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Moderate Drinking May be a Heart-Smart Choice...

... But alcohol is but one piece of a healthy lifestyle

FRIDAY, April 4, 2003 (HealthDayNews) -- Whenever a new study touts yet another health benefit associated with drinking -- and there have been legions in the last decade -- most of us are poised to raise a toast.

Whether the latest research confirms yet again that moderate alcohol consumption confers protective effects on our cardiovascular system, helping us to live longer, or whether it points to wine as a better choice than beer or hard liquor, our response is usually the same:

"We'll drink to that."

Fine, say alcohol researchers, most of them ready to join us. But what's often missing, they say, is some perspective. What often gets lost in the shuffle is that wine or other alcohol is but one health practice of many that's potentially valuable in helping us stay healthier and live longer.

That's a message that bears repeating, particularly in April, which has been designated Alcohol Awareness Month.

The word "moderate" is often not heard, either. For women and men over age 65, that's one drink a day; for younger men, two.

Even moderate drinking, as good as it can be for the heart, isn't good for everyone. Those with a family history of alcohol abuse, for instance, might be better off the wagon, experts say.

Nor does the evidence, strong as it is, warrant persuading abstainers with no interest in alcohol to take up the habit.

But the research that alcohol in moderation improves our health, particularly our heart health, is indisputable, experts say.

Alcohol works in a variety of ways to lower heart disease risk, researchers say, including raising levels of high-density lipoprotein (HDL), the so-called good cholesterol, and apparently affecting blood clotting in a way that prevents heart attacks.

And alcohol may help more than the heart.

"In addition to coronary benefits, there are papers out there showing that moderate alcohol intake is also associated with a variety of other benefits," says John Barefoot, a professor of psychiatry and behavioral sciences at Duke University and a researcher on the topic.

Alcohol has been found to reduce the risk of stroke and gallstones and may cut the risk of diabetes and peripheral vascular disease, a review of medical literature shows.

Not a bad return for a daily glass of wine, shot of liquor or mug of beer.

But it might not be as simple as that, researchers suspect. It could be that those who drink alcohol moderately -- especially wine drinkers -- are just healthier overall, the same people who are likely to eat a healthful diet, exercise often and get regular physical examinations.

That's what Barefoot found when he evaluated 4,435 men and women enrolled in the University of North Carolina Alumni Heart Study. The wine drinkers ate more fruits and vegetables and less red meat. They were also less likely to smoke and more likely to be leaner and to work out.

So moderate drinking, perhaps especially wine drinking, "might be something that goes with a whole lifestyle," Barefoot says. "The whole lifestyle is what is really important."

The moderation part of the equation is important, too, adds Dr. Wendy Chen, an oncologist and epidemiologist at Brigham and Women's Hospital and the Dana Farber Cancer Institute, both in Boston.

"All the studies have looked at average daily use [of alcohol, meaning a moderate intake]. With a higher level, there is an increased risk of health problems," she says.

Heavy drinking is associated with a variety of ills, including liver damage and throat cancer, not to mention the increased risk of automobile accidents.

The other emerging consensus is that there's no one-size-fits-all recommendation for who should drink and who should not.

While some studies have linked two drinks a day to a 30 percent greater risk of breast cancer, that doesn't mean a woman, even one with a family history of the disease, should never drink, Chen says. Depending on individual risk factors, having a drink a day might give such a woman a net health benefit because it would probably protect her from heart disease and stroke more than it would raise her risk for breast cancer.

The decision to drink or not must be tailored to a person's health profile and take into account medical history and family history, among other factors.

During pregnancy, alcohol use is generally discouraged, although Chen says there's some disagreement about alcohol in the second trimester, with most experts agreeing it should be strictly avoided in the first and used only sparingly, if at all, in the third.

The moderate message is one that experts are always trying to get across. "Non-drinkers have a higher risk [of heart disease]," says Barefoot, "but once you get into heavy drinking the health risks go up dramatically."

More information

To read a report about moderate alcohol consumption and health benefits, see the American Council on Science and Health. To learn about National Alcohol Screening Day, click here.

SOURCES: John Barefoot, Ph.D., professor, psychiatry and behavioral sciences, Duke University Medical Center, Durham, N.C.; Wendy Chen, M.D., M.P.H., oncologist and epidemiologist, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston; National Institute on Alcohol Abuse and Alcoholism; February 2003 Scientific American
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