Making Coffee Out of This World by Jeffrey Dach MD
Natural Medicine in Your Own Kitchen
The very best coffee is made with fresh whole coffee beans, freshly ground and mixed with boiling water in a French Coffee Press. The most important component is the quality of the coffee beans. And among the very best beans are the Ethiopian Yirgacheffe beans (organic or fair trade). These are “out of this world”, and far better than Starbucks coffee. Also excellent is the Britt Costa Rica Organic Bajo Sombra (grown in the shade)..
Coffee Beans Should Look Like This: 
First Step to Make Coffee:
The first step is to boil water in the kettle. While waiting for the water to boil, get out your French coffee press, and remove the plunger. Also get out your electric coffee bean grinder. For my taste, the best coffee right now is the Ethiopian Yirgacheffe, Whole Bean.
The Coffee Bean Grinder: 
Fill the coffee grinder with whole beans, replace the lid, and turn on the grinder. After 30 seconds or so, the beans will be fully ground into small particles. Dump these small particles into the large glass beaker called a French Coffee Press. Above Left Image: Electric coffee grinder Courtesy Wikimedia Commons
A whistling kettle is recommended since it will alert you when the water comes to a full boil. Once boiling, the water is now ready to pour into the French coffee press. Be careful as you fill the glass beaker about ¾ full, because the water is scalding hot.
Left Image: French Coffee Press with plunger in center.Courtesy Wikimedia Commons
Stir once and let the coffee sit for a variable length of time depending on your taste and experience. I usually give it 30-60 seconds and then push down on the plunger which then pushes the coffee grounds down to the bottom of the glass beaker. Others suggest giving it 3-4 minutes before using the plunger.
This is how your coffee should look:
Now you can pour off the coffee into your coffee cup or mug. The surface should have a rich creamy bubbly look (see above image). I usually add a small amount of milk, and wait a few minutes to cool off, and then the coffee is ready to drink. This is the really good part. It’s heaven.
How Does Caffeine Work? Natural Medicine at its Best
Left image is caffeine, and right image is adenosine. Note the red arrow points to a module in adenosine which is very similar to caffeine.
Caffeine is the Drug in Coffee
The active ingredient in coffee is a drug called caffeine, a stimulant of the central nervous system. This natural plant drug is the reason we all drink coffee. The chemical structure of caffeine (see above image) is similar to adenosine, which is an inhibitory neurotransmitter in the brain. Caffeine blocks the action of adenosine, and therefore acts as a brain stimulant. There are about 200,000 research articles on caffeine in the scientific and medical literature.(4) Because caffeine is a CNS stimulant, it can product dependence, tolerance, and withdrawal symptoms just like any other addictive drug.(3) 
Phospho Diesterase Inhibitor
Another mode of action of caffeine is blockage of an enzyme called Phosphodiesterase which normally degrades cyclic AMP. This allows the build-up of cyclic AMP which intensifies and prolongs epinephrine, a potent stimulant in the body. This also increases Cortisol.(5)
Left Image: Chemical Structure of Cyclic AMP, which has Adenosine with a phosphate group attached (Blue Ellipse =phosphate). Red Circle shows caffeine-like structure at the upper right.
As mentioned above, Caffeine is a Phosphodiesterase Inhibitor which increases epinephrine and cortisol.(5) Other PDI’s in medical use include Methylxanthines, aminophylline, theophylline and sildenafil.(6) According to Dr Anwar in a 2013 publication,
“Phospho-diesterase inhibitors (PDIs) have important vascular and myocardial protective effects and thus have shown therapeutic usefulness in the clinical settings for treatment of patients with heart failure, pulmonary hypertension, and coronary artery disease”.(6)
Long term health benefits of coffee consumption include reduction in all-cause mortality, reduction in neuro-degenerative diseases like Alzheimer’s and Parkinsons, reduction in various types of cancer.(7-11) Enjoy your cup of “Out of This World” Coffee, plant based Natural Medicine from your own kitchen.
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Jeffrey Dach MD
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References:
1) http://coffeescience.org/ www.coffeescience.org, a service of the National Coffee Association.
2) http://www.acnp.org/G4/GN401000165/CH161.html Caffeine : A Drug of Abuse? Roland R. Griffiths and Geoffrey K. Mumford
3) http://www.hopkinsmedicine.org/Press_releases/2004/09_29_04.html CAFFEINE WITHDRAWAL RECOGNIZED AS A DISORDER
4) http://scholar.google.com/scholar?q=caffeine&hl=en&lr= 191,000 research articles on Caffeine from Google Scholar
Cortisol Response
5) Lovallo, William R., et al. “Caffeine stimulation of cortisol secretion across the waking hours in relation to caffeine intake levels.” Psychosomatic medicine 67.5 (2005): 734.
After 5 days of caffeine abstinence, caffeine challenge doses caused a robust increase in cortisol across the test day (p < .0001). In contrast, 5 days of caffeine intake at 300 mg/day and 600 mg/day abolished the cortisol response to the initial 9:00 AM caffeine dose, although cortisol levels were again elevated between 1:00 PM and 7:00 PM (p = .02 to .002) after the second caffeine dose taken at 1:00 PM. Cortisol levels declined to control levels during the evening sampling period.
Conclusion Cortisol responses to caffeine are reduced, but not eliminated, in healthy young men and women who consume caffeine on a daily basis.
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caffeine PD inhibitor
6) Anwar, Siraj, and M. H. Alchter. “Cardiovascular and other pharmacological approaches of phosphodiesterase enzyme inhibitors.” Int. J. Adv. Pharm. Ned. Bioallied Sci 1 (2013): 35-39.
Phosphodiesterase inhibitors (PDIs) have important vascular and myocardial protective effects and thus have shown therapeutic usefulness in the clinical settings for treatment of patients with heart failure, pulmonary hypertension, and coronary artery disease (Boswell-Smith, 2006 Guazzi et al., 2007).
The therapeutic efficacy of PDE inhibitors in myocardial protection after ischemic preconditioning (IPC) is well documented
PDIs prevent the breakdown of nitric oxide (NO)-driven cGMP, primarily in vascular smooth muscle cells, and thus act as potent vasodilators.
Non-selective PDE inhibitors including theophylline and papaverine have been used as therapeutic agents for over 70 years for a range of diseases. However, it is only in the last 10 years, that potent PDE selective drugs have been proved as effective therapeutic agents in the treatment of disease, and the worldwide success of sildenafil in the treatment of erectile dysfunction is evidence of the effect of such drugs.
We all drink coffee for the caffeine, a CNS stimulant whose chemical structure is similar to adenosine, an inhibitory neurotransmitter in the brain. Caffeine blocks the action of adenosine, thus exerting CNS stimulant effects. Abrupt cessation may induce withdrawal symptoms like any other addictive drug. Caffeine is also a Phosphodiesterase Inhibitor which increases epinephrine and cortisol. Other PDI’s in medical use include Methylxanthines, aminophylline, theophylline and sildenafil, According to Dr Anwar in a 2013 publication, “Phospho-diesterase inhibitors (PDIs) have important vascular and myocardial protective effects and thus have shown therapeutic usefulness in the clinical settings for treatment of patients with heart failure, pulmonary hypertension, and coronary artery disease”. For more see: https://jeffreydachmd.com/making-coffee-out-of-this-world/
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7) O’Keefe, James H., James J. DiNicolantonio, and Carl J. Lavie. “Coffee for cardioprotection and longevity.” Progress in cardiovascular diseases (2018).
Coffee, a complex brew containing hundreds of biologically active compounds, exerts potent effects on long-term human health. Recently, a plethora of studies have been published focusing on health outcomes associated with coffee intake. An inverse association between coffee consumption and all-cause mortality has been seen consistently in large prospective studies. Habitual coffee consumption is also associated with lower risks for cardiovascular (CV) death and a variety of adverse CV outcomes, including coronary heart disease (CHD), congestive heart failure (HF), and stroke; coffee’s effects on arrhythmias and hypertension are neutral. Coffee consumption is associated with improvements in some CV risk factors, including type 2 diabetes (T2D), depression, and obesity. Chronic coffee consumption also appears to protect against some neurodegenerative diseases, and is associated with improved asthma control, and lower risks for liver disease and cancer. Habitual intake of 3 to 4 cups of coffee appears to be safe and is associated with the most robust beneficial effects. However, most of the studies regarding coffee’s health effects are based on observational data, with very few randomized controlled trials. Furthermore, the possible benefits of coffee drinking must be weighed against potential risks, which are generally due to its high caffeine content, including anxiety, insomnia, headaches, tremulousness, and palpitations. Coffee may also increase risk of fracture in women, and when consumed in pregnancy coffee increases risk for low birth weight and preterm labor.
8) Wierzejska, Regina. “Can coffee consumption lower the risk of Alzheimer’s disease and Parkinson’s disease? A literature review.” Archives of medical science: AMS 13.3 (2017): 507.
Most reports indicate that moderate coffee consumption may in fact lower the risk for common neurodegenerative conditions, i.e. Alzheimer’s and Parkinson’s diseases.
9) Poole, Robin, et al. “Coffee consumption and health: umbrella review of meta-analyses of multiple health outcomes.” bmj 359 (2017): j5024.
Objectives To evaluate the existing evidence for associations between coffee consumption and multiple health outcomes. Design Umbrella review of the evidence across meta-analyses of observational and interventional studies of coffee consumption and any health outcome. Data sources PubMed, Embase, CINAHL, Cochrane Database of Systematic Reviews, and screening of references.
Eligibility criteria for selecting studies Meta-analyses of both observational and interventional studies that examined the associations between coffee consumption and any health outcome in any adult population in all countries and all settings. Studies of genetic polymorphisms for coffee metabolism were excluded.
Results The umbrella review identified 201 meta-analyses of observational research with 67 unique health outcomes and 17 meta-analyses of interventional research with nine unique outcomes. Coffee consumption was more often associated with benefit than harm for a range of health outcomes across exposures including high versus low, any versus none, and one extra cup a day. There was evidence of a non-linear association between consumption and some outcomes, with summary estimates indicating largest relative risk reduction at intakes of three to four cups a day versus none, including all cause mortality (relative risk 0.83, 95% confidence interval 0.83 to 0.88), cardiovascular mortality (0.81, 0.72 to 0.90), and cardiovascular disease (0.85, 0.80 to 0.90). High versus low consumption was associated with an 18% lower risk of incident cancer (0.82, 0.74 to 0.89). Consumption was also associated with a lower risk of several specific cancers and neurological, metabolic, and liver conditions. Harmful associations were largely nullified by adequate adjustment for smoking, except in pregnancy, where high versus low/no consumption was associated with low birth weight (odds ratio 1.31, 95% confidence interval 1.03 to 1.67), preterm birth in the first (1.22, 1.00 to 1.49) and second (1.12, 1.02 to 1.22) trimester, and pregnancy loss (1.46, 1.06 to 1.99). There was also an association between coffee drinking and risk of fracture in women but not in men.
Conclusion Coffee consumption seems generally safe within usual levels of intake, with summary estimates indicating largest risk reduction for various health outcomes at three to four cups a day, and more likely to benefit health than harm. Robust randomised controlled trials are needed to understand whether the observed associations are causal. Importantly, outside of pregnancy, existing evidence suggests that coffee could be tested as an intervention without significant risk of causing harm. Women at increased risk of fracture should possibly be excluded.
10) Gunter, Marc J., et al. “Coffee drinking and mortality in 10 European countries: a multinational cohort study.” Annals of internal medicine 167.4 (2017): 236-247.
The relationship between coffee consumption and mortality in diverse European populations with variable coffee preparation methods is unclear.
Objective: To examine whether coffee consumption is associated with all-cause and cause-specific mortality.
Design: Prospective cohort study.
Setting: 10 European countries.
Participants: 521 330 persons enrolled in EPIC (European Prospective Investigation into Cancer and Nutrition).
Measurements: Hazard ratios (HRs) and 95% CIs estimated using multivariable Cox proportional hazards models. The association of coffee consumption with serum biomarkers of liver function, inflammation, and metabolic health was evaluated in the EPIC Biomarkers subcohort (n = 14 800).
Results: During a mean follow-up of 16.4 years, 41 693 deaths occurred. Compared with nonconsumers, participants in the highest quartile of coffee consumption had statistically significantly lower all-cause mortality (men: HR, 0.88 [95% CI, 0.82 to 0.95]; P for trend < 0.001; women: HR, 0.93 [CI, 0.87 to 0.98]; P for trend = 0.009). Inverse associations were also observed for digestive disease mortality for men (HR, 0.41 [CI, 0.32 to 0.54]; P for trend < 0.001) and women (HR, 0.60 [CI, 0.46 to 0.78]; P for trend < 0.001). Among women, there was a statistically significant inverse association of coffee drinking with circulatory disease mortality (HR, 0.78 [CI, 0.68 to 0.90]; P for trend < 0.001) and cerebrovascular disease mortality (HR, 0.70 [CI, 0.55 to 0.90]; P for trend = 0.002) and a positive association with ovarian cancer mortality (HR, 1.31 [CI, 1.07 to 1.61]; P for trend = 0.015). In the EPIC Biomarkers subcohort, higher coffee consumption was associated with lower serum alkaline phosphatase; alanine aminotransferase; aspartate aminotransferase; γ-glutamyltransferase; and, in women, C-reactive protein, lipoprotein(a), and glycated hemoglobin levels.
Limitations: Reverse causality may have biased the findings; however, results did not differ after exclusion of participants who died within 8 years of baseline. Coffee-drinking habits were assessed only once.
Conclusion: Coffee drinking was associated with reduced risk for death from various causes. This relationship did not vary by country.
11) Ann Intern Med. 2017 Aug 15;167(4):228-235. Association of Coffee Consumption With Total and Cause-Specific Mortality Among Nonwhite Populations.
Park SY1, Freedman ND1, Haiman CA1, Le Marchand L1, Wilkens LR1, Setiawan VW1.
Coffee consumption has been associated with reduced risk for death in prospective cohort studies; however, data in nonwhites are sparse.
Objective: To examine the association of coffee consumption with risk for total and cause-specific death.
Design: The MEC (Multiethnic Cohort), a prospective population-based cohort study established between 1993 and 1996.
Setting: Hawaii and Los Angeles, California.
Participants: 185 855 African Americans, Native Hawaiians, Japanese Americans, Latinos, and whites aged 45 to 75 years at recruitment.
Measurements: Outcomes were total and cause-specific mortality between 1993 and 2012. Coffee intake was assessed at baseline by means of a validated food-frequency questionnaire.
Results: 58 397 participants died during 3 195 484 person-years of follow-up (average follow-up, 16.2 years). Compared with drinking no coffee, coffee consumption was associated with lower total mortality after adjustment for smoking and other potential confounders (1 cup per day: hazard ratio [HR], 0.88 [95% CI, 0.85 to 0.91]; 2 to 3 cups per day: HR, 0.82 [CI, 0.79 to 0.86]; ≥4 cups per day: HR, 0.82 [CI, 0.78 to 0.87]; P for trend < 0.001). Trends were similar between caffeinated and decaffeinated coffee. Significant inverse associations were observed in 4 ethnic groups; the association in Native Hawaiians did not reach statistical significance. Inverse associations were also seen in never-smokers, younger participants (<55 years), and those who had not previously reported a chronic disease. Among examined end points, inverse associations were observed for deaths due to heart disease, cancer, respiratory disease, stroke, diabetes, and kidney disease.
Limitation: Unmeasured confounding and measurement error, although sensitivity analysis suggested that neither was likely to affect results.
Conclusion: Higher consumption of coffee was associated with lower risk for death in African Americans, Japanese Americans, Latinos, and whites.
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