What a great pic!  This was caught by one of our wives in the middle of the jungle at an animal sanctuary on a trip our families took together to Costa Rica in December 2019.

While most people go to Costa Rica for the climate, the ocean, and the Pura Vida,  Dave and I got most amped up at a coffee demonstration.  That’s us wafting the aroma while our kids are likely somewhere in the background bored out of their minds.

I have a long history with coffee.

Throughout high school I worked at a little golf course in Oakville.  Being the youngest on the crew I was frequently assigned the best and most challenging tasks (getting coffee for everyone).

I always remember one of the grounds crew guys named Abe specifically for his coffee order.  Most of us 5:30AM workers would order an extra large black coffee, some would order a regular and the occasional person would order a double double.

 

Abe would order a double, quadruple.  That means 2 creams and 4 sugars.  He would drink at least 3-4 extra large of these daily.

 

We used to tease Abe and say the consistency of his coffee was more like sand than liquid.  He said he ‘needed the sugar rush’.

 

Over the past handful of years numerous studies have been published showing that drinking coffee has a positive impact on longevity.  Typically they have a catchy headline like “drink more coffee to live longer”.  As someone who automatically assumes a catchy headline like this means the underlying studies are flawed, I have been pleasantly surprised to see the consistency in this research.  In general we don’t know the mechanism, but on observational studies, drinking coffee (not just having caffeine, but actually drinking coffee) seems to reduce your risk of dying.

 

But not all coffee is created equal.  What about Abe and is double, quadruple compared to my black coffee?  What about the exponential rise in caramel macchiato’s and other drinks that better resemble dessert than a morning cup of joe?

 

Recently a headline catching study was completed in a prestigious medical journal looking specifically at how many cups of coffee you consume and your risk of dying. But this has been done over and over so who cares?

 

The important difference with this study compared to all its predecessors is for the first time ever it also looked at your risk of dying by regularly drinking coffee with sugar versus black coffee.

 

Read below for the very (and non-intuitive) findings, but as an added bonus at the end of this article, we reveal how much coffee each of our staff at The Proactive Athlete drinks, and how much sugar they have in it.  The reason I have included this is entirely for your benefit so you can judge us.

 

This study utilized data from the U.K. Biobank, one of the largest health databases ever created.  The Biobank is a huge cohort study of over 500,000 people aged 37-73 from 22 centres across the UK.  From 2006-2010 this project saw volunteer participants complete massive amounts of questionnaires, family history data, nutritional data, as well as physical and medical tests.  These participants were then followed for years to assess health outcomes and to allow researchers a massive dataset to use in a prospective manner allowing them to draw high quality conclusions.  Essentially it means they can group people together based on any kind of variable, create a hypothesis and then follow them along to see what happened in real life.  Very cool.

 

For this study, they included folks that completed at least one 24 hour dietary recall questionnaire as part of their intake.  In total, 171,616 people were included.  From the questionnaires, they found out how many cups (250ml) of coffee people drank in a day, the type of coffee (instant, ground, or decaf), and how much sugar was added to their coffee.

 

The outcome measure was simple.  Death.  That sounds bad, but it is simple, straightforward and easy to follow.  The researchers simply looked at death certificates in England and Scotland to corroborate this.

 

Before getting into the mortality results, here are some interesting facts about coffee intake across a broad spectrum of a population in the UK:

• Of the 171,616 participants, 75.8% were coffee drinkers (Tea drinkers were excluded).
• The average person has coffee with 1.1 teaspoons of sugar or artificial sweetener added (more on this later).
• Non-coffee drinkers were more likely to drink tea (but remember the study was in the U.K where tea is part of the social fabric).
• Males were more likely to drink coffee with sugar. The same goes for smokers, those with less healthy diets, and those from a lower socioeconomic class.
• Those that used artificial sweeteners were more likely older, former heavy smokers, and obese with hypertension, diabetes, depression and had a family history of cardiovascular disease.
• Those that drank unsweetened coffee (black coffee) ate a healthier diet and were from a higher socioeconomic class.

 

That is great, but what about the risk of mortality?  Well here is where the data became quite interesting.

• Over the 7 year follow up there were 3177 total deaths. Of those, 1725 died from cancer, 628 from cardiovascular disease and the rest from all other causes.
• Overall, the amount of coffee one consumes creates what is called a U shaped distribution. Those that drank no coffee obviously had the same risk of dying as the control group (because the control group were people that did not drink coffee).  With each successive cup of coffee one drinks, the total risk of dying decreases.  This decrease maxed out around 3 cups of coffee for the unsweetened group and about 2 cups for the sweetened group.  and then slowly crept back up towards the control group after about 4.5 cups of coffee for the unsweetened group and after 3 cups for the sweetened group (see chart below).
• Very interestingly, the U shaped association with sweetened coffee was very similar to unsweetened coffee (more on this later).
• Overall, drinking about 3 or 4 cups of coffee, whether sweetened or not, reduced your risk of dying by about 30% in the study period compared to those that did not drink coffee.
• The association with artificially sweetened coffee was less consistent and non-conclusive statistically.
• The risks for different types of coffee consumed (instant, ground, and decaf) were consistent. So this means it did not matter which type of coffee you drank, the lowered risk of dying was the same across the board meaning it is not the caffeine that is causing this outcome, but something else about coffee that lowers your risk of death.

 

This is the ‘U-shaped’ distribution from drinking coffee and your total risk of mortality.  The left side of the line shows something called your hazard ratio which you can think of as a statistical comparison with a control group (in this case non-coffee drinkers).  So if you drink no coffee, and are compared with a group that drinks no coffee, your hazard ratio is 1.0.  As you move along the X axis, showing more cups of coffee drank, you will notice a lowering of the hazard ratio.  At about 3 cups, you get your maximum lowering for both unsweetened (2 cups for sweetened coffee).  After this it levels off the more you drink for unsweetened, but there is a sharp incline for sweetened, showing that drinking too much sweetened coffee is not great for longevity.

 

Before the big reveal of how much coffee we all drink, let’s talk about a few huge caveats to this important paper.

 

The editor of the journal (the annals of internal medicine) actually wrote an accompanying letter to the article which shows just how important this paper was.  One interesting point that she brought up was that this study was from data collected on average 10 years ago and from the UK.  ‘Sweetened coffee’ was defined as coffee with just 1 teaspoon (4 grams) of sugar.  As a comparison, one of Stabucks most popular drinks (a grande Caramel Macchiato) has a whopping 33g of sugar.  With whipped topping it is over 44g.  That is 8-11 times the amount taken from the data in the study.  Even a delicious plain old latte has 17g of sugar.  So just a single latte is the same as drinking 4 cups of sweetened coffee in this study data.  A caramel macchiato puts you off the chart above.  So interpret this data with caution.

 

Another important point is that in general those that drink sweetened coffee often drink this in lieu of other very sugary drinks such as power drinks and soda.  Overall the total sugar ingested in their diets is much higher so it becomes more difficult to draw conclusions about the coffee specifically.

 

So what have we learned?

 

• Drinking coffee seems to have a decrease in mortality.
• This is maximal at around 3 cups for unsweetened coffee drinkers and levels off the more you drink.
• This is maximal at around 2 cups for those drinking sweetened coffee (1 tsp of sugar) and then rises the more you drink after that.
• The cumulative decrease seems to be about 30% at its maximum which is quite significant.
• Interpret the sugar data with caution. Though the headlines are catchy (“drinking coffee with sugar makes you live longer”) this is from 10 year old data.  Today’s drinks have WAY more sugar and you have to look at total sugar ingested to draw meaningful conclusions.

 

Ok, time for the big reveal in order of least to most drank.  Remember there is a U-shape where drinking too little or too much have minimal effect on longevity, with around 3-4 cups as optimal.

 

Carolynn: 2 latte’s per week total so roughly 0.33 cups per day sweetened.

Larissa: 3 cups per day unsweetened

Cara: 3-4 cups per day unsweetened

Kate: 3-4 cups per day unsweetened

Dave: 4-5 cups per day unsweetened

Adam: 2 fancy turbo Americano’s from Tamp (6-7 cups equivalent)

Pete: 6-7 cups per day unsweetened

Alex: 3-4 cups per day unsweetened