The Intoxicating News About Beverage Alcohol and Health
Restaurants USA, April 1996

Consumers and operators alike are toasting the accumulating research showing that moderate alcohol consumption may be good for your health.
By Paul Moomaw

Those who get no kick out of champagne may still get a big kick out of the increasing evidence that there's a link between moderate consumption of beverage alcohol and health. It's not world-changing news — or a prescription urging people to drink — but it is a welcome development after decades of bad publicity about beverage alcohol.

Everyone remembers the original "French Paradox" story that aired on the "60 Minutes" television program in November 1991. On that segment, a connection was made between consumption of beverage alcohol and a reduced rate of heart disease for French people, despite the fact that the French have higher levels of fat intake than Americans. The results of the TV show? A spurt of publicity in the form of newspaper headlines and a few jokes at the bar about red wine being the new health food.

But the implications about the cardiovascular benefits of moderate alcohol use are no joke. And the evidence is not just "some French study" that made its way onto "60 Minutes." There are now hundreds of studies linking moderate drinking with a reduced risk of heart disease. Yet ask average Americans what they know about alcohol and health, and you're likely to hear some unsure mumblings such as, "I try not to drink except on weekends," or "I hear red wine isn't so bad."

This sheepish attitude is the result, in part, of years of negative public information disseminated about the dangers of alcohol — as well as other foods, for that matter. "We've been made to feel uncomfortable about things that give us pleasure," says Morris Chafetz, a medical doctor who is among the foremost authorities on alcohol issues and co-author of the book Drink Moderately and Live Longer.

What is moderation?

To determine what moderate drinking is, it's important first to answer the question "What is a drink?" International standards generally define a drink as containing about 13.6 grams of alcohol. That's approximately the amount found in one 12-ounce glass of beer (5 percent alcohol), one 5-ounce glass of table wine (12 percent alcohol) or a 1.5-ounce serving of liquor (40 percent alcohol).

The most liberal of analysts (particularly in Europe) define moderation as "whatever amount of drinking does you and others no harm." But U.S. norms are more tempered. The Dietary Guidelines, produced by the U.S. Department of Agriculture (USDA), recommend no more than two drinks a day for men and no more than one drink a day for women. These recommendations are right in the range where numerous studies have shown a link between alcohol consumption and health benefits.

If one's only goal in drinking beverage alcohol were to obtain the maximum possible clinical health benefit (and there are of course many other cultural and culinary reasons for partaking), some of the latest research points to light-level drinking of two to three drinks a week for women and four to six drinks a week for men as optimal. Study results vary, but at levels above those, the possible incidence of negative health consequences rise to a level at which they must be weighed against the possible heart benefits.

The concept of moderation isn't new, either. In 1862, Sir Francis Anstie, a British psychiatrist, proposed Anstie's Law of Safe Drinking, which listed 1.5 ounces of absolute alcohol a day as a safe upper limit. More than 100 years later, when the American Council on Science and Health (ACSH) in New York City was looking for a standard, it arrived at a similar conclusion through different means. The ACSH translates that upper-limit amount to approximately three drinks a day for men and half that amount for women. Most medical studies show that the known negatives associated with heavier alcohol use tend to show up at levels above two or three drinks a day. Above six drinks a day, the negatives increase sharply.

The benefits of imbibing

What is the good news in terms of health benefits for moderate drinkers? Generally speaking, the big news is the link between moderate drinking and low incidence of heart disease — no small health matter, since heart disease is the number-one killer of Americans. And scientists now believe they're getting a handle on how it is that moderate drinking helps reduce risk of heart disease.

At least two factors are commonly acknowledged. Many studies credit increased levels in drinkers of the so-called "good cholesterol" (HDL cholesterol) and decreased levels of "bad cholesterol" (LDL cholesterol) for the reduced risk. HDL cholesterol prevents heart disease by cleaning blood vessels of fatty buildups. Also, moderate drinking is associated with an increased level of the enzyme known as t-PA antigen, which helps prevent chronic internal blood clotting.

The results of most studies on heart disease and drinking are variations on a theme:

a seven-year study of 11,688 U.S. men between the ages of 35 and 57 showed that those who consumed an average of two drinks a day reduced their risk of death from heart disease by about 22 percent

a 10-year study of 44,059 males ranging from 40 to 74 years of age showed that moderate consumption of alcohol reduced the risk of heart disease by 37 percent

a 12-year study of 121,700 women showed that the death rate among women who drank roughly one to three drinks a week was 17 percent lower than that of nondrinkers.

"There now seems little doubt that alcohol exerts a protective effect against coronary heart disease," wrote Arthur Klatsky, a doctor who has researched the alcohol/heart relationship for decades, in an editorial in the New England Journal of Medicine. To find a definite health benefit for one of mankind's oldest, most cherished traditions — the raised glass — is truly a delight for moderate drinkers. And there's the possibility of more good news ahead. "Alcohol doesn't reduce just coronary risks, but overall mortality," says Elisabeth Holmgren, director of research and education for the Wine Institute, an association of more than 400 California wine growers and makers. Limited studies hold out promise in some of the following areas:

a study showed increased cognitive reasoning among wine and alcohol drinkers in a study of 4,000 elderly twins

another study found that elderly moderate drinkers were more than twice as likely to have high functioning abilities as abstainers

a study found greater bone density among lifelong social drinkers

a study of 400 U.S. and U.K. adults reported that nonsmoking drinkers were more resistant to certain common cold viruses than nondrinkers.

These emerging research findings outside the realm of heart disease, and others that are just being uncovered, need further study, but they point in general to the fact that moderate drinking can be part of a well-balanced lifestyle and a healthy diet.

Is this a red-wine thing?

Although the wine industry has had the most success in distributing good news in the form of educational information to the health community and the public, the benefits of moderate drinking are not limited to red-wine drinkers. It is almost certainly ethanol itself-which is contained in all beverage alcohol-that yields the lion's share of beneficial health effects.

Some research has been wine-specific and posits that additional factors may make wine drinkers particular beneficiaries, including the fact that wines contain high concentrations of compounds with antioxidant capabilities and the fact that wine tends to be consumed with meals, when the opportunity to counter effects of saturated fat may be crucial. But the record is clear: Cardiovascular health benefits flow to moderate drinkers whether they drink beer, wine or spirits.

Why the good news matters

In addition to the fact that heart disease is the number-one killer of Americans, it's important for public-policy reasons that the truth be told about the effects of moderate drinking.

The U.S. government has spent billions of dollars in an attempt to reduce the problems associated with problem drinkers. But Morris Chafetz, an outspoken critic of the federal government's alcohol policy, sums up America's alcohol problems this way: "Alcohol abuse is a major public-health problem. Alcohol use is not."

Chafetz was the founding director of the National Institute on Alcohol Abuse and Alcoholism in the U.S. Department of Health and Human Services. He's also founder and president of the Health Education Foundation, the group responsible for creating the TIPS program, which trains bartenders and waitstaff to serve alcohol responsibly.

Aside from its effect on government policy, it is of special concern to the foodservice industry that even-handed messages (including health news) about alcohol be disseminated. Since so many of today's younger generation have been raised on negative information about alcohol, they may be reluctant to enter into careers that place them in the role of alcoholic-beverage server or salesperson, says Chafetz.

Alcohol ambivalence

Americans have always shown a tortured ambivalence toward alcohol. The temperance movement of the '20s, after all, produced both Prohibition and speakeasies — historical ends of a continuum that could hardly be more different. The U.S. beverage-alcohol industry — manufacturers, distributors and retailers — has been on the defensive for so long with regard to social issues that it can hardly be blamed for soft-pedaling the good news about moderate drinking.

Despite having reams of evidence showing the favorable health links, even doctors often deem it imprudent to recommend increased partaking of alcohol for anyone, although a few doctors have quietly told patients who are at a risk of heart disease that a drink a day might provide some protection. Generally speaking, doctors find it hard to reduce the complex research on alcohol and the heart into meaningful medical directives.

"We don't have enough information to start using words like 'causation' between moderate alcohol use and reduction of heart disease," said researcher Robert Lipton at a University of Toronto symposium on the health benefits of alcohol held in October of last year. "It's part of a constellation of behavior," he said, implying that it's hard to break out the effects of moderate alcohol use from other moderate, healthful behaviors.

Outside forces, too, have conspired to keep the news in check. Washington DC interest groups such as the Center for Science in the Public Interest (CSPI) and quasi-governmental groups such as the National Council on Alcoholism (NCA) are cool to any mentions linking alcohol use with health. "Although some of the studies are pretty good science, the conclusions are sometimes exaggerated," says George Hacker, director of the Alcohol Policies Project at CSPI. "Individuals are better off getting advice about alcohol from their physicians."

A toast to change

But perhaps waiting for the medical community and the press to explain the scientific news is unnecessary. It's when the moderate enjoyment of beverage alcohol is placed within its culinary, cultural and even family context that many people wake up to the fact that there is more than a medical model for food, drink and health.

The Wine Institute, for example, has had enormous success in explaining to a broad audience the contextual role wine plays in the Mediterranean diet. The result has been both good publicity and increased health knowledge for Americans.

There are other hopeful signs in changing attitudes toward moderate drinking. For instance, the Wine Institute's Elisabeth Holmgren touts a "drastic" change to the USDA's Dietary Guidelines released in December 1995, with the government finally dropping its language "alcohol consumption is not recommended."

"Americans deserve to know the truth about the scientific facts regarding the health implications of abstention, moderate drinking and heavy drinking, so that they can make informed decisions about these dietary choices," says Holmgren.

Clearly, it's inappropriate for operators to trumpet beverage alcohol as a health food in the restaurant and at the bar. It's illegal to make such health claims, and it's unnecessary as well. But the time may be right for the foodservice industry to play a more prominent role. U.S. citizens seem to be pulling away from centralized control and toward a take-control attitude in regard to their own lives and health.

Chafetz, who has dedicated years of his life to the study and shaping of alcohol issues, thinks the industry can do more to remind people that beverage alcohol has a historical and cultural role to play in the context of family, culinary traditions, friendship and health. "We're apathetic," he says, in describing the inability of those in the know to spread the word.

Although Chafetz acknowledges the difficulties — and even the legal liability — that restaurateurs face, he thinks more can be done in terms of sharing articles and books with employees and customers, supporting forums on health issues, and promoting healthful news about alcohol in the consumer press. Chafetz raises the issue to one of prime historical importance. "Restaurant and bar owners serve an important social purpose," he says. "A place where people have been properly trained to serve food and beverages safely provides an outlet for socialization that this country desperately needs."

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