Drink to this

Evidence grows about benefits of moderate drinking

By Maggie Rosen, Globe Correspondent, 4/6/2004

http://www.boston.com/yourlife/heal.../drink_to_this/

A story on the Sunday night TV show, "60 Minutes," was the turning point.

Before that, for at least 2,000 years, people claimed alcohol had medicinal benefits, but no one knew for sure. In the dozen years since the show aired, scientists around the world have been looking at alcohol's upside, and their findings have been consistent: Drinking in moderation appears healthier than not drinking at all.

The show, which said this link might explain why French people have less heart disease than Americans, made it politically acceptable to talk about the pluses of alcohol and encouraged researchers to explore the health consequences of drinking, a number of scientists said.

Dr. Harvey Finkel, then a Boston University School of Medicine professor, said he didn't believe it at first: How could something that so clearly destroyed people's lives and their health possibly be good for them? But after years of examining the data, Finkel said he changed his mind. Now, in his retirement, he lectures about the health benefits of drinking a glass or two of wine or beer with dinner.

The key distinction that Finkel and other doctors and scientists make about drinking is the definition of "moderation." They are strongly against drinking to get drunk, or drinking and driving. They suggest people eat while they drink to mitigate against drunkenness. But they believe that most people who can handle their liquor would do themselves a favor by sipping wine or beer every day.

"Responsible drinking may actually prevent the common diseases of old age," said Dr. R. Curtis Ellison, professor of medicine and public Health at the Boston University School of Medicine. "The mortality rate [among moderate drinkers] is 20 percent lower and the rate of heart disease 40 percent lower than in abstainers with similar behavior and [physical] characteristics."

Over the last dozen years, in dozens of epidemiological studies examining tens of thousands of patient records, researchers have noted a link between moderate drinking and better health. Repeated studies from all over the world have shown that people who consume moderate amounts of alcohol have lower risk of heart disease, stroke, lung disease, diabetes, dementia, and maybe even obesity.

Not everyone is convinced. There has never been and may never be the gold-standard study -- a randomized, double-blind test, giving some people a placebo and others an alcoholic punch. Researchers say it would be nearly impossible to get someone to fund a study that made people drink.

Short of that, "the evidence is not compelling [enough] to make a recommendation to drink alcohol," said Dr. Daniel Jones, dean of the University of Mississippi School of Medicine and a spokesman for the American Heart Association, which shares his position. Other ideas, like hormone-replacement therapy, seemed convincing when examined in large epidemiological trials, Jones said, but then were debunked when tested more rigorously.

Jones said he would not tell someone not to drink in moderation, but he wouldn't advise them to start drinking, either, "because of the potential risk, because of the uncertainty of the benefit and because there are so many other factors we know are beneficial, such as exercise, controlling weight and so forth."

Back in the alcohol-can-be-good-for-you camp, though, Dr. J. Michael Gaziano of Brigham and Women's Hospital and the Veterans Administration Boston Healthcare System recently completed a study of hypertensive men that found moderate drinking dramatically reduced their risk of developing cardiovascular disease.

"The conventional wisdom is that heavy drinking is bad -- there's no disputing this. It raises blood pressure," which can damage the heart muscle, Gaziano said. "But our study suggests that for men -- and probably women -- light to moderate drinking not only is not a problem, but it actually does significant good."

Scientists now believe that alcohol encourages production of "good" HDL-cholesterol, helps wash the gunk out of the lining of blood vessels and reins in "free radicals," which can damage cells, causing heart disease, cancer, and other problems. Researchers are beginning to examine the psychological benefits of having a relaxing glass of wine or mug of beer with dinner.

Until recently, most alcohol research focused on the health benefits of red wine. One British physician, Dr. William McCrea of the Great Western Hospital in Swindon, found that a specific Chilean wine -- Montes Cabernet Sauvignon Reserve 2001 -- helped prevent blood clotting and cholesterol buildup in the blood vessels of cardiac patients.

But the focus has now expanded to include white wine, dark beer, cider and spirits, which all seem to confer roughly the same benefit. It's not yet clear whether the health boost comes from the skins, stems, seeds, husks or even the oak in which alcohol is aged, though researchers are searching for those answers. The fermentation appears to be crucial; grape juice does not extend lifespans as one recent Harvard Medical School study suggests alcohol might.

Dark beer contains antioxidants, as well as high levels of important dietary minerals such as chromium, which may help control blood glucose levels, and silicon, which may help with bone health.

Research also implies that hard cider, "colored" spirits like whisky, and to a lesser extent white wine, have the same polyphenols and flavonoids found in red wine, and so provide the same antioxidant and anti-inflammatory benefits. Flavonoids are what give many fruits and vegetables their dark color.

Not all alcohol conveys equal benefit: Light beers and "white spirits" like gin and vodka don't appear to contain any health-giving ingredients.

And drinking is obviously not for everyone. Doctors and researchers agree that anyone with a previous history of abuse, a dislike for alcohol, contrary religious beliefs, or who is on medication that is incompatible with alcohol should not drink.

Different people respond to alcohol differently. A recent study out of Tufts University suggests that for people with certain genetic mutations, alcohol consumption may actually boost their bad cholesterol instead of the good, potentially making them sicker instead of healthier.

"There are no external symptoms, and we have no way of knowing who has this without doing genetic testing," said Jose M. Ordovas, a senior scientist at the Friedman School of Nutrition Science and Policy at Tufts University. "The message is that no single recommendation can fit everyone, and until we have more efficient ways of doing personalized therapy, its dangerous to generalize."

Responsible, moderate drinking means not driving, drinking with meals when the food dilutes the "tipsying" effect of alcohol, and not drinking a weekly quota all at once, Ellison and other scientists said.

"You cannot save your `drink a day' all week and then have seven drinks on Saturday night," Ellison said.

Finkel said it's still harder than it should be to convince Puritanical Americans that drinking might be healthy.

There are people, Finkel said, "who can't accept the idea that even one drop of alcohol could possibly be good for you."

Good for what ails you

Drinking alcohol in moderation can reduce your chances of suffering a wide range of maladies, according to a selection of recent studies.

Heart disease A study of 14,000 male doctors treated for hypertension found that those who consumed one or two drinks a day reduced their risk of developing heart disease by 44 percent, compared to nondrinkers.

Lung disease Resveratrol, found in the skins of red fruits such as grapes reduced lung infl ammation in patients with chronic obstructive pulmonary disease, the cause of at least 3 million deaths per year.

Type 2 (adult onset) diabetes In a study of 22,000 twins, moderate drinkers were less likely to develop type 2 diabetes than nondrinkers, particularly among those who were not overweight. Heavy and binge drinking may increase the risk of type 2 diabetes in women.

Osteoporosis People with diets high in silicon, a mineral found in dark beer, had higher bone densities and therefore a lower chance of developing osteoporosis. The bone-benefi ts in the 2,800-person study appeared most clearly in premenopausal women.

Dementia Those who consumed one to three drinks per day reduced their risk of getting dementia by 42 percent compared to nondrinkers. There was no difference in the source of alcohol the 5,400 test subjects drank.

Obesity The extra calories in a glass of wine or beer with dinner don't end up on people's hips, but instead, in this preliminary study, appear to help the body get rid of excess weight.

Sources: Heart disease: Archives of Internal Medicine, March 22, 2004; Lung disease: National Heart and Lung Institute, London, October 2003; Type 2 diabetes: Diabetes Care, Finland, October 2003; Osteoporosis: Bone and Mineral Research, Feb. 2004; Dementia: The Lancet, Netherlands, Jan. 26, 2002; Obesity: Paper presented at American Heart Association Epidemiology Meeting, San Francisco, March, 2004.