Alcohol’s Mixed Message : Health: You think you’re helping your heart by drinking in moderation? Winemakers might agree, but health officials continue to point to the risks.
A decade after Americans came to grips with the dangers of heavy drinking--raising the legal drinking age to 21 and stiffening drunk-driving penalties--a new debate has emerged: What are the risks and benefits of drinking moderately?
In the scientific world, the debate centers on whether moderate consumption is good or bad for your health. But in the real world of conflicting business, social and political interests, the crucial issue is who will get to say what about alcohol.
During the past year, wine industry officials have sought to promote the purported health benefits of wine consumption. But the industry appears on the verge of defeat. The federal Bureau of Alcohol, Tobacco and Firearms is expected to rule this month that health messages touting alcohol consumption will be prohibited.
Meanwhile, two bills now before Congress would, if passed in their current forms, require broader health warnings on alcoholic beverages and in ads.
“I think the public is greatly confused by the mixed message about whether alcohol is good for you or bad for you. And part of the problem is, who is the messenger,” says Dr. Ernest P. Noble, director of the alcohol research center at UCLA and former director of the National Institute on Alcohol Abuse and Alcoholism.
Interest in the benefits of moderate drinking has soared recently because of several new studies that suggest moderate drinkers have a much lower risk of coronary heart disease.
For example, the Harvard Nurses’ Health Study of 121,700 nurses showed that moderate drinking is linked to a 50% decrease in death rates from coronary heart disease in post-menopausal women. Other studies show a 25% to 35% lower risk of coronary disease among moderate drinkers of both sexes.
But the way in which alcohol reduces coronary disease is unclear. Researchers believe something in ethyl alcohol increases the levels of HDL, the “good” cholesterol, and interferes with the tendency of some blood cells, called platelets, to form clots that can trigger heart attacks, says Dr. Arthur Klatsky, chief of cardiology at Kaiser Permanente Medical Center in Oakland and longtime researcher on alcohol consumption.
Another explanation, says Klatsky, is that many moderate wine drinkers have other healthy behaviors. They tend to smoke less, exercise more and eat nutritiously.
A third explanation also holds promise. In a recent study, UC Davis researcher Edwin Frankel found that a nonalcoholic component of red wine, called flavonoids or phenolic compounds, may inhibit heart disease. Flavonoids are anti-oxidants found in grapes as well as other fruits and vegetables. The study looked at compounds in a test tube and has yet to be replicated in humans. But Frankel says: “It’s fairly well accepted that moderate consumption has a beneficial effect.”
If that conclusion wasn’t enticing enough to raise a glass of Cabernet, research presented in March at the annual Society of Behavioral Medicine meeting suggested that moderate drinkers are much less likely to become depressed than teetotalers, perhaps because they are more “moderate” about all aspects of their lives.
Yet the industry has not been able to fully take advantage of these findings. Many health officials--from cardiologists to substance-abuse experts--deplore the idea that Americans be urged to consume alcohol to reduce heart disease. Indeed, when the Beringer Winery tried last year to introduce plans for a wine bottle tag publicizing the coronary benefits of drinking wine, the plans were quickly shot down by critics.
“It’s one thing for someone to say to his doctor, ‘Hey, doc, can I have two drinks a day?’ But it’s another thing entirely to give public health advice to the entire population without regard to gender and race. I think that is totally irresponsible,” says Hilary Abramson, a spokeswoman for the Marin Institute for the Prevention of Alcohol and Other Drug Problems.
Health officials also worry that the benefits of moderate drinking might not be presented in balance with the risks.
“When you look at the scientific data, for every beneficial effect, I can think of 20 negative effects,” says Noble. “But that isn’t what the public gets. The public gets the message that it protects against heart attacks.”
For example, Noble says, while moderate drinking may lower the risk of coronary heart disease, the most common form of heart disease, it can increase the risk of hypertension, stroke and a type of heart disease that produces irregular heartbeat.
In addition, Noble says, alcohol is a major cause of malnutrition among adults because it adds calories to the diet without contributing any substantial nutrients.
Alcohol consumed during pregnancy can also produce fetal alcohol syndrome, a form of mental retardation. Health officials are so concerned with the effects of alcohol use during pregnancy--which are not well understood--that abstinence is recommended for all women who are pregnant or trying to conceive.
Moreover, recent research suggests that, in at least some women, alcohol might increase the risk of breast cancer. The Harvard Nurses’ Study showed a 20% to 40% increased risk of breast cancer in post-menopausal women who drank moderately. According to one theory, alcohol might raise estrogen levels, which could increase breast cancer risk.
Alcohol is also known to contribute to the risk of stomach and throat cancer, cirrhosis, automobile and industrial accidents, and injuries related to violence. Further, anyone who uses alcohol runs the risk of triggering a dependence on the substance, Noble says.
A final problem is the difficulty of defining moderate.
“The liquor industry is going to say alcohol is good for you, but don’t overdo. But they don’t tell you what moderate is,” Noble says. “The public doesn’t know if one drink is good or 10 drinks are good.”
Others disagree, saying the industry can be trusted to act in the public interest.
“I think Americans can handle this kind of information. They know what moderation means,” says Elizabeth Holmgren, director of research and education for the San Francisco-based Wine Institute. She adds that the industry stands by its desire to educate consumers on the benefits of moderate consumption.
“I think (the government) is holding back information that is part of everyday living,” says Holmgren. “The consumer gets more negative information on alcohol than anything about its beneficial effects. Alcohol should be treated like sugar or butter or meat and (experts should) stress the difference between moderation and abuse.”
Still others urge a more middle-of-the-road approach.
“Every discussion on alcohol has to start off with a clear exposition on the dangers of heavy drinking,” Klatsky says. “They are numerous and well-established. Having said that, I think most people are not so dumb that they cannot understand the difference between heavy drinking and a safe level of drinking. I really think people can make that distinction.”
Individuals should seek the advice of their physician to determine their risks of consuming alcohol in moderation, experts suggest. Factors that should be considered include a family history of alcoholism, risk of breast cancer or heart disease, psychological state and lifestyle habits, such as driving or operating machinery.
This month, the Bureau of Alcohol, Tobacco and Firearms is expected to tighten restrictions on the alcoholic beverage industry by banning winery newsletters from publishing health claims or using bottle hangers and other traditional marketing devices that include health claims. Also, trade associations may be barred from taking out ads in newspapers and magazines to make health claims.
In addition, a bill introduced by Rep. Patricia Schroeder (D-Colo.) would require the contents, ingredients and calories to be listed on alcoholic beverages. The bill would create a new, user-friendly unit of serving size called the “drink” and would gauge the level of impairment a “drink” will produce.
Finally, Sen. Strom Thurmond (R-S.C.) has introduced the Sensible Advertising and Family Education Act, which would require manufacturers to print one of seven rotating health warnings on all alcoholic beverages and advertising, including television and radio promotions. Currently, health warnings on alcoholic beverages are limited to product labels, and manufacturers are not required to rotate the warnings.
Ironically, Thurmond introduced the bill this spring, a few weeks before his daughter was killed by a drunk driver.
“He is not for prohibition or teetotalism,” says aide Susan Pelter. “His main concern is that alcohol advertising targets young people. And research shows that people are not aware of the negative health effects--fetal alcohol syndrome or the contribution alcohol makes to various diseases. His aim is to increase awareness.”
