Bottoms Up: The Science of Alcohol
A recent Academy conference addressed the ages-old question: Is drinking good for you? The answer is more complicated than you might think.
Published June 1, 2001
By Fred Moreno and Jill Stolarik
Academy Contributors

Evidence of winemaking and wine drinking has been found in the Tigris-Euphrates River Valley, dating back to 5400 BC. And throughout antiquity, wine has served multiple purposes in multiple cultures—in religious ceremonies, celebrations, social gatherings, and in promoting health and treating illness. The supposed therapeutic effects of wine are even mentioned in Greek and Persian mythology and in both the Old and New Testaments.
The potential benefits and risks of drinking are still under debate today. To address those issues and consider the latest research on the topic, scientists from around the world gathered at a conference in Palo Alto, California sponsored by The New York Academy of Sciences (the Academy).
“The harm that results from heavy drinking and the benefit that comes from light drinking have been known for as long as wine has been around,” said Arthur Klatsky, cardiology consultant to the Kaiser Pemanente Medical Center. But it wasn’t until the rise of epidemiology and modern medicine in the 19th century that public health investigations started to accumulate systematic data on the relation between drinking and mortality.
“Alcohol is a double-edged sword,” said Klatsky. “The health benefits of light drinking cannot, in any way, be construed as a license to drink as much as one wants, nor can the dangers of heavy drinking be used to justify complete abstinence.”
Epidemiological Evidence
Klatsky described the J-shaped curve developed by Raymond Pearl of Johns Hopkins in 1926 showing that heavy drinkers died young, teetotalers were in the middle, and moderate drinkers died later. The curve is a classic in epidemiological studies of alcohol.
Researchers at the conference agreed, however, that current research cannot definitively establish a causal relationship, partly because of all the confounding factors that could account for whatever protective or pernicious effects evident when correlating the degree of alcohol use with the incidence of heart or other types of disease or mortality.
“The J-shaped curve may not equally fit everyone,” said Morton Gronbaek, a Danish epidemiologist and medical doctor.
Speakers described studies on the following confounding factors:
Age
Some research has indicated that moderate drinking may benefit older adults. For example, one study showed that those who were over 60 years of age were at higher risk for cardiovascular disease and were able to lower their risk from moderate drinking. Others who were under 40 were not yet at risk for cardiovascular disease and so gained no benefit from moderate drinking.
Gender
The sex of the drinker makes a difference, too. Whereas men who have two drinks a day tend to live longer and have healthier hearts than men who drink less or more, for women the magic number is one drink a day. There is, however, a slight increase in the risk of breast cancer among women who engage in light drinking, although taking extra folate may provide some protection.
Genetics
About 40 per cent of Caucasians carry a genetic variation, polymorphism (A DH3), that causes them to oxidize alcohol slowly and thus retain it longer in the body. With moderate drinking, such “slow oxidizers” have increased “good” cholesterol (HDLs) and consequently a lower risk of coronary heart disease. People with fast-oxidizing genotypes benefit less from alcohol.
Exercise
Some researchers find that exercise has been found to interact positively with alcohol, in both men and women, in increasing HDLs, with little impact if any of lowering “bad” cholesterol (LDLs). Others report that in women, physical activity may counteract the positive effects of moderate alcohol consumption.
Diet
What people eat is perhaps one of the most important confounders in studies of alcohol and health. The so-called “French Paradox” reflects a low incidence of heart disease despite the presence of such risk factors as low income, low levels of physical activity, high cholesterol diet and high levels of smoking. Could the heart-healthy foods of the Mediterranean diet, plus consumption of mild to moderate levels of wine, provide the explanation?
Some research shows that without wine, the level of LDL goes up dramatically after eating, due to the sudden influx of fats or lipids that become oxidized into hydroperoxides. With wine, lipid oxidation is halted or decreased because the antioxidant polyphenols of the wine are present to act upon the lipids from the meal before the pernicious chain reaction starts.
“In order to reap the heartprotective benefits of light drinking, one must have those drinks during the meal,” said Fulvio Ursini of the Department of Biochemistry at the University of Padova, Italy.
Drinking Patterns
Much current research is focused in this area, with initial findings indicating that light drinking spread out over time is protective against coronary heart diseases, but that drinking the same amount all at once yields no positive effect.
“The positive benefits of alcohol are transient and you cannot ‘stock up’ on them by drinking a lot in one sitting,” said R. Curtis Ellison of the Department of Medicine at the Boston University School of Medicine. “To reap a continuing positive effect, you must drink small amounts every day, continually replenishing the supply at a low constant level.”
Alcohol Types
Researchers are beginning to study the relationship between different types of alcoholic beverages and health, since wine, beer, and hard liquor each differ not only in the amount of alcohol but also in the remaining nonalcoholic components. Some scientists believe that the alcohol itself carries the beneficial effect, whereas others insist that the other components (of wine, in particular) carry at least as much, if not more. When confounding variables are not controlled, wine comes out looking healthier than beer or hard liquor, but when the confounding variables are controlled, the beneficial effects appear to be similar.
“When socioeconomic status is controlled, the three classes of alcoholic beverages show little difference in their health benefit, indicating that the benefit may be due to healthier eating and lifestyle, rather than to drinking,” added Gronbaek.
According to Mier Stampfer of the Harvard School of Public Health, most epidemiological studies show that moderate drinking halves the risk of coronary heart disease, and nearly all studies show a lower incidence of heart attack regardless of the type of alcoholic beverage.
“It’s not the beverage but ‘moderation’ that is the key word,” he said.
What is Moderate?
The United States Department of Health and Human Services classifies “moderate” as not more than one drink per day for women and no more than two drinks per day for men.
“Certain people should never be advised to drink, regardless of the health benefits,” said Stampfer. “These include children, teenagers, and anyone with a past alcohol or other substance abuse problem or a family history of alcoholism.”
Similarly, he added, patients with certain medical conditions, or those under medication, should not be encouraged to drink. But what about the vast majority of non-teetotaling adults who are neither ill nor at risk for alcoholism?
“Consult your physician,” said Stampfer. “He or she will know what’s best for you.”
The conference was organized by Dipak K. Das, University of Connecticut Health Center, Farmington; and Fulvio Ursini, University of Padova, Italy.
Also read: Harmonious: A Quick Course in Wine Chemistry