PICKLED OR PRESERVED: SHOULD YOU HAVE A COUPLE OF DRINKS A DAY?

Should you be drinking alcohol every day? The question arises because research now conclusively shows that drinking moderate amounts of alcohol confers health benefits well into old age.

Evidence in support of alcohol’s beneficial effects is compelling: in middle and old age a small amount of alcohol reduces the risk of premature death. On the basis of this information alone, it seems logical that people older than about 40 should be advised to drink moderately. But the issue is not so simple.

Some doctors are concerned that if they encourage abstainers to drink and light drinkers to consume more, they will raise the general level of alcohol consumption in society and risk an individual cure becoming a community disease. The reasoning is that as more people drink, albeit moderately, hazardous drinkers will have more opportunity to drink and do themselves and others harm.

An Oxford study of 12 000 middle-aged and elderly British doctors over 13 years found mortality was lowest in those who averaged about two or three drinks a day. It is known that moderate drinking protects people from coronary heart disease. It achieves this in three ways. First, it increases levels of high-density lipoprotein (HDL) cholesterol (the ‘good’ cholesterol) in the blood, which inhibits the formation of plaque inside the artery walls. Second, it inhibits the formation of blood clots by making the little platelets of blood less sticky. Third, there is evidence that it stimulates the breakdown of clots.

Recent studies have also shown that modest alcohol consumption protects against the development of gallstones and can reduce blood pressure. However, high levels of drinking can increase blood pressure.

A man who has one or two drinks a day is at 30 to 50 per cent less risk of developing coronary heart disease than if he abstains totally.

So what advice do most doctors give? If their male patients are alcohol-dependent or have chronic physical, neurological or psychiatric disease related to alcohol, they advise them to abstain completely. Any beneficial effects of drinking would be more than negated by the damage they would continue to do to themselves. This group of men would also be unlikely to be able to keep their drinking to moderate levels.

If the men were not dependent but were in the habit of drinking to hazardous levels, and might or might not be beginning to experience some alcohol-related harm, they would be advised to reduce their intake to the safe levels recommended by Australia’s National Health and Medical Research Council. (The recommendation is that men drink no more than four drinks a day and women no more than two, and that both have at least two alcohol-free days a week.)

The issue is more complex when it comes to giving general advice. There is the question of age: as the incidence of coronary heart disease rises progressively over the age of 40, it would not be advisable to recommend that an 18-year-old start drinking.

But what about men in their 40s who presently don’t drink. Should they be advised to drink in moderation? Some doctors say yes. They give their patients all the facts, tell them that the peak protective effect is two drinks a day on average (for men) and then encourage them to consume that amount.

The problem is that these men may be inclined to drink more than that themselves and also encourage those already drinking four a day to increase their intake to six and start clocking up harm.

There are other ways of reducing the risk of coronary heart disease, such as exercising, stopping smoking, improving diet and taking aspirin.

On the surface, advising 40-something men to have a couple of drinks a day for the health benefit it confers seems simple and attractive. But it has attendant risks. Such men are twice as likely as women to suffer morbidity and mortality associated with alcohol consumption, so why exhort this high-risk group to drink? It’s difficult to lift moderate alcohol consumption without increasing immoderate consumption at the same time.

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