A Toast To Better Health? The Heart May Say Yes, But The Head Hesitates

Alcohol has taken on many roles through the years, from magic elixir to prohibited potion. In the past decade, heart-saver has been added to the list. But this is a simplistic and overly optimistic?perhaps even harmful?view that has left those who imbibe feeling invincible and those who don’t, wondering if they should.

To Toast or Not?

Moderate intake of alcohol may provide protection against heart disease if:

  • You have risk factors for heart disease.
  • You are male.
  • You are a postmenopausal female without breast cancer.

If you currently do not drink, you should not begin simply for health reasons. The following people should not drink at all:

  • People taking medications that interact with alcohol, including but not limited to antidepressants, certain antibiotics and heart medications.
  • Pregnant women or those trying to conceive.
  • Women at risk for breast cancer.
  • People about to drive or operate machinery.
  • People with a history of alcohol abuse.

Evidence for Heart Health. During the last 10 years, population studies have shown that moderate drinkers are 30% to 40% less likely to die from heart disease. Alcohol may help protect the heart by increasing protective blood lipids, such as high-density lipoproteins (HDL’s, the “good” cholesterol), whose job it is to remove cholesterol from artery walls and return it to the liver. Much like aspirin, alcohol also helps reduce platelet aggregation, the process that makes blood sticky, making an artery-obstructing blood clot less likely to form.

Scientists began pondering alcohol’s beneficial aspect after discovering that French people who ate high-fat diets suffered little heart disease. It was dubbed the French Paradox. Baffled scientists gave credit to the daily glass of red wine that’s as much a part of French cuisine as the baguette and Brie. Subsequent research found that red wine contains a compound called resveratol, a flavonoid that acts as a potent antioxidant. Case closed? Not so fast.

Why Not Grape Juice? If resveratrol were the answer, then wouldn’t drinking grape juice or even eating grapes provide similar benefits? The skins of grapes contain the same flavonoid found in red wine, and some studies have now demonstrated the antioxidant potential of grape juice. One such study found that people who drank a large glass of grape juice daily had reduced oxidation of low-density lipoproteins (LDL’s, the “bad” cholesterol, made “badder” when oxidized).

The grape juice option sounds like good news for teetotalers and women. But most experts believe that grape juice simply does not measure up to alcohol in cardio-protective abilities. Although the flavonoids in grape juice and red wine have been theorized to fend off heart disease, there’s little proof of substantial benefit. Moreover, Michael Thun, M.D., of the American Cancer Society, points out that all types of alcohol have been shown to reduce heart disease, not just red wine. The most convincing evidence comes from a review of 25 studies over two decades that directly link alcohol consumption to a positive effect on the heart.

Beyond Heart Benefits. Though much less well known and less studied than heart-protective contributions, other benefits have been linked to alcohol as well. A recent study found that postmenopausal women who drank a little more than one to two drinks a week had higher bone density than teetotalers. This was attributed in part to alcohol’s role in suppressing parathyroid hormone (a hormone that causes calcium to be lost from bone) and slightly increasing estrogen levels. However, the researchers caution against heavy drinking, which is known to be detrimental to skeletal health.

Moderation Defined

Women:  One drink a day
Men:  Two drinks a day
One drink =
4 ounces wine or
12 ounces beer (1 bottle or can) or
1 ounce hard liquor (1 weakly mixed drink)

The Down Side of Drinking. Amid all the good news, don’t forget that alcohol can cause its share of harm. Drinking alcohol can cause car accidents, violence, alcohol poisoning and alcohol-medication interactions. Chronic drinking can lead to alcohol addiction, high blood pressure, cirrhosis, pancreatitis and depression. And while moderate alcohol consumption may provide heart protection, binge and heavy drinking can damage the heart, triggering angina and risking a heart attack.

Alcohol has also been shown to increase the risk of bleeding strokes. However, 80% of strokes are “ischemic,” the kind that stem from a lack of blood flow due to a blood clot, and alcohol seems to have the same beneficial effect here as on the heart. The benefits are thought to be similar to those seen in heart disease?less platelet aggregation and higher HDL levels. But more alcohol is not better. Experts advise that moderate drinking (up to two drinks a day) may protect against ischemic strokes, but heavy drinking (seven or more drinks a day) increases the likelihood of an ischemic stroke.

Why Women Should Be Wary. Drinking alcohol is a particular minefield for women. Indeed, a woman’s risk is raised with every glass raised. Women are more at risk than men for liver disease from the same amount of alcohol; it can be triggered by as few as two drinks a day. They also risk an enlarged heart and damage to brain cells more than men would with the same intake. But most worrisome is alcohol’s effect on breast cancer?not good news, especially for young, premenopausal women.

“Alcohol consumption increases a woman’s risk of developing breast cancer,” states the American Cancer Society’s Thun unequivocally. His research team found the risk of breast cancer to be as much as 30% greater for a woman who drinks daily, a result confirmed by other studies. Women with a family history of breast cancer should be especially leery of alcohol. The benefits probably are not worth the risks.

Overall, the consequences of drinking are surprisingly different for women than for men. Women have significantly less alcohol dehydrogenase, an enzyme that helps break down alcohol. And because women have less body water available to dilute the alcohol, their blood alcohol concentrations rise faster. That’s why the limits for “moderation” for women are set at half of that for men (see box, left).

Is it Really the Alcohol? Some research suggests that moderate drinkers are different than nondrinkers, raising the possibility that these differences?and not alcohol?account for benefits.

“Perhaps people who drink moderately also exercise more, eat better, have lower blood pressure,” says Mary C. Dufour, M.D., M.P.H., of the National Institute of Alcohol Abuse and Alcoholism. “Perhaps one of these other variables explains the relationship.”

Recent studies have attempted to control for these variables, however, and alcohol continues to come out the winner. Still, as with many health issues, it is an association that has yet to be proved conclusively.

EN‘s Bottom Line. Few, if any, experts are promoting alcohol consumption, despite headlines to the contrary. It must be an individual choice, based on your own health history. If you currently drink and can keep your intake moderate, there’s no reason to stop, especially if you are a man. Drinking to stave off disease, however, is not appropriate. There are plenty of other ways to lower the risk of heart disease and osteoporosis.

“Experts need to recommend a balance,” says Dufour. Should abstainers start popping the cork? Absolutely not, agree most experts. Especially not young women, who are the most at risk and benefit the least from alcohol consumption.

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