Benefits Of Alcohol

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Throughout the 10,000 or so years that humans have been drinking fermented beverages, they’ve also been arguing about their advantages and disadvantages. The debate still rages today, with a lively back-and-forth over whether alcohol is good for you or bad for you. It’s safe to say that alcohol is both a tonic and a poison. The difference lies mostly in the dose.

In some studies, the term “moderate drinking” refers to less than one drink per day, while in others it means three or four drinks per day. Exactly what constitutes “a drink” is also fairly fluid. In fact, even among alcohol researchers, there’s no universally accepted standard drink definition. In the U.S., one drink is usually considered to be 12 ounces of beer, 5 ounces of wine, or 1½ ounces of spirits (hard liquor such as gin or whiskey). Each delivers about 12 to 14 grams of alcohol. The definition of moderate drinking is something of a balancing act. Moderate drinking sits at the point at which the health benefits of alcohol clearly outweigh the risks. The latest consensus places this point at no more than one to two drinks per day for men, and no more than one drink per day for women. This is the definition used by the U.S. Department of Agriculture and the Dietary Guidelines for Americans, and is widely used in the United States.

The active ingredient in alcoholic beverages, a simple molecule called ethanol, affects the body in many different ways. It directly influences the stomach, brain, heart, gallbladder, and liver. It affects levels of lipids (cholesterol and triglycerides) and insulin in the blood, as well as inflammation and coagulation. It also alters mood, concentration, and coordination.

More than 100 prospective studies show an inverse association between moderate drinking and risk of heart attack, ischemic (clot-caused) stroke, peripheral vascular disease, sudden cardiac death, and death from all cardiovascular causes. The effect is fairly consistent, corresponding to a 25 percent to 40 percent reduction in risk.

The connection between moderate drinking and lower risk of cardiovascular disease has been observed in men and women. It applies to people who do not apparently have heart disease, and also to those at high risk for having a heart attack or stroke or dying of cardiovascular disease, including those with type 2 diabetes, high blood pressure, and existing cardiovascular disease. The benefits also extend to older individuals. The idea that moderate drinking protects against cardiovascular disease makes sense biologically and scientifically. Moderate amounts of alcohol raise levels of high-density lipoprotein (HDL, or “good” cholesterol), and higher HDL levels are associated with greater protection against heart disease. Moderate alcohol consumption has also been linked with beneficial changes ranging from better sensitivity to insulin to improvements in factors that influence blood clotting, such as tissue type plasminogen activator, fibrinogen, clotting factor VII, and von Willebrand factor. Such changes would tend to prevent the formation of small blood clots that can block arteries in the heart, neck, and brain, the ultimate cause of many heart attacks and the most common kind of stroke. {kjsdk}

Part of a national 1985 health interview survey showed that moderate drinkers were more likely than non-drinkers or heavy drinkers to be at a healthy weight, to get seven to eight hours of sleep a night, and to exercise regularly. Researchers have statistically accounted for such confounders, and they do not come close to accounting for the relationship between alcohol and heart disease. This, plus the clearly beneficial effects of alcohol on cardiovascular risk factors, makes a compelling case that alcohol itself, when used in moderation, reduces the risk of cardiovascular disease. The most definitive way to investigate the effect of alcohol on cardiovascular disease would be with a large trial in which some volunteers were randomly assigned to have one or more alcoholic drinks a day and others had drinks that looked, tasted, and smelled like alcohol but were actually alcohol free. Many of these trials have been conducted for weeks, and in a few cases months, to look at changes in the blood, but a long-term trial to test experimentally the effects of alcohol on cardiovascular disease over many years will probably never be done. Nevertheless, the connection between moderate drinking and cardiovascular disease almost certainly represents a cause-and-effect relationship. The comparatively low rate of heart disease in France despite a diet that includes plenty of butter and cheese has become known as the French paradox. Some experts have suggested that red wine makes the difference, but other research suggests that beverage choice appears to have little effect on cardiovascular benefit.

The benefits of moderate drinking aren’t limited to the heart. In the Nurses’ Health Study, the Health Professionals Follow-up Study, and other studies, gallstones and type 2 diabetes were less likely to occur in moderate drinkers than in non-drinkers. The emphasis here, as elsewhere, is on moderate drinking. In a meta-analysis of 15 original prospective cohort studies that followed 369,862 participants for an average of 12 years, no benefit was observed for heavy drinkers who consumed more than 48 grams of alcohol (the equivalent of four drinks) a day. The social and psychological benefits of alcohol can’t be ignored. A drink before a meal can improve digestion or offer a soothing respite at the end of a stressful day; the occasional drink with friends can be a social tonic. These physical and psychic effects may contribute to health and well-being.

What you drink (beer or wine) doesn’t seem to be nearly as important as how you drink. Having seven drinks on a Saturday night and then not drinking the rest of the week isn’t at all the equivalent of having one drink a day. The weekly total may be the same, but the health implications aren’t. Among participants in the Health Professionals Follow-up Study, consumption of alcohol on at least three or four days a week was inversely associated with the risk for myocardial infarction. The amount consumed, less than 10 grams a day or more than 30 grams, didn’t seem to matter as much as the regularity of consumption. A similar pattern was seen in Danish men.

Despite these benefit, alcohol’s two-faced nature shouldn’t come as a surprise. Heavy drinking is a major cause of preventable death in most countries. In the U.S., alcohol is implicated in about half of fatal traffic accidents. Heavy drinking can damage the liver and heart, harm an unborn child, increase the chances of developing breast and some other cancers, contribute to depression and violence, and interfere with relationships.

The bottom line you should balance how you drink and you should drink responsibly. Given the complexity of alcohol’s effects on the body and the complexity of the people who drink it, blanket recommendations about alcohol are out of the question. Because each of us has unique personal and family histories, alcohol offers each person a different spectrum of benefits and risks. Whether or not to drink alcohol, especially for “medicinal purposes,” requires careful balancing of these benefits and risks.

Stephano Moundelek

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