The Man Who Ate Everything - Jeffrey Steingarten [83]
But geographic comparisons like these can only suggest a connection, not prove one. The first clinical evidence came early in this century from pathologists who noticed that the arteries of deceased alcoholics were remarkably clean. More recent angiogram examinations of live alcoholics are in close agreement. Alcoholics should take no consolation, of course, because any of the CDC’s thirty-six other afflictions, including noncoronary diseases of the heart, is likely to get them early in life.
The most powerful demonstration of alcohol’s protective effects comes from what are called prospective studies. Researchers enroll a large group of people; take extensive information about their medical history, smoking habits, diet, alcohol intake, exercise, and every blood component you can think of; and watch them closely for ten or fifteen years.
The first prospective study of alcohol consumption and its effect on heart disease was conducted in Baltimore in the 1920s; the past two decades have seen a blizzard of them. And nearly every study has found that moderate drinkers suffer far fewer heart attacks—between 21 and 60 percent fewer—than people who do not drink at all. In most, moderate drinkers live longer than either nondrinkers or heavy drinkers.
The consistency of these studies is remarkable—with similar outcomes in Chicago and Albany, in Yugoslavia and Puerto Rico, in Finland and New Zealand and Framingham, Massachusetts, among Japanese men living in Hawaii and Japanese physicians living in Japan, among West Australians, Trinidadians, and British civil servants, among 276,802 men followed for twelve years by the American Cancer Society, among 87,526 women nurses and 51,529 male health professionals in separate studies at Harvard, and among 123,840 patients at the Kaiser Permanente medical centers in the Bay Area. Only one study, in Alameda County, California, failed to find that moderate alcohol consumption protects the heart.
Summing up the results, Walter Willett, M.D., chairman of the Department of Nutrition at the Harvard School of Public Health, wrote in the New England Journal of Medicine in January 1991: “At present, the only dietary factor consistently associated with the risk of coronary heart disease in epidemiologic studies is alcohol, which apparently exerts [a] powerful protective effect.”
Several prospective studies found that the more you drink, even to the point of perpetual drunkenness, the lower your chances of becoming a coronary fatality. But in most, the benefits of alcohol follow what now has become the famous U-shaped curve. The odds of suffering a heart attack drop as you take one to three drinks a day, then begin to increase and come up to the starting point somewhere around four or five—which means that people who never drink have about the same chance of suffering a heart attack as those who take four or five drinks a day. At the bottom of the U-shaped curve, moderate drinkers have a much lower risk than either group.
The protective effects of moderate drinking—on coronary disease, stroke, and overall mortality—are even more impressive for women than for men. But women are also more sensitive to a given dose of alcohol. The reasons are that, on average, women weigh less; their bodies have a higher proportion of fat (also known as curves), and this can increase blood levels of alcohol because fat contains fewer blood vessels and less blood than other tissues; and, most important, women have smaller amounts of a gastric enzyme that breaks down alcohol before it enters the bloodstream. If a moderate dose of alcohol for men is two