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Is Moderate Drinking Good for Your Health? Some Scientists Don’t Think So

Posted in Alcohol Abuse

Every few years, the media tells us that something that used to be bad for us is now good for us and vice versa. At one point, salt was bad for us—now it can be dangerous to cut out salt altogether. Chocolate was once to be avoided but now is said to prevent certain cancers and keeps arteries from clogging.

Similarly, many recent studies are suggesting that alcohol in moderation may promote heart health and even ward off diabetes and dementia. But according to an article in the New York Times, some scientists contend that no study has ever proven a casual relationship between moderate drinking and lower risk of death, but instead that the two go together. Instead, it may be that moderate drinking is something healthy people do—not something that makes people healthy.

Some researchers are worried that these alcohol-promoting studies may have been done in exchange for money from the alcoholic beverage industry to pay for research, train students, and promote findings. These questions were raised after financial relationships started springing up between the alcoholic beverage industry and many academic centers.

“The bottom line is there has not been a single study done on moderate alcohol consumption and mortality outcomes that is a ‘gold standard’ kind of study — the kind of randomized controlled clinical trial that we would be required to have in order to approve a new pharmaceutical agent in this country,” said Dr. Tim Naimi, an epidemiologist with the Centers for Disease Control and Prevention.

Avid supporters of moderate drinking still warn about the dangers of alcohol, which is linked to breast cancer and other types of cancer, liver disease, heart damage, and strokes when consumed in large amounts.

“It’s very difficult to form a single-bullet message because one size doesn’t fit all here, and the public health message has to be very conservative,” said Dr. Arthur L. Klatsky, a cardiologist in Oakland, CA, who wrote a study in the early 1970s finding that members of the Kaiser Permanente health care plan who drank in moderation were less likely to be hospitalized for heart attacks than those who abstained from alcohol.. He has received grants financed by an alcohol industry foundation, but has also published a study that found that alcohol increases the risk of hypertension.

“People who would not be able to stop at one to two drinks a day shouldn’t drink, and people with liver disease shouldn’t drink,” Dr. Klatsky said. However, “the man in his 50s or 60s who has a heart attack and decides to go clean and gives up his glass of wine at night — that person is better off being a moderate drinker.”

The association between moderate alcohol consumption and health benefits was first made in 1924, when a Johns Hopkins biologist published a graph that showed that moderate drinkers had the lowest death rates, particularly with respect to heart disease.

Alcohol is believed to reduce coronary disease because it has been found to increase the “good” cholesterol and have anticlotting effects. A small study in China found that cognitively impaired elderly patients who drank in moderation did not deteriorate as quickly as abstainers, and researchers have reported that moderate drinkers are less likely than abstainers to develop diabetes, and that people with Type 2 diabetes who drink moderately are less likely to develop heart disease.

But some scientists are asking who these abstainers are and why they avoid alcohol. Some suggest that abstainers might have stopped drinking because they already had heart disease. In addition, people tend to cut down on drinking as they age, making the average abstainer older and more susceptible to disease than the average moderate drinker.

In addition, two central question remain unanswered: are abstainers and moderate drinkers fundamentally different, and if so, is it these differences that make moderate drinkers live longer? Dr. Naimi of the CDC says the two groups are so different that they simply can’t be compared. Moderate drinkers are healthier, wealthier, and more educated, and they have better health care.

Some scientists say that large, long-term randomized controlled clinical trials should be conducted, like the ones performed for new drugs. One method might be to randomly assign a large group of abstainers to either to get a daily dose of alcohol or not, and then closely follow them for several years; another might be to recruit people who are at risk for coronary disease. But large randomized trials are expensive and they might lack credibility unless they are financed by the government, which could create controversy.

“The last thing we want to do as researchers and physicians is expose people to something that might harm them, and it’s that fear that has prevented us from doing a trial,” said Dr. Sei Lee of the University of California, San Francisco, who recently proposed a large trial on alcohol and health.

“But this is a really important question,” he added. “Because here we have a readily available and widely used substance that may actually have a significant health benefit — but we just don’t know enough to make recommendations.”

Source: The New York Times, Roni Caryn Rabin, Alcohol’s Good for You? Some Scientists Doubt It, June 15, 2009