Coffee stomach intestines and liver

coffee
stomach, intestines and liver

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Coffee and Health Information Bureau

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© January 2009, Coffee and Health Information Bureau, Rijswijk, Netherlands

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‘Coffee, stomach, intestines and liver’ – Contents

Page

Introduction 5

1 Coffee and stomach
Dyspepsia (stomach complaints) 7-8
Gastroesophageal reflux (heartburn) 8-12
Making coffee, decaffeinated coffee 12-13
Peptic ulcer (stomach ulcer) 13
Gastritis (inflamed stomach lining) 14
Stomach operation 14
References 15

2 Coffee and the intestines
Ulcus duodeni (duodenal ulcer) 17-18
Fluid excretion bowel movement 18-20
Irritable bowel 19
Colon cancer 20-21
References 23

3 Coffee, liver and gall
Effect on liver 25-26
Gall bladder, gallstones 26-28
Pancreatitis (inflammation of the pancreas) 28
References 30-31

Study of coffee and health 33-34

Coffee, stomach, intestines and liver | 3

Introduction

In the Netherlands in total we drink some 6.5 million litres of coffee a day
(VNKT, 2007). This makes coffee an important source of fluid in our diets. In this
respect it goes without saying that one wonders what the effects of coffee on
health might be. This brochure deals with common questions about coffee in
relation to the stomach, intestines and liver. The questions have been drawn up in
collaboration with the Dutch Association of Stomach Intestine and Liver Nurses.
Questions have also been included that were asked as a result of an appeal in the
email newsletter published by the Dutch Coffee and Health Information Bureau.

Two stomach, intestine and liver physicians and two dieticians working on behalf
of the Dutch Association of Dieticians assisted with answering the questions:
- Dr. Paul Boekema (stomach, intestine and liver physician, Máxima Medisch
Centrum, Eindhoven)
- Drs. Marco Becx (stomach, intestine and liver physician, Mesos Medisch
Centrum, Utrecht)
- Joan Rentzing (stomach, intestine and liver dietician, St. Antonius Ziekenhuis,
Nieuwegein)
- Gertien Hiemstra (stomach, intestine and liver dietician, UMC Utrecht)

It was possible to provide sound answers to many of the questions asked on the
basis of various scientific studies. However, there were some questions that remain
unanswered. On one hand because the body of research is not yet sufficient, and
on the other hand because some aspects are very difficult to examine. Clinical
research into the effect of nutrition on gastroesophageal reflux for instance is
difficult to carry out as it requires a catheter to be introduced into the oesophagus,
which can be rather uncomfortable. In addition to coffee, many other foods and
drinks are consumed, which does not make it any simpler to link the complaint
to the right food.


If after reading this brochure you still have questions or comments, we will be
pleased to hear from you. You can also order Dutch copies of the brochure free
of charge or download it at www.koffieengezondheid.nl. Naturally we will
continue to monitor scientific developments closely and should views change,
they will be shown on our website and in our email newsletter.

Coffee and Health Information Bureau
(Voorlichtingsbureau voor Koffie en Gezondheid)

Literature

Vereniging van Nederlandse Koffiebranders en Theepakkers (VNKT), Annual Report 2007.

6 |

1 Coffee and the stomach

1 Is there a relationship between coffee consumption
and dyspepsia (stomach complaints)?

Dyspepsia means literally poor digestion. Symptoms of dyspepsia include pain
or discomfort such as a bloated feeling in the upper part of the stomach. Other
symptoms are early satiation, nausea, burping, a heavy feeling in the stomach or
vomiting. Consumers regularly associate coffee with these stomach complaints.

In order to discover the extent to which dyspepsia occurs in the Netherlands
and in order to determine the relationship with alcohol, coffee and tea,
500 people were approached by means of a telephone sample survey. Of
these people 428 were willing to take part in an interview about the presence
of gastro-intestinal complaints and the use of alcohol, coffee and smoking
(Boekema, 2001). Of those questioned 14% indicated that they suffered from
stomach complaints. No association was shown between coffee and dyspepsia,
nor between alcohol and dyspepsia. Smoking and having stopped smoking,
however, were strongly associated with stomach complaints. An earlier
Norwegian study similarly found no relationship between coffee and dyspepsia
(Haug, 1995). An Australian cross-sectional survey of 592 people also found no
relationship between coffee drinking and dyspepsia (Nandurkar, 1998).
Dyspepsia was found to be related to smoking and use of aspirin. A large
cross-sectional survey of 8.407 adults in the UK showed a signiﬁcant relationship
between the presence of Helicobacter pylori and dyspepsia. There was no
relationship with coffee consumption (Moayyedi, 2000).

The scientiﬁc studies available show no relationship between coffee consumption
and dyspepsia.


Functional dyspepsia

Sensitive stomach or stomach complaints is a collective name for all sorts of
symptoms such as stomach pain, nausea, vomiting and a heavy or bloated
feeling in the stomach area. If no explanatory abnormalities or specific clinical
picture are identified during examination of the complaints, the diagnosis
‘functional dyspepsia’ is made.

2 If you have dyspepsia (stomach complaints) may you still
drink coffee?

Based on the available scientific studies no relationship can be demonstrated
between coffee consumption and dyspepsia (Boekema, 2001; Haug, 1995;
Nandurkar, 1998; Moayyedi, 2000). Of the people with dyspepsia 38% assumed
that coffee consumption was related to their complaints, although their pattern
of coffee consumption was no different from that of people who did not assume
a relationship with coffee (Boekema, 2001).

There are no proven arguments for advising against coffee in the case of
dyspeptic complaints, other than personal preference.

3 Is there a relationship between gastroesophageal reflux disease
(GERD) and coffee?

People with reflux complaints regard spicy food, fatty food and overeating as
the most important nutritional factors affecting the complaints (Bolin, 2000).
Stress is also frequently named. Coffee is named to a lesser extent in relation to
acid reflux (see table on page 10).

8 |

Clinical research into gastroesophageal reflux is (very) difficult to carry out as it
takes place by introducing a catheter into the oesophagus and can therefore be
aggravating. Nevertheless Dutch researchers succeeded in carrying out such a
survey. This survey included an examination of the effects of drinking coffee on
the lower oesophageal sphincter (constrictor) and exposure to acid in the oeso-
phagus during normal activities in eight healthy people and in seven patients with
gastroesophageal reflux disease (Boekema, 1999b). Only if coffee was drunk on
an empty stomach was there an increase in the exposure to acid in the oesopha-
gus in the case of patients with GERD. This effect was smaller than the effect of
a meal. Coffee was found not to affect any other reflux parameters, such as the
motility of the oesophagus body and the lower oesophageal sphincter.
It was concluded that coffee has no significant effect on gastroesophageal reflux
in patients and no effect whatsoever in the case of healthy volunteers.

In an extensive patient control study in Norway among 3.153 people with reflux
complaints and 40.210 controls, the relationship was examined between reflux
and various lifestyle factors (Nilsson, 2004). Smoking scored most unfavourably,
followed by high salt consumption. Coffee consumption, high-fibre bread and
regular physical movement on the other hand were found to lower the risk of
reflux. In an Italian study coffee was found to have no relationship with GERD
(Dore, 2007).

A study of the relationship between lifestyle factors and gastroesophageal reflux
complaints in identical twins, BMI, smoking and heavy physical activity during
work were found to be risk factors for frequent GERD symptoms, while physical
activity during leisure time appeared to have a protective effect (Zheng, 2007).
After correction for these factors none of the nutritional factors (including
coffee) was found to show a relationship to the complaints. In the case of men
it was found that consumption of high amounts of coffee (more than seven cups
a day) was accompanied by a lower risk.


Production of stomach acid

Approximately 1.5 litres of gastric juice is produced in the stomach every day:
pepsin (protein-splitting enzymes), stomach acid (hydrochloric acid) and the
so-called intrinsic factor. All foodstuffs (solid and liquid) increase the production
of stomach acid. Hence also coffee, water, a meal or a biscuit. This is a normal,
physiological reaction of the digestive system, which is no cause for complaints.
It only becomes clinically relevant if stomach acid regularly flows back into
the oesophagus.

5 What is the influence of the method of preparing coffee?

The gastrointestinal tract can be stimulated by foodstuffs with a substantial
calorie content, acidity, osmolarity or volume (Boekema, 1999a). Coffee’s acidity
is virtually neutral (pH 5-6), which makes a pH effect very improbable. Coffee
contains virtually no energy.

The method of roasting the coffee beans (conduction or convection) does not
appear to make any difference (DiBaise, 2003). No research has been undertaken
into the effect of the different brewing methods. Nor is any research known in
which the physiological effects on coffee of the addition of milk are examined.
The addition of milk or evaporated milk does affect the taste and may mask any
bitterness. As a result, the coffee is generally perceived as milder, which may also
give the idea that the effect of the coffee on the stomach would also be milder.
However, this cannot be confirmed by scientific research.

12 |

6 Is decaffeinated coffee better in the case of GERD?

There is one study in which it was found that decaffeinated coffee at breakfast
gave less reflux (Pehl, 1997). However, the relationship between drinking coffee
and the occurrence of reflux complaints could not be confirmed in other
studies (Boekema, 1999b; Nilsson, 2004; Dore, 2007; Zheng, 2007). There
are insufficient indications to conclude that decaffeinated coffee is better than
regular (caffeinated) coffee.

7 Is there a relationship between coffee consumption and
the risk of peptic ulcers (stomach ulcers)?

In the past coffee has been associated with the development of stomach ulcers.
However, since the identification of Helicobacter pylori, understanding of the
pathogenesis of peptic ulcers has changed radically, as a result of which coffee
has ceased to be of interest as a possible causal factor (Boekema, 1999a).

In a Danish cohort study among 2.416 Danish adults into risk factors for stomach
ulcers Helicobacter pylori infection, smoking and the use of tranquillisers were
identified as the most important factors. Coffee was found not to be a risk factor
(Rosenstock, 2003).

There are no indications that coffee forms a risk for the development of
a stomach ulcer.


8 Can people with gastritis (inflamed stomach lining) continue
to enjoy drinking coffee?

Gastritis is a (slight) inflammation of the stomach lining as a result for example
of an infection with Helicobacter pylori. This generally does not result in com-
plaints and is usually a coincidental finding during an endoscopic examination
(gastroscopy).

If the gastritis is more serious and results in sores or ulcers in the mucous
membrane, this can explain complaints (see also page 17). In a prospective
cohort study among 47.806 men, after six years there were found to be
138 new cases of ulcus duodeni (duodenal ulcer). No relationship was found
with smoking, alcohol or caffeine intake (Aldoori, 1997).
Coffee has no influence on the development of this disorder but it may
influence the complaints. Patients themselves often already avoid such drinks
or foodstuffs if they experience discomfort after consumption.
Advice is generally not necessary.

9 May one drink coffee again soon after a stomach operation?

Coffee has no special effects different from those of other drinks or food in
this respect. Therefore as soon as eating and drinking are permitted after the
operation, this can include drinking coffee if the patient feels like it.

14 |

References

Aldoori WH et al. (1997). A Prospective Study of Alcohol, Smoking, Caffeine, and the Risk of Duodenal
Ulcer in Men. Epidemiology, 8: 420-424.

Boekema PJ et al. (2001). Functional bowel symptoms in a general Dutch population and associations
with common stimulans. Neth J Med, 59(1): 23-30.

Boekema PJ et al. (1999a). Chapter 4: Prevalence of functional bowel symptoms in a general Dutch
population and associations with use of alcohol, coffee and smoking. Coffee and upper gastrointestinal
motor and sensory functions, Zeist (the Netherlands).

Boekema PJ et al. (1999b). Effect of coffee on gastroesophageal reflux in patients with reflux disease and
healthy controls. Eur J Gastroenterol Hepatol, 11: 1271-1276.

Bolin TD et al. (2000). Esophagogastroduodenal Diseases and Pathophysiology, Heartburn: Community
perceptions. J Gastroenterol Hepatol, 15: 35-39.

DiBaise JK (2003). A Randomized, Double-Blind Comparison of Two Different Coffee-Roasting Processes
on Development of Heartburn and Dyspepsia in Coffee-Sensitive Individuals. Dig Dis Sci, 4(48): 652-656.

Dore MP et al. (2007). Diet, Lifestyle and Gender in Gastro-Esophageal Reflux Disease. Dig Dis Sci, 53(8):
2027-2032.

Haug TT et al. (1995). What Are the Real Problems for Patients with Functional Dyspepsia?
Scan J Gastroenterol, 30(2): 97-100.

Kaltenbach T et al. (2006). Review: sparse evidence supports lifestyle modifications for reducing
symptoms of gastroesophageal reflux disease. Arch Intern Med, 166: 965-971.

Moayyedi P et al. (2000). The Proportion of Upper Gastrointestinal Symptoms in the community
Associated With Helicobacter pylori, Lifestyle Factors, and Nonsteroidal Anti-inflammatory Drugs.
Am J Gastroenterol, 95(6): 1448-1455.

Nandurkar S et al. (1998). Dyspepsia in the community is linked to smoking and aspirin use but not to
Helicobacter pylori infection. Arch Intern Med, 158(13): 1427-1433.

Nilsson M et al. (2004). Lifestyle related risk factors in the aetiology of gastroesophageal reflux.
Gut, 53: 1730-1735.

Pehl C et al. (1997). The effect of decaffeination of coffee on gastroesophageal reflux in patients with
reflux disease. Alim Pharm Ther, 11: 483-486.

Rosenstock S et al. (2003). Risk factors for peptic ulcer disease: a population based prospective cohort
study comprising 2,416 Danish adults. Gut, 52: 186-193.

Zheng Z et al. (2007). Lifestyle factors and Risks for Symptomatic Gastroeosophageal Reflux in Monozy-
gotic Twins. Gastroenterology, 132: 87-95.


2 Coffee and the intestines

1 Is there a relationship between coffee and ulcus duodeni
(duodenal ulcer)?

In a large-scale prospective cohort study of 47.806 American men (Aldoori, 1997)
the relationship between alcohol, smoking, caffeine and the risk of an ulcus duodeni
(duodenal ulcer) was examined. None of the factors examined were found to be
associated with a substantial increase of the risk. This result confirms the outcome of
an earlier study (Kato, 1992), in which similarly no connection could be established
between coffee consumption and the risk of ulcus duodeni. There was found to be
no difference in the daily pattern of coffee consumption between people with ulcus
duodeni, dyspepsia and healthy controls (Elta, 1990). Similarly there was found to be
no difference in the pattern of complaints after drinking coffee between patients with
ulcus duodeni and healthy controls. The available scientific studies show no relation-
ship between coffee consumption and the risk of ulcus duodeni.

Ulcus duodeni

Ulcus duodeni is the general medical term for duodenal ulcer. The duodenum is
the first part of the small intestine after the stomach. In addition to the stomach
(see page 12), this part of the intestine is also exposed to stomach acid. The
stomach and duodenum produce mucus to protect themselves against the acid.
Infection with Helicobacter pylori or the use of painkillers or anti-inflammatories
(Non Steroidal Anti-Inflammatory Drugs NSAID) can slow the process of main-
tenance of the mucous membrane, which can result in inflammation of the
mucous membrane. In the case of a minority of people infected by Helicobacter
pylori or using NSAID, ulcers may arise, which can cause pain in the epigastrium.


2 May patients with duodenal ulcers still drink coffee?

There was not found to be any difference in the daily pattern of coffee consump-
tion between people with ulcus duodeni, dyspepsia and healthy controls
(Elta, 1990). Similarly there was not found to be any difference in the pattern of
complaints after drinking coffee between patients with ulcus duodeni and healthy
controls. There are also no indications that coffee influences the course of various
intestinal disorders, such as diverticulitis, Crohn’s disease or colitis ulcerosa. People
who feel ill often modify their feeding pattern of their own accord, in particular
eating less fat, and drinking less coffee. This is a natural response in order to avoid
stimulation of the intestinal system as much as possible.

3 Does coffee affect fluid discharge in the intestines?

Approximately 9 litres of all sorts of digestive juices are added daily to the first part
of the gastrointestinal tract, which are virtually entirely re-absorbed into the body
further on in the intestinal system. A foodstuff has to have a very strong effect
on the secretion of digestive juices to be capable of causing any relevant change.
There are no indications that coffee affects fluid secretion in the intestines.

4 Does coffee have a stimulating effect on the large intestine?

In some people coffee has a stimulating effect on the peristalsis of the large
intestine. Results of a survey among 99 people (aged 17-27) concerning bowel
movement indicate that in 29% of the people coffee stimulated bowel move-
ment (Brown, 1990). The effect of regular (caffeinated) coffee (240 ml of coffee
with 150 mg of caffeine) and decaffeinated coffee (240 ml) on intestinal motility
was compared with that of the same amount of hot water or a complete meal

18 |

(1.000 kcal) (Rao, 1998). The effect of caffeinated coffee was found to be as
substantial as that of a complete meal, and was 60% stronger than water and
23% stronger than decaffeinated coffee. In a study by Sloots et al. (2005) strong
coffee (280 ml) and hot water were both found to have a signiﬁcant effect on
bowel movement.

and irritable bowels (IBS)?

Patients with Irritable Bowel Syndrome (IBS) have symptoms that cannot be
related to a clear clinical picture. It is regarded as a chronic disturbance of the
functioning of the intestinal system. The symptoms, such as abnormal bowel
motions (constipation or diarrhoea) and stomach pain or an uncomfortable
feeling in the stomach, can also occur after consumption of food by people
without IBS (Dapoigny, 2003). Almost everyone has intestinal complaints once
in a while. In the Netherlands during a screening exercise 5.8% of the adults
were found to be suffering from IBS, which is surprisingly low compared with
other countries (Boekema, 2001). No association with coffee consumption was
found. In a Swedish survey it was found that 63% of patients with IBS assume
that their symptoms are related to meals (Simren, 2001). In particular foodstuffs
that are rich in carbohydrates and fat were associated with complaints.
Coffee was associated by 10% of the patients with serious complaints (dyspepsia,
stomach pain and thin faeces). No general nutritional advice can be given
to people with IBS. People often avoid foodstuffs that they themselves already
associate with their complaints.


6 What is the effect of coffee on bowel movements?

In healthy people coffee can have a stimulating effect on the large intestine,
which can have a positive effect on bowel movements. The same amount of hot
water or a meal have a comparable effect (see question 4). The possible relevance
of this effect for people who are troubled by constipation will differ individually
and will depend among other things on the seriousness of the constipation.

There are no indications that coffee causes diarrhoea in healthy people. A small
percentage of patients with IBS associate coffee with thin faeces (see question 5).
They will often already modify their pattern of consumption themselves.

7 Is there a relationship between coffee and colon cancer?

Three cohort studies and nine case-control studies published between 1990 and
2003 showed no significant relationship between coffee consumption and colon
cancer (cancer of the large intestine) (Tavani, 2004). Three cohort studies and
four case-control studies also showed no relationship with cancer of the rectum
(Tavani, 2004). In a meta-analysis, in which the results from five cohort studies
and 12 case-control studies were combined, people who consumed four or
more cups of coffee daily were found to have a 24% lower risk of colon cancer
compared with people who did not drink any coffee (Tavani, 2004).

In an extensive, prospective cohort study no relationship was observed between
coffee and colon cancer. Consumption of two or more cups of decaffeinated
coffee a day was found to be associated with a significantly lower risk of colon
cancer (Michels, 2005). In two large Swedish prospective cohort studies of
61.433 women and 45.306 men no relationship was found between coffee and
colon cancer (Larsson, 2006), as well as in a prospective Japanese cohort study

20 |

(Naganuma, 2007). On the other hand in a prospective cohort study (among
50.139 women and 46.023 men) Lee et al. (2007) did ﬁnd a halving of the risk
of colon cancer in the case of women who consumed three or more cups of
coffee a day, and no relationship in the case of men. For cancer of the rectum
no relationship was found with coffee consumption in either women or men.

Based on the studies mentioned above it can be concluded that coffee con-
sumption is not related to a heightened risk of cancer of the colon or rectum.
The possibly protective effect of coffee with respect to cancer of the colon
deserves further investigation.

How much caffeine per day?

The caffeine in coffee has a slightly stimulating effect on the central nervous system.
As a result, coffee can increase alertness and concentration. In the case of some
people it takes longer before they fall asleep after drinking coffee. In that case
decaffeinated coffee offers a solution. The amount of caffeine at which someone
feels comfortable can vary widely. This depends among other things on body
weight and possibly nicotine consumption. In general 400 mg of caffeine a day
(4 to 5 cups of coffee) is regarded as a safe and comfortable amount. Pregnant
women are advised to limit the amount of caffeine to a maximum of 300 mg daily.
In some countries e.g. the UK, the upper recommended limit is 200mg.


References

Aldoori WH et al. (1997). A Prospective Study of Alcohol, Smoking, Caffeine, and the Risk of Duodenal
Ulcer in Men. Epidemiology, 4(8): 420-424.

Boekema PJ et al. (2001). Functional bowel symptoms in a general Dutch population and associations
with common stimulans. Neth J Med, 59(1): 23-30.

Brown SR et al. (1990). Effect of coffee on distal colon function. Gut, 31: 450-453.

Dapoigny M et al. (2003). Role of Alimentation in Irritable Bowel Syndrome. Digestion, 67: 225-233.

Elta GH et al. (1990). Comparison of coffee intake and coffee-induced symptoms in patients with
duodenal ulcer, nonulcer dyspepsia, and normal controls. Am J Gastroenterol, 85:1339-1342.

Kato I et al. ( 1992). A prospective study of gastric and duodenal ulcer and its relation to smoking,
alcohol, and diet. Am J Epidemiol, 135(5): 521-530.

Larsson SC et al. (2006). Coffee consumption and incidence of colorectal cancer in two prospective
cohort studies of Swedish women and men. Am J Epidemiol, 163(7): 638-644.

Lee KJ et al. (2007). Coffee consumption and risk of colorectal cancer in a population-based
prospective cohort of Japanese men and women. Int J Cancer,121(6): 1312-1318.

Michels KB et al. (2005). Coffee, tea, and caffeine consumption and incidence of colon
and rectal cancer.

J Natl Cancer Inst, 97(4): 282-292.

Naganuma T et al. (2007). Coffee consumption and the risk of colorectal cancer: a prospective cohort
study in Japan. Int J Cancer, 120(7): 1542-1547.

Rao SSC et al. (1998). Is coffee a colonic stimulant. Eur J Gastroenterol Hepatol, 10: 113-118.

Simren M et al. (2001). Food-Related Gastrointestinal Symptoms in the Irritable Bowel Syndrome.
Digestion, 63: 108-115.

Sloots CEJ et al. (2005). Stimulation of defecation: Effects of coffee use and nicotine on rectal tone
and visceral sensitivity. Scan J Gastroenterol, 40: 808-813.

Tavani A and La Vecchia C (2004). Coffee, decaffeinated coffee, tea and cancer of the colon and
rectum: a review of epidemiological studies, 1990-2003. Cancer Causes and Control,15: 743-757.


3 Coffee, liver and gall

1 Does coffee affect the liver?

Various studies show that the consumption of coffee is associated with a lower risk
of various disorders of the liver, particularly in people who have a heightened risk
of such disorders as in the case of excessive alcohol consumption, viral hepatitis,
overweight and a reduced glucose metabolism (Ruhl, 2005b; La Vecchia, 2005;
Cadden, 2007).

At the start of the 1990s in a large prospective epidemiological study of
128.934 adults it was demonstrated that four or more cups of coffee a day can
reduce the risk of alcoholic liver cirrhosis by 80% and the risk of death from liver
cirrhosis by 23% (Klatsky, 1992, 1993). This result was conﬁrmed in a Norwegian
study of 51.306 adults, in which coffee consumption was similarly found to be
related to lower mortality as a result of liver cirrhosis, both alcoholic and non-
alcoholic liver cirrhosis (Tverdal, 2003).

In various retrospective and cohort studies, too, an inverse relationship is found
between liver cirrhosis and consumption of coffee (Corrao, 1994, 2001; Gallus, 2002;
Klatsky, 2006). The effect was only found for coffee and not for other caffeine
containing drinks (Corrao, 2001).

Increased activity of liver enzymes (alanine aminotransferase (ALT), aspartate
aminotransferase (AST), gamma glutamyl transferase (␥GT)) forms an indicator
of liver damage and a heightened risk of liver cirrhosis. In various studies a link
has been found between coffee consumption and reduced enzyme activity
(Honjo, 2001; Nakanishi, 2000; Ruhl, 2005a; Klatsky, 2006). In a meta-analysis
based on six patient control studies and four cohort studies it was found that
coffee drinkers have a 41% lower risk of hepatocellular carcinoma (liver cancer)


when compared with people who never drink coffee (Bravi, 2007).

These results indicate that coffee consumption is associated with a reduced risk
of (serious) liver disease. Various components in coffee are associated with this,
such as caffeine, kahweol and cafestol (components in coffee oil) and anti-
oxidants. However, more research is needed in order to demonstrate a possible
mechanism. It is also still too early to attach a consumption recommendation
to this, though the results give no cause to discourage coffee consumption.

2 May people with functional liver disorders drink coffee?

There are no indications that coffee consumption has an adverse effect on the
liver functions. The results of various major studies point in fact to an association
between a reduced risk of (serious) liver disease and coffee consumption.
It is as yet too early to attach preventive consumption advice to this. However,
the results do not constitute a reason to advice against coffee consumption.

3 What is the effect of coffee on the gall bladder?

Coffee can stimulate contraction of the gall bladder (Douglas, 1990; Lindaman,
2002). As a result, coffee may possibly contribute to a lower risk of gallstones
(Lindaman, 2002).

A number of older epidemiological studies of the relationship between gallstones
and coffee consumption found no relationship (Jorgensen, 1989; Basso, 1992;
Kratzer, 1997; Pastides, 1990; La Vecchia, 1991; Sahi, 1998) or a signiﬁcant inverse
relationship (Misciagna, 1996).

Leitzmann et al (1999) monitored 46.008 men in the age range from 40 to 74

26 |

over time. Men who drank four or more cups of coffee a day were found to
have 40% less risk of gallstones than men who did not drink coffee regularly.
Decaffeinated coffee was not found to be associated with a lower risk. In a
comparable study of 80.898 women in the age range from 30 to 55, who were
monitored for a period of 20 years, a signiﬁcantly lower risk of cholecystectomy
(removal of the gall bladder) was found (Leitzmann, 2002). Cholecystectomy
is regarded as a measure of colelithiasis (gallstones). Decaffeinated coffee was
found to have no effect. In a smaller Japanese study no relationship was found
between coffee, green tea and caffeine consumption and colelithiasis among
7.167 men (Ishizuk, 2003).

Further research will be needed to show whether coffee consumption can have
a preventive effect on the development of gallstones.

4 Can someone with gall or gallstone problems continue
to drink coffee?

In the case of gallstone complaints people are often advised to avoid fatty meals
in order to avoid the attacks. Although the effect is less, coffee can also affect
the contraction of the gallbladder and therefore will be avoided by a lot of
people suffering from gallstone complaints. This is supported by the fact that
coffee consumption (just like consumption of a fat-rich meal) is followed by a
contraction of the gallbladder (Douglas, 1990). If a gallbladder compresses but
cannot empty itself as the result of a blocking gallstone, the pressure and wall
tension will increase. This stimulates the stretching and pain nerves and can
therefore be very painful. Not all gallstones cause complaints. Most gallstones
remain asymptomatic. Complaints occur in 20-25% of people with gallstones
(symptomatic gallstones). Mostly in the case of clear gallstone attacks treatment
(operative or otherwise) will be suggested.


5 Can you still drink coffee if you no longer have a gall bladder?

Yes, this makes no difference. The bile duct takes over part of the gallbladder’s
reservoir function.

6 Do caffeinated and decaffeinated coffee differ in their effect
on the bile?

There are indications that caffeinated coffee stimulates a contraction of the
gallbladder but an effect of decaffeinated coffee cannot be excluded. Adding
milk is primarily a question of taste; there are no indications that this inﬂuences
the effect.

and pancreatitis?

In a study among 129.000 people into the effect of smoking and coffee con-
sumption on pancreatitis (inﬂammation of the pancreas) it has been found that
coffee consumption is related to a lower risk of alcohol-associated pancreatitis,
while smoking is associated with a higher risk (Morton, 2004). There is also
no relationship between coffee consumption and carcinoma of the pancreas
(Tavani, 2000).

28 |

References

Basso L et al. (1992). A descriptive study of pregnant women with gallstones. Relation to dietary and
social habits, education, physical activity, height, and weight. Eur J Epid, 8: 629-633.

Bravi F et al. (2007). Coffee Drinking and Hepatocellular Carcinoma Risk: A Meta-Analysis.
Hepatology, 46(2): 430-436.

Cadden ISH et al. (2007). Review article: possible beneﬁcial effects of coffee on liver disease
and function. Alim Pharm Ther, 26: 1-7.

Corrao G et al. (1994). The effect of drinking coffee and smoking cigarettes on the risk of cirrhosis
associated with alcohol consumption: a case-control study. Eur J Epid, 10: 657-664.

Corrao G et al. (2001). Coffee, Caffeine, and the Risk of Liver Cirrhosis. Ann Epid, 11: 458-465.

Douglas BR et al. (1990). Coffee stimulation of cholecystokinin release and gallbladder contraction
in humans. Am J Clin Nutr, 52: 553-556.

Gallus S et al. (2002). Does Coffee Protect Against Liver Cirrhosis? Ann Epid, 12: 202-205.

Honjo S et al. (2001). Coffee consumption and serum aminotransferases in middle-aged Japanese men.
J Clin Epidemiol, 54: 823-829.

Ishizuk H et al. (2003). Relation of coffee, green tea, and caffeine intake to gallstone disease
in middleaged Japanese men. Eur J Epidemiol, 18(5): 401-405.

Jorgensen T et al. (1989). Gallstones in a Danish population. Relation to weight, physical activity,
smoking, coffee consumption, and diabetes mellitus. Gut, 30: 528-534.

Klatsky AL and Armstrong MA (1992). Alcohol, smoking, coffee and cirrhosis. Am J Epidemiol,
136(10): 1248-1257.

Klatsky AL et al. (1993). Coffee, tea, and mortality. Ann Epidemiol, 3: 375-381.

Klatsky AL et al. (2006). Coffee, Cirrhosis, and Transaminase Enzymes. Arch Intern Med,
166: 1190-1195.

Kratzer W et al. (1997). Gallstone Prevalence in Relation to Smoking, Alcohol, Coffee Consumption,
and Nutrition. The Ulm Gallstone Study. Scan J Gastroenterol, 32(9): 953-958.

La Vecchia C et al. (1991). Risk Factors for Gallstone Disease Requiring Surgery.
Int J Epidemiol, 20: 209-215.

La Vecchia C (2005). Coffee, liver enzymes, cirrhosis and liver cancer. J Hepatol, 42: 444-446.

Leitzmann MF et al. (1999). A prospective Study of Coffee Consumption and the Risk of Symptomatic
Gallstone Disease in Men. JAMA, 281: 2106-2112.

30 |

Leitzmann MF et al. (2002). Coffee intake is associated with lower risk of symptomatic gallstone disease
in women. Gastroenterology, 123: 1823-1830.

Lindaman BA et al. (2002). The Effect of Phosphodiesterase Inhibition on Gallbladder Motility In Vitro.
J Surg Res, 105: 102-108.

Misciagna G et al. (1996). Epidemiology of cholelithiasis in southern Italy. Part II: Risk factors.
Eur J Gastroenterol Hepatol, 8: 585-593.

Morton C et al. (2004). Smoking, coffee and pancreatitis. Am J Gastroenterol, 99(4): 731-738.

Nakanishi N et al. (2000). Coffee consumption and decreased gamma-glutamyltransferase: a study
of middle-aged Japanese men. Eur J Epidemiol, 16: 419-423.

Pastides H et al. (1990). A case-control study of the relationship between smoking, diet,
and gallbladder disease. Arch Int Med, 150: 1409-1412.

Ruhl CE and Everhart JE (2005a). Clinical-liver, pancreas, and biliary tract. Coffee and Caffeine
Consumption Reduce the Risk of Elevated Serum Alanine Aminotransferase Activity in the United States.
Gastroenterology, 128: 24-32.

Ruhl CE and Everhart JE (2005b). Clinical-liver, pancreas, and biliary tract. Coffee and Tea Consumption
Are Associated With a Lower Incidence of Chronic Liver Disease in the United States. Gastroenterology,
129: 1928-1936.

Sahi T et al. (1998). Body Mass Index, Cigarette Smoking, and Other Characteristics as Predictors of
Self-Reported, Physician-Diagnosed Gallbladder Disease in Male College Alumni. Am J Epidemiol,
147: 644-651.

Tavani A and La Vecchia C (2000). Coffee and Cancer: a review of epidemiological studies, 1990-1999.
Eur J Cancer Prev, 9: 241-256.

Tverdal A and Skurtveit S (2003). Coffee intake and mortality from liver cirrhosis. Ann Epidemiol,
13(6): 419-423.


Study of coffee and health

Every type of research has its own evidential value and limitations.
Most of the studies reported in this brochure can be differentiated into:

1. Meta-analysis: A literature study of various studies (intervention studies,
cohort studies and/or patent control studies) of the relationship between
coffee consumption behaviour and a biomarker or (medical) condition,
with the aim of obtaining a more precise outcome.
2. Cohort study (prospective): In this type of research people in a certain age
category (the cohort) are monitored over a longer period. Participants have
been selected before the outcome (for example a particular (medical)
condition) occurred. At the start of the research an examination has been
made of exposure, for example coffee consumption, which can be related
afterwards to the outcome. The pattern of coffee consumption of the
participants has therefore not been inﬂuenced by the condition.
3. Cross-sectional study: This is a study in which one monitors simultaneously
(smaller) cohorts which follow each other in time. For example a group in
the age range 31-45 and a group in the age range 45-60 are then examined
simultaneously. In this case at the start of the study differences in coffee
consumption have been examined between people who did and people
who did not acquire the (medical) condition during the study. In this
manner a good picture can be obtained of the association between for
example coffee consumption and the development of a condition between
the ages of 30 and 60.
4. Clinical study: This type of study is carried out in a hospital or clinic under
the supervision of a physician. The effect of the substance or nutrient to be
examined is measured in patients and possibly also in a control group. Studies
in the area of coffee research are mostly of limited scope and short duration.


5. Patient-control study: In the case of this type of study the differences in
coffee consumption patterns are investigated in groups of people who have
and have not developed a (medical) condition. In this case therefore
questions are asked after the event about previous coffee consumption
behaviour. A disadvantage of this type of study may be that the coffee
consumption pattern of the people who have that condition has been
modiﬁed or is assessed differently than in the case of people who do not
have the condition.
6. Telephone interview: In this brochure in this type of study relatively small
groups of people are interviewed by telephone at a particular moment.
An examination is made of differences in the pattern of coffee consumption
in groups of people who have or have not developed a particular disorder.
These people are asked retrospectively about their consumption behaviour.
A disadvantage of this type of study can be that the pattern of coffee
consumption of people with the disorder has been changed or is assessed
differently than that of people who have not developed the illness.

34 |

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