Alcohol's Benefits Well Documented But Caution is Important

The harm that alcohol does to human society is immense.  Over 100,000 Americans are killed every year due to the effects of this addictive natural substance.  It is the number one cause of murder, suicide, family violence, rape, auto fatalities, and more.  While some perpetrators are alcoholics, many are not.  Indeed, many of the deceased don't even use alcohol, but are killed by the alcohol users.  

The health benefits of alcohol are widely promoted in the media and are real.  The risk of developing diabetes is also reduced. However, the benefits for heart disease don't start to appear until after age 45, while the harmful effects of alcohol are very serious long before this age.  The one large study looking at abstainers who pick up drinking found no overall health benefits.  The health benefits of alcohol appear mostly short-term in their impact, i.e., the drinking you did 10 years ago doesn't have much health benefit.

The best rules are these:  1) Don't drink until at least age 40 unless you are at risk for diabetes, 2) never drink more than one drink per day, 3) never drive after drinking even one drink, 4) if you do drink for health reasons, remember, alcohol is addictive and will make you want to drink more, 5) don't engage in social drinking since it sets a bad example and makes alcohol more likely to get out of control.  You don't take your medicine at parties.  

A 12 ounce 4% alcohol beer has 13.44 grams of alcohol or the same as 4 ounces of a 12% wine or one ounce (pony shot) of 96 proof whiskey.  A 6 ounce cup of 12% wine or a regular 1.5 ounce shot of 96 proof whiskey would be 20 grams.  For an 80 proof whiskey, a shot would be 16.67 grams.

Alcohol Negative Effect on Health to Age 45: Swedish Karolinska study on 49,000 conscripts for a follow-up of 25 years showed an increased mortality of 14% with alcohol consumption (205 deaths!), especially if over 15 g/d (over 5-6 drinks/week). BMJ 1999;319:821-822. Ed: Binge drinking would seriously worsen the results, e.g. if a person drinks all 6 drinks in one day.

Abstinence Not Increase Mortality In NHAHES I: UCSF report that abstainers in the large nationwide NHAHES-1 study who picked up drinking did not increase longevity, but heavy drinkers who decreased or stopped their drinking did.  20 year follow-up of adults 22 and older. Changes in drinking status, serious illness and mortality. Fillmore KM, Kerr WC, Bostrom A. J Stud Alcohol. 2003 Mar;64(2):278-85

Alcohol Protective, High Blood Pressure Bad: Individuals with hypertension (2.4) or diabetes (1.7) showed a higher risk of CHD. High low density lipoprotein cholesterol (LDL-C) (1.5), high fasting triglyceride (1.5) and low high density lipoprotein cholesterol (HDL-C) (1.3) showed a lesser but still increased risk. Alcohol intake was protective with non-drinkers having an increased risk of CHD (1.8). Obesity (body mass index > or =30) showed an increased risk (1.8). An increased risk of CHD was found in cigarette smokers of > or =20 pack years (1.5) but not with lesser amounts. 10 year f/u 2800 Singapore adults. : Int J Epidemiol 2001 Oct;30(5):983-8

Alcohol, Vegetables, Fish Good; Meat, Butter, Pastries & Milk Bad: A 7 nation (US, Greece, Japan, Italy, Finld, Yugo) of 12,000 men with 25 years of follow-up study of their diets found animal food-groups were directly correlated, and vegetable food-groups (except potatoes) as well as fish and alcohol were inversely correlated with CHD mortality. Univariate analysis showed significant positive correlation coefficients (increased CHD death) for butter (R = 0.887), meat (R = 0.645), pastries (R = 0.752), and milk (R = 0.600) consumption, and significant negative correlation coefficients for legumes (R = -0.822), oils (R = -0.571), and alcohol (R = -0.609) consumption. Combined vegetable foods (excluding alcohol) were inversely correlated (R = -0.519), whereas combined animal foods (excluding fish) were directly correlated (R = 0.798) with CHD death rates. Eur J Epidemiol 1999 Jul;15(6):507-15

Helps Japanese: Smoking, HBP, angina increased heart attacks in both middle age and elderly and while alcohol decreased them. Hypercholesterol assoc with heart attacks only in middle age. Jpn Circ J 2000 Feb;64(2):103-9. A small case control study of 92 men and 271 controls found alcohol protective after controlling for HBP, DM, smoking, age, etc. with rr 0.35 for 30-60 ml and 0.13 for 60 ml or more per day. Am J Cardiol 1991 Oct 15;68(10):1011-4

Alcohol Helps: 1100 middle-aged adults followed for 41 months. Those drinking alcohol had a heart disease of Risk Ratio 0.3 and independent of heart calcium which had RR 3.0. Am J Cardiol 1999 Oct 1;84(7):802-6

Highest Quartile High Risk: Finnish study with 6.7 years of follow-up of 2160 males: The 25% of men drinking the most had frequent hangovers with 43% reporting at least monthly hangovers had a coronary heart disease death Risk Ratio of 2.36 for these 239 men, a 136% increase over the others. Kauhanan, Epid ’97;8:310

Alcohol Causes High Premature Death in France: Using national data and a prospective study of 2687 men with 9.3 yr follow-up, alcohol caused 19% male and 13% female to die prematurely. Over three drinks (over 60 g/d) had a 90% increased risk of death RR 1.9 and 2-3 drink + over one and up to three drinks a 30% increase (25-59) g/d RR 1.3. French Natl Inst Health, Alc Clin Exp Res ’96;20:428

Meta-analysis Says No Difference for Different Types of Alcohol: Dr. Rimm of Harvard reviewed 10 prospective, 3 case-control and 12 epidemiologic studies. Wine, beer, and spirits all appeared to have similar beneficial effects. BMJ ’96;312:731

0 Drinks/Week Lowest for Death Before 65: Drinkers of 2 drinks per day or more were twice as likely to die before age 65 (42.3%) vs 22.4% in abstainers. Study of 15,000 deceased adults. 25% men and 7% women had been heavy drinkers and 30% men and 61% women abstainers. Bertolucci, Natl Inst on Alc Abuse. AP NY 10/3/90

1 Drink/Week Ideal for Physician Mortality: In a 5.5 year follow-up of the 89,000 physicians health study with over 3,000 deaths, researchers found alcohol risk ratio for death .74, .77, .79, and .82 for one drink/week, 2-4/wk, 5-6/wk, and 1/day. At two/day, there was no benefit. No harm or benefit to specific cancers although those at 2/day had 28% increase in cancer which was non-significant while having CVD RR .76. J Am Coll Cardiol 2000 Jan;35(1):96-105; Review article = Biomed Pharmacother 1999 Oct;53(9):417-23

1-4 Drinks/Week Ideal for Stroke Prevention: 12 yr f/u 22,000 physicians found RRs of .78, .75, .83, .80 for 1/wk, 2-4/wk, 5-6/wk and 1/day compared to less than once a week. No benefit over that. Brigham and Women’s. N Engl J Med 1999 Nov 18;341(21):1557-64

2+ Drinks/Week Decreases Heart Disease: People drinking two of more drinks per week decreased heart-disease risk by half in patients of average age 74 years. J Am Geriatr Soc ’99;47:396-401

2-3 Drinks/Week Decreased BP Young Women: Ravi Thadhani of Brigham and Women's Hospital in Boston. But over 10 drinks/wk increase BP. Arch Int Med 3/2002.

1-6 Drinks/Week Lowers Atherosclerosis: In a study by Ken Makamal of the Univ of Washington, 4247 subjects free of confirmed cardiovascular disease (CVD) and 1592 diagnosed with CVD underwent B-mode ultrasonography of the internal and common carotid artery with measurement of the intima-media thickness (IMT). The J-shaped relation found with mortality and heart disease was also found with arterial wall thickness with those drinking 1-6 drinks per week having vessels that were 0.07 mm thinner than abstainers while those drinking over 14 drinks per week had vessels 0.14 mm thicker than abstainers.  Arterioscler Thromb Vasc Biol 12/2003;23:2252-2259.

2-6 Drinks/Week Alcohol Helps After MI: 2-6 drinks per week prevented 18 deaths per 1000 pt-years in male survivors of an MI. Lancet ’98;352:1882-5. Authors say type of alcohol probably makes no difference. Lancet ’99;353:1272-3

2-8 Drinks/Week Lowest Mortality in Germany: In a study of 2084 adults ages 45-64, during eight years of follow-up, total mortality was 41% lower (RR 0.59) for drinkers vs. non-drinkers. Lowest male CHD deaths occurred with 4-8 drinks/week (RR 0.46) and for females for up to 5 drinks per week RR 0.46.

2-4 Drinks/Week Lowest After Heart Attack Mortality: Physician’s Health Study with 90,150 and over 5000 already had had heart attacks. In 5 years of follow-up of these 5000, researchers found 1-4 drinks/month produced a relative risk (RR) of 0.85, 2-4 drinks/week RR 0.72, 1 drink/day RR 0.79, 2 or more/d RR 0.84. Muntwyler, Harvard, Lancet 12/12/98;352:1882. Similar in Arch Intern Med ’97;157:79

2-4 Drinks/Week Ideal for Stroke Prevention, But 1/Week About the Same: 12 years of follow-up for 22000 physicians found RRs of .78, .75, .83, .80 for 1/wk, 2-4/wk, 5-6/wk and 1/day compared to less than once a week. There was no benefit over that. Brigham and Women’s. N Engl J Med 1999 Nov 18;341(21):1557-64

1-7 Drinks/Week Lowest Mortality: 40,000 Hawaiians on a 20-year follow-up cohort study found a 20% decreased mortality with 1-7 drinks/week with no decrease in mortality over 7 drinks/week. Protective benefit was strongest in white males vs. females or Asians. Maskarinec, Epidem 11/98;9:654

5-7 Drinks/Week Ideal for Physicians; Frequency, Not Type, Key: Harvard male health profession study of 38,077 men who had not stopped drinking in the past 10 years and without cancer or diseases of heart or blood vessels. Type of alcohol made no difference. Those who drank 3-4 days a week had 32% fewer heart attacks than nondrinkers. Almost no difference whether drank half a drink or four. Once or twice a week had only a 16% lower risk. 5-7 times a week 37% lower. Recent more important than past consumption. Alcohol raises HDL and thins blood but breaks down fairly rapidly and effects on RBCs is short-lived. Mukmal. AP 1/9/03. Roles of Drinking Pattern and Type of Alcohol Consumed in Coronary Heart Disease in Men," 1/9/03 NEJM 348(2):109-118

1-6 Drinks/Week as Good as 1-2 Drinks/Day: Light or Moderate Drinking Associated with Fewer Heart Deaths in Those with High Blood Pressure: 14,125 men in the Physicians’ Health Study with a history of treatment for hypertension but free of heart attack, stroke, cancer and liver disease were followed for 5 years. Compared with nondrinkers, those drinking 1-6 drinks per week had a 39% decrease and those drinking 1-2 drinks per day a 44% decrease in risk of death due to cardiovascular disease. J. Michael Gaziano, Harvard, Arch Int Med 3/22/04. Ed: Since alcohol is a dangerous and addictive drug, using the lowest amount that achieves the desired effect is the right thing to do.  One drink per day for 2-7 days a week once again appears best.

1-6 Drinks per Week Slowed Cognitive Decline in Elderly Nurses: In a 20-year follow-up of the cognitive function in 12,480 retired nurses ages 70-81 in the Nurses' Health Study who were 70 to 81 years old, after multivariate adjustment, moderate drinkers (less than one drink (15.0 g of alcohol) per day) had better mean cognitive scores than nondrinkers with a 23% lower risk of impairment (RR 0.77). Over a carefully measured 2 year period at the end of the study, there was a 15% lower risk of a substantial decline (RR 0.85). Those drinking 1-2 drinks per day did not show this benefit. The type of alcohol made no difference nor did the apolipoprotein E genotype. Effects of moderate alcohol consumption on cognitive function in women. Stampfer MJ, Kang JH, et al. Brigham and Women's, Harvard. N Engl J Med. 2005 Jan 20;352(3):245-53

0.5-2 Drinks/Day Reduced Heart Attacks in Hypertensive Men But No Effect on Mortality: In a prospective cohort study of 11,711 American men with hypertension from the Health Professionals Follow-Up Study, during 16 years of follow-up, 653 patients with heart attacks were documented. Compared with patients abstaining from alcohol, the hazard ratio for 0.1 to 4.9 grams of alcohol per day was 1.09; consuming 5 to 9.9 grams of alcohol per day was 0.81; consuming 10 to 14.9 grams of alcohol per day was 0.68 (CI, 0.51 to 0.91 g/d); consuming 15 to 29.9 grams of alcohol per day was 0.72; consuming 30 to 49.9 grams of alcohol per day was 0.67; and consuming 50 or more grams of alcohol per day was 0.41(P < 0.001 for trend). Associations were similar for fatal and nonfatal MI. Alcohol consumption was not associated with total death or death due to CVD. Risks for total and ischemic stroke for patients consuming 10 to 29.9 g of alcohol per day were 1.40 and 1.55 compared with that of abstainers. When corrected for measurement error in alcohol consumption, dietary variables, and body mass index, the hazard ratio for participants with MI per 12.5 grams per day increment of alcohol intake was 0.68. Alcohol consumption and risk for coronary heart disease among men with hypertension. Joline Beulens, et al. University Medical Center Utrecht, Netherlands. Annals of Internal Medicine 1/07.

1 Drink per Day Associated with Slower Mental Decline in Elderly Women: In a 4.2 year follow-up of 4,461 women ages 65-79 in the Women's Health Initiative Memory Study, compared with no intake, intake of at least 1 drink per day was associated with higher baseline Modified Mini-Mental State Examination scores (p < 0.001) and a 60% lower level of cognitive decline (covariate-adjusted OR = 0.40). Associations with incident probable dementia and mild cognitive impairment were of similar magnitude. Associations with intakes of <1 drink per day were intermediate. Association between Reported Alcohol Intake and Cognition: Results from the Women's Health Initiative Memory Study. Espeland MA, Gu L, et al. Wake Forest University. Am J Epidemiol. 2005 Feb 1;161(3):228-38

1 Drink/Day Ideal for Periferal Vascular Disease: In the Male Physician’s Health Study, 22,071 doctors were followed for 11 years. There was a decreased risk of PAD with 1-6 drink/wk RR 0.82 and over 7 drinks/wk RR 0.74 after controlling for smoking, age, exercise, DM, parental history of heart attacks before 60. Strong positive association between alcohol consumption and HDL <.0001. Problems with heavy drinking complicate recommending drinking. Carlos Camargo, Harvard, Circ 95:577-80, ’97.

1 Drink/Day Protective: In a study of 490,000 adults ages 30-104 with 9 years follow-up with 46,000 deaths, researchers found drinking at least 1 drink/day resulted in a 30% decrease in death with lowest rate around 1 drink/day. Thun, ACS, NEJM 12/11/97;337:1705

1 Drink/Day Increases Arterial Flexibility: Reuven Zimlichman, Tel Aviv Univ. American Society of Hypertension. Moderate drinkers had pulse rates that were significantly lower than those of nondrinkers. 243 healthy people between the ages of 15 and 80 who volunteered to fill out questionnaires and be tested at clinics in seven European countries.They excluded people who drank more than one drink a day and adjusted their findings for age. No diff wine, beer, hard liquor. Reuters 3/14/03.

3-12 Drinks/Week Better for Elderly Women: A national random sample of 12,432 Australian women aged 70 to 75 at baseline found that women who drank rarely and who did not consume alcohol were 58% and 94% more likely to die than women in the low-intake reference category (1-2 drinks per day, 3-6 days per week), or if they survived, they had lower health-related quality-of-life after adjustment for smoking, comorbidity, education, body mass index, and area of residence. Nondrinkers also scored lower on the Mental Health and Social Functioning subscales. A Drink to Healthy Aging: The Association Between Older Women's Use of Alcohol and Their Health-Related Quality of Life. Byles J, et al. University of Newcastle, Callaghan, Australia. J Am Ger Society 2006 Sep;54(9):1341-7.

0.5-2 Drinks/Week Reduced Male Heart Attacks: A 16-year prospective study of 8867 nonsmoker professionals with normal body weight and vigorous daily exercise on a healthy diet found that 1/2-2 drinks of beer, wine, or liquor a day had a 41-62% lower risk of heart attack. 2006.

1-1.8 Drinks/Day Lowered Heart Failure and Cardiovascular Death Most: in 5,595 elderly over 64 after 7-10 year follow-up, 1-6 drinks per week had 16% less harm and 7-13 drinks 30% less.  Benefit occurred even after adjusting for smoking, exercise, BMI, and heart disease. Bryson CL, et al. Harvard. J Amer Coll Cardiol 7/18/06.

1-2 Drinks/Day Helps Diabetics: Two studies report moderate drinking diabetics less likely suffer heart disease. J Am Heart Ass 8/00 those consuming over ½ drink per day cut heart disease in half vs those rarely or never drinking. 1999 study with 12 year follow-up of 983 diabetics found 1-2 drinks per day 80% less likely die of heart disease.

1-2 Drinks/Day Lowest French Mortality: In a 10-15 year follow-up study of 34,014 adults, overall mortality for 22-32 grams of alcohol per day (1-2 drinks) decreased by 30% (RR 0.70), for 33-54 g/d (2+-4 drinks) 24% (RR 0.76), for over 128 g/d increased 37% (RR 1.37). 77% drank wine. Authors misrepresent their own findings by suggesting lowest was 2-5 drinks/d. Renaud, Epid ’98;9:184. Many other studies have found serious harmful effects on longevity at these doses, i.e. over 2 drinks per day and no benefit over 1 drink per day.

Light Drinking Keeps Heart Arteries From Blocking Off Again: In 225 males who had balloon angioplasty, 42% of those who drank little or no alcohol needed repeat angioplasty. They had more blocked arteries, worse cholesterol levels and poorer heart function when compared to patients who drank 50 grams of alcohol per week, or about three small 6 oz. glasses of wine or four 12 oz. cans of beers per week, a week of whom only 23% needed repeat angioplasty. Feraydoon Niroomand, Heidelberg University, Reuters, London 9/13/04. Ed: This supports my rule of waiting until age 45 to start drinking and never drinking over 1 drink per day.

Diabetes: Alcohol: Light Drinking Decreases DM-2 Risk: Women who consumed ½ to two drinks a day were 58% less likely to develop type 2 diabetes. The association between light and moderate drinking was most apparent with wine or beer. Drinking more than two drinks a day of hard liquor doubled a woman's risk. The study covered 100,000 25-44 year old women with 10 year follow-up in the Nurses Health Study-II. Archives of Internal Medicine 2003;163:1329-1336

Diabetes: Alcohol: In a meta-analysis of 14 studies, conducted in the United States, Japan, Finland, Korea, the Netherlands, Germany and the UK, and involving a total of 11,959 cases of type 2 diabetes among 369,862 men and women who were followed for 4 to 20 years, or an average 12 years, the lowest risk of diabetes, a 30% decrease, was found among moderate drinkers (1/2 drink per day to 4 drinks per day) and the highest risk occurred among nondrinkers and heavy drinkers. Body mass index, a measure of height versus weight, did not seem to affect the results. Koppes LL, el a. VU University, Amsterda. Diabetes Care, March 2005. Ed: Since alcohol is a dangerous and addictive drug, it should be treated very carefully.  Individuals with past histories of alcohol abuse should not risk going back to drinking.  Those with family histories of alcoholism should be very careful. Social drinking is a bad idea, since it leads to heavier drinking and driving after drinking.  Heart research suggests that between 1/2 and 1 drink per day achieves the maximum benefit.  This study is agrees with that finding.  Set a strict rule of never drinking over one drink on any given day, drink it at home, and don't drive for at least two hours afterward.

Exercise, Weight More Important: In a 15 year follow-up of over 7000 English men ages 40-59 with 1059 dying, researchers found moderate exercise vs. none had a relative risk of death of RR 0.60 with no added benefit from still more exercise; heavy smoking vs. none had an RR 2.50 for death; an obese BMI of 30+ vs. 20-21.9 had a RR 2.11, light alcohol vs. none (none to infrequent) had a RR 0.84. Wannamethee, Arch Intern Med 12/98;158:2433

Obesity Less with One Drink a Day: People who average around a drink a day are 54% less likely to be obese than non-drinkers. Half of moderate drinkers were in the normal weight range, compared with only one-quarter of the teetotalers. Consuming four or more drinks per day, however, increases the risk of being obese by 46%. Binge drinking had similar results. Researchers used NHNES III national data from 8,236 non-smokers. Current drinkers who drank one to tw0 glasses regularly, but less than five drinks per week, were significantly less likely to be obese than non-drinkers and heavy drinkers. Ahmed Arif et al. Texas Tech University and Mayo Clinic. BMC Public Health12/5/05. http://www.biomedcentral.com/1471-2458/5/126/abstract 

Less Than 2 drinks/d Protective to Chinese: Prosp study Chinese men. 19% decr mortality risk. Nutr Rev 1/98;56:25-6

Alcohol Negative Effect on Health to Age 45: A Swedish Carolinska study on 49,000 conscripts with a 25 year follow-up showed an increased mortality of 14% with alcohol consumption (205 deaths!). This was especially significant if over 1 drink/day was consumed. BMJ 1999;319:821-822

Alcohol Protective, HBP Bad: Individuals with hypertension (2.4) or diabetes (1.7) showed a higher risk of CHD. High low density lipoprotein cholesterol (LDL-C) (1.5), high fasting triglyceride (1.5) and low high density lipoprotein cholesterol (HDL-C) (1.3) showed a lesser but still increased risk. Alcohol intake was protective with non-drinkers having an increased risk of CHD (1.8). Obesity (body mass index > or =30) showed an increased risk (1.8). An increased risk of CHD was found in cigarette smokers of > or =20 pack years (1.5) but not with lesser amounts. 10 yr f/u 2800 Singapore adults. : Int J Epidemiol 2001 Oct;30(5):983-8

Alcohol, Vegetables, Fish Good, Meat, Butter, Pastries & Milk Bad: A 7 nation (US, Greece, Japan, Italy, Finld, Yugo) 12000 men, 25 yr f/u study of diets found animal food-groups were directly correlated, and vegetable food-groups (except potatoes) as well as fish and alcohol were inversely correlated with CHD mortality. Univariate analysis showed significant positive correlation coefficients for butter (R = 0.887), meat (R = 0.645), pastries (R = 0.752), and milk (R = 0.600) consumption, and significant negative correlation coefficients for legumes (R = -0.822), oils (R = -0.571), and alcohol (R = -0.609) consumption. Combined vegetable foods (excluding alcohol) were inversely correlated (R = -0.519), whereas combined animal foods (excluding fish) were directly correlated (R = 0.798) with CHD death rates. Eur J Epidemiol 1999 Jul;15(6):507-15

Helps Japanese: Smoking, HBP, angina increased heart attacks in both middle age and elderly and alcohol decreased them. Hypercholesterol was associated with heart attacks only in middle age. Jpn Circ J 2000 Feb;64(2):103-9. A small case control study of 92 men and 271 controls found increased alcohol protective after control for high blood pressure, DM, smoking, age, etc. with an RR of 0.35 for 30-60 ml of alcohol (2-4 drinks) and 0.13 for 60 ml or more per day. Am J Cardiol 1991 Oct 15;68(10):1011-4

Alcohol Helps: 1100 adults were followed for 41 months and had a relative risk of RR 0.3 which was independent of heart calcium which had RR 3.0. Am J Cardiol 1999 Oct 1;84(7):802-6

Less Than 2 drinks/d Protective to Chinese: Prospective study of Chinese men. 19% decrease in mortality risk. Nutr Rev 1/98;56:25-6

Pregnancy

Any Amount Harmful: On 1982 study of 565 drinking mothers has found that even light drinking, 1 ½ drinks/week in first trimester has a harmful effect resulting in 3# underweight at age 14. Heavy drinking ends with kids weighing 14# less than kids of non-drinking moms. Nancy Day, U Pitt. Alcoholism: Clinical and Experimental Research. 10/02.

Thomas E. Radecki, M.D., J.D.

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