HEALTHY CHOICE?
Alcohol, what do the experts say?
If you were hoping for simple advice about drinking alcohol, you might be disappointed. Although alcoholic beverages may reduce your risk of heart attack and stroke, excessive use may harm your health. Alcohol, experts say, is not a one-size-fits-all drug.
Dr. Arthur Klatsky is a senior consultant in cardiology at Kaiser Permanente Medical Center in Oakland, California. In 1974 he, along with several other scientists, confirmed that moderate alcohol use reduces heart-disease risk.
More recently he has looked at strokes in drinkers and nondrinkers. He says that light-to-moderate drinkers are at lower risk of the most common kind of stroke, in which a blood vessel to the brain becomes blocked. Heavy drinkers and nondrinkers have the same level of risk, he says, slightly higher than that of light drinkers.
The less common but often fatal kind of stroke, caused by bleeding in the brain, occurs more often in people who have six or more drinks per day, Klatsky says. But he adds that moderate drinkers do not have higher risk of bleeding strokes compared with nondrinkers.
According to Klatsky, alcohol protects the heart and brain in two ways. It increases HDL cholesterol, also called good cholesterol, and it makes the blood less likely to clot. These effects help prevent blockage of arteries that cause heart disease and stroke, leading killers of Americans.
Despite this, the American Heart Association recommends that no one begin drinking for health reasons and urges moderation for those who already drink. Men should have no more than two servings of alcohol per day; women, no more than one. Pregnant women should not drink any alcohol because of its toxic effects on the fetus.
Doctors advise nondrinkers against beginning to drink because excessive alcohol use takes a heavy toll on health, and they cannot predict who might develop alcoholism. If they could, "a lot of our problems would be solved," Klatsky says. The consequences of heavy drinking include addiction, liver disease, high blood pressure, strokes and cancer.
According to the American Cancer Society, the link between alcohol and cancers of the mouth, throat and liver is well-established. Any alcohol consumption increases risk for those cancers; heavy drinkers have a much higher risk.
Alcohol also increases the risk of breast cancer for older women, according to Dr. Heather Feigelson, a senior epidemiologist at the American Cancer Society in Atlanta. She published a study finding that women drinkers who had been through menopause were 30-to-50-percent more likely to die from the disease than similar nondrinkers.
But to put this in perspective, heart disease kills more women than all cancers combined, according to the National Center for Health Statistics. And some studies suggest that high intake of folic acid, a vitamin, can reduce the alcohol-related risk of breast cancer.
Alcohol is not Klatsky's first choice for a healthy heart. "There are other, better ways to reduce risk for heart disease including weight loss, diet, exercise, cholesterol medication if indicated, and blood pressure and diabetes control." He adds that quitting smoking should be "at the top of the list."
As for what to drink, some studies find wine drinkers have the lowest heart-disease risk compared with beer or liquor drinkers. Although laboratory studies suggest certain chemicals in red wine are beneficial, Klatsky's studies show no difference in health effects between red and white wine.
Many scientists believe that alcohol itself is the protective ingredient in wine and spirits. Still, Dr. Christopher Sempos, Professor of Social and Preventive Medicine at State University of New York at Buffalo, cautions that alcoholic beverages contain many chemicals. Sorting out their effects is difficult.
"The pattern of drinking may be very important," says Sempos. Countries such as Russia and Scotland have more deaths from heart attacks on Mondays. He says this may be because weekend binge drinking, which can cause abnormal heart rhythms, is common in those places. Studies have found that wine drinkers seldom binge and often drink with meals, a pattern that may be more protective than drinking apart from meals.
Drinking alcohol, especially for someone with a personal or family history of alcoholism, comes with risks. Religious practice may prohibit some people from using alcohol at all. But established, moderate drinkers may enjoy benefits.
Anyone who wants to know more about alcohol and health should consult the web sites and publications of the American Heart Association, the American Cancer Society and the National Institute on Alcohol Abuse and Alcoholism. For making a decision about your own alcohol use, consider your health risks and family history, and consult your doctor.
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"HEALTHY CHOICE?"
authored by:
Dr. Randall F. White, MD is a psychiatrist who practices in Atlanta and Hiawassee, Georgia, with an interest in rural and geriatric psychiatry. He graduated with honors from Emory University School of Medicine, completed his psychiatry residency at W...
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