Here's to Your Heart

If you've been reluctant to give up your martini at the end of a hard day or a glass of your favorite wine with dinner, here's some good news. According to Richard Doll, one of the pioneering researchers in smoking and lung cancer who caused a whole generation to swear off cigarettes, we can relax when it comes to moderate indulgence in the pleasures of alcohol. In a recent article in the British Medical Journal, Doll says the evidence of a health benefit from one or two drinks a day is now "massive." A host of studies indicate a reduction of mortality from heart disease by about a third. Because heart disease is such an important cause of death in middle and old age, moderate drinking reduces total mortality. And though even moderate alcohol consumption can have a downside, such as an increased risk of breast cancer in women, it appears that the beneficial effects on total mortality outweigh the harmful effects. All this is not exactly news, with the first scientific reports appearing as early as 1926. But, says Doll, "the belief that alcohol was bad for health was so ingrained that the idea that small amounts might be good for you was hard to envisage, and it is only in the past 10 years that cardiologists and specialists in preventive medicine have begun to take it seriously." Doll cites a number of key studies during the past decade. A California prepaid health plan studied 20,000 men and women over an eight-year period. The American Cancer Society studied 490,000 Americans age 30 and over. Doll and his associates conducted a study of 12,000 middle-aged and elderly British doctors. Even after adjusting for risk factors such as dietary fat, smoking and socioeconomic standing, these studies establish a strong link between moderate drinking and reduced mortality. Is wine better?According to Doll, the only proven benefit is from ethanol in alcohol, so it doesn't matter whether your drink of choice is wine, beer or spirits. Experiments have shown that ethanol has a number of helpful effects including raising of the "good" cholesterol and acting on platelets in the blood to prevent clotting. As a way of explaining the "French Paradox"- Frenchmen who eat lots of saturated fat but still live a long time-other researchers have suspected added health benefits from wine. Results of a new study by Serge Renaud of 34,000 middle-aged men living in eastern France may offer supporting evidence. Renaud reported a 30% reduction in death from all causes with 2-3 glasses of wine a day, a 35% reduction from heart disease and 18-24% reduction from cancer. The latter finding, he claims, is due to the antioxidant action of polyphenol compounds in grapes. And of course, the very pleasure and relaxing effect of a drink or two, especially in the company of friends, may partly account for the health benefit-a possibility that deserves more research. How much is enough?Regardless of what you drink or why it's good for you, Drs. Doll and Renaud both emphasize that moderation is the key. Virtually all the research supports a "U" or "J" shape relationship between drinking and mortality. This means the mortality risk is higher for "teetotalers", dips for consumers of one or two drinks a day, and rises sharply for those who drink "excessively," putting themselves at risk from alcohol-related accidents, cancers and liver disease. What actually constitutes moderation or excess is not so easy to define. In the French study, adverse effects on death rates begin to occur after four glasses of wine a day. In the studies discussed by Doll, the optimal consumption levels varied. There are a number of reasons says Doll. Both heavy and moderate drinkers tend to understate how much they imbibe-especially in societies where alcohol consumption is in general disrepute. And the definition of "one drink" varied among the studies. For most Americans, one drink is a 12-ounce glass of beer, a 4-ounce glass of wine or a 1-ounce shot of spirits. Further studies will refine the details, but meanwhile, the basic message is clear: once we reach middle age, enjoying some small amount of alcohol in the range of one or two drinks a day reduces the risk of premature death. David S. Sobel M.D.