COFFEE, DIABETES & WEIGHT LOSS

1. COFFEE, DIABETES & WEIGHT LOSS James Greenberg, PhD., Brooklyn College of the City University of New York.

2. OUTLINE . coffee promises to decrease diabetes risk; . coffee can be hazardous to persons with diabetes; . biological mechanisms that may explain coffee’s promise; . coffee constituents that may explain coffee’s promise; . weight loss may also play a role; . gaps in the knowledge base; . Conclusions.

3. COFFEE PROMISES TO DECREASE DIABETES RISK. . Based on results of about 20 epidemiological studies; (Greenberg et al, 2006; Pereira et al, 2006; Paynter et al, 2006); . both caffeinated & decaf coffee exhibit the effect; . non-caffeine constituents & maybe caffeine appear to be involved.

4. COFFEE PROMISES TO DECREASE DIABETES RISK. There is considerable interest in investigating & harnessing coffee’s potential to decrease diabetes risk. . Most Americans drink coffee (Lundberg, 1998); . diabetes is widespread & burgeoning(CDC, 2005; CDC, 2006). . estimated 24 million diabetics & 57 million prediabetics in U.S. in 2005 (Amer Diabetes Assoc); . Diabetes incidence increased >200% between 1980 & 2005; . sixth leading cause of death in the U.S. in 2002; . serious complications including CVD, blindness, kidney failure, and limb amputations.

5. COFFEE CAN BE HAZARDOUS TO PERSONS WITH DIABETES AND PREDIABETES. . caffeine & caffeinated coffee acutely impair glucose metabolism (Greenberg et al, 2006; Lane et al, 2008); . causes repeated bouts of poor glycemic control;

6. from Battram et al (2006)

7. COFFEE CAN BE HAZARDOUS TO PERSONS WITH DIABETES AND PREDIABETES. Some types of decaf may acutely impair glucose Metabolism: . four human trials found that instantdecaf had no acute effects on glucose metabolism (Johnston et al, 2003; Thom, 2007; van Dijk et al, 2009; Louie et al, 2008); . Battram et al (2006) found that ground decaf acutely enhancedglucose metabolism; . Greenberg et al (2009) found that ground decaf acutely impaired glucose metabolism.

8. from Battram et al (2006)

9. from Greenberg et al (2009)

10. COFFEE CAN BE HAZARDOUS TO PERSONS WITH DIABETES AND PREDIABETES. It is possible that some types of decaf have: . higher concentrations of constituents that enhance glucose metabolism; . lower concentrations of constituents that impair glucose metabolism.

11. BIOLOGICAL MECHANISMS THAT MAY EXPLAIN COFFEE’S PROMISE . adiponectin, an adipokine polypeptide. Caffeinated coffee increased adiponectin in an epidemiological study (e.g. Williams et al, 2008); . inflammation. Caffeinated & decaffeinated coffee decreased markers of inflammation in epidemiological studies (e.g. Lopez-Garcia et al, 2006; Kotani et al, 2008); . oxidative Stress. Coffee is a major source of antioxidants (Halvorsen et al, 2006);

12. COFFEE CONSTITUENTS THAT MAY EXPLAIN COFFEE’S PROMISE . chlorogenic acids,polyphenols, e.g. 5-caffeoylquinic acid (e.g. van Dijk et al, 2009; Thom, 2007); . trigonelline a nonphenolic phytochemical, N-methylnicotinic acid(e.g. van Dijk et al, 2009; Mishkinsky et al, 1967);

13. from van Dijk et al (2009).

14. COFFEE CONSTITUENTS THAT MAY EXPLAIN COFFEE’S PROMISE . chlorogenic acids,polyphenols, e.g. 5-caffeoylquinic acid (e.g. van Dijk et al, 2009; Thom, 2007); . trigonelline a nonphenolic phytochemical, N-methylnicotinic acid(e.g. van Dijk et al, 2009; Mishkinsky et al, 1967); . quinides, nonacidic quinolactones, e.g. the synthetic quinidine, 3,4- diferuloyl-1,5-quinide (e.g. Shearer et al, 2003); . magnesium(e.g. Lopez-Ridaura et al, 2004; Rodriguez-Moran & Guerrero-Romero, 2003);

15. COFFEE CONSTITUENTS THAT MAY EXPLAIN COFFEE’S PROMISE . Some possible biological mechanisms: . chlorogenic acid(e.g. Johnston et al, 2003)& quinides (e.g. Shearer et al, 2003) may decrease hepatic glucose production by inhibiting glucose-6-phosphatase; . chlorogenic acidmay decrease intestinal glucose absorption (e.g. Bassoli et al, 2008) & preserve beta-cell function by antioxidant action (e.g. McCarty, 2004); . magnesium may increases tyrosine kinase activity in muscle cells and adipocytes (e.g. Yokota et a, 2004);

16. WEIGHT LOSS MAY ALSO PLAY A ROLE. There is empirical evidence: . caffeinated & decaf coffee drinking => decrease in diabetes risk, only for subjects with prior weight loss & it was a dose-response relation (Greenberg et al, 2005);

17. from Greenberg et al (2005).

18. WEIGHT LOSS MAY ALSO PLAY A ROLE. There is empirical evidence: . caffeinated & decaf coffee drinking => decrease in diabetes risk, only for subjects with prior weight loss & it was a dose-response relation (Greenberg et al, 2005); . Increase in caffeinated & decaf coffee drinking <=> moderate weight loss over 12-years (Lopez-Garcia et al, 2006); . a large trial (N=1,079) found that a relatively small weight loss of 5.3% body weight => 55% decrease in diabetes risk in a 3.2 yr follow up (Hamman et al, 2006);

19. WEIGHT LOSS MAY ALSO PLAY A ROLE. There is randomized human trial evidence: . a French trial (N=50) found that a decaf extract of green coffee beans, high in chlorogenic acid => weight loss of 2.8% of body weight in 60 days (Dellalibaria et al, 2006); . a Norwegian trial (N=32) found that the same decaf extract => weight loss of 4.3% of body weight in 84 days (Thom, 2007);

20. WEIGHT LOSS MAY ALSO PLAY A ROLE. An empirically-based hypothesis. Weight loss => . decrease in risk of diabetes (e.g. Hamman et al, 2006); . increase in adiponectin (e.g. Heinonen et al, 2009); . decrease in inflammation (e.g. Barinas-Mitchell et al, 2006); . decrease in oxidative stress (e.g. Rector et al, 2007);

21. WEIGHT LOSS MAY ALSO PLAY A ROLE. Coffee’s potential to induce weight loss is important: . about 2/3 of Americans are overweight and about 1/3 are obese (Flegal et al, 2002); . obesity decreases longevity (Fontaine et al, 2003) & quality of life (Fontaine et al, 2000), & increases medical costs (CDC, 2005); . obesity is a serious burgeoning world-wide public health problem (WHO, 2009);

22. GAPS IN THE KNOWLEDGE BASE We lack adequate knowledge of which constituents & which underlying biological mechanisms explain: . coffee’s acute effects on glucose metabolism & long-term effects on diabetes risk; . coffee’s acute and long-term effects on appetite, food intake & body weight; . differences between the acute and long-term effects;

23. CONCLUSION We need more research on coffee’s constituents.

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