What I learned about drinking coffee after my heart attack

My coffee journey post-heart attack

“Can I still drink coffee?”

This was one of my first few questions that I asked my health care providers while recovering from my heart attack in hospital in March 2023. I wrote about my heart attack saga here.

“Only one cup a day” was their instruction to me.

I love my coffee, so that was somewhat of a relief. And so began my “only one cup of coffee each day” journey after my discharge from hospital.

Actually, after my discharge, I wanted to stop my coffee drinking completely and even gave away a bag of prized coffee beans. But after some time, my intended divorce from my beloved coffee proved to be too much and was short-lived. My love affair with that distinctive aroma and flavour of coffee reunited us. But only “one cup per day” is what I have uncompromisingly stuck with till this day. (OK, I own up – there were the very rare occasions that I had two per day when friends wanted to have coffee meetups after my morning brew)

While on holiday in Penang at the end of 2023 with a group of friends, we even made a couple of impromptu videos of me drinking my “only one cup of coffee per day.” Here is one video of me dressed in a Peranakan attire at the Pinang Peranakan Mansion that had garnered more than 10,000 views:

Getting to know my coffee

Because I was limited to only one cup per day due to my heart condition, I became more curious to find out about heart heath related information linked to coffee. These were the questions I had:

1.           Is it still safe for heart attack survivors to drink coffee?

2.           Are certain types of coffee more heart friendly than others?

3.           Does brewing methods matters for heart health?

Hence, I started researching.

Firstly, a review on why too much coffee consumption can be bad for the heart.

Potential downsides of coffee drinking for the heart

Excessive consumption of coffee can potentially have negative effects on heart health. Here are 6 reasons:

Caffeine Content: Coffee contains caffeine, a natural stimulant that can increase heart rate and blood pressure. Consuming too much caffeine can lead to palpitations, arrhythmias (irregular heartbeats), jitteriness, and increased risk of hypertension (high blood pressure), all of which can strain the heart over time.

Increased Stress Hormones: Caffeine consumption stimulates the release of stress hormones like cortisol and adrenaline. These hormones can cause temporary spikes in blood pressure and heart rate, which may be problematic for individuals with existing heart conditions or predispositions.

Sleep Disruption: Excessive caffeine intake, particularly in the afternoon or evening, can disrupt sleep patterns. Poor sleep quality or insufficient sleep is associated with an increased risk of heart disease, including hypertension and heart attacks.

Dehydration: Caffeine is a diuretic, meaning it increases urine production and can lead to dehydration if not balanced with adequate fluid intake. Dehydration can strain the cardiovascular system and exacerbate existing heart conditions.

Impact on Cholesterol Levels: Some studies suggest that high caffeine intake may adversely affect lipid profiles by raising LDL cholesterol levels (often referred to as “bad” cholesterol) in certain individuals, which is a risk factor for heart disease.

Interactions with Medications: Caffeine can interact with certain medications, including those used to manage heart conditions. It is essential for individuals taking medication to consult with their healthcare provider about potential interactions and recommended caffeine intake levels.

Benefits of drinking coffee

Now for the good news. Research has shown that moderate consumption of coffee offers a number of health benefits. For examples,

• According to the American College of Cardiology, “drinking coffee—particularly two to three cups a day—is not only associated with a lower risk of heart disease and dangerous heart rhythms but also with living longer.”  The studies also stated that “coffee beans actually have over 100 biologically active compounds. These substances can help reduce oxidative stress and inflammation, improve insulin sensitivity, boost metabolism, inhibit the gut’s absorption of fat and block receptors known to be involved with abnormal heart rhythms” Source: https://www.acc.org/About-ACC/Press-Releases/2022/03/23/17/55/Good-News-for-Coffee-Lovers-Daily-Coffee-May-Benefit-the-Heart
  
• According to nutrition experts from Johns Hopkins University School of Medicine, moderate consumption of coffee can reduce the likelihood of dying due to coronary heart disease, stroke, diabetes, and kidney disease. They further found that coffee drinking can also reduce the risks of developing Parkinson’s disease, colon cancer and Alzheimer’s disease. Source: https://www.hopkinsmedicine.org/health/wellness-and-prevention/9-reasons-why-the-right-amount-of-coffee-is-good-for-you
  
• Dr Ooi Yau Wei, a cardiologist at Mount Elizabeth Novena Hospital in Singapore advised that “low to moderate coffee consumption (up to 3 cups per day) has been shown to protect against heart attacks. On the other hand, he warned that taking more than 3 cups of caffeine a day may trigger coronary (heart artery) problems and heart rhythm irregularities in people with underlying heart disease.” Source: https://www.mountelizabeth.com.sg/health-plus/article/coffee-what-caffeine-does-to-your-heart-and-brain

There were other studies that suggested links between moderate coffee consumption to and reduction of risks of Alzheimer’s and dementia such as Santos, C., Costa, J., Santos, J., Vaz-Carneiro, A., Lunet, N. (2010). Caffeine intake and dementia: systematic review and meta-analysis. Journal of Alzheimer’s Disease, 20(1), pp. 187-204. and Paula, S. (2013, September). Health Benefits of Green Tea [Website Article].

The overall consensus is that moderation is key when it comes to coffee consumption after a heart attack. Limiting intake to three to four cups per day is often recommended, but individual tolerance and health factors such as age, overall health, and lifestyle habits should be considered. Some individuals may be more sensitive to caffeine or may experience adverse effects from excessive coffee intake, such as palpitations or gastrointestinal discomfort.

As I did more research, I realized that health friendly coffee enjoyment goes beyond quantity. I discovered that how coffee is roasted and prepared matters.

Heart friendly roast

The different types of coffee roast have the following impact on heart health:

• Light Roast: Light roast coffee beans are roasted for a shorter period, resulting in a lighter colour, and generally retaining more of their original flavour profile. Some studies suggest that light roast coffee may contain slightly higher levels of antioxidants compared to darker roasts because the beans are roasted for a shorter time, preserving more of the antioxidant compounds. Antioxidants are beneficial for heart health as they help combat oxidative stress and inflammation in the body. On the other hand, according to Dr Michael Greger, a founding member and Fellow of the American College of Lifestyle Medicine, the number of cholesterol-raising compounds in the lightest roast coffee beans may be twice as high as in very dark roast coffee beans. (Source:  https://nutritionfacts.org/blog/is-light-or-dark-roast-coffee-healthier/)
  
• Medium Roast: Medium roast coffee falls between light and dark roasts in terms of flavour profile and roast time. While medium roast coffee may have slightly lower levels of antioxidants compared to light roast due to longer roasting times, the difference is likely minimal. Studies published in the Journal of Agricultural and Food Chemistry as well as the Journal of Nutrition and Metabolism found that medium roast coffee beans contain higher levels of chlorogenic acids (CGAs), antioxidant compounds linked to cardiovascular benefits when compared with darker roast. Medium roast coffee is a popular choice for its balanced flavour and aroma.
  
• Dark Roast: Dark roast coffee beans are roasted for a longer period, resulting in a darker colour and stronger, bolder flavour profile. According to Dr Greger, dark roasting may also destroy up to nearly 90 percent of the chlorogenic acids, the antioxidant, anti-inflammatory phytonutrients purported to account for many of coffee’s benefits.  On the other hand, dark roasting can wipe out up to 99.8 percent of pesticides in conventionally grown coffee and more than 90 percent of a fungal contaminant called ochratoxin. Furthermore, some people find that dark roast coffee is easier on the stomach, as the longer roasting process reduces the acidity of the beans.

The below chart shows which roast is better according to the respective benefits:

	Light Roast	Dark Roast
Preserving chlorogenic acids, antioxidant, and anti-inflammatory phytonutrients	X
Eliminating cholesterol-raising compounds		X
Eliminating pesticides		X
Aiding weight loss		X

Choosing organic and low-acid options can support heart health by mitigating the risks of harm from pesticides found in conventional coffee beans while minimizing potential gastrointestinal issues.

Furthermore, the use of paper filters can eliminate up to 95 percent of the cholesterol-raising compounds of coffee regardless of the roast. And this led to my research on brewing methods.

Healthier brewing methods

The brewing method has significant impact on heart-friendliness of coffee. Filtered coffee methods like the pour over/drip (e.g. V60 pour-over & Chemex) and plunger/press with filter paper (e.g. Aeropress) are known for producing clean and balanced cups with minimal sediment and oil.

The process of filtering coffee with paper filters reduced the levels of cafestol and kahweol. Cafestol and kahweol are two compounds found in coffee beans that can raise cholesterol levels, particularly LDL cholesterol (often referred to as “bad” cholesterol). These compounds are oily substances that are present in higher concentrations in unfiltered coffee, such as French press or Turkish coffee. When coffee is brewed using a paper filter, as in drip coffee or pour-over methods, the filter traps most of the cafestol and kahweol, resulting in lower levels of these compounds in the final cup. By reducing the intake of these cholesterol-raising substances, filtered coffee may be more heart-healthy. Additionally, according to a study published in Food Chemistry, pour-over brewing resulted in higher extraction of chlorogenic acids compared to other methods like French press. Chlorogenic acid is abundantly found in plants, fruits, and vegetables. They provide significant protection in cardiovascular diseases (CVDs), type 2 diabetes, and inflammation-related conditions.

Filtered coffee methods also complement light to medium roast beans well, allowing their natural flavours and antioxidants to shine through

Coffee to avoid

Finally, here is a summary of other types of coffee that I avoid as they may be harmful for the heart due to their high caffeine content or added ingredients:

1. Espresso Shots: While a single shot of espresso might not be harmful, excessive consumption can lead to elevated heart rate and blood pressure.
2. Turkish Coffee: This type of coffee is made by boiling finely ground coffee beans with water and sometimes sugar. The high caffeine concentration in Turkish coffee can potentially affect heart health if consumed excessively.
3. Vietnamese Coffee: Often made with sweetened condensed milk, Vietnamese coffee can be high in sugar and fat, which may not be heart-healthy when consumed in large quantities.
4. Iced Coffee Drinks: Many commercially prepared iced coffee beverages contain added sugars, syrups, and whipped cream, which can contribute to heart health issues if consumed frequently.
5. Flavoured Coffee: Flavoured coffees often contain added sugars, syrups, or artificial flavourings, which can be detrimental to heart health when consumed regularly.
6. Instant Coffee Mixes: Some instant coffee mixes contain high levels of sugar, creamer, and artificial additives, which can negatively impact heart health if consumed in excess.
7. Singapore kopitiam (coffeeshop) coffee: This coffee typically consists of a blend of robusta and arabica coffee beans roasted with sugar and margarine which can potentially have negative effects on heart health if consumed in excess.

More than just “only one cup per day”

As it turns out, the type of coffee beans and how they are prepared matters as much as the moderation of consumption difference in supporting heart health.

In a nutshell:

• opt for light to medium roast beans for maximum benefits from antioxidant and anti-inflammatory phytonutrients

• choose filtered coffee brewing methods to eliminate cholesterol-raising compounds
• avoid coffee with high caffeine content or added ingredients such as sugar, fats, and artificial addictive
• buy organic coffee beans where possible to minimize harm from pesticides
• and again, consume in moderation

I should also point out that I purchase whole beans as opposed to ready ground coffee to enjoy the maximum benefit of freshness, flavour, and aroma since coffee starts to lose its flavour once it is ground.

As always, anyone with an underlying heart condition (like myself) or those at risk of heart disease should consult with healthcare providers (like I did) for personalized recommendations to determine a safe and appropriate level of coffee consumption for their individual health needs. Each of us vary in our sensitivity to caffeine and some of us may experience adverse effects even with small amounts of caffeine.

I enjoyed this journey of safer coffee drinking discovery. I unknowingly started out with the French press which turned out to be less beneficial for my heart heath. I am now proud a owner of the V60 pour-over (Amazon Affiliate Link) and Aeropress (Amazon Affiliate Link) manual brewing equipment and you can get yours too from my personalized Amazon links.

I will continue my research on coffee and will be sharing new tips on brewing healthy and flavourful coffee as well as any new findings from the latest studies.