Drink Your Medicine? Weighing
The Health Benefits, Risks of Alcohol
December 28, 2004; Page D1

There is a drug that can lower your risk of heart attack, diabetes, osteoporosis and mental decline by 30% to 60%, but doctors aren't prescribing it.

The reason? It is alcohol.

Increasingly, scientific research supports the idea that drinking a small amount of alcohol each day is better for you than never drinking at all. This isn't true for people with some conditions, but overall, data collected from large observational studies show that drinking moderate amounts of alcohol can lower the risk of dying by about 25% in any given year for the average person, compared with those who rarely drink.

The evidence that alcohol is good for you continues to spark debate in the medical community about whether doctors have an obligation to inform patients about the health benefits of drinking. Because excessive alcohol consumption can be harmful -- causing addiction, traffic accidents and potentially fatal medical problems -- most doctors say it is never a good idea to tell a nondrinking patient to start consuming alcohol. Although most people can drink responsibly, it is impossible to know which patient may eventually start to abuse alcohol as a result of moderate daily consumption.

In addition, even small amounts of alcohol can increase risk for certain health worries, such as breast and colon cancer. And much of the research on alcohol's benefit comes from studies that observe people over time, rather than controlled clinical trials, which are more reliable.

So while the evidence is strong, it isn't conclusive. As a result, the American Heart Association doesn't recommend drinking alcohol to gain cardiovascular benefit, noting that there are less risky ways to protect your heart.

But the issue poses a significant dilemma for doctors. If a physician is aware of a drug that could have life-saving benefits, he or she has an ethical and legal obligation to inform the patient -- even if the drug carries risks. Shouldn't the same rules apply to alcohol?

"There's no doubt in my mind that if we had a public policy encouraging people to drink a little bit of alcohol, the net outcome would be very negative," says Pittsburgh cardiologist Richard N. Fogoros. "But doctors don't treat society -- they treat individuals, and for any given individual, this information may be materially beneficial."

TO YOUR HEALTH

Here's a look at the benefits of moderate drinking.

HEALTH RISK EFFECT OF ALCOHOL
Heart attack 37% lower risk in men who drink five to seven days a week
Diabetes 34% lower risk of developing disease; up to 60% more protection for diabetics at high risk of heart attack
Stroke 40% to 60% lower risk with one to two drinks a day
Dementia 42% lower risk with consumption of one to three drinks daily
Osteoporosis Women who have six or seven drinks a week have significantly higher bone density than nondrinkers

Source: Southern Medical Journal, July 2004

Another reason doctors should be talking more about alcohol is that patients are confused. Countless news reports have touted the health benefits of alcohol, while others have linked it with a higher risk for certain cancers and other problems. Few people understand how much alcohol is good for you and at what point it can start to cause harm.

In a scientific advisory statement issued in 2001, the American Heart Association noted that there were at least 60 studies linking alcohol consumption with lower heart-attack risk. Research also shows that regular and moderate alcohol consumption lowers risk for diabetes, osteoporosis, dementia and stroke.

For instance, in the Nurses Health Study, which follows more than 80,000 women, those with diabetes who drank at least a half-serving of alcohol a day had a 52% lower risk for heart attack than nondrinkers. (A serving is a glass of wine or beer or a shot -- 1 to 1.25 ounces -- of whiskey). A 2,000-patient study showed that people who were moderate drinkers in the year before heart attacks had a 32% lower risk of dying during the four years after the heart attack. A 17-year study in England of more than 5,000 men found that moderate drinkers were 34% less likely to develop diabetes.

But even in small amounts, alcohol can increase some health risks. A person who has two drinks a day has a 75% higher risk for oral cancers and a 51% higher risk of esophageal cancer than the average person who rarely drinks. Two drinks a day increases the risk for colon cancer by 8%. For women, even small amounts of alcohol increase breast cancer risk by 30%.

As a result, people need to take into account family history and personal concerns. A woman with a strong family history of breast cancer or someone with a family history of alcoholism might decide to forgo alcohol altogether. But someone without those added risk factors who is worried about heart attack might consider drinking small amounts of alcohol daily.

This summer, the Southern Medical Journal published a review of the major studies looking at alcohol and health, including data collected in the nurses study and on 88,000 doctors in the Physican's Health Survey. The bottom line: the maximum health benefits come with one half to one serving of alcohol a day. At that amount, heart protection is high but risk for other alcohol-related health problems is at its lowest.

People who drink somewhat more -- for women, two to three drinks a day, for men, three or four -- aren't changing their odds. Their overall risks are the same as people who don't drink at all. But once women go above three drinks and men go above four drinks, they put themselves at far higher risk for other alcohol-related problems.

John B. Standridge, associate professor at the University of Tennessee and a specialist in both addiction and family medicine who authored the SMJ review, doesn't think doctors should advise patients to start drinking because it is impossible to know who might become addicted. At the same time, he notes that a patient who is well-known by a doctor, has no abuse history and needs aggressive intervention for heart risk, might consider moderate alcohol.

"Nowhere in medicine is the double-edged sword so sharp on both sides," Dr. Standridge notes.

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