A spirited debate over who gets to say what about alcohol

June 16, 1993|By Shari Roan | Shari Roan,Los Angeles Times

A decade after Americans came to grips with the dangers of heavy drinking -- raising the legal drinking age to 21 and stiffening drunk-driving penalties -- a new debate has emerged: What are the risks and benefits of drinking moderately?

In the scientific world, the debate centers on whether moderate consumption is good or bad for your health. But in the real world of conflicting business, social and political interests, the crucial issue is who will get to say what about alcohol.

During the past year, wine industry officials have sought to promote the purported health benefits of wine consumption. But the industry appears on the verge of defeat. The federal Bureau of Alcohol, Tobacco and Firearms is expected to rule this month that health messages touting alcohol consumption will be prohibited.

Meanwhile, two bills now before Congress would, if passed in their current forms, require broader health warnings on alcoholic beverages and in ads.

"I think the public is greatly confused by the mixed message about whether alcohol is good for you or bad for you. And part of the problem is, who is the messenger," says Dr. Ernest P. Noble, director of the alcohol research center at the University of California, Los Angeles, and former director of the National Institute on Alcohol Abuse and Alcoholism.

Interest in the benefits of moderate drinking has soared recently because of several new studies that suggest moderate drinkers have a much lower risk of coronary heart disease.

For example, the Harvard Nurses' Health Study of 121,700 nurses showed that moderate drinking is linked to a 50 percent decrease in death rates from coronary heart disease in post-menopausal women. Other studies show a 25 percent to 35 percent lower risk of coronary disease among moderate drinkers of both sexes.

But the way in which alcohol reduces coronary disease is unclear.

Researchers believe something in ethyl alcohol increases the levels of HDL, the "good" cholesterol, and interferes with the tendency of some blood cells, called platelets, to form clots that can trigger heart attacks, says Dr. Arthur Klatsky, chief of cardiology at Kaiser Permanente Medical Center in Oakland, Calif., and longtime researcher on alcohol consumption.

Another explanation, says Dr. Klatsky, is that many moderate wine drinkers have other healthy behaviors. They tend to smoke less, exercise more and eat nutritiously.

A third explanation also holds promise. In a recent study, University of California, Davis, researcher Edwin Frankel found that a non-alcoholic component of red wine, called flavonoids or phenolic compounds, may inhibit heart disease.

Flavonoids are anti-oxidants found in grapes as well as other fruits and vegetables. The study looked at compounds in a test tube and has yet to be replicated in humans. But Mr. Frankel says: "It's fairly well-accepted that moderate consumption has a beneficial effect."

If that conclusion wasn't enticing enough to raise a glass of Cabernet, research presented in March at the annual Society of Behavioral Medicine meeting suggested that moderate drinkers are much less likely to become depressed than teetotalers, perhaps because they are more "moderate" about all aspects of their lives.

Not so fast, critics say

Yet the industry has not been able to fully take advantage of these findings. Many health officials -- from cardiologists to substance-abuse experts -- deplore the idea that Americans be urged to consume alcohol to reduce heart disease. Indeed, when the Beringer Winery tried last year to introduce plans for a wine bottle tag publicizing the coronary benefits of drinking wine, the plans were quickly shot down by critics.

"It's one thing for someone to say to his doctor, 'Hey, doc, can I have two drinks a day?' But it's another thing entirely to give public health advice to the entire population without regard to gender and race. I think that is totally irresponsible," says Hilary Abramson, a spokeswoman for the Marin (Calif.) Institute for the Prevention of Alcohol and Other Drug Problems.

Health officials also worry that the benefits of moderate drinking might not be presented in balance with the risks.

"When you look at the scientific data, for every beneficial effect, I can think of 20 negative effects," says Dr. Noble. "But that isn't what the public gets. The public gets the message that it protects against heart attacks."

For example, Dr. Noble says, while moderate drinking may lower the risk of coronary heart disease, the most common form of heart disease, it can increase the risk of hypertension, stroke and a type of heart disease that produces irregular heartbeat.

In addition, Dr. Noble says, alcohol is a major cause of malnutrition among adults because it adds calories to the diet without contributing any substantial nutrients.

Another problem is the difficulty of defining "moderate."

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