05.15.11

Is Alcohol Really Good for You?

Study after study promotes alcohol as good for you, but are the benefits overblown? Alizah Salario on how our eagerness to believe an appealing claim left us drunk on wishful thinking.

Go ahead. Chase that glass of pinot noir with a couple of beers. It's doctor's orders.

That type of medical advice is starting to become conventional wisdom, as a proliferation of studies and the magazine articles they generate increasingly seem to suggest that drinking is good for you. The appeal is understandable. After years of telling us to eat our veggies and go for a jog, suddenly science is demanding that we have a glass of wine. Oh, twist our arms.

It's true that the medical establishment has produced a legitimate body of research suggesting that mild to moderate alcohol consumption can increase "good" cholesterol and lower the risk of heart disease. And many doctors will indeed sign off on the occasional antioxidant-rich glass of wine. But the drumbeat of research recommending booze as a health beverage may be disorienting us.

One of the latest studies that could easily be misinterpreted comes from Boston University Medical Center, where researchers recently suggested that all forms of alcohol consumption, even at levels considered hazardous, lower the risk of coronary heart disease. The study, published in the American Journal of Addiction, used a national survey to track the drinking habits and the incidence of cardiovascular disease in more than 43,000 adults for a 12-month period.

Participants were divided into four categories of drinking frequency: abstinent, moderate, hazardous, and alcohol-dependent. Hazardous drinking was defined as 14 or more drinks per week for men and seven or more per week for women; moderate drinking was one per week for women, two for men.

Individuals in the moderate and hazardous groups were found to have a decreased likelihood of heart disease, compared with those in the abstinent group. The odds of heart disease weren't significantly different between the moderate and hazardous groups, after controlling for social and psychiatric factors.

Reading such a thing might convince the layman that getting hammered is healthy for the heart.

Not exactly, says Kaye Fillmore, senior scientist at the Institute for Scientific Analysis in San Francisco, who has extensively researched alcohol usage.

In a meta-analysis of 54 studies showing causation between moderate alcohol use and reduced mortality from heart disease, Fillmore found the methodologies highly skewed.

For instance: "Drinking and cardiovascular disease are measured at the same time," says Fillmore about the Boston University study. "To do such a study 'correctly,' one must start with a disease-free sample, categorize the drinkers, and then follow the sample up for some years to see who does and does not get the disease or die from it."

The drumbeat of research recommending booze as a health beverage may be disorienting us.

A closer look at studies linking increased drinking to decreased mortality rates reveals that nondrinkers may have a higher incidence of heart disease not because they don't drink but because they're unhealthier to begin with. Abstainers—rare in American society, where more than two thirds of adults imbibe—are often what are known as "sick quitters," individuals who stop drinking because they are elderly or already in poor health.

What's more, individuals qualifying as abstainers could have been heavy drinkers in the past. Because drinking patterns tend to shift throughout a lifetime, the notion of nailing down people in fixed drinking categories is problematic, suggests Fillmore. As with many studies on alcohol consumption, the Boston researchers relied on participants to self-report the amount of alcohol they consumed, and people tend to flub their estimates of how much they drink (even when they're sober).

Methodology, however, is only the first issue. Some wonder about the ethical implications of medical experts endorsing a drug that ranks as the third-leading cause of mortality in the United States. Every year, 85,000 Americans die from alcohol-related accidents or diseases. And while small amounts may be harmless—even healthy—alcohol is still a toxin.

"I don't think there's anything wrong with having a drink—it's an issue of abusing it," says Jonathan Wynn, M.D., chief of cardiology at White Plains Hospital in White Plains, N.Y. "These studies promote a point of view."

People like Fillmore worry that even when studies are accurate, including "alcohol" and "lowered risk" in the same sentence sends the wrong message. The notion that something fun and relaxing can also be healthy is extremely enticing, and may overshadow alcohol's drawbacks. "Extremely heavy drinking is related to a lot of negative outcomes including liver damage, accidents and injury, cardiovascular disease, and so on," says Fillmore.

The authors of the study, however, are quick to clarify that their findings were by no means intended to promote drinking.

“We were quite surprised by our findings that patterns of drinking traditionally considered harmful were not positively associated with cardiovascular disease, and were even associated with a lower rate,” said Dr. Yann Le Strat, one of the authors of the Boston study, in an email. “The take-home message of our study is certainly not to have a drink of alcohol if you are an abstainer, because this message would be false, and may have a very negative impact from a public-health point of view."

Le Strat’s researcher partner, Philip Gorwood, emphasizes the importance of distinguishing between moderate and excessive drinking, and admits that the correlation between alcohol and heart disease may have to do with factors other than the amount imbibed. “An interesting hypothesis is that people with moderate drinking are moderate for everything in life, and are then protected for many morbidity risks in life because of the reduced associated risk factors,” he said in an email.

Even if a certain amount of alcohol does mitigate the risk of coronary disease, the heart is divided when it comes to the health effects of drinking. There are a plethora of additional cardiovascular risks associated with drinking in excess, such as increased risk of high blood pressure and heart failure. Binge and excessive drinking have been shown to lead to increased risk for cardiovascular disease, strokes, and sudden cardiac death.

And though the American Heart Association notes alcohol's ability to increase HDL (good cholesterol) in the blood, the organization doesn't recommend drinking alcohol for its potential benefits because of its numerous risks. Plus, it's more complicated than "add alcohol, mix, and stir" for heart health. "Technically, there are different subfractions of HDL, and it's not clear which of the subfractions is beneficial, and which subfraction increases with alcohol use," says Wynn.

The AHA also suggests that the linkage between alcohol and decreased risk of heart disease may be due to factors other than alcohol consumption. Lifestyle attributes like increased physical activity and a diet high in fruits and vegetables but lower in saturated fats tend to be associated with moderate drinking—and both reduce the risk of heart disease more than alcohol.

But as long as studies continue to show that drinking is good for us, we'll continue to chug down the booze, even if we don't bother to get all the details. It's just too tempting. Because ideas that validate what we'd like to believe are easiest to accept. As the renowned doctor Sara Murray Jordan once said, "In medicine, as in statecraft and propaganda, words are sometimes the most powerful drugs we can use."

Alizah Salario is a freelance journalist based in New York. Her work has appeared in Women's eNews, Ms. Magazine, The Huffington Post, at the Poetry Foundation, and elsewhere.