Coffee, But Not Dalgona!

"Everything good in life is either illegal, immoral, or fattening."1

Coffee has been one of the most commonly consumed beverages in the world. More recently, the ‘quarantine’ coffee, or its more fanciful name ‘the Dalgona Coffee’ has taken the world by storm. It looks stunningly beautiful and eminently instagrammable. It has a texture and taste like silky ice-cream. But I hate to shatter your dreams. It may not match up to the real thing. Yes, I am talking purely from the health perspective.

Coffee has health benefits

Beneficial effects of coffee consumption on health are being increasingly recognised.²,³ Coffee is a very rich source of antioxidants. The protective effects of coffee have been proposed in a variety of conditions such as heart disease, strokes, type 2 diabetes and Parkinson disease.⁴,⁵

History: Banned as an immoral intoxicant

Around 1460, in Ethiopia, some villagers noticed that goats were acting hyperactive and friskier, if they grazed in an area containing some red cherries. These villagers subsequently, picked, dried, roasted and brewed the cherries and the brew became an instant hit. It soon travelled to Yemen and became known as ‘Qahwah’ or ‘Kehveh’.

In no time, the debate about salubrity, morality and legality of this intoxicating plant was set in motion. It was banned in Mecca and Cairo in 1511. Dealers were beaten, their inventories burnt. Kehveh arrived in Turkey in the 16th century, but the bean was officially forbidden under a penalty of death. By 17th Century, it reached Europe and was marketed as a health remedy for headache, ‘cough of the lungs’, and ‘a very good stuff’ to prevent miscarriage! It was also acclaimed as a remedy of melancholia, mind degeneration and impotence. Coffee Houses became popular but some called them the sites of vice and sedition. In 1675, King Charles II issued an edict to abolish Coffee Houses. But you can’t keep a good thing down.⁶

Tricks in making coffee

Coffee fruits (cherries)  are harvested and undergo pulp extraction to obtain green coffee seeds. It can now be either roasted or processed for decaffeination. Roasting the seeds bestows the characteristic aroma and flavour to the coffee. Interestingly, the most expensive coffee in the world (cost: around Rs.40,000 per kilogram), ‘Kopi Luwak’ has an additional step to complete. The seeds are ingested by the Asian Palm Civet, a small cat-like animal, and defecated undigested. The unique aroma of this coffee is attributed to processing in the intestine of Civet, hence it is also called Civet Coffee.⁷

Another factor that can affect the chemical composition of coffee is the method of brewing. It may involve percolation, boiling, French press, electric coffee maker, espresso machine or Italian coffee maker. ⁸ Instant coffee production typically involves treating ground-roast coffee with hot water followed by use of high pressure to extract the water-soluble compounds. This soluble material is then cooled and centrifuged; again concentrated by heating and lastly dried through freeze-drying to reduce moisture to approximately 5%. 

Coffee deconstructed

The basic chemical composition of green coffee depends primarily on genetic (species of plant), and physiologic aspects (degree of maturation of plant). Chemical composition on an average is as shown in Figure-1. Most studies have focused on the effects of caffeine (1,3,7-trimethylxanthine), a purine alkaloid, which is just one of the myriads of chemicals that are contained in coffee. Diterpenes, cafestol and kahweol are compounds that have also been studied to varying extent. Diterpenes have been blamed for coffee induced rise in cholesterol levels in human studies. ⁹,¹⁰ There are at least 30 organic compounds that have been shown to impact the typical aroma of coffee. ¹¹

How does it work?

It is a difficult question, since coffee contains more than 1000 substances.¹³ Of note is that caffeine may not be the most important component, as other caffeinated drinks do not provide similar protection against liver disease. The polyphenols (i.e. chlorogenic acid or CGA) may be responsible for the positive metabolic effects of coffee. There is experimental evidence that coffee with high CGA concentrations can modulate glucose intolerance and improve/decrease NAFLD development in obese rats.¹⁴,¹⁵

Coffee is a rich source of dietary antioxidants.¹⁶,¹⁷ It lowers the circulating levels of inflammatory biomarkers.¹⁸,¹⁹ Coffee possibly induces autophagy in vivo,²⁰ and protects against liver fibrosis.²¹,²²,²³

Favourable effects of coffee

Some beneficial effects are summarised in Figure-2 below.²⁴,²⁵,²⁶,²⁷,⁷⁸,⁷⁹,²⁸,²⁹,³⁰,³¹,³²,³³,³⁴,³⁵

Effect on the liver

Due to my interest in liver disease, you have to bear with this paragraph. Coffee consumption has been associated with improvement in deranged liver functions.³⁷ This effect is more pronounced in patients at highest risk of liver injury (e.g. overweight patients, significant alcohol intake, impaired glucose metabolism, viral hepatitis).³⁸,³⁹,⁴⁰,⁴¹ There are a number of other trials showing a beneficial effect of coffee on evolution of chronic hepatitis C with or without treatment as well as better tolerability of therapy with interferon & ribavirin.⁴²,⁴³,⁴⁴

The available experimental as well clinical evidence suggests that coffee consumption has protective effects against metabolic syndrome as well as development of fatty liver (Non-alcoholic fatty liver disease or NAFLD).⁴⁵,⁴⁶,⁴⁷,⁴⁸ Coffee drinking has also been shown to reduce the risk of insulin resistance. Histology based studies have shown reduced liver fibrosis in coffee drinkers.⁴⁹,⁵⁰,⁵¹,⁵²,⁵³,⁵⁴

Coffee has been shown to retard the development of cirrhosis. This effect was seen across high as well as low to moderate coffee consumption groups and is operative for all aetiologies of cirrhosis like HCV, NAFLD and alcohol.⁵⁵,⁵⁶Not only cirrhosis, coffee also protects the liver from developing liver cancer(Hepatocellular carcinoma).⁵⁷,⁵⁸,⁵⁹,⁶⁰

How much coffee should I have?

The beneficial effects of coffee are reported for 2 or more cups/day. One cup is equivalent to 10 gm of whole bean coffee and 5 gm of instant coffee. Incremental beneficial effects have been reported up to 4-6 cups of coffee a day. Upto 400 mg of caffeine a day is considered safe.⁶¹

A note of caution. Coffee drinking in pediatric age group should be discouraged in view of the side effects of caffeine in form of anxiety, restlessness, etc. Young people consuming large amount of coffee should always be warned about possible side effects such as headaches and insomnia and potential risk of dependence. High caffeine intake can lead to dependence in a manner similar to other psychoactive substances. ⁶² Excessive coffee can have serious untoward effects. ⁶³.

Adverse effects

Everything about coffee is not good. Some effects are definitely undesirable. Insomnia and dependence have already been mentioned in the previous para. In a meta-analysis of five prospective and eight case control studies, coffee consumption was associated with an increased risk of lung cancer ⁶⁴. Some studies examining caffeine consumption and urinary tract cancers found a small increase in bladder cancer risk among coffee drinkers. ⁶⁵ In addition, one cohort study in older women (70 to 73 years) found that consumption of five or more cups of coffee per day was associated with decreased bone mineral density among lean women. ⁶⁶. There are also reports of increased incidence of urgency incontinence, related to higher caffeine intake. ⁶⁷ Health Canada recommends not exceeding 2.5 mg per kg of body weight per day.⁶⁸And one should always opt for a trusted brand of coffee, preferably organic, to avoid getting pesticides along with it.⁶⁹

Why not Dalgona?

If you love Dalgona, go ahead and enjoy your cuppa. But most of the studies quoted for the health benefits are related to black coffee. Does adding sugar and milk negate all the benefits? There is no straight answer in the medical literature. It adds to calories for sure! There are reports that indicate that adding sugar and nondairy creamer interfere with anti-oxidants properties of coffee.⁷⁰ Sugar is a well known villain.⁸⁰ Milk may interfere with the bioavailability of chlorogenic acids,⁷¹ but does not not interfere with the antioxidant properties.⁷², On the other hand, for those who can tolerate it, milk helps prevent osteoporosis.⁷³

There are other flavour additives that are not so bad. A study has shown that intake of 1, 3, or 6 g of cinnamon per day reduces serum glucose, triglyceride, LDL cholesterol, and total cholesterol in people with type 2 diabetes. It also suggests that the inclusion of cinnamon can reduce the cardiovascular diseases in diabetes.⁷⁴ Popular in some parts if India, the practice of adding a dash of cocoa powder on coffee may not be too bad either.⁷⁵,⁷⁶

So, go and enjoy that aroma of freshly ground heaven. Black as devil, hot as hell, pure as an angel, and sweetened only with love.⁷⁷ Don’t procaffeinate!