The Old Days: Loaves of Bread, Jugs of Wine, and Myocardial Infarcts
Years ago, prior to the interest in the European experience, it was commonly assumed that alcoholic beverages caused heart disease. It made sense. If, for instance, there was a proven relationship between elevated blood pressure and risk of a heart attack, then anything that raised blood pressure (like alcohol) obviously had to be a risk factor. In other words, if A causes B, and B causes C, then A must cause C - a common sense (but frequently erroneous) way of thinking. Take, for instance, a quote from an excellent 1988 reference, The Columbia Encyclopedia of Nutrition, a publication of the respected Columbia College of Physicians and Surgeons: “...even from the time you take your first drink, alcohol impairs liver function and puts you in a high risk group for high blood pressure, heart disease, and cancer”. In other words, Gallo, Bud, and Johnny Walker are totally void of any health-redeeming value, including risk reduction of the number one killer.

Frenchmen Unplugged: Lessons of the French Paradox (i.e. Can’t Get Well Without Muscatel)
Enter the French experience... It is well documented that the people of France, including children, consume a higher average level of alcohol than Americans – an inherent part of their lifestyle. It is also well established that almost half the deaths in the U.S. each year are caused by a fatal heart attack. In France, roughly one-quarter of all mortality is from heart disease. Question: Could the extra alcohol consumed by Frenchmen have contributed to their lower rate of heart attacks? Wow - talk about an issue certain to have caused heated (and sometimes less-than-scientific) debate...this is it! When a few courageous scientists first suggested a possible health-supportive role of moderate alcohol consumption, the rest of the scientific community was forming a lynch mob. How dare we suggest that alcohol is good for anything - particularly health and longevity? But here it is, well over a decade later with the smoke cleared, and yes...alcohol does reduce the risk of cardiovascular heart disease.

According to Dr. Thomas A. Pearson, MD, PhD in “Alcohol and Heart Disease” (a 1996 American Heart Association Medical/Scientific Statement), “More than a dozen prospective studies have demonstrated a consistent, strong, dose-response relation between increasing alcohol consumption and decreasing incidence of CHD (cardiovascular heart disease). The data are similar in men and women in a number of different geographic and ethnic groups. Consumption of one or two drinks per day is associated with a reduction in risk of approximately 30% to 50%. Studies of coronary narrowings defined by cardiac catheterization or autopsy show a reduction in atherosclerosis in persons who consume moderate amounts of alcohol. In general, the inverse association is independent of potential confounders, such as diet and cigarette smoking. Concerns that the association could be an artifact due to cessation of alcohol consumption in persons who already have CHD have largely been disproved”. For the record, the way in which alcohol protects against heart disease is by (mainly) raising the good (HDL) cholesterol and (secondarily) by not raising the bad (LDL) cholesterol, inhibiting clot formation, and by the inhibiting oxidation of LDL cholesterol by a few unique substances found in red wines and dark beers.

What Pearson is implying is that a small amount of daily alcohol may be good medicine for some, but certainly not all. The relationship between all cause mortality and alcohol consumption is j-shaped. People who are t-totalers living in this society (and France) and, like average affluent citizens are eating unhealthful and generally, not exercising, will predictably live 1-2 years less than those who are consuming a few drinks every day. Those who consume 3 or more drinks per day die earlier, but not from heart disease! Generally the alcohol-related causes of death in heavy drinkers includes cancer (several types), pancreatitis, liver disease, stroke, and accidents.

The scenario I’ve been describing includes average members of affluent societies. For gung-ho individuals who embark on an alcohol-free lifestyle of healthy nutrition and regular exercise (like many of our readers), several additional years of high-quality (low-morbidity) life is a statistical expectation – but one that is dramatically reduced with even small amounts of regular alcohol consumption.

The Bruneck Monkey Wrench
Firing up another round of controversy, researchers from Europe report that moderate to heavy drinking (2 glasses of wine per day or more) is a prominent risk factor for early atherogenesis, surpassing even heavy smoking as a risk factor. Folks, this is the Bruneck Study as reported in the May 1998 Issue of the medical journal “Stroke”. Even after the researchers took into account the effects of elevated blood pressure, smoking, and high-cholesterol levels, their statistical analysis showed that alcohol consumption was an independently significant risk factor for atherosclerosis. There were no significant differences between the results for men and women. The only similarities between earlier research and the Bruneck Study is that a slight protective effect against heart disease was documented in light drinkers, i.e. those who consumed 1-2 drinks per day.

For those of you struggling with the preceding statistical jargon, the concept being challenged is that alcohol reduces the risk of heart disease with higher doses directly related to greater protection. The Bruneck team sees it differently. Granted, they do document a protective effect with light consumption but they also have observed an atherogenic effect in moderate to heavy drinkers suggesting a u-shaped relationship between alcohol and heart disease.

So, until the issue is clarified, should responsible physicians and health authorities recommend 1 or 2 drinks per day to beat the odds with the grim reaper? In a few limited cases, it just might be good advice. For anyone with a family history of heart disease, elevated homocysteine levels, excessive ferretin (stored iron) or runaway lipid (cholesterol) profiles - none of which can be controlled by diet, exercise, fiber supplements, etc. - yes, a few drinks every day may be advisable. Or, if you have loved ones, a roommate, co-workers, a favorite Uncle Henry and Aunt Hilda, etc. who never exercises (hate it!), and intend to enjoy Julia Child/James Baird gourmet meals to their last days on this earth, they just might enjoy one or two additional years on this earth if you can convince them to regularly enjoy a few glasses of Zinfandel to accompany the filet. For the rest of the world, abstinence with (at the very most) infrequent celebrations (birthdays, anniversaries, etc) is the best medicine.

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