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January 8, 2000
Caffeinated Cure
Coffee may prevent gallstones in men
By Rebecca Chastenet de Géry

Coffee shops lure us in a number of ways. They boast about fine beans from exotic lands, rave about roasting and brewing methods that bring out intense flavors, and even create hip, inviting interiors that encourage us to sit down and stay awhile -- at least long enough for a second cup. Rarely, though, do they claim that coffee is good for your health. Yet recent studies suggest that men who indulge in more than a single cup of coffee a day may derive health benefits from their habit.

Researchers at Harvard University and Brigham and Women's Hospital have found that coffee consumption may aid in the prevention of symptomatic gallstone disease in men over 40. In this study, which followed 46,000 subjects over a ten-year period, men who consumed two to three cups of caffeinated coffee a day were 40 percent less likely to develop gallstones than men who drank less coffee or abstained from drinking coffee. Those who drank four cups of coffee or more each day reduced their risk of developing gallstones by 45 percent.

Gallstones, which affect more than 20 million Americans, are made up primarily of crystallized cholesterol. These painful concentrations form in the gallbladder, a sac located under the liver where bile is stored. Gallstones are the most common digestive-related cause of hospitalization in the United States, landing some 800,000 people in hospitals each year.

According to the study, coffee's role in preventing the development of gallstones is multifold. First, the caffeine in coffee inhibits cholesterol buildup in the gallbladder. It does so by:

  • stimulating the release of cholecystokinin, a hormone that stimulates contraction of the gallbladder, the process that breaks down fat
  • enhancing the gallbladder's flexibility
  • increasing activity in the colon
  • limiting the amount of fluid the gallbladder is able to absorb (Fluid absorption precedes the formation of gallstones.)

Because caffeine is excreted through bile, it also increases the body's bile flow and aids in the absorption of bile acids that might otherwise contribute to gallstone formation. Another way caffeine may prevent gallstone development is by increasing the body's energy expenditure. This may ultimately reduce the body's store of surplus cholesterol, which otherwise might crystallize in the gallbladder.

Coffee industry officials are aware of this research and have begun to examine ways they can use it, along with dozens of other positive coffee/health studies, to their advantage. Gary Goldstein, spokesman for the National Coffee Association, says, "This study and a half a dozen others released in the past year or so have demonstrated that coffee possesses a real gastrointestinal benefit that people simply aren't aware of." Goldstein explains that studies conducted in the 1960s and 1970s generally claimed that coffee had negative effects on health. But, he says, these short-term studies failed to consider a number of scientific and medical factors. "The long-term studies that have come out recently," continues Goldstein, "indicate that coffee consumption is entirely safe. In fact . . . it appears to have long-term health benefits. Recent research has shown a protective benefit in the gastrointestinal area by reducing the risk of kidney stones, gallstones, colon cancer, and cirrhosis of the liver."

Gastroenterologists, however, aren't ready to send their patients off on coffee binges just to prevent gallstones. Paul Farkas, M.D., at Western Massachusetts GI Associates, in Springfield, Massachusetts, warns against using coffee as preventive medicine. "I can picture all these people driving down the highway with five cups of coffee in them," he says, "and that I wouldn't recommend. I would not use coffee as a therapeutic method of preventing gallstones, simply because the negative side effects of caffeine -- such as jitteriness, heart palpitations, and painful reflux, which causes heartburn -- can be severe."

Medications such as Actigall (ursodiol) and Urso (ursodiol) help prevent gallstones, but these medications are "only for people who are at high risk ... which usually includes people who are overweight and people on rapid weight-loss diets," Dr. Farkas counsels. (This is because the gallbladder contracts when fat is present. Fat-free diets slow the gallbladder contractions, which tends to leave residue that can calcify into stones.)

As for whether "drink your coffee," will ever become a maxim to rival "eat your vegetables," even Goldstein admits it is too early to say. "I think people in the coffee industry are as surprised by the number of health benefits researchers are attributing to coffee as they are pleased by them. We may look at promoting coffee's benefits in the future," he adds, "but for now we want to get the word out that drinking coffee is safe." As Dr. Farkas points out, at one time coffee was thought to contribute to ulcers and pancreatic cancer. "Those theories have gone by the wayside," he says, "but it was bad press for coffee, and perhaps that is what spawned these new studies."