Is moderate drinking good for you?

Is moderate drinking good for you? – includes related information

Will a glass of wine or a shot of vodka a day keep the doctor away? Accumulating evidence 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 look-out 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.

The possible “cardioprotective” benefits of moderate alcohol intake

Studies from around the world show a consistent link between moderate alcohol consumption and decreased deaths from coronary heart disease, 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. However, even with modest drinking, 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.

Despite the consistent relationship between modest alcohol consumption and lowered CHD risks, “causality remains unproven,” notes one researcher from Toronto’s Addiction Research Foundation (ARF), “and there’s no absolute proof that it is alcohol rather than diet, exercise or some other lifestyle factor associated with light drinking that is helping hearts. There are also major flaws with many of the heart-alcohol studies, especially imprecise data and imperfect study methods, with inaccuracies in estimating or measuring alcohol intakes and misreporting of amounts consumed. Any risk-reduction for CHD obtained through drinking applies mostly to older people who are in danger of coronary disease, not to young people in whom the dangers of drinking (injuries, violence) usually outweigh the benefits.” One must remember that even moderate drinking increases death rates from violence, trauma, fire, water and road injuries.

The “J-shaped” curve

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. 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.

Not all scientists accept the J-shaped curve uncritically. Critics argue that the apparently greater risk of heart attack among abstainers may be due to the fact that some are ex-alcoholics or heavy drinkers who have quit, or people in poor health, advised not to drink. For example, some abstainers might be “sick quitters” — people told to give up liquor because they had early signs of cardiac illness. In this case, it would hardly be surprising if they died prematurely. Or, in a society where social drinking is the norm, abstainers may be somewhat odd … “uptight” or “stressed out” leading to higher death rates. Surveys show that abstainers tend to be of low socioeconomic status and often in poor health. Recent large-scale studies have tried to eliminate sources of bias by giving all study participants baseline health, economic and psychological exams, excluding ex-alcoholics from the studies. Even when rigidly controlling such factors, with the abstainer group consisting entirely of “never-drinkers,” the cardioprotective influence of moderate drinking remains the same. “Overall,” states one University of Toronto cardiologist, “the heart-protecting effects of modest alcohol intake remain consistent in many countries, including Holland, Denmark, Britain, Sweden, Japan, the U.S. and Canada. There seems little doubt that moderate alcohol consumption confers some protection against coronary heart disease. In fact, research shows that as little as one drink every other day can still protect the heart in both men and women over age 35.”

How much is enough: What is moderate drinking?

Concepts of “moderate” drinking vary 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 g alcohol; in Britain it would have 8.5 g alcohol per drink, while in German beer halls each glass might contain 20 g per drink. In general, 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 different countries

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.

The “French paradox”

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. France is the world’s largest per capita alcohol consumer but has one of the lowest coronary death rates (with an excess of road injuries, violent deaths and high death rates from liver cirrhosis). Some suggest that the apparent cardioprotection offered by wine may in fact stem from the French “Mediterranean style” meals, rich in plant foods. But since the mid 1960s, there has been a steady “Americanization” of French diets, with a drop in vegetable intake and an unhealthy rise in meat and fat consumption. “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.”

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 bloodflow (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 antithrombitic — 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. Besides helping to offset heart attacks, one daily drink for women and two daily drinks for men may protect against ischemic stroke. There is also some preliminary evidence that modest alcohol intake may improve the body’s tissue sensitivity to the hormone insulin, reducing the risk of adult-onset diabetes and improving the blood sugar and lipid (fat) profiles. A little alcohol also helps people relax, reduces stress, eases social intercourse, enhances conviviality and may even help people fall sleep (although later in the night it tends to disrupt sleep patterns). The emphasis is on light drinking, preferably with meals, never a “week-end” binge or many drinks at one sitting. Episodic or binge drinking (five or more drinks at one time) or more than three daily drinks are likelier to increase rather than lower CHD risks.

The possible benefits of modest drinking must be balanced against the fact that there’s no level of alcohol consumption without some adverse effects. Even modest drinking increases death rates from violence, auto collisions, trauma, fire and water injuries. And moderate alcohol consumption can increase health problems such as hypertension (high blood pressure) and possibly elevate risks of breast and colon cancer. Higher level drinking — more than 30 ml ethanol (pure alcohol) a day — can produce a slew of health problems, including elevated risks for cardiovascular illness, such as hemorrhagic stroke and arrhythmias (heartbeat irregularities), as well as liver disease and many cancers (including esophageal, mouth, lip, throat, laryngeal and pancreatic cancer). Moreover, other methods of reducing CHD risks — such as smoking cessation, regular daily exercise and low-fat diets — are far more powerful heart protectors than drinking alcohol.

Women’s bodies react more sensitively 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. Since women’s bodies contain more fat than water, they have less liquid with which to dilute the alcohol, increasing possible liver and brain damage. Owing to enzyme differences, women’s stomachs also oxidize less alcohol so that more gets through into the bloodstream than in men, and women also metabolize (break down) alcohol more slowly so its effects linger in the body. Women are also at possibly greater risk of certain cancers through alcohol consumption, especially breast cancer (perhaps because drinking alcohol raises the body’s estrogen levels). A recent “meta-analysis,” pooling results from many studies, showed a slightly elevated risk of breast cancer even with modest drinking. “At levels of one drink a day,” notes one preventive medicine expert, “there is a reduction in CHD deaths with no increased risk of breast cancer, but above that level risks seem to increase.”

Pregnant women advised to refrain from drinking

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 because of the risk of causing fetal alcohol syndrome (FAS) or the less devastating fetal alcohol effects (FAE). A clear threshold of alcohol consumption, above which there is a demonstrable and significantly elevated risk of FAS or FAE, has yet to be established, but some professionals believe that even one heavy drinking bout could damage the fetus. Episodic drinking and drinking during the first trimester (first three months) of pregnancy are particularly risky.

Fetal alcohol syndrome is a pattern of abnormalities seen in about 5 per cent of infants born to alcoholic women, affecting more males than females. In FAS, the baby is skinny and small (growth-retarded), with an abnormal-looking face, often heart or kidney defects, hearing impairment, cognitive (thought) problems, and may be hyperactive, mentally retarded or suffer from Attentional Deficit Disorder. FAS is particularly common among alcoholic women in poverty-stricken inner city areas. One study found a progressive relationship between increasing alcohol intake and facial abnormalities in the newborn, with some effects even at the lowest levels of alcohol intake, and even late in pregnancy. Since there is no safe time or safe level of alcohol consumption during pregnancy, it might be prudent for pregnant women not to drink. Indeed, all women contemplating pregnancy are encouraged to go easy on drinking or have only an occasional glass of wine or other alcoholic beverage.

Health authorities do not encourage drinking

Medical associations and public health officials, who for decades have said that alcohol is bad for health, have been put in a “sticky spot” by research suggesting that drinking benefits the heart. Although moderate drinking might be good for the heart, health authorities point out that alcohol has many ill effects. It upsets coordination, leads to falls and car crashes and makes people violent; it raises blood pressure, produces hemorrhagic stroke, and destroys the liver and pancreas. It can also cause cancers of the esophagus, mouth, lips, pharynx, larynx, and possibly breast and bowel. Encouraging people to drink might increase these and many other health problems.

Apart from a possible reduction in CHD risks, there is no health reason to impel people who don’t drink alcohol to take up the habit. Non-drinkers are definitely not encouraged to consider alcohol a “heart medicine” nor to start consuming it. Some future study could uncover an unsuspected flaw that has skewed the results showing benefits for CHD. “It would be highly irresponsible,” notes one public health official, “to suggest as public policy that people use alcohol to prevent coronary heart disease, since even low-risk drinking can cause problems and lead to ultimate dependency (addiction). Moreover, coronary risks can be more certainly reduced by other means.” Those who want to or need to protect their hearts can quit smoking, increase daily exercise levels and eat a heart-healthy diet low in fats and high in vegetables and fruits.

Beware the slippery slope of addiction

For those who start drinking alcohol, especially at a young age, one key danger is the tendency to drink more and more, with the chance of becoming alcohol-dependent. Many who start with one or two glasses a day gradually increase the 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. Current teetotallers who never drink are not advised to start consuming alcohol in order to lower heart disease risks. Those who drink lightly should not step up consumption.

Less is usually better

Guidelines in many countries have established safe limits for “low risk drinking,” specifying amounts above which damage to health and danger to others become likely. Guidelines range from one to three drinks a day, with lower limits for women. Recommendations on low-risk drinking are not statements about optimal levels of drinking for individuals or society but general guidelines for reducing the risk of harm from drinking. It’s best to drink lightly, consuming small amounts on each occasion, and not every day.

The best way to decide on personal drinking habits is to do an individual risk-benefit calculation and weigh the rewards and pleasures obtained from alcohol against possible dangers. As a basic rule, “less is better.” For example, for a middle-aged man who is at very high risk of coronary artery disease, but who is not a problem drinker nor prone to wife beating or an irresponsible driver, a daily drink or two with meals might be a relatively painless way to improve heart health. However, for most people, especially someone who has liver disease or other health risks, drinking is not a wise idea. And remember, the protective effects of alcohol consumption only apply to coronary heart disease, not other cardiovascular illnesses.

Some people should never drink

Drinking is not recommended for people with certain illnesses, those who are pregnant, people driving vehicles, operating complex machinery, or in charge of firearms or public safety, nor in people using certain medications (such as psychoactive drugs, painkillers, antihistamines sleep medications, tranquillizers).

RELATED ARTICLE: Red wine not necessarily best

Many believe that red wind tops the list of heart-helping alcoholic beverages. But despite the popular notion that red wine is “best for the heart,” scientific evidence has not so far designated one form of alcohol better in preventing CHD better than others. According to most studies, it makes little or no difference to the heart whether alcohol is consumed in the form of beer, spirits, red or white wine. Nonetheless, researchers are investigating the possibility that something in red wine is especially beneficial to human hearts. Some scientists theorize that phenolic substances (antioxidants) in wine may protect against heart attacks. Others think resveratrol, an antifungal compound (and antioxidant) found in grape skins, may be the agent in wine that lowers blood clotting tendencies (by reducing platelet aggregation). But these ideas await confirmation and carefully controlled studies are needed to substantiate the allegedly superior heart-protecting properties of red wine. At present, the results show no distinction between the merits of red or white wine, spirits or beer in reducing coronary heart disease.

RELATED ARTICLE: 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 and no drinking during pregnancy One standard drink in Canada contains approximately 13.6 g alcohol, and equals one average 5 oz (142 ml) glass of wine (12 per cent alcohol), or one 12 oz (341 ml) regular strength bottle of beer (5 per cent alcohol), or one 1.5-oz (45 ml) shot of liquor (40 per cent alcohol).

(According to Toronto’s Addiction Research Foundation)

RELATED ARTICLE: Possible adverse effects of drinking alcohol

* 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,” (above daily intakes of 30 ml ethanol a day), with increased blood clotting;

* Pancreatitis (pancreas inflammation);

* Alcoholic gastritis (stomach irritability, bleeds);

* Liver cirrhosis;

* Increased rates of many cases – head, neck, throat, lip, mouth, larynx, pancreas and perhaps colon (bowel) and breast;

* Dependency (addiction);

* Abusive behaviour, emotional problems;

* Alcohol-related psychosis, breakdown of family, work and social relationships.

RELATED ARTICLE: Advice on low-risk drinking

* Drink no more than two standard drinks in any day — a guideline endorsed by the Addiction Research Foundation, the Royal College of Physicians and Surgeons of Canada, the Canadian Medical Association, the Canadian Medical Society on Alcohol and Other Drugs, and the Canadian Centre on Substance Abuse.

* Abstainers should not begin drinking to protect the heart. For many, if not most, abstainers, the risks from alcohol consumption would likely outweigh any reduction in CHD risks. Although drinking might reduce CHD risks, abstainers should consider less dangerous alternatives such as more regular exercise, eating less fat.

* Do not step up consumption to lower health risks. Any reduction in CHD risk is achieved at very low consumptions, with as little as one drink every other day. Although the exact pattern of drinking that reduces coronary risks isn’t yet known, occasional drinkers who increase consumption would likely increase bad health effects.

* 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. Many studies have shown a relationship between invariable daily drinking and high-volume consumption.

* 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 (many medications interact with alcohol, and pharmacists or physicians can provide information about them); — 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.

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