It Depends - Coffee vs Tea

I'm working on a book. One of the chapters will be Coffee vs Tea.

Thought it would be fun to preview some of the content. I'll try turning this into a Tweetorial. (17 in 🧵)

Several polls, several fun facts.

Are you a coffee or a tea drinker?
Coffee vs Tea and health

Which do you think is a HEALTHIER choice?

2/17
How many of you paused in trying to answer the previous question thinking.....it depends?

Doesn't it depend on what you add?
Maybe even what type of coffee or tea?

Most common additions, sweetener & dairy

Start with sweetener, do you add:

3/17
How about dairy or dairy substitute?

Do you add......?

4/17
So, let's say the comparison is between mocha-frappa-crappa-cino, and green tea. Which is healthier?

(no poll, just a picture, assuming everyone gets this one right) 🤣

5/17
How about black coffee vs. Boba/bubble tea?
Which is healthier?

(again, no poll. Confident you got this one too)

7/17
How about mocha-frappa-crappa-cino vs. Bubble tea?
Which do you think is healthier?

Or, do you think this is no longer a question of coffee vs. tea. Isn't this is more of a question of which sugar and dairy delivery system is less unhealthy (double negative intended)? 😱

8/17
Obviously context matters.
If we are going to ask whether coffee or tea is healthier, we'd have to provide that additional context of:

"With what?"

And "Instead of what?"

So, let's go head to head, black coffee vs green tea, with no additives

9/17
In the book chapter, I will cover -
Cultural context
Evidence for plausible mechanisms of benefit or harm
Environmental factors
Labeling

...and then revisit the question - Is Coffee or Tea "Better" with more context.

10/17
Evidence for plausible mechanisms of benefit or harm:

For coffee this discussion would include components such as caffeine, chlorogenic acid, cafestol and kahweol

11/17
Evidence for plausible mechanisms of benefit or harm:

For tea this discussion would include a family of antioxidants.

12/17
A 2017 meta-analysis in BMJ concludes coffee is probably healthy.

There is obviously a dose issue.
The conclusion is 3-4 cups/day is optimal.

RCT's lacking.
Who's gonna agree to be randomized to drink it or avoid it for several decades?!
Not me.
Don't hold your breath for RCT.
A 2019 meta-analysis in Mol Nutr Food Res concludes tea is probably healthy.

There's obviously a dose issue
Conclusion is 2-3 cups/d is optimal

RCT's lacking
Who's gonna agree to be randomized to drink it or avoid it for several decades?!
Not me.
Don't hold your breath for RCT
For the Eco-Warriors out there, a coffee vs. tea comparison would include consideration of impacts on green house gas emissions, water usage, and more.

(Hint: not much difference between them, according to
Oxfam, 2016, Feeding Climate Change)

15/17
Possibly helping with the eco-warrior claims and issues, there are various labels used for coffees and teas.

In the book I discuss a bit about verification, use, and cost.

16/17
For final conclusion you'll have to buy the book (if I ever finish writing it). 🤦‍♂️

Is Coffee or Tea "Better"?
IT DEPENDS!
With what?
Instead of what?
What dose?

Purpose of the book is to show that controversial nutrition topics are much less so after considering proper CONTEXT.

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More from @GardnerPhD

Mar 13, 2021
#KetoMedStudy
Week #5
1/5

For past 4 wks, we've been sharing study design details of forthcoming Keto vs Mediterranean Study

This week, we want to share the 36-wk time point & get your thoughts.

Poll on next post in thread - vote on time point you think is most interesting 🤔
2/5
Which is most interesting?

Adherence best at Wk #4 of each phase (food delivered)
⬆️rigor (efficacy)

Wk #12 of each phase
⬆️generalizabilty

36 wk - reality check (effectiveness)
Who is following what?
3/5

Caveat

Primary outcome=HbA1c (ct.gov)
12wk Keto vs 12wk Med, relative to baseline

HbA1c not appropriate for assessing 4 wk change

We have Hba1c @ wks 0, 12, 24 & 36
We have CGM glucose @ wks 0, 4, 12, 16, 24

(Not enuf $$ to get CGM @ wk 36) 🙁
Read 5 tweets
Feb 13, 2021
1/9
Just completed trial
Keto vs Mediterranean

Just submitted Design & Adherence paper PRIOR to main results paper

While waiting for reviews & decision…
 ~10 weekly mini-threads - #KetoMedStudy

⬆️design understanding &
⬆️twitter civility?🙏
 
Week #1
Main study question Image
2/9
US calories: 1999-2016
pubmed.ncbi.nlm.nih.gov/31550032/

Low quality carbs
Added sugars, refined grains: ~40%

High quality carbs (whole grains, legumes, fruits): ~10%

3 types fat: ~10% each

Protein: Animal ~10%; plant ~5%

***Biggest impact potential - ⬇️ low quality carbs Image
3/9
Most/all healthy diet patterns recommend avoiding/minimizing added sugars & refined grains, while including non-starchy vegetables

Is there additional overall health benefit to also eliminating:
*Legumes/beans
*Whole intact grains
*Fruits

Poll next tweet Image
Read 9 tweets
Sep 30, 2019
Series of 6 papers published today in Ann Int Med from “NutriRECS” group.

They recommend people continue to consume unprocessed & processed red meat at current rates

I disagree, in USA

My perspective - in 17 tweets
#ReduceRedMeat in USA

n.pr/2mkxWN7
2 of 17

I seek to dispute it
As does @TrueHealthINIT & @HSPHnutrition

It isn’t hard
3 of 17

The recommendations are stated to be “weak, with low-certainty evidence”.
I agree.

Beyond weak, they are reckless.
They will confuse the public & undermine scientific credibility.
Potential to harm public health & environment.
Read 17 tweets
Jun 6, 2019
Apologies for not responding sooner with specifics to @bigfatsurprise @ProfTimNoakes with specifics.
Here are some......
Fundamental flaw
Yes, RCT’s are design w/ highest causal inference
But many topics can’t be studied w/ RCT
Can’t randomly assign & follow until morbidity/mortality:
*Cigarettes & lung cancer
*Parachutes when sky diving
*Vegan/Vegetarian
Lack of RCT does not = lack of evidence
Claim about review of nutritional epi findings-“0% [to 20%] confirmed in clinical trials”
Refuted?
Or not conducted?
There are very few RCT nutrition trials w/ hard outcomes
Most are done with supplements, not foods
Not surprising that few are “confirmed” if few are “conducted”
Read 12 tweets

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