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Is Moderate Drinking Good For You?
by Loring A. Windblad

For me this is going back 40 or so years, to my Aunt and Uncle. Aunty had a bad ticker and, on her doctor's advice, took a shot of scotch every evening. Uncle Bud didn't have any problem with "a shot" every night. Where Uncle Bud drew the line was her insistence on having 2 or even 3 "shots" every night. And Aunty's "shots" were more like "ponys" than shots...an ounce and a half to two ounces rather than just one ounce! This is back in the early 1960's. But...she did live an extra 10-12 years beyond the original "less than a year" prognosis, which the doctor's attributed to the "kick-start" effect of those massive shots on her heart!

Additionally, since the 60's and perhaps much earlier, it is often recommended that women take a glass of beer a day when pregnant because of the added Vitamin D and other benefits. This is wholly contrary to the concept that pregnant women should consume absolutely ZERO alcohol during pregnancy.

Let's take a quick trip to Europe where, in Germany, they drink beer rather than water; in France and Italy and Spain the drink is wine rather than water. We're talking people of all ages, from children up. Generally in Europe the water is unsafe to drink unless boiled or bottled from the store. And they have a lower heart disease and resultant stroke and especially heart attack problem than the US and Canada.

So here's the big question: Will a glass of wine or a shot of vodka a day keep the doctor away?

A large body of evidence collected over the past few years shows that modest alcohol consumption can reduce deaths from coronary heart disease (CHD) in middle and old age. Since heart disease accounts for about half of the deaths among older adults, it might seem that finding a way to cut the death rate would be greeted with joy by public health officials, who are always on the lookout for a means to prevent premature death.

However, we are not likely to see cheerful "have one for the heart" posters replacing the current warnings about the bad effects of alcohol. This is because, despite its benefits for the heart, most medical authorities consider the ill effects of alcohol too dire to recommend it as "heart medicine." The risks of injuries, assault and various health problems related to drinking are too great to suggest that non-drinkers start consuming alcohol to improve heart-health. These risks are present because most people can't, or won't, have "just one" -- take my Aunty's example for a case in point. Aunty, after two ponys (3 to 4 "1-ounce shots") was about half looped. And if she had a third there wasn't any "about" about it -- she was very definitely loaded.

So what is this body of evidence showing about possible benefits of moderate alcohol intake as "cardioprotective" benefits?

Studies from around the world show a consistent link between moderate alcohol consumption and decreased deaths from coronary heart disease, and in both sexes over age 35-40, but especially among middle aged men. Modest alcohol consumption seems to reduce risks of death from coronary disease by 40-50 per cent. This effect is termed the "cardioprotective" effect of moderate alcohol consumption. The benefits of modest alcohol intake hold true even for those who have had heart attacks or are at known risk for CHD.

Depending on the studies, the heart protection occurs with alcohol consumptions of one to five drinks a day. But most studies show the heart-saving effects of alcohol peak at levels of two or fewer drinks a day, and that benefits plateau at three drinks per day. In fact, the research suggests that as little as one drink every other day may confer heart-protecting effects in both sexes over age 35.

The downside here is that excessive consumption not only improves the cardioprotective benefits but, even with modest drinking but in amounts over two daily drinks, the possible benefits gained for the heart are negated by the bad health effects of alcohol -- more falls, bruises, cuts, road injuries, violence, rising blood pressure, hemorrhagic (bleeding) stroke, liver cirrhosis and some types of cancer.

Now I, personally, from a lifetime (I'm 69 and counting) of observation on friends and relatives, including 4 years living in the heart of Europe (Orleans, France), am convinced of the beneficial effects of moderate alcohol consumption. Never-the-less, one must remember that even moderate drinking can cause increases in the death rates from violence, trauma, fire, water and road injuries.

The "J-shaped" curve -- here's where I have a big problem.

Studies in many countries find that people who consume alcohol in moderation have lower death rates (from all causes) than those at either extreme: abstainers and those who drink to excess. My problem here is that, so far as I know, "Life is 100% fatal." Thus, there is absolutely no way in which "people who consume alcohol in moderation have lower death rates (from all causes) than those…" Anyway, back to the "J-Curve". In other words, heavy drinkers and abstainers have higher death rates than moderate drinkers. Graphs that plot deaths from heart attacks against amounts of alcohol consumed have a so-called "J-shaped pattern" with a shallow dip in total mortality for modest drinkers. This indicates that people who drink a lot die early, relatively speaking, and -- contrary to expectations -- that those who drink no alcohol also have increased premature death rates. Recent data from the U.S. National Health and Nutrition Examination Study (NHANES) found the coronary mortality rate of moderate drinkers (who average a daily one to two glasses of wine, beer or spirits) was 50 per cent lower than that of total abstainers and 60 per cent lower than that of heavy drinkers.

So, then, what is moderate drinking -- How much is enough?

The concept of "moderate drinking" varies from one country or population to another, as do the amounts of alcohol in beverages. For example, one average North American drink contains 12-14 gm alcohol; in Britain it would have 8.5 gm alcohol per drink, while in German beer halls each glass might contain 20 gm per drink. In general, the "experts" consider moderate drinking to be one to two 5-oz. glasses of table wine, two bottles of regular beer or a couple of 1.5-oz. shots of spirits a day for men and less for women, but not every day. Current recommendations for low-risk drinking suggest no more than one to two standard alcoholic drinks a day for women, no more than two a day for men.

Drinking standards vary widely in countries around the world

The "drinking norm" is an elusive concept as drinking patterns vary widely among nations and cultural or religious groups, with different "right and wrong" times and places to drink -- for instance, with or without meals, as part of a daily regime or only on special occasions. In some societies, having a "couple of drinks before dinner" is usual, in others it may cause raised eyebrows. In France and Italy, for example people habitually sip wine with meals, but drunkenness is unacceptable. In Canada, "restrained drinking" has been cited as "less than five drinks on one occasion," and drunken behaviour is mildly tolerated. In Finland, drinking is not part of everyday life but is often binge drinking reserved for special occasions, sometimes with many drinks at one go, perhaps explaining the country's high incidence of hemorrhagic (bleeding) stroke.

Then we have "The French Paradox"

I lived for four years in France and have observed this "Paradox" in person. The idea that wine might offset coronary heart disease arose from the finding that the heart attack rates in France are far lower than those in most of Europe and other industrialized nations, despite French diets high in fat, low exercise levels and much tobacco smoking. Epidemiologists suggest that the low heart attack rates among the French might be due to their high wine consumption, mostly red wine, usually taken with meals. Although the French food supply is still relatively healthful," notes one nutritionist, "the gap is narrowing as their eating patterns change from a typical Mediterranean diet (low in saturated fats, rich in minimally processed plant foods) to one higher in animal fats. A rise in French heart attack rates may soon follow." It is my opinion that there is a growing tendency among "health professionals and dietitians" to infer that "a healthy diet is a vegetarian-based diet and contains little or no animal protein," yet there is no evidence anywhere to prove such a hypothesis.

How alcohol might protect the heart

There are several plausible biological mechanisms by which modest alcohol consumption might lower coronary heart disease risks. In the short term, alcohol can reduce the formation of blood clots that block arterial blood flow (leading to heart attacks) by diminishing blood platelet aggregation and altering the action of fibrinogen (an enzyme necessary for clotting). The immediate action of alcohol is anti-thrombitic -- decreasing the blood's clotting power in much the same way that ASA (Aspirin) protects against heart attacks. In the long run, modest alcohol intake gradually curtails the build-up of atherosclerotic plaque on artery walls and helps raise levels of high-density lipoproteins -- HDL or "good" cholesterol -- which removes cholesterol from the bloodstream and eliminates it via the liver. Alcohol may also help preserve the vitamin E and other antioxidants in cell membranes.

Narrow "window of benefit" for alcohol drinkers

The influence of alcohol in reducing heart attacks occurs only within a narrow range or small "window" of modest consumption. Cardiac protection from alcohol only occurs with low-level drinking -- at intakes of two or fewer drinks per day (and not every day) and only in people over age 35-40.

Women are much more sensitive to alcohol

Although fewer women than men are heavy drinkers, women are more susceptible to damage from alcohol at lower levels. At a given dose per body weight, women suffer more harmful effects than men, except, of course, for the knowns benefits of a glass of beer a day during pregnancy -- but only for "some" women, not for all women "across the board". Pregnant women advised to refrain from drinking

Except as noted previously, and then only on the advice of your doctor, women who drink alcohol while pregnant, especially more than one drink a day, can harm the developing fetus. Pregnant women are advised to abstain from alcohol (except as previously noted) because of the risk of birth defects and fetal alcohol syndrome.

Even though some medical professionals recommend moderate drinking for some few patients, health authorities in general do not encourage drinking in any amount.

Beware the slippery slope of addiction

Addiction -- the status of having become alcohol-dependent. Some people who start with one or two glasses a day, gradually increase this amount until they are consuming many drinks a day with all the attendant consequences. Some reach a "point of no return" where they find it impossible to cut back or do without their (several) daily drinks. There is a real risk factor involved in consumption of alcohol and that is "Addiction" -- becoming an alcoholic!

Here's a few simple guidelines to follow:

Less is usually better.
Some people should never drink.
If you do drink never, never, never mix alcohol and medications of any kind.
Red wine is not necessarily best.
Moderate or low-risk drinking is:
* For men: no more than two drinks a day, but not every day
* For women: one to two drinks a day, but not every day

These are some of the possible adverse effects of drinking alcohol over a long period of time:

* Diminished coordination, cognitive impairment;
* Injury or death from falls, motor crashes, fire, water mishaps;
* Drownings, suicide;
* Assault, violence, firearm use;
* Choking deaths (asphyxiation);
* Elevated blood pressure;
* Stroke;
* Cardiac myopathy and heartbeat irregularities (arrhythmias) with possible heart failure;
* Possible "rebound coagulability" with increased blood clotting;
* Pancreatitis (pancreas inflammation);
* Alcoholic gastritis (stomach irritability, bleeds);
* Liver cirrhosis;
* Dependency (addiction);
* Abusive behaviour, emotional problems;
* Alcohol-related psychosis, breakdown of family, work and social relationships.

Advice on low-risk drinking

* Drink no more than two standard drinks in any day.
* Abstainers should not begin drinking to protect the heart.
* Do not step up consumption to lower health risks.
* Anyone who drinks more than two drinks in any one day should reduce consumption.
* To minimize risks of dependence, have at least one alcohol-free day per week.
* All persons who consume alcohol should avoid drinking to intoxication.
* The following should drink no alcohol:
-- people with certain psychological and physical illnesses;
-- those taking certain medications such as antihistamines, psychoactive drugs and sleep-aids
-- people driving vehicles or operating machinery;
-- those responsible for public order or safety;
-- people unable to control their drinking;
-- those legally prohibited from drinking, such as under-age persons.

And so we come to my conclusions: Yes, moderate drinking can be very beneficial to a person. However, the side of this coin to be carefully watched is: what is moderate for one person is not enough for another person and excessive for yet another. What is "just right" for the 200-220 lb man is excessive for the 145 lb man and not quite enough for the 300 lb man. So be very careful when drinking "moderately".

© Loring A. Windblad

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About Loring: Loring Windblad has studied nutrition and exercise for more than 40 years, is a published author and freelance writer. His latest business endeavor is at http://www.organicgreens.us