Alcohol and Health: Medical Evidence

Interview with Dr. Eric Rimm

The relationship between alcohol and health is explained in this interview with an internationally recognized authority on the medical evidence, Dr. Eric Rimm of the Harvard School of Public Health.

Dr. Hanson--

Dr. Rimm, you've researched the impact of alcohol on health for 15 years. Could you explain why moderate drinkers tend to be healthier and live longer on average than either abstainers or heavy drinkers?

Dr. Rimm--

Yes, I'd be glad to. Consuming alcohol in moderation either decreases the risk or has no effect on most of the major causes of death in the U.S. Of course, drinking heavily increases the risk of illness and premature death. Moderation is the key.

Dr. Hanson--

Well, what exactly is moderation?

Dr. Rimm--

Other countries usually define moderation at higher levels of consumption, but federal guidelines in the U.S. define moderation as consuming no more than one drink per day for women and no more than two drinks per day for men.

Dr. Hanson--

There's been a lot of news in the press about the health benefits of red wine. What's the story?

Dr. Rimm--

Yes, there has been a lot of press, but a review of 34 studies in which subjects were followed over time demonstrates that wine, beer, and distilled spirits are all beneficial and that no one alcohol beverage stands out as superior. The important ingredient in alcohol beverages is the alcohol. And standard servings of beer, wine, and distilled spirits contain equivalent amount of alcohol.

Dr. Hanson--

About half the deaths in the U.S. are caused by heart disease. It appears that moderate alcohol consumption can dramatically reduce the risk. Could you elaborate?

Dr. Rimm--

Yes. There's an overwhelming amount of evidence that moderate drinking reduces heart disease. A very large number of studies show that those who consume one to two drinks per day have about a 30-40% lower risk of having a heart attack. And the findings are highly consistent around the world.

Dr. Hanson--

What about the effects of lifestyle and other factors?

Dr. Rimm--

Research has carefully taken these factors into consideration and the results still stand.

Dr. Hanson--

What about cancer?

Dr. Rimm--

While heavy drinking is linked to mouth and throat cancers, moderate drinking has not been associated with these cancers.

With regard to breast cancer, there appears to be about a 10% increase per drink per average consumption. However, while a woman who consumes one drink per day may increase her risk of breast cancer by about 10%, her risk of developing the much more probable heart attack is reduced by 30-40%. And a woman is many times more likely to die from heart disease than from breast cancer. In the U.S., about 10 times more women die of heart disease than breast cancer. Of course, this is little consolation if you know of a friend or colleague diagnosed with breast disease, especially since breast cancer usually strikes at a much earlier age than heart disease.

The most exciting news on this front is related to other lifestyle factors that interact biologically with alcohol and alleviate the alcohol-related increased breast cancer risk. Several new studies suggest that moderate drinkers with high levels of folate (a vitamin found in fruits, vegetables, bread and cereals) do *not* have an increased risk for breast cancer.

Dr. Hanson--

What can you tell us about alcohol and diabetes?

Dr. Rimm--

Adult-onset (type 2) diabetes is becoming more common as obesity increases in the U.S. A number of studies report a 30-35% reduction in risk for diabetes among moderate drinkers.

Weight is a very important factor in type 2 diabetes. A new not yet published study of over 70,000 nurses over a period of eight years found that those who consumed an average of one-half to one drink per day weighed the *least,* and that all drinkers weighed less on average than abstainers, after adjusting for lifestyle factors such as diet an exercise. This is consistent with other research which suggests that moderate alcohol consumption, an individual's basal metabolic rate may increase more than compensating for the modest increase in calories. However at higher levels of consumption above two drinks a day, the increase in alcohol-related calories leads to weight gain.

Dr. Hanson--

You've shared some interesting and very important information on alcohol and health. Thank you for your time.

Dr. Rimm--

You're very welcome.

 

Dr. Eric Rimm, Associate Professor of Epidemiology and Nutrition at the Harvard School of Public Health, is project director of the Health Professionals Follow-Up Study, a prospective investigation of diet and chronic disease among 50,000 male health professionals. His research, especially on the associations between diet and other lifestyle characteristics and the risk of cardiovascular disease, has been extensively published.

References

  • Ajani, U. A., et al. Seven-year changes in alcohol consumption and subsequent risk of cardiovascular disease in men. Archives of Internal Medicine, 2000, 160(7), 2605.

  • Baer, D. J., et al. Moderate alcohol consumption lowers high risk factors for cardiovascular disease in postmenopausal women fed a controlled diet. American Journal of Clinical Nutrition, 2002, 75(3), 593-599.
  • Cummings, J. H., and Bingham, S. A. Fortnightly review: Diet and the prevention of cancer. British Medical Journal, 1998, 317, 1636-1640.
  • de Groot, L., and Zock, P. L. Moderate alcohol intake and mortality, Nutrition Reviews, 1998, 56(1), 25-27.
  • Health Professionals Follow-Up Study (HPFS) www.hpfs.harvard.edu/hpfs/
  • Lahti-Koski, M., et al. Association of body mass index and obesity with physical activity, food choice, alcohol intake, and smoking in the 1982-1997 FINRISK Studies. American Journal of Clinical Nutrition, 2002, 75(5), 809-817.
  • Rimm, E. B., Chan, J., Stampfer, M.J., Colditz, G.A. and Willett, W.C. Prospective study of cigarette smoking, alcohol use and the risk of diabetes in men. British Medeical Journal, 1995, 310, 555-559.
  • Rimm, E. B., Klatsky, A., Grobbee, D., and Stampfer, M. J. Review of moderate alcohol consumption and reduced risk of coronary heart disease: Is the effect due to beer, wine or spirits? British Medical Journal, 1996, 312, 731-736.
  • Rimm, E. B., Williams, P., Fosher, K., Criqui, M., and Stampfer, M. J. A biologic basis for moderate alcohol consumption and lower coronary heart disease risk: A meta-analysis of effects on lipids and hemostatic factors. British Medical Journal, 1999, 319, 1523-1528.
  • Sesso, H. D., et al. Seven-year changes in alcohol consumption and subsequent risk of cardiovascular disease in men. Archives of Internal Medicine, 2000, 160(7), 2605.
  • Thun, M. J., et al. Alcohol consumption and mortality among midle-aged and elderly U.S. adults (data from the Cancer Prevention Study II. The New England Journal of Medicine, 1997, 337(24), 1705-1714.
  • Willlett, W. C., et al. Eat, Drink, and be Healthy: The Harvard Medical School Guide to Healthy Eating. New York: Simon & Schuster, 2001.

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