Coffee: grounds for concern?

C aff eine is the most widely ingested nonregulated substance on earth. A major portion of this drug is consumed as coff ee, with an annual production of over 7.8 million metric tons. Over 2.5 billion cups of coff ee are consumed worldwide each day. Given its popularity, it is hard to conceive of how Western civilization might begin each workday without this critical liquid allotment. Despite the prominent role it has assumed in our daily lives, comparatively little about it has been published in the strictly academic press over the past 300 years or more. Th e most comprehensive compilation of this literature is, undoubtedly, contained in the two-volume collection of von Hünersdorff and Hasenkamp (1). Included within these 1661 pages are over 16,000 references. However, there is no index, making it diffi cult to use for research. Furthermore, almost all references predate the late 20th century and thereafter. Th e references themselves are principally works concerning the distribution, planting, preparation, and other aspects of coff ee, with few representing physiological studies or what we would now consider adequate population studies. Often referred to as " the bible " of pharmacology, Goodman and Gilman does not even list coff ee among its references and only includes a few remarks about symptoms related to caff eine withdrawal (2). Fortunately, a number of excellent monographs concerning coff ee and caff eine have appeared in recent years, and two of these were consulted for this article (3, 4). As well entrenched as coff ee is in our daily lives, it might be diffi cult for some to imagine the trials and tribulations coffee has endured over the centuries. Signifi cant consumption of coff ee spread from the Middle East and Africa to Europe in the latter half of the 17th century. Th e fi rst coff eehouse in England opened in Oxford in 1637. Th e fi rst in France opened in 1639. Before this, in large cities such as London, the available drinking water was so vile that those who could would fortify themselves with various kinds of beer or wine each morning. On switching to coff ee, such consumers were immediately struck by the improvement in their mental alertness and clarity, as the haze of alcohol was removed from the start of each day, and coff ee-houses soon became centers of lively debate and enlightened conjecture. Th is dichotomy of …