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Article [12]
MODERATE
ALCOHOL
CONSUMPTION
–
CONTROVERSY
AND
CONFUSION
We
hear
of
studies
showing
the
cardiovascular
benefits
of
moderate
alcohol
consumption,
yet
a
host
of
other
health
problems
are
caused
by
alcohol.
What
is
a
person
to
believe?
It
can
be
very
confusing
to
the
consumer
to
hear
cardiologists
and
many
health
newsletters
(even
in
the
alternative
health
field)
recommending
moderation
in
alcohol
consumption.
Moderation
is
usually
defined
as
1-2
drinks/day,
and
often
no
caveats
are
given
about
its
dangers.
After
extensive
review
of
summaries
of
the
many
medical
journal
references
and
other
publications,
it
appears
that
there
needs
to
be
a
big
question
mark
after
this
advice.
Would
it
really
be
poor
advice
to
recommend
total
avoidance
of
drinking
ethanol? What appear to be benefits of moderate alcohol consumption stem from many epidemiological, case control, and non-randomized prospective studies comparing moderate drinking population groups or individuals with non-drinkers. Many of these studies show markedly decreased risk of coronary disease, myocardial infarction, cardiac deaths, and in some cases, decrease in total mortality. One study showed slight decrease in total mortality with one drink per day. New England Journal of Medicine Dec 11, 1994; 337:1705-1714. One study showed decrease in gallbladder disease Hepatology 1998; 27:1492-1498. Some also showed decrease in osteoporosis.
This
article
questions
the
validity
of
the
purported
cardiovascular
benefits
of
alcohol
and
questions
its
relevance
in
the
face
of
many
other
health
issues.
When
we
speak
of
moderation,
what
is
moderate
drinking,
and
what
is
a
drink?
Commonly
1-2
drinks
a
day
is
called
moderation.
I
drink
is
usually
counted
as
a
12oz
beer,
a
6
oz
wine,
or
1
½
oz
of
whiskey.
(Dr.
John
R.
Lee,
M.D.,
in
What
Your
Doctor
May
Not
Tell
You
About
Menopause,
p.
173.
A
can
of
beer
usually
contains
13
grams
of
ethanol,
a
glass
of
wine
about
11
grams,
and
a
shot
of
whiskey
15gms.
Medical
Tribune
July
9,
1992:9.
How
much
alcohol
is
needed
for
maximum
benefit
for
the
heart?
The
literature
appears
confusing
regarding
that.
A
Japanese
study
showed
decreased
risk
for
heart
disease
with
22-68
grams/day,
which
could
be
as
much
as
4-5
drinks
per
day.
American
Journal
of
Epidemiologist
1998;147(1)59-65.
What
a
way
to
save
the
heart
by
being
drunk
every
day!
Most
studies
show
a
benefit
up
to
about
2
drinks
a
day,
and
usually
beyond
that,
heart
disease
risk
goes
up.
Circulation
December
1,
1996;
94(11)3023-3025.
Here
is
where
the
picture
gets
fuzzy.
We
don’t
have
a
precisely
standardized
dose
to
recommend
(which
is
necessary
for
a
drug,
whether
prescription
or
non-prescription).
Every
drug
has
its
(presumed)
benefits
at
a
certain
dosage
level,
and
its
overdose
level
or
danger
zone.
Alcohol
is
a
toxic
drug
and
no
one
has
defined
precisely
how
much
is
the
minimal
amount
needed
for
benefit
nor
the
maximum
benefit
level,
nor
the
minimum
risk
level
in
regard
to
cardiovascular
disease,
not
to
mention
all
the
other
health
risks
related
to
alcohol.
The
other
missing
piece
in
a
responsible
recommendation
for
taking
a
drug
is
to
have
sufficient
randomized
prospective
(preferably
double-blind
placebo)
controlled
experiments.
What
we
have
now
in
regard
to
alcohol
is
epidemiological,
case
controlled,
or
non-randomized
prospective
studies,
which
may
be
sufficient
for
recommendations
for
foods
or
nutritional
supplements
which
are
basically
nontoxic;
however,
drugs
require
much
more
stringent
scientific
safety
testing.
Alcohol
in
common
parlance
is
spoken
of
often
like
a
food,
since
it
is
commonly
consumed
with
meals
as
a
beverage
like
water
or
sodas,
but
it
needs
to
be
underscored
that
ethanol
is
not
a
food. This lack of adequate scientific evidence in regard to alcohol and heart disease could be considered enough by itself to discredit any public statement that alcohol even in moderation is beneficial for one’s health, or that it prevents death from heart disease, but there are other factors which further cast doubt on this approach.
Some
possible
mechanisms
by
which
alcohol
could
prevent
heart
attacks
are
raising
HDL
cholesterol,
decreasing
fibrinogen,
decreasing
platelet
“stickiness”
(by
decreasing
thromboxane
A2),
and
increasing
plasminogen.
Postgraduate
Medicine
April
1992;91(5)271-277,
Journal
of
Nutritional
Biochemistry
Nov
1992;3:562-579.
Most
of
these
actions
are
ant-clotting
factors,
which
can
be
accomplished
also
by
fish
oil,
ginkgo
biloba,
garlic,
and
other
natural,
less
toxic
supplements
and
foods.
This
issue
is
also
muddled
by
the
benefits
of
the
non-alcohol
portion
of
red
wine,
rich
in
polyphenols
and
other
antioxidants.
Red
wine
is
included
in
many
of
the
alcohol
studies
commonly
quoted.
An
HDL
increase
can
be
accomplished
by
exercise
and
other
nutritional
measures.
Some
of
the
platelet-inhibiting
actions
can
be
accomplished
by
aspirin,
which,
if
introduced
today,
would
probably
be
available
only
by
prescription
because
of
its
toxic
effects.
The
other
common
“benefit”
of
alcohol,
to
relax
the
body,
“kill”
emotional
pain,
and
reduce
the
feelings
of
anxiety
(the
real
reason
most
people
drink),
may
be
similar
to
the
reasons
people
take
Valium,
an
addictive
schedule
4
controlled
substance,
regulated
by
the
DEA.
So
would
this
be
considered
a
safe
recommendation
to
take
a
drug
combination
of
Valium/aspirin
(Vaspirin
or
Aspium?),
without
a
prescription
and
without
precise
dosage
recommendations?
Regarding
addictive
substances,
no
one
knows
who
is
susceptible
to
addiction
to
a
drug
until
he
or
she
tries
it
out
for
a
period
of
time,
than
it
is
too
late
to
prevent
it.
There
are
approximately
18
million
Americans
addicted
to
alcohol.
Even
if
there
were
a
precise
dosage
to
recommend,
how
many
people
would
drink
that
precise
amount,
especially
considering
that
it
is
commonly
used
recreationally
and
socially,
not
as
a
medicine,
and
that
the
substance
itself
impairs
one’s
judgment
about
how
much
to
drink?
Regarding
any
drug
that
decreases
feelings
of
anxiety
and
covers
up
emotional
pain,
how
are
people
to
make
the
necessary
adjustments
and
changes
in
habits,
choices,
work,
and
attitudes
when
there
is
a
constant
cover-up
and
avoidance
of
feeling
emotional
pains?
These
are
warning
signals,
valuable
information
given
by
the
mind/body
for
improved
health
and
growth,
and
in
some
instances,
for
much
needed
counseling.
When
giving
health-related
advice,
why
not
take
the
high
road
of
recommending
the
best
way
to
maximize
our
well
being
instead
of
the
low
road
of
making
the
most
short-
term
choices
to
get
by
with
something
second
best?
People
are
often
capable
of
accomplishing
a
lot
more
than
they
are
given
credit
for.
There
are
many
stress-relieving
activities
like
exercise,
sleep,
play,
recreation,
positive
social
interactions,
meditation
and
prayer
that
accomplish
relaxation
with
longer
lasting
benefits
than
the
expedient
“solution”
that
alcohol
offers,
with
its
resultant
rebound
anxiety
and
other
“backlashes.”
For
health
and
well
being,
recommending
things
that
enhance
the
spiritual
aspect
of
life
cannot
be
ignored,
because
we
are
whole
persons,
emotional,
mental,
and
spiritual,
in
addition
to
coronary
vessels
and
myocardial
tissue.
Alcohol
use
has
never
been
known
to
promote
long-term
spiritual
growth,
integrity,
commitment,
ethics,
and
other
values
that
strengthen
a
culture
or
society.
More
precisely,
ingesting
a
mind-numbing
substance
can
compete
with
and
distract
from
experiencing
the
“intoxicating”
appreciation
of
beauty,
for
being
“drunk”
with
the
love
of
God
in
worship,
for
being
inspired
by
inner
peace
discovered
in
prayer
and
meditation.
Lifestyle
choices
can
boost
longevity
as
well
as
extending
quality
of
life,
as
shown
by
Dr.
James
Fries
in
his
study
at
Stanford
University
which
showed
lengthened
disease-free
interval,
resulting
in
“compression
of
morbidity”
to
a
time
near
the
end
of
life,
cited
in
the
British
Medical
Journal
2000,
vol.
321,
pp1149-51.
There
is
no
such
data
regarding
drugs
and
the
quality
life-years
saved.
The
same
applies
to
the
drug
ethanol.
So
far
we
have
sketchy
crude
morbidity
and
mortality
data. These are some of the arguments for careful skepticism about giving advice publicly about moderation in alcohol use. Part II will go into more detail regarding other health risks associated with light to moderate drinking.
By David G. Schwartz, M.D. |
