink
or more cups of caffeinated coffee daily reduced their risk for this terrible disease by more than 50 percent; women who drank the same
amount reduced their risk by almost 30 percent.
Those findings were confirmed by a meta-analysis conducted at
Australia’s University of Sydney. A team of international researchers
examined 18 studies involving more than 450,000 participants and
their meta-analysis found: “Every additional cup of coffee consumed
in a day was associated with a 7 percent reduction in the excess risk of
In both of these studies it really was quantity that mattered. In the
world of coffee, quality is in the cup of the holder. The philosopher
Voltaire was purported to drink as many as 50 small cups of coffee a
day—and died in 1778 at age 83. While that certainly seems extreme,
in the Harvard study those people who consumed fewer than four
normal-size cups daily reduced their risk of contracting Type 2 diabetes only by about 2 to 7 percent. But adults who routinely had four or
five cups reduced their risk by 30 percent. And six or more cups? An
extraordinary 50 percent. Oddly, that study showed that for women,
drinking five or more cups a day provided no additional benefits. Like
the Australian study, the Harvard study did examine the difference
between caffeinated and decaffeinated coffee and found that for men
drinking four or more cups daily of decaffeinated coffee reduced the
risk of developing diabetes by 25 percent and for women by 15 percent, so clearly there are benefits no matter what type of coffee you
drink—as long as you drink a lot of it.
Further confirming this link was an 11-year study beginning in
1986 conducted at the University of Minnesota examining the relationship between coffee and diabetes in postmenopausal women.
Women who drank six or more cups of any type of coffee were 22 percent less likely to be diagnosed with diabetes than women who drank
no coffee. Surprisingly, especially to those people who believe the medicinal value of coffee is derived from its caffeine content, women
who drank six or more cups of decaffeinated coffee reduced their risk
by 33 percent. The present theory about why there has consistently
Is Coffee Truly a Lifesaver?
been a difference in the benefits of heavy coffee intake in men and
women is that women’s hormones or, more often, hormone-replacement
drugs in postmenopausal women, mitigate the effect.
Another analysis, this one conducted by Harvard with researchers
working with colleagues from the Universidad Autónoma de Madrid,
investigated the link between coffee
Because coffee does
and strokes in women. Because cofstimulate the heart, there
fee does stimulate the heart, there
has been a supposition that
has been a supposition that too much
too much coffee might
coffee might cause heart problems.
cause heart problems. In
For that reason it was long believed
fact, this study showed
that drinking a substantial amount
exactly the opposite effect.
of coffee could be very dangerous. In
fact, this study showed exactly the
opposite effect. Using data from the Nurses’ Health Study, in which
83,000 women regularly completed food frequency questionnaires,
including about coffee consumption, for 24 years, researchers discovered that women who drank two or three cups of coffee a day reduced
their risk of stroke by 19 percent—and the more coffee they drank the
greater the reduction. Women who did not smoke reported even greater
benefits; nonsmoking women who drank four or more cups of coffee a
day reduced their risk by an amazing 43 percent! This level of risk reduction is on par with the impact of some of the best-selling drugs in
Although the reasons for this are not known, there is some very
interesting associated data. It turns out that these benefits are not associated with caffeinated tea or soft drinks—and people who drank at
least two cups of decaffeinated coffee did show a reduced risk for
stroke. According to epidemiologist Esther Lopez-Garcia, one of the
directors of the study, “This finding supports the hypothesis that components in coffee other than caffeine may be responsible for the potential benefit of coffee on stroke risk.” This is an important point:
Coffee, like wine, has hundreds of component chemicals, including potassium, magnesium, vitamin E, and antioxidants. It is naïve to believe
Food and Drink
that only one of those substances is some sort of magic bullet. Researchers in the University of Sydney diabetes study reached the same conclusion, pointing out, “Our findings suggest that any protective effects of
coffee . . . are unlikely to be solely effects of caffeine, but rather, as has
been speculated previously, they likely involve a broader range of chemical constituents present in these beverages, such as magnesium, lignans
and chlorogenic acids.”
A companion study to the Nurses’ Health Study, published in the
Journal of Internal Medicine in 2008, followed more than 40,000 male
health professionals for 18 years and concluded that men who drank
five cups of coffee a day reduced their risk of dying from heart disease
by 44 percent. In fact, men who drank more than five cups of java
every day were 35 percent less likely to die from any cause, while women
who drank between four and five cups reduced their risk of mortality by
According to a Swiss study, that reduced risk is seen even in people
who have suffered heart attacks. The Stockholm Heart Epidemiology
Program enrolled more than 1,300 men and women who had a confirmed heart attack between 1992 and 1994. Eight years later those
patients who normally drank between one and three cups of coffee
daily reduced their risk of death by a third over those people who averaged less than a cup a day, while those participants who consumed
four to five cups reduced their risk of suffering a fatal heart attack almost by half.
While it has long been accepted that people with heart arrhythmia
should avoid coffee, another Kaiser Permanente long-term prospective
study published in March 2010 reported just the opposite. People who
drank at least four cups of coffee daily were almost one-fifth less likely
to be admitted to a hospital with a heart rhythm disturbance than
non-coffee drinkers. Dr. Klatsky and colleagues analyzed data collected from more than 130,000 people over a seven-year period and
found that the reduced risk extended to the various types of rhythm
disturbance. Dr. Klatsky admitted that “This [study] is going to surprise people. I think conventional wisdom is that coffee can cause
Is Coffee Truly a Lifesaver?
palpitations and it can cause rhythm problems. I think, though, that
conventional wisdom is not always right, and the data that were available before this study do not support the idea that moderate amounts
of coffee provoke rhythm problems.”
Dr. Klatsky pointed out that “we’re not going to recommend that
people drink coffee to prevent rhythm problems,” but that people who
drink a moderate amount of coffee can be reassurred they are not increasing their risk of significant heart rhythm problems.”
There may well be even more benefits to drinking a lot of coffee.
Both the Kaiser Permanente study and the Nurses’ study indicated
that heavy coffee drinkers were less likely to commit suicide and
men, but not women, had a reduced risk for Parkinson’s disease. In
2000 the Journal of the American Medical Association reported that
a federally funded study of 8,000 Hawaiian men found that those
who didn’t drink coffee had double the risk of getting Parkinson’s
than men who drank four ounces to four cups of coffee a day. While
these links are not as statistically compelling as the reduction in cirrhosis or diabetes, they’re certainly worth considering. Again, no one
knows precisely why this is true, but it is known that in Parkinson’s
patients the cells that produce the chemical dopamine have stopped
working, and caffeine increases the production of dopamine in the
Every year I spend four weeks attending on the hepatology ser vice
at Beth Israel Deaconess Medical Center, a major teaching affiliate of
Harvard Medical School. For the last several years I’ve been telling
every student, resident, and fellow on our liver ser vice to ask all our
patients how much coffee they drink. And what I’ve heard, over and
over, is that none of these patients with severe liver disease drinks coffee. It’s remarkable how consistent that has been. But one year, on my
last day, a resident approached me smiling broadly and said, “Dr. Chopra, I’ve finally got a patient who drinks coffee.”
“Tell me about him,” I said.
“This was a patient admitted with cellulitis. He drinks four cups of
regular coffee a day.”
Food and Drink
When I took my own history, I asked him, “Please, tell me about
tea and coffee.”
“I don’t drink tea,” he said. “But I love coffee.” I asked him if he drank
regular or decaf. “Regular.” I asked him how many cups he drank every
day. “Four cups.” What size? “Usual size.” Then I asked one more question, “How long have you been drinking coffee?”
And matter-of-factly he responded, “Ever since my liver transplant.”
Well, no wonder coffee hadn’t prevented his disease. I then asked,
“Did someone tell you to drink coffee after your transplant?”
He shook his head. “No, but after my transplant I suddenly had this
incredible urge to drink coffee.”
Personally, I love coffee and drink about four or five cups a day.
Usually with skim milk or black, but no sweetener. My collaborator, Dr.
Lotvin, drinks between three and five cups of black coffee daily. Once
I was asked to compare the benefits of drinking coffee to exercising in
patients with Type 2 diabetes. After thinking about it for a moment I
said, “They’re both quite beneficial. It seems to me that the best thing
to do is run to Starbucks!”
But before you run out and start chugging coffee by the pot please
remember that coffee does have some negative effects on a lot of
people. It can keep you awake at night. It may be dangerous for people
with serious cardiac arrhythmias. It can worsen heartburn and also
the symptoms of irritable bowel syndrome. It can raise your blood
pressure and make you irritable. And some studies have shown that
drinking two or more cups a day does increase the risk of a miscarriage for pregnant women and may result in lower-weight babies. But if
you can drink a considerable amount of coffee without any repercussions, some very good studies indicate you may well be adding an additional layer of protection against some very dangerous diseases. If
you intend to start drinking, start slow, have half a cup. If there is no
problem, have a full cup. See how you feel. And if it doesn’t affect you,
go ahead, have another cup.