 Decades ago, a group of researchers in Norway came upon an unexpected finding. Alcohol consumption was associated with liver inflammation, no surprise, but a strong protective association was found for coffee consumption. These findings were replicated in the US and around the world. Those who risked for liver disease, those who drank a lot of alcohol, or were overweight, and therefore at risk for fatty liver disease, appeared to cut the risk in half if they drank more than two cups of coffee a day. Liver cancer is one of the most feared complications of liver inflammation. Hepatocellular carcinoma is the third leading cause of cancer death. Furthermore, it has a rapidly rising incidence in the United States and Europe, largely driven by the burden of hepatitis C infection and fatty liver disease. Putting together all the best studies done today, those drinking the most coffee had half the risk of liver cancer compared to those that drank the least. Since this meta-analysis was published, a new study found that male smokers may be able to cut the risk of liver cancer more than 90% by drinking four more cups of coffee a day. Of course, they could have also stopped smoking. It's like if you look at heavy drinkers of alcohol. Drinking more coffee may decrease liver inflammation, but not as much as drinking less alcohol. Liver cancers are among the most avoidable cancers through hepatitis B vaccination, controlled hepatitis C transmission, and reduction of alcohol drinking. These three measures could, in principle, wipe out 90% of liver cancers worldwide. It remains unclear whether coffee drinking has an additional role on top of that, but in any case, such a role will be limited compared to preventing liver damage in the first place. But if we already have hep C, or are among the 30% of Americans with non-alcoholic fatty liver disease due to obesity, which may quadruple one's risk of dying from liver cancer. Well, coffee seems to help with hepatitis C. Reducing liver damage, disease activity, and mortality seems to help reduce the risk of developing liver cancer. Only the lack of randomized trials, interventional studies on the topic prevents us from considering the protective effect of coffee as fully ascertained. But we didn't have such trials until now. A randomized controlled trial on the effects of coffee consumption in chronic hepatitis C. 40 patients with chronic hep C were randomized into two groups. The first consumed four cups of coffee a day for 30 days, while the second group remained coffee abstinent. And then the group switched for the second month. Now, two months is too soon to detect changes in cancer rates, but they were able to demonstrate that coffee consumption reduces oxidative DNA damage, increases the death of virus-infected cells, stabilized the chromosomes, and reduces fibrosis, all of which could explain the role coffee appears to play in reducing the risk of disease progression and of evolution to cancer. So, is it time to write a prescription for coffee? For those at risk for liver disease? Some say no. Although the results are promising, additional work is needed to identify which specific component of coffee is the contributing factor in reducing liver disease and related mortality. There are more than 1,000 compounds that could be responsible for its beneficial effects. That's such a pharmacological worldview. Why do we have to know exactly what it is in the coffee bean before we can start using it to help people? Yes, more studies are needed, but in the interim, moderate daily unsweetened coffee ingestion is a reasonable adjunct to therapy for people at high risk, such as those with fatty disease. Yes, daily consumption of caffeinated beverages can lead to physical dependence. Caffeine withdrawal symptoms can include days of headaches, fatigue, difficulty with concentration, mood disturbances, but this dependence could be a good thing. The tendency for coffee to promote habitual daily consumption may ultimately turn out to be advantageous if its myriad potential health benefits are confirmed.