The benefits of alcohol

Decades ago pathologists noticed that alcoholics had less fatty build up, or plaque, on the inner walls of their arteries than non-alcoholics. It is this build-up which can obstruct the coronary arteries causing heart attacks and angina. Less plaque results in a lower risk.

The controversy over the health benefits of moderate drinking started in 1974 when a study was published which showed that people who drank no alcohol suffered more heart attacks than those who drank moderate amounts of alcohol.

Although this result was seized upon by the press and public, the scientists themselves were cautious, attacking their hypothesis from every angle they could think of. However, it seems that the conclusions are sound - a moderate amount of alcohol reduces the risk of heart disease.

Cause and effect?

Is this a cause and effect relationship? One argument against any benefit from moderate drinking is called the "sick quitters" hypothesis. This was put forward in the late 1980s, and suggests that the group characterised as non-drinkers includes people who have given up alcohol because they have already damaged their health through excessive drinking. If people who never drink actually live longer than those who drink, but are lumped in with this group, then this effect could be masked. But, when ex-drinkers were separated from those who had never drunk, both groups were found to be at higher risk than moderate drinkers.

It seems that how you drink is also important. If you take small amounts of alcohol daily, in the way that the French drink wine, then the protective effect of alcohol is evident. But a study from industrial Scotland showed that binge drinking does not offer this protection.

At least one researcher, Gerry Shaper, the originator of the "sick quitter" hypothesis, still thinks that the virtues of moderate drinking are being exaggerated.

The French story

The French have a high incidence of risk factors such as raised cholesterol and high blood pressure, and eat significant amounts of animal fats. But they have a surprisingly low incidence of heart disease. The usual explanation for this is that the French drink lots of red wine.

One group of researchers is not convinced by this, arguing that the French have only recently started to eat large quantities of animal fats, and may yet have an increased incidence of heart disease, which takes some decades to develop.

However, there are studies from all over the world which suggest that moderate drinking protects against heart disease. We also know that alcohol is only beneficial if spread over the week, which is how the French drink, and that France is the largest consumer of alcohol, particularly wine, in the world. So it seems unlikely that alcohol consumption plays no part in their low rate of heart disease.

How does alcohol protect against heart disease?

No-one really knows! The most popular idea is that it acts through changes in levels of cholesterol in the blood. Alcohol increases the amount of HDL-cholesterol, the so-called "good cholesterol" in the blood. HDL seems to protect the heart and arteries. Alcohol also decreases amounts of fibrinogen, a substance which causes blood to clot. See Fats and heart disease for an explanation of the different types of cholesterol.

No-one really knows if it matters what you drink either. Current thinking is that wine, red in particular, does you more good that beer or spirits. However studies are inconclusive, and many people now think that it is alcohol itself which is important.

It may be that there are differences in the people who drink different types of alcohol. In many parts of the world, those who regularly drink wine are better educated and take better care of themselves, with a better diet and more exercise, than beer and spirit drinkers.

What is "moderate"?

This is the crucial point, and one frequently overlooked by those happily knocking back the red wine! Moderate consumption really is not a lot of alcohol!

If moderate drinking does protect you against heart disease you are looking at one to two bottles of beer, one to two glasses of wine and a reasonable tot of spirits per day, depending on your size and gender.

If you don't drink, should you start? No reputable health care professional would actually encourage anyone to start drinking. If you encourage drinking in any way you tend to increase overall consumption, and although non-drinkers may become light drinkers, moderate drinkers may become heavy drinkers, with all the resulting health problems.

However, it would seem that, as in all things, moderation is the key, and a little of what you fancy really does do you good. Cheers!