 To the latest edition of Tell Health in Hawaii, I hope everyone had a healthy, safe, and fun July 4th weekend. Back by popular demand, my friend, physician, researcher, author, leader from Harvard Medical School, Dr. Sanjiv Chopra is on the show. Dr. Chopra, how are you? It's good to see you again. I'm doing very well. Thank you so much. I'm honored to be on your show again, looking forward to it. Well, we're happy to have you back. Very happy to have you back. Today, it's a great subject, one that I'm gonna enjoy as well as many others around the subject of coffee and how coffee can help improve your health. Here's the book written by Dr. Chopra, Coffee, The Magical Elixir, Facts That Will Astound and Perk You Up. To get things started, Dr. Chopra, provide us a little bit about your background, where you're from, your role as a physician, and we'll go from there. Yeah, so I went to high school in New Delhi, St. Columbus High School, did pre-med at Delhi University, Antraj College. Then I joined the All-Indian Institute of Medical Sciences in 1966. And then after graduating, came to America in 1972 and did a year of internship, medical internship in New Jersey. And then moved to Boston in 73. I've been in Boston since then. I've been very fortunate and privileged to have been at Harvard Medical School for more than 40 years and even served as the faculty dean for continuing medical education for 12 years. My specialty is liver disease, but I also speak many countries and in America giving keynotes on diverse topics, leadership, microbiome, man and medicine, happiness in living with purpose, invitation to good health, and in the invitation to good health, the first topic I touch upon is coffee. And I got intrigued about coffee some 20 plus years ago. I'm a liver specialist. And I read an article in gastroenterology that people who drink coffee have low levels of liver enzymes. So when we go and see our primary care clinician once a year for a regular checkup, they do a battery of tests, they check up blood counts and thyroid function and cholesterol, but also a liver function profile and two enzymes, ALT and AST, if they're high, it almost always signals that something going on with the liver. But coffee drinkers had low levels. What does that mean? Coffee protective, is it an artifact? And then the next study came that people who drink coffee have less fibrosis or scarring of the liver. The next study, drink two cups of regular coffee a day, 50% reduction in hospitalization and mortality from chronic liver disease. Maybe 2 billion people in the world have chronic liver disease. And then the next study, that if you drink two cups of regular coffee a day, 40% reduction in death from primary liver cancer. Primary liver cancer is the third leading cause of cancer mortality in the world. And in 10 countries, including Vietnam, China, Mongolia, Egypt, it's the number one cause of cancer death. You drink coffee, you lower the risk. So that's why I wrote the book because more and more research is coming out. They are mechanistic explanations and there's a dose dependent effect. It's just amazing research that you've done around coffee. And sometimes when people drink too much coffee, doctors will tell you that you get jittery or your blood pressure starts to go up or you shouldn't be careful when it comes to your intake or for your heart function. How do you balance that out with the liver function and some of the results that you've seen for people that wanna drink coffee but are worried about some of those things aspects of it? Yeah, that's a great question. And I think we all need to be cognizant that coffee, although I call it a magical elixir or a soup of food, that there can be side effects. And they're not that frequent, but they do occur. And the first one is heartburn, gastroesophageal reflux disease. And it has nothing to do with the caffeine. So decaf coffee will give you the same heartburn. So be wary about that. Number two, a lot of people in Somnia, if they drink coffee after three o'clock or four o'clock, they will be up all night. Some people will get anxiety. Some people will get a tremor. Some people will get an increase in their pulse rate and in their blood pressure. The blood pressure rise is minuscule. It's only one or two millimeters. And we develop something called tolerance. So once we keep drinking coffee, after a while the blood pressure doesn't go up. The heart, we used to worry. Will it lead to cardiac arrhythmias? A very common cardiac arrhythmia, abnormal rhythm, is as you know, atrial fibrillation. And if it is uncorrected, it leads to a higher risk of stroke. Well, there are now studies saying that coffee is actually good for the heart. That coffee drinkers have no risk of atrial fibrillation. So everything that sounds good or bad, often when the research comes out, it's contrary. So coffee has so many amazing health benefits and lower mortality. So the benefits far, far outweigh the side effects, but be careful. I drink three to four cups of regular coffee a day. By three o'clock or four o'clock, Eastern Standard Time, I'm done. I don't drink anymore. I don't even chance drinking decaf at a restaurant. You're not sure what they're pouring in that cup. And I think my recommendation is that people should drink two to four cups of regular, has much more health benefits, much more robust. If you're not a coffee drinker, start slowly. You know, start with half a cup. Start then get up to one cup. After a week, get up to one and a half. At the end of a month or two, if you can get to two to three, you're doing great. Walter, the French philosopher, had some of the best sayings. He said, every man is guilty of all the good he did not do. He said, cherish those who seek the truth, but beware of those who find it. What a great quote. Now, Walter lived, he was born in 1694 and passed away in 1778 at the ripe old age of 83 years. And life expectancy back then, mean life expectancy was probably in the 40s. And it's not proof that he lived to 83 because he drank a lot of coffee. But you will never guess how much coffee he drank. And when I ask people, and because I'm asking, some people say six, 10, you know, the answer, and you can look this up, 52 cups of coffee a day. What? 52? 52. Now, some people say, Dr. Chopra, what size? And I say, it doesn't matter. Even if it's this much, 52 adds up to a lot. Jefferson drank a lot of coffee. Teddy Roosevelt drank a lot of coffee and he actually had a very, very large mug. And his grandson once said, grandpa's coffee mug is so big, it is akin to a bathtub. Huge mug of coffee. So right now it's the number one, probably the number one beverage consumed in the world, 2.25 billion cups of coffee consumed every day. One of the worst things we can drink is soda and diet drinks, diet soda changes the gut microbiome, the hundred trillion bacteria in our gut. And there's actually a three times risk of heart attack and stroke with diet drinks. So don't drink that, please. If you want to drink a soda once in a while, drink a coke, drink half of it, but the best drink is water and then coffee. And Coca-Cola has seen the sign. They bought Costa, which is a chain of coffee shops. If you go to Europe, at any airport, you'll see a whole bunch of Costa coffee, Costa coffee. About two years ago for close to $4 billion. Pepsi is coming out with a coffee-infused drink. Two years ago, more than $1 billion dollars were invested in new coffee startups in America. So the science is caught up in the last 20, 30 years ago. There was a big scare about 20 plus years ago in the New England Journal of Medicine, nartical linking coffee with pancreatic cancer, which is one of the most deadly cancers. And it got debunked in the next six months with multiple studies. But you know what? Negativity is very heavily weighted. And I have physician friends, when I have talked to them about health benefits of coffee, Sanjeev, isn't there a link with pancreatic cancer? They still remember that article and don't remember the articles that came out in the next six months, saying that study was broad and the other's research has shown no link. And now we know that coffee drinkers have a lower risk of seven common cancers. Very astounding. Head and neck cancer, breast cancer, colon cancer, endometrial cancer, skin cancer, prostate cancer, and primary liver cancer. And a recent study about a year ago in JAMA, Journal of the American Medical Association on Collegy, just floored me. It said patients with advanced colon cancer, so sorry, metastatic had spread to the liver and distant organs from the colon, who drink coffee, including decaf coffee, have improved disease-free survival. What? They live longer and those dependent. So four cups better than three, three better than two, which always add credibility to the study. Now, for those that like to put cream and sugar in their coffee, what do you tell them? You know, they like the coffee and... Yeah, it's very... What do we do about that? I think if somebody doesn't have diabetes and they want to put sugar, go ahead. You want to put a little bit of cream, go ahead. The one thing you should never, never do is put artificial sweeteners. Okay, I drink it black. It makes it easy. I don't have to worry that the milk is not hot and I add cold milk and now my coffee isn't that piping hot. I drink it black. And for friends of mine who have suggested that, they said, you know, Sanjeev, you were so right. After two weeks, I don't miss the sugar. I don't miss the milk. I was on a TV show called Chronicle, which is an award-winning ABC show in Boston. And Nicole Esther Fan, she's interviewed me previously of other books, came to my home and interviewed me. And sort of the last question was, what is the best way to drink coffee? And I said, Nicole, the best way to drink coffee is to drink coffee with a friend. It went viral. I said, no, let me be serious now. Drink it black. That's how I suggest you drink coffee. Now, what about if we start into the world of espresso? You know, some people like espresso, some people like espresso over coffee or they like espresso in their coffee. What are your thoughts on espresso? Yeah, so I have in the book, Coffee, the Magical, Elixir, Facts, Ethereal, Astronomy, Percure, all the different kinds of coffee and what it means and a short description of each. And I think Light was shared on this about four years ago in the annals of internal medicine. There were two articles on coffee and an editorial on coffee. And one of the articles was looking at more than half a million subjects in Europe, in 10 countries where they drink the coffee differently, they make it differently. It didn't matter. Men and women had lower total and cost specific mortality. If longer, the other study was, by the way, from Hawaii with more than 200,000 subjects, published in the same issue of the annals of internal medicine. And what was neat about this was there were different ethnic groups. So there were Caucasians, there were Hispanics, there were Asian-Americans, didn't matter. You drink coffee, men and women, you live long. So if you like to have espresso or cappuccino, you want a latte, you want an Americano, go ahead, enjoy it. So that's interesting. So it doesn't matter what type of coffee I drink. It could be any one of those that you described. Yeah, anyone organic may be healthier, that is not proven yet. Instant coffee is not as healthy as regular coffee. Dark roast is probably not the way to drink your coffee. Dark roast is very consistent. So people like it. They say every time they order a dark roast at whatever coffee shop they go, it's the same. But it turns out in the process of dark roasting it, one actually destroys some of the health constituents. So if you want to have medium or light roast, don't have dark roast. Don't have instant coffee, have regular coffee. Now, when you're working with your patients who may have fatty liver disease, for example, do you tell them, obviously, the benefits of coffee, but concurrently at the same time, improve your diet and reduce the alcohol intake? So there's a couple of things you want to do. Absolutely, very good question. So non-alcoholic fatty liver disease is now the dominant chronic liver disease in the world. It is estimated that a hundred million Americans have non-alcoholic fatty liver disease. We have four year olds in our country with fatty liver. We have 16 year olds where it's beyond fatty liver. They now even have inflammation. And then we have 28 and 30 year olds developing cirrhosis and liver failure and coming to a liver transplant. It is the number one or two indication for liver transplant in our country, Nash cirrhosis, liver failure. And the estimate in the world is that there may be 1.5 billion people in the world with non-alcoholic fatty liver disease. So what do we do? We have to make sure that they get the hepatitis A and B vaccine if they don't have protective antibodies against those two viruses. If you already have liver disease and on top of it, you get another superimposed acute infection. It can be very serious. So that's number one. Number two, take vitamin D. Vitamin D deficiency has been linked to aggressive non-alcoholic fatty liver disease. Number three, drink coffee. Drink two cups if you can even drink two cups. There's a study published that in patients with non-alcoholic fatty liver disease, the one variable that is associated with the least amount of scarring in the liver is the ones who drink coffee. Pretty astounding. So if you drink coffee, chances are you won't develop cirrhosis and need a liver transplant. Number four, you gotta lose weight. And the important thing about weight loss is that if somebody is 100 pounds overweight, they don't need to lose 80 pounds, 100 pounds to see improvement. They lose 10, 15, 18 pounds marked improvement in liver function, blood pressure, cholesterol, triglycerides. Now the extreme treatment for weight loss is bariatric surgery. So patients who are significantly overweight have diabetes, other complications. And guess what happens? 60% of the time, the liver improves dramatically at the end of the year, including reversal of early cirrhosis. We used to think cirrhosis is end stage irreversible. It's not. Now we should get to bariatric surgery, but it's the one surgical procedure that's been shown to increase longevity compared to the same patients who don't undergo bariatric surgery. Recent article three or four weeks ago that obesity-related cancer deaths. So obesity is linked to multiple cancers. And if patients have cancer and obesity, they're worse off than the patients with the same cancer or not obese. So this study, obesity-related cancer deaths, plummeted. And it's very important for people to understand that start the journey. Don't worry about the end goal that you need to lose 60, 80 pounds, 50 pounds, 40 pounds. There is a new drug now. It's Zepetite. And this is absolutely astounding. I will predict that this will be a trillion dollar drug because they used it in three doses, five, 10, 15 milligrams per kilogram given once a week as an injection. At the end of 72 weeks, very well-tolerated, minimal side effects. The patients on the lower dose had lost about 32 pounds. Intermediate dose, 42 pounds. And the higher dose, 52 pounds. This is going to be a game changer. It may put bariatric surgeons out of business. Now it will be expensive when it first gets in the market. It's going to be approved. If it hasn't been approved recently, it will be approved very soon. It's Zepetite and it'll be expensive. But in the long run, it will be worth it. Bariatric surgery, at the end of two years, the decrease in medical problems, the decrease in medications taken by patients, pays for the bariatric surgery. So this drug will do something similar. I'm sure for lowering your weight can also help those that may have a combination of fatty liver and diabetes as well, correct? Oh yeah, oh yeah. Actually, for diabetes, people who lose weight and people often ask, what's the best diet? The best diet is the one the patient can adhere to. Right, they all work. But if you take it and after three weeks, you say, oh my God, I'm bored. I can have this diet for the rest of my life. What good was it? So the best diet is the one you can adhere to, but intermittent fasting, Mediterranean diet, plant-based diet, less red meat, more fruits, vegetables. Fruit juices increase the risk of type 2 diabetes. Eating fruits decreases the risk. There are three patients that we wrote about in our book on diabetes, who went on intermittent fasting, which means you don't eat for 16 hours. So if my last morsel of food is 6 p.m. this evening, I don't eat anything till 10 a.m. tomorrow morning. I can have black coffee in the morning. And you lose weight. You eat in an eight-hour period. And by the way, you can eat what you want and how much you want. You lose weight. Three patients with type 2 diabetes on insulin came off insulin. One of them had been on insulin for 25 years. So meet with the nutritionist, dietitian, learn about the different diets, see what suits you, do it, it'll improve your health. Amazing. Everything, from your blood pressure, to your cholesterol, to your heart, to your liver, to your joints, to your bones. You know, for the knee, if somebody is 50 pounds overweight, that is like having, it's Laplace's law in physics applies to the knee. If you're going up, down, standing, walking, you multiply by seven. The amount of pressure on the knee is not 50 pounds extra, it's 350. Now the beauty of that is, if you lose 20 pounds, you take away 140 pounds of pressure on your knees. I know people who have avoided bilateral total knee replacement, bone on bone, by losing weight, working with a personal trainer, doing exercises. So weight loss is amazing, the benefits. Now, you're a hepatologist, you're a liver doctor. Those that, patients that you see through telehealth, or through in-person visits, how does someone get access to a hepatologist, a liver doctor, to ask these questions and manage these types of conditions? How do you access someone like yourself? I think, usually the patients are referred from a primary care physician, or sometimes it's somebody on the board at the hospital and they have a friend or colleague in this, they can you please see so and so on, of course you do. Sometimes people have read my book, the liver book or the big five, and they will seek me out. I'm also the editor in chief of the hepatology section of Up to Date, which is an electronic textbook that has more than 100,000 pages. And I recruited 200 of my colleagues from around the world to contribute. It's called Up to Date because it is virtually updated every single week, every single week. So for textbook of liver disease comes out today and it has 70 chapters. The editor in chief, she or he was held hostage by the slowest contributor and the book is already outdated a year or two. So Up to Date is electronic. We have a team of five, six associate editors who between them scan 50 journals. And if they see something new of relevance to a particular topic, they insert it, they send it to me as the editor in chief to the section editor and the author. We're given two weeks to look at it and approve or modify it, it's done. So it's constantly updated. It is now subscribed to by 1.5 million physicians in 195 countries. My colleague, Burton Rose, who founded this company Up to Date, people referred to him as the Steve Jobs of medicine. Some people nominated him for the Nobel Prize in medicine or physiology. Brilliant man, way ahead of his time. So Up to Date also by the way has patient information. And it's geared to people at the 5th grade level. So we have lots of information there. So almost every day on my computer, on my iPhone, I get an email from Up to Date. This card needs to be updated. This one, this author has added this to your proof. So without much effort, I'm getting updated all the time. You know, I happened to have won a number of prestigious awards by the American Gastroenterology Association, Harvard Medical School, American College of Physicians. Now when I go as a visiting professor, they don't mention any of those. They say Sanjeev is the editor-in-chief of Hepatology Up to Date. It's an amazing thing that he conceived 20 years ago and playing tennis. And it was supposed to be just for the house staff at the Brigham and Women's Hospital. You know, they ask a question. What is the natural history of somebody with asymptomatic gallstones? Gallstones were discovered by chance. Somebody had blood in the urine. They did an ultrasound and not the liver or gallstones. What's the natural history? And if they want to look it up in a textbook, it takes time. There's a small section, it's outdated. So let's develop this stuff. Amazing individual. 10 years later, it was bought by Walter's Clure for $500 million. And as I go to the annual meeting and some years ago, I said, I have one major complaint. I get very good royalty, but Up to Date is the best program of its kind in the world, but it's not the best program for the world. You people are prohibitively expensive. The average physician in Cuba makes $30 a month and you're selling it for $400 a year. Come on, give it away. Knowledge belongs in the domain of the seeker. And number two, you need to translate it. And you can do it these days into Mandarin and Spanish. Then you have the whole world. So now it's being translated into Mandarin, but it's an amazing, amazing invention. Dr. Chopra, you always take the time for us. And despite your hectic schedule, being a physician, speaking, writing, and everything in between, you always take the time for us to break down very important health concepts, diabetes, the benefits of coffee. And we really, I personally really appreciate you coming on the show. Oh, thank you very much. It's my honor, I'm thrilled. I'm thrilled. We're definitely gonna have you back on soon to discuss more topics around liver. But now, we appreciate your time and for our audience, coffee, the magical elixir. By Dr. Sanjeev Chopra. Thank you very much, Dr. Chopra, for being on the show. We appreciate you very much. Absolutely, great to be on the show. All the best. You too. Thank you. Thank you so much for watching Think Tech Hawaii. If you like what we do, please like us and click the subscribe button on YouTube and the follow button on Vimeo. You can also follow us on Facebook, Instagram, Twitter, and LinkedIn, and donate to us at thinktechhawaii.com.