The dairy people tell us milk and dairy products are good for our health. Cattle industry ads hint at red meat's undeserved fall from grace. Now, even our sometimes-wacky federal government seems to be promoting the medicinal value of marijuana. Call me old-fashioned but I was a tad skeptical when a shiny document came across my medical office desk once, apparently endorsed by several prominent Canadian medical specialists, trumpeting the health protective benefits of "responsible drinking." (Yup, you guessed it, on the back was the logo of the Brewers Association of Canada.) I decided to review the evidence for myself. So what's the bottom line on booze?

It's true, for the majority of adults, regular consumption of small amounts of alcoholic beverages reduces the incidence of certain medical conditions, and probably extends life. It's also true, however, that for about 10% of our population, repeated attempts to consume moderate amounts of alcohol will result in heightened risk of sickness, social disruption, and even death.

The evidence

Studies show that when small amounts (1 to 2 drinks) of alcohol are consumed regularly there is reduction in coronary artery disease and ischemic stroke and decreased mortality rates. (Note: ischemic stoke is the kind that happens when blood vessels shut down. Alcohol actually increases the risk of the other type of stroke due to rupture or bleeding of blood vessels around the brain.)

Other studies show that consumption of wine decreases the incidence of certain types of cancer. The mechanisms for these protective effects are several. Moderate alcohol consumption is shown to increase levels of the type of cholesterol (HDL cholesterol) that is associated with reduced risk of clogging of arteries to the heart muscle and brain. It also decreases the tendency of blood to clot, resulting in a similar effect to taking a baby Aspirin® (acetylsalicylic acid) every day. The other effect, seen with certain types of wine is due to flavenoids or antioxidants, protects against some of the cellular changes preceding some cancers. So, yes, the evidence is pretty strong, small amounts of alcohol can have beneficial health effects.

Yet the prestigious Institute of Medicine warns physicians that, because of the risks of drinking alcohol, they should not prescribe alcoholic beverages or encourage their nondrinking patients to consume this drug. Why not?

The rest of the evidence

When health harm due to alcohol is plotted against the amount of drug consumed, a J-shaped curve appears. In other words, a little bit of alcohol is good, but very quickly a little more becomes bad. In the report of the Canadian Task Force on Preventive Health, there is ample evidence that excessive consumption of alcohol is associated with deaths due to suicide, cancer of the upper digestive and respiratory systems, fatal bleeds due to ulcers and enlarged blood vessels around the esophagus, cirrhosis, pneumonia, and accidents.

There are many more nonfatal but serious medical and psychiatric consequences of heavy drinking. These negative health consequences show a clear dose-response relationship, with dramatic a rise once the threshold of 2 to 3 drinks per day in men and 1 to 2 in women is exceeded. Just to keep us honest here, a standard drink refers to 12 oz. of beer, 5 oz. of wine, or 1.5 oz. of liquor.

The problem

Nobody sets out to become an alcoholic. Calling it "responsible drinking" implies that those who drink anything other than moderately are simply irresponsible. Hogwash! Nearly 10% of those who decide to drink alcohol will become alcohol dependent. For them, because part of their brain is altered through genetics or environment, at some point in their moderate drinking they develop a powerful compulsion to drink, loss of control over their drinking once they begin to drink, and a growing accumulation of negative consequences due to their use of this drug. And what makes this phenomenon so tricky is that the person quickly develops a type of blindness to the magnitude of their growing problem: it's called denial.

So when scientific studies look at the health of populations of those who have been light social drinkers for many years, they have automatically eliminated all those people who drink heavily by choice and, more important, that 10% who have repeatedly tried to drink moderately but who have developed the disorder called alcohol dependence. In scientific terms it's called sample bias and is considered a serious flaw in study design.

If someone came along with a new experimental drug that was a sedative, a sleeping medication, a social lubricant, and a disinhibitor, they would be forced to put it through a set of clinical trials in stages. The first experiments, usually on animals, would determine if it did what it was supposed to do. Next it would be tested for safety and adverse effects. But if the drug caused 1 in 10 of the subjects to develop a progressive disease with serious worsening morbidity and mortality, it would never be released. Or, if it was an important drug, such as for the treatment of serious illness for which there were no safer alternatives, it would be placed under restrictive prescribing guidelines.

The bottom line

If you already drink, and neither you nor those who care about you believe your drinking is a problem, then you should limit yourself to

  • no more than 2 drinks per day (or no more than 3 drinks on special occasions), to a maximum of 10 drinks per week for women
  • no more than 3 drinks per day (or no more than 4 drinks on special occasions), to a maximum of 15 drinks per week for men

Delaying the first drink in youth has shown protective benefits, so encourage your youngsters to wait until they are of legal drinking age before trying this drug. If you have certain illnesses, such as diabetes, psychiatric illness, peptic ulcer disease, seizure disorder, or if you are pregnant you should refrain from alcohol consumption. If you are being prescribed medications such as antibiotics, antidepressants, sedatives, sleeping pills, and many, many more types of medication, any alcohol consumption could be hazardous so check with your pharmacist or physician. If you come from a family in which there is a history of alcoholism or other addictions, you might be wise to choose not to drink.

If you wonder if you or a loved one has an alcohol problem, go to the addiction channel and take the AUDIT (Alcohol Use Disorder Identification Test). If you score 8 or greater on this, get an assessment from a professional skilled in the diagnosis and treatment of addictive disorders.


Ray Baker, MD