Thursday, May 27, 2010

Health benefits of Alcohol

Those of you who have read my blog regularly know that I think that alcohol is a valuable medicine that lowers the heart-attack risk. This whole subject was recently reviewed in the Journal of the American Medical Association in the May 26, 2010 issue (vol. 303, # 20, pp. 2065-2073). It is a fairly comprehensive review, with an extensive list of references. Before summarizing the review, I should like to iterate my opinions:

(1) We should lower the legal drinking age to 16. The age was forcibly raised to 21 by the U.S. Gov't, who threatened to reduce federal aid for highway construction to any state (e.g. New York) that did not raise the age to 21. The result is that many adolescents do their first serious drinking at college, away from parental supervision, and without the necessity of coming home to their parents in a somewhat sober condition. The system is even worse at state colleges. My daughter went to a state college, which was kept rigorously dry, even in the fraternity houses. The only result is that the students went off-campus to drink, and drove back to their dorms drunk. I hardly think that this is an improvement.

(2) If the greatest fear is that of teen-age drunken driving, then why not make it legal for teenagers who do NOT have a driving license to drink?

(3) My oldest grand-nephew just finished a 3 year tour in the Marines. He is allowed to drive a tank, operate a 50. caliber machine gun, a SAW, and kill our enemies, but was not even allowed to drink 3.2 beer on his base. There is something wrong with this picture if we trust him to kill responsibly, but not to drink responsibly.

The JAMA article made the following points, all of which were referenced to published articles. I should add that we still do not know the direct mechanism by which alcohol exerts its beneficial effects.

(1) Alcohol increases the "good' cholesterol HDL-C, in a dose-dependent effect.

(2) Alcohol decreases the level of fibrinogen, a clotting factor.

(3) Alcohol increases insulin sensitivity, and decreases the generation of glucose by the liver, so its ingestion opposes diabetes by two different mechanisms.

(4) Alcohol prolongs bleeding time.

(5) There is also an inverse relationship between alcohol intake and risk for stroke.

(6) All alcoholic beverages appear to be equipotent, and seem to benefit men more than women, provided that the alcohol is ingested on a regular basis.

(7) Alcohol does contain calories, and also increases a woman's risk for breast cancer (but the latest Danish study showed that pregnant women can imbibe a drink a day without harm to the fetus).

Overall, since cardiac disease causes the most deaths in the US, and since regular alcohol use can reduce the risk of coronary artery disease by as much as 30%, I think that doctors should consider recommending this as a daily medicine to men, and perhaps thrice weekly to women.

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