Objective: To study the effects of prolonged intake of cafetiere coffee, which is rich in the diterpenes cafestol and kahweol, on serum aminotransferase and lipid concentrations. Design: Randomised parallel controlled trial. Subjects: 46 healthy men and women aged 19 to 69. Intervention: Consumption of five to six strong cups (0.9 litres) a day of either cafetiere (22 subjects) or filtered coffee (24 subjects) for 24 weeks. Main outcome measures: Mean changes in serum aminotransferase and lipid concentrations. Results: Cafetiere coffee raised alanine aminotransferase concentration by up to 80% above baseline values relative to filtered coffee. After 24 weeks the rise was still 45% (9 U/l (95% confidence interval 3 to 15 U/l), P = 0.007). Alanine aminotransferase concentration exceeded the upper limit of normal in eight of the 22 subjects drinking cafetiere coffee, being twice the upper limit of normal in three of them. Cafetiere coffee raised low density lipoprotein cholesterol concentrations by 9–14%. After 24 weeks the rise was 0.26 mmol/l (0.04 to 0.47 mmol/l) (P = 0.03) relative to filtered coffee. Triglyceride concentrations initially rose by 26% with cafetiere coffee but returned close to baseline values within six months. All increases were reversible after the intervention was stopped. Conclusions: Daily consumption of five to six cups of strong cafetiere coffee affects the integrity of liver cells as suggested by small increases in serum alanine aminotransferase concentration. The effect does not subside with prolonged intake. High intakes of coffee brews rich in cafestol and kahweol may thus be responsible for unexplained increases in this enzyme activity in apparently healthy subjects. Cafetiere coffee also raises low density lipoprotein cholesterol concentration and thus the risk of coronary heart disease. Key messages This randomised study found that cafetiere coffee also increased alanine aminotransferase and low density lipoprotein cholesterol concentrations, and they were still raised after six months of daily intake. Filtered coffee had no effect The increase in liver enzyme activity could be innocuous, but the increase in cholesterol concentration may increase coronary risk and could be a reason to advise patients to drink filtered coffee

Since the serum potassium level is under beta 2-adrenergic influence, we studied serum potassium values on admission in psychiatric patients. Data are reported on 683 patients from nine major diagnostic groups. Among these nine groups significant differences were found concerning the mean serum potassium level and incidence of hypokalemia. Significant differences existed between the alcohol withdrawal and attempted suicide groups compared to the dysthymic, bipolar manic, schizophrenic and nonschizophrenic psychosis groups. Like alcohol withdrawal, attempted suicide is assumed to be a hyper-adrenergic state. Although the relative contribution of factors like nutritional state, aldosterone, insulin, and beta 2-receptor density or sensitivity is unclear, the catecholamine-potassium relationship deserves further study.