Teaching moderation

By Raymond Scalettar

An interesting government-funded study recently published in the Archives of Internal Medicine reported that men with healthy lifestyles who consumed light to moderate amounts of liquor, beer or wine had a 40 to 60 percent reduced risk of heart attack compared with men who had similarly healthy lifestyles but did not drink at all.

Dozens of previous studies have shown that moderate alcohol consumption is associated with a reduced risk of heart disease and heart attack. However, many have wondered whether the reduced risk was actually from some positive lifestyle factors such as maintaining a healthy diet and getting proper exercise as moderate drinkers also have generally healthy lifestyles.

This is the first major study to try to answer this important question. According to the findings, men who reported healthy lifestyles and who also consumed one half to two drinks per day had the lowest risk for heart attack. As the study's lead author Dr. Kenneth Mukamal stated, "This latest research speaks to how robust the link is between moderate drinking and heart attack risk."

This raises some interesting questions for the medical community. Indeed, patients have already contacted me because of the wide publicity of this article in the news media to inquire what this study means for them. Can patients include drinking alcohol as part of a healthy diet and lifestyle? How much and how often can they drink? Should they start drinking or drink more?

Having spent more than 40 years in the practice of medicine, I believe doctors should use questions about alcohol studies as an opportunity for a more general discussion. In fact, studies show that patients who frankly discuss their drinking with a physician (or other health professional) are able to make the most informed decisions about whether to include alcohol as a diet and lifestyle choice or abstain. Together, physicians and patients can weigh the potential benefits and risks of drinking alcohol based on each individual's family and medical history and drinking behavior.

It is imperative that patients understand that any potential benefit from moderate consumption can be negated by the many harmful effects of excessive consumption and that even moderate drinking is risky for some individuals.

The U.S. Dietary Guidelines for Americans define moderation as the consumption of up to one drink per day for women and up to two drinks per day for men. The Guidelines define a drink as 1.5 ounces of 80-proof distilled spirits, 5 ounces of wine or 12 ounces of regular beer.

Furthermore, drinking alcohol does not mean an individual can stop doing all the important things they already do or should do to reduce their risk of heart attack, such as exercise and healthy eating.

Finally, once a doctor answers all of his patient's questions about alcohol, it is an opportunity to discuss other diet and lifestyle factors associated with heart disease, the leading cause of death in the United States.

So my best medical advice to those adults who have questions about drinking or not drinking: Talk to your own personal physician about your individual benefits and risks. And as the science continues to point to potential benefits of moderate alcohol consumption, it is critically important that adults who drink do so moderately and responsibly or otherwise abstain.

Raymond Scalettar, M.D., is the former chair of the American Medical Association. He is a clinical professor of medicine at George Washington University and an adviser to the Distilled Spirits Council.