Asia-Pacific medical and healthcare forum

I received several inquiries regarding my column last week on the health effects of coffee.

Rolando Fortes says he used to be a coffee lover consuming four to five cups of brewed coffee daily until he had a heart attack (myocardial infarction) five years ago. He stopped drinking coffee since then, and is asking if he can resume drinking it. Others who are noncoffee drinkers, like Remedios Santos and Edgar Chua, would like to know if they should start drinking coffee for its potential health benefits.

For the general population, one to two cups daily, which would contain 100-200 mg of caffeine, should be safe and might even have some long-term benefits based on some studies. However for those with significant heart problems like Mr. Fortes, it would be best to consult your physician, who would be in the best position to answer the question.

Considered as a drug

Caffeine in coffee may be considered as a drug which, depending on the dose and individual capacity to metabolize it, can increase the heart rate and blood pressure. Being a drug in itself, it can interact also with drugs the patient may be taking. In heart patients with concomitant asthma who are taking bronchodilators, caffeine can add up to the effects of some bronchodilators in causing tachycardia (fast heart rate) and increasing blood pressure. It can also aggravate the hand tremors of some.

Many heart patients, particularly after a heart attack, are taking beta-blockers, which are drugs to slow down the heart rate. Caffeine can offset this effect, and that may aggravate the patient’s unstable ischemia or lack of oxygen in the heart. The faster the heart rate and the higher the blood pressure, the more the oxygen consumption, which is bad if there is significant ischemia.

So if one’s heart condition is unstable, like when one is experiencing frequent chest pains, signs and symptoms of heart failure like shortness of breath on ordinary physical exertion, and cardiac arrhythmia (irregular heartbeat) felt as palpitations, then it’s best to stay away from coffee. For those with stable heart condition, it should be safe but one’s physician is the best authority to ask.

Metabolic rates vary

It must also be emphasized that different individuals have varying rates in metabolizing caffeine through the liver and excreting it. This is genetically determined and influences the level of one’s enzyme needed to break down or metabolize caffeine. Those with good levels of the enzyme can safely take more cups of coffee like they’re just taking any fruit beverage, but the “slow metabolizers” can have problems even with just one cup of regular coffee.

Since we don’t have the laboratory here to determine fast and slow caffeine metabolizers, my crude way to determine it is by asking the coffee drinker if he’s able to sleep soundly at night within four hours of taking regular brewed coffee. If the answer is “yes,” then one must have a normal rate of caffeine metabolism. If one says that he can’t sleep even after more than six hours of taking coffee, then, he’s likely a relatively slow caffeine metabolizer.

Just like anything inherently good in life, the key is moderation.

As reader Felipe Soriano commented: “Enjoy all foods in moderation; this (including coffee) is one of life’s pleasures. Depriving ourselves of some food is bad mentally and physically.”

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Coming at the heels of the Asia-Pacific Economic Cooperation (Apec) summit is another important meeting called the Sino-Asia Pacific Forum organized by the Gusi Peace Prize Foundation and the Philippine Medical Association, together with some Chinese colleagues headed by Doctors Manson Fok and Billy Chan.

The whole-day medical summit will be held this coming Monday (Nov. 23) at the Manila Peninsula Hotel. Ten countries from the Asia-Pacific region will be represented, sharing medical advances and best practices in addressing various clinical problems besetting the region.

Distinguished speakers

I’m privileged to deliver the first talk of the forum, which will deal with the optimal conservative medical management of patients with heart artery narrowing. There has been a shift from aggressive (surgical bypass or angioplasty) to optimizing medical treatment in these patients which could spare them from bypass or angioplasty with stenting.

Other renowned experts in different medical fields will also update the expected 300 international delegates on state-of-the-art management of prevalent medical and healthcare issues. In one of the sessions, former senator Dick Gordon will also share the experiences of the Philippine Red Cross in disaster management during natural calamities.

At the end of the meeting, a joint communique will be signed by the representatives of the various countries forging a collaborative “forward-looking” action in furthering medical practice and healthcare delivery in the Asia-Pacific region.

I’d like to congratulate Ambassador Barry Gusi and Dr. Evelyn Gusi for spearheading this important event with Chinese colleagues in the medical academe.