For years we’ve been told alcohol is good for us. In moderation, alcohol, and red wine in particular, was part of a heart healthy diet. But recent studies are challenging that recommendation. And even in moderation, alcohol may no longer be part of a healthy lifestyle.
Alcohol has been around for more than 10 000 years, with the earliest evidence in China and later in the Middle East. Consumption of alcohol varies throughout the world, with some of the top drinking countries in eastern Europe. In many cultures, it’s a fixture of gatherings and celebrations. And more than half of adults in the U.S. and Europe consume alcohol.
Alcohol and Heart Health
Historically, dietary guidelines acknowledged the health benefits of drinking in moderation. The 2010 Dietary Guidelines in the U.S. recommended a limit of one drink per day for women and two drinks for men. A drink being defined as a bottle of beer (341 mL), a glass of wine (142 mL) or a shot of liquor (40 mL). Excluded from these recommendations were pregnant women, people recovering from substance abuse and taking certain medications. Nor was it recommended for people who don’t drink, to start drinking.
These recommendations were based on studies showing that when it comes to heart health, some alcohol was better than none. The pattern is a so-called ‘J-shaped’ curve. Those people who drank alcohol (one drink/day) had lower risk for heart disease than those who didn’t. And a 12-year study found a modest increase in alcohol was associated with lower risk. Even the heart-healthy Mediterranean Diet, which has been shown to reduce heart disease, includes consumption of alcohol. However, more isn’t necessarily better. At higher amounts the benefit disappeared.
These observational studies are supported by beneficial effects of alcohol on various risk factors. In particular, consumption of alcohol increases HDL cholesterol, and higher HDL is associated with lower chances for heart disease. There is also evidence alcohol reduces inflammatory and hemostatic factors. This makes the blood thinner and less likely to clot when an atherosclerotic plaque ruptures. In addition, women who drink wine may have greater heart rate variability (fluctuation in beat to beat frequency). A possible indication of lower risk for heart disease.
But is alcohol really good for you?
More recent studies have caused quite a stir. One, in over half a million adults found having more than seven drinks per week was associated with early death, even though this amount was associated with fewer heart attacks. And any amount of alcohol increased chances for stroke and other heart diseases such as atrial fibrillation. The Global Burden of Disease Study estimated alcohol as the seventh leading risk factor for early death worldwide, and the number one for people aged 15 to 49 years. They concluded “…the safest level of drinking is none.”
While these conflicting findings may be enough to give you whiplash, even at the time when alcohol was promoted for heart health, there was underlying caution. Alcohol is an addictive substance and heavy drinking is associated with liver damage, depression and early death. Early studies also indicated alcohol could increase your chances for cancer, and breast cancer in particular. And, from a dietary standpoint, alcohol provides calories without any nutritional benefit, providing a challenge for people wanting to lose weight.
But all of these findings are based on observational studies, which have limitations to them. This can be especially complicated when it comes to nutrition as drinking may be associated with other behaviours, whether healthy or not. For example, people who drink in modest amounts may be generally more health conscious. Or that many non-drinkers may abstain due to pre-existing medical conditions. In addition, the Global Burden of Disease Study was roundly criticized for its strict recommendation of no drinking at all. In fact, the actual increased health risk was very small.
Recent guidelines have taken a more balanced approach. They have shifted away from any mention of heart health benefits and highlight the potential health hazards. In addition, the recommendations of up to one drink per day for women and two for men are emphasized as upper limits and not targets. The guidelines also emphasize this is not a daily average and to avoid binge drinking. At the same time, guidelines have specifically avoided recommending complete abstinence.
So while there’s consensus heavy drinking, and binge drinking, are associated with poor health outcomes, it’s not quite as clear at lower amounts. For now, however, it appears to be okay to raise the odd glass.
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