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Bottoms up for health? Guidelines for alcohol consumption remain controversial

March 1, 2000
Web posted at: 4:12 PM EST (2112 GMT)


In this story:

The arguments for alcohol

The downside of drinking

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(WebMD) -- In 1995, federal health officials created an uproar by issuing dietary guidelines stating that alcohol can be good for the heart. The revised guidelines, due out soon, are expected to go even further -- spelling out exactly who might benefit from a drink or more a day.

Some experts have even suggested that a glass of wine be pictured in the U.S. Department of Agriculture's official food pyramid -- following the example of the Mediterranean food pyramid, whose accompanying guidelines recommend a daily glass of wine for women and up to two glasses for men. (The Mediterranean pyramid is an alternative model conceived by scientists from the World Health Organization and the Harvard School of Public Health.)

"It's clear that there are important health benefits associated with moderate drinking," says Curt Ellison, M.D., a professor of medicine at Boston University School of Medicine and a leading expert on alcohol and heart disease.

But what constitutes "moderate"? Researchers don't yet agree on how much wine consumption is safe. And aside from moral or religious qualms -- this is the nation that once passed a constitutional amendment prohibiting alcohol, after all -- recommending regular drinking remains controversial for medical reasons, says Marion Nestle, Ph.D., M.P.H., professor of food sciences at New York University.

Even if a little drinking can promote health, the fact remains that too much drinking can be dangerous, quickly erasing any potential benefits. And the imprecise line between moderation and excess makes some experts reluctant to officially sanction any alcohol at all. Once a positive message about alcohol is out of the bottle, so to speak, the question becomes: Do the benefits really outweigh the risks?

The arguments for alcohol

Research does point to some striking evidence on the plus side. More than 50 studies have shown that moderate drinkers live longer than teetotalers and are less likely to have heart disease. In one of the most recent reviews, published in the British Medical Journal in December 1999, Harvard researchers looked at 42 studies and concluded that regularly consuming 30 grams of alcohol -- the equivalent of about three drinks a day -- increased "good" HDL cholesterol (high-density lipoproteins) and reduced factors in the blood that lead to clotting. That translates to a whopping 24.7 percent reduction in heart-disease risk, the researchers found.

The French, the world's greatest wine connoisseurs, presented even better news in a 1998 issue of the journal Epidemiology: In a five-year study in France, people who drank two to five glasses of wine a day had up to 31 percent less risk of death from any cause than nondrinkers.

The benefits may go beyond the heart. In a study of 3,072 men and women published in the Journal of the American Geriatric Society in January 1998, researchers at Howard University Hospital in Washington, D.C., found that moderate wine drinkers are 14 percent less likely than nondrinkers to develop age-related macular degeneration, a disease of the retina that can cause blindness.

Other research suggests that a daily glass of wine or beer with a meal may also help lower risk for diabetes. In a six-year Harvard study of more than 41,000 health professionals, the moderate drinkers were almost half as likely to develop the disease as nondrinkers, according to a March 1995 report in the British Medical Journal.

The downside of drinking

So why not recommend a glass or two for everyone? First, because not everyone stands to benefit: Drinking apparently has very little to offer women in their 20s and 30s, for instance. In findings from the Harvard Nurses Study, published May 11, 1995, in the New England Journal of Medicine, alcohol cut heart-disease risk almost in half and lowered overall death rates by 14 percent, but mostly for women over 50. That makes sense medically, since women's risk for heart disease begins to climb steeply only after menopause.

And for people at any age, too much alcohol can cause major health problems. Excessive imbibing actually increases the danger of heart disease, according to a report published in the Novartis Foundation Symposium in 1998. It can also elevate blood pressure and cause irregular heartbeat. Serious alcoholism damages the liver and can lead to liver failure. Overall, an estimated 100,000 people die every year of alcohol-related causes, according to the federal Centers for Disease Control and Prevention.

So how much is too much? Research is inconclusive: While the French study found that up to five glasses of wine a day lowered heart disease risk for men, a study published last January in the Journal of the American College of Cardiology found that the risk of certain cancers may begin to outweigh the heart benefits after only two drinks a day. And certainly more than two drinks can get you in big trouble behind the wheel.

To be safe, the new federal guidelines are expected to recommend no more than one drink a day for women and two for men. They may also make it clear that drinking alcohol has health benefits starting only in middle age. And they could add other caveats as well, such as the guidelines that accompany the wine-friendly Mediterranean pyramid. Those guidelines recommend that people drink wine with their meals, which slows the absorption of alcohol and may enhance cardiac benefits by blocking the oxidation of fats.

© 2000 Healtheon/WebMD. All rights reserved.



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