Question

What is the individual's risk of developing alcoholic medical disease if they drink a little each day. Do you recommend 1-2 glasses of wine a day?

Answer

Only 10-30% of heavy persistent alcohol drinkers develop cirrhosis, and in one series, the average alcohol consumption was equivalent to over 2 bottles of wine, 4.5 litres of average strength lager or two thirds of a bottle of spirits per day for 8 years. It is probable that there is no risk of significant alcoholic related liver disease if the consumption per day is 1/4 of that, i.e. less than 1/2 bottle of wine. Secondly there is an important genetic susceptibility to alcoholism and alcoholic liver disease.

Good evidence exists in well referenced journals that a little alcohol is good for you from a cardiovascular point of view - only moderate drinking, because heavy drinking is associated with higher levels of blood pressure and possibly stroke. However moderate drinkers (defined as having up to 3 glasses of wine per day) have been consistently shown to have a lower mortality from ischaemic heart disease than non-drinkers. The evidence for this observation now comes from many studies in many different parts of the world in both women and men. It does not seem that it is the non-drinkers who are increasing their risk by doing something else apart from not drinking. There seems to be a positive relation between alcohol and benefit in cerebrovascular disease.

There is a suggestion that red wine is particularly beneficial, because of the lower heart disease in France and Switzerland and Southern Europe, where they drink a lot of red wine. However it seems most likely that it is the alcohol per se and that people should consume what they find enjoyable without any worry that one man's beer is better than another man's wine.

How does the alcohol work in this way? That is not clear, but it may be an action on high density lipoproteins - which are raised (a good finding) or an associated lower level of plasma fibrinogen. It may also be entirely psychological, in that moderate drinking is a successful way of dealing with stress.

Links

• Moderate alcohol intake
• Wine or beer?
• Alcohol abuse