PERSONAL HEALTH : Is Drinking a Good Move? : Health: To drink or not? For those trying to decide, there are a raft of studies, many conflicting. In the end, it may boil down to considerations of age, sex and family history.
For millions of Americans, deciding whether to drink moderate amounts of alcohol presents a health dilemma that must be resolved differently for every person.
On the one hand, studies do show that downing two or three drinks a day probably lowers the risk of heart disease, possibly by altering cholesterol levels, and it certainly can make life in general feel less stressful.
But on the other hand, taking this limited and in some cases inconclusive research to heart isn’t as simple as making happy hour a daily event, especially for women.
Consumers can’t expect to get easy answers about imbibing from doctors, because they generally shy away from advising patients to drink for fear of promoting alcohol abuse. They settle, instead, for accepting moderate drinking in someone who already drinks that way.
“To tell someone to begin drinking simply to potentially reduce their cholesterol would be an insane thing,” said Dr. Stephen Oesterle, directory of the coronary intervention laboratories at the Hospital of the Good Samaritan in Los Angeles. “Alcohol is a toxin. In high quantities, it destroys people’s lives. I don’t think anyone should start drinking simply to change their cholesterol.”
Dr. Irving K. Loh, medical director at the Ventura Heart Institute, at Los Robles Regional Medical Center in Thousand Oaks, agreed, saying: “As a physician, it’s very hard for me to make that as a recommendation for treatment because of the complex social and medical issues involved.”
Still, Oesterle and Loh are among those physicians who tell moderate-drinking patients that such a habit appears to be, at worst, relatively harmless. At best, they say, alcohol may help lower the risk of heart attack by raising the level of “good” or HDL blood cholesterol.
Studies show that you’re most likely to benefit from moderate drinking if you’re male, middle-aged, exercise regularly, have a cholesterol reading of 200 or higher and if you drink in an even pattern from day to day, rather than bingeing on one or two days.
Your heart is least likely to benefit from moderate drinking if you’re a premenopausal woman, because your estrogen levels tend to keep your cholesterol levels and heart disease low any way. But after menopause, both conditions rise dramatically.
Premenopausal women also are more susceptible than any other group to negative results of daily drinking, in the form of a 60% increase in breast cancer risk from one or more drinks per day.
Consequently, a premenopausal woman with risk factors for breast cancer--such as a family history of the disease--might consider daily drinking too risky. But a woman without risk factors might view as worthwhile the psychological or stress-reducing effects of two daily cocktails or glasses of wine.
An alternative strategy: A woman might avoid regularly consuming alcohol early in life but consider a drink or two each day once she reaches menopause, as part of an overall exercise and diet program to keep her cholesterol levels from soaring as the estrogen in her body decreases.
One group that should avoid even moderate drinking: Those with irregular heart rhythms or whose heart’s efficiency already has been damaged by inadequate blood supply to the heart muscle. Alcohol can worsen both conditions, potentially causing death, doctors say.
As these examples illustrate, patients and their doctors face a balancing act that is very individual, said Dr. Arthur Klatsky, chief of cardiology at Kaiser-Permanente Medical Center in Oakland.
It was a 1974 report by Klatsky, Gary D. Friedman and A. B. Singelaub indicating that teetotalers had more heart attacks than drinkers that spawned recent interest in alcohol’s possible protective effect. The Kaiser group since has continued its studies using records on 230,000 patients.
Today, Klatsky said, he advises patients that those studies and others indicate that patients receive maximum cardiovascular benefits if they consume not more than two drinks a day. (A drink is defined as a 12-ounce beer, a 3 1/2-ounce glass of wine or a one-ounce shot of distilled spirits, such as whiskey.)
“If you already are a person who takes light to moderate amounts of alcohol--which really is a majority of the population--then you’re all right. If you’re a person who drinks more, then I’d be likely to tell you to cut down,” Klatsky said.
“If you don’t drink at all, I’d ask, ‘Why?’ If you don’t drink, because when you do, you go on a bender, you’re better off not drinking,” he said. “Or, even if your father was an alcoholic and you’re afraid you may have inherited a tendency for it, you shouldn’t drink, because there are other and better ways to prevent heart attack.
“However, if you used to drink and you gave it up because maybe you thought your three glasses or four glasses of wine a week might be bad for your heart, then you made a mistake. Then I might tell you to drink,” he said.
In that statement, he goes further than most physicians.
Dr. Myron Weisfeldt, director of cardiology at Johns Hopkins Medical School and president of the American Heart Assn., said the group hopes to clear up some of the disagreement by reviewing literature on alcohol and heart disease and considering its position on the issue.
After conducting a similar review, a National Research Council panel concluded last year that people who consumed 10 or fewer alcoholic drinks a week did have fewer heart attacks. But the group could not endorse drinking because of the health and social effects of alcohol abuse. For the moment, the heart association takes a similar stance.
Klatsky said he understands that doctors are concerned about saying anything that might be used to justify heavy drinking, which everyone agrees is bad.
Heavy drinkers, estimated at 9% of the U.S. population, are especially susceptible to high blood pressure, heart disease, cancer, certain kinds of stroke and diseases of the liver, pancreas and nervous system. They also cause family and social disruption.
“I don’t think the scientific community should deny the empiric evidence because of this,” Klatsky said. “I think we have to deal with the facts as they are, and the facts really rather strongly suggest for at least some persons lighter drinking may be beneficial because it reduces heart attack risk.”
But critics of the alcohol-cholesterol studies suggest that matter is far from settled.
Epidemiological studies such as Klatsky’s cannot separate alcohol’s impact from that of unknown life style variables, said Peter E. Nathan, director of the Center of Alcohol Studies at Rutgers University in New Jersey who questions the finding that teetotalers have a higher risk of heart attack than do moderate drinkers.
“I’m inclined to believe that people who drink moderately do a whole variety of things moderately, and therefore are more inclined to be healthy than people who do things immoderately,” he said.
Since the Klatsky group’s 1974 results, there have been a series of studies narrowing which groups appear to benefit from moderate alcohol consumption and why.
Most of the studies focus on middle-aged men, the group most at-risk of heart attack, and show a U-shaped curve: The frequency of heart attacks is lowest in the middle at moderate drinking levels; higher on the left among abstainers; it rises to its highest level among heavy drinkers.
In women, the results have been inconclusive.
Among the elderly, one Massachusetts study found that people older than 66 years who drank less than three drinks per day had lower mortality from heart attack than did those who drank more than that.
Most recently, attention has focused on the relative proportions of two cholesterol carriers in the blood, combinations of fat and protein known as LDL and HDL.
LDL, or low-density lipoprotein, is a cholesterol carrier manufactured by the liver in response to caloric and fat intake. HDL, or high-density lipoprotein, is a cholesterol carrier involved in clearing cholesterol out of the body.
The amounts of these two lipoproteins are added together to obtain total cholesterol. Below 200 mg. total cholesterol per deciliter of blood serum is considered healthy, 200 to 240 is considered border line high-risk and above 240 is considered at high risk of atherosclerosis--accumulation of cholesterol that blocks blood vessels.
If blockages are in arteries leading to the heart, they damage it and cause heart attack. In blood vessels leading to the brain, they can result in stroke.
Moderate alcohol consumption, researchers suggested early, could protect against heart attack because it raises levels of the HDL-2, a sub-type that has been linked to lower heart attack risk. A 1984 study at Stanford University cast doubt on that by finding that alcohol consumption raised only the level of another HDL sub-type, HDL-3 and not HDL-2. That led physicians to speculate that some mechanism other than HDL levels was responsible for alcohol’s association with lower heart disease.
But a report recently completed by Houston researchers gives the first evidence that HDL-2 levels may, indeed, be affected by moderate drinking.
The study at Baylor College of Medicine found that HDL-2 levels rose an average of 17% from drinking three beers a day, but only in men who jogged or ran at least 20 miles a week and only after three weeks of daily alcohol intake. Among sedentary men and those who drank only one beer a day, hints of rising HDL-2 levels were not large enough to be considered statistically significant.
The results were reported by a group that included G. Harley Hartung, John P. Foreyt, Antonio M. Gotto Jr., Rebecca S. Reeves, Larry P. Krock, Wolfgang Patsch and JosefR. Patsch. The study is to be published within the next few months in the scientific journal Metabolism.
Even if the group’s conclusion holds up, it offers yet another example of how limited are the lessons any individual study can offer for daily living: Though conclusively elevated HDL-2 levels occurred only from drinking three beers a day, it is known that drinking more than two alcoholic beverages a day raises a person’s blood pressure.
And, if it is HDL-2 that rises as a result of alcohol intake and protects from heart attack, there are other better ways of raising those levels and lowering “bad” LDL cholesterol, including:
* Quitting smoking.
* Exercising regularly.
* Avoiding overeating, either at one sitting or during the total course of a day.
* Losing excess weight.
* Lowering fat consumption to no more than 30% of calories, with only a third of those from saturated fats in meat and dairy products.
* Eating foods high in soluble fiber, such as pectin, oat bran and seeds such as psyllium.
In that framework, a couple of beers, cocktails or glasses of wine each day become just one element in an overall life-style strategy to stay one’s healthiest.
What Is ‘Just One Drink?’ The same amount of ethanol, the intoxicating agent in alcoholic drinks, is delivered to the body by: a 1-ounce shot of whiskey a 3 1/2-ounce glass of wine a 12-ounce bottle of beer Although definitions of a single drink can vary slightly, experts agree that two to three daily drinks of the sizes described above are the maximum that may a protect people from heart attacks. Source: National Research Council Pros and Cons of Moderate Drinking: Experts agree that two or three drinks a day constitute moderate drinking. Pros: Appears to reduce risk of coronary heart disease caused by obstruction of the blood vessels that supply the heart. Reduces anxiety, Increases relaxation. Appears to cause obesity. Lowers incidence of strokes caused by blocked blood vessels. Cons: Cirrhosis of the liver increased detectably with two drinks a day for women, four drinks a day for men. Women who drink 1 1/2 drinks a day increase by 60% their chances of contracting breast cancer. High blood pressure from two or more drinks per day. Higher incidence of hemorrhagic stroke. Slight damage to motor development in toddlers of women who consumed one to four drinks a day while breast-feeding. Sources: National Research Council, U.S. Department of Health and Human Services and the American Heart Assn. Heavy Drinking and Your Health Heavy drinking-more than four drinks a day-causes increased incidence of many serious problems: Heart attack Cancer of the mouth, larynx, esophagus, stomach, breast and rectum. Cirrhosis of the liver. Kidney failure. Stroke. Reduced testosterone in men, early menopause in women. Vulnerability to infections because of weakened immune system. Physical and mental deficiencies in children of alcoholic mothers. Nervous system problems such as dementia, shaking and difficulty in walking. Sources: National Research Council and the U.S. Department of Health and Human Services.
