Moderate alcohol consumption: The gentle face of Janus

Objectives: The regular consumption of alcohol in moderate amounts (defined in North America as up to 2 drinks per day for men and 1 drink per day for females) has been recognized in the last decade as a negative risk factor for atherosclerosis and its clinical sequelae: coronary heart disease (CHD) , ischemic stroke, and peripheral vascular disease. Mortality and morbidity attributable to CHD are 40-60% lower in moderate drinkers than among absta iners. Among the mechanisms accounting for these reductions, increased circ ulating concentrations of HDL-cholesterol and inhibition of blood coagulati on appear to be paramount. Additional benefits are, in certain beverages, c onferred by the presence of constituents other than alcohol (e.g., flavonoi ds and hydroxystilbenes), which prevent oxidative damage, free radical form ation, and elements of the inflammatory response. Conclusions: A number of other diseases appear to be beneficially modulated by moderate alcohol consumption based on epidemiologic surveys and, in som e instances, experimental evidence. These include duodenal ulcer. gallstone s, enteric infections, rheumatoid arthritis, osteoporosis, and diabetes mel litus (type II). Compared with abstainers, moderate drinkers exhibit improv ed mental status characterized by decreased stress and depression, lower ab senteeism from work, and decreased incidence of dementia (including Alzheim er's disease). Although limits of safe drinking have been conservatively de fined, it is regrettable that political considerations are hampering the cl inical application of this knowledge and its dissemination to the lay publi c. Copyright (C) 1999 The Canadian Society of Clinical Chemists.