WHEN it comes to drinking alcohol for medicinal purposes, most Americans get it wrong. Take a sampling of wine samplers at a recent tasting in Santa Barbara.
"I usually drink wine, but not every day," says Mike White, 45. "Then one day a week, I go big -- maybe half to three-quarters of a bottle." -- \o7Wrong.
\f7"I drink on the weekends only," says Sophie Calvin, 40. -- \o7That's not it either.
\f7"I have a glass of wine when I take a bubble bath," says Mary Whitney, 40. "Every night." -- \o7Getting close, but it might be better if she also brought an entree into the tub.
\f7"I have a glass of wine with dinner each night. I like the taste," says Mark Biddeson, 52. "Or I'll have a beer instead sometimes, depending on what I'm eating." -- \o7Bingo! He's got it!\f7
People drink to drown sorrows, celebrate victories, enhance a meal or loosen up with friends -- not necessarily to protect their hearts. Small wonder.
The folks who wag warning fingers over the dangers of trans fats, and hail the benefits of leafy greens, are silent on alcohol. These public health messengers -- who remind us to quit smoking, eat fresh fruits and vegetables and exercise every day -- are not about to tell people to start drinking.
Their reluctance comes even amid growing evidence that moderate drinking is beneficial. A study last week in the Archives of Internal Medicine showed that light to moderate alcohol consumption in people age 70 to 79 is associated with significantly lower rates of cardiac events and longer survival. A week earlier, researchers reported in the July 18 issue of the Journal of the American College of Cardiology that moderate alcohol consumption may help ward off development of heart failure.
Those studies join dozens of others showing that a drink a day for a woman, two for a man, is good for heart health. Studies from at least 20 countries in North America, Europe, Asia and Australia consistently show that moderate drinkers have rates of heart disease between 20% and 40% lower than abstainers or heavy drinkers, according to the National Institute on Alcohol Abuse and Alcoholism.
Other research is showing exactly how alcohol is beneficial -- and how to use it to best effect.
The guardians of public health aren't ignoring these data. They know that for most people, alcohol can be good for the heart. But they also know that for others, it can be a health and social disaster.
Most doctors err on the side of caution, believing that the risk to the few outweighs the benefit to the many. They fear that some people encouraged to drink moderately will end up going too far.
And crossing the line from moderate to abusive drinking not only erases the heart health benefits, it introduces dozens of additional health problems. In the former Soviet Union and parts of Eastern Europe, for example, binge drinking was found to eliminate the rise in HDL, the cholesterol that protects the heart, seen in moderate drinkers, according to a 1998 study in the Journal of the Royal Society of Medicine. In a 2001 study in the International Journal of Epidemiology, weekend binge drinking in Lithuania was found to be responsible for spikes in the numbers of deaths from heart disease over the weekend.
"This is a true public health conundrum," says Dr. Thomas Pearson, chairman of the department of community and preventive medicine at the University of Rochester School of Medicine. "If you really want to shift the alcohol balance toward the benefit, you'll concentrate on responsible drinking among young people. It's in the 45-plus-year-old where alcohol may be beneficial."
Predicting who would be helped, who might be hurt, by adding a drink or two a day to the healthy-living formula is an age-related numbers game. In the United States, an estimated 100,000 excess deaths a year are attributed to alcohol, most of them in people younger than 45, according to the Centers for Disease Control and Prevention.
And an estimated 7% to 10% of Americans are alcoholics or abusive drinkers. They cannot drink moderately, and should not drink at all. Last year, the CDC ranked alcohol as the third-leading cause of preventable death in the country. Alcohol-related death and disability results from organ damage, brain damage and hemorrhagic stroke as well as injuries from accidents and violence. The estimated annual cost of alcohol abuse, including lost productivity, is $185 billion.
On the other hand, if current drinkers all suddenly quit, losing the protective benefits of alcohol, about 80,000 excess deaths would occur, most of them among people older than 45, according to a 1997 study by Pearson in the journal Circulation. That's when people begin to hit the heart disease years.