Alcohol has certainly been the subject of considerable disagreement over the years, and recent findings and discussions related to alcohol and heart disease continue to fuel the fire.

For centuries, alcohol consumption has been both revered as a culinary, cultural, and even religious tradition as well as reviled as a pestilence that has wreaked death, disability, and despair upon humanity. So, as heart disease sufferers, what are we to do with this divergence of opinion? I believe the answer can be found in separating fact from fiction and applying a little good, old-fashioned common sense.

Can alcohol be “good” for you?

The negative effects of alcohol are well-documented and appreciated. Cirrhosis of the liver, alcohol poisoning, and numerous other alcohol-related physical maladies combined with the tragic results of cognitive impairment brought on by drinking alcoholic beverages paints a grim picture. But, is it possible that, despite it all, alcohol can actually be “good” for you?

The so-called “French Paradox” is widely credited for advancing the notion that alcohol may have beneficial heart-health effects. Studies by French medical researcher Serge Renaud noted that the heart attack rate of residents of Toulouse, France, was a scant 20 percent of the rate experienced by residents of Belfast, Ireland, and Glasgow, Scotland, despite having populations with similar cholesterol levels and saturated fat intake. The study postulated that the difference was the increased consumption of alcoholic wine and dubbed the effect the “French Paradox.”

Later, the Renaud-led Lyon Diet Heart Study reported an astounding 70 percent reduction in heart attacks in persons with heart disease following the Mediterranean diet, a diet containing significant amounts of fruits, vegetables, olive oil, and red wine. That same year (1995), the Copenhagen City Heart Study, which followed 11,000 people for 10 years, reported that those who drank three to five glasses of wine per day had half the mortality rate of non-drinkers, while liquor drinkers had an increased mortality rate.

The problem with the early studies that triggered the French Paradox sensation and the notion of alcohol being good for you is that they focused primarily on red wine and included several other significant dietary factors. Was it the alcohol or something else in the wine—or perhaps the other foods consumed along with the wine—that caused the benefit? Fortunately, since that time numerous other studies have established several certainties about consuming “standard servings” of alcoholic beverages (four ounces of wine, twelve ounces of beer, or two ounces of hard liquors.)

Alcohol increases HDL (good) cholesterol. One to two servings per day increases HDL between four and 10 mg/dl. The effect is common to virtually all alcoholic beverages and is beyond dispute, having been verified in dozens of independent studies. Moreover, the increase is largely in what is called large-HDL cholesterol particles thought to be the work-horse in the phenomena known as “reverse cholesterol transport”—the actual of removal of cholesterol from arteries.

Alcohol reduces blood pressure. Studies have attributed a small drop in blood pressure to alcohol consumption in part due to its ability to relax artery constriction.

Alcohol “thins” the blood. Alcohol reduces platelet activity and fibrinogen, two factors responsible for blood clotting.

Alcohol reduces inflammation. Alcohol reduces inflammation factors such as C-reactive protein (CRP).

Of course, this does not mean you can drink unlimited amounts of alcohol. Consuming more than two servings per day can actually have the opposite effects mentioned above in addition to other negative effects such as increasing triglycerides and blood sugar.

Separating fact from fiction

The alcohol-related effects noted above (both good and bad) are well-established. But that is not the end of the story. Many additional health effects have been attributed to alcohol, most notably when consumed as red wine.

First, it is important to note that, in addition to alcohol, red wine contains numerous other compounds that exhibit healthful effects, including flavonoids and polyphenols. When studying the effects of wine consumption, the question will always remain as to whether the benefit is due to the alcohol or to the other ingredients. Other lifestyle factors also confound and muddle the evidence. Do wine drinkers have fewer heart attacks because of the wine or because they are more likely to exercise, weigh less, or consume certain foods in addition to the wine?

Several interesting studies examined whether alcohol drinkers had fewer arterial plaques than non-drinkers but found no such differences. Of course, it is not necessarily just a reduction in plaque that could account for fewer heart attacks. Heart attack is primarily the result of the rupture of an unstable plaque. Perhaps alcohol or some other compound mixed with the alcohol stabilizes plaque.

The best evidence for the ”other compounds” theory comes from the fact that red wine contains nutrients shown to have powerful heart-health effects.

Flavonoids and polyphenols. This group of compounds demonstrates significant anti-inflammatory, antioxidant effects, and anti-hypertensive effects.

Catechins. These compounds have recently shown promise in reducing arterial plaques in animal models.

Resveratrol. This compound has been much ballyhooed in recent studies as increasing longevity as well as having numerous other healthful effects. However, it is my opinion it has been over-hyped due to the fact that it is difficult to achieve therapeutic levels without consuming massive quantities of resveratrol supplements. Perhaps the most interesting observation is that resveratrol is a potent inhibitor of the matrix metalloproteinase (MMP) enzyme. The enzyme is believed to be responsible for making arterial plaque unstable and prone to the ruptures, which are the primary causes of heart attacks. I have personally undergone two courses of treatment with a prescription agent specifically to reduce my MMP.

I recently became a red wine convert. The Tannat and Malbec varieties are among my favorites and have some of the highest concentrations of polyphenols and resveratrol. The simple answer seems to be that you can indeed enjoy the benefits of red grape consumption but the specific benefit of increasing HDL level and size seems to be a function of the alcohol. Further speculation asks whether the fermentation and barrel storage process may also contribute to the effects observed.

And now a dose of common sense

It is my opinion that the question of whether to include alcohol in your heart-disease-fighting regimen boils down to a simple piece of wisdom: moderation in all things.

Alcohol has undeniable heart-health benefits that cross a broader range when red wine is selected as the means of alcohol consumption. However, alcohol is also undeniably a two-headed beast with a decidedly unhealthful side if one is not careful. Two standard servings of alcohol per day seems to be a healthful guideline.

As always, I recommend you consult your doctor before engaging in any activity designed to provoke a change in your health. I consulted my good friend and cardiologist Dr. William R. Davis on the subject and he offered up this quote from noted alcohol researcher and wine enthusiast, Dr. Jean-Paul Brouet, of Hospital Cardiologique Haut Leveque in Pessac, France.

“The [benefits] of a good red wine are strongly linked to the pleasure of educating the nose and palate, the wine selection, the knowledge of its vineyard, and the degustation in a warm and enjoyable company. Respect for the good and honestly made wines is the best protection against adverse effects of common drinks and spirits: dilated cardiomyopathy, atrial fibrillation, hypertension, liver cirrhosis, traffic accidents, dementia, and polyneuritis are problems of naughty drinkers. The daily consumption of half a bottle of red wine with food does not seem to have any harmful effects other than adding 250 kcal to your diet!”

Here’s to your health—in moderation, of course!