Alcohol Diagnosed

A
mountain of
evidence based upon sound medical science indicates that
abstinence can be considered a health risk, that heavy
drinking dangerously damages health and shortens life, and
that moderate drinking improves health and lengthens life.
The J-shaped curve rules. It illustrates that moderate
drinking is associated with a lower death rate than is
abstinence and a much lower rate than is heavy drinking.
Maybe life is a J-shaped curve. Alcohol itself appears to
supply at least half these benefits. Those beverages, red
wine in particular, that are imbued with polyphenolic
antioxidants are especially salutary. We are just beginning
to understand the remarkably complex mechanisms at
work.

The so-called
French paradox graphically calls attention to drinking as
possibly healthy. Behold the stereotypical Frenchman:
overweight and indolent, sated with butter, cream and fois
gras, Gauloise ever hanging from lips, shunning vegetables
and exercise, save for flexion of elbow. The paradox is the
low coronary death rate in France compared to, say, America
with its healthier lifestyle. Perhaps what the elbow flexion
is conveying to the Frenchman’s mouth, red wine, makes the
difference.

I have written
overviews of wine’s influences upon health from time to
time, when it seemed updates were needed. The current piece
will review significant developments mainly during the past
couple of years.

Most qualified
observers continue to believe that the healthiest drinking
is moderate in quantity, say two glasses of wine daily for
men, one for women, regularly with meals. The stomachs of
women contain only half as much of the enzyme that
neutralizes alcohol as those of men’s. All agree that
spreading out consumption in modest doses is far better than
concentrating one’s drinking. (One well-done study
concluded, however, that only the frequency of doses counts,
within reasonable limits of quantity, not what one drinks,
nor whether with meals.) We must continue to support
research, and to demand that conclusions are based upon
objective scientific data. The roles of genetic factors and
of various enzymes must be clarified.

Cardiovascular
disease (atherosclerosis), the most frequent cause of death
and disability in the developed world, is the most studied
and carries the greatest weight of evidence of the
beneficial effects of moderate drinking: dramatic reductions
of risk of heart attack, ischemic stroke (due to obstruction
of a diseased artery supplying the brain), and of
obstruction of arteries elsewhere in the body. (It takes
very prolonged and heavy drinking to damage the heart.) Most
of such benefits can be demonstrated only in those over 4O
years of age, but neither the disease nor its alleviation
would be apparent in young people. We know that the
atherosclerotic process begins early in life, and we all
hope to attain older age with healthy hearts and blood
vessels. Many studies report that moderate drinking is
associated with a reduction of greater than 4O percent in
coronary risk.

It is worth
reviewing the now numerous cardiovascular risk factors known
to be affected by moderate drinking.

Blood fat
(lipid) deposition into the walls of arteries in the heart
and elsewhere is a prime step in the development of
atherosclerosis. Alcohol stimulates the liver to increase
production of high-density lipoprotein (HDL) cholesterol,
the “good cholesterol”, which purges arteries of low-density
lipoprotein (LDL) cholesterol, “bad cholesterol”, and carts
it back to the liver for excretion in the bile. Other
potentially noxious fats, such as triglyceride and
lipoprotein (a), may also be favorably impacted by drinking.
LDL cholesterol is particularly toxic only after it is
oxidized. Antioxidant polyphenols of wine, and perhaps HDLs,
coat LDLs, protecting them from oxidation.

A blood clot is
the coup de grace of a heart attack or ischemic stroke,
obstructing the flow of blood with its oxygen and
nourishment to the unfortunate tissue beyond. Both alcohol
and wine’s polyphenols beneficially modulate several facets
of an overactive coagulation (clotting) cascade. (The risk
of much less frequent hemorrhagic strokes is increased by
drinking.)

Homocysteine, an
amino acid, when overabundant due to genetic factors or
lifestyle, encourages harmful blood clotting, and may
directly injure arterial walls. Abusers of alcohol are often
deficient in the important vitamin folic acid. This
deficiency and perhaps alcohol itself may raise the
homocysteine level. Supplemental folic acid or vitamins B12
or B6 protect against homocysteine excess.

The inner
endothelial layer of the blood vessel wall is a vital
working tissue. Nitric oxide elaborated by endothelial cells
relaxes vessel walls, allowing freer blood flow, reduces
aggregation of platelets, decreasing clot risk, and inhibits
excessive muscle growth within the vessel wall. Polyphenols
of wine stimulate production of nitric oxide.

Abnormal
arterial stiffness and thickening appear to obey the
J-shaped curve.

A red-wine
polyphenol extract strongly inhibits production of
endothelin-1, a human peptide that may play a role in the
development of coronary disease.

The inflammatory
process initiated by endothelial injury is thought to
perpetuate the atherosclerotic process. Drinking reduces
blood concentrations of C-reactive protein and other signs
of inflammation correlating with coronary risk. Gallic acid,
a polyphenol of wine, was recently reported to inhibit
inflammation, and perhaps thrombosis and cancer.

Wine polyphenols
appear to protect against Helicobacter pylori and Chlamydia
pneumoniae, bacteria suspected of provoking athersclerosis.
They both make other mischief.

Diabetes
mellitus, a common and dangerous disorder, renders its
sufferers highly susceptible to atherosclerosis, often at
unusually young ages. Moderate drinking protects diabetics
at least as much as others, and improves insulin
sensitivity, thus enhancing control and reducing
cardiovascular risk and the risk of developing type 2
diabetes to begin with. Both alcohol and polyphenols are
operative. Benefits may be greater among those who drink
wine or beer than for spirit drinkers. Dry wine contains
almost no carbohydrate and few calories. Diabetics must eat
when drinking to avoid hypoglycemia.

Elevated blood
pressure (hypertension) a stealthy, potentially disabling
and lethal disorder, may be ameliorated by moderate drinking
and, in keeping with the J-shaped curve, exacerbated by
excessive drinking.

Excessive
weight, another well-recognized cardiovascular risk, may be
lost with the aid of moderate consumption, but see the liver
paragraph.

The production
of antioxidant polyphenols in the vine, where they act in
fungal protection and likely in other ways, is stimulated by
various stresses. They help protect wine from premature
senility, and contribute to color, flavor and texture.
Abundant in grape skins, they are found abundantly in red
wines, our main source, also to a lesser extent in white
wine, beer, especially the darker types, cask-aged spirits,
hard cider and fruits, nuts, and vegetables. Resveratrol,
quercetin and the catechins are among the most familiar and
most biologically active. Specific beneficial effects of
these compounds continue to be elucidated. Oxidative
reactions, part of normal living, additionally incited by
smoking, noxious chemicals, radiation, and acetaldehyde, a
breakdown product of alcohol, lie at the core of most of the
damaging sequences leading to aging, cancer, dementia
(including Alzheimer’s disease), immune dysfunction,
inflammation, cataract formation, and other degenerative
disorders. It is hoped that the antioxidants can diminish
these pathological processes.

Mimicking severe
calorie restriction, polyphenols activate sirtuin genes,
thus stabilizing DNA and preventing lethal accumulation of
toxic products in older cells, in this manner increasing
maximum life span. Resveratrol extends yeast life span by 7O
percent. The sirtuins are operative in roundworm, insect and
in mammalian cells, where they play a favorable role in fat
metabolism. Research continues.

In addition to
anti-inflammatory effects, wine has been found to combat a
number of infections. Contrary to what one might assume, it
is mostly the polyphenols, not the alcohol, that do the job.
Wine effectively inhibits growth of bacterial terrors of the
gastrointestinal tract, including H. pylori, implicated in
causing gastritis, ulcers, stomach cancer, and perhaps
atherosclerosis. It likewise retards the virus of hepatitis
A and of C. pneumoniae, a bacterium which causes upper and
lower respiratory infections of varying severity and
duration, and which also may provoke atherosclerosis. Recent
research suggests, however, that the old notion implicating
alcohol in virulence of infection may be true.

We know that
prolonged excessive consumption of alcohol increases the
risk of several cancers. Alcohol can stimulate the growth of
blood vessels in tumors, thereby promoting the spread of
cancer. There are reasons to believe that antioxidants may
help protect against cancer. Still unresolved is the
question of whether moderate drinking might increase the
risk of breast cancer, perhaps of colorectal cancer. If
increase there be, it must be very small, and it would
appear submerged by the cardiovascular benefits. (Remember
that heart disease is also women’s most frequent cause of
death.) Dietary folate may protect drinkers against breast
cancer. Individualized risk assessment can be provided only
by one’s own physician. A recent study found a substantial
reduction of prostate cancer, particularly of the more
aggressive types, associated with red wine consumption.
(Might the wine’s contribution of boron have played a role?)
Risk of other cancers, including lymphoma and those of lung
and ovary, may also be reduced.

Evidence
continues to come in suggesting that even modest drinking
may be a bad idea for those trying to conceive and during
early pregnancy. Both male and female alcohol intakes of ten
or more drinks during the week of conception increased the
risk of early pregnancy loss. Women who drank four or more
drinks per week had increased risk of preterm delivery,
especially those who drank seven or more drinks per week.
The female offspring of rats fed low to moderate amounts of
alcohol during pregnancy developed more breast tumors than
those of abstinent pregnancies. Some adolescent children of
human mothers who had averaged even fewer than one drink per
day during pregnancy continued to exhibit growth
deficit.

At the other end
of life, mental function is of great concern. Studies
continue to demonstrate an association between moderate
drinking and a substantial reduction in risk of dementia. Of
course, heavy drinking is well known to damage the brain and
nerves.

The liver, the
canary of the body in its sensitivity to alcohol,
surprisingly, in one study of rats, regenerated more briskly
after injury if the rats partook of light libation. A study
of mice suggested that obesity might increase risk of liver
damage from drinking. Cirrhosis of the liver remains the
chief fatal consequence of prolonged excessive
drinking.

Isolated reports
on miscellanea continually appear, then await, hopefully,
confirmation, or, fearfully, denial or silence. Although of
interest, they should not arouse credence. Moderate drinking
has been reported to reduce risk of visual loss from macular
degeneration, preserve hearing of the elderly and kidney
function, both impair and improve lung function and bone
strength. The acidity of wine can erode dental enamel in
those who must have wine in their mouths for long periods
(e.g., winemakers, buyers, judges). The carbon dioxide of
Champagne enhances absorption of alcohol. Extract of a
cactus plant suppresses some of the symptoms of
hangover.

Finally, I’ll
offer a general prescription that is largely common sense
and mostly heart healthful, but which cannot be taken as
individual advice. If no contraindication and you are so
inclined, enjoy wine moderately: say two glasses per day for
men, one for non-pregnant women. Drinking regularly with
meals is probably best. A Russian proverb advises, “Drink a
glass of wine after your soup, and you steal a ruble from
the doctor.” Red wine, with its higher content of
polyphenols, is likely more beneficial than white. Do not
binge. Drinking excessively risks damage to your liver,
brain, heart, and neighbor’s automobile. Wine should be used
to enrich life, not to medicate it.