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“Is Alcohol Advantageous?”
Alcohol and its affects on reducing the risk of cardiovascular disease has been the most popular and perhaps the most controversial subject of recent debate. This topic has found its way into newspaper articles, medical journals, and television news programs. However there are many important pieces of information that must be looked at before any conclusion can be made.
The Benefits of Alcohol
Currently research is being conducted to determine the advantages of alcohol consumption.
Antioxidants may reduce the accumulation of atherosclerotic plaque that can clog arteries. They can be found in fruits and vegetables as well as red grape juice. There is some controversy and not enough data regarding the statement that wine is a better source of antioxidants than fruits and vegetables, and that antioxidants are more active in the presence of alcohol. Specific antioxidants called flavonoids also decrease the risk of cardiovascular disease. They act to improve vasodilaton (free flow of blood through veins and arteries), prevent LDL (“bad”) cholesterol from oxidizing, and reduce the clotting ability of platelets in the blood. Phenolics, another type of antioxidant, also reduce LDL oxidization, platelet clotting, and fatty acid production and they bring about a more desirable HDL-LDL ratio. Some researchers have also said that a diet high in antioxidants can reduce the risk of chronic diseases.
Cholesterol is a waxy substance found in the body; it comes from foods and the liver. There are two types of cholesterol, high density lipoprotein (HDL-the good kind) and low density lipoprotein (LDL-the bad kind). HDL removes cholesterol from tissue and the blood so that it will not build up in the arteries. It is important to note that some of these benefits can be obtained through other sources. Levels of HDL cholesterol can be increased through regular exercise, weight loss, avoidance of saturated fat, and the cession of smoking.
As mentioned earlier, the antioxidant flavonoids and phenolics reduce platelet clotting. Substances known as resveratrols that are found in alcoholic beverages may also prevent the clotting of platelets. Purple grape juice also contains resveratrol but in a smaller quantity than is found in red wine. Therefore, grape juice provides a good source of this compound with no significant downside. Aspirin is also thought to posses these same properties.
Lifestyles of Wine Drinkers
The results obtained in these studies may have less to do with alcohol and more to do with lifestyles. A study conducted by Dr. Arthur Klatsky of Kaiser Permanente Medical Group reveals that wine drinkers are more likely than the general population to smoke less, exercise more, drink moderately, maintain a nutritious diet, and in general have a healthier lifestyle. Wine consumers tend to be better educated, are less likely to be overweight, and are responsible drinkers. They drink wine in a home setting roughly 80% of the time, and on average they drink no more than 1.5 glasses at any given time and 4.5 glasses in any given week.
Klatsky points out that the way wine is consumed is important. Studies show that alcohol has the most direct effect on food absorbed into the blood around mealtime. Countries like France where the fat intake is higher have low rates of heart disease. A French researcher states, “ Because wine is mostly consumed during meals it is absorbed more slowly, and thus has a prolonged effect on blood platelets at a time when they are under the influence of alimentary lipids that are known to increase there reactivity.” Dr. Maurizio Trevisan from the University of Buffalo conducted research that states alcohol with meals may prevent the clotting of blood triggered by fat.
Researchers at the Harvard School of Public Health and Brigham and Women’s Hospital conducted a study based on gene variety. The gene ADH3 codes for alcohol dehydrogenase type 3, which breaks down alcohol. There are two forms of this gene, one works faster than the other one does. The members of the study that drank moderately had a lower risk of heart disease. Those participants that were moderate drinkers and that had the gene that worked slower had higher levels of HDL cholesterol.
Men vs. Women
A study was conducted using 18455 men between the ages of 40 and 84. At the end of the 7-year follow up period, 1091 cardiovascular cases were reported. This data led researchers to conclude that men who initially consumed one drink or less a week could lower their risk of CVD if they moderately increased their alcoholic consumption. However, men that initially drank greater than one glass of alcohol a week did not lower their risk of CVD if they moderately increased their alcoholic consumption.
Studies of men showed that light to moderate alcohol consumption reduced the risk of coronary heart disease. Women that consumed the same amount of alcohol as men increased their risk for breast cancer. A study was conducted using 85709 women between the ages of 34 and 59. During the 12-year follow up period, 2658 women died. From the data gathered, those women who drank light to moderate amounts of alcohol reduced there mortality rate, but most of the women that benefited from the alcohol tended to be in a higher risk group for coronary heart disease.
What does the Science Show?
Over the last few decade researchers have been looking into this topic, but the results have been mixed.
It has been proposed that antioxidants and polyphenolic flavonoids found in alcoholic beverages may protect against stroke and coronary heart disease. According to a study conducted by Dr. Puddey of the University of Australia, “…the conclusion at present is that while we may continue to speculate that there are anti-oxidants and pro-oxidants in alcoholic beverages that influence the development of atherosclerotic cardiovascular disease, this cannot yet be considered as an established scientific fact” (Puddey 1999, page1). Recent studies fail to show that vitamin E, a presumed antioxidant, has a cardiopositive effect (Goldberg, Mosca, Piano, Fisher 2001).
Members of the Brigham and Woman’s Hospital and Harvard Medical School conducted a case-control study, using 340 people, relating alcohol and myocardial infarctions (MI). They analyzed fasting venous blood samples for lipid profiles. What they found was that the levels of HDL were significantly higher when compared to levels of nondrinkers. They concluded that, “…regular consumption of small to moderate amounts of alcoholic beverages, regardless of type, reduces the risk of MI, and further suggests that there is benefit, in large part, from increases in HDL levels” (Gaziano, Hennekens, Godfried, Sesso, Glynn, Breslow, Buring 1993, page1). Two drinks a day increase the levels of HDL about 12%; these same results can be obtained with exercise and other programs. Niacin therapy can increase these levels by about 20% (Goldberg, Mosca, Piano, Fisher 2001).
Resveratrols are thought to prevent the clotting of platelets in the blood. But studies have shown conflicting results on the effects of resveratrols on atherosclerosis in animals. Numerous studies have shown that there is a decrease in platelet clotting associated with drinking alcohol. Researchers believe that the inhibition of prostaglandin synthesis is how platelet aggregation is decreased. Aspirin is believed to work by similar mechanisms (Goldberg, Mosca, Piano, Fisher 2001).
Alcohol and Stroke
A population based case-control study involving 467 cases of stroke and 477 controls was conducted for a year. The results from this study show that atherosclerosis of the large and medium cerebral arteries and this type of stroke shows a J-shaped relationship with alcohol. However, atherosclerosis of the penetrating arteries and this type of stroke does not show any relationship with alcohol. This is why alcohol does not have a protective effect on cerebral hemorrhages (Rodriguez, Cuello, Caicoya, Corrales, Lasheras 1999).
Some of the adverse effects of alcohol consumption are: fetal alcohol syndrome, cardiomyopathy, hypertension, hemorrhagic stroke, cardiac arrythmia, and sudden death (Goldberg, Mosca, Piano, Fisher 2001).
More than 50 cross-sectional studies and 10 prospective population-based studies show a direct link between alcohol consumption and hypertension. More than 20g (2drinks) of alcohol a day for women between the age of 30 and 55 is associated with a linear increase in hypertension. The same results were seen in men except they were less linear (Goldberg, Mosca, Piano, Fisher 2001).
Long-term heavy drinking increases the risk for all types of strokes. However, the effects of moderate drinking are less clear because of conflicting data. Some studies show moderate drinking decreases the risk of ischemic stroke in specific populations. Other studies do not show a protective association between drinking and stroke. There are many variables including race/ethnicity, sex, drinking patterns, age, etc. (Goldberg, Mosca, Piano, Fisher 2001).
What is Moderate Drinking?
The U.S. Department of Health and Human Services defines moderate drinking as no more than one drink a day for women and people over the age of 60. Two drinks a day for men and no more than one an hour. Women who are pregnant or trying to conceive, people that are going drive or participate in any activities that require skill, people on medication, alcoholics, and people under the age of 21 should not drink at all. It is also healthier to drink a small amount everyday than a large amount in a short period of time.
Benefits vs. Risks
Quick Recovery After Heart Attack
Associated with Lower Heart Disease Risk
Associated with Protective Levels of Estrogen in Postmenopausal Women
Increased Appetite – Especially in Elderly
Alcohol-Related Diseases (cirrhosis)
Alcohol-Related Behaviors (smoking, unprotected sex)
Risk of Breast Cancer
Birth Defects if Pregnant
A Study on Drinking and Health Risks
While drinking can lower the risk of cardiovascular disease, it does increase other health risks. In the following chart, mortality rates for non-drinkers serve as the baseline health risk (1.0 on the vertical axis). The risk for coronary heart disease even for heavy drinkers remains below the baseline; but risk of death from other causes goes up. The risk of death from liver disease skyrockets off the chart after only a couple of drinks a day.
Source: Bofetta, P, and Garfinkel, L. "Alcohol drinking and mortality among men enrolled in an American Cancer Society prospective study." Epidemiology 1:342-348, 1990.
The potential benefits of alcohol or wine reducing the risk of cardiovascular disease merits further research. Currently the American Heart Association does not recommend drinking any alcoholic beverage to achieve these potential benefits.
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