Coffee

From Wikipedia, the free encyclopedia

[http://en.wikipedia.org/wiki/Coffee]

Coffee is a widely-consumed stimulant beverage prepared from roasted seeds, commonly called coffee
beans, of the coffee plant. Coffee was first consumed in the 9th century, when it was discovered in the
highlands of Ethiopia.[1] From there, it spread to Egypt and Yemen, and by the 15th century had reached
Azerbaijan, Persia, Turkey, and northern Africa. From the Muslim world, coffee spread to Italy, then to
the rest of Europe, Indonesia and the Americas.[2] Today, coffee is one of the most popular beverages
worldwide.[3]

Coffee berries, which contain the coffee bean, are produced by several species of small evergreen bush
of the genus Coffea. The two most commonly grown species are Coffea canephora (also known as
Coffea robusta) and Coffea arabica. These are cultivated in Latin America, Southeast Asia, and Africa.
Once ripe, coffee berries are picked, processed, and dried. The seeds are then roasted, undergoing
several physical and chemical changes. They are roasted to varying degrees, depending on the desired
flavor. They are then ground and brewed to create coffee. Coffee can be prepared and presented in a
variety of ways.

Coffee has played an important role in many societies throughout modern history. In Africa and Yemen,
it was used in religious ceremonies. As a result, the Ethiopian Church banned its consumption until the
reign of Emperor Menelik II of Ethiopia.[4] It was banned in Ottoman Turkey in the 17th century for
political reasons,[5] and was associated with rebellious political activities in Europe.

Coffee is an important export commodity. In 2004, coffee was the top agricultural export for 12
countries,[6] and in 2005, it was the world's seventh largest legal agricultural export by value.[7]

Some controversy is associated with coffee cultivation and its impact on the environment. Many studies
have examined the relationship between coffee consumption and certain medical conditions; whether the
effects of coffee are positive or negative is still disputed.[8]

Etymology

The English word coffee first came to be used in the early- to mid-1600s, but early forms of the word
date to the last decade of the 1500s.[9] It comes from the Italian caffè. The term was introduced to Europe
via the Ottoman Turkish kahve which is in turn derived from the Arabic: ‫قهوة‬, qahweh.[10][11] The origin
of the Arabic term is uncertain; it is either derived from the name of the Kaffa region in western
Ethiopia, where coffee was cultivated, or by a truncation of qahwat al-būnn, meaning "wine of the bean"
in Arabic. In Eritrea, "būnn" (also meaning "wine of the bean" in Tigrinya) is used.[12] The Amharic and
Afan Oromo name for coffee is bunna.

History

Over the door of a Leipzig coffeeshop is a sculptural representation of a man in Turkish dress receiving
a cup of coffee from a boy.
Coffee use can be traced at least to as early as the 9th century, when it appeared in the highlands of
Ethiopia.[1] According to legend, Ethiopian shepherds were the first to observe the influence of the
caffeine in coffee beans when the goats appeared to "dance" and to have an increased level of energy
after consuming wild coffee berries.[13] The legend names the shepherd "Kaldi." From Ethiopia, coffee
spread to Egypt and Yemen.[14] It was in Arabia that coffee beans were first roasted and brewed similarly
as they are today. By the 15th century, it had reached the rest of the Middle East, Persia, Turkey, and
northern Africa.

In 1583, Leonhard Rauwolf, a German physician, gave this description of coffee after returning from a
ten year trip to the Near East:[15]

A beverage as black as ink, useful against numerous illnesses, particularly those of the
“ stomach. Its consumers take it in the morning, quite frankly, in a porcelain cup that is passed
around and from which each one drinks a cupful. It is composed of water and the fruit from
a bush called bunnu. ”
From the Muslim world, coffee spread to Italy. The thriving trade between Venice and North Africa,
Egypt, and the Middle East brought many goods, including coffee, to the Venetian port. From Venice, it
was introduced to the rest of Europe. Coffee became more widely accepted after it was deemed a
Christian beverage by Pope Clement VIII in 1600, despite appeals to ban the "Muslim drink". The first
European coffee house opened in Italy in 1645.[2] The Dutch were the first to import coffee on a large
scale, and they were among the first to defy the Arab prohibition on the exportation of plants or
unroasted seeds when Pieter van den Broeck smuggled seedlings from Aden into Europe in 1616.[16] The
Dutch later grew the crop in Java and Ceylon.[17] The first exports of Indonesian coffee from Java to the
Netherlands occurred in 1711. [18] Through the efforts of the British East India Company, coffee became
popular in England as well. It was introduced in France in 1657, and in Austria and Poland after the
1683 Battle of Vienna, when coffee was captured from supplies of the defeated Turks.[19]

When coffee reached North America during the colonial period, it was initially not as successful as it
had been in Europe. During the Revolutionary War, however, the demand for coffee increased so much
that dealers had to hoard their scarce supplies and raise prices dramatically; this was partly due to the
reduced availability of tea from British merchants.[20] After the War of 1812, during which Britain
temporarily cut off access to tea imports, the Americans' taste for coffee grew, and high demand during
the American Civil War together with advances in brewing technology secured the position of coffee as
an everyday commodity in the United States.[21]

Noted as one of the world’s largest, most valuable, legally traded commodities after oil, coffee has
become a vital cash crop for many Third World countries. Over one hundred million people in
developing countries have become dependent on coffee as the primary source of income (Ponte 1).
Coffee has become the primary export and backbone for African countries like Uganda, Burundi,
Rwanda, and Ethiopia[22] as well as many Central American countries (1)

Biology

The Coffea plant is native to subtropical Africa and southern Asia.[23] It belongs to a genus of 10 species
of flowering plants of the family Rubiaceae. It is an evergreen shrub or small tree that may grow
5 meters (16 ft) tall when unpruned. The leaves are dark green and glossy, usually 10–15 centimeters
(3.9–5.9 in) long and 6.0 centimeters (2.4 in) wide. It produces clusters of fragrant, white flowers that
bloom simultaneously. The fruit berry is oval, about 1.5 centimeters (0.6 in) long,[24] and green when
immature, but ripens to yellow, then crimson, becoming black on drying. Each berry usually contains
two seeds, but from 5 to 10 percent of the berries [25] have only one; these are called peaberries.[26] Berries
ripen in seven to nine months.

Cultivation

Coffee is usually propagated by seeds. The traditional method of planting coffee is to put 20 seeds in
each hole at the beginning of the rainy season; half are eliminated naturally. Coffee is often intercropped
with food crops, such as corn, beans, or rice, during the first few years of cultivation.[24]

The two main cultivated species of the coffee plant are Coffea canephora and Coffea arabica. Arabica
coffee (from C. arabica) is considered more suitable for drinking than robusta coffee (from C.
canephora); robusta tends to be bitter and have less flavor than arabica. For this reason, about three-
quarters of coffee cultivated worldwide is C. arabica.[23] However, C. canephora is less susceptible to
disease than C. arabica and can be cultivated in environments where C. arabica will not thrive. Robusta
coffee also contains about 40–50 percent more caffeine than arabica.[1] For this reason, it is used as an
inexpensive substitute for arabica in many commercial coffee blends. Good quality robustas are used in
some espresso blends to provide a better foam head and to lower the ingredient cost. [27] Other cultivated
species include Coffea liberica and Coffea esliaca, believed to be indigenous to Liberia and southern
Sudan, respectively.[1]

Most arabica coffee beans originate from either Latin America, eastern Africa, Arabia, or Asia. Robusta
coffee beans are grown in western and central Africa, throughout southeast Asia, and to some extent in
Brazil.[23] Beans from different countries or regions usually have distinctive characteristics such as
flavor, aroma, body, and acidity.[28] These taste characteristics are dependent not only on the coffee's
growing region, but also on genetic subspecies (varietals) and processing.[29] Varietals are generally
known by the region in which they are grown, such as Colombian, Java, or Kona.

Ecological effects

Originally, coffee farming was done in the shade of trees, which provided habitat for many animals and
insects.[30] This method is commonly referred to as the traditional shaded method. Many farmers (but not
all) have decided to modernize their production methods and switch to a method where farmers would
now use sun cultivation, in which coffee is grown in rows under full sun with little or no forest canopy.
This causes berries to ripen more rapidly and bushes to produce higher yields but requires the clearing of
trees and increased use of fertilizer and pesticides.[31] Traditional coffee production, on the other hand,
caused berries to ripen more slowly and it produced lower yields compared to the modernized method
but the quality of the coffee is allegedly superior.[citation needed] In addition, the traditional shaded method is
environmentally friendly and serves as a habitat for many species. Opponents of sun cultivation say
environmental problems such as deforestation, pesticide pollution, habitat destruction, and soil and
water degradation are the side effects of these practices.[30] The American Birding Association has led a
campaign for "shade-grown" and organic coffees, which it says are sustainably harvested.[32] However,
while certain types of shaded coffee cultivation systems show greater biodiversity than full-sun systems,
they still compare poorly to native forest in terms of habitat value.[33]

Another issue concerning coffee is its use of water. According to New Scientist, it takes about 140 litres
of water to grow the coffee beans needed to produce one cup of coffee, and the coffee is often grown in
countries where there is a water shortage, like Ethiopia.[34]
Economics

Brazil remains the largest coffee exporting nation, but in recent years Vietnam has become a major
producer of robusta beans.[35] Indonesia is the third exporter and the largest producer of washed arabica
coffee. Robusta coffees, traded in London at much lower prices than New York's arabica, are preferred
by large industrial clients, such as multinational roasters and instant coffee producers, because of the
lower cost. Four single roaster companies buy more than 50 percent of all of the annual production:
Kraft, Nestlé, Procter & Gamble, and Sara Lee.[36] The preference of the "Big Four" coffee companies
for cheap robusta is believed by many to have been a major contributing factor to the crash in coffee
prices,[37] and the demand for high-quality arabica beans is only slowly recovering.

Many experts believe the giant influx of cheap green coffee after the collapse of the International Coffee
Agreement of 1975–1989 led to the prolonged price crisis from 1989 to 2004. [33] In 1997 the price of
coffee in New York broke US$3.00/lb, but by late 2001 it had fallen to US$0.43/lb.[38] In 2007,
wholesale coffee was about US$1/lb (e.g. 69 cents in London in March to 134 cents in New York in
October), with robusta being about 70% of the price of arabica. Retail prices varied from an average of
$3 in Poland to $3.50 in the US to $17 in the UK.[39]

The concept of fair trade labeling, which guarantees coffee growers a negotiated pre-harvest price,
began with the Max Havelaar Foundation's labelling program in the Netherlands. In 2004, 24,222 metric
tons out of 7,050,000 produced worldwide were fair trade; in 2005, 33,991 metric tons out of 6,685,000
were fair trade, an increase from 0.34 percent to 0.51 percent.[40][41] A number of studies have shown that
fair trade coffee has a positive impact on the communities that grow it. A study in 2002 found that fair
trade strengthened producer organizations, improved returns to small producers, and positively affected
their quality of life.[42] A 2003 study concluded that fair trade has "greatly improved the well-being of
small-scale coffee farmers and their families"[43] by providing access to credit and external development
funding[44] and greater access to training, giving them the ability to improve the quality of their coffee.[45]
The families of fair trade producers were also more stable than those who were not involved in fair
trade, and their children had better access to education.[46] A 2005 study of Bolivian coffee producers
concluded that Fairtrade certification has had a positive impact on local coffee prices, economically
benefiting all coffee producers, Fairtrade certified or not.[47]

The production and consumption of "Fair Trade Coffee" has grown in recent years as some local and
national coffee chains have started to offer fair trade alternatives.[48]

Processing

Roasting

Coffee berries and their seeds undergo several processes before they become the familiar roasted coffee.
First, coffee berries are picked, generally by hand. Then, they are sorted by ripeness and color and the
flesh of the berry is removed, usually by machine, and the seeds—usually called beans—are fermented
to remove the slimy layer of mucilage still present on the bean. When the fermentation is finished, the
beans are washed with large quantities of fresh water to remove the fermentation residue, which
generates massive amounts of highly polluted coffee wastewater. Finally the seeds are dried, sorted, and
labeled as green coffee beans.[49]

The next step in the process is the roasting of the green coffee. Coffee is usually sold in a roasted state,
and all coffee is roasted before it is consumed. It can be sold roasted by the supplier, or it can be home
roasted.[50] The roasting process influences the taste of the beverage by changing the coffee bean both
physically and chemically. The bean decreases in weight as moisture is lost and increases in volume,
causing it to become less dense. The density of the bean also influences the strength of the coffee and
requirements for packaging. The actual roasting begins when the temperature inside the bean reaches
200 °C (392 °F), though different varieties of beans differ in moisture and density and therefore roast at
different rates.[51] During roasting, caramelization occurs as intense heat breaks down starches in the
bean, changing them to simple sugars that begin to brown, changing the color of the bean.[52] Sucrose is
rapidly lost during the roasting process and may disappear entirely in darker roasts. During roasting,
aromatic oils, acids, and caffeine weaken, changing the flavor; at 205 °C (400 °F), other oils start to
develop.[51] One of these oils is caffeol, created at about 200 °C (392 °F), which is largely responsible for
coffee's aroma and flavor.[17]

Depending on the color of the roasted beans as perceived by the human eye, they will be labeled as light,
medium-light, medium, medium-dark, dark, or very dark. A more accurate method of discerning the
degree of roast involves measuring the reflected light from roasted beans illuminated with a light source
in the near infrared spectrum. This elaborate light meter uses a process known as Spectroscopy to return
a number that consistently indicates the roasted coffee’s relative degree of roast or flavor development.
Such devices are routinely used for quality assurance by coffee roasting businesses.

Darker roasts are generally smoother, because they have less fiber content and a more sugary flavor.
Lighter roasts have more caffeine, resulting in a slight bitterness, and a stronger flavor from aromatic
oils and acids otherwise destroyed by longer roasting times.[53] A small amount of chaff is produced
during roasting from the skin left on the bean after processing.[54] Chaff is usually removed from the
beans by air movement, though a small amount is added to dark roast coffees to soak up oils on the
beans.[51] Decaffeination may also be part of the processing that coffee seeds undergo. Seeds are
decaffeinated when they are still green. Many methods can remove caffeine from coffee, but all involve
either soaking beans in hot water or steaming them, then using a solvent to dissolve caffeine-containing
oils.[17] Decaffeination is often done by processing companies, and the extracted caffeine is usually sold
to the pharmaceutical industry.[17]

Storage

Once roasted, coffee beans must be stored properly to preserve the fresh taste of the bean. Ideal
conditions are air-tight and cool. Air, moisture, heat and light are the environmental factors [55] in order of
importance to preserving flavor in coffee beans.

Folded-over bags, a common way consumers often purchase coffee, is generally not ideal for long-term
storage because it allows air to enter. A better package contains a one-way valve, which prevents air
from entering.

Preparation

Coffee beans must be ground and brewed in order to create a beverage. Grinding the roasted coffee
beans is done at a roastery, in a grocery store, or in the home. They are most commonly ground at a
roastery then packaged and sold to the consumer, though "whole bean" coffee can be ground at home.
Coffee beans may be ground in several ways. A burr mill uses revolving elements to shear the bean, an
electric grinder smashes the beans with blunt blades moving at high speed, and a mortar and pestle
crushes the beans.

The type of grind is often named after the brewing method for which it is generally used. Turkish grind
is the finest grind, while coffee percolator or French press are the coarsest grind. The most common
grinds are between the extremes; a medium grind is used in most common home coffee brewing
machines.[56]

Coffee may be brewed by several methods: boiled, steeped, or pressured. Brewing coffee by boiling was
the earliest method, and Turkish coffee is an example of this method.[57] It is prepared by powdering the
beans with a mortar and pestle, then adding the powder to water and bringing it to a boil in a pot called a
cezve or, in Greek, a briki. This produces a strong coffee with a layer of foam on the surface.[57]

Machines such as percolators or automatic coffeemakers brew coffee by gravity. In an automatic

coffeemaker, hot water drips onto coffee grounds held in a coffee filter made of paper or perforated
metal, allowing the water to seep through the ground coffee while absorbing its oils and essences.
Gravity causes the liquid to pass into a carafe or pot while the used coffee grounds are retained in the
filter.[58] In a percolator, boiling water is forced into a chamber above a filter by steam pressure created
by boiling. The water then passes downwards through the grounds due to gravity, repeating the process
until shut off by an internal timer.[58] or, more commonly, a thermostat which turns off the heater when
the entire pot reaches a certain temperature. This thermostat also serves to keep the coffee warm (it turns
on when the pot cools), but requires the removal of the basket holding the grounds after the initial
brewing to avoid additional brewing as the pot reheats. Purists do not feel that this repeated boiling is
conducive to achieving the best flavoured coffee.

Coffee may also be brewed by steeping in a device such as a French press (also known as a cafetière or
coffee press). Ground coffee and hot water are combined in a coffee press and left to brew for a few
minutes. A plunger is then depressed to separate the coffee grounds, which remain at the bottom of the
container. Because the coffee grounds are in direct contact with the water, all the coffee oils remain in
the beverage, making it stronger and leaving more sediment than in coffee made by an automatic coffee
machine.[59]

The espresso method forces hot, but not boiling, pressurized water through ground coffee. As a result of
brewing under high pressure (ideally between 9-10 atm) the espresso beverage is more concentrated (as
much as 10 to 15 times the amount of coffee to water as gravity brewing methods can produce) and has
a more complex physical and chemical constitution. A well prepared espresso has a reddish-brown foam
called crema that floats on the surface.[56] The drink "Americano" is popularly thought to have been
named after American soldiers in WW II who found the European way of drinking espresso too strong.
Baristas would cut the espresso with hot water for them.

Presentation

Once brewed, coffee may be presented in a variety of ways. Drip brewed, percolated, or French-
pressed/cafetière coffee may be served with no additives or sugar (colloquially known as black) , or with
either milk, cream, or both. When served cold, it is called iced coffee.

Espresso-based coffee has a wide variety of possible presentations. In its most basic form, it is served
alone as a "shot" or in the more watered down style café américano—a shot or two of espresso with hot
water.[60] The Americano should be served with the espresso shots on top of the hot water to preserve the
crema. Milk can be added in various forms to espresso: steamed milk makes a cafè latte,[61] equal parts
espresso and milk froth make a cappuccino,[60] and a dollop of hot, foamed milk on top creates a caffè
macchiato.[62] The use of steamed milk to form patterns such as hearts or maple leafs is referred to as
latte art.
A number of products are sold for the convenience of consumers who do not want to prepare their own
coffee. Instant coffee is dried into soluble powder or freeze dried into granules that can be quickly
dissolved in hot water.[63] Canned coffee has been popular in Asian countries for many years, particularly
in Japan and South Korea. Vending machines typically sell varieties of flavored canned coffee, much
like brewed or percolated coffee, available both hot and cold. Japanese convenience stores and groceries
also have a wide availability of bottled coffee drinks, which are typically lightly sweetened and pre-
blended with milk. Bottled coffee drinks are also consumed in the United States.[64] Liquid coffee
concentrates are sometimes used in large institutional situations where coffee needs to be produced for
thousands of people at the same time. It is described as having a flavor about as good as low-grade
robusta coffee and costs about 10 cents a cup to produce. The machines used can process up to 500 cups
an hour, or 1,000 if the water is preheated.[65]

Types of popular coffee beverages

Social aspects

Coffee was initially used for spiritual reasons. At least 1,000 years ago, traders brought coffee across the
Red Sea into Arabia (modern day Yemen), where Muslim monks began cultivating the shrub in their
gardens. At first, the Arabians made wine from the pulp of the fermented coffee berries. This beverage
was known as qishr (kisher in modern usage) and was used during religious ceremonies.[citation needed]

Coffee became the substitute beverage in place of wine in spiritual practices where wine was
forbidden.[13] Coffee drinking was briefly prohibited to Muslims as haraam in the early years of the 16th
century, but this was quickly overturned. Use in religious rites among the Sufi branch of Islam led to
coffee's being put on trial in Mecca: it was accused of being a heretic substance, and its production and
consumption were briefly repressed. It was later prohibited in Ottoman Turkey under an edict by the
Sultan Murad IV.[66] Coffee, regarded as a Muslim drink, was prohibited to Ethiopian Orthodox
Christians until as late as 1889; it is now considered a national drink of Ethiopia for people of all faiths.
Its early association in Europe with rebellious political activities led to its banning in England, among
other places.[67]

A contemporary example of coffee prohibition can be found in The Church of Jesus Christ of Latter-day
Saints.[68] The organization claims that it is both physically and spiritually unhealthy to consume
coffee.[69] This comes from the Mormon doctrine of health, given in 1833 by Mormon founder Joseph
Smith, in a revelation called the Word of Wisdom. It does not identify coffee by name, but includes the
statement that "hot drinks are not for the belly", which has been interpreted to forbid both coffee and
tea.[69]

Quite a number of members of the Seventh-day Adventist Church also avoid caffeinated drinks. In its
teachings the church requires members to avoid tea and coffee and other stimulants. Studies conducted
on Adventists have shown a small but statistically significant association between coffee consumption
and mortality from ischemic heart disease, other cardiovascular disease, all cardiovascular diseases
combined, and all causes of death. [70]

Health and pharmacology

Coffee ingestion on average is about a third of that of tap water in North America and Europe.[3]
Worldwide, 6.7 million metric tons of coffee were produced annually in 1998–2000, and the forecast is a
rise to 7 million metric tons annually by 2010.[71]
Scientific studies have examined the relationship between coffee consumption and an array of medical
conditions. Findings are contradictory as to whether coffee has any specific health benefits, and results
are similarly conflicting regarding negative effects of coffee consumption.[8]

Coffee consumption has been linked to breast size reduction[72] and taking regular hits of caffeine
reduces the risk of breast cancer.[73] Coffee appears to reduce the risk of Alzheimer's disease, Parkinson's
disease, heart disease, diabetes mellitus type 2, cirrhosis of the liver,[74] and gout. It increases the risk of
acid reflux and associated diseases.[75] Some health effects of coffee are due to its caffeine content, as the
benefits are only observed in those who drink caffeinated coffee, while others appear to be due to other
components.[76] For example, the antioxidants in coffee prevent free radicals from causing cell
damage.[77]

Over 1,000 chemicals have been reported in roasted coffee: more than half of those tested (19/28) are
rodent carcinogens.[78] Coffee's negative health effects are often blamed on its caffeine content. Research
suggests that drinking caffeinated coffee can cause a temporary increase in the stiffening of arterial
walls.[79] Excess coffee consumption may lead to a magnesium deficiency or hypomagnesaemia.[80]
Coffee is no longer thought to be a risk factor for coronary heart disease.[81] Some studies suggest that it
may have a mixed effect on short-term memory, by improving it when the information to be recalled is
related to the current train of thought, but making it more difficult to recall unrelated information.[82]
About 10% of people with a moderate daily intake (235 mg per day) reported increased depression and
anxiety when caffeine was withdrawn,[83] and about 15% of the general population report having stopped
caffeine use completely, citing concern about health and unpleasant side effects.[84]

American scientist Yaser Dorri has suggested that the smell of coffee can restore appetite and refresh
olfactory receptors. He suggests that people can regain their appetite after cooking by smelling coffee
beans, and that this method might also be used for research animals.[85]

Caffeine content

Depending on the type of coffee and method of preparation, the caffeine content of a single serving
can vary greatly. On average, a single cup of coffee of about 207 milliliters (7 fluid ounces) or a
single shot of espresso of about 30 mL (1oz) can be expected to contain the following amounts of
caffeine:

• Drip coffee: 115–175 mg (0.56–0.85 mg/ml)

• Espresso: 60 mg (2 mg/ml)
• Brewed/Pressed: 80–135 mg (0.39–0.65 mg/ml)
• Instant: 65–100 mg (0.31–0.48 mg/ml)
• Decaf, brewed: 3–4 mg
• Decaf, instant: 2–3 mg.
Diabetes mellitus type 2
From Wikipedia, the free encyclopedia

Diabetes mellitus type 2 or Type 2 Diabetes (formerly called non - insulin-dependent diabetes mellitus
(NIDDM), or adult-onset diabetes) is a metabolic disorder that is characterized by high blood glucose in
the context of insulin resistance and relative insulin deficiency. [1] While it is often initially managed by
increasing exercise and dietary modification, medications are typically needed as the disease progresses.
There are currently 23.6 million people in the U.S. (8% of the population) diagnosed with diabetes[2],
90% of which are type 2.[3] With prevalence rates doubling between 1990 and 2005, CDC has
characterized the increase as an epidemic.[4] Traditionally considered a disease of adults, type 2 diabetes
is increasingly diagnosed in children in parallel to rising obesity rates.[5]

Unlike type 1 diabetes, there is little tendency toward ketoacidosis in type 2 diabetes, though it is not
unknown. One effect that can occur is nonketonic hyperglycemia which also is quite dangerous, though
it must be treated very differently. Complex and multifactorial metabolic changes very often lead to
damage and function impairment of many organs, most importantly the cardiovascular system in both
types. This leads to substantially increased morbidity and mortality in both Type 1 and Type 2 patients,
but the two have quite different origins and treatments despite the similarity in complications.

Pathophysiology
Insulin resistance means that body cells do not respond appropriately when insulin is present. Unlike
type 1 diabetes mellitus, the insulin resistance is generally "post-receptor", meaning it is a problem with
the cells that respond to insulin rather than a problem with insulin production.

Other important contributing factors:

• increased hepatic glucose production (e.g., from glycogen degradation), especially at

inappropriate times (typical cause is deranged insulin levels, as insulin controls this function in
liver cells)
• decreased insulin-mediated glucose transport in (primarily) muscle and adipose tissues (receptor
and post-receptor defects)
• impaired beta-cell function—loss of early phase of insulin release in response to hyperglycemic
stimuli
• Cancer survivors who received allogenic Hematopoietic Cell Transplantation (HCT) are 3.65
times more likely to report type 2 diabetes than their siblings. Total body irradiation (TBI) is also
associated with a higher risk of developing diabetes.

This is a more complex problem than Type 1, but is sometimes easier to treat, especially in the early
years when insulin is often still being produced internally. Type 2 may go unnoticed for years before
diagnosis, since symptoms are typically milder (eg, no ketoacidosis, coma, etc) and can be
sporadic.[citation needed] However, severe complications can result from improperly managed Type 2 diabetes,
including renal failure, blindness, slow healing wounds (including surgical incisions), and arterial
disease, including coronary artery disease. The onset of Type 2 has been most common in middle age
and later life, although it is being more frequently seen in adolescents and young adults due to an
increase in screening programs. A type of diabetes called MODY is occasionally also seen in
adolescents, but this is classified as a diabetes due to a specific cause and not as type 2 diabetes.

Diabetes mellitus type 2 is presently of unknown etiology (i.e., origin). Diabetes mellitus with a known
etiology, such as secondary to other diseases, known gene defects, trauma or surgery, or the effects of
drugs, is more appropriately called secondary diabetes mellitus or diabetes due to a specific cause.
Examples include diabetes mellitus such as MODY or those caused by hemochromatosis, pancreatic
insufficiencies, or certain types of medications (e.g. long-term steroid use).

According to CDC about 23.613 million people in the United States, or 8% of the population, have
diabetes. The total prevalence of diabetes increased 13.5% from 2005-2007. Only 24% of diabetes is
undiagnosed, down from 30% in 2005 and from 50% ten years ago.

About 90–95% of all North American cases of diabetes are type 2,[6] and about 20% of the population
over the age of 65 has diabetes mellitus Type 2. The fraction of Type 2 diabetics in other parts of the
world varies substantially, almost certainly for environmental and lifestyle reasons, though these are not
known in detail. Diabetes affects over 150 million people worldwide and this number is expected to
double by 2025.[6] There is also a strong inheritable genetic connection in Type 2 diabetes: having
relatives (especially first degree) with Type 2 increases risks of developing Type 2 diabetes very
substantially. In addition, there is also a mutation to the Islet Amyloid Polypeptide gene that results in an
earlier onset, more severe, form of diabetes[7][8]. About 55 percent of type 2 are obese[9] —chronic obesity
leads to increased insulin resistance that can develop into diabetes, most likely because adipose tissue
(especially that in the abdomen around internal organs) is a (recently identified) source of several
chemical signals to other tissues (hormones and cytokines). Other research shows that Type 2 diabetes
causes obesity as an effect of the changes in metabolism and other deranged cell behavior attendant on
insulin resistance.[10]

Diabetes mellitus Type 2 is often associated with obesity, hypertension, elevated cholesterol (combined
hyperlipidemia), and with the condition often termed Metabolic syndrome (it is also known as
Syndrome X, Reavan's syndrome, or CHAOS). It is also associated with acromegaly, Cushing's
syndrome and a number of other endocrinological disorders. Additional factors found to increase risk of
type 2 diabetes include aging[11], high-fat diets[12] and a less active lifestyle.[13].

Blood sugar
In medicine, blood sugar is a term used to refer to levels of glucose in the blood.

Blood sugar concentration, or serum glucose level, is tightly regulated in the human body.

Glucose, transported via the bloodstream, is the primary source of energy for the body's cells..
The idealised diagram shows the fluctuation of blood sugar (red) and the sugar-lowering hormone
insulin (blue) in humans during the course of a day containing three meals. In addition, the effect of a
sugar-rich versus a starch-rich meal is highlighted.

Blood sugar is a term which in colloquial usage refers to the amount of glucose present in a mammal's
blood. However, the term, if used in a physiological context, is a misnomer and misleading because
other sugars besides glucose are always present. However, since these other sugars are largely inert, and
only glucose serves as a controlling signal for metabolic regulation, the term has gained some currency
and is used by medical persons and lay persons alike. Glucose, transported via the bloodstream from the
intestines or liver to body cells, is the primary source of energy for the body's cells.

Blood sugar concentration, or glucose level, is tightly regulated in the human body. Normally, the blood
glucose level is maintained at a reference range between about 4 and 6 mM (mmol/l). The normal blood
glucose level is about 90mg/100ml, which works out to 5mM (mmol/l), since the molecular weight of
glucose, C6H12O6, is about 180 g/mol daltons. The total amount of glucose in circulating blood is
therefore about 3.3 to 7g (assuming an ordinary adult blood volume of 5 litres, plausible for an average
adult male). Glucose levels rise after meals for an hour or two by a few grams and are usually lowest in
the morning, before the first meal of the day.

Failure to maintain blood glucose in the normal range leads to conditions of persistently high
(hyperglycemia) or low (hypoglycemia) blood sugar. Diabetes mellitus, characterized by persistent
hyperglycemia from any of several causes, is the most prominent disease related to failure of blood
sugar regulation.

Normal values

Despite widely variable intervals between meals or the occasional consumption of meals with a
substantial carbohydrate load, human blood glucose levels normally remain within a remarkably narrow
range. In most humans this varies from about 80 mg/dl to perhaps 110 mg/dl (3.9 to 6.0 mmol/litre)
except shortly after eating when the blood glucose level rises temporarily (up to maybe 140 mg/dl or a
bit more in non-diabetics).
It is usually a surprise to realize how little glucose is actually maintained in the blood and body fluids.
The control mechanism works on very small quantities. In a healthy adult male of 75 kg (165.35 lb) with
a blood volume of 5 litres (1.32 gal), a blood glucose level of 100 mg/dl or 5.5 mmol/l corresponds to
about 5 g (0.2 oz or 0.002 gal, 1/500 of the total) of glucose in the blood and approximately 45 g (1½
ounces) in the total body water (which obviously includes more than merely blood and will be usually
about 60% of the total body weight in men). A more familiar comparison may help – 5 grams of glucose
is about equivalent to a commercial sugar packet (as provided in many restaurants with coffee or tea)

(http://en.wikipedia.org/wiki/bloodsugar)

Hyperglycemia, hyperglycaemia, or high blood sugar is a condition in which an excessive amount of

glucose circulates in the blood plasma. This is generally a blood glucose level of 10+ mmol/L (180
mg/dl), but symptoms and effects may not start to become noticeable until later numbers like 15-20+
mmol/L (270-360 mg/dl).

The origin of the term is Greek: hyper-, meaning excessive; -glyc-, meaning sweet; and -emia, meaning
"of the blood".

(http://en.wikipedia.org/wiki/Hyperglycemia)
Drinking Decaffeinated Coffee May Be Harmful
To Heart Health
ScienceDaily (Nov. 20, 2005) — Decaffeinated -- not caffeinated -- coffee may cause an increase in
harmful LDL cholesterol by increasing a specific type of blood fat linked to the metabolic syndrome,
hints a new study presented at the American Heart Association's Scientific Sessions 2005.

The Coffee and Lipoprotein Metabolism (CALM) study included 187 people, randomized to three
groups: one that drank three to six cups of caffeinated coffee a day; another that drank three to six cups
of decaffeinated coffee a day; and a third, the control group, that drank no coffee.

Some studies have linked coffee drinking to heart disease, but others have suggested that it is not
harmful.

"The problem with the results from these previous studies is that many of them were association studies,
which looked broadly at free-living populations and drew associations between lifestyle factors,
volitional coffee consumption, and disease risk. Our study randomized subjects to a specific type and
amount of coffee consumption, brewed in a standardized manner, just like a drug study," said H. Robert
Superko, M.D., lead author of the study and chairman of molecular, genetic, and preventive cardiology
at the Fuqua Heart Center and the Piedmont-Mercer Center for Health and Learning in Atlanta, Ga.

In this study researchers gave participants a nationally popular home-brewed caffeinated coffee and
decaffeinated coffee brand, and coffee makers. Researchers then instructed participants on how to
prepare the coffee in a standardized manner and asked them to drink only this coffee. All participants
drank only black coffee.

"Whether coffee has caffeine is not the only thing that differentiates caffeinated from decaffeinated
types," Superko said. "Caffeinated and decaffeinated coffees are often made from different species of
beans. Caffeinated coffee, by and large, comes from a bean species called coffee Arabica, while many
decaffeinated coffees are made from coffee Robusta. The decaffeination process can extract flavonoids
and ingredients that give coffee flavor. So decaffeinated brands usually use a bean that has a more robust
flavor."

Researchers measured the level of caffeine in the blood of the participants, as well as levels of the key
heart-health indicators before and after the three-month study.

They sought to clearly demonstrate the effects of caffeinated and decaffeinated coffee consumption on
key indicators of the metabolic syndrome, which is the umbrella term for a cluster of several harmful
heart disease risk factors. Researchers looked at blood pressure, heart rate, BMI, total cholesterol,
triglycerides, HDL (good cholesterol) levels of insulin, glucose, non-esterified fatty acids (NEFA -- fat
in the blood), apolipoprotein B (ApoB -- a protein associated with LDL or "bad" cholesterol) and high-
density lipoprotein 2 (HDL2 -- a type of "really good" cholesterol). Researchers found no significant
changes among the three groups' levels of blood insulin and glucose, or other major risk factors.

But they reported for the first time that, after three months of coffee drinking, the decaffeinated group
experienced a rise in fatty acids, which is the fuel in the blood that can drive the production of low-
density lipoprotein LDL. ApoB went up 8 percent in the decaffeinated group but did not significantly
change in the other two groups. ApoB is the only protein attached to LDL, and studies show that ApoB
might be a better predictor of cardiovascular disease risk than one's LDL level.

NEFA rose an average 18 percent in the decaffeinated group, while it did not change in the other two
groups. "NEFA is the fuel that can drive the increase in ApoB and LDL," Superko said. "These results
are very surprising and have never been reported before for coffee consumption. This is the first non-
industry-sponsored study of its kind. Until now, researchers had not reported on a randomized
prospective study looking at the mechanism of how a particular kind of coffee consumption increases
ApoB and LDL-cholesterol.

"There is a real difference between caffeinated and decaffeinated coffee and, contrary to what people
have thought for many years, I believe it's not caffeinated but decaffeinated coffee that might promote
heart disease risk factors that are associated with the metabolic syndrome, an expanding heart-health
hazard in the United States." In measuring HDL cholesterol, researchers looked specifically at HDL2, a
type of HDL in which high levels are particularly associated with lower risk of heart disease. They found
that HDL2 didn't change significantly overall among the three groups in the study. But in the
decaffeinated group, it changed significantly according to participants' body fat.

For those who had body mass indexes (BMIs) of more than 25 (considered overweight), drinking
decaffeinated coffee increased HDL2 by about 50 percent. But those in the decaffeinated group, who
were not considered overweight according to BMI, saw their HDL2 drop by about 30 percent.

"This illustrates to the public that this is not a simple story of one coffee is good, one coffee is bad," he
added. "It illustrates a concept that is becoming very important in medicine, which is the
individualization of treatment. We have to individualize therapy based on the patient's characteristics. It
is important for the public to appreciate that one diet or one drug is not the optimal treatment for every
patient."

Coffee drinkers in the United States consume an average of 3.1 cups each day. However, "if you only
drink one cup each day, the results of our study probably have little relevance because at that level your
daily coffee dose is relatively low," Superko said.

Superko said people concerned about increasing fatty acids and LDL cholesterol should think twice
about drinking a lot of decaffeinated coffee. "But those who are overweight and have low levels of
HDL2 but normal levels of ApoB, might consider the potential benefit of drinking decaffeinated over
caffeinated coffee," he said.

According to the American Heart Association, whether high caffeine intake increases the risk of
coronary heart disease is still under study, however moderate coffee drinking - 1-2 cups per day - doesn't
seem to be harmful. Co-author is Peter D. Wood, Ph.D.

(http://www.sciencedaily.com/releases/2005/11/051120122949.htm)
Decaffeinated Coffee Is Not Caffeine-free,
Experts Say
ScienceDaily (Oct. 15, 2006) — Coffee addicts who switch to decaf for health reasons may not be as
free from caffeine's clutches as they think. A new study by University of Florida researchers documents
that almost all decaffeinated coffee contains some measure of caffeine.

Caffeine is the most widely consumed drug in the world. And because coffee is a major source in the
supply line, people advised to avoid caffeine because of certain medical conditions like hypertension
should be aware that even decaffeinated brew can come with a kick, UF researchers report in this
month's Journal of Analytical Toxicology.

"If someone drinks five to 10 cups of decaffeinated coffee, the dose of caffeine could easily reach the
level present in a cup or two of caffeinated coffee," said co-author Bruce Goldberger, Ph.D., a professor
and director of UF's William R. Maples Center for Forensic Medicine. "This could be a concern for
people who are advised to cut their caffeine intake, such as those with kidney disease or anxiety
disorders."

Despite caffeine's widespread use, most medical texts have no guidelines for intake, Goldberger said, but
even low doses might adversely affect some people. So UF researchers set out to conduct a two-phase
study designed to gauge just how much caffeine is likely to turn up in decaffeinated coffees.

First they purchased 10 16-ounce decaffeinated drip-brewed coffee beverages from nine national chains
or local coffee houses and tested them for caffeine content. Caffeine was isolated from the coffee
samples and measured by gas chromatography. Every serving but one - instant decaffeinated Folgers
Coffee Crystals - contained caffeine, ranging from 8.6 milligrams to 13.9 milligrams.

In comparison, an 8-ounce cup of drip-brewed coffee typically contains 85 milligrams of caffeine.

In the study's second phase, scientists analyzed 12 samples of Starbucks decaffeinated espresso and
brewed decaffeinated coffee taken from a single store. The espresso drinks contained 3 milligrams to
15.8 milligrams of caffeine per shot, while the brewed coffees had caffeine concentrations ranging from
12 milligrams to 13.4 milligrams per 16-ounce serving.

Even though the amount of caffeine in these coffees is considered low, some people could conceivably
develop a physical dependence on the beverages, said co-author Mark S. Gold, M.D., a distinguished
professor of psychiatry, neuroscience and community health and family medicine at UF's College of
Medicine.

"One has to wonder if decaf coffee has enough, just enough, caffeine to stimulate its own taking," Gold
said. "Certainly, large cups and frequent cups of decaf would be expected to promote dependence and
should be contraindicated in those whose doctors suggested caffeine-free diets."

And even moderate caffeine levels can increase agitation, anxiety, heart rate and blood pressure in some
susceptible individuals, Goldberger said.

"Carefully controlled studies show that caffeine doses as low as about 10 milligrams can produce
reliable subjective and behavioral effects in sensitive individuals," said Roland Griffiths, Ph.D., a
professor of behavioral biology and neuroscience at the Johns Hopkins School of Medicine. "More than
30 percent can discriminate the subjective effects of 18 milligrams or less. The present study shows that
many decaffeinated coffee drinks deliver caffeine at doses above these levels.

"The important point is that decaffeinated is not the same as caffeine-free," Griffiths added. "People who
are trying to eliminate caffeine from their diet should be aware that popular espresso drinks such as
lattes (which contain two shots of espresso) can deliver as much caffeine as a can of Coca-Cola - about
31 milligrams."

(http://www.sciencedaily.com/releases/2006/10/061012185602.htm)

Coffee Intake Linked To Lower Diabetes Risk

ScienceDaily (June 28, 2006) — Drinking coffee, especially when it is decaffeinated, may be associated
with a reduced risk of type 2 diabetes, according to a report in the June 26 issue of Archives of Internal
Medicine, one of the JAMA/Archives journals.

Previous studies in the United States and Europe have linked coffee to a reduced risk of type 2 diabetes,
according to background information in the article. The link between coffee and diabetes risk appears to
be consistent across different ages and body weights; in addition, most research has found that the more
coffee an individual generally drinks, the lower his or her risk for diabetes. However, it remains unclear
whether it is the caffeine or another ingredient in coffee that may confer a protective effect.

Mark A. Pereira, Ph.D., and colleagues at the University of Minnesota, Minneapolis, studied coffee
intake and diabetes risk in 28,812 postmenopausal women in Iowa over an 11-year period. At the
beginning of the study, in 1986, the women answered questions about their risk factors for diabetes,
including age, body mass index, physical activity, alcohol consumption and smoking history. They also
reported how often they consumed a variety of foods and beverages over the previous year, including
regular and decaffeinated coffee.

Based on information reported in the initial questionnaire, about half of the women (14,224) drank one
to three cups of coffee per day; 2,875 drank more than six cups; 5,554 four to five cups; 3,231 less than
one cup; and 2,928 none. Over the following 11 years, 1,418 of the women reported on surveys that they
had been newly diagnosed with type 2 diabetes. After adjusting the data for some of the other diabetes
risk factors, women who drank more than six cups of any type of coffee per day were 22 percent less
likely than those who drank no coffee to be diagnosed with diabetes; those who drank more than six
cups of decaffeinated coffee per day had a 33 percent reduction in risk compared with those who drank
none.

Overall caffeine intake did not appear to be related to diabetes risk, further suggesting that some other
ingredient in coffee was responsible. "Magnesium, for which coffee is a good source, could explain
some of the inverse association between coffee intake and risk of type 2 diabetes mellitus through
known beneficial effects on carbohydrate metabolism," the authors write. However, the study found no
association between this mineral and diabetes risk. Other minerals and nutrients found in the coffee
bean--including compounds known as polyphenols that have also been shown to help the body process
carbohydrates and antioxidants that may protect cells in the insulin-producing pancreas--may contribute
to its beneficial effects and should be examined in future studies.
"In summary, we observed an inverse association between coffee consumption, especially decaffeinated
coffee consumption, and the risk of type 2 diabetes mellitus over an 11-year period in postmenopausal
women residing in the state of Iowa," the authors conclude. "Although the first line of prevention for
diabetes is exercise and diet, in light of the popularity of coffee consumption and high rates of type 2
diabetes mellitus in older adults, these findings may carry high public health significance."

(Arch Intern Med. 2006;166:1311-1316. Available pre-embargo to the media at www.jamamedia.org.)

This work was supported by a grant from the National Cancer Institute.

(http://www.sciencedaily.com/releases/2006/06/060628091738.htm)

Long-Term Coffee Consumption Significantly

Reduces Type 2 Diabetes Risk
ScienceDaily (Jan. 6, 2004) — Boston, MA -- A study by researchers at the Harvard School of Public
Health and Brigham and Women’s Hospital has found that participants who regularly drank coffee
significantly reduced the risk of onset of type 2 diabetes, compared to non-coffee drinking participants.
The findings appear in the January 6, 2004 issue of the Annals of Internal Medicine.

More than 125,000 study participants who were free of diabetes, cancer, and cardiovascular disease at
the start of the study were selected from the on-going Health Professionals Follow-up Study and the
Brigham and Women’s Hospital-based Nurses Health Study. Some 41,934 men were tracked from 1986
to 1998 and 84,276 women from1980 to 1998 via food frequency questionnaires every two to four years
to assess their intake of both regular and decaffeinated coffee.

During the span of the study, 1,333 new cases of type 2 diabetes were diagnosed in men and 4,085
among the women participants. The researchers also found that for men, those who drank more than six
cups of caffeinated coffee per day reduced their risk for type 2 diabetes by more than 50 percent
compared to men in the study who didn’t drink coffee. Among the women, those who drank six or more
cups per day reduced the risk of type 2 diabetes by nearly 30 percent. These effects were not accounted
for by lifestyle factors such as smoking, exercise, or obesity. Decaffeinated coffee was also beneficial,
but its effects were weaker than regular coffee.

The researchers note that caffeine, the best known ingredient in regular coffee, is known to raise blood
sugar and increase energy expenditure in the short-term, but its long-term effects are not well
understood. Coffee (both regular and decaffeinated) has lots of antioxidants like chlorogenic acid (one of
the compounds responsible for the coffee flavor) and magnesium. These ingredients can actually
improve sensitivity to insulin and may contribute to lowering risk of type 2 diabetes.

“This is good news for coffee drinkers, however it doesn’t mean everyone should run out for a latté,”
said Frank Hu, senior author of the study and an associate professor of nutrition and epidemiology at the
Harvard School of Public Health. “We still don’t know exactly why coffee is beneficial for diabetes, and
more research is clearly needed.”

The research was supported by a grant from the National Institutes of Health.
(http://www.sciencedaily.com/releases/2004/01/040106081416.htm)

How Antioxidant Therapy May Play A Role In

The Treatment Of Type 2 Diabetes
ScienceDaily (Jan. 11, 2008) — The incidence of type 2 diabetes in Western society is on the rise, due
largely to an increasing prevalence of obesity.

Dysfunction of skeletal muscle mitochondria, the powerhouses of a cell, is associated with type 2
diabetes; however, whether this association is causal or consequential has not been understood.

A new study by Jennifer Rieusset and her colleagues at INSERM U870, France, has shed light on this
question and has provided evidence that alterations in mitochondrial function are the result, and not the
cause, of insulin resistance (which usually precedes full-blown clinical type 2 diabetes) in mice.

Mice fed a high-fat, high-sucrose diet (HFHSD) developed insulin resistance and type 2 diabetes. The
authors found that mitochondrial defects were present in diabetic, but not pre-diabetic glucose intolerant,
mice.

The mitochondrial disruptions were subsequently shown to be the result of the generation of reactive
oxygen species (ROS), highly reactive molecules implicated in a number of cellular disruptions. Indeed,
ROS production coincided with mitochondrial dysfunction, and antioxidant treatment blocked the
mitochondrial alterations in muscle cells.

The authors therefore concluded that treatment of diabetics with medications that either block ROS
production or counteract their deleterious effects might improve the success of conventional therapies.

Journal article: Mitochondrial dysfunction results from oxidative stress in the skeletal muscle of diet-
induced insulin-resistant mice. Journal Of Clinical Investigation. January 10, 2008.

(http://www.sciencedaily.com/releases/2008/01/080110190902.htm)