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Comment by nirv | Hacker News Reader

"Conclusions: [...] Moderate coffee consumption was inversely significantly associated with CVD risk, with the lowest CVD risk at 3 to 5 cups/d, and heavy coffee consumption was not associated with elevated CVD risk."

I am confused here (with the word "inversely"). Do I understand correctly that: a) moderate consumption of coffee leads to a reduction in the risk of CVD compared to when a person does not drink coffee at all, and b) strong consumption does not affect CVD risk comparing to the moderate coffee consumption?

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The relative risk vs coffee consumption curve fist goes below 1.0 (no coffee = 1.0) and reaches minimum around 3-5 cups then starts to increase slowly again. cardiovascular disease and stroke risk go above 1.0 after 9-10 cups per day.

The study mentions that results may not apply to unfiltered coffee (eg, French press, Scandinavian boiled, or Turkish/Greek coffee). Other studies have shown that cholesterol-raising factor in coffee does not pass a paper filter.

Thanks for the clarification. It's a pity that there's no complete data, as I drink mostly French press coffee.

I an a fan of French press as well and I've found the aeropress to be a great substitute with both health benefits (paper filter) and ease of use (cleaning is easier than a press). It's also measurably improved my cholesterol. YMMV, hopefully obviously.

For a while I used a metal reusable mesh filter but my measured cholesterol was elevated during this period.

I'm dubious about generalizing paper-filter results to the paper-under-pressure aeropress; you can see the oils come through. It's great for the body of the coffee though.

That's a good point, and it depends on how you brew. Many people use the aeropress differently. I do push but not very hard. Some let it drip (gravity).

Also, just my anecdata.

French press is filtered; the filter is just coarser than a paper filter, though the grind is typically coarser as well.

Typically thought of as "strained" and not filtered.

The difference seems academic. What does espresso quality as?

The difference is far from academic. Paper absorbs the oils, metal does not.

Espresso is definitely not filtered, the oils are necessary for a good crema. There's a fascinating review paper on crema with lots of pictures and microscope images by E. Illy et al. (yes, that Illy) on the subject.

https://link.springer.com/article/10.1007/s11483-011-9220-5 [open access]

I stand corrected (filtration is through a multi level matrix, sieving through a single level), though the absorption of oils is a by-product of filtration.

> Other studies have shown that cholesterol-raising factor in coffee does not pass a paper filter.

And yet other studies are increasingly pointing towards dietary cholesterol intake not being such an important causal factor for CVD after all [1], and that important evidence going against the cholesterol-is-bad theory was never published properly [2] since the people doing the studies thought the data was flawed since it went against the prevailing theory.

[1] http://annals.org/article.aspx?articleid=1846638&atab=7

[2] http://blogs.sciencemag.org/pipeline/archives/2016/04/15/fro...

Coffee doesn't contain cholesterol. It contains diterpenes, which are shown to increase "bad cholesterol". How meaningful this effect is, I don't know, but it's not the same as dietary cholesterol.

I was born in the early 70's. It seems like a good many of the dietary recommendations I was raised on were BS. It's strange.

It's worse than strange. Consider margarine vs butter. I mean, margarine was promoted during WWII to conserve dairy for the military. And it was later promoted as healthy. Gotta cut down on those bad saturated fats! Except ... Except that hydrogenation (to make vegetable oil solid) creates trans partially saturated fats. Which raise LDL more than saturated fats!

Most Margarine is no longer hydrogenated.

Right. Because we now know that synthetic trans fats are bad.

I still love eggs fried in butter. But otherwise, I mostly use olive oil. Or almond butter.

I've recently taken to just not having any spread on my bread other than the main ingredient.

Example: toasted slice of yeast bread (my recipe is 50% white, 20% rye, 30% wholemeal) with jam or with a slice of cheese or hummus or fool maddamas or an apple. Just no butter/marge/whatever.

I do now have butter and toast a couple of times a week.

Try olive oil with a pinch of salt.

Actually, I have found that I don't need any spread at all, just the bread and the main ingredient.

Meta: Downvotes on original post, HN is very touchy on diet. Good heavens.

Oh no... you eat bread? ;)

Yup. I even bake my own ;-}

Getting into rye and spelt though.

Giving up the bread and keeping the butter would be the more healthy choice.

I take the point, and I do cut the carbs quite often when actively losing weight (actually specifically reducing my waist measurement)

The gluten in that bread (read: insulin spike) will hurt you a lot more than the butter.

Gluten is protein, which isn't going to cause an insulin spike. I suspect you mean carbs.

What happens in the body when it's consumed?

I'm not sure I follow. Are you saying that eating bread causes an insulin spike, and since bread contains gluten, that's part of the insulin spike? Eating gluten-free carbohydrates also create an insulin spike. If I'm misunderstanding you, please feel free to clarify. I'd rather not be building a straw man inadvertently.

You got it right. They are two different things. Closely tied but none the less separate. Thanks for the reminder.

Sorry. Ignore my previous comment(s).

You can largely blame the media. Scientific research is always finding new results and refining our knowledge. When a new study is published it's often oversold by the media. Then later more research adds to the original finding, sometimes changing the recommendation. Then the media hypes up the new finding.

In support: The fact that the 'cholesterol is bad theory' is wrong/outdated is the current state of teaching at German medical schools.

This study was funded by big Pharma and Nestle... I’d be hard pressed to trust it.

What is especially suspicious is how the study gives the maximum benefits at 3-5 cups, that is what one typically consumes. It looks like threat - continue drinking coffee or you die.

Cholesterol increasing effect in coffee is not coming from dietary cholesterol.

It comes from cafestol and kahweol. They seem to affect cholesterol regulation in the body. http://www.annualreviews.org/doi/10.1146/annurev.nutr.17.1.3...

There are people running billion dollar industries that desperately want to obscure the truth about this. The fact is that blood cholesterol rises predictably and reliably in response to ingestion of dietary cholesterol. Your body will eventually clear it but not if you keep downing one cholesterol heavy meal after another:

https://www.youtube.com/watch?v=vBtfzd43t8o

Futhermore, you (specifically your brain) needs cholesterol. There is such a thing as not enough cholesterol.

Thank you.

To which I'd like to add: It's sugar and carbs that are doing the damage. The bad reputation of cholesterol is at this point a myth, a myth that more need to be aware of.

I typically drink one large coffee (30g beans) per day. That's about three standard cups. Plus 100mg modafinil. Without the modafinil, I typically drank about twice that. With that much coffee, I occasionally experienced premature ventricular contractions (PVCs). Which are extremely disconcerting, but rarely fatal. Or at least, that's what the cardiac specialist said, after the isotope imaging stress test ;) And generally, I'm happier with the caffeine-modafinil combination.

If I ever had "premature ventricular contractions", whatever they are, I would never touch a coffee ever again. How can you do that? "rarely fatal" is not good enough for me :/

You wouldn't lean to assuming the modafinil was the odd factor there before the coffee?

I got the impression that this happened before OP started taking modafinil.

Yes, and I haven't had any PVCs since taking modafinil. Because, I presume, I'm drinking less coffee.

Well, that was my thought, at first! PVCs feel like your heart is trying to jump out of your chest. Very freaky.

But, as I said, I've seen cardiac specialists. At least twice, over the years. They basically said to drink less coffee. But they found no evidence of heart damage.

That sounds strange to fear something purely based on its medical name. Driving is "rarely fatal", and that seems good enough for almost everybody.

premature ventricular contractions are basically extra heart beats that disrupt the normal rythm. If you have the feeling that your heart skips a beat, that's most likely caused by a premature ventricular contraction. It can be caused by heart problems but is in itself apparently harmless.

(note: I am not a doctor)

Do you cycle the modafinil ? and How ?

No. I just take 100mg per day, upon arising. As prescribed.

If I need to work a long day, I take another 50mg, plus more coffee.

I'm surprised you feel anything from that dose daily.

I found Modafinil to be somewhat worthless due to it only coming as an instant release tab and the resulting insta-tolerance.

It works for me. But then, I'm not looking for a buzz. Modafinil modulates my ability to focus, and my need for sleep. But not in an acute way like caffeine does.

15g of Lavazza Red ground coffee in a mokapot. Once a day. Assuming this hits the 'not major consumption' spot.

How bad is the withdrawal when you stop all of that?

What do you mean "stop"?

I've been drinking coffee for some decades. And taking modafinil for at least one decade.

If you don't do it for a week, how bad is your headache?

Why would I want a headache?

I do know from experience that I'll have headache if I cut off coffee. If I cut modafinil, I'll just not feel like doing anything, and sleep a lot.

> cardiovascular disease and stroke risk go above 1.0 after 9-10 cups per day.

Is this black coffees, or 800 kcal creamed and sugared lattes?

And to clarify further: Normal activity with no coffee (or caffeine?) represents the common risk factor “1.0” as the control group. People who claim to totally avoid this psychoactive stimulant (but naming brewed coffee specifically), and are otherwise typical, have this risk level.

The study links improved health and coffee, with its statistics. People drinking a handful of 8 oz. cups of coffee (black? light and sweet?) seem to do better, having somewhat healthier hearts with less disease, than the control group of consumers of exclusively non-caffeinated substances (naming brewed coffee specifically). Coffee drinkers do best when consuming 24 to 40 fluid ounces of brewed coffee, distributed throughout waking hours, with the range of optimum quantities likely varying based on body weight.

According to this research, excessive drinking of coffee at 80 ounces (or more?) is as bad (or worse?) than drinking none at all. The research examines 1,279,804 participants and 36,352 heart disease cases.

Any info about expresso and nespresso?

Expresso is what the baby gets, espresso is what the parents need and nespresso shouldn’t be consumed and is awful.

After reading the Nespresso supported article: it is an observational study. The types of coffee described are not considered because the studied population does not usually drink them.

The ironic side of the study is that since expresso coffee has more cafesol than filtered coffee (but less than french press), if people start to use more their nespresso the population study would probably change.

See this: https://www.hsph.harvard.edu/nutritionsource/2015/02/23/ask-...

Quoting:

9. Is drinking coffee made with a paper filter healthier than drinking boiled coffee or other types of coffee?

Coffee contains a substance called cafestol that is a potent stimulator of LDL-cholesterol levels (12). Cafestol is found in the oily fraction of coffee, and when you brew coffee with a paper filter, the cafestol gets left behind in the filter. Other methods of coffee preparation, such as the boiled coffee common in Scandinavian countries, French press coffee, or Turkish coffee, are much higher in cafestol. So for people who have high cholesterol levels or who want to prevent having high cholesterol levels, it is better to choose paper filtered coffee or instant coffee, since they have much lower levels of cafestol than boiled or French press coffee. Espresso is somewhere in the middle; it has less cafestol than boiled or French press coffee, but more than paper filtered coffee.

Urgert R, Katan MB. The cholesterol-raising factor from coffee beans. Annu Rev Nutr. 1997;17:305-24.

It's fairly well documented by numerous studies that for most people blood cholesterol is not significantly impacted by cholesterol consumed in food. That is, cholesterol in your coffee is likely a non issue.

Furthermore, the connection between cholesterol and heart disease is greatly overstated. The true culprit is sugar and too many carbs. In most cases sugar/carbs will kill you before cholesterol will.

Knowning that correlation does not imply causation, does that mean that it could be more counter intuitive here? Meaning that people with better heart condition stands coffee better and are hence more apt to drink more? I personally go into an annoying (if not dangerous?)) tachycardia if I would drink 2 cups of coffee.

I am actively running this experiment. I will comment back 50 years later to share my experience. ;)

After about 50 years, it works for me…

I wish you many more years to go on with your experiment!

I wish you're over 40 (or 50). Will be glad to see your update in 2067 :-)

Yes.

This is also not very surprising. There's been plenty of research indicating that coffee consumption has moderate health benefits.

This should all be taken with a grain of salt. Researching nutrition and particularly its long term effects is extremely difficult and prone to all kinds of biases, as you usually can't practically do controlled studies. But as far as the research we have tells us drinking coffee is not so bad.

Yes, and on the subject of salt; a tiny pinch in a cup of coffee really does help to bring out the flavour. I've no idea about the effects on health, (probably depends on the rest of ones sodium intake) but it tastes good.

+1 I put a pinch of salt in my coffee. It modifies the flavor in a subtle way that is hard to describe.

Yes you understood the conclusion correctly. The lowest risk of CVD is for people drinking 3-5 cups daily.

> Do I understand correctly that ... moderate consumption of coffee leads to a reduction in the risk of CVD

You do not understand correctly. :) Moderate coffee consumption is associated with a reduction in the risk of CVD. It is more likely than not that there is no causal relationship here, or that any causal relationship that does exist is significantly less powerful than the observed relationship.

>Definitely not.

Says who? Just because correlation is not the same as causation doesn't mean a correlation means there is "definitely not" a causation.

I was not clear about what I was trying to reply to. I've expanded my quote and reworded. Thanks for pointing this out.

"leads to" is a really dangerous term here.

same as therapeutical amphetamine

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