Is Drinking Good Or Bad for Me

Think Mediterranean: blue sky, white beaches, sumptuous foods covered with sauces, and that bottle of red wine with every meal. Add to the idyllic picture an unexpected bonus—that the to-die-for Mediterranean diet may lower your risk of heart disease and stroke. It may even help fight cancer.

Part of the reason for the French paradox—the fact that rich French cuisine accompanies an unexpectedly low risk of heart disease—may lie in the vine, researchers believe. Or, more precisely, in the ethanol, the main ingredient in alcoholic beverages—the stuff that can make you light-headed.

Scientists also have found that some of the plant chemicals in wine provide protection from disease. While you're getting happy and relaxed, they go to work blocking the formation of harmful oxidized low-density lipoprotein (LDL) cholesterol and warding off cancers.

Bending the elbow at the dinner table may be part of the reason that people in Mediterranean countries can eat rich foods and still have low rates of heart disease.

Light to moderate drinking—a drink or two per day—may help you live longer, says J. Michael Gaziano, M.D., director of cardiovascular epidemiology at Brigham and Women's Hospital in Boston. "People who drink light to moderate amounts of alcohol have the lowest mortality—even lower than nondrinkers."

"In some instances the risk of heart attack is 20 percent to 30 percent lower in light drinkers than in people who don't drink," says Arthur Klatsky, M.D., senior consultant in cardiology for the Kaiser-Permanente Medical Center in Oakland, California.

When researchers at the Harvard School of Public Health studied 85,709 women over a 12-year period, they found that light to moderate drinkers had the lowest risk of fatal heart disease—even if they already had other heart disease risk factors.

Raise a Toast to the Health of Your Heart

"The cardiovascular benefits of alcohol come from the alcohol itself, no matter what drink it's in," says Dr. Gaziano. Ethanol raises the levels of high-density lipoprotein cholesterol, which helps to keep your arteries from filling up with plaque and, therefore, reduces your risk of heart disease. Dr. Gaziano's research shows that you get the same protective effects from wine, beer, and liquor.

Alcohol may help your circulatory system in other ways, too. Some data suggest that it reduces the blood's tendency to clot. And it may help keep the blood vessels more flexible. Furthermore, it's possible that a drink a day relieves stress. All of this could lead to lower risks of heart attack and possibly stroke.

"We know that the phytochemicals in wine are potent antioxidants that may help keep blood from clotting," says Andrew Waterhouse, Ph.D., a researcher in the Department of Viticulture and Enology at the University of California, Davis. Wine is rich in a group of phytochemicals called flavonoids, which also protect against cancer and prevent LDL cholesterol from oxidizing.

In one of his studies, Dr. Waterhouse tested the effect of California wines on the oxidation of the harmful form of human cholesterol, LDL. Both red and white wines blocked LDL formation by 46 percent to 100 percent, but three times as much white wine was needed for the effect.

Another "protective" factor: Researchers say that wine may attract a crowd that is more fit to begin with. "People who drink wine seem to have a healthier lifestyle in general," says Dr. Klatsky.

Some research suggests that you get the same antioxidant protection from nonalcoholic foods such as grape juice, fruits, and vegetables. That route will steer you clear of the risks of alcohol, including addiction, traffic accidents, and driving-under-the-influence citations.

Just a Little Protects Your Heart

Alcohol is a bit like jalapeño pepper. A pinch adds spicy flavor. But more than that seems to set your system on fire.

"Luckily, light drinking doesn't affect blood pressure. But more than two drinks a day may make your blood pressure go up," says Dr. Gaziano.

It's not completely understood why a little alcohol is good for you while a lot can do big-time damage. But the fact is, heavy drinkers—people who put away three or more drinks a day—increase their risk of a variety of problems, including heart disease, stroke, esophageal cancer, and liver disease.

That's not all. In a study of more than 15,000 women up to age 74, researchers found that moderate drinking significantly increases the risk of breast cancer. And a lifetime average of even one drink a day increases the risk.

"For most people, light drinking is associated with a lower chance of prematurely dying because the benefits in terms of lower rates of heart disease outweigh any small risk of cancer," says Dr. Gaziano.

Get Maximum Protection

For some folks the best approach to alcohol is not approaching it at all. Drinking is off-limits to anyone who might abuse it, for instance. The advantages of alcohol are not so huge that a nondrinker should take up the habit, given the risks of addiction. But for many other people, a little can do a lot of good. So if you do drink, here is how to get the most protection from alcohol.

A little goes a long way. Alcohol concentrates in lean body tissue such as muscle, not fat. As you age, lean body mass decreases and fat increases. Not only are you more likely to feel the effects of alcohol when you're older, but also it is more likely to do damage to your system if you overindulge. "There's absolutely no reason for anyone, especially older people, to have more than a drink or two a day," says Dr. Gaziano.

Because women tend to have less body mass than men, along with a slightly different liver metabolism, they should have no more than a half to one drink per day.

Spread it out. "One reason that French and Italians have lower heart attack rates might be because they drink wine a little each day with meals, while northern Europeans drink large amounts on weekend nights," says Dr. Gaziano. "You wouldn't take all your cholesterol medicine on Saturday—you take it in very small doses every day."

Wine and dine. Having your drink with a meal is a doubly good idea. For one thing, large meals promote blood clotting, which increases your risk of stroke, says Dr. Klatsky. Drinking wine—either red or white—may help prevent that. "But wine's biggest benefit may be that it encourages people to eat more slowly, which also reduces risk," he says.

Imbibe in the evening. Have your drink (or part of it) with your evening meal. Beyond the digestive benefits, you cut down on other types of risk as well. "You're less likely to climb ladders, drive cars, and do other activities that increase risk," says Dr. Klatsky.

Call it a food. In some cultures people consume alcohol primarily in small amounts with meals. That keeps consumption within safe limits and may explain why there is less alcoholism in those countries. "In Mediterranean countries such as Greece and Italy, people think of alcohol as a food rather than something that you consume on the weekends for its mind-numbing effect," says Dr. Gaziano.

Switch to red? Because red wine is richer in flavonoids, some people are choosing red over white for protection. So should you switch?

It's true that the more intense the color of the wine, the greater the antioxidant content. Red wine contains skins, seeds, and stems. All of this ferments, giving red wine color and flavor. Dr. Klatsky notes that the darker the wine, the greater the concentration of flavonoids.

White wine also contains flavonoids and other antioxidants, although in far lesser amounts than red. If you can't stand chianti but you would still like to add wine to your diet, chardonnay or another white variety should give you some of the same health benefits.

Prescription for Prevention

Just a little alcohol protects against heart disease and heart attacks. But just a bit too much can do major damage to your heart and other vital organs. It can also increase your risk of cancer.

As you get older, your body stores alcohol a little differently, making it especially important to keep consumption low.

Do:

* Discuss your drinking habits with your doctor. If he feels it is safe for you to drink, limit yourself to one or two drinks per day.

* If your drinking is okayed by your doctor: Drink a little every day for maximum protection. Drink with a meal to lower risk of blood clots.

Don't:

* Drink more than two drinks a day because it will increase your risk of cancer, heart disease, and stroke.

* Drink if you have ever had a problem with alcohol addiction.