One after another the guests arrived, climbing the steep steps up to the ancient stone house. And dish by dish, the long kitchen table filled with homemade local specialties. Friends of ours —one Greek, one Dutch—had restored a centuries-old house in the village of Agios San Marcos, on a steep hillside on the island of Corfu. Tonight they were throwing the Greek equivalent of a potluck to celebrate the arrival of their American guests.

 

And what a feast! Grilled squid with lemon. A peppery fish stew called bourdeto. A salad of fresh arugula and another, called horiatiki, made with tomatoes, cucumbers, onions, and feta. For dessert: a walnut cake and a mélange of pineapple, kiwi, yoghurt and honey. Quintessential Mediterranean fare, a bounty of the foods we now associate with good health and long life—fish, leafy greens, tomatoes, garlic, olive oil, yogurt, walnuts and…

 

“Vino!” a voice called from the courtyard. Shouts and laughter followed. Nikos, a neighbor who lived down the hill, had enlisted one of the donkeys that are used to hoist heavy building materials up the steep paths to carry two five-gallon jugs filled at a nearby winery.

 

Of course. From the time the ancient Greeks sailed the “wine-dark seas” celebrated in the Odyssey and even before, alcoholic beverages have held a cherished place not only in Greece but in many Mediterranean cultures. Where there is no wine, a Greek proverb has it, there is no love. And there might not be such robust good health, either. Olive oil may have been the first darling of Mediterranean diet, but lately more and more research has focused on wine’s contribution to a healthy heart and long life.

 

It’s hardly news that drinking in moderation protects against heart disease—more than a hundred studies have come to that conclusion. “But now we’re beginning to see that alcohol may protect against type 2 diabetes as well, a disease that is becoming a huge health problem among Americans,” says epidemiologist Eric Rimm, PhD, a leading authority on alcohol and health at the Harvard School of Public Health. People who drink moderately also appear to gain protection against age-related memory loss and even some forms of cancer, new findings suggest. And though wine has been the focus of most research, the latest evidence suggests that alcoholic beverages of all kinds, in moderation, offer similar health benefits.

 

Drinking has a dark side, of course. Consuming too much increases the risk of high blood pressure, heart disease, liver disease, and cancer. Alcoholism ruins lives and destroys families. According to the latest statistics, more than 17,000 traffic deaths a year are alcohol-related. That’s roughly 40 percent of all traffic fatalities. Especially worrisome is the fact that after declining from 1993 to 1997, episodes of alcohol-impaired driving are becoming more frequent, according to a report published in 2005 in the American Journal of Preventive Medicine. “We have to be very cautious when we talk about alcohol to acknowledge that it’s a double-edged sword,” says physician JoAnn Manson, MD, MPH, chief of preventive medicine at Brigham & Women’s Hospital in Boston. “For people who abuse alcohol, the risks far outweigh any benefits.”

 

Still, for people who imbibe sensibly, the benefits are impressive. Some experts in the field say that given the evidence, doctors have a duty to talk to patients, particularly those at risk of heart disease, about the effects, both good and bad, of alcohol.

 

From ancient Egypt to modern epidemiology

 

“From ancient Greek writings to the Bible, the historical record is filled with references to the health benefits of wine and beer,” says Joseph A. Hill, MD, PhD, a cardiologist at the University of Texas Southwestern Medical Center. Farming may well have begun in order to ensure a reliable supply of ingredients needed to make alcoholic beverages. In ancient Egypt, mothers were enjoined to send their children to school with bread and beer for lunch. The Pilgrims decided to go ashore at Plymouth Rock not because they thought it was prime real estate but rather because they’d run out of beer on board, according to Hill. That’s less astonishing than it seems at first. For most of human history, as it happens, wine and other alcoholic beverages were the only safe things to drink; plain water was usually contaminated with harmful microbes.

 

Alcohol has also long been believed to possess medicinal qualities. Hippocrates himself recommended wine for a variety of ailments. Modern physicians first began to suspect that alcohol might protect against heart disease almost a century ago, when autopsies revealed that the arteries of heavy drinkers were remarkably free of cholesterol build-up. In the 1970s, researchers began to look at large populations of people to compare drinkers and nondrinkers and their risk of heart disease. Arthur Klatsky, MD, a cardiologist at Kaiser Permanente Medical Center in Oakland, California, published the first epidemiological evidence that consuming alcohol was associated with a lower risk of coronary disease in 1974. Updating those findings, which now include data from 128,934 people who have been followed for more than 20 years, he and his colleagues calculated that people who imbibe one to two drinks a day enjoy a 32 percent lower risk of dying from coronary heart diseases than people who abstained from alcohol.

 

“The benefits show up in men and women, in people with diabetes and without, in all ethnic groups, across the board,” says Klatsky. More than 100 studies, in fact, conducted in countries around the world, have confirmed that people who consume moderate amounts of alcohol are about one-third less likely to get heart disease or die of a heart attack than teetotalers.

 

Hearts and minds

 

The benefits of alcohol go beyond heart disease protection. One of the biggest surprises in recent years has been evidence that moderate drinking protects against diabetes. “By now something like a dozen studies have shown that people who drink moderately have less risk of diabetes and fewer complications if they do have the disease,” says Rimm. Insulin resistance, which often occurs when people become overweight, is the hallmark of type 2 diabetes. Several small clinical trials have shown that moderate alcohol consumption improves insulin sensitivity. One reason moderate drinking is linked to lower danger of heart disease, in fact, may be that it helps prevent diabetes, which is known to increase cardiovascular risk.

 

What’s good for the heart also seems to be good for the head. A 2005 study of women between the ages of 65 and 79 conducted at Wake Forest University Baptist Medical Center in North Carolina found that those who consumed one or two drinks a day performed better on a variety of tests of cognitive function and dementia. A 1999 Boston University study similarly found that among both men and women, moderate drinkers performed better than abstainers on a host of mental function tests. Researchers speculate that alcohol may protect the brain in exactly the same way it protects the heart: by keeping blood vessels healthy, thus ensuring that brain cells get all the nutrients they need. By preventing blood clots in the brain, alcohol may also reduce the risk of small cerebral strokes which can impair memory and brain function.

 

And yet…

 

Health experts have remained remarkably reticent to trumpet the news about alcohol’s potential benefits.In the mid 1970s, when data from the landmark Framingham Heart Study suggested that moderate drinking was associated with significantly lower heart disease risk, officials from the National Institutes of Health insisted that the information be withheld from the published study, according to R. Curtis Ellison, MD, professor of medicine at Boston University, one of the leading authorities on alcohol and health. They went further, urging the researchers to report that there was “no significant relationship” between alcohol and the incidence of heart disease—which was simply wrong.

 

Why? Part of the answer lies in history and culture. “We are a temperance nation,” says Ellison. “When it comes to alcohol, we’ve tended to see the choices as either getting drunk or abstaining.” Small wonder, then, that when positive data surfaced, federal officials feared that if scientists said anything good about alcohol, people would rush to the bottle and become alcoholics. Other cultures view alcohol very differently, says Ellison. “Many Mediterranean countries see alcohol, particularly wine, simply as one of the pleasures of life, part of a meal to be enjoyed, like everything else, in moderation.”

 

Ironically, countries that have the most nondrinkers also tend to have the most problem drinkers—with the fewest people falling within the moderate-drinking category. Of course, for some people, drinking can be dangerous, even deadly. While moderate amounts of alcohol protect the heart, too much actually raises the risk of high blood pressure, heart attacks, liver disease and other serious medical problems. In many studies that look at alcohol and health, in fact, the results typically trace what epidemiologists call a J-shaped curve. Non-drinkers turn out to be at increased risk, indicated by the raised left-hand hook of the letter J. Risk drops for moderate drinkers (the falling curve of the bottom of the letter) and then rises again for people who drink to much (the right side of the J).

 

Little fools, great fools

 

The J-shaped curve demonstrates the age-old injunction to observe “moderation in all things.” (Or as a bit of anonymous doggerel puts it: “God in His goodness sent the grapes, to cheer both great and small; little fools will drink too much, and great fools not at all.”)

 

For health officials trying to make recommendations, however, defining too little and too much hasn’t been easy. Some studies show that risk may begin to climb after two drinks. Others see no problems at all until people reach four or five drinks a day. In some cases, the window of safety between too little and too much can be very narrow. One study found that women who drank half a drink a day lowered their risk of developing high blood pressure by 14 percent; those who consumed one and a half drinks raised the danger by 20 percent. The difference between benefit and risk, in other words, was just one drink.

 

Today, most official recommendations agree that one glass a day for women, two for men represents a reasonable guideline. And most experts agree on this, too: people who drink much more than that should be counseled to cut back or quit entirely. More than half of American adults say they drink alcoholic beverages. The vast majority fall into the “light” to “moderate” drinking category, which means no more than one to two drinks daily. (One drink is usually defined as 12 ounces of beer, 5 ounces of wine, or one ounce of 100-proof liquor. All have about the same amount of alcohol.) If researchers are right, moderate drinkers are the healthier for it.

 

Sante!

 

For people who already drink alcohol in moderation, the latest findings offer one more reason to enjoy a glass or two. To get the optimal health benefits from alcohol, research suggests, it’s wise to consume alcohol with a meal, for two reasons. First, food slows the rise of alcohol in the bloodstream, so it’s less likely to impair judgment or reflexes. Moreover, the anti-clotting effect of alcohol is believed to offer the most protection just after a big meal, when fat particles in the blood increase and thus clots are more likely to form.

 

 

And since that effect lasts only a matter of hours, experts say the best advice–if you drink–is to consume small to moderate amounts of alcohol most days of the week. “Drinking one glass of wine a day is not the same as drinking seven during the weekend,” says Ellison.

 

In the end, of course, although people around the world toast to their health when they raise a glass—Sante! (France), Na zdvave! (Bulgaria), Saude! (Portugal), Egeszsegedre! (Hungary)–alcohol is more than just a tonic. Alcoholic beverages are deeply woven into the rich tapestry of many cultures. They’re part of the way people in many places around the world have traditionally celebrated the gathering of friends and the observance of holidays.

 

“To take wine into your mouth,” the American writer Clifton Fadiman once observed, “is to savor a droplet of the river of human history.” So it certainly seemed one night on the island of Corfu, as the last daylight ebbed from the sky and, looking down from the balcony, we watched the Adriatic turn wine-dark and the lights of town begin to blink on as the first stars appeared overhead. The bounteous food, wine made from local grapes, the generous laughter of friends, the sight of the last swallows dipping and playing in the honeysuckle-scented air over that sweeping vista of sea and sky—all of them have been savored here for centuries not for reasons of should and shouldn’t but simply for what they are: the unadorned pleasures of a good life.

Tags: alcohol, cardiovascular diease, health benefit, moderation, wine