Coffee: The Good and The Bad

Patients ask all the time: “Is it alright for me to continue drinking coffee?”

 

Well, it really depends on how you drink your coffee. Coffee has evolved in many ways since it was discovered. Until now, many innovations involving coffee have invaded the homes of every family in the world.

 

The question if it is still appropriate to drink arises for two possible reasons; patients have read stories of its potential harmful effects, or they attribute some of their symptoms to caffeine intake. Despite coffee being a very popular beverage, many are afraid it could also be the cause of their chronic diseases. 

 

The total coffee consumed in the Philippines in 2020 was about 3.3 million 60kg bags according to Statista Research Department. The most recent National Nutrition Survey conducted by the Food and Nutrition research Institute also noted that 1/3 of all households in the country consume either 3 in 1 coffee or regular coffee every day. Among the youth and young adults, coffee consumption has increased due to the many coffee chains and shops built in every corner of the street.

 

Coffee has rich phytochemistry, most common of which are caffeine, chlorogenic acid, caffeic acid and hydroxy hydroquinone (HHQ). A lot of reliable research are available supporting the health promoting potential of coffee. Significant studies also show the beneficial effects of coffee towards several disease conditions such as neurodegenerative diseases, Type II diabetes, Hepatitis and hepatocellular carcinoma including nonalcoholic fatty liver diseases. 

 

Caffeine, polyphenols, trigonelline and diterpenes in coffee have antioxidant, anti- inflammatory and anti- apoptotic effects which helps in neuroprotection to delay onset or progression of Alzheimer’s and Parkinson’s Diseases as well as Ischemic Strokes and Cognitive deficits. The antioxidant activity of coffee has been noted to have inverse association with the risk of type 2 diabetes mellitus. There were studies which showed that habitual coffee consumption is associated with lower risks for cardiovascular death and a variety of adverse CV outcomes including Congestive Heart Failure and even stroke. 

 

In some studies, coffee is associated with improved asthma control due to its’ bronchodilation effect.  In a meta-analysis study, the inverse association between coffee and all- cause mortality was consistent. 

 

Studies on the health benefits of coffee are robust yet most of these are observational studies. There are very few randomized controlled trials which may significantly produce more accurate results. However, in these few studies, beneficial results may not be entirely attributed to coffee intake.

 

Consumption of 2-4 cups of coffee per day seems to be the most recommended amount of coffee intake, with 2 tablespoon of ground coffee in every 8-ounce cup. The US FDA also recommended that moderate intake is at 3-4 cups per day. 

 

Studies show that despite its’ seemingly beneficial effects, coffee may not be good for everyone. Most of the symptoms reported are due to the effects of caffeine.

 

Caffeine, the most common chemical in coffee may also be found in tea, energy drinks, some food and even medications. It is a natural stimulant. It keeps one awake and is responsible for that happy morning mood. Like any other stimulants, too much caffeine may pose problems.

 

The Mayo Clinic noted that up to 400 milligrams of caffeine a day appears to be safe for most healthy adults. A teaspoon of pure powdered caffeine is equivalent to 28 cups of coffee. This level can cause serious problems and even death. Too much caffeine can lead to a fatal overdose.

 

Caffeine in moderate amount is generally safe among older adults. However, it is not recommended for children. Even adolescents and young adults are warned of excessive caffeine intake especially that most beverages have varied amounts of caffeine in it. The idea of mixing it with alcohol and other drugs also pose serious side effects. Pediatricians discourage the consumption of caffeine and other stimulants by children and adolescents.

 

Caffeine may have a negative impact on pregnancy and fertility. Among those who are pregnant and breast-feeding, caffeine must be limited to 200mg daily. Among women, more than 2 cups of coffee a day may increase the risk of osteoporosis.

 

Caffeine may also trigger a gout attack among people sensitive to hyperuricemia causing gouty arthritis. Among the elderly, too much caffeine even 6 hours before bedtime may affect sleep and reduce its quality. Apart from sleep, the risk of incontinence and other bladder problems is also higher.

 

Although not true for everyone, caffeine may cause hyperacidity due to increase release of hydrochloric acid in the stomach. Some people go to work with just a cup of coffee and this may cause an upset stomach and even heartburn or gastroesophageal reflux.

 

Caffeine may also interact with medications or supplements one is taking. It is always best to consult a physician. Certain over the counter medications  when taken with caffeine may increase the risk of high blood pressure, heart attack or stroke.

 

It has been noted that too much caffeine may worsen symptoms of anxiety and depression. People suffering from anxiety may experience palpitations and nausea which may be affected by too much caffeine intake. On a personal note, I was rushed to a hospital due to excessive intake of coffee one morning, which triggered a plethora of annoying symptoms and led me to avoid coffee for the past ten years now. My daily caffeine supply comes from green tea and other organic tea I drink every day.

 

Is coffee good or bad? Your personal experience should tell you if you may need to curb your caffeine intake. Generally, if upon taking a certain amount of coffee you start to experience headache, insomnia, nervousness, irritability, frequent urination, fast heartbeat and muscle tremors, perhaps, you need to adjust or stop drinking coffee. Just a warning though, caffeine withdrawal may occur if one regularly consumes coffee and then suddenly decides to stop drinking. The above symptoms enumerated may be felt exaggeratedly for two weeks. It is advised that one should drink a lot of water or decrease coffee intake slowly.

 

Moderation is the key to almost everything. 

 

Well, get up and pour that hot coffee in your cup now.

Beginning Again

After 8 years of hibernation, I decided to blog again. There are so many things I want to talk about but at the moment, I begin again.

I will still cotinue writing about the daily anecdotes of each day as a doctor, a mother, a wife and a daughter.

Life has completely changed since my last entry. Just the same I would like to share stories.

And yes, I am  beginning again.

A MAN WILL REAP WHAT HE SOWS...

A month ago, I had an 81 yr old female patient, retired teacher who suffered from stroke. She is quite on the heavy side and couldn't talk coherently because of the cerebrovascular accident. She was subsequently admitted and was referred to a neurologist. During my first rounds, I started counseling the family already regarding long term care for their mom. When I had the chance to talk to her daughter, I told her that now is the best time to show her mom how much she had loved them and how she took care of them when they were young. To my surprise, the daughter answered ;" Im sorry Dra, hindi nya ako maaasahan diyan! (she cannot rely on me to do that) , lumaki ako sa katulong! (I grew up with my nanny)"....

Sometimes, we thought we did a great job raising our kids. We worked hard to give them the best education and the best life but we forget that a simple hug and daily time devoted for them is enough to make them remember how we love them so dearly.

Sowing good things is never too late... even in our twilight years, to age gracefully, one must learn to sow good things-- for his physical health, for the community and neighbors where one lives, and for one's mental health. The truth is... we will only reap what we sow...

My Geria Babies

There was a time when the secretary in one of my clinics called and said "Doc, your Geria babies are here already!". True enough, I had 5 patients waiting in the clinic at the age range of 79 to 90 accompanied by their adult children. This is in contrast to the patients of the Pediatrician with me in the clinic with patients who are babies accompanied by their mothers.

Many times, elderly, particularly the old-old, are in my clinic because their children could no longer understand their behaviour. They easily forget what the doctor just told them and they easily get irritated when they forget things. Their children get irritated too because of fatigue both in work and in taking care of them. One daughter, after the consult, stayed and asked if she could talk to me for a while. While the father left, she started to become teary- eyed. She said she doesn't know what to do. She gets tired reminding her father to take his medications. She gets tired checking on the food he eats. She gets tired being reprimanded by him when he is irritated. She gets tired seeing him sleep in the morning because she knows he will be awake at night and they sleep in one room together. While narrating her misery, I listened and looked at her straight in the eyes smiling. She paused and looked at me too. Then she realized, she was complaining in the same manner that she complained when her son was still a baby. All I have to say to her was " we'll all get there and he just came before us. Just remember, he was once like that to you too, taking care of all your moves because you were once a very fragile baby.."

As children, we have to realize that our parents were once as active as us. Even if they've been too harsh at one point or another, we wouldn't be where we are if not for them. Just look at the old people and start to imagine yourself with all the skin creases and wrinkles and think how would you act if you are already 90. Think again and again.

Hypoglycemia in the Elderly

Last year I wrote that Diabetes is better treated aggressively to avoid complications. True. However, when the diabetic patient becomes an elderly, this may not be so.

I had several cases admitted in the hospital, of elderly who suffered severe hypoglycemia after diligently taking their prescribed meds. One is 90 the other is 89. Hypoglycemia should be watched out among our elderly patients. They may not manifest as simple tremors or dizziness. My 90 year old patient had a very good appetite when I left her after my rounds. She even thanked me for taking care of her. However, that night her sugar started to fluctuate. I had just discontinued her hypoglycemic drugs two days prior. Her sugar dropped down to less than 50 which prompted me to give D50's. She would respond well but after several hours, the sugar would drop again. The resident on duty just continued monitoring her glucose levels and managed accordingly. However, at 4AM, the ROD called to tell me that my patient died- suddenly- seated down. Relatives said she requested to be seated down so she can eat, after several minutes, she just closed her eyes and did not breathe. Altthough she was 90, I still felt deep inside that I should have sent her home so she could have rested in the arms of all her children.

I noticed hypoglycemic agents should be used with caution when patients become 60 and above. Their response to these agents is very unpredictable. Nowadays, when I see my elderly patients whose children complain that their sugar is high, except when there are other signs and symptoms, I tell them to observe and not to feel alarmed. It is better to have higher sugar levels when you're old old. Monitoring of sugar levels is recommended.

Acne

One day, my 20 year old cousin asked me to prescribe meds for an erupting acne on her beautiful face. She is very much worried that it will ruin her pretty face. It's true a small seemingly unharmful eruption on the face becomes a big deal especially among adolescents.

How does an acene develop? You must have encountered, at least, once in your life acne eruptions especially when you were teenagers. Acne commonly starts in the early teen years because the oil glands in the body starts making more oil. In people who have acne, dead skin cells mix with the extra oil and plug up hair follicles in the skin. Bacteria that grows in the hair follicles causes more skin irritation. Remember, an open skin is a site of entry for bacteria which are not normal 'inhabitants' of the tissues under the skin.

A "whitehead" occurs when the hair follicle is plugged with oil and skin cells. If the follicle is plugged near the surface of the skin and the air touches it, it turns black and is called a "blackhead." A blackhead isn't caused by dirt. If the wall of a plugged follicle breaks, the area swells and turns into a red bump. If the follicle wall breaks near the skin surface, the bump usually becomes a pimple. If the wall breaks deep in the skin, acne nodules or cysts can form.

Things that often make acne worse include : oil-based makeup, suntan oil and hair products , stress, hormonal changes, especially during menstruation, squeezing or picking at blemishes and hard scrubbing of the skin.

Both boys and girls get acne. But it may be worse in boys because they have more skin oils. Heredity also plays a role. If your mother and father had bad acne, you may too. Your immune system plays a role too. Some people are extra sensitive to the bacteria that get trapped in their hair follicles.For many people, acne fades by the age of 25, but it can continue well into the adult years. When it happens, proper care of the face and your skin in general is a must!

Many drugstores sell products for the skin. Some over-the counter drugs such as benzoyl peroxide, resorcinol, salicylic acid and sulfur are used to treat acne. These medications are available in many forms, such as gels, lotions, creams, soaps or pads. In some people, over-the-counter acne medications may cause side effects such as skin irritation, burning or redness. Keep in mind that it can take up to eight 8 weeks before you notice an improvement in your skin.

Sometimes we recommend antibiotics, which can be very effective for treating acne. They can be taken by mouth or used on the skin in a lotion, cream or gel.

Some forms of acne can cause scars in some people. You can help reduce scarring by not squeezing or picking at blemishes. Also, avoid scrubbing your skin. When you have acne eruption, avoid touching it especially when your hands are dirty. For more concerns, it is always good to ask your doctor.

Love builds on beautiful memories....

HOMILY by Rev. Fr. Rolando V. Dela Rosa, O.P. (December 3, 2005, Caleruega)

Good morning Jerome and Cheri. Your ordeal is now over. The month of preparation for this wedding, the nervous anxiety , the worries, the sleepless nights, the endless planning, despedidas, the disagreements on schedules, choice of food, clothes and venues- all these will soon be just memories.

So now, I invite you both to relax, take it easy, concentrate on every moment of this ceremony, to celebrate the fact that you are indeed getting married in this beautiful Chapel, and to ask the Lord for the strength you need to face the challenges of married life. Focus your attention on this ceremony. The moment is unrepeatable. Savor its significance and cherish its value.

Besides, compared to all the time you spent preparing for this wedding, this ceremony is indeed very short. And judging from the length of time devoted to it, the most important part of the wedding ceremony is no longer the exchange of marriage vows, but the picture-taking. that might not be ideal, but it has practical advantages.

Cheri and Jerome, I am sure you will have beautiful pictures and videotapes of your wedding. Don't lose them, consider them as one of your priceless conjugal possessions. Together with your marriage contract. Pace your pictures in an air-tight cabinet where moths and termites and humidity could not harm them. You know why? Because wedding pictures make your love transfixed in tme, ritualized carefully to become unforgettable. these pictures will be a source of strenth and inspiration. Love builds on beautiful memories.

This is one thing many couples forget. the moment they are married, their new- found security makes them complacent. they no longer exert effort to increasing their store of past joys and happiness. They surrender to routine. Routine kills enthusiasm. Would it not be tragic if, after ten years, you start kissing eeach other not out of love, but out of sheer determination?

This is why your wedding is held within the sacrifice of the Mass. the Mass is a celebration of a beautiful memory. the Eucharist is Christ's love, transfixed and ritualized in time, so we will not forget Him. When I elevate the host and the wine, Christ speaks to you through us, saying: "Jerome and Cheri, I love you even at the risk of losing my life. This is the kind of love you must have for each other. Do this, in memory of me." In marriage, you become eucharists for one another: like Jesus, you are transfigured to become a body given, a blood shed for each other. This is why you say when you exchange vows: "I will love you for better or for worse, in sickness and in health, for richer or poorer, un til death do us part." You don't say: Until further notice.

Jerome, in a little while, you will declare to Cheri in the presence of all of us as witnesses,: "Cheri, although our marriage vows are spoken in a matter of minutes, these are promises that will last a lifetime." But, what guarantee do you have that your marriage will indeed last a lifetime? What guarantee do you have that your wedding will not end in separation? What guarantee do you have that your children will not live in a broken home? Jerome and Cheri, at this early, let me remind you: there is no human guarantee for a successful marriage.

If you rely on human strength, sooner or later you will grow weak. Even the strongest resolve and commitment become weak in time. The only guarantee for a successful marriage is the fact that marriage is not only a human invention, but a divine creation. Your falling in love was not a coincidence. It was part of God's plan. God called you to be together. And if you rely on his power and strength, if you put your faith in him, he will never disappoint you.

I remember one beautiful song that goes: "When Christ is allowed to enter our lives every storm becomes a calm, the tumult becomes peace, what cannot be done is done, the unbearable become bearable, and you pass the breaking point without breaking. For to walk with Christ is to conquer the storm." So beginning today, allow God to take charge of your life. Pray together. Pray for each other. tell him to take control of your life, for only when He is in control that you experience Peace.

In moments of difficulties, ask the Lord to make you, not only strong, firm and courageous. Ask him to give you the gift of understanding. Understanding is the prelude to forgivenness. And let's face it, everyday you will have many things to forgive each other for. We are not perfect. We commit mistakes. It is inevitable that once in a while you will hurt each other. You will even oppose each other on many issues and matters. But remember this, in marriage misunderstanding and opposition are inevitable; but quarrels are optional.

Finally, look to the example of the happily married couples around you. Their marriage may not be perfect, but they are happy, peaceful and thankful because they allowed Christ to take charge of their lives. Learn to do the same. With God at the center of your married life, there will be no mistakes, just lessons to be learned.

God bless you. Jerome and Cheri.