The dose makes the poison or the remedy

A group of American scientists recently published a critical review of the studies relating the consumption of alcoholic beverages to cardiovascular health and thereby explaining the importance of dose on the resulting effects.

The researchers emphasized in the introduction that consuming alcoholic beverages is a double-edged sword and that probably no other health or lifestyle factor exists that can have such profound effects in either direction – either toxic or beneficial – depending on how it is used. On the one hand, the harmful abuse of alcohol is the world’s leading risk factor for death among males between ages 15 and 59 years, mainly due to injuries, violence, and cardiovascular (CV) diseases. Excessive drinking is linked to cirrhosis, seizures, stroke, poisonings, accidents, violence, and cancers of the colon and rectum, breast, esophagus, and liver. Accordingly, the yearly health care and economic costs associated with excessive alcohol intake are staggering.

On the other hand, however, the evidence is strong that there are benefits associated with light to moderate drinking (up to 1 drink per day for women and 1 to 2 drinks per day for men), such as a substantial reduction in cardiovascular disease which is the leading cause of death in the western world. Moderate regular intake of alcoholic beverages also appears to be linked to a lower risk of diabetes mellitus (DM), stroke, heart failure (HF), and total mortality.

The authors concluded that a drinking pattern with a daily low-to moderate-dose of alcoholic beverages, ideally red wine before or during the meal is associated with the strongest reduction in cardiovascular risk. They point out that health care professionals should not recommend non-drinkers to start drinking because no randomized study data (i.e. following up a study group that consumes wine moderately and a control group receiving placebo wine for a period of time) exist and habitual alcohol intake appears to be a “slippery slope” with the potential for drinking problems even among individuals at apparently low risk.

According to the scientists, the “ideal drinking pattern, dose and beverage” are the following:

1. Up to 1 drink per day for women and up to 2 drinks per day for men seems the ideal dosage.
2. Among the various alcoholic beverages, (red) wine, because of its unique non-alcoholic components (the polyphenols), is generally associated with the best health outcomes, especially for cardiovascular disease.
3. A binge drinking pattern (excessive alcohol intake > 5 drinks within a few hours) is associated with 2-fold higher risk of death. Even occasional binges can weaken the protection offered by otherwise light to moderate consumption.
4. Cultures with a traditional Mediterranean diet, where alcoholic beverages are consumed before or during the daily meals seem to have most benefits from regular light to moderate drinking. With such a drinking pattern, glucose peaks after the meal and subsequent inflammation seem to be prevented by a moderate dose of alcohol or may possibly be related to an enhanced social bonding with an emphasis on moderation generally supported by this tradition.
5. The health benefits of drinking appear to be best attained when done daily and in moderation. This is likely due to the fact that many of the benefits of light to moderate drinking are transient, generally disappearing within 24 hours.

O’Keefe JH, Bhatti SK, Bajwa A, Dinicolantonio JJ, Lavie CJ. Alcohol and Cardiovascular Health: The Dose Makes the Poison…or the Remedy. Mayo Clin Proc. 2014;89(3):382-393.