Coffee and Parkinson Disease: Is Starbucks the treatment ? By Abraham Lieberman MD, Medical Director, National Parkinson Foundation Coffee drinking has, in some studies, been inversely associated with Parkinson disease. But the evidence, to date, has been equivocal. Thus, in an earlier study from the Honolulu Heart Program, coffee drinking appeared to be protective against Parkinson disease. But there were confounding factors and the evidence was not compelling. A recent article, from the same group, with Dr. G. Webster Ross as the lead researcher, revisited the study between coffee drinking and the risk of developing Parkinson disease. The new study is based on a longer follow-up and nearly twice the number of new Parkinson cases. The role of other risk factors was analyzed separately. The study appeared in the 24/31 May 2000 widely-read and respected Journal of the American Medical Association (JAMA). ABSTRACT Design, Setting, and Participants: Data were analyzed from 30 years of follow-up of 8004 Japanese-American men (aged 45-68 years) enrolled in the prospective longitudinal Honolulu Heart Program between 1965 and 1968. Main Outcome Measure: Incident Parkinson disease (number of participants who developed Parkinson during the study) by amount of coffee intake (measured at study enrollment and 6-year follow-up) and by total dietary caffeine intake (measured at enrollment). Results: During follow-up, 102 men were identified as having Parkinson disease. Age-adjusted incidence of Parkinson disease declined consistently with increased amounts of coffee intake, from 10.4/10,000 person-years in men who drank no coffee to 1.9/10,000 person-years in men who drank at least 28 oz/d ( these results were significant with). Similar relationships were observed with total caffeine intake and caffeine from non-coffee sources. Consumption of increasing amounts of coffee was also associated with lower risk of Parkinson disease in men who were never, past, and current smokers at baseline. Other nutrients in coffee, including niacin, were unrelated to Parkinson disease incidence. The relationship between caffeine and PD was unaltered by intake of milk and sugar. Conclusions: Our findings indicate that higher coffee and caffeine intake is associated with a significantly lower incidence of Parkinson disease. This effect appears to be independent of smoking. The data suggest that the mechanism is related to caffeine intake and not to other nutrients contained in coffee. Comment: The median age of the 8004 men at study enrollment (1965-1968) was 53 years (range, 45-68 years). The median length of follow-up was 27 years, minimum follow-up was 0.8 years to the first death, and maximum follow-up was 30 years from the baseline examination. Among the men, 102 developed Parkinson disease over the 30 years of follow-up. The median age of PD diagnosis was 73.6 years (range, 54-89 years), and the median interval between baseline examination and Parkinson onset was 16.6 years (range, 2-30 years). Coffee drinkers had significantly lower incidence of Parkinson disease than nondrinkers. This effect was apparent when examining incidence of Parkinson disease based on 30 years of follow-up according to amounts of coffee consumed at the time of study enrollment and at the 1971 examination. At each examination, increasing amounts of coffee consumed were associated with a decline in Parkinson disease. Based on data collected at the time of study enrollment, nondrinkers of coffee had a risk of developing Parkinson disease more than 5 times that of men who consumed 28 oz of coffee or more per day ( 4 or 5 cups of coffee, 6-oz in each cup). The progressively lower risk of developing Parkinson disease with increasing amounts of coffee consumed was also observed in men who were never, past, and current smokers. This is important because there may be a decreased risk of developing Parkinson disease among cigarette smokers. Thus the two factors, coffee drinking and cigarette smoking, must be analyzed separately. Among the other nutrients contained in coffee that were analyzed, including niacin, no associations were observed with risk of Parkinson disease. Adjustment for alcohol consumption, hypertension, cholesterol level, total energy intake, and saturated fat level had no effect on the development of Parkinson disease. Parkinson disease afflicts 3% of the population older than 65 years and is a significant source of morbidity and health services use. Based on the projected growth of the US population, this percentage could double in the next 30 - 40 years. While rare genetic forms exist, determinants of typical late-onset disease appear to be largely environmental. No treatment has definitively been shown to prevent disease or slow progression. Identification of risk factors may lead to an understanding of pathogenic mechanisms and to effective strategies for prevention. This is the first prospective study demonstrating a significant inverse association between coffee consumption and development of Parkinson disease. There are several possible mechanisms. 1.The lower frequency of coffee consumption during mid-life among men who eventually developed Parkinson disease could reflect an intolerance to caffeine among persons with a tendency to develop Parkinson disease. 2.Regular exposure to caffeine over many years might counteract the age-related degenerative processes that cause loss of dopamine cells. 3.Caffeine could also modulate the receptors on pigmented cells in the midbrain and/or striatum. Thus, caffeine is a known stimulant thought to act by blocking adenosine receptors in the brain. Adenosine is an internally generated brain chemical. Blocking adenosine receptors results in increased movement possibly through increasing dopamine levels. Thus, rather than having a direct effect on the development of Parkinson disease, coffee and other caffeine sources may be a form of self-medication that decreases the expression of Parkinson symptoms. There are limits to the study as noted by the authors. 1.The population is Japanese-American men with older age at diagnosis. Generalizations to younger-onset cases, women, and other ethnic groups cannot be made with certainty. A review of the worldwide frequency of Parkinson disease suggests that incidence is lower in Japan, with rates ranging from 5.4 - 10.2 compared with rates in North America and Europe (range, 6-23). 2.The study design is such as to prevent the researchers from concluding, definitively, that coffee or caffeine directly protect against development of Parkinson disease. At this time there is not enough evidence to urge you to go to Starbucks and drink 6 café-latte's a day. However, the possibility that caffeine may have a protective effect against developing Parkinson disease must be investigated further. -- Cheers, Joao Paulo - Salvador,BA,Brazil [log in to unmask] ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn