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Alcohol and Your Heart

Straight Up

A drink or two each day may indeed help keep the doctor away--but health officials have balked at encouraging the public to drink.

April 09, 2001|BENEDICT CAREY | TIMES HEALTH WRITER

You thought you were a lightweight; look how incoherent health officials can get over a drink or two.

For more than a decade now, researchers have been reporting that adults who drink moderate amounts of alcohol--a drink or two a day, on average--are 20% to 30% less likely to develop heart disease than those who drink rarely or never.

Yet just last year, a team of health officials in France challenged the so-called French paradox, the theory that the French custom of drinking with meals explains the country's low rate of heart disease, despite rich food. And earlier this year, the American Heart Assn. published a strong caution against drinking, urging doctors to downplay the "popular but unproven supposition that drinking red wine can ward off heart attacks" and denying there is good evidence that alcohol improves cholesterol readings.

Was it all hype? Or another story of false promise, like vitamin E or beta carotene, in which early enthusiasm over possible protection against heart disease cooled after further research?

Neither, say those who study the relation between alcohol and heart disease. For one thing, alcohol is not a supplement or a drug administered for health reasons; it is part of the human diet that, for better or worse, predates the fields of nutrition and cardiology by thousands of years.

For another, the evidence that moderate drinking protects against heart disease has not suddenly become murky, as happened with beta carotene and vitamin E. If anything, researchers say, the case for moderate drinking has only gotten stronger in the last year. "Any epidemiologist worth anything who looks at the 60 or so studies on this would conclude that moderate drinking reduces the risk of heart disease and overall mortality," says Eric Rimm, who studies the interaction of diet and disease at the Harvard School of Public Health. "You get the benefit by drinking beer in Germany, or wine in France, or distilled spirits in Asia. You name a country, they've done studies showing this effect."

The recent double talk about alcohol is more political than scientific, researchers say, and reflects officials' reluctance to trust the public with good news about a substance that causes so much harm when abused. The assault on the French paradox, for example, came at a time when the French government was waging a campaign against alcohol consumption, according to critics of the recent research.

The concern is easy to understand: About 15% of regular drinkers have serious alcohol problems, according to government data. And any statement from a group such as the American Heart Assn. is bound to have a strong influence on recommendations across the country, according to Dr. Edward Fisher, a heart disease researcher at the Mount Sinai School of Medicine in New York, who co-authored the AHA report. Fisher says that the AHA chose to "err on the conservative side, because the benefits of light drinking aren't absolutely proven for everybody, and we wanted to avoid any hint of endorsing it."

Yet the resulting message blurs the crucial distinction between heavy and moderate drinking, researchers say, and confounds the understanding of both. "Any discussion of alcohol should start with a clear statement of the risks of heavy drinking: car accidents, suicide, alcoholism and so on," says Dr. Arthur Klatsky, a cardiologist at Kaiser Permanente Medical Center in Oakland, who in 1974 authored one of the first papers linking alcohol to reduced heart disease risk. "But 70% of adults in this country drink, and the vast majority do so moderately, not heavily. There is a difference."

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That difference is fairly well defined, in fact, for a substance whose effect varies so much from person to person. Studies find that "problem" drinking usually begins after people start downing three or more drinks a day, on average. That's when the DUIs turn up; that's when it becomes harder to get to work on time (or at all); that's when the family arguments flare and relationships suffer.

Not coincidentally, that third beer or glass of wine also marks the difference, for many people, between drinking and drunk, when alcohol noticeably turns on the body. Having three pops or more in an evening quickly raises blood pressure in many people, for example, which is especially dangerous for those with hypertension (chronic high blood pressure), doctors say.

Over time, this kind of heavy drinking raises a person's risk of liver and digestive diseases, cardiomyopathy (a weakening of the heart muscle), not to mention suicide and depression.

It is a truly morbid list--but one that does not apply to moderate drinkers, as far as doctors can tell. While some argue that a substance that's toxic in large doses must be damaging in smaller amounts, there's no solid evidence linking the diseases of problem drinking to those of moderate drinking, says Dr. Meir Stampfer, a professor of nutrition and epidemiology at the Harvard School of Public Health.

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