Should people with high cholesterol levels stop drinking coffee?

Research has been inconclusive on this issue. Coffee drinking has been associated with increased serum cholesterol levels in some, but not all, studies. In a recent meta-analysis, researchers identified 14 published trials examining the re-lationship between coffee consumption and cholesterol levels. They found a statistically significant dose response between coffee drinking and both total and low-density lipoprotein cholesterol.1 The more coffee people drank, the higher their cholesterol levels were. However, when the researchers broke the studies down further, they found filtered coffee demonstrated negligible increases in serum cholesterol, but unfiltered or boiled coffee increased total and LDL cholesterol. Quite probably the paper filter traps certain coffee chemicals that affect cholesterol levels. Recent work seems to confirm this analysis. In a Swedish study, researchers evaluated the effects of drinking filtered and boiled coffee on the incidence of initial nonfatal heart attacks. They concluded drinking boiled coffee appeared to increase the likelihood of an initial heart attack.2 That's not to say drinking lattes is not without its downside, but they probably won't significantly increase cholesterol levels or heart attack risk.

Can probiotic supplements help those with inflammatory bowel disease?

Yes, it seems enough evidence has accumulated to suggest probiotic therapy may be effective in treating a subset of IBD called ulcerative colitis, a disease of the large intestine (colon) characterized by inflammation of the intestinal tract lining and rectal bleeding. Probiotics, generally defined as microbial food supplements that benefit the host by improving intestinal microbial balance, seem to have caught the gastroenterological community's fancy in the past few years. Although UC's pathogenesis is not clearly understood, there is evidence to suggest controlling the intestine's bacterial balance may be beneficial. Animal models of colitis have shown that probiotics can prevent and treat established intestinal inflammation.3

Controlled clinical studies demon-strate probiotics can help prevent a condition called pouchitis that often results from colectomy surgery to treat UC, and can induce and maintain UC remission. Often in UC treatment the diseased colon is removed and the small intestines are made into a reservoir or pouch and attached to the rectum. Unfortunately, this pouch can become inflamed, causing the same problems doctors were attempting to resolve with surgery. In a recent double-blind study, researchers showed supplementation with probiotics significantly decreased the onset of acute pouchitis and improved patients' quality of life following colectomy.4 Researchers reported results of another study at a recent national gastro-enterological conference suggesting probiotics may help induce UC remissions in patients who had not had surgery.⁵ Both studies used a combination probiotic supplement called VSL3. Of course, large controlled trials are needed to definitively establish the place for probiotics in UC treatment and resolve issues such as the dose, duration, treatment frequency and use of single- or multiple-strain probiotics. But given the treatment's benign nature, these results suggest probiotics should have a place in the conventional care and treatment of ulcerative colitis.

Dan Lukaczer, N.D., is director of clinical research at the Functional Medicine Research Center, a division of Metagenics Inc., in Gig Harbor, Wash.

References

1. Jee SH, et al. Coffee consumption and serum lipids: a meta-analysis of randomized controlled clinical trials. Am J Epidemiol 2001;153(4):353-62.

2. Hammar N, et al. Association of boiled and filtered coffee with incidence of first nonfatal myocardial infarction: the SHEEP and the VHEEP study. J Intern Med 2003;253(6):653-9.

3. Hart AL, et al. Use of probiotics in the treatment of inflammatory bowel disease. J Clin Gastroenterol 2003;36(2):111-9.

4. Gionchetti P, et al. Prophylaxis of pouchitis onset with probiotic therapy: a double-blind, placebo-controlled trial. Gastroenterology 2003;124(5):1202-9.

5. Fedorak R, et al. VSL3 probiotic mixture induces remission in patients with active ulcerative colitis. Digestive Disease Week 2003;Abstract #102453.

Natural Foods Merchandiser volume XXIV/number 9/p. 108