What’s in a Dose?

Most agree on a definition of moderate drinking: an average of one or two drinks a day for men and one drink a day for women who are not pregnant. (One drink is 12 ounces of beer, 4 ounces of wine or 1 ounce of 100-proof liquor.) (2) But some studies suggest that it’s not the amount but the pattern of drinking that confers benefits. Moderate drinkers tend to consume a little every day, rather than having weekend binges. Researchers are still teasing out the ingredients that underlie alcohol’s benefits. And doctors vary on whether moderate alcohol use should be recommended only for those at risk for heart disease or to a wider spectrum.

No Prescription for Alcohol?

Despite studies connecting moderate drinking to improved cardiovascular health, few physicians recommend a half-glass of wine with dinner as a prescription for better health. This silence could be a big mistake, says Curtis Ellison, M.D., of the Boston University School of Medicine.

“The current data are so strong that it is incumbent on each physician to inquire into the drinking habits of their patients, and if there are no contraindications, to make them aware of the research on the benefits of moderate drinking,” he says.

Ellison argues that there is enough evidence to include moderate drinking in the familiar litany of lifestyle recommendations: Don’t smoke, be active, maintain a healthy weight and eat a balanced diet.

But other researchers think it may be premature to elevate alcohol to that status.
“ There is insufficient information to encourage patients who do not drink alcohol to start,” says Ira J. Goldberg, M.D., of Columbia University College of Physicians and Surgeons.

Goldberg says “nothing has changed” since he wrote a New England Journal of Medicine editorial (14) this year cautioning against alcohol as preventive medicine.

Few physicians would recommend a drug like alcohol that reduces the risk of heart attack by 25 percent to 50 percent, “but that would result in thousands of additional deaths per year due to cancer, motor vehicle accidents and liver disease,” he wrote.

Ellison disagrees, saying it is unlikely that a recommendation for moderate drinking would lead to an increase in alcohol abuse and health problems.

In fact, he says, a frank discussion of alcohol’s risks and benefits might help some heavy drinkers “learn a healthier pattern of drinking.”

“We’re what’s known as a temperance community,” Ellison says. “We consider alcohol as ‘let’s get drunk’ or ‘abstain’ and nothing in between.”

“The danger is in not including alcohol in a healthy lifestyle,” he asserts.

The two agree that alcohol’s potential benefits need to be confirmed by a randomized clinical trial.

Goldberg says that “such data are especially important if the therapy has potentially adverse effects.” He notes that a randomized trial could help pinpoint whether drinkers get health benefits from alcohol or whether they just lead healthier lives.

But Ellison says researchers, including himself, have had problems getting funding for such a trial.

“The NIH up to now has been worried about doing anything that might make alcohol come up looking good,” he says.

The health community’s attitude may be changing. Ellison says a draft statement recently circulated among researchers by the National Institute on Alcoholism and Alcohol Abuse makes some favorable recommendations about moderate drinking.

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