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Coffee- should we give up this liquid gold?

Written by: Dr Jay Narainsamy, MBChB (Natal), FRCP (SA), MMed (UKZN), Cert Endocrinology (SA) Specialist Physician/Endocrinologist
Published: 25 January 2024

Happy new year to the CDE family!

As we are all aware, a new year comes with the usual flurry of new resolutions and plans to improve our lives and lifestyles. Let us hope that we have realistic goals which we can achieve and adhere to. I have made the typical promises to myself - eat healthier, exercise more and greater self-care and work-life balance. I then thought about my copious coffee consumption and whether I should be addressing this addiction as well. I admit I am addicted! I love everything about coffee… from the smell while preparing a good cuppa to the minute I take my first sip. I would beloath to give this up. So, this inspired me to do a deep dive into this addictive brew we all love.

Caffeine in coffee is a stimulant and therefore raises concerns about increasing blood pressure, arrythmias and possibly contributing to coronary artery disease.1-2 However, research has also proven that coffee is a potent antioxidant and therefore could be beneficial in reducing inflammatory markers and possibly reducing insulin resistance.3 Cardiovascular risk has its fundamental pathophysiology in the inflammatory processes which accompany lifestyle diseases. Thus, any reduction in these inflammatory markers is a welcome benefit.

Caffeine is a non selective adenosine receptor antagonist which enhances calcium release from muscle cells and can cause premature ventricular contractions. A study published in the New England Journal of Medicine looked at the risk of premature atrial contractions in coffee drinkers versus non-drinkers.4 This randomized trial showed no overall increased risk in coffee-drinkers. However, there was a positive association in the number of cups of coffee and the risk of premature ventricular contractions.

Coffee was shown to be inversely related to total and cause-specific mortality.5 These inverse associations included heart disease, respiratory disease, stroke, diabetes and infections. There was no association with cancer. It must be noted that the type of coffee was not analysed, so espresso drinkers might have been compared to the standard ‘instant coffees’. In addition, coffee drinking was associated with a decreased risk of developing type 2 diabetes, likely because of decreased insulin resistance.6

Unfortunately, any good thing can be a problem in excess. Excess caffeine intake may be also associated with anxiety and insomnia. The recommended daily intake according to the United States Food and Drug Administration is a maximum of 400 mg - this equates to 3-5 cups per day depending on the type of coffee. This obviously does not apply to pregnant women!

So as a coffee addict, I am somewhat comforted. I always tell my clients that life and diabetes are about moderation, so the same would apply to coffee. In recommended doses there are definite benefits. One must balance this benefit with possible issues like increases in anxiety, blood pressure and heart rate, and insomnia. I would still caution those who are at high risk for arrhythmias, have poorly managed blood pressure or fast heart rates to err on the side of caution. I would suggest you trade in this liquid gold for something a little less ‘stimulating’.


  1. Blomström-Lundqvist C,Scheinman MM, Aliot EM, et al. (2003). ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias — executive summary: are port of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients with Supraventricular Arrhythmias) developed in collaboration with NASPE-Heart Rhythm Society. J Am Coll Cardiol; 42:1493- 531.
  2. Al-KhatibSM, Stevenson WG, Ackerman MJ, et al. (2018). 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation; 138(13): e210-e271.
  3. Gomez-Ruiz JA et al.(2007). In vitro antioxidant activity of coffee consumption and their metabolites. J Agric Food Chem; 55:6962-9.
  4. Marcus MG et al. (2023). Acute effects of coffee consumption on health among ambulatory adults. NEJM;388: 1092-100.
  5. Freedman ND, Park Y, AbnetCC, Hollenbeck AR, Sinha R (2012). Association of coffee drinking with total and cause-specific mortality. NEJM; 366:1891-904.
  6. van Dam RM & Feskens EJ(2002). Coffee consumption and risk of type 2 diabetes mellitus. Lancet360(9344), 1477–1478.
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