EVE

TO

WN

SON

FP

G

newsSCAN

Henny Youngman once quipped thatwhen he read about the evils of drink-ing, he gave up reading. But reading

and drinking may mix badly in another sense.When you read the conflicting messagesabout the health benefits of moderate drink-

ing, you may throw down yournewspaper in exasperation. It hasbeen about 10 years since the“French paradox” became a sen-sation: the observation of a lowincidence of heart disease inFrance, despite a grande bouffeof foie gras and other fatty Gallicfoods. Researchers suggestedthat this may be attributable tohigh wine consumption. And thetheory brought renewed vigor tothe debate about the benefits ofmoderate alcohol intake.

The bickering continues. The 60-plus stud-ies that establish links between moderatedrinking and reduced heart disease have ledsome experts to claim that the weight of evi-dence is enough for physicians—on a case-by-case basis—to advise some teetotalers to drinkmoderately. This is a departure from previousmedical counsel, which ran along the lines of:if you don’t drink, don’t start. At a recent con-ference in Palo Alto, Calif., on the effects of al-cohol on health, sponsored by the New YorkAcademy of Sciences (NYAS), Arthur L.Klatsky, a leading investigator on the epi-demiology of alcohol, and physician colleagueRoger Ecker presented an “algorithm” forhelping physicians to advise patients.

This flow chart recommends moderatedrinking (one to three drinks a week) for menbetween the ages of 21 and 39 and womenbetween 21 and 49 who have coronary heartdisease or two or more risk factors for it. Inaddition, it suggests that men who are 40 orolder and women who are 50 or older shouldconsider similar imbibing if they have heartdisease or one or more risk factors for it. Thechart makes exceptions for certain groups,such as pregnant women and recovering al-coholics. And Klatsky and Ecker emphasizethat this advice doesn’t obviate other pre-ventive measures, such as stopping smoking.

This type of recommendation might still

provoke a backlash from the medical estab-lishment. Last January in its journal Circula-tion, the American Heart Association (AHA)urged physicians to emphasize to patientsheart-protective measures other than drinkingred wine that have a firmer grounding of sci-entific research: lowering cholesterol andblood pressure, for instance. The documentnoted that any benefits of drinking must beweighed against risks for conditions such asfetal alcohol syndrome and stroke.

The AHA advisory argued that more evi-dence is needed to prove the benefits hypoth-esized from the French paradox. Other life-style factors, such as a high consumption offruits and vegetables among those studied, notthe wine drinking, might play a role. Epidemi-ologists have acknowledged for a long timethat, short of difficult-to-conduct randomizedtrials, solid confirmation of the salutary effectsof alcohol may never be forthcoming.

A recent finding, however, about a genet-ic difference in the way people metabolize al-cohol could help quell doubts about the epi-demiology. Researchers from Brigham andWomen’s Hospital in Boston and the HarvardSchool of Public Health wrote in the February22 New England Journal of Medicine thatone form of the gene for the enzyme thatbreaks down alcohol, alcohol dehydrogenase,does its work more slowly than other formsof the gene. Those who have that gene andwho drink moderately retain higher levels ofhigh-density lipoproteins, the so-called goodcholesterol, and face about half the risk ofheart attack of drinkers without the gene.“This is kind of a poor person’s randomizedtrial,” said Harvard School of Public Healthepidemiologist Meir J. Stampfer at the NYASconference. “The gene is basically distributedat random with respect to behavioral charac-teristics, including alcohol consumption. Soyou can’t argue that people with this gene ex-ercise more or have a better diet.”

If Stampfer is right, that may be good newsfor people who like to end the day with a nip.At a time when much hyped but little studiedalternative medicine treatments may turn outto be nothing more than expensive placebos,a shot a day to keep heart disease away mayhold increasing allure.

À Votre SantéSHOULD PHYSICIANS TELL SOME NONDRINKERS TO START? BY GARY STIX

HE

ALTH

Most of the coronary benefits comefrom alcohol, not other

components of various drinks.—British Medical Journal

(epidemiological review), Vol. 312; 1996

Something in wine in addition to alcohol may reduce

the overall death rate for moderate wine drinkers.

—Annals of Internal Medicine(study of nearly 25,000 Danes),

Vol. 133, No. 6; 2000

Growing evidence suggests thatalcohol wards off heart disease by

boosting levels of high-densitylipoprotein cholesterol,

thinning the blood or reducinginsulin resistance.

—Journal of the American MedicalAssociation (editorial),

April 18, 2001

The major risk for moderatedrinking is a 10 percent increase in

the likelihood of breast cancer for women, which might be negated

through increased folate intake.—Meir J. Stampfer,

New York Academy of Sciences conference, April 2001

DECANTINGTHE DATA

WINE that maketh glad the

heart of man.—Psalms 104:15

24 S C I E N T I F I C A M E R I C A N J U L Y 2 0 0 1

Copyright 2001 Scientific American, Inc.