Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, September 29, 2026

Coffee's Optimal Liver-Protective Dose

 Since no one can guarantee how much coffee will prevent Parkinsons and dementia I will continue my 12 cup pot of coffee daily! And this covers my social drinking which is vastly increasing my social connections that are going to prevent dementia!

How coffee protects against Parkinson’s Aug. 2014 

Coffee May Lower Your Risk of Dementia Feb. 2013

Coffee drinkers rejoice! Drinking coffee could lower the risk of Alzheimer’s disease 

And this: Coffee's Phenylindanes Fight Alzheimer's Plaque December 2018

New research suggests drinking coffee may reduce the risk of frailty May 2025

I think I'm in this category:  I never get the jitters or flushed skin.

Genetics determine how much coffee you can drink before it goes wrong

I'm doing a 12 cup pot of coffee a day with full fat milk to lessen my chances of dementia and Parkinsons. Tell me EXACTLY how much coffee to drink for that and I'll change. Yep, that is a lot more than the 400mg. suggested limit, I don't care! Preventing dementia and Parkinsons is vastly more important than whatever problems it can cause! 

Of course, your fuckingly incompetent? doctor did nothing with this from 3+ years ago! And still hasn't created a 24 hour coffee station

Dementia risk could drop by drinking just one shot daily of common beverage  August 2023

Coffee's Optimal Liver-Protective Dose

This transcript has been edited for clarity. 

Hello. I'm Dr David Johnson, professor of medicine and chief of gastroenterology at the Eastern Virginia Medical School/Macon & Joan Brock Health Sciences at Old Dominion University in Norfolk, Virginia. 

Coffee is one of the most widely consumed beverages in the world. We enjoy it, as I suspect many of our patients do too. 

Article Key Points
  • 2-4 cups coffee/day captured most liver benefit signal.
  • Cohort: 350k UK Biobank; 13-year follow-up; observational data.
  • Coffee intake linked to ↓ cirrhosis, HCC, and liver-related death.
  • MRI: higher coffee intake associated with ↓ hepatic fat, iron, fibroinflammation.
  • Benefit seen with caffeinated + decaffeinated coffee; sugar/sweeteners unchanged clinical outcomes.
What mechanisms link coffee to reduced hepatic fibrosis?
How does coffee affect MASLD progression longitudinally?
Which coffee compounds drive liver-protective effects?

It's been long associated with certain adverse outcomes. I remember when I was a resident in 1981, a report was published in the New England Journal of Medicine suggesting that coffee was strongly associated with pancreatic cancer. So, the word was: Coffee is bad. 

Since then, observational studies have suggested that coffee may have some health benefits, particularly as we look at inverse associations (more may be better) related to liver diseases. Both cross-sectional and retrospective studies have shown an association between coffee consumption and reduced risks for cirrhosis and hepatocellular carcinoma.

In 2025, the American College of Gastroenterology (ACG) published its most recent guideline on malnutrition and nutritional recommendations in liver disease, which I reviewed on Medscape earlier this year. In that review, I highlighted the ACG’s recommendation of two or more cups of coffee daily to reduce the risk for fibrosis progression or development of hepatocellular carcinoma. That was a conditional recommendation based on a low level of evidence. 

New Study Strengthens the Coffee-Liver Link

Most recently, a report published in Clinical Gastroenterology and Hepatology looked at approximately 350,000 participants in the UK Biobank over a median follow-up of 13 years. The investigators excluded participants diagnosed with cirrhosis or hepatocellular carcinoma at or within a year of enrollment. They also evaluated daily coffee intake, and what they found, I think, was striking. 

For incident cirrhosis, they observed a 20% risk reduction associated with 1-2 cups a day, 35% with 3-4 cups, and 32% with five or more cups.

For incident hepatocellular carcinoma, the risk reductions were 24% with 1-2 cups, 35% with 3-4 cups, and 47% with five or more cups a day. 

Then they looked at liver-related death. The risk reductions were 31% with 1-2 cups, 41% with 3-4 cups, and, not notably greater, 42% with five or more cups. 

Now, why does this make sense? 

Coffee has hundreds of compounds, and it's unclear exactly which specific ones may account for the benefit. They may include polyphenols and other antioxidants that decrease oxidative stress, hepatic cell activation, collagen deposition, and fibrogenesis. 

This particular UK Biobank study looked at some very interesting things beyond the clinical outcomes. The investigators looked at imaging outcomes using MRI. They assessed proton density fat fraction as a measure of hepatic fat and iron-corrected T1 as a marker of hepatic fibroinflammation. Higher coffee intake was associated with lower hepatic fat, iron, and fibroinflammation. 

Then they further backed this up with proteomic profiling. The markers they analyzed consistently changed in a favorable direction with coffee consumption. Higher coffee intake was associated with higher levels of proteins related to hepatocellular synthesis and complement proteins associated with hepatic health and regeneration, and lower levels of fibrogenic and macrophage-activation markers associated with fibrosis and progression. All of these changes were favorable.

Importantly, caffeine did not appear to be solely responsible. The favorable associations were similar with caffeinated and decaffeinated coffee. 

The investigators also looked at the addition of sugar or artificial sweeteners, not something we would endorse if it can be avoided, particularly for our patients with metabolic dysfunction-associated steatotic liver disease (MASLD). Nonetheless, adding sugar or artificial sweeteners did not significantly alter the associations with incident cirrhosis, hepatocellular carcinoma, or liver-related death.

There were some differences in MRI measures, including iron-corrected T1, but not in the three clinical outcomes I just mentioned. 

When I talk to my patients about this and ask them about coffee, some will say, "Well, I don't drink coffee.” So, then I will ask them about tea.

There is some evidence regarding tea, and a benefit is biologically plausible. A 2025 UK Biobank study suggested favorable associations with hepatic fat and other imaging measures, but not necessarily with clinical fibrotic liver disease.

Let’s return to the recommendations. Neither the 2025 ACG guideline nor the 2024 European Association for the Study of the Liver recommendations suggest tea as an alternative. 

Coffee is really the beverage that should be at the forefront of this discussion.

How Much Should We Emphasize Coffee?

It's important to tell patients that coffee may be helpful, but it's also important for them to understand that it is not the entire treatment. 

For fatty liver disease, we're talking about metabolic risk factors and weight reduction, and perhaps targeted treatment of MASLD. We now have therapies and lifestyle interventions that really go hand in hand. Coffee does not treat MASLD, nor does coffee reverse fibrosis. 

These impressive clinical data are observational, and residual confounding remains possible. 

But what does the data suggest? Certainly, 2-4 cups of coffee a day appear to capture much of the observed benefit. The ACG recommendation is for two or more cups, and the more recent data recommend perhaps 3-4 cups a day. 

Coffee seems to have an impressive association with a reduced risk for cirrhosis and other adverse liver outcomes. So, more is less. If you like coffee, java up. 

Put this in perspective however, when you talk with your patients. We need to look comprehensively at the other factors that may be influencing their liver disease and related outcomes. 

I’m Dr David Johnson. Thanks again for listening.

David A. Johnson, MD, a regular contributor to Medscape, is professor of medicine and chief of gastroenterology at Eastern Virginia Medical School/Macon & Joan Brock Virginia Health Sciences at Old Dominion University in Norfolk, Virginia, and a past president of the American College of Gastroenterology. His primary focus is the clinical practice of gastroenterology. He has published extensively in the internal medicine/gastroenterology literature, with principal research interests in esophageal and colon disease, and more recently in sleep and microbiome effects on gastrointestinal health and disease. 


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