Please note: This article is a sequel to ALCOHOL, THE WORLD’S BEST MEDICINE — PART I. The full list of references can be found at http://www2.potsdam.edu/hansondj/AlcoholAndHealth.html
Moderate drinkers tend to have better health and live longer than those who are either abstainers or heavy drinkers. In addition to having fewer heart attacks and strokes, moderate consumers of alcoholic beverages (beer, wine and distilled spirits or liquor) are generally less likely to suffer strokes, diabetes, arthritis, enlarged prostate, dementia (including Alzheimer’s disease), and several major cancers.
Alcohol has been used medicinally throughout recorded history; its medicinal properties are mentioned 191 times in the Old and New Testaments.1 As early as the turn of the century there was evidence that moderate consumption of alcohol was associated with a decrease in the risk of heart attack.2 And the evidence of health benefits of moderate consumption has continued to grow over time.
Reviews of research evidence report a strong, consistent relationship between moderate alcohol consumption and reduction in cardiovascular disease in general and coronary artery disease in particular.4
On the basis of its extensive review of research, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) reported that moderate drinkers have the greatest longevity. It also found that moderate drinking is beneficial to heart health, resulting in a sharp decrease in heart disease risk (40%-60%).5 This is important because cardiovascular disease is the number one cause of death in the United States, and heart disease kills about one million Americans each and every year.6
The health benefits of moderate alcohol consumption have long been known. One of the earliest scientific studies on the subject was published in the Journal of the American Medical Association in 1904.3
The Director of the National Institute on Alcohol Abuse and Alcoholism wrote that “Numerous well-designed studies have concluded that moderate drinking is associated with improved cardiovascular health,” and the Nutrition Committee of the American Heart Association reported that
“The lowest mortality occurs in those who consume one or two drinks per day.”7
A World Health Organization Technical Committee on Cardiovascular Disease asserted that the relationship between moderate alcohol consumption and reduced death from heart disease could no longer be doubted.8 But the benefits are not limited, important as they are, to reductions in heart disease.
Alcohol vs. Lifestyle
Why drink to reduce the risk of heart disease? Wouldn’t eating a good diet, exercising, and losing weight do the same thing?
No, it wouldn’t. The moderate consumption of alcohol appears to be more effective than most other lifestyle changes that are used to lower the risk of heart and other diseases.
For example, the average person would need to follow a very strict low-fat diet, exercise vigorously on a regular basis, eliminate salt from the diet, lose a substantial amount of weight, and probably begin medication in order to lower cholesterol by 30 points or blood pressure by 20 points.
But medical research suggests that alcohol can have a greater impact on heart disease than even these hard-won reductions in cholesterol levels or blood pressure. Only cessation of smoking is more effective. Additionally, other medical research suggests that adding alcohol to a healthful diet is more effective than just following the diet alone.9
Moderate drinkers tend to live longer than those who either abstain or drink heavily.
- The National Institute on Alcohol Abuse and Alcoholism has found that the lowest death rate from all causes occurs at the level of one to two drinks each day.10
- Drinking alcohol in moderation (1-2 drinks per day for women and 2-4 for men) was found to reduce risk of mortality significantly according to meta-analysis of 34 studies of alcohol and total mortality among 1,015,835 men and women around the world.11
- An exhaustive review of all major heart disease studies found that “Alcohol consumption is related to total mortality in a U-shaped manner, where moderate consumers have a reduced total mortality compared with total non-consumers and heavy consumers.”12
- A Harvard study found the risk of death from all causes to be 21% to 28% lower among men who drank alcohol moderately, compared with abstainers.13
- A large-scale study in China found that middle-aged men who drank moderately had a nearly 20% lower overall mortality compared with abstainers.14
- Harvard’s Nurses’ Health Study of over 85,000 women found reduced mortality among moderate drinkers.15
- A British analysis of 12,000 male physicians found that moderate drinkers had the lowest risk of death from all causes during the 13 year study.16
- A large study of about 88,000 people conducted over a period of ten years found that moderate drinkers were about 27% less likely to die during the period than were either abstainers or heavy drinkers. The superior longevity was largely due to a reduction of such diseases as coronary heart disease, cancer, and respiratory diseases.17
- A twelve year long prospective study of over 200,000 men found that subjects who had consumed alcohol in moderation were less likely to die during that period than those who abstained from alcohol.18
- A study of more than 40,000 people by the Cancer Research Center in Honolulu found that “persons with moderate alcohol intake appear to have a significantly lower risk of dying than nondrinkers.”19
- An analysis of the 89,299 men in the Physicians’ Health Study over a period of five and one-half years found that those who drink alcohol in moderation tend to live longer than those who either abstain or drink heavily.20
- An Italian study of 1,536 men aged 45-65 found that about two years of life were gained by moderate drinkers (1-4 drinks per day) in comparison with occasional and heavy drinkers.21
- A study of 2,487 adults aged 70-79 years, who were followed for an average period of over five and one-half years, found that all-cause mortality was significantly lower in light to moderate drinkers than in abstainers or occasional drinkers (those who drank less than one drink per week).22
- A large prospective study found that older men consuming up to about three drinks per day and older women consuming over one drink per day had a dramatically lower risk of dying than did non-drinkers.23
- A large study found that moderate drinkers, even after controlling for or adjusting for numerous factors, maintain their high longevity or life survival advantage over alcohol abstainers.24
- A Danish study of about 12,000 men and women over a period of 20 years found that abstaining from moderate alcohol consumption is a health and longevity risk factor. Choosing not to drink alcohol increases the risk of illness, disease and death.25
- A 14-year study of nearly 3,000 residents of an Australian community found that abstainers were twice as likely to enter a nursing home as people who were moderate drinkers. Drinkers also spent less time in hospitals and were less likely to die during the period of the study.26
- A prospective study of middle-aged Chinese men found that the consumption of two drinks per day was associated with a 19% reduction in mortality risk. This protective effect was not restricted to a specific type of alcoholic drink.27
- Alcohol prevents more deaths than its abuse causes in the United Kingdom, according to research from the London School of Hygiene and Tropical Medicine.28
- Scientists at the University of London concluded that light and moderate drinking saves more lives in England and Wales than are lost through the abuse of alcohol. If everyone abstained from alcohol, death rates would be significantly higher.29
- The Cancer Council of New South Wales concludes that “If the net effect of total alcohol consumption on Australian society is considered, there is a net saving of lives due to the protective effect of low levels of consumption on cardiovascular disease.”30
Moderate drinkers tend to enjoy better health than do either abstainers or heavy drinkers.
- A nation-wide survey in the U.S. revealed that daily moderate drinkers experienced significantly less acute hospitalization.31
- A nine year study of indicators of good health found moderate alcohol consumption to be associated with the most favorable health scores.32
- A study that examined nearly 10,000 men and women at age 23 and again at age 33 found that the moderate drinkers experience lower levels of poor general health, long-term illness, and psychological distress when compared to abstainers and heavy drinkers.33
- A study of nearly 20,000 Spaniards found that moderate consumption of any alcohol — beer, wine, or spirits — was linked to better overall health, compared to abstinence from alcohol.34
- A nation-wide Canadian study found that moderate drinkers who consumed alcohol daily had 15% less disability than the general population.35
- A Dutch study found that moderate drinkers under stress were less likely to be absent from work than were either abstainers or heavy drinkers. The investigators concluded that “abstinence is at least as unhealthy as excessive drinking.”36
- A study of 3,803 individuals age 18 to 101 found that lifelong teetotalers as well as former drinkers are consistently less healthy than light to moderate drinkers (those who consume up to 60 drinks per month). The health superiority of light and moderate drinkers extends to both physical and mental health.37
Hospitals Serve Alcohol
Nearly three-quarters of the teaching hospitals in the United States serve alcoholic beverages to their patients.38
- A review of the research reports that moderate drinking appears to reduce the risk of numerous diseases. “These include duodenal ulcer, gallstones, enteric infections, rheumatoid arthritis, osteoporosis, and diabetes mellitus (type II). Compared with abstainers, moderate drinkers exhibit improved mental status characterized by decreased stress and depression, lower absenteeism from work, and decreased dementia (including Alzheimer’s disease).”39
- Moderate drinking and exercise appear to slow down the health deterioration that occurs with aging, according to a study of about 2,500 people aged 65 and older who were followed regularly for about eight years. Those who drank and exercised regularly had fewer difficulties with their daily activities and physical functioning.40
The National Institute on Alcohol Abuse and Alcoholism found that moderate drinking is beneficial to heart health, resulting in a sharp decrease in heart disease risk (40%-60%).42 This is important because cardiovascular disease is the number one cause of death in the United States and heart disease kills about one million Americans each and every year.43
- Researchers studied volunteers in seven European countries and found that people who have a daily drink of beer, wine or distilled spirits (whiskey, rum, tequila, etc.) have significantly better arterial elasticity, a strong indicator of of heart health and cardiovascular health, than nondrinkers. Moderate drinkers also had significantly better pulse rates than those of abstainers from
- A study of 1,795 subjects found that “the risk of extensive coronary calcification was 50% lower in individuals who consumed one to two alcoholic drinks per day than in nondrinkers.”46
- Research demonstrates that moderate alcohol consumption is associated with better endothelial function, which contributes to better heart health and lowers risk of atherosclerosis and cardiovascular disease.47
- A study of over 3,000 men and women found that those who never drank alcohol were at a greater risk of having high levels of CRP and IL-6 (excellent predictors of heart attack) than were those who consumed alcoholic beverages in moderation.48
Moderate Drinkers are Less Likely to Suffer Coronary Heart Disease and Heart Attacks (Acute Myocardial Infarctions) than are Abstainers or Heavy Drinkers
- A National Institute on Alcohol Abuse and Alcoholism review of research studies from at least 20 countries around the world demonstrate a 20- to 40-percent lower coronary heart disease (CHD) incidence among drinkers compared to nondrinkers. It asserts that “The totality of evidence on moderate alcohol and CHD supports a judgment of a cause-effect relationship… there are cardio protective benefits associated with responsible, moderate alcohol intake.”49
- Harvard researchers have identified the moderate consumption of alcohol as a proven way to reduce coronary heart disease risk.50
- A study of 18,455 males from the Physicians Health Study revealed that those originally consuming one drink per week or less who increased their consumption up to to six drinks per week had a 29% reduction in CVD risk compared to those who did not increase their consumption. Men originally consuming 1-6 drinks per week who increased their consumption moderately had an additional 15% decrease in CVD risk.51
- The Harvard Health Professionals Follow-Up Study of over 44,000 men found moderate alcohol consumption to be associated with a 37% reduction in coronary disease.52
- A British study of women found moderate consumption of alcohol to be associated with lower levels of cardiovascular risk factors.53
- A study of over 5,000 women with type 2 diabetes mellitus found that coronary heart disease rates “were significantly lower in women who reported moderate alcohol intake than in those who reported drinking no alcohol.” Women who drank more than 5 grams (about one-third glass) a day reduced their risk of CHD (fatal or nonfatal) by more than half.54
- In a study of nearly 88,000 men, researchers found that drinking reduced risk of coronary heart disease risk among both diabetics and non-diabetics. Weekly consumption of alcohol reduced CHD risk by one-third (33%) while daily consumption reduced the risk by over half (58%) among diabetics. For non-diabetics, weekly consumption reduced CHD risk by 18% while daily consumption reduced the risk by 39%.55
- Light to moderate consumption of alcohol appears to reduce the risk of coronary heart disease by as much as 80% among individuals with older-onset diabetes, according to a study published in the Journal of the American Medical Association.56
- The Honolulu Heart Study found a 49% reduction in coronary heart disease among men who drank alcohol in moderation.57
- Harvard researchers concluded about coronary heart disease that “Consumption of one or two drinks of beer, wine, or liquor per day has corresponded to a reduction in risk of approximately 20-40%.”58
- At a scientific conference, researchers from Korea, Italy, Germany, Poland, the Netherlands, and the United States reported finding striking reductions in death among moderate drinkers, with heart disease and total mortality rates about one half or less compared to non-drinkers.59
- After over 6,000 participants in the Framingham Heart Study were followed for a period of six to ten years, researchers found that “when consumed in moderation, alcohol appears to protect against congestive heart failure.”60
- The American Heart Association, based on the research evidence, concludes that the “Consumption of one or two drinks per day is associated with a [CHD] reduction in risk of approximately 30% to 50%.”61
- After reviewing the research, Dr. David Whitten reported that “The studies that have been done show pretty clearly that the chances of suffering cardiac death are dramatically reduced by drinking” one or two drinks a day and asserted that “We don’t have any drugs that are as good as alcohol.”62
- Based on the medical evidence, noted investigator Dr. Curtis Ellison asserted that “abstinence from alcohol is a major risk factor for coronary heart disease.“63
The Moderate Consumption of Alcohol Increases the Survivability of Heart Attacks
- Drinking alcohol in moderation throughout the year before a heart attack or acute myocardial infarction (AMI) has been found to reduce the risk of dying afterward. Moderate drinkers had the lowest mortality rate, reducing their risk by 32%, compared to abstainers. The health benefits were virtually identical for beer, distilled spirits, and wine.64
- Men who consume two to four drinks of alcohol after a heart attack are less likely to experience a second heart attack than are abstainers, according to a study of 353 male heart attack survivors. Researchers found that men who consumed an average of two drinks of alcohol per day were 59% less likely than non-drinkers to have another heart attack. Those who drank an average of four drinks per day experienced a risk reduction of 52% compared to abstainers.65
- Research at the University of Missouri-Columbia found that drinking alcohol (beer, wine, or distilled spirits) in moderation reduced the damage to effected tissue following a heart attack.66
- A study for a five year period of over 85,000 men who had suffered previous heart attacks found that “moderate alcohol intake was associated with a significant decrease in total mortality” compared to nondrinkers.67
Alcohol Abstainers Who Begin Drinking Reduce Their Risk of Cardiovascular Disease
- During a ten year study of 7,697 non-drinkers, investigators found that 6% began consuming alcohol in moderation. After four years of follow-up, new moderate drinkers had a 38% lower chance of developing cardiovascular disease than did those who continued abstaining. Even after adjusting for physical activity, Body Mass Index (BMI), demographic and cardiac risk factors, this difference persisted.
The health benefits associated with drinking in moderation are also similar for beer, wine and spirits. The primary factor associated with health and longevity appears to be the alcohol itself.
This study is important because it provides additional strong evidence that the reduced risk of cardiovascular disease among moderate drinkers is a result of the alcohol itself rather than any differences in lifestyle, genetics, or other factors.68
- A study of men with high blood pressure found that those who averaged one to six drinks per week has a 39% lower risk of death from cardiovascular causes than were abstainers. Those who averaged more (one or two drinks each day) were 44% less likely to experience such death.69
Frequent Drinkers Enjoy Greater Heart-Health Benefits than Those Who Drink Less Often
- In a study of nearly 88,000 men, researchers found reductions in coronary heart disease risk with increasing frequency of drinking alcohol for both diabetics and non-diabetics. Weekly consumption of alcohol reduced CHD risk by one-third (33%) while daily consumption reduced the risk by over half (58%) among diabetics. For non-diabetics, weekly consumption reduced CHD risk by 18% while daily consumption reduced the risk by 39%.70
Moderate Drinking vs. Lifestyle
Why drink to reduce the risk of heart disease? Wouldn’t eating a good diet, exercising, and losing weight do the same thing?
No, it wouldn’t. The moderate consumption of alcohol appears to be more effective than most other lifestyle changes that are used to lower the risk of heart and other diseases. For example, the average person would need to follow a very strict low-fat diet, exercise vigorously on a regular basis, eliminate salt from the diet, lose a substantial amount of weight, and probably begin medication in order to lower cholesterol by 30 points or blood pressure by 20 points.
But medical research suggests that alcohol can have a greater impact on heart disease than even these hard-won reductions in cholesterol levels or blood pressure. Only cessation of smoking is more effective.
Additionally, other medical research suggests that adding alcohol to a healthful diet is more effective than just following the diet alone.71
- The lowest risk of fatal heart disease occurred among those who both drank moderately and exercised. They had a 50% reduced risk compared to non-drinkers who didn’t exercise. (Moderate drinking was defined as consuming an average of up to two drinks per day for both men and women. This is twice as high as the US federal recommendation for women.)
- A higher risk was found among (a) those who abstained from alcohol but exercised and (b) those who drank in moderation but didn’t exercise. In both cases the risk of heart disease dropped about 30% compared to abstaining non-exercisers.
- The highest risk was found among those who neither drank nor exercised. Their risk of dying from heart disease was twice as high as those who drank moderately and exercised.
Moderate drinking and exercise are cumulative in their positive effects on the cardiovascular system. Doing one is better than nothing, but doing both is the best choice of all and dramatically reduces the risk death from heart attack. The same is also found for all-cause mortality.72
How Alcohol Promotes Good Heart Health
The moderate consumption of alcohol promotes good heart health in a number of ways, including the following:
- Alcohol improves blood lipid profile73
- It increases HDL (“good”) cholesterol74
- It decreases LDL (“bad”) cholesterol75
- It improves cholesterol (both HDL and LDL) particle size76
- Alcohol decreases thrombosis (blood clotting)
- It reduces platelet aggregation77
- It reduces fibrinogen (a blood clotter)78
- It increases fibrinolysis (the process by which clots dissolve)79
- It reduces coronary artery spasm in response to stress
- It increases coronary blood flow81
- It reduces blood pressure82
- It reduces blood insulin level83
- It increases estrogen levels84