Dr. Kevin Most: The dangers of Coffee…Is America’s favorite drink really all it’s cracked up to be?
Coffee- cardiovascular benefits
Everyone loves their coffee, well almost everyone, I am one of the few who do not drink coffee, I mean what is coffee, water we have washed coffee beans with, right? We have discussed in the past the health benefits of coffee. Research has shown it has cardiovascular benefits, brain health benefits, slows prostate cancer and in some studies shows increasing an individual’s life span. A study out this week shows that just because something is good for you does not mean that more of it is better for you.
Approximately 75% of adults consume coffee each day and the use of coffee has been on the rise for the past decade. There are blocks in Chicago where there are multiple Starbucks stores on the same block. Across the world it is the most popular beverage if you exclude plain water. In the US alone we consume 1.5 billion kilograms of coffee each year.
A study out of Australia, published in The American Journal of Clinical Nutrition, they looked at 350,000 individuals and the impact coffee had on their heart. The study showed that those individuals who drank more than six cups of coffee, defined as one cup of coffee had 75 mg of Caffeine, had an increase in their cardiovascular disease risk and an increase in high blood pressure. That equates to 450 mg of caffeine a day. Now let’s see how much caffeine is in the coffee we drink.
1.) Medium Dunkin donuts coffee, 14 oz.- 210 mgs of caffeine
2.) Starbucks Coffee, Pike place roast 12 oz. – 235 mg of caffeine
3.) Mountain Dew- 95 mg of caffeine
4.) Monster Energy drink- 160 mg of Caffeine
If you are a coffee drinker you should know how much caffeine is in the drink and for the cardiovascular health benefit try to keep your daily limit of caffeine below the 450 mg level
Osteoporosis awareness month is May
Remember when “ break a leg” used to be cheer of good luck, you may wonder how that ever came about and it is quite simple. The thought of wishing someone “good luck” was often seen as bad luck, and thus “break a leg “ was often said to actors and musicians before they took stage. The hope was by wishing bad luck one would have good luck. It also had a meaning of good luck as an actor would cross a line called the leg line from the side of the stage, you could not cross that line or patrons in the crowd could see you when you should, but when you did break the leg it was a sign of success.
So why talk about breaking a leg, well this month is osteoporosis awareness month. Osteoporosis is the leading cause of fractures, it is well beyond the other main cause of trauma in seniors. The word, osteoporosis has a meaning of porous bone, which is the condition as our bones lose density. The density of the bone decreases and the bones become very fragile and the chance of a fracture is greatly increased. This happens as we age and is a disease that is silent and often with no symptoms.
We think of this disease as a condition that women get, as many celebrities have shared their struggles with osteoporosis. Sally Field, Meredith Viera, Gwyneth Paltrow have all shared that they suffer from osteopenia or Osteoporosis. It is unfortunate that more celebrity men have not shared this as this condition will impact men as well. Estimates are that close to 2 million men in the US suffer from osteoporosis. Men usually will see symptoms 5-10 years later than women. Reasons for this may include activity, hormones and diet. The concern is that men who have osteoporosis and break a hip have a much higher chance of death within a year of that fracture than women who suffer from the same fracture.The sad thing is most men do not think about it and will find out after a fall with a fracture.
Our bones are living tissue and are changing daily, we have our highest bone density in our early to mid 20’s. Bones are continuing to dissolve bone matrix and rebuild in the same area thus maintaining our bone strength. As we age the amount of bone being resorbed out paces the amount of new bone being laid down and thus we end up with a situation where the bone cannot keep up and this results in weaker bones.
Under that scenario you can understand why this is so prevalent.
1.)Currently in the US alone we have close to 55 million people with clinically low bone mass or osteoporosis, and at risk for a fracture from a simple fall. 2.)Estimates are that 1-3 women or 1-5 men are at risk as early as the age of 50, the risk increases from there as we age.
3.) one in two women will break a bone due to osteoporosis, 1 in 4 men will do the same.
4.) Osteoporosis is responsible for 2 million broken bones a year.
5.) The cost to the health system is over $20 Billion a year
6.) 80 % of older Americans are not tested for osteoporosis The common fractures we hear about are hip fractures, often occurring after a senior falls injuring their hip. You have probably also heard of individuals who fractures in their spine resulting in a loss of stature, pain in the back and some deformity.
So, If we all know we are at risk for this, what can we do to prevent it or slow it down. Believe it or not we should be working on our bone health from Childhood all the way thru our later years. Waiting for the issue to be present may be too late.
As a child what can we do, or as a parent what should you be doing for your children’s bone health? First if you are a smoker, stop smoking as this will impact your bone health as well as your children’s. Diet, activity and Vit D are also needed as we grow. A diet that has calcium as well as has enough protein is key to bone growth as we age. How important is it, estimates show that an increase of 10% bone mass in children reduces the risk of an osteoporosis fracture by 50% later in life. As you can imagine the increase in video gaming, computer use and sedentary lifestyles in children may lead to bigger issues in years to come. We do not think about bone health as a child or as a parent of a child but medical data shows us we should.
As we move into adulthood the importance of diet continues as does our need for Vit D, especially those living in the north as their sun exposure is decreased during the winter. As adults one of the most important things we can do is participating in weight bearing activities. This may be as simple as taking a walk regularly or using a stand up desk for a portion of your day at work. Talking a 30 minute walk at lunch is good for your bones as well as for your minds and your heart. Other things to do is minimize the chance of a fall, wear low heels, do a check of the house for cords and throw rugs, make sure the rooms are brightly lit.
As far as diet needed to help prevent osteoporosis and promote bone growth there is some controversy. We would all think that supplementing our diet with additional calcium and Vitamin D are needed to make strong bones and prevent fractures. Well a study showed that as we grow individuals need to eat more vegetables, fruits, whole grains, beans and nuts, poultry and fish, many loaded with calcium to have better bone health. The balanced diet is more important than any supplements of calcium and Vit D
Good forms of Calcium in our diet is what we need. The goal is to have 1,000 mg of calcium a day for adults and then increase to 1200 for women over 50 and men over 70.
- Dairy products- single serving of cheese or milk has 300 mg of Calcium
- Almond or Soy milk- be sure to shake the carton as the calcium will settle to the bottom
- Salmon- single serving 300mg Calcium
- Dark vegetables- Kale, cabbage 250 mg Calcium per cup
Now we need to know that Vitamin D helps us absorb Calcium. The body will make its own Vitamin D with sun exposure, but in the winter Vit D supplement is need to insure that the dietary calcium is absorbed. Unfortunately we do not have a lot of foods loaded with Vit D. Some that are, milk is fortified with Vit D and has been since —–. Canned fish like tuna and sardines have Vit D, Egg yolks and beef liver have some Vit D but in small amounts.
So the combo of a good balanced diet with foods rich in Calcium, some dietary, supplemental or sun exposure Vit D will assure that you have the calcium you need to have strong bones.
This is a silent disease, most people do not know they have it until they fall and break a bone and then they are told. Knowing you have osteoporosis may lead you to change things about your environment, your diet and your exercise. Currently the guidelines are for women over the age of 65 to be screened if their risk is normal. Those at high risk may be told to screen earlier. Men should be screened at age of 70.
The most common screening is a dexascan, this is essentially a low dose x ray. We look at the density of your hip and spine as those are the bones that have a high chance of fracture and can lead to bad outcomes. The density score can give you a risk score of your chance for a fracture in the future. People always want to know if a standard x ray will show this process and the answer is not until it is in the later stages. Some physicians may use other screening tools where the wrist, arm, finger or heel are screened, many of these are done as screening in a doctor’s office or at a health fair and are then followed up with the more formal test. Any of these are good for awareness.
Depending on your results the doctor may suggest screening every one or two years. The test will give you a score called a T score and that is used to see if treatment is necessary.
Treatment- is usually tailored to the patient, the doctor may use medications like bisphosphates. These medications will slow down the reabsorption of bone, so that the bones can be rebuilt. So by slowing the reabsorption they allow the bones to maintain their strength or lose it slower.. Current drugs you may have heard of include, Fosamax, Actonel, Reclast, these are a few of the popular ones right now. Physicians may also use hormone therapy however there are risks related to this therapy and should be discussed with your doctor.
The newest drug, which was just recently released called Enenity is a bit different, other medications either try to slow the reabsorption or help build the bones. This medication actually does both, slowing the reabsorption and building stronger bones. This medication actually helps build stronger bones which is exactly what many of these patients need in order to prevent another fracture. The studies have shown that taking this medications may decrease the risk of a future fracture in the spine by 70%. It was studied in more than 11,000 women. Now the drug as you can imagine is not inexpensive, the cost is $1,825/ month or over $20,000 a year. Many may find that outrageous, but preventing a spine fracture or a hip fracture that could end up with a long hospitalization that would cost much more than the $20,000 cost of the medication. It is data like this that we have to use to see if the cost of a drug is worth the benefits we would receive both physically and financially. would cover the cost for the patient who is on Medicare.
The most exciting study that is going on now is the impact of estrogen on a portion of the brain that tells the body to stop building bones and scientist have now found a way to block this in mice and the results have shown that female mice develop and maintain strong bones and stayed that way as they aged. Scientists now think that this will be a future “cure” for osteoporosis. It would also eliminate the need for hormone therapy and the possible side effects. They feel this may be the early stages of developing a drug that may eliminate osteoporosis in women. Odd that this condition in the future may only be thought of as a male condition.
Treatment recommendations are often based on an estimate of your risk of breaking a bone in the next 10 years using information such as the bone density test. If the risk is not high, treatment might not include medication and might focus instead on modifying risk factors for bone loss and falls.