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Alcohol and Cardiovascular Health By James H. O'Keefe, M.D. "It has long been recognized that the problems with alcohol relate not to the use of bad things, but to the abuse of a good thing." Abraham Lincoln Alcohol is analogous to the proverbial double-edged sword; and no other health factor is capable of cutting so deeply in either direction depending upon how it is used. Science shows that light-to-moderate drinking done on a daily basis improves cardiovascular health and substantially reduces risk of death. On the other hand, excessive alcohol intake and/or "binge" drinking is toxic to the heart and overall health, and is the third leading cause of premature death among Americans. Missouri's own Harry Truman, one of the healthiest and longest-lived of the U.S. presidents, started off each day, before his morning walk, with his one daily drink-a shot of bourbon whiskey. Now, I am not suggesting that you start your day with an "eye opener," but it is quite likely that his drinking pattern contributed to his exceptional vigor and longevity. The developing scientific consensus indicates that the specific alcoholic beverage you drink is less important than the quantity of alcohol and the pattern of intake. Having one drink daily (or up to two drinks daily for men) appears to be the ideal drinking pattern for improving cardiovascular health. Some studies suggest that wine, particularly red wine, might be the healthiest form of alcohol; but most studies show equal protection from any alcoholic beverage. It is the alcohol (ethanol) itself, rather than any other specific component of the wine, beer or spirits, that is the major factor in conferring health benefits. Alcohol reduces fats and sugar in the bloodstream and decreases inflammation, but only temporarily-for about 12 to 24 hours. This is probably why drinking a small amount five to seven days a week is more heart healthy than just occasional alcohol use. So alcohol intake, like exercise, is best done daily and in moderation. From a health standpoint, a drink immediately before or during your evening meal is ideal. However, avoid drinking within three or four hours before bedtime, because alcohol can disturb your deep, restorative sleep and/or worsen sleep apnea. Doctors Know the Score In the American Journal of Cardiology the Mid America Heart Institute recently published a study of 800 U.S. cardiovascular physicians that showed about three out of four drank alcohol regularly, with nearly half of those consuming one or two drinks a day; suggesting that American cardiologists personally recognize the potential health benefits of regular alcohol intake. However, nearly all studies evaluating the health effects of alcohol report a J-shaped curve, whereby light to moderate drinking confers health benefits, but increasingly heavy drinking results in progressive worsening of cardiovascular and overall health. A recent study of over one million people showed that one drink daily for women, or one or two drinks daily for men, was linked to an 18 percent lower death rate during follow up. In that same study, more than two drinks daily in women, or more than three drinks daily in men, increased risk of death in a dose-dependent fashion. Reduce Your Risks for Other Diseases Light to moderate drinking lowers risk of heart attack and cardiac death by approximately 30 to 35 percent, which for example, is about as much as we see with the powerful statin cholesterol drugs. A recent study showed that people who were already following all of the four major healthy lifestyle behaviors (not smoking, maintaining a healthy weight, exercising 30 minutes a day, and eating a healthy diet) still received the cardiac benefits of light to moderate drinking. Other studies show that consuming one or two drinks daily reduces the risk of stroke, congestive heart failure, high blood pressure, and even Alzheimer's disease; but again, heavier alcohol intake progressively increases the risk for each of these problems. A small to moderate dose of alcohol also reduces the risk of diabetes by about 30 percent. Evidence indicates that light to moderate drinking might even be good for weight control, especially for reducing belly fat. People who have one or two drinks a day seem to have less abdominal obesity than do non-drinkers, but those who consume more than two drinks a day have-you guessed it-a larger "beer-gut," which expands in proportion to the amount of alcohol consumed. Although Mark Twain once quipped, "Everything in moderation, including moderation," in fact even occasional immoderate drinking is bad for your health. Regular drinking is a slippery slope that many individuals cannot safely navigate; and let's be clear, getting drunk on Saturday night is not heart healthy. Binge drinking, defined as more than five drinks per drinking day, increases the risk of heart attack and other problems like motor vehicle accidents, stroke, dangerous heart rhythms, sudden death, suicide, cancer, liver disease, and death from all causes. Some studies suggest that alcohol abuse and binge drinking are on the rise, and alcohol abuse is currently the third largest preventable cause of death, killing more than 100,000 Americans each year. Drink Responsibly So, if you drink alcohol responsibly, you can take heart in the knowledge that it is good for your health. If you are considering taking up alcohol for its heart benefits, make sure you keep your intake to not more than one drink a day if you are a woman, and not more than two drinks a day if you are a man. Keep in mind that a drink is considered 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof spirits. If in the past you have had problems with abuse of alcohol or other substances, or if you smoke or have a history of depression, or have moral or religious objections to alcohol use, or have chronic health issues like liver disease that make alcohol use more dangerous, you should avoid alcohol use altogether. As always, it is a good idea to discuss issues or questions about alcohol with us when you come in for your visit. |
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