YesNoYesNoYesNoYesNo

It is not an easy task sifting through mountains of information on supplements and vitamins, touting with promises of health and longevity, stronger bones, better memory, smoother skins, extended erections, anti-this and anti-that. Full of promise yesterday, debunked today. Yesterday's herbal rage, today's snake oil. Or sometimes, debunked yesterday, but resurrected today with new studies, or reincarnated for new uses. It is the frustrating YesNoYesNo of not just vitamins, minerals, supplements, and foodstuff (eggs, alcohol, caffeine, chocolates, etc) but also of prescription pharmaceuticals that somehow managed to slide through the supposedly rigorous standards of testing, only to be shown later on, after reports of adverse reactions and deaths, to be toxic and unsafe. These pages will attempt to sort through some of these sundry topics caught in the yes-no-yes and seesawing of information.

Eggs Vit D • Calcium • Chocolates • Wine • Aspirin • Caffeine • Medicines • Supplements

Alcohol

No other food item has gone through the tug-of-war of censure and approval, sin and virtue, good and evil, healthy and unhealthy as alcohol. It is the quintessence of Yes-and-No. None has been so deified, none so satanized, none so celebrated, none so consumed.

It has been around for millenniums. Stone beer jugs suggest fermentation since Neolithic times. Beer might even have preceded bread as a staple (Braidwood et al, 1953; Katz and Voigt, 1987). Egyptians have pictographed it as early as 4,000 B.C. and made at least 17 types of beer and 24 varieties of wine. After the Great Flood, a vineyard was one of Noah's first projects in Mount Ararat. Renaissance art is replete with colorful depictions of bacchanalia and debauchery. (Man, did those Romans know how to party.) Wine has been used as a form of payment for services rendered. In Medieval England, ale was used for the payment of rent and debts.

The Drunkenness of Noah / Bellini
 

The bible, for the most part, has been pro-booze, or at least pro-wine, considering it a symbol of joy (psalms 104; zachariah 10:7). St. Paul wrote of wine as God's creation, inherently good, and recommended it for medicinal use. Of course, there was the Wedding at Cana, running out of wine, and Jesus saving the day with his first miracle - changing water into wine. And of course, its ultimate use in the Last Supper - the transubstantiation of wine into the blood of Christ.

Other religions, however, are not exactly passing goblets of wine to each other. Some have warred and continue to war against it. Heretical sects consider the consumption of alcohol as a sin. Many religions - Baptists, Pentecostals, Methodists, among others - hold an abstentionist position. Among the Muslims, it is forbidden - haraam. Rastafarians frown on it while they embrace the spiritual use of cannabis.

And although it has served medicinal uses since antiquity - as tonic, antiseptic, cure, and as base for countless homeopathic tinctures - alcohol failed to mount a cultural good side. Despite isolated religions attribution of spirituality, many saw it as an instrument of sin and social evil.

And In medicine, it wasn't doing any better. By late 19th century, the therapeutic benefits were increasingly being disputed by practitioners. In 1916 whiskey and brandy were deleted off the list of scientifically approved medicines. In June of 1917, American Medical Association - finding no scientific basis for its therapeutic use as tonic or stimulant or health benefit as food item - passed a resolution opposing the use of alcohol as beverage and discouraged any use as a therapeutic agent. It was a consensus that likely provided support to the Great Experiment of Prohibition, which, of course, was an abject failure.
The thing is, it's a hell of a drug
consistent in providing a generic alcohol buzz, from the inexpensive tribal brewskies, to the wino's thunderbird, to wine bottles that can cost up to the thousands of dollars. In civilized measured amounts, it's a social lubricant, strips inhibitions, and causes logorrhea. In various degrees of excess, it can make you silly drunk, get you a DUI, crash you into an accident, make you throw up or wake up with a hell-of-a-hangover.

Growing up, there was not much science being published on alcohol. One obscure but seminal article warned that every drink would destroy a million or some incredible number of betz cells in the brain. Betz cells are the main effector neurons responsible for voluntary movement and located within the fifth layer of the primary motor cortex. I did some crude math and decided that with moderation, I have enough betz to last a lifetime, and so far that is proving to be true.

There were a few other obscure trials for intravenous use of alcohol in medicine - for analgesia and anesthesia, and for premature deliveries. But there was a lot of preaching about its dark side - betz cell destruction, dependence, dementia, cirrhosis of the liver, hepatitis, pancreatitis, diabetes, gout, headaches, neuropathy, hypertension, cardiomyopathy, and psychosexual dysfunction, besides the more immediate side effects of making one silly drunk, stripped of civilized inhibitions, vomiting from gastritis, and waking up with a hell-of-a-hangover.

And the press helped keep the perception on alcohol on the negative. Social derogatives for alcoholics abounded. Alky. Badload. Boozehound. Boozer. Barfly. Crippled. Dipso. Lush. Sot. Stinko. Stumble fuck. Tippler. Wino. A goodly amount of dedicated adjective: Blitzed blasted, inebriated, plastered, sauced, sloshed, soused, sozzled, wrecked. Add to that the a few physical giveaways: the beer belly, the alky nose, rhinophyma, facial telangiectasias, and vascular skin spiders.

And just when we thought that alcohol users were forever consigned to suffer in some kind of social purgatory. . . came the French Paradox, a milestone report that claimed France's high red wine consumption was the reason for the observation of low coronary heart disease death rates despite diets high in cholesterol and saturated fats. The paradox, however, didn't hold true for other countries with higher wine consumption. Still, in its wake, there was a steep boost in red wine commerce and consumption, to boot, introduced a slew of new neutraceutical words to alcohol's lexicon: antioxidants, flavonoids, resveratrol, polyphenols, procyanidins.

Since the French Paradox, there has been a slew of studies. Although there is a preponderance of studies touting benefits with alcohol use, some studies are cause for caution and concern. Besides alcohol-drug interactions, alcohol can worsen a spectrum of medical conditions: hypertension, gout, pancreatitis, ulcers, seizures, etc. For women who drink alcohol even in small amounts, breast cancer looms as a gender spectre.

Studies Touting Alcohol Health Benefits
Wine Consumption Decreases Age-Related Blindness
A 1977 report suggests even small amounts of wine could stave off age-related macular degeneration, the leading cause of blindness over age 65. The benefit was attributed to wine's high phenolic content and its ability to decrease platelet aggregation. Medical Tribune, June 1997
Wine Is Fine, But Beer May Be Better
In a report comparing benefits of beer and wine, beer was given the edge. Beer is a rich source of dietary silicon, while wine, unfortunately, is not. There is also a greater reduction in osteoporosis risk and lower rates of blood pressure with beer, compared to wine or other spirits. While wine might boast of its reported antioxidants and resveratrol, beer counters with xanthohumol, providing a greater estrogenic boost than soy, and to boot, test tube experiments showing cancer cell inhibition. It also contains folic acid, B vitamins and soluble fiber. Although it's blamed for the beer belly, ounce for ounce, it has less calories than wine or spirits. And as for cardioprotective benefits, reduction in heart attack risks are comparable with wine. (In a study of Japanese men, beer was associated with an increase in rectal cancer.)
Beneficial Effect on HDL Cholesterol
The large-scale epidemiologic Klatsky study showed an inverse association between alcohol and coronary heart disease, and the possible mechanism of alcohol effect was attributed to the rise in HDL. (There are, however, conflicting reports on the effects of alcohol on HDL, particularly HDL subclasses.)
Effect on Blood Pressure
Reports on blood pressure effects are conflicting. Alcohol consumption of 3 drinks a day can raise blood pressure. In a Kaiser-Permanente study, women who took 2 or less drinks a day had lower blood pressures vasopressor effect of alcohol may explain the rise in blood pressure with long-term consumption.
Reduced Risk of Heart Disease
• A strong evidence exists for the association between moderate drinking and reduced risk of heart disease. Men who consumed alcohol between three and seven days a week had fewer heart attacks than men who drank once a week. The benefit has been attributed to alcohol's effect on the good cholesterol, HDL cholesterol or an improvement on insulin sensitivity.
• Men who drank less than a glass a day showed a 22 percent reduction in risk of death after a heart attack from any cause; one to two glasses a day saw a 34 percent reduction in risk.
Stroke Effects
The Nurses's Health Study, in contrast to an increase in breast cancer risk, showed a decrease in the risk of both ischemic and hemorrhagic strokes with low to moderate amounts of alcohol. Those who drank less than half a glass of alcohol daily were 17 percent less likely than nondrinkers to experience a stroke; at 0.5 to 1.5 glasses per day, the percent decrease in stroke risk was 21 percent.

Resveratrol
• Much on the hype on red wine centers on resveratrol, a stilbenoid, found in the skin of red grapes. Red wine contains between 0.2 and 5.8 mg/L, white wine has much less.
• However, resveratrol can be found in other fruits and selected foods, like peanuts, peanut butter, and cocoa powder.
• Resveratrol can also be produced from its glucoside, piceid, found in the Japanese knotweed
• Animal experiments have reported anti-inflammatory, hypoglycemic, anticancer, anti-aging, neuroprotective, and cardiovascular benefits. However, many of the benefits found in animal studies are unproven in humans.

Benefits on Dementia
Although earlier studies reported impaired cognition with moderate drinking, later studies failed to confirm alcohol's detrimental nervous system effects. In fact, studies started reporting on its neuroprotective benefits. and overwhelmingly found moderate drinking either reduced or had not effect on risk of dementia of cognitive impairment. (1) Light to Moderate Alcohol Use Protective Against Dementia in Older Adults: A new study of adults 75 years and older suggests drinking light to moderate amounts of alcohol may help protect against the develop met of dementia. Medscape Education Clinical Briefs (2) A Drink A Day May Keep Alzheimer's Away: According to a study published in the August 2011 issue of Neuropsychiatric Disease and Treatment, light to moderate drinking may reduce the risk of dementia and cognitive decline. Moderate drinking, defined as no more than 2 drinks a day for a man and 1 drink a day for a woman, reduced by the risk for Alzheimer's and other forms of dementia by 23%. Amount matters. While light to moderate drinking conferred benefit, heavy drinking - more than 3 to 5 drinks a day) was associated with a nonsignificant higher risk for dementia and cognitive impairment.. Medscape Medical News
Apolipoprotein E
An analysis also showed that the presence of apolipoprotein E epsilon 4 allele eliminated the benefit of moderate drinking. However, several other studies showed a beneficial effect of the epsilon e4 allele.
Decreased Risk of Stroke in Women
New study concludes light-to-moderate alcohol consumption was associated with a lower risk of total stroke in women.
Moderate Drinking Linked to Lower RA Risk in Women
Drinking 3 glasses of alcohol weekly is associated with a decreased risk of developing rheumatoid arthritis (RA), possibly through downregulation of proinflammatory mediators. (BMJ 2012;345:e4230)
Long-Term Alcohol Consumption and Decreased Cardiovascular Mortality
Study reports long-term moderate alcohol consumption is associated with a decreased cardiovascular mortality among men who survived a first myocardial infarction. There was a suggestion of excess mortality for men consuming more than two drinks a day after the heart attack, again stressing the importance of moderation.
With High Blood Pressure, Light to Moderate Drinking May Protect Heart
Findings of a meta-analysis suggest that low-to-moderate alcohol consumption was inversely significantly associated with the risk of CVD and ACM in patients with hypertension. (Medscape: Internal Medicine / Sept 2014) (Association Between Alcohol Consumption and Risk of Cardiovascular Disease and All-Cause Mortality in Patients With Hypertension: A Meta-Analysis of Prospective Cohort Studies) Mayo Clinic Proceedings

Health Risks Associated with Alcohol Use

Link Found Between Breast Cancer and Alcohol
(1) A prospective observational study of 105,986 women enrolled in the Nurses' Health Study followed up over a 28-year period, women over a 28-year period, women who have three to six drinks of week showed a modest increase (15%) in the risk of breast cancer compared to women who never drank alcohol. The risk was dose-dependent, with one to two drinks per day increasing the risk to 22 percent. The most consistent measure was cumulative alcohol intake throughout adult life. The risk is the same for wine, beer, and spirits.
(2) An epidemiological data update on alcohol and breast cancer focused on light alcohol consumption and reviewed the mechanisms of alcohol mediated mammary carcinogenesis. Heavy alcohol consumption - 3 or more drinks a day - is associated with a 40 -50% increase in breast cancer risk. Alcohol increases estrogen levels, and estrogen may exert a carcinogenic effect on breast tissue directly or via the ER or directly. Other possible mechanisms include acetaldehyde, oxidative stress, etc. Study suggests women should not exceed one drink per day., and those at elevated risk for breast cancer should avoid alcohol or drink alcohol only occasionally.
(3) 2.9% of 1,000 live births have fetal alcohol syndrome.

Alcohol-Drug Interactions
• Alcohol-drug interactions may be prevalent in patients with multiple medical conditions, especially those taking drugs metabolized through the hepatic CYP system. Beer, with its prenylflavonoids, inhibit CYP enzymes. Those on warfarin therapy (blood thinners) may have increased risk of hemorrhage, and requires closer monitoring.
Osteoporosis
• Osteoporosis is the condition of bone brittleness and fragility, usually a result of hormonal changes or deficiencies of calcium and vitamin D.
• Alcohol negatively impacts bone health. Alcohol interferes with the absorption and utilization of calcium and vitamin D. In men, alcoholism is linked with decreased testosterone production which can lead to decrease in bone-building osteoblasts. In women, chronic alcohol exposure causes hormonal changes and increased osteoporosis risk. Osteoporosis is linked to increase risk of fractures
.• Regular consumption of 2 to 3 ounces of alcohol every day increases the risk of osteoporosis.
Atrial Fibrillation and Alcohol
• A new analysis reports drinking alcohol, even light to moderate consumption, appears to be associated with an increased risk of developing atrial fibrillation. The risk increased among those who consumed just one to two drinks per day, or seven to 14 drinks per week. The risk increased 12% compared with nondrinkers. (21)

Statistics on Alcohol-Related Fatalities and Crime
Somewhat lost in the seesawing debates on alcohol benefits and risk is the societal realities of alcohol's link to fatal accidents and crime. How many of those converted by the Paradox and lured by the promise of resveratrol, phenolics, and health benefits would end in vehicular accidents or alcohol-related crimes? How does that figure in the statistics of longevity and lives lost?
Vehicular fatalities
• In the U.S. alcohol related crashes kill someone every 22 minutes. At any minute, one of 50 drivers on the road is drunk; on weekend nights, one out of ten.
• According to the Center for Disease Control, there are 105,000 alcohol related deaths and injuries (6/90).
• In 1996, although rates of intoxication in fatal accidents decline, there was one intoxicated driver in a fatal accident for every 17,200 drivers, from 1 in 10,500 drivers.
• One half of all traffic accidents are alcohol related.
• From a California Capitol Report, 65 people die each day on the highways due to alcohol (11/89).
Crime and Suicides,
• In child abuse convictions, mothers are 3x more likely to be alcoholics, and fathers 10 times more likely.
• Heavy drinking is involved in 60% of violent crimes, 30% of suicides.
• A U.S. Department of Justice report of Alcohol and Crime found that alcohol abuse was a factor in 40% of violent crimes committed in the U.S. Two-thirds of victims who suffered violence by an intimate reported alcohol as a factor.
• Suicide rates of alcoholics is 30 times that of the general population.

Yes to alcohol. . . if. . .
As the wine, beer, and liquor industries continue to battle for market share with image, sophistication, and health campaigns, the health benefit claims are becoming less product-specific. While many of the earlier studies suggested wine as being more beneficial than beer or spirits, more recent studies do not distinguish between the different types of alcohol; in fact, some have given the edge to beer, especially for men.

When wine, beer, and spirits join ranks, the conclusion is inconvertible - alcohol is beneficial to heart, health, longevity, and much more. It can help prevent heart attacks and strokes, and recent studies suggest it might be protective against dementia in older adults.

If you're a healthy male who enjoys his daily drink, then toast to your health. If you're a male being treated for sundry kind of medical problems, weigh the risks and benefits. Be aware, that while alcohol can decrease the risk for one disease, it can increase the risk for another.

  If you don't drink alcohol, don't start just because of the reported health benefits.  

No. . . if. . .
If you don't drink alcohol, then you shouldn't start drinking just because of the health benefits reported. Alcohol can lead to dependence, behavioral outbursts, traffic accidents, and various other predictable and unpredictable medical and social consequences.

If you health is burdened by obvious medical problems, the risks can greatly outweigh the benefits. As mentioned, many medical conditions are aggravated by alcohol - diabetes and its many related complications, hypertension, seizures, liver problems, neuropathy, sexual dysfunction, osteoporosis, to name a few.

If you're female, the studies reporting an increased risk of breast cancer are quite compelling. You should be vigilant in your moderation and limit alcohol intake to not more than one drink or less a day. If you are at high risk for breast cancer, you should avoid alcohol altogether or drink only occasionally.

In pregnancy, the literature is extensive and confusing. Fetal-alcohol is often written about. Other correlations abound, albeit, some debatable and unjustified - abruptio placenta, leukemias in children, IQ scores. Some studies suggest 1 to 3 drinks a week show no harmful effects. Scientific studies have not set a threshold below which alcohol use in pregnancy is definitely safe. Nor have studies shown evidence of harm at low levels. Some studies suggest a small benefit at low levels of use.

Moderation is the key.
While studies suggest moderate drinkers fare better than teetotalers on certain health measures, evidence is overwhelming that drinking more than what the guidelines suggest can lead to various health problems - cancers, liver disease, strokes, depression, hypertension, and sexual dysfunction.

Alcohol is both Jekyll and Hyde. Both food and drug. Both good and bad. Both boost and detriment to health. Both preventive and pathogenic.

Moderate means one drink for women and two drinks for men. A drink defined as a 5-ounce glass of wine, one 12-ounce glass of beer, or 1.5 ounces of 80-proof distilled beverage, each of which contains about 14 g of alcohol.

Unfortunately, for many, moderation is a wishful goal. The National Institute of Health estimates 4 out of 10 imbibers are heavy drinkers or at risk of becoming one, and nearly 19 million Americans have problems with alcohol. And that's the rub.

Measures of Moderation

Indeed, moderation is easier said than done. Alcohol is part of our cultural DNA. It entertains, it relaxes. We celebrate, we drown our sorrows with it. It is the inexpensive and too easily accessible icebreaker and social lubricant. And how many fun-loving beer-guzzling men out with their buddies stop after the second 12-ounce glass of beer? What couple out on a romantic evening, music in the air, stars alit, stop after a 5-ounce glass of wine? How often does one stop after the prescribed moderation ounces of spirit?

So, while we search for a god of moderation,
Here's to the gods of wine and beer.
Here's to the gods and goddesses of health and medicine.
Here's to health and bacchanalia.
Prosit.

by Godofredo U. Stuart Jr., MD                                                                                                             April 2012
IMAGE SOURCE: The Wedding Feast at Cana / Julius Schnorr von Carosfeld / 1819 / Wikispaces
OTHER IMAGE SOURCE: File:Drunkenness of Noah bellini.jpg / Giovanni Bellini / 1430-1516 / Public Domain / Wikipedia
OTHER IMAGE SOURCE: What's In A Drink? / Harvard Health Publications
OTHER IMAGE SOURCE:/ Alcohol Kills Slowly / Desicomments
Additional Sources and Suggested Readings
(1)
History of Alcohol and Drinking around the World / David J. Hanson, Ph.D. / Potsdam.edu
(2)
A Case of Severe Brain Atrophy Found in the Man in His Twenties Who Drinks Moderate Amount of Alcohol / Yoo JW, Choi JS / Korean J Fam Med. 2010 Sep;31(9):711-715. Korean. / http://dx.doi.org/10.4082/kjfm.2010.31.9.711
(3)
Alcohol Enhances Oxysterol-Induced Apoptosis in Human Endothelial Cells by a Calcium-Dependent Mechanism / Ioakim Spyridopoulos; Jörg Wischhusen; Björn Rabenstein; Petra Mayer; Dorothea I. Axel; Kai-Uwe Fröhlich; Karl R. Karsch / Arteriosclerosis, Thrombosis, and Vascular Biology. 2001;21:439-444
(4)
The aging human betz cell / Madge E. Scheibela, Uwami Tomiyasua, Arnold B. Scheibel
/ Experimental Neurology, Volume 56, Issue 3, September 1977, Pages 598–609
(5)
The French paradox: lessons for other countries / Jean Ferrières / Heart. 2004 January; 90(1): 107–111.
(6)
Wine is Fine, But Beer May Be Better / Sid Kirchheimer / March 2007 / Revolution Health Group
(7)
Alcohol and Health: A drink a day won't keep the doctor away / Charles Lieber, MD / Cleveland Clinic Journal of Medicine, Vol 70, No 11, Nove 2003.
(8)
A Drink a Day May Keep Alzheimer's Away / Medscape Medical News
(9)
Moderate alcohol consumption and cognitive risk / Neafsey EJ, Collins MA / Neuropsychiatric Disease and Treatment, August 2011 Volume 2011:7(1) Pages 465 - 484 / DOI: http://dx.doi.org/10.2147/NDT.S23159
(10)
Alcohol Consumption and Risk of Stroke in Women / Monik Jimenez, Stephanie E. Chiuve, Kathryn M. Rexrode l / STROKEAHA.111.639435, March 8, 2012, / doi: 10.1161/​STROKEAHA.111.639435
(11)
Long-term alcohol consumption in relation to all-cause and cardiovascular mortality among survivors of myocardial infarction: the Health Professionals Follow-up Study / Jennifer K. Pai, Kenneth J. Mukamal, and Eric B. Rimm / Eur Heart J (2012) / doi: 10.1093/eurheartj/ehs047
(12)
Intravenous alcohol -- a single blind study in the prevention of premature delivery: a preliminary report.
/ Watring WG, Benson WL, Wiebe RA, Vaughn DL. / J Reprod Med. 1976 Jan;16(1):35-8.
(13)
Study supports alcohol, breast cancer link / Carolyn Schatz, Editor, Harvard Women's Health Watch
(14)
Moderate Alcohol Consumption During Adult Life, Drinking Patterns, and Breast Cancer Risk
/ Wendy Y. Chen, MD, MPH; Bernard Rosner, PhD; Susan E. Hankinson, ScD; Graham A. Colditz, MD, DrPH; Walter C. Willett, MD, DrPH / JAMA
(15)
Epidemiology and Pathophysiology of Alcohol and Breast Cancer: Update 2012
/ Helmut K. Seitz, Claudio Pelucchi, Vincenzo Bagnardi, and Carlo La Vecchia / Alcohol and Alcoholism (2012) / doi: 10.1093/alcalc/ags011
(16)
Alcohol: weighing the risks versus the benefits / David Dunalef, MD / Times Beacon Record
(17)
Enhanced Antithrombotic Effect of Warfarin: Discussion / Medscape
(18)
Alcohol and Osteoporosis / Osteoporosis Health Center / WebMD
(19)
Impact of Alcohol Abuse On American Society / Alcoholics Victorious /
(20)
Long term alcohol intake and risk of rheumatoid arthritis in women: a population based cohort study / Daniela Di Giuseppe, PhD student, Lars Alfredsson, professor, Matteo Bottai, professor, Johan Askling, associate professor, Alicja Wolk, professor / BMJ 2012;345:e4230
(21)
Alcohol Consumption and Risk of Atrial Fibrillation: A Prospective Study and Dose-Response Meta-Analysis / Susanna C. Larsson, PhD∗; Nikola Drca, MD†; Alicja Wolk, DMSc∗ / J Am Coll Cardiol. 2014;64(3):281-289. doi:10.1016/j.jacc.2014.03.048
,
April 2012
Last Updated September 2014
by Godofredo U. Stuart Jr., MD
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