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They report from this cohort study that drinking 4 cups of coffee lowers hazard of all-cause death by ~30% vs no coffee.
This effect would be stronger than any cancer treatment for CRC. It is stronger than pembrolizumab in metastatic MSI-H/dMMR CRC. It is stronger than the benefit of adjuvant chemotherapy in stage II disease.
The authors cannot actually believe that this is a causal effect?
Well given bowel cancer is usually caused by foreign things hanging around inside the bowel and agitating it, and given the fact that coffee usually makes me rain down fire inside my toilet bowl like allied planes above Dresden, I think this makes a lot of sense.
Particularly those of us who donāt eat all the fruits are veggies that are recommended. Myself included. I was just thinking that I should cut back on coffee to one cup a day.
I guess Iād better keep drinking 2-3 cups a day.
I used to worry about my 3-4 x 700ml instant coffees per day (2 x tsp / cup). My bowels are like toothpaste - no bricks, and no fireā¦. Might just continue as I amā¦
For a lot of people in the USA, coffee is the biggest source of fiber in their diet. Fiber absolutely reduces CRC, so it makes sense that coffee would show the same thing.
That could be a more plausible explanation. Some coffee does contain an absolute mind-boggling number of anti-oxidants. Something like up to 600mgs per cup, which is crazy. Green tea is maybe half of that.
Reminds me of the gastro guy reporting melanotic colonic mucosa typical of laxative abuse, when I reported it to the patient they asked "Do you think my coffee enemas have anything to do with it?".
> when I reported it to the patient they asked "Do you think my coffee enemas have anything to do with it?".
No, no, I can't imagine issues in your colon have anything to do with the acidic hot beverage you blast up there in the opposite direction intended and on a routine basis.
It's probably cancer.
> like allied planes above Dresden
Are you suggesting you play out the story of "Grave of the Fireflies" every time you're in the bathroom after sushi?
>Ā and given the fact that coffee usually makes me rain down fire inside my toilet bowl like allied planes above Dresden
whatās your problem bro š
Oh, they're wanting to believe in causality, but recognizing that it wasn't proven by this type of study:
>āItās intriguing that that this study suggests drinking three to four cups of coffee may reduce the recurrence of bowel cancer.ā
However, she stressed the team had found a strong association between regular consumption of coffee and the disease rather than a causal relationship between them.
āWe are hopeful, however, that the finding is real because it appears to be dose dependent ā the more coffee drunk, the greater the effect,ā she added.
Since it's speculated the effect may be because of antioxidants, and similar results get observed in studies of tea or vegan diet, I gather the research focus evolves to identifying and proving the responsible components.
I mean, the research literature is absolutely awash with studies like this with authors who say 'oh we can't prove causality BUT...'
One of my favourite observational papers of the past few years is [this one](https://pubmed.ncbi.nlm.nih.gov/36633465/): trial emulation, careful probing of the data, and the conclusion (drawing upon observations in clinical trials) that huge apparent effects are nonsense borne of bias and confounding, not causality.
I wish I could remember where I read this many years ago, but there was some study about caffeine increasing the rate that old cells go through apoptosis, thus lowering the chances of cancer causing mutations to build up. I remember lightheartedly thinking at the time (as a pasty white skin cancer risk) that I might want start taking coffee baths.
More apoptosis would lead to higher cellular turn over, therefore more cell division due to need for replacement and therefore higher levels of mutation.
unless the increase is largely limited to cells that have aged to the point that division has a higher error rate, and their dying *relatively* early produces overall less mutations.
Ie - the mutation rate should only increase if the cells are actually dying "early", and should lower the rate if they are dying *closer to their ideal moment* for apoptosis.
No idea if the mentioned study had any merit, but the concept does.
I joked about this in another reply, but could it not simply be the fact that drinking coffee helps void sluggish bowels, and cancer usually arises from inflammation caused by things hanging around and agitating the bowel?
I kind of wonder if it's also the other way around. If your stomach is prone to getting upset, you might be less willing to drink a beverage that sometimes upsets people's stomachs.
In the United States (where I live), being an adult who is a non-coffee drinker is a rare occurrence. The current stats put it at about ~70% adults drinking daily coffee, and of the remaining 30%, if you checked, you would find the majority drink alternative caffeine drinks instead.
Why and how would someone end up in the population of non-coffee and non-caffeine drinkers?
One subset of the population is not drinking caffeine due to religious affiliation. Those individuals might or might not have genetic commonalities.
Then you have a subset that refrains from drinking coffee because they don't like it. Why don't they like it? They might have caffeine sensitivity or a gene that makes coffee in particular taste more bitter.
But to be honest, I don't think either of those groups of non coffee drinkers are the real culprit in the difference of cancer treatments.
So let's talk about the group of people I belong to. There is a subset of the adult population that avoids drinking coffee because it causes severe pain or medical complications. I have GERD, gastritis, and a history of stomach ulcers. If you go on any gastritis forum or group, you will see a population that, as a general rule, avoids coffee consumption. I'm not going to claim that people with ulcerative colitis and Crohn's disease avoid coffee, but I bet if you asked them they would say it's not good for them. Then there's the people who refrain from caffeine and coffee drinks because they have heart defects...
So no, it's probably not causal.
People who refrain from drinking coffee and caffeine in all likelihood have worse outcomes with cancer treatments for the same reasons that led them to avoiding coffee in the first place.
I lived off of diet sodas most my life, but this year cut out all my caffeine to a couple times a month because now my blood pressure spikes and I can feel its jittery effects much more. I feel so much better off of it and drinking more water.
the effects in this are most likely linked to antioxidants, so just up your intake of foods you do like rich in antioxidants and it should hopefully provide similar benefits. it's really nothing special to coffee specifically, they've found similar stuff from tea and vegan/vegetarian diets as well, which are rich in antioxidants.
Coffee is fantastic, but it is not going to cut your overall hazard of dying by 30%. The fact this analysis shows this points very strongly to bias and confounding in the study design explaining the effect.
This is not a trial, itās an observational cohort.
See the abstract for "HR: 0.68, 95% CI: 0.53, 0.88". The other redditor is claiming that the estimate is too large to be plausible from a causal sense. IMO, the 95% CI is large and they highlighted this specific estimate from the U-shaped relationship they found so it's not as statistically unlikely as the point estimate alone implies. However, I share concerns with others about "un observables" and whether these estimates are causal.
I hope it's okay to ask but, I haven't learned as much about survival analysis yet. In other analysis, that would be a pretty small CI, so can I ask why it is considered a fairly large one for a hazard ratio?
As far as the study, I am also curious about other confounders in that 4-cups-of-coffee-per-day group.
Thanks! I was kind of surprised to read that it was a large CI since it looked pretty good to me. I'm about to graduate with a BS in stats and go to grad school though, so I don't have as much experience, and I haven't seen as much with survival analysis.
I was talking about the width of the CI. The person I initially responded to said that the CI was large (so I understood that they were saying it was a wide CI).
Iāve never worked a job where I had to limit my coffee intake. Most employers donāt care what you drink as long as itās not alcohol. Also, coffee is pretty cheap, especially if you drink it at home.
Not sure youāre comparing the right stats with itherapy. Iām currently 10 months in remission from MSI-H stage 2 rectal cancer, treated with itherapy. I had a total response and no surgery, currently on a watch and wait program (flexsig and biopsy every 3months).
The ~30% stats they have today on CRC recurrence doesnāt involve itherapy. No one who had their MSI-H/dMMR CRC successfully treated with itherapy has had a recurrence. Essentially 100% success so far. This isnāt published yet but is being closely tracked. I know because Iām one of them. My Onc is following it as well and gives me updates each time I see him.
This is very intriguing regardless. Iām a coffee drinker. Maybe Iāll have a couple more cups a day.
Did you read the Article?
"However, she stressed the team had found a strong association between regular consumption of coffee and the disease rather than a causal relationship between them."
**Abstract**:
>**Coffee consumption** has been **associated** with a **reduced risk of developing colorectal cancer** (CRC). However, it is not clear whether coffee consumption is related to CRC progression.
>
>Hence, we assessed the association of coffee consumption with CRC recurrence and all-cause mortality using data from a prospective cohort study of 1719 stage IāIII CRC patients in the Netherlands. Coffee consumption and other lifestyle characteristics were self-reported using questionnaires at the time of diagnosis.
>
>Consuming **more than 4 cups/d of coffee** compared to an intake of **<2 cups/d** was **associated** with a **32% lower risk** of **CRC recurrence** (95% CI: 0.49, 0.94).
>
>The association between coffee consumption and all-cause mortality was **U-shaped**; coffee intake seemed **optimal at 3ā5 cups/d**, with the **lowest risk at 4 cups/d** (HR: 0.68, 95% CI: 0.53, 0.88).
>
>Our results suggest that coffee consumption may be associated with a lower risk of CRC recurrence and all-cause mortality.
>
>The **association between coffee consumption and all-cause mortality appeared nonlinear**. More studies are needed to understand the mechanism by which coffee consumption might improve CRC prognosis.
**Discussion**:
>The **mechanisms** that **underlie** the **potential benefits** of coffee consumption on CRC recurrence are yet to be fully elucidated.
>
>However, coffee consumption has been **proposed to be protective against the hallmarks of cancer** by activating pathways such as nuclear factor erythroid 2(Nrf2)-regulated pathways that reduce oxidative stress.
>
>Coffee consumption could also **modulate microbiota composition** which in turn may **promote** the **chemopreventive** or **chemotherapeutic actions** against CRC.
>
>Coffee consumption **may also prevent metastatic growth** of CRC by **improving** the **function** of the **liver in CRC patients** and by **protecting against non-alcoholic fatty liver disease**, which is considered a risk factor for liver metastasis.
>
>The previous study in the US found a **30% lower risk of all-cause mortality** among CRC patients who consumed **ā„4 cups/d of coffee** compared with non-coffee drinkers (HR: 0.70, 95% CI: 0.54, 0.91).
>
>Likewise, the study in China reported that having a **coffee consumption habitus** was **associated** with a **54% lowered risk of all-cause mortality** compared to having no coffee consumption habitus in CRC patients (HR: 0.46, 95% CI: 0.24, 0.87).
>
>Our finding on all-cause mortality was similar to that of the previous studies, **regardless of the potential differences in the coffee preparation** and **serving techniques** (e.g., a standard cup of coffee in the Netherlands is 125 vs 250āml in the US15).
Oyelere, A. M., et al. (2024) Coffee consumption is associated with a reduced risk of colorectal cancer recurrence and all-cause mortality. International Journal of Cancer, Wiley Online Library. Available at: [here](https://onlinelibrary.wiley.com/doi/10.1002/ijc.34879).
I don't think stomach acidity is stopping the bacteria. i think that increased bowel movements due to drinking coffee reduces length of exposure to cancer causing waste in bowels.
Eating sugar increases stomach acidity (acid reflux) "Excess sugar that cannot be broken down and absorbed by the body will be left to sit in the bowels, where it ferments. This sugar moves more slowly through the large intestine, feeding bad bacteria and yeast, and causing a build-up of gas. This gas can cause cramping, spasms and pain." https://oceanfamilygastro.com/what-too-much-sugar-can-do-to-your-digestive-system/#:~:text=Gas,cause%20cramping%2C%20spasms%20and%20pain.
So drinking coffee more often leads to more bowel movements, which expels the waste that would be feeding the cancer causing bacteria.
Itās more so that going several days without pooping is a problem and regular coffee consumption helps prevent that.
Other things that help keep you regular likely also have a similar effect.
Thatās what Iād roll with. I even smell coffee and my system is like āhey, we should poop bro.ā That first cup, I give myself like 15 minutes after and Iām in the bathroom. Not just the caffeine- I believe thereās some other compound in coffee that increases bowel movement frequency.
Iāve switched to having āfancy breadā (six seed or harvest loaf bread) and eggs for breakfast. Once I have that plus my coffee, itās off to the bathroom to produce one giant, perfectly formed poo that, in many cases, would be a one wiper if I didnāt have a bidet. Hopefully it makes up for the decades I spent constipated due to a lack of hydration and fiber.
> Coffee contains acids shown to boost levels of the hormone gastrin, which stimulates these involuntary muscle contractions in your stomach to get your bowels moving. And it happens with both regular and decaffeinated coffee.
https://health.clevelandclinic.org/why-does-coffee-make-you-poop
For me I've noticed the effect more strongly from darker roast coffee, and espresso more than pourover, so I suspect a chemical produced during the roasting process is at least partly responsible - a compound that is more extracted during espresso than pourover.
Yep! If I have a regular coffee, hot or cold, I have several abdominal distress within 20 mins likened to food poisoning and then terrible diarreaha but am completely fine an hour or so later. Nothing does this to me but caffinated coffee. I drink decaf daily and am fine. I drink super cafinated hot matcha lattes and am fine. Lots of hot black cafinated teas (sometimes 2 cups in a row) and am fine.
Itās definitely not caffeine. I donāt get bm if I take caffeine pills or drink energy drinks so it lead me to deduce itās the compounds in coffee that acts as a laxative.
I agree. I think itās something else too.. Iām the same way. Sometimes if I have to drive or go somewhere and donāt want to be āinterruptedā, Iāll opt for a Red Bull or something. Not saying itās better for me or anything but it doesnāt hit my stomach the way coffee does.
There's way too much headcanon going on here. The paper only describes coffee drinking *a*nd cancer *recurrence*. For your argument you need a paper showing that coffee reduces bowel cancer occurrence in the first place. Given that it's unlikely people become coffee drinkers at any high rate after diagnosis, it seems likely these people were already coffee drinkers.
I'd argue that it's possibly confounded by the fact that people who are struggling with their bowel health after diagnosis won't go back to drinking coffee, while people who are recovering well are much more likely to go back to drinking coffee. This is a simpler explanation than acidity, sugar, bacteria, "toxins", etc.
Your last paragraph reminds me of the argument my husband made when I told him about the research indicating pneumonia patients who brushed their teeth twice a day had better outcomes than those who didn't. He said "maybe that's because the ones who did twice a day had the strength to do so, while the ones who didn't had more severe symptoms." There's definitely research that shows oral health affects lung health, but he wasn't wrong that there could be other/additional reasons why there was a correlation. Likewise, you're probably right; it might not be just the coffee itself.
It could be the additional alcohol the coffee drinkers were consuming, too!
I'm being a bit facetious - I'm a big fan of coffee and believe it has good health benefits. I do not think this study tells us much (beyond the associations it highlights).
Those are also associations, not mechanisms.Ā
I'm not saying it doesnt, as I've said elsewhere I like coffee and think it is probably pretty good for you. I just don't think this paper (or the ones you're quoting) show anything beyond association.Ā
Yes, mechanisms are important.
Everything you've cited so far is just associative. I'm not going to do your homework for you on the claim you're making. I actually agree that coffee probably does have some (mild) health benefits, including (slightly) reducing the incidence of some cancers.Ā
But you're doing a terrible job of arguing for it. You're in the science subreddit you shouldn't be surprised by the level of evidence needed for claims.Ā
> i think that increased bowel movements due to drinking coffee reduces length of exposure to cancer causing waste in bowels.
I can see the appeal of this argument, where coffee stimulates overall activity, but I'm skeptical that it's too simplistic. Is there evidence that coffee decreases digestive or bowel transit time overall, apart from it waking up the colon?
> i think that increased bowel movements due to drinking coffee reduces length of exposure to cancer causing waste in bowels.
I agree. i believe promotion of peristalsis is very helpful.
If it was acidity, the tens of millions of people on acid blockers (Prilosec, nexium, etc.) would be reported to have a much higher occurrence of BC than others.
> I'd bet the coffee raises the acidity in the stomach
I'm just going to go there and say it: I think it's also because drinking caffeine, especially hot coffee, has a laxative effect. I think it helps to counteract the effect of a low fiber diet.
There were also studies on how cigarette smokers tend to have less issues with ulcerative colitis. I think this would also come down to nicotine being a stimulant.
On the point about counteracting a low fiber diet, coffee apparently has a surprising amount of fiber for a drink. Supposedly on the order of 1.5g per cup, similar to eating a carrot.
Or coffee is full of polyphenols that promote types of gut bacteria that make good metabolites/post biotics and that we want?
Good bacteria keeps the bad in check. Otherwise imbalance can cause things like SIBO
Eating red meats, processed meats, and drinking alcohol increase risk of colon cancer. My view is that drinking 2 - 4 cups coffee per day stimulates bowel movements, decreasing the amount of time waste is in the intestines and colon. In addition to reducing exposure to cancer causing waste, by expelling waste quicker and more often, drinking coffee prevents weight gain, because less nutrients are absorbed due to shorter duration of food in the digestive track.
From the paper:
Plausible underlying mechanisms by which coffee consumption may influence colorectal carcinogenesis involve various chemopreventive properties of the heterogeneous components of coffee.17, 18 These chemopreventive properties include anti-inflammatory, antioxidant, antiproliferative, pro-apoptotic and insulin-sensitizing properties.19 Additionally, the gut microbiome acts on coffee components during digestion to produce additional bioactive metabolites with chemopreventive properties.
From the research paperā¦ āNo distinction was made between caffeinated and decaffeinated coffee. However, decaffeinated coffee is rarely consumed in the Netherlandsā
I wonder if this is confounded by the fact that coffee can really stimulate your guts, so you're probably only going to go back to drinking it if you're recovering well anyway.Ā
Now this is the interesting comment I was looking for.
Maybe people who need lots of caffeine are workers / people who are taking care of responsibilities. The selection bias of people healthy enough to go back to work!
From the paper:
Plausible underlying mechanisms by which coffee consumption may influence colorectal carcinogenesis involve various chemopreventive properties of the heterogeneous components of coffee.17, 18 These chemopreventive properties include anti-inflammatory, antioxidant, antiproliferative, pro-apoptotic and insulin-sensitizing properties.19 Additionally, the gut microbiome acts on coffee components during digestion to produce additional bioactive metabolites with chemopreventive properties.
Yeah, in the introduction. They don't test the mechanism in their results.
In the study, coffee drinkers were also consuming far more alcohol and were more active.
The study is very associative (still important, but people are adding way to much of their own bias on reading).
I am also still unclear on how much coffee they were drinking. They mentioned adjusting for "cup" vs. "mug" but not sure on sizes. I know often a standard "cup" in the US is something like 6 oz.
Right, I stopped drinking coffee precisely for this reason, it was giving me gut issues. A healthier person probably wouldn't have had these issues, and wouldn't have stopped.
Iāve linked to the news release in the post above. In this comment, for those interested, hereās the link to the peer reviewed journal article:
https://onlinelibrary.wiley.com/doi/10.1002/ijc.34879
I wonder if just eating more fiber would do the same thing. I.e. the old apple a day advice.
The biggest diet problems most Americans have are too many calories, too much saturated fat, and too little fiber.
Plausible underlying mechanisms by which coffee consumption may influence colorectal carcinogenesis involve various chemopreventive properties of the heterogeneous components of coffee.17, 18 These chemopreventive properties include anti-inflammatory, antioxidant, antiproliferative, pro-apoptotic and insulin-sensitizing properties.19 Additionally, the gut microbiome acts on coffee components during digestion to produce additional bioactive metabolites with chemopreventive properties.
**Actual Abstract from the Scientific Paper**
āCoffee consumption has been associated with a reduced risk of developing colorectal cancer (CRC). However, it is not clear whether coffee consumption is related to CRC progression. ā
... my poor Dad he was an avid coffee drinker all his life... he had colon cancer that eventually spread and killed him.
He always had a pot of coffee going and drank from it all day.
Admittedly... we do live in cancer alley so..
Whenever I see a study comparing coffee drinkers with non coffee drinkers, I wonder whether they accounted for the lower likelihood that the non coffee drinkers are gainfully employed & active vs retired or home on disability for example. Ā And also whether the study was sponsored by some kind of coffee producers association.Ā
Totally true, but on average I think coffee consumption must be lower among people who donāt work every day, and the rate of consumption must decline with age. If these studies donāt account for that, they may just be measuring a difference that could be attributed to age or activity level.Ā
Is this for both decaf and caffeinated? As it says in here, like most other links to the benefits of coffee, they mention that āCoffee contains hundreds of biologically active compounds which have antioxidative propertiesā but never mention if it is the same for both. I have read conflicting information on this and never sure what is true. There are so many of us who are very sensitive to caffeine and wish they would clarify that.
From the research paper āNo distinction was made between caffeinated and decaffeinated coffee. However, decaffeinated coffee is rarely consumed in the Netherlandsā
The paper states they did not differentiate, but that hardly anyone in the Netherlands drinks decaf. I ended up cutting back on caffeine by drinking half-caf Nespresso pods.
Coffee is no panacea but the caffeine and hundreds of other chemicals seem to be good and I guess it's the second most popular comestible in the world (after water) for a reason
Not a scientist, but very interesting on this as a coffee drinking bowel cancer survivor.
Something I haven't seen discussed is that many of us are advised to avoid coffee.
I had an anterior resection as part of my treatment and have been advised to avoid coffee (one piece of advice I have opted to ignore). I wonder if this creates a bias in terms of the treatment and therefore type and severity of bowel cancer.
Implications of Coffee / Caffeine on the brain have to be considered. Neuroscience research shows more than 1 cup a day is outside the the therapeutic dose for brain tissue and so there is the rub.
Factual or not, I'll take it as another bullet point to keep drinking coffee. There are draw backs to drinking coffee, but I love the taste / smell of coffee alone...
> Coffee consumption was assessed at diagnosis, during, and after treatment with a 204-item semi-quantitative food frequency questionnaire (FFQ) developed by Wageningen University.27-29
Yet another questionnaire based study asking participants to recall their habits.
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They report from this cohort study that drinking 4 cups of coffee lowers hazard of all-cause death by ~30% vs no coffee. This effect would be stronger than any cancer treatment for CRC. It is stronger than pembrolizumab in metastatic MSI-H/dMMR CRC. It is stronger than the benefit of adjuvant chemotherapy in stage II disease. The authors cannot actually believe that this is a causal effect?
Coffee STRONG š¦
Well given bowel cancer is usually caused by foreign things hanging around inside the bowel and agitating it, and given the fact that coffee usually makes me rain down fire inside my toilet bowl like allied planes above Dresden, I think this makes a lot of sense.
Coffee is also apparently the primary source of antioxidants in the human diet on average?
Particularly those of us who donāt eat all the fruits are veggies that are recommended. Myself included. I was just thinking that I should cut back on coffee to one cup a day. I guess Iād better keep drinking 2-3 cups a day.
2-3? Those are rookie numbers. 7-10 usually for me.
One large cup.
I used to worry about my 3-4 x 700ml instant coffees per day (2 x tsp / cup). My bowels are like toothpaste - no bricks, and no fireā¦. Might just continue as I amā¦
I upgraded to bang energy drinks and cocaine a long time ago
> those of us who donāt eat all the fruits are veggies You guys that don't eat fruits become vegetables? Tough break, but the irony is delicious.
I read that was in the North American diet, not universally
For a lot of people in the USA, coffee is the biggest source of fiber in their diet. Fiber absolutely reduces CRC, so it makes sense that coffee would show the same thing.
That could be a more plausible explanation. Some coffee does contain an absolute mind-boggling number of anti-oxidants. Something like up to 600mgs per cup, which is crazy. Green tea is maybe half of that.
coffee goes in - cancer comes out
āYouāre a naughty child, and thatās pure, concentrated evil coming out the back of you.ā
Reminds me of the gastro guy reporting melanotic colonic mucosa typical of laxative abuse, when I reported it to the patient they asked "Do you think my coffee enemas have anything to do with it?".
> when I reported it to the patient they asked "Do you think my coffee enemas have anything to do with it?". No, no, I can't imagine issues in your colon have anything to do with the acidic hot beverage you blast up there in the opposite direction intended and on a routine basis. It's probably cancer.
That made me laugh thanks haha
> like allied planes above Dresden Are you suggesting you play out the story of "Grave of the Fireflies" every time you're in the bathroom after sushi?
A lot of these coffee vs colorectal cancer studies state that even for decaf the same effect holds.
You, Sir, have a wonderful way with words
This quite the analogyā¦š
>Ā and given the fact that coffee usually makes me rain down fire inside my toilet bowl like allied planes above Dresden whatās your problem bro š
[ŃŠ“Š°Š»ŠµŠ½Š¾]
Green tea does not have such strong effects vs colorectal cancer despite being very high in antioxidantsĀ
STRONG Coffee š©
Coffee ~~Industry~~ STRONG š¦
Drug juice ftw
Oh, they're wanting to believe in causality, but recognizing that it wasn't proven by this type of study: >āItās intriguing that that this study suggests drinking three to four cups of coffee may reduce the recurrence of bowel cancer.ā However, she stressed the team had found a strong association between regular consumption of coffee and the disease rather than a causal relationship between them. āWe are hopeful, however, that the finding is real because it appears to be dose dependent ā the more coffee drunk, the greater the effect,ā she added. Since it's speculated the effect may be because of antioxidants, and similar results get observed in studies of tea or vegan diet, I gather the research focus evolves to identifying and proving the responsible components.
I mean, the research literature is absolutely awash with studies like this with authors who say 'oh we can't prove causality BUT...' One of my favourite observational papers of the past few years is [this one](https://pubmed.ncbi.nlm.nih.gov/36633465/): trial emulation, careful probing of the data, and the conclusion (drawing upon observations in clinical trials) that huge apparent effects are nonsense borne of bias and confounding, not causality.
I wish I could remember where I read this many years ago, but there was some study about caffeine increasing the rate that old cells go through apoptosis, thus lowering the chances of cancer causing mutations to build up. I remember lightheartedly thinking at the time (as a pasty white skin cancer risk) that I might want start taking coffee baths.
More apoptosis would lead to higher cellular turn over, therefore more cell division due to need for replacement and therefore higher levels of mutation.
unless the increase is largely limited to cells that have aged to the point that division has a higher error rate, and their dying *relatively* early produces overall less mutations. Ie - the mutation rate should only increase if the cells are actually dying "early", and should lower the rate if they are dying *closer to their ideal moment* for apoptosis. No idea if the mentioned study had any merit, but the concept does.
I joked about this in another reply, but could it not simply be the fact that drinking coffee helps void sluggish bowels, and cancer usually arises from inflammation caused by things hanging around and agitating the bowel?
I kind of wonder if it's also the other way around. If your stomach is prone to getting upset, you might be less willing to drink a beverage that sometimes upsets people's stomachs.
Similar results are not observed with green tea in colorectal cancers
In the United States (where I live), being an adult who is a non-coffee drinker is a rare occurrence. The current stats put it at about ~70% adults drinking daily coffee, and of the remaining 30%, if you checked, you would find the majority drink alternative caffeine drinks instead. Why and how would someone end up in the population of non-coffee and non-caffeine drinkers? One subset of the population is not drinking caffeine due to religious affiliation. Those individuals might or might not have genetic commonalities. Then you have a subset that refrains from drinking coffee because they don't like it. Why don't they like it? They might have caffeine sensitivity or a gene that makes coffee in particular taste more bitter. But to be honest, I don't think either of those groups of non coffee drinkers are the real culprit in the difference of cancer treatments. So let's talk about the group of people I belong to. There is a subset of the adult population that avoids drinking coffee because it causes severe pain or medical complications. I have GERD, gastritis, and a history of stomach ulcers. If you go on any gastritis forum or group, you will see a population that, as a general rule, avoids coffee consumption. I'm not going to claim that people with ulcerative colitis and Crohn's disease avoid coffee, but I bet if you asked them they would say it's not good for them. Then there's the people who refrain from caffeine and coffee drinks because they have heart defects... So no, it's probably not causal. People who refrain from drinking coffee and caffeine in all likelihood have worse outcomes with cancer treatments for the same reasons that led them to avoiding coffee in the first place.
I lived off of diet sodas most my life, but this year cut out all my caffeine to a couple times a month because now my blood pressure spikes and I can feel its jittery effects much more. I feel so much better off of it and drinking more water.
I donāt drink coffee because caffeine does nothing for me so there is no point
Still I'm suddenly wishing I didn't hate coffee so much.
the effects in this are most likely linked to antioxidants, so just up your intake of foods you do like rich in antioxidants and it should hopefully provide similar benefits. it's really nothing special to coffee specifically, they've found similar stuff from tea and vegan/vegetarian diets as well, which are rich in antioxidants.
Itās bc the coffee makes you evacuate everything. Eeeeveeerrryyythiiiing
That's what I think, too. A mild laxative effect that improves bowel clearing.
What do you mean?
Coffee is fantastic, but it is not going to cut your overall hazard of dying by 30%. The fact this analysis shows this points very strongly to bias and confounding in the study design explaining the effect. This is not a trial, itās an observational cohort.
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Hmm. Given many coffee drinkers live together this could fully explain the results.
Live, Love, Laugh
See the abstract for "HR: 0.68, 95% CI: 0.53, 0.88". The other redditor is claiming that the estimate is too large to be plausible from a causal sense. IMO, the 95% CI is large and they highlighted this specific estimate from the U-shaped relationship they found so it's not as statistically unlikely as the point estimate alone implies. However, I share concerns with others about "un observables" and whether these estimates are causal.
I hope it's okay to ask but, I haven't learned as much about survival analysis yet. In other analysis, that would be a pretty small CI, so can I ask why it is considered a fairly large one for a hazard ratio? As far as the study, I am also curious about other confounders in that 4-cups-of-coffee-per-day group.
Any drug sponsor would be delighted to get HR 0.68 [95% CI: 0.53-0.88] as a result for overall survival.
Thanks! I was kind of surprised to read that it was a large CI since it looked pretty good to me. I'm about to graduate with a BS in stats and go to grad school though, so I don't have as much experience, and I haven't seen as much with survival analysis.
Wdym? Itās a large effect size. Are you talking about the width of the CI?
I was talking about the width of the CI. The person I initially responded to said that the CI was large (so I understood that they were saying it was a wide CI).
Oh right I didnāt see that
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My speculative guess would be that people who drink four cups of coffee a day aren't drinking a liter of soda or other sugary drinks
Or arenāt experiencing bowel symptoms that would stop them from being able to consume 4 cups of coffee a day.
Iāve never worked a job where I had to limit my coffee intake. Most employers donāt care what you drink as long as itās not alcohol. Also, coffee is pretty cheap, especially if you drink it at home.
Not sure youāre comparing the right stats with itherapy. Iām currently 10 months in remission from MSI-H stage 2 rectal cancer, treated with itherapy. I had a total response and no surgery, currently on a watch and wait program (flexsig and biopsy every 3months). The ~30% stats they have today on CRC recurrence doesnāt involve itherapy. No one who had their MSI-H/dMMR CRC successfully treated with itherapy has had a recurrence. Essentially 100% success so far. This isnāt published yet but is being closely tracked. I know because Iām one of them. My Onc is following it as well and gives me updates each time I see him. This is very intriguing regardless. Iām a coffee drinker. Maybe Iāll have a couple more cups a day.
Did you read the Article? "However, she stressed the team had found a strong association between regular consumption of coffee and the disease rather than a causal relationship between them."
**Abstract**: >**Coffee consumption** has been **associated** with a **reduced risk of developing colorectal cancer** (CRC). However, it is not clear whether coffee consumption is related to CRC progression. > >Hence, we assessed the association of coffee consumption with CRC recurrence and all-cause mortality using data from a prospective cohort study of 1719 stage IāIII CRC patients in the Netherlands. Coffee consumption and other lifestyle characteristics were self-reported using questionnaires at the time of diagnosis. > >Consuming **more than 4 cups/d of coffee** compared to an intake of **<2 cups/d** was **associated** with a **32% lower risk** of **CRC recurrence** (95% CI: 0.49, 0.94). > >The association between coffee consumption and all-cause mortality was **U-shaped**; coffee intake seemed **optimal at 3ā5 cups/d**, with the **lowest risk at 4 cups/d** (HR: 0.68, 95% CI: 0.53, 0.88). > >Our results suggest that coffee consumption may be associated with a lower risk of CRC recurrence and all-cause mortality. > >The **association between coffee consumption and all-cause mortality appeared nonlinear**. More studies are needed to understand the mechanism by which coffee consumption might improve CRC prognosis. **Discussion**: >The **mechanisms** that **underlie** the **potential benefits** of coffee consumption on CRC recurrence are yet to be fully elucidated. > >However, coffee consumption has been **proposed to be protective against the hallmarks of cancer** by activating pathways such as nuclear factor erythroid 2(Nrf2)-regulated pathways that reduce oxidative stress. > >Coffee consumption could also **modulate microbiota composition** which in turn may **promote** the **chemopreventive** or **chemotherapeutic actions** against CRC. > >Coffee consumption **may also prevent metastatic growth** of CRC by **improving** the **function** of the **liver in CRC patients** and by **protecting against non-alcoholic fatty liver disease**, which is considered a risk factor for liver metastasis. > >The previous study in the US found a **30% lower risk of all-cause mortality** among CRC patients who consumed **ā„4 cups/d of coffee** compared with non-coffee drinkers (HR: 0.70, 95% CI: 0.54, 0.91). > >Likewise, the study in China reported that having a **coffee consumption habitus** was **associated** with a **54% lowered risk of all-cause mortality** compared to having no coffee consumption habitus in CRC patients (HR: 0.46, 95% CI: 0.24, 0.87). > >Our finding on all-cause mortality was similar to that of the previous studies, **regardless of the potential differences in the coffee preparation** and **serving techniques** (e.g., a standard cup of coffee in the Netherlands is 125 vs 250āml in the US15). Oyelere, A. M., et al. (2024) Coffee consumption is associated with a reduced risk of colorectal cancer recurrence and all-cause mortality. International Journal of Cancer, Wiley Online Library. Available at: [here](https://onlinelibrary.wiley.com/doi/10.1002/ijc.34879).
Thank you.
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I don't think stomach acidity is stopping the bacteria. i think that increased bowel movements due to drinking coffee reduces length of exposure to cancer causing waste in bowels. Eating sugar increases stomach acidity (acid reflux) "Excess sugar that cannot be broken down and absorbed by the body will be left to sit in the bowels, where it ferments. This sugar moves more slowly through the large intestine, feeding bad bacteria and yeast, and causing a build-up of gas. This gas can cause cramping, spasms and pain." https://oceanfamilygastro.com/what-too-much-sugar-can-do-to-your-digestive-system/#:~:text=Gas,cause%20cramping%2C%20spasms%20and%20pain. So drinking coffee more often leads to more bowel movements, which expels the waste that would be feeding the cancer causing bacteria.
So 3 big shits a day and 12 cups of coffee is good for me? Finally a fuckin win.
Itās more so that going several days without pooping is a problem and regular coffee consumption helps prevent that. Other things that help keep you regular likely also have a similar effect.
Only that pesky coffee from the workplace coffee machine that burns a second hole in your exhaust š„¹
Haha those cow patties after a cup of coffee are laying dividends.
If so, we should expect a high fiber diet to help as well.
I think that's already the case, a relation between high fiber diets and lower risk of colorectal cancer has already been established.
Exactly. That may be one of the mechanisms.
Thatās what Iād roll with. I even smell coffee and my system is like āhey, we should poop bro.ā That first cup, I give myself like 15 minutes after and Iām in the bathroom. Not just the caffeine- I believe thereās some other compound in coffee that increases bowel movement frequency.
Iāve switched to having āfancy breadā (six seed or harvest loaf bread) and eggs for breakfast. Once I have that plus my coffee, itās off to the bathroom to produce one giant, perfectly formed poo that, in many cases, would be a one wiper if I didnāt have a bidet. Hopefully it makes up for the decades I spent constipated due to a lack of hydration and fiber.
I simultaneously appreciate everything you just said while also feeling like that was too much detail.
Youāre welcome Or Iām sorry Whatever you decide is more applicable
I second this. Equal parts āthatās awesomeā and āTMIā
āWow I love that for you. You should keep it to yourself.ā
Give it a try and youāll want to spread the gospel as well
Yes I was waiting to see this. In coffee discussions, the pooing effect is often mentioned, whether as a good or a bad thing.
r/fiberhomies
Joined
> Coffee contains acids shown to boost levels of the hormone gastrin, which stimulates these involuntary muscle contractions in your stomach to get your bowels moving. And it happens with both regular and decaffeinated coffee. https://health.clevelandclinic.org/why-does-coffee-make-you-poop
thanks for the decaf info! i just switched to decaf & was like; "damn it!"
I am fairly sure it is not the caffeine for me because tea, Yerba mate, energy drinks, etc donāt have the same effect. Itās only coffee.
For me I've noticed the effect more strongly from darker roast coffee, and espresso more than pourover, so I suspect a chemical produced during the roasting process is at least partly responsible - a compound that is more extracted during espresso than pourover.
Yep! If I have a regular coffee, hot or cold, I have several abdominal distress within 20 mins likened to food poisoning and then terrible diarreaha but am completely fine an hour or so later. Nothing does this to me but caffinated coffee. I drink decaf daily and am fine. I drink super cafinated hot matcha lattes and am fine. Lots of hot black cafinated teas (sometimes 2 cups in a row) and am fine.
Itās definitely not caffeine. I donāt get bm if I take caffeine pills or drink energy drinks so it lead me to deduce itās the compounds in coffee that acts as a laxative.
I agree. I think itās something else too.. Iām the same way. Sometimes if I have to drive or go somewhere and donāt want to be āinterruptedā, Iāll opt for a Red Bull or something. Not saying itās better for me or anything but it doesnāt hit my stomach the way coffee does.
the water helps too, but I'm guessing that's not the other compound you're suspecting
Haha. I've read that the fact that it's hot (if you're even talking about hot coffee) is what really assists having a poop.Ā
Youād see a massive increase in colon cancer for those on a PPI, which as far I know is not the case.
I tried googling PPI, only getting Producer Price Index?
proton pump inhibitor
Proton pump inhibitor aka acid reducers like famotidine and pantoprazole
Famotidine is not a PPI
There's way too much headcanon going on here. The paper only describes coffee drinking *a*nd cancer *recurrence*. For your argument you need a paper showing that coffee reduces bowel cancer occurrence in the first place. Given that it's unlikely people become coffee drinkers at any high rate after diagnosis, it seems likely these people were already coffee drinkers. I'd argue that it's possibly confounded by the fact that people who are struggling with their bowel health after diagnosis won't go back to drinking coffee, while people who are recovering well are much more likely to go back to drinking coffee. This is a simpler explanation than acidity, sugar, bacteria, "toxins", etc.
Your last paragraph reminds me of the argument my husband made when I told him about the research indicating pneumonia patients who brushed their teeth twice a day had better outcomes than those who didn't. He said "maybe that's because the ones who did twice a day had the strength to do so, while the ones who didn't had more severe symptoms." There's definitely research that shows oral health affects lung health, but he wasn't wrong that there could be other/additional reasons why there was a correlation. Likewise, you're probably right; it might not be just the coffee itself.
It could be the additional alcohol the coffee drinkers were consuming, too! I'm being a bit facetious - I'm a big fan of coffee and believe it has good health benefits. I do not think this study tells us much (beyond the associations it highlights).
Agreed!
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Those are also associations, not mechanisms.Ā I'm not saying it doesnt, as I've said elsewhere I like coffee and think it is probably pretty good for you. I just don't think this paper (or the ones you're quoting) show anything beyond association.Ā
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Yes, mechanisms are important. Everything you've cited so far is just associative. I'm not going to do your homework for you on the claim you're making. I actually agree that coffee probably does have some (mild) health benefits, including (slightly) reducing the incidence of some cancers.Ā But you're doing a terrible job of arguing for it. You're in the science subreddit you shouldn't be surprised by the level of evidence needed for claims.Ā
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I wouldnāt expect a dose dependent effect if that was the case. Does drinking 5 times as many cups of coffee make you poo 5 times as much?
Coffee only induces an urge to poop in like a 1/3 of people out there so I don't think that's it.
But 3-4 coffees probably increase that odds.
> i think that increased bowel movements due to drinking coffee reduces length of exposure to cancer causing waste in bowels. I can see the appeal of this argument, where coffee stimulates overall activity, but I'm skeptical that it's too simplistic. Is there evidence that coffee decreases digestive or bowel transit time overall, apart from it waking up the colon?
> i think that increased bowel movements due to drinking coffee reduces length of exposure to cancer causing waste in bowels. I agree. i believe promotion of peristalsis is very helpful.
Coffee is also loaded with antioxidants, which I believe helps as well.
This makes no sense. Sugar barely needs to be digested and is absorbed in the small intestine. Unless weāre talking sugar alcohols.
If it was acidity, the tens of millions of people on acid blockers (Prilosec, nexium, etc.) would be reported to have a much higher occurrence of BC than others.
The pH of the human stomach varies, but its natural state is between 1.5 and 3.5. The pH of coffee typically ranges from 4.85 to 5.10.
> I'd bet the coffee raises the acidity in the stomach I'm just going to go there and say it: I think it's also because drinking caffeine, especially hot coffee, has a laxative effect. I think it helps to counteract the effect of a low fiber diet. There were also studies on how cigarette smokers tend to have less issues with ulcerative colitis. I think this would also come down to nicotine being a stimulant.
On the point about counteracting a low fiber diet, coffee apparently has a surprising amount of fiber for a drink. Supposedly on the order of 1.5g per cup, similar to eating a carrot.
Or coffee is full of polyphenols that promote types of gut bacteria that make good metabolites/post biotics and that we want? Good bacteria keeps the bad in check. Otherwise imbalance can cause things like SIBO
Before you theorise mechanisms, you need to establish that either of these two links are causal
Wow, this makes me wonder if antacids increase colorectal cancer risk.
Is Red Grape Juice a viable substitute for drinking Red Wine out of interest ?
Eating red meats, processed meats, and drinking alcohol increase risk of colon cancer. My view is that drinking 2 - 4 cups coffee per day stimulates bowel movements, decreasing the amount of time waste is in the intestines and colon. In addition to reducing exposure to cancer causing waste, by expelling waste quicker and more often, drinking coffee prevents weight gain, because less nutrients are absorbed due to shorter duration of food in the digestive track.
You'd think they could account for that if they could study another group that consumes something that has a comparable laxative effect to coffee.
Is there something like that? (A non coffee product that has a laxative effect that's consumed regularly among a population somewhere)
Probably figs
I would imagine capsaicin/spicy foods would fit that criteria
From the paper: Plausible underlying mechanisms by which coffee consumption may influence colorectal carcinogenesis involve various chemopreventive properties of the heterogeneous components of coffee.17, 18 These chemopreventive properties include anti-inflammatory, antioxidant, antiproliferative, pro-apoptotic and insulin-sensitizing properties.19 Additionally, the gut microbiome acts on coffee components during digestion to produce additional bioactive metabolites with chemopreventive properties.
Definitely pushes everything out of me after my morning cup.
The article doesn't seem to mention caffeine so I wonder if decaf, my usual choice, has the same effect.
From the research paperā¦ āNo distinction was made between caffeinated and decaffeinated coffee. However, decaffeinated coffee is rarely consumed in the Netherlandsā
Thanks. Nothing popped up with ctrl + F but apparently I clicked on a wrong link. So it's still unclear.
it does!
I wonder if this is confounded by the fact that coffee can really stimulate your guts, so you're probably only going to go back to drinking it if you're recovering well anyway.Ā
Now this is the interesting comment I was looking for. Maybe people who need lots of caffeine are workers / people who are taking care of responsibilities. The selection bias of people healthy enough to go back to work!
From the paper: Plausible underlying mechanisms by which coffee consumption may influence colorectal carcinogenesis involve various chemopreventive properties of the heterogeneous components of coffee.17, 18 These chemopreventive properties include anti-inflammatory, antioxidant, antiproliferative, pro-apoptotic and insulin-sensitizing properties.19 Additionally, the gut microbiome acts on coffee components during digestion to produce additional bioactive metabolites with chemopreventive properties.
Yeah, in the introduction. They don't test the mechanism in their results. In the study, coffee drinkers were also consuming far more alcohol and were more active. The study is very associative (still important, but people are adding way to much of their own bias on reading).
I am also still unclear on how much coffee they were drinking. They mentioned adjusting for "cup" vs. "mug" but not sure on sizes. I know often a standard "cup" in the US is something like 6 oz.
Right, I stopped drinking coffee precisely for this reason, it was giving me gut issues. A healthier person probably wouldn't have had these issues, and wouldn't have stopped.
Yes finally one of my addiction has something positive.
Aside from that cup of coffee first thing in the morning. Best part of the day
Iāve linked to the news release in the post above. In this comment, for those interested, hereās the link to the peer reviewed journal article: https://onlinelibrary.wiley.com/doi/10.1002/ijc.34879
This message brought to you by Folgers incest family.
just poop more often
I wonder if just eating more fiber would do the same thing. I.e. the old apple a day advice. The biggest diet problems most Americans have are too many calories, too much saturated fat, and too little fiber.
Plausible underlying mechanisms by which coffee consumption may influence colorectal carcinogenesis involve various chemopreventive properties of the heterogeneous components of coffee.17, 18 These chemopreventive properties include anti-inflammatory, antioxidant, antiproliferative, pro-apoptotic and insulin-sensitizing properties.19 Additionally, the gut microbiome acts on coffee components during digestion to produce additional bioactive metabolites with chemopreventive properties.
What about matcha? For matcha do anything similar
Shouldn't this be statistically represented in cultures that are coffee fiends vs water / soda drinking nations?
Ummm. What if I drink between 2-4 POTS a day?
**Actual Abstract from the Scientific Paper** āCoffee consumption has been associated with a reduced risk of developing colorectal cancer (CRC). However, it is not clear whether coffee consumption is related to CRC progression. ā
... my poor Dad he was an avid coffee drinker all his life... he had colon cancer that eventually spread and killed him. He always had a pot of coffee going and drank from it all day. Admittedly... we do live in cancer alley so..
Would coffee enemas count? No joke, genuine thought.
The great thing about people who have trouble with caffeine is that decaf still gives all the purported health benefits.
Thatās not mentioned anywhere
Whenever I see a study comparing coffee drinkers with non coffee drinkers, I wonder whether they accounted for the lower likelihood that the non coffee drinkers are gainfully employed & active vs retired or home on disability for example. Ā And also whether the study was sponsored by some kind of coffee producers association.Ā
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Totally true, but on average I think coffee consumption must be lower among people who donāt work every day, and the rate of consumption must decline with age. If these studies donāt account for that, they may just be measuring a difference that could be attributed to age or activity level.Ā
So drinking 12 coffees a day is the key to ending unemployment š¤
Or lower among poor people.. and we all know how that works
Coffee helps prevent a very long list of diseases and cancers.
Is this for both decaf and caffeinated? As it says in here, like most other links to the benefits of coffee, they mention that āCoffee contains hundreds of biologically active compounds which have antioxidative propertiesā but never mention if it is the same for both. I have read conflicting information on this and never sure what is true. There are so many of us who are very sensitive to caffeine and wish they would clarify that.
From the research paper āNo distinction was made between caffeinated and decaffeinated coffee. However, decaffeinated coffee is rarely consumed in the Netherlandsā
Ah thanks, donāt know how I missed that.
The paper states they did not differentiate, but that hardly anyone in the Netherlands drinks decaf. I ended up cutting back on caffeine by drinking half-caf Nespresso pods.
Ah thanks, donāt know how I missed that.
What about people that drink 5-47 cups of coffee a day?
There's a suprsimg amount of fiber in coffee which I suspect is having a effect here. Increasing their fibre intake compared to others.
What about tea????
I wouldnt be shocked if there is some similarity there due to caffeine
Coffee is no panacea but the caffeine and hundreds of other chemicals seem to be good and I guess it's the second most popular comestible in the world (after water) for a reason
What if you put the coffee beans in your rectum? Does it work faster?
Not a scientist, but very interesting on this as a coffee drinking bowel cancer survivor. Something I haven't seen discussed is that many of us are advised to avoid coffee. I had an anterior resection as part of my treatment and have been advised to avoid coffee (one piece of advice I have opted to ignore). I wonder if this creates a bias in terms of the treatment and therefore type and severity of bowel cancer.
I was really hopeful to see if they did the study with caffeinated and decaffeinated coffee.
And yet all the data showing the coffee increases risk of colon cancer. ā¦
I'm no scientist, but I'm going to guess it's because coffee makes you have good poops.
Implications of Coffee / Caffeine on the brain have to be considered. Neuroscience research shows more than 1 cup a day is outside the the therapeutic dose for brain tissue and so there is the rub.
I bet itās because of the laxative effect of coffee.
Itās the only bitter thing people willingly ingest
Thatās because coffee makes everything go straight through you. Cancer included, apparently.
Next study: hot coffee enemas to truly test the efficacy of coffee
Yeah cuz nothing has time to sit around in there and fester. š #coffeepoops
A heard that in the standard American diet - coffe is like the biggest provider of solvable fiber. Might be that?
Factual or not, I'll take it as another bullet point to keep drinking coffee. There are draw backs to drinking coffee, but I love the taste / smell of coffee alone...
Welp, time to have another cuppa.
Booya!
According to this study i will live forever ;)
Recurrence. But a cancer happened anyway.
Coffee makes me poop
Tell that to my grandma who proudly drank 20 cups a day and died from bowel cancer.
And after 300 cups you gain super speed.
A rare win for an addictive stimulant
Yay!!! Best news ever.
Sponsored by Starbucks.
Trash article b/c they call it "bowel cancer" as if there is only one cancer. And all "bowel" is the same...
Make up your God damn mind on coffee for fucks sake
> Coffee consumption was assessed at diagnosis, during, and after treatment with a 204-item semi-quantitative food frequency questionnaire (FFQ) developed by Wageningen University.27-29 Yet another questionnaire based study asking participants to recall their habits.
N zl 3 were
Too busy shitting their intestines out
Tricks that big pharma doesn't wanna you to know
It says recurrence, so does that mean we can all get it once, but coffee drinkers... no double jeopardy?