Coffee and the Sleeve

[Arts137 1,811]

An interesting summary of the 'state of research'.

I normally post a link, but that does not work. So here is the full thread.

Full disclosure, I drink coffee, and my program does NOT like that. I really DO follow my program in most things, but coffee is the ONLY drug I've got left...

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Dear Ontherighttrack,

You’ve asked a great question. What is the effect of caffeine on sleeve gastrectomy?

To answer your question, I did a search of the medical literature on PubMed, the index for the National Medical Library. I couldn’t find any articles that address your question directly. Incidentally, there were no articles that addressed the effect of caffeine on gastric bypass either. Next I searched for both sleeve gastrectomy and gastric bypass and coffee. Again the medical library search engine did not return any articles. Thus, so far there have been no studies performed on sleeve gastrectomy patients or gastric bypass patients that would permit or discourage caffeine or coffee use.

Most surgeons recommend that gastric bypass and sleeve gastrectomy patients avoid caffeine or coffee. These recommendations stem from research work that has been done on non-weight loss surgery patients. Before looking into this further let’s distinguish between caffeine and coffee. Caffeine is an alkaloid chemical that has stimulant effects on the central nervous system as well as other parts of the body. Caffeine is a moderate stimulant of gastric acid production. In some studies it has been shown to decrease lower esophageal sphincter pressure and thus potentially promote reflux. In other studies, the effect on sphincter pressure is not so clear.

Coffee is brewed from the coffea plant. Coffee contains numerous biologically active chemicals including caffeine. The degree to which these compounds are present in a given cup of coffee depends on the specific species of coffee plant as well as the roasting and processing methods used to bring the coffee to market (see article by Van Deventer below). Even the type of filter used in a coffee maker will change the types of plant oils that remain in the brew.

Gastroesophageal reflux (GERD or GORD) is reflux of stomach juices into the esophagus. GERD can cause heartburn.

There are several full medical articles attached at the bottom of this reply. Please download these for further information.

Coffee/caffeine and gastric acid stimulation

There is general agreement that caffeine and coffee are two factors that stimulate stomach acid production.

According to Cohen and Booth (1975) “Decaffeinated coffee gave a maximal acid response of 16.5 per hour (mean)which was similar to that of regular coffee, 20.9 mEq per hour, both values being higher than that of caffeine, 8.4, on a cup-equivalent basis.” Thus there are chemicals in coffee aside from caffeine that have potent acid stimulatory effects. In this study, decaffeination did not reduce acid stimulation.

Further information about decaffeinated coffee was put forth by Feldmen et. Al (1981): “At equal concentrations, decaffeinated coffee was a more potent stimulant of acid secretion and of gastrin [an acid stimulating gut hormone] release than peptone [a Protein meal acid stimulus]. The ingredient(s) of decaffeinated coffee that accounts for its high potency in stimulating acid secretion and gastrin release has not been identified.”


Coffee, caffeine, and esophageal reflux

There is considerable controversy in the medical literature as to the effects of coffee and caffeine on esophageal reflux. Here are the conclusions to three articles on the subject. The full article summaries are added below.
Wendl (1994) writes, “Coffee, in contrast to tea, increases gastro-oesophageal reflux, an effect that is less pronounced after decaffeination. Caffeine does not seem to be responsible for gastro-oesophageal reflux which must be attributed to other components of coffee.”

Boekema (1999) and associates came to an opposite conclusion: “Coffee has no important effect on gastro-oesophageal acid reflux in GORD [GERD] patients, and no effect at all in healthy subjects.”

Zheng (2007) conludes, “In conclusion, this large monozygotic co-twin study provides evidence that BMI, tobacco smoking and physical activity at work facilitate the development of GER, while physical activity at leisure time appears to be a protective factor. The association between BMI and frequent GER symptoms among men may be attenuated by genetic factors. In addition, heavy coffee intake may be a protective factor of GER in men and lower education may be a potential risk factor in women.”


CONCLUSIONS

Caffeine, and more so, coffee and Decaf coffee stimulate gastric acid production.
Caffeine and coffee may promote gastroesophageal reflux.
Caffeine and coffee are just two of many factors that promote gastric acid production and gastroesophageal reflux.

Clinical Implications:

For sleeve patients who suffer from gastroesophageal reflux, it is best to avoid caffeine and coffee. For sleeve patients who do not have reflux, I do not see any reason not to enjoy coffee or use caffeine products in moderation.

For gastric bypass patients, most surgeons recommend against caffeine and coffee because the acid stimulation that occurs may contribute to the development of anastomotic ulcers. Since there are many other factors involved in the development of these ulcers (alcohol, cigarette smoking and nicotine, and NSAID drugs), it is impossible to know how important the role of coffee and caffeine is. Most surgeons are thus saying avoid coffee and be “better safe than sorry.”


REFERENCES

Good Water, sports drink, and sports drink with caffeine.

drinks for gastric pH and reflux during the preexercise, the cycling, and the postexercise episode, respectively. Gastric emptying, orocecal transit time, and intestinal permeability showed no significant differences between the three trials. However, glucose absorption was significantly increased in the CES + caffeine trial compared with the CES trial (P = 0.017). No significant differences in gastroesophageal reflux, gastric pH, or gastrointestinal transit could be observed between the CES, the CES + caffeine, and the water trials. However, intestinal glucose uptake was increased in the CES + caffeine trial.
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lunch, 1 h after dinner and after an overnight fast Reflux and oesophageal motility parameters were assessed for the first hour after each coffee or water intake.
RESULTS:

Coffee had no effect on postprandial acid reflux time or number of reflux episodes, either in GORD patients or in healthy subjects. Coffee increased the percentage acid reflux time only when ingested in the fasting period in the GORD patients (median 2.6, range 0-19.3 versus median 0, range 0-8.3; P = 0.028), but not in the healthy subjects. No effect of coffee on postprandial lower oesophageal sphincter pressure (LOSP), patterns of LOSP associated with reflux episodes or oesophageal contractions was found.
CONCLUSION:

Coffee has no important effect on gastro-oesophageal acid reflux in GORD patients, and no effect at all in healthy subjects.
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beverages and of their major component, caffeine, have not been quantified. The aim of this study was to evaluate gastro-oesophageal reflux induced by coffee and tea before and after a decaffeination process, and to compare it with water and water-containing caffeine.
METHODS:
Three-hour ambulatory pH-metry was performed on 16 healthy volunteers, who received 300 ml of (i) regular coffee, decaffeinated coffee or tap water (n = 16), (ii) normal tea, decaffeinated tea, tap water, or coffee adapted to normal tea in caffeine concentration (n = 6), and (iii) caffeine-free and caffeine-containing water (n = 8) together with a standardized Breakfast.< /span>
RESULTS:
Regular coffee induced a significant (P < 0.05) gastro-oesophageal reflux compared with tap water and normal tea, which were not different from each other. Decaffeination of coffee significantly (P < 0.05) diminished gastro-oesophageal reflux, whereas decaffeination of tea or addition of caffeine to water had no effect. Coffee adapted to normal tea in caffeine concentration significantly (P < 0.05) increased gastro-oesophageal reflux.
CONCLUSIONS:

Coffee, in contrast to tea, increases gastro-oesophageal reflux, an effect that is less pronounced after decaffeination. Caffeine does not seem to be responsible for gastro-oesophageal reflux which must be attributed to other components of coffee.

Angeles, California.
Abstract

This study tested the hypothesis that differences in the processing of raw coffee Beans can account for some of the variability in gastric effects of coffee drinking. Coffees were selected to represent several ways that green coffee beans are treated, ie, processing variables. These included instant and ground coffee processing, decaffeination method (ethyl acetate or methylene chloride extraction), instant coffee processing temperature (112 degrees F or 300 degrees F), and steam treatment. Lower esophageal sphincter pressure, acid secretion, and blood gastrin was measured in eight human subjects after they consumed each of the different coffees. Consumption of coffee was followed by a sustained decrease in lower esophageal sphincter pressure (P less than 0.05) except for three of the four coffees treated with ethyl acetate regardless of whether or not they contained caffeine. Caffeinated ground coffee stimulated more acid secretion that did decaf ground coffees (P less than 0.05), but not more than a steam-treated caffeinated coffee. Instant coffees did not differ in acid-stimulating ability. Ground caffeinated coffee resulted in higher blood gastrin levels than other ground coffees (P less than 0.05). Freeze-dried instant coffee also tended toward higher gastrin stimulation. It is concluded that some of the observed variability in gastric response to coffee consumption can be traced to differences in how green coffee beans are processed.
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JAMA. 1981 Jul 17;246(3):248-50.
Gastric acid and gastrin response to decaffeinated coffee and a peptone meal.

Feldman EJ, Isenberg JI, Grossman MI.
Abstract

We compared five graded doses of decaffeinated coffee and a widely used protein test meal (Bacto-peptone) as stimulants of acid secretion (intragastric titration) and gastrin release (radioimmunoassay) in eight healthy men. In each subject, for both acid and gastrin, the sums of the responses to all five doses were greater to decaffeinated coffee than to peptone. The mean +/- SE peak acid output in millimoles per hour was 18.5 +/- 2.9 to decaffeinated coffee and 14.7 +/- 2.7 to peptone, representing 70% and 55%, respectively, of the peak acid output to pentagastrin. The mean +/- SEM peak increment over basal rate in serum gastrin in picograms per milliliter was 84.8 +/- 4.4 to decaffeinated coffee and 44.8 +/- 2.1 to peptone. At equal concentrations, decaffeinated coffee was a more potent stimulant of acid secretion and of gastrin release than peptone. The ingredient(s) of decaffeinated coffee that accounts for its high potency in stimulating acid secretion and gastrin release has not been identified.
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Dis Esophagus. 2006;19(3):183-8.
Effect of caffeine on lower esophageal sphincter pressure in Thai healthy volunteers.

Lohsiriwat S, Puengna N, Leelakusolvong S.
Source

Department of Physiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. sislr@mahidol.ac.th
Abstract

Caffeine affects many aspects of body function including the gastrointestinal system. A single-blinded experimental study was performed to evaluate the effect of caffeine on lower esophageal sphincter (LES) and esophageal peristaltic contractions in healthy Thai adults. The volunteers were six men and six women aged 19-31 years. Subjects drank 100 mL of water. Five wet swallows were performed 30 min after the drink. The basal LES pressure was continuously measured using esophageal manometric technique. They then consumed another 100 mL of water containing caffeine at the dose of 3.5 mg/kg body weight. The swallows and basal LES pressure monitoring were repeated. The results showed no change in basal LES pressure after a water drink while caffeine consumption significantly lowered the pressure at 10, 15, 20 and 25 min. The mean amplitude of contractions and peristaltic velocity were decreased at the distal esophagus at 3 and 8 cm above LES. The mean duration of contraction was decreased at the distal part but increased at the more proximal esophagus. The heart rate, systolic and diastolic blood pressures were increased significantly at 10-20 min after caffeine ingestion. This study indicated that caffeine 3.5 mg/kg affected esophageal function, resulting in a decrease in basal LES pressure and distal esophageal contraction, which is known to promote the reflux of gastric contents up into the esophagus.



N Engl J Med. 1975 Oct 30;293(18):897-9.
Gastric acid secretion and lower-esophageal-sphincter pressure in response to coffee and caffeine.
Cohen S, Booth GH Jr.
Abstract
Caffeine stimulates gastric acid secretion and reduces the competence of the lower esophageal sphincter in man. These effects of caffeine have been used as evidence that regular coffee should not be used by patients with peptic-ulcer disease or gastroesophageal reflux. We compared the dose-response relations of caffeine, regular coffee and decaffeinated coffee for gastric acid secretion and sphincter pressure in normal subjects. Decaffeinated coffee gave a maximal acid response of 16.5 +/- 2.6 mEq per hour (mean +/- S.E.M.), which was similar to that of regular coffee, 20.9 +/- 3.6 mEq per hour, both values being higher than that of caffeine, 8.4 +/- 1.3, on a cup-equivalent basis. Sphincter pressure showed minimal changes in response to caffeine, but was significantly increased by both regular and decaffeinated coffee (P less than 0.05). These data suggest that clinical recommendations based upon the known gastrointestinal effects of caffeine may bear little relation to the actual observed actions of coffee or decaffeinated coffee.

[Steamywindows 39]

Thank you for this post. It is very helpful.

[Georgia 2,908]

Good article. I do t drink coffee. Never have but I do have a very small amount of caffeine through my Crysytal Light Energy.

[No game 14,437]

Great read whilst I'm drinking my second cuppa joe this morning Arts

[Busymomof3 181]

My clinic is fine with coffee drinking. I didn't drink coffee for the first week post op because i can only drink it with sugar free Creamer and I was on clear liquids. For the first few weeks post of, it upset my tummy a little bit so I didn't drink much. I'm 8 weeks out now and can drink a cup in the morning and afternoon with no problems.

[mistysj 1,940]

I was allowed coffee in the hospital after my swallow test. I have cut way back because it takes me a while to drink it and I don't have it with my breakfast now. I used to drink a good 4 cups in the morning and 2 at night. Now I have 1 in the morning (lasts me all morning in my awesome Zojirushi vacuum flask) and 1 most nights. I drink it black, brewed in a French press. I do have acid but it is managed by 20mg of nexium per day. It seems independent of coffee. My surgeon fixed a hiatus hernia but it is not a 100% fix so I need the nexium.

[MisFit 10]

I miss my coffee, and detest de-caf! Based on this research, I'm going to ease back into my morning cup o' joe tomorrow! :-)

[cindyh1 3]

Thanks for all the info

[feedyoureye 3,087]

I always thought it was discouraged because its a diuretic....