Is a Little Wine Good?- Part 1: A Scientific Perspective

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Is a Little Wine Good?- Part 1

A Scientific Perspective

 

Many of you have heard or read that moderate alcohol may be

beneficial to your health. Here is an example of a New York Times

press release printed on December 11, 1997. " STUDY FINDS DRINK A DAY

KEEPS THE GRIM REAPER AWAY " . It stated that " researchers report that

modest drinking is, on balance, healthful and alcohol's ill effects

are offset by alcohol's benefit to the heart. "

 

As a physician, it was important to me to go to the scientific

literature myself to examine the evidence before I would start

advising patients, as some doctors have, that alcohol be used for

medicinal purposes.

 

First, I obtained the original research paper printed in the New

England Journal of Medicine, December 1997 and then I did a

literature search of all the articles that have been published on

alcohol in the last three years.

 

What I found was quite surprising, considering all the popular press

coverage of the beneficial and medicinal properties of alcohol. The

largest and longest study to date was published in the New England

Journal of medicine in December 1997 and was entitled " Alcohol

Consumption and Mortality among Middle-aged and Elderly U.S.

Adults " . (Thun et al., NEJM 1997; 337: 1705-14).

 

It followed nearly 500,000 individuals for nine years and reported a

20% decrease in mortality for those aged 35 to 70 during the study

period for those who consumed at least one alcoholic beverage per

day as compared to non drinkers.

They attributed nearly all of the lower death rates to medicinal

effects of alcohol in protections against cardiovascular disease.

 

From a purely medical point of view should physicians start

recommending alcohol consumption to protect against heart disease

and to promote good health? Many people have interpreted these

findings to suggest moderate drinking of alcoholic beverages should

be part of a healthy lifestyle.

 

After carefully studying the original research paper from the New

England Journal of Medicine (NEJM) plus reviewing over fifty other

alcohol related articles published in the medical literature in the

last three years, the following seven points should be considered

before using alcohol for medicinal purposes:

 

Alcohol is a well-established risk factor for numerous cancers. The

NEJM study showed a 30% increase in breast cancer in women consuming

as little as 1 drink per day.

 

This added to the already known increased incidence of mouth,

throat, esophagal, stomach, pancreatic and liver cancer associated

with alcohol consumption. (Rosener L. " Alcohol consumption and the

risk of breast cancer. " Epidemiology Review 1993: 15:133-44). The

only reason that an overall decreased mortality rate was shown in

the alcohol drinking population was because many more people die

from heart disease than cancer.

How could any physician face a patient dying a slow, painful death

from a cancer clearly linked to the alcohol that had previously been

recommended as a way to decrease the chance of a heart attack by

only 30% when other less risky preventative measures are available

without causing cancer as a side effect?

 

 

By analysing only those aged 35 to 70, the study did not accurately

reflect the lifetime risk of alcohol consumption. Alcohol related

injury is the number one cause of death in the 15 to 30 years old

age group. (McGinnis, J.M. " Actual causes of death in the United

States " , Journal of the American Medical Association, 1993; 279:2207-

12)

 

The mechanism by which alcohol gives cardiac protection may be

harmful to other body systems. Alcohol appears to protect against

heart attach in two ways.

First, by raising the level of HDL cholesterol which reduces the

build up of atherogenic plaque in the blood vessels, and secondly,

by acting as a " blood thinner " which clots from forming in the

already narrowed coronary arteries which is the initial event in

most heart attacks. (Kannel, WB. " Serum cholesterol, lipoproteins,

and the risk of coronary heart disease " , The Framingham Study, Ann

Int Medicine 1971: 38: 1224-32).

 

Interfering with the delicate balance in the blood clotting

mechanism may be a dangerous thing. A few years ago, it was noted

that aspirin had blood thinning properties that prevented heart

attacks.

 

The initial reports were so impressive that thousands of physicians

voluntarily started taking aspirin daily as a part of a study to

look at the long term benefits. The research project was stopped

prematurely when it was noted that the aspirin group was

experiencing an unexpectedly high incidence of hemorrhagic stroke.

 

While trying to prevent a heart attack by thinning the blood, some

of these doctors died, or were permanently disabled by bleeding into

their brains.

Now most doctors only recommend aspirin to patients who have

already had one heart attack.

The reasoning being that the risk of a second heart attack is

greater than the aspirin induced stroke and the potential benefit

outweights the risk.

 

 

It clearly points out the danger of interfering, as alcohol does,

with the delicate balance of the body in such areas of blood

clotting.

In addition, while preventing certain types of heart disease,

alcohol has been clearly linked to cardiac arrhythmias and

cardiomyopathy leading to congestive heart failure. (Cowie,

M.R. " Alcohol and the heart " British Journal of Hospital Medicine,

1997; 57: 548-51).

 

The 30% decrease in the death rate from heart disease attributed to

alcohol may be achieved and surpassed by other much less risky

methods.

 

Numerous studies have shown that simple lifestyle measures can

reduce cardiac risk by 50 to 70% without any of the many harmful

side effects documented with alcohol usage. (Miller, G.J. " Alcohol

consumption: protection against coronary disease and risk to

health. " Int. Journal Epidemiology, 1990; 19:923-30)

 

The study methodology and analysis bring into question the validity

of the conclusions. It must be understood that all studies relating

health risk and alcohol consumption rely on voluntary questionnaires

being accurately completed.

 

No one actually follows the patients around to document their

consumption or verify their claims. One of the editors of the NEJM

who wrote an editorial response pointed out that the study group

reported their yearly alcohol consumption to be only half of US

government per capita estimates based on industry production and

sales. (Potter, J.D. " Hazards and benefits of alcohol " . NEJM 1997:

337: 1763-64).

He pointed out that either this study group did not reflect average

American drinking habits, or they did not accurately complete their

questionnaires. (A third possibility which he did not mention would

be that one half the alcohol produced in this country gets poured

down the drain or is used to kill slugs).

 

Anyone who has ever worked with alcoholics knows they are often in

denial regarding their drinking patterns and some may have

inaccurately placed themselves in the non-drinking groups statistics

which would affected the validity of the conclusions.

 

Additionally, the NEJM study excluded from their statistics without

explanation 32,000 individuals who had cancer or cirrhosis at the

start of the study. These diseased are known to be closely linked to

alcohol consumption and their exclusion could markedly effect

mortality rates.

 

Apart from the heart, alcohol has physiologic negatives on virtually

every major body system. When reading in the lay press one could

easily conclude that most medical research in recent years has

focused on the positive medicinal value of alcohol on the heart. In

reality, a totally different picture emerges.

 

A computer research of all English language research papers in the

scientific literature in the last three years revealed 355 published

articles of which 48 were review articles. Review article summarize

and condense research findings on a related topic.

 

After carefully reading the abstracts of the 48 review articles, 44

were clearly dealing with the toxic affects of alcohol and of the

remaining 4 which death with the cardiac benefits each clearly

included in the negative side effect. Here is only a sampling of

statements taken from these abstracts.

 

" Alcohol is a neurotoxin associated with significant morbidity and

mortality...it may raise blood pressure, damage the myocardium,

precipitate arrhythmias and damage the developing fetal heat. "

(Sceepers, B.C. " Alcohol and the Brain. "

British Journal of Hospital Medicine, 1997; 57: 543-51)

 

" It is well recognized that alcohol increases the risk of injury. "

(Guohua, L. " Alcohol and injury severity. " Journal of Trauma 1997;

42:562-69)

 

" Alcohol can lead to potentially hazardous hypoglycemia... "

(Meeking, D.R. " Alcohol ingestions and glycemic control. " Diabetic

Medicine 1997; 14:279-83)

 

" ...alcohol related problems include liver disease, dementia,

confusion, peripheral neuropathy, insomnia, seizure disorders, poor

nutrition, incontinence, diarrhea, myopathy, inadequate self care,

macroaocytosis, depression, fractures, and adverse reactions to

medications. " (Fink, A. " Alcohol related problems in older persons. "

Archives of Internal Medicine 1997; 157:242-3).

 

" Alcohol has consistently been related to risks of sqaumous cell

cancer... " (Thomas, D.B. " Alcohol as a cuase of cancer. "

Environmental Health Perspectives 1995; 103:153-60) " The influence

of alcohol on sexual behavior is part of popular knowledge. "

(Donovan, C. " A review of the literature examining the relationship

between alcohol use and HIV related sexual risk-taking in young

people. " Addiction 1997; 90:319-28)

 

Other studies showed the relationship between alcohol and

osteoporosis, chronic gastritis, peptic ulcers, decreased immune

response, aggressive behavior, fetal malformation, spontaneous

abortion and this is only a sampling!

 

It is difficult to see how anyone could review the data and conclude

that the beneficial properties of alcohol outweighs the toxicology

even when taken in moderate amounts.

 

One must consider the addictive potential of alcohol with its

resultant social and economic implications.

 

It is recognized that approximately 10% of the individuals who

begin drinking will become sufficiently addicted to be considered

problem drinkers or alcoholics.

 

In a Gallup poll, 1out of 4 American report their families being

negatively impacted by alcohol abuse. The economic loss of worker

productivity is measured in the billions of dollars.

 

A medical pharmacology textbook states: " Alcohol is discussed here

separately because its wide and abuse leads to more behavioral and

organic toxicity than any other agent. The social and therapeutic

problems thus generated are an unavoidable concern of every

practitioner...Ethyl alcohol is an addictive drug and it would no

doubt immediately be placed under the jurisdiction of the Food and

Drug Adminisration, if it were first discovered today. " (Meyers,

F.H. Review of Medical Pharmacology. Lange 1980; 242-46)

 

In conclusion, let's suppose you went to your physician and were

offered a medication with the following informed consent:

 

" This is a drug which can reduce your chance of heart attack by 30%,

but I must warn you that this drug is a direct brain and liver

toxin.

It will increase your chance of contracting cancer, contribute to

osteoporosis, ulcers, and hypertension.

There's also a 5-10% chance that you will become hopelessly

addicted to this drug which could easily lead to losing your job and

destroy your marriage.

 

I must also inform you that there are some essential risk-free

alternatives that are even more effective in preventing heart

disease, but I think you'll really like the euphoric feeling you get

when you take this drug. "

 

First, the Federal Drug Administration would never allow a drug with

this degree of risk-to-benefit profile to ever be marketed. Second,

if they did, what patient in their right mind would accept such a

prescription and ever trust the judgment of that physician again?

 

It is probably fair to say that many people who claim to be using

alcohol for medicinal purposes were already recreational drinkers

who were happy to find science supporting their lifestyle.

 

From a purely medical perspective, it is hard to justify it. The

medical journal Cardiology Clinics summarizes this as

follows: " Given the complex nature of alcohol disease relationships,

alcohol consumption should not be considered a primary preventive

strategy. " (Gaziano, J. " Diet and Heart Disease: the role of fat,

alcohol, and antioxidance. " Cardiology Clinics 1996; 14:69-83)

 

Our decision to drink alcoholic beverages should not be based solely

on scientific data, but also on the moral implications. I do not

consider my life to be merely a series of chemical reactions which

can be tested in lab experiments and reported in the medical

literature.

Aside from the physiology of my body, I believe my existence has

spiritual and mental dimensions which are intricately linked

together. Medical science increasingly recognizes that the patient

should be treated as a complex being with a intricately connected

body, mind, and spirit.

 

Recently, I attended a Harvard Medical School conference

entitled " Spirituality and Healing " , which dramatically documented

this wholistic view of man. It becomes clear that decisions I make

about my body have a major influence on my mental and spiritual

dimensions. In Part 2, we will discuss the moral and spiritual

implications of alcohol consumption.

 

By Dr. Rick Westermeyer, M.D.

 

Dr. Westermeyer is a practicing physician at the Portland Adventist

Medical Centre in Portland, Oregon, U.S.A.

 

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