Eric Rimm, a nutritional epidemiologist, has a drink with dinner most evenings.
“To me, it’s a part of a healthy lifestyle,” said the Harvard School of Public Health associate professor, who has spent years studying the health effects of alcohol.
“There is overwhelming evidence to suggest that moderate alcohol consumption lowers the risk of heart disease,” he said.
For middle-age people, he said, the benefit to the heart of moderate drinking — about a 25 percent drop in the risk of a heart attack — is equivalent to losing 30 pounds, exercising 30 minutes a day four times a week, or eating five servings of fruits and vegetables a day.
Others are quick to point out the enormous social and medical cost of excessive drinking. But many alcohol experts agree that people who drink moderately — one drink a day for women and up to two drinks for men — have a lower risk of heart attacks, the most common kind of stroke, and premature death in general. Moderate drinking seems to lessen the risk of osteoporosis in post-menopausal women. There is some evidence that it reduces the chances of developing adult-onset diabetes.
Years of medical studies have made it clear that a glass of champagne could help many older revelers usher in a healthy new year.
But the growing body of evidence that there’s a positive side to demon rum has put doctors in a very uncomfortable spot. Studies showing that moderate drinking is good for you routinely contain a strongly worded caveat that this information should not be taken as encouragement to drink.
Consider this one from a New England Journal of Medicine study in November, showing that moderate drinking reduced the risk of stroke: “Any public health recommendation that emphasizes the positive aspects of alcohol would be likely . . . to do more harm than good.”
The problem, of course, is that alcohol is the classic double-edged sword. It might be good for you in small doses, but it’s really bad in large ones. About 14 million Americans are problem drinkers. The government estimates that 100,000 people each year die from alcohol-related causes. In large amounts it can damage the heart, liver, brain, bones and sex organs. It causes some kinds of cancer. And it’s a big factor in traffic accidents, murders, rapes and child abuse cases.
“Unfortunately,” said Charles Hennekens, a former Harvard University researcher who was among the first to study alcohol and heart disease, “the difference between drinking a small amount and a larger amount is the difference between preventing and causing premature death.”
Thus, the question of what to do with this information.
“The data are really quite clear,” said Julie Buring, a Harvard Medical School professor and co-author of the stroke study. “The science isn’t the problem. It’s the recommendation you make that’s the problem.”
New rules allowing wineries to backhandedly advertise the health benefits of their products are facing vocal opposition in Washington. Controversial federal dietary guidelines that included positive information about alcohol for the first time in 1995 are also undergoing a revision that’s being closely watched by anti-alcohol forces.
“This is a dangerous product,” said John DeCrosta, press secretary for Sen. Strom Thurmond (R-S.C.), who is fighting the new wine health labels. “There are very serious health consequences to consuming alcohol. The public should be aware of that.”
Many worry that heavy drinkers will use positive data on alcohol as an excuse to drink too much and that some non-drinkers will become alcoholics.
“Once you tell someone a little bit is good, people tend to believe a lot is better,” said Hilary Abramson, media specialist for the Marin Institute for the Prevention of Alcohol and Other Drug Problems in California. She worries that positive publicity is leading some to think alcohol is “some kind of health elixir.”
Many doctors say their standard advice is that heavy drinkers should cut back and moderate drinkers need feel no guilt.
“Clearly, you shouldn’t give the message that everyone should drink,” said Rimm, who, nonetheless, believes doctors should suggest it to some people. Most agree that the benefits of alcohol apply only to those in middle age and up.
Obviously, people with a family history of alcoholism are not good candidates for drinking, doctors said. Anyone with hepatitis C should not drink, because the combination of that disease and alcohol appears to accelerate the liver problems associated with each. Some medications and alcohol don’t mix. Doctors say pregnant women should not drink.
While there are few dangers associated with moderate drinking, it can cause liver damage or heart rhythm problems in some people, and it’s a trigger for migraine headaches, doctors said. In a small study, Emma Meagher, an assistant professor of medicine at the University of Pennsylvania, found that as little as two drinks led to “oxidant stress,” damage that is associated with diabetes, heart, liver, Alzheimer’s and Parkinson’s diseases.
Widely publicized research connecting moderate drinking and breast cancer has been controversial. Some doctors still believe it increases the risk somewhat. But Emanuel Rubin, chairman of the pathology, anatomy and cell biology department at Jefferson Medical College and a longtime alcohol researcher, said he has reviewed all the studies and found only a “weak association” between heavy drinking and breast cancer. There was no clear evidence that moderate drinking caused cancer, he said.
As for the benefits, researchers believe that alcohol protects the heart in two ways. It increases the level of HDL, or good cholesterol. And it reduces blood clotting. Clots can trigger a heart attack when they become trapped in narrowed vessels.
Despite much publicity to the contrary, most experts believe the type of drink is immaterial. It’s the ethyl alcohol in the drink that’s important. So the cheapest whiskey is as good for your heart, if not your palate, as the best red wine.
