Dear Mark: New Coffee Study, Letting a Fever Run its Course, Collagen Dosage

Dear_Mark_Inline_PhotoFor today’s edition of Dear Mark, I’m answering three questions from readers. First, I give my take on a new, big coffee study, which analyzed several meta-analyses of existing coffee and health data. Second, should you let a fever run its course or try to defeat it at all costs? The body obviously “wants” to get hotter in these situations. Is there a good reason? And finally, how much glycine do people need per day?

Let’s go:

Rudy asked:

Hey Mark,

Did you get a chance to see the latest study on coffee? There are a lot of connections, both good and bad. What were your biggest takeaways?

Here’s the full study.

On the whole, coffee seems to help, not hurt. While there are some associations between coffee consumption and poor health outcomes, they’re outweighed by the beneficial associations.

What’s a bigger scourge our society—type 2 diabetes or childhood cleft malformations? No disease or disorder should be taken lightly, however rare it may be, but if we’re just crunching numbers, the diseases coffee consumption seems to reduce are a bigger threat than the diseases it seems to promote.

The studies that found health benefits for coffee were more numerous and had more participants than those finding negative effects. For instance, there were 27 studies including over a million participants showing benefits against type 2 diabetes but only 6 studies with just under 5000 participants showing links between coffee and acute child leukemia.

What I found most interesting (and telling) was the apparent coffee/LDL/heart disease paradox. One of the strongest protective associations coffee had was with cardiovascular disease. People with high intakes had a much lower rate of death from cardiovascular disease than people with low intakes. It hasn’t been causally linked, of course, as the authors drew primarily on observational studies, but we can at least surmise that it’s not bad for your heart. Yet, despite those protective associations, coffee consumption was also linked to higher LDL levels—and in a dose response manner, meaning the more coffee one drank, the higher their LDL levels.

How could this be? Isn’t LDL supposed to ravage our bodies, clog our arteries, and doom us to cardiovascular disease?

Maybe LDL increases that result from diet are qualitatively different than LDL increases with non-dietary causes (like genetics). I don’t know, but it sure is interesting.

In the end, most of the associations with negative health effects were weak, inconsistent, and they often disappeared when you controlled for other health variables like smoking. There were some standout categories where coffee really did seem to be problematic, like in pregnancy or fracture risk. Even those are easy to solve—don’t drink caffeinated coffee during pregnancy, and be sure to keep an eye on your bone health if you’re a woman who drinks a lot of coffee.

Sara asked:

Hi Mark,

It’s cold and flu season and with three kids, it seems like someone’s always got something. Should I treat the fever or let it do its thing? Sara

I’m a firm believer in letting the fever run its course. That fever is happening for a reason.

And that’s without “hard evidence.” It’s my bias talking, but I tend to assume that if the body responds the same way every time, you shouldn’t just get in the way.

Luckily, you don’t have to take my personal gut instinct as evidence. Actual empirical evidence exists, and the bulk of it supports my bias. Higher body temperatures tend to enhance immune function, while lowering body temperature in the event of fever degrades it:

When mice are injected with an antigen, increasing their body temperature by 2 degrees increases production of CD-8 T-cells, which can attack infected or cancerous cells.

In kids with salmonella infections, those with higher body temperatures expel the bacteria more quickly.

I still don’t quite get why so many people, even many doctors, insist on “getting that fever down.” It wasn’t always this way. Ancient doctors used heat therapy—hot stones, hot baths, hot steam, hot sand, hot mud—to raise the patient’s body temperature. In the 19th and early 20th centuries, doctors induced fevers by injecting malaria to treat syphilis. And it worked.

Okay, maybe I do understand why people treat the fever. Fevers feel bad. You get hot, then cold, then hot again. You wake up soaked, if you can even sleep. It’s manageable when you only have to worry about yourself. It’s downright exhausting when you’re dealing with sick kids.

Unless other troubling symptoms exist (e.g. severe malaise, dehydration, seizures, a stiff neck—suggesting the possibility of meningitis), fevers below 104ºF generally aren’t an emergency. Very young babies (under 3 months) are another story and should be seen and treated for lower fevers.

But in non-acute scenarios, I’d still try to hold out and let the fever run its course.

Caitlin wondered:

Great post! Wondering, if you’re supplementing with a powdered collagen, what’s the recommended dosage? I’ve always just added a heaping tablespoon of the Great Lakes Collagen to my AM fat coffee, but would I benefit from adding more into my daily routine?

The average person requires at least 10 grams of glycine a day for basic physiological repair and various metabolic processes. We can make about 3 grams in house, leaving 7 grams for us to get from diet.

Collagen is roughly 33% glycine, so you’ll need at least 20 grams of collagen protein to hit 7 grams of glycine.

Now, that’s for your basic human being. Other human beings will need more or less glycine than 7 grams/day. Athletes, weight lifters, martial artists, runners, dancers, skiers, snowboarders, and anyone else engaging in intense and demanding physical toll that stresses the connective tissue will need more than 7 extra grams of glycine to rebuild and restrengthen.

If you fit into the above categories, or you’re just overall more active than average, grab some extra collagen—maybe another 5-10 grams.

A heaping tablespoon of Great Lakes collagen hydrolysate contains 6 grams of collagen, or about 2 grams of glycine. A good start, to be sure.

Hope these all helped! Thanks for reading!

Let’s hear from you guys below. Anyone have anything to add (or subtract)?


About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.

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35 thoughts on “Dear Mark: New Coffee Study, Letting a Fever Run its Course, Collagen Dosage”

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  1. Since I’ve just started incorporating collagen regularly into my routine using the Primal Collagen Fuel, I’m really appreciating the blog info lately regarding all things collagen. I turn 65 this week and I know I need to stay vigilant about my wellbeing. As someone once said, “It’s not about lifespan, it’s about healthspan.”

    1. Nicely said. I have my Primal Collagen Fuel with my coffee.

  2. Reduce fever, kill pain, neutralize inflammation, and take drugs to crush symptoms?

    Or allow fever, listen to pain, respect inflammation, and concentrate nutrition to address the cause?

    Well, there’s a lot more money to be made with one approach than the other.

    1. With you on this one. I only take drugs if the pain gets unbearable (like the extreme sinus congestion I got with my last cold). Bottom line: people rely on drugs way too much, and I feel it prolongs the actual illness by preventing something like a fever from doing its job.

      1. I used to take pain killers regularly for headaches, period pain, etc, etc, etc. I herniated my disc a couple of years ago, and really hit the pain meds, until one day I decided I’d had enough and I’d just suck it up unless it got really, really bad. 2 years on I’ve probably had the grand total of 1 paracetomol tablet and 2 ibuprofen. It has been a real eye-opener to me to see how quickly you get used to treating pain. I’d argue the pain, when I get it, isn’t so bad anymore either.

        1. Absolutely. As Mark pointed out in the weekend links, endurance activity (like that of our ancestors) improves pain tolerance. When we develop pain tolerance, we can use pain as a source of information, which is clearly its adaptive purpose.

          My experience is that painkillers and anti-inflammatories predispose to injury by blocking the body’s homeostatic mechanisms for preventing, stabilizing, and working around stressors before they get out of hand.

      2. For congestion, try to put a bit of water to steam and dump some apple cider vinegar in it, it will get that congestion to clear. Works every time, however, if it’s just inflammation, well, aspirin is great if you can take it.

        1. Good idea, or just get into a warm steamy shower. Painkillers, if taken regularly, are not a good idea. Not only can they result in GI bleeding and kidney or liver damage (depending on what you take), they can also cause hearing loss. Best to leave all painkillers for those times when they are absolutely necessary.

    1. Lisa, how are you taking it? I mix it with my first cup of hot coffee in the morning, and, when I remember, with an afternoon cup. I prefer to run in the morning before work, and it doesn’t give me any stomach issues. If that’s not working for you, try mixing it up until you find what works for you, with food or without, and when during the day.

    2. I may be healing stomach issues you didn’t know you had.

      I had a friend taking this and she started bleeding (she was in menopause). She asked me why. I researched and told her it was healing her stomach problems. But she stopped taking this. I wish she had kept taking … several months later she was hospitalized because she couldn’t keep anything down. They pumped her out, told her she had diverticulitus and sent her home after a week. She still could not keep anything down.. Was getting dehydrated and weak. Husband took her to his dr. and he admitted to another hospital. Had surgery the next day. She had abscesses outside on her colon (could it have been Leaky Gut? don’t know) They took 41 inches of her colon and she has a bag.

  3. Any thoughts on isolated glycine vs collagen/gelatin for supplementation? You can get a kilo of glycine from for about $20, so in terms of grams of glycine per dollar it’s much cheaper than collagen. Glycine is also very sweet, almost as sweet as sucrose, so it would seem to be an excellent healthy sweetener.

    1. Would also like to hear thoughts on this. I’m sure collagen is better for the synergistic combination of amino acids but if I’m strapped for cash is glycine a solid alternative? Just curious if taking it in isolation would have any negative effects.

      1. I too am also curious on whether supplementing with plain old glycine powder would provide 90% or more of the proven benefits: since as you say it is SO much cheaper than the Great Lakes hydrolysed collagen?

        At the moment though I am still going with my hunch that there may be some extra benefit associated with collagen (on one of Rhonda Patrick’s videos she states that as well as being broken down into the constituent aminos of glycine, proline and hydroxyproline, some portion of the collagen is also absorbed fully intact into joints, which she believes provides a unique benefit of the collagen matrix itself). So in order to minimise costs I go with the 2 heaping tablespoons serving of Great Lakes Hydrolysed Collagen/ day (which actually contains 29% glycine according to the pack, ie just over 3g per 2 heaping tablespoons serving) and make up the other 7g of glycine via the much cheaper Bulk Powders glycine powder (I lift weights 3 days/ week ‘Body by Science’ HIT style, so figure I’ll need the extra 3g of glycine per day mentioned in the article for those involved in intense exercise). Thanks for helping me firm up the dosage Mark! And yes, I agree with Daniel above: with most of the population deficient in glycine (particularly given our high muscle-meat consumption) why on earth has no-one commercialised glycine powder into a sweetener? It must be even healthier than Stevia? That’s what I put into the sugar bowl for my family anyway..

  4. “Fevers feel bad. You get hot, then cold, then hot again. You wake up soaked….” Huh, and all these years I thought it was menopause.

    But on a serious note, are menopause body temperatures protective from cancer the same way a fever is….. “When mice are injected with an antigen, increasing their body temperature by 2 degrees increases production of CD-8 T-cells, which can attack infected or cancerous cells.” If it is, then at least there’s a positive to it.

    1. No, those menopause symptoms aren’t protective, they’re detrimental. There was a study showing that menopausal women with hot flashes had increased risk of cardiovascular disease in later years, and the more severe the symptoms, the higher the risk. There was also a connection with obesity and hot flashes.

      I think menopause symptoms are one of the many, many health issues that society seems as normal while they’re actually a symptom of less than ideal health, or at least there’s some evolutionary mismatch involved. Surely if hot flashes were a feature and not a pathology, having them wouldn’t be associated with poorer general health and higher mortality risk? I’ve been trying so hard to find any sources on what menopause is like in hunter-gatherer societies. Was only able to find one account on !Kung San women, but it said women there don’t have those “typical” menopause symptoms that are so common in the West. I think it also has to do with the fact that hunter-gatherer women have later menarche, more children and spend much longer breastfeeding. But many Western women who have 2 children or fewer still experience more symptoms, so I doubt it’s the whole story. Anecdotally I’ve seen a lot of women report their symptoms have diminished or even disappeared on Primal diet.

      1. It is a shame there’s not more info available. Recently I asked my doctor if I should be on hormone replacement and said “no, we don’t do that anymore.” I think she meant routinely do that anymore but I didn’t question it.

      2. Evidently we’re all exposed to too much stress, which pushes menarche earlier. Hormone mimics in food, environmental toxins don’t help. I haven’t had children but never had hot flashes. Some of it is bound to be genetic.

  5. The coffee study was something that interested me too. It seems to me that the study confirms that coffee is generally good for people – or at least isn’t bad for them. But, there are likely to be exceptions. People who are hypersensive to caffeine, for example, may need to weigh up their coffee consumption more carefully.

    I think that’s a good reminder – as it’s easy to take the conclusions from articles like this and assume that they apply to most or all of the population.

    1. I quit drinking coffee years ago because it gave me GI problems. I couldn’t drink decaf either, so it wasn’t the caffeine. I read somewhere that some of us can’t tolerate the oils in coffee. Don’t know how true that is, but I feel much better if I stick with tea.

      1. I’d heard that the problem was the acid in coffee. If that was the problem for you, you’d do better with a darker roast. I read somewhere that the darker the roast, the lower the acid. A co-worker of mine was having a lot of trouble with her coffee, but hated to give it up. I suggested the dark roast for the acid level. She replied that she’d recently changed from a dark roast to a lighter one, and the problem seemed to have started about the time she’d made the switch. About a week later, she told me that she’d switched back to dark roast and wasn’t having any issues with it. Worth considering if you ever get the urge to try coffee again.

  6. In Balkans, traditional remedy for fever is to sweat it off. Hot shower, full body alcohol rub, hot tea and hermetically sealing your self in as much blanketes as you can find. When you become soaking wet then you take a break for half an hour, change your PJs and sheet. Repeat. Until you feel better.

  7. Dear Mark, I’ve heard a lot about the immunoproliferative benefits of heat therapy when it comes to attacking pathogens and even tumors. But how does that play into the cold acclimatization needed to reliably activate brown adipose tissue?

    In other words, come winter, should I or should I not wear just a T-shirt when I go about my day? Do the benefits of brown fat activation outweigh the risks of a depressed immune system? Or does that depend on cold thermogenesis – in other words, should one stay out in the cold in thin clothing only if one knows how to produce enough heat by themselves?

    1. Follow-up: If the answer to that last question is yes, how can one safely train consistent thermogenesis in a persistently cold environment over the course of many hours, without risking to catch a cold in the interval of training before full acclimatization is achieved?

  8. I’m going with the N=1 idea on the coffee thing. Coffee is a known antibiotic. Maybe that’s why it people use it for colon cleansing? Drinking it every day or lots of it everyday has to have an effect on the microbiome, which I’d expect to show mixed health results because the results might depend on the starting state of the microbiome, before one started drinking coffee. Coffee consumption may also introduce a demethylation issue to the gut – whether for better or worse, which makes me wonder if that is why some people are more sensitive to the caffeine than others or accounts for it’s ability to prevent microbial adhesion – like cranberries for urinary tract symptoms. And what machine the coffee coming from is now a consideration. There’s a recent study on the microbial community in the coffee machine detritus, some species that are coffee adjusted are known to be pathogenic in certain findings (I’ll skip the coffee if I’m ever in the hospital) – but conversely those same species are being considered as environmental remediators specifically because they are capable of breaking down caffeine, which is an environmental contaminant and environmental health indicator. I quit coffee once and my stomach was much stronger for it, but it took 3 weeks before natural regularity to the elimination cycle recovered. And for my eyes to fully open on their own. I’m trying again because I got back on coffee 18 months ago and the ole’ stomach’s tanking again. But not cold turkey – have decided to treat it like alcohol or chocolate – have a cup every several days just for enjoyment, and the keeping up of biodiversity..

    1. Yes, coffee edemas are quite healthful…. administered through the mouth of course!

  9. Fever phobia was the bane of my existence when I worked in the ED. The triage nurse would always rush the panicking mother and slightly feverish toddler past the queue and everyone would be freaking out for no reason.

    I’m not sure where this excessive fear originated but it’s absolutely reinforced by protocol driven medicine – most triage sheets will make you “orange” or “severely ill” for having a fever, which of course means you jump the queue, reinforcing the idea that fever is terrifying and serious. And perhaps in the past when lots of kids died from infectious diseases that was justified (perhaps again in the future if the anti-vaxxer crowd gets their way), but these days it’s mostly mildly ill kids with colds.

  10. Thanks for the breakdown on the collagen – something I had been wondering about for a while. I take the collagen hydrolysate powder but clearly not enough.
    I also drink bone broth sometimes. The nutrition info says 5g protein/ 100ml.
    How much of this would be collagen protein? (It’s Daylesford Organic brand – in the UK).
    Huge thank you in advance for anyone who can answer this!

  11. Interesting stuff! So many coffee studies…I’ve had issues with coffee when I was drinking too much, but now I have a good relationship with it. It’s also something I truly enjoy…a pleasant ritual that gets my day off to a good start, and there’s something to be said about that. Mine is always blended with a healthy fat, like coconut oil, and some collagen peptides or collagen fuel. Having the fat added has really seemed to keep me from getting as wired as I used to…curious if anyone else has noticed this. And I’ve been a believer in letting the fever run its course (in most situations) for years now. Our bodies are designed to heal themselves (in most cases). Although since I started following a Primal lifestyle I just don’t get sick. Honestly can’t remember the last time.

  12. I read an interesting study a while back (which I now cannot find, but will look again later) suggesting that the negative effects of coffee on pregnancy aren’t due to the coffee itself. Since you can’t run a double-blind coffee-during-pregnancy study (for ethical reasons), they only sort the data by “who chose to drink coffee” and “who didn’t choose to drink coffee”. And it turns out, the women who didn’t choose to drink coffee had worse morning sickness & nausea, and therefore could not stomach the coffee. This is relevant because mild morning sickness is associated with an optimal hormone profile during pregnancy. A woman whose hormones are out of balance is less likely to have morning sickness and more likely to have other more serious problems, particularly miscarriage. A woman without morning sickness is also more likely to drink coffee. Therefore, some of the coffee-is-bad-during-pregnancy studies are really showing only correlation, not causation — the true root cause is the hormone balance.

    That said, don’t drink coffee during pregnancy if your doctor says “don’t”!!!!!! I drank only one cup of tea per day with each of my kids, to stay on the safe side.

  13. I’ve been having so much fun using the Primal Kitchen Collagen Fuel in dessert recipes. The monk fruit extract adds enough sweetness so that I haven’t been using any other sweeteners (no sugar, no honey, no stevia, no maple syrup). I just made an amazing keto collagen cheesecake that I’m pretty proud of. 😉

    Out of curiosity, how do people feel about monk fruit?

  14. A scan of article and replies doesn’t reveal any mention of brain damage caused by extremely high fever. 102 F, even 104 F might be okay, but any higher aren’t you at risk for brain damage?