October 23, 2013

Ask the Doctors

Ihave enjoyed reading the Ask the Doctors column throughout the years, but I wonder whether you are as rigorous as you claim to be about evidence-based opinions. Take coffee, for example: the latest huge study in the New England Journal of Medicine suggests that it’s good for us. Will you now accept the evidence for coffee?

We smile at this question, because we are like the veggie meat in the sandwich: open to criticism from both the more liberal and conservative of our readers.

The Bible and the writings of Ellen G. White have provided insights into most of the ways we should live. We do realize, however, that in modern life many new factors exist that may make claims not referenced in the inspired Word and prophetic writings.

Our encouraging of exercise, for example—particularly of walking—would have seemed unnecessary to Jesus, because He and His disciples walked everywhere. It also appears obvious that Jesus was not a vegetarian. Yet still, we recommend a vegetarian diet.

We might easily reference Ellen White on the elimination of flesh foods from our diet, and rationalize the difference between Christ’s diet and ours as existing because we’re the “end-time people.” We must, however, be careful not to make too much of a “spiritual virtue” of our vegetarianism.

On the whole, we call for evidence—not about the Lord’s plain and clear instructions, but on the less clear and convoluted construction many might impose upon them. Additionally, as we see the burgeoning plethora of new ideas about disease prevention or control, we call for rational thinking. The call for evidence then becomes a filter to keep out the “nonsense.”

On the matter of tea and coffee, however, we have strong advice to avoid it. Ellen White describes the pharmacologic properties of caffeine with the scientific precision of an expert. She then goes on to recommend that we not use tea or coffee. As an “end-time people,” we need empowering by more than a shot of caffeine.

The study we believe you are referencing appeared in the New England Journal of Medicine 366 (May 17, 2012): 1891-1904. The researchers followed 229,119 men and 173,141 women, ages 50 to 71, for some 13 years. After adjusting for smoking (and coffee drinkers were more likely to smoke), they showed a reduction in the number of deaths among coffee drinkers that was not huge, but statistically significant. The reduction was dosage-related (the number of cups of coffee per day), and because the endpoint was for death, it had a very clear cutoff. The reduction in deaths held true for most causes, but not for cancer.

This study involved a large number of people, which is impressive, but whether the coffee caused longer life or whether longevity was associated in some way with other causal factors could not be determined. Nor did the researchers explore why more coffee drinkers smoke. If coffee drinking is causally related to smoking, then it’s not valid to remove the smokers from the equation. When left in, coffee drinkers who are smokers did not do well.

Whether a group of vegetarians would benefit from drinking coffee is not clear. Perhaps the phytochemicals in coffee are already present in the vegetarian diet, and, as with vitamins, once you have enough, more does not help. 

What would the results have shown for decaffeinated coffee drinkers? We don’t know. Will we now recommend coffee? No, because caffeine is still addictive. But we will put this study in our memory file and compare it to future studies. Others must replicate the results.

Our call for evidence is really a call for balance. Just as we are cautious about this study, we are cautious about some of the data used to promote one or another position in lifestyle among Adventists. Our caution does not mean we reject the proposed position (though sometimes we do), but that evidence has to be more than a published opinion with which we resonate.

Send your questions to Ask the Doctors, Adventist Review, 12501 Old Columbia Pike, Silver Spring, Maryland 20904. Or e-mail them to [email protected]. While this column is provided as a service to our readers, Drs. Landless and Handysides unfortunately cannot enter into personal and private communication with our readers. We recommend you consult with your personal physician on all matters of your health.