This question spurs great conversation at cocktail parties, backyard cookouts and even tailgates. Could it possibly be the truth that red wine (or alcohol in general) adds to heart health? If you’re like most of us, you crave a positive answer to this question. Read on; you’ll be pleased with our conclusion.

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Wine as medicine throughout the ages

We doctors have been interested in wine for a long time. In fact, physicians’ interest in wine predates even our love affair with golf. The belief that wine possesses medicinal properties has endured for centuries. In ancient Egypt, wine was used to treat ear infections. A pharmacopeia from the year 2200 BCE lists wine as a medicine. And Hippocrates (450-370 BCE), the “Father of Medicine,” used wine as a key component in many of his remedies, prescribing it as a treatment for fevers, a diuretic, an antiseptic and a general aid for convalescence. Displaying his customary wisdom, Hippocrates advised moderation, writing, “Wine is fit for man in a wonderful way provided that it is taken with good sense.”

The French paradox: Modern doctors agree with Hippocrates

In 1979, an English researcher named St. Leger published an influential scientific paper suggesting a correlation between a lower rate of developing coronary heart disease and wine consumption. He discovered that France, a country renowned for making fine wine and drinking plenty of it, had the lowest coronary heart disease mortality of any developed country. Despite a high-fat diet rich in heavy sauces, crepes, and croissants, French people died from coronary heart disease at a rate less than one-third that of Americans. St. Leger suggested that regular wine consumption was the key factor protecting the French from developing heart disease.

How much should you drink?

Other scientists and doctors soon jumped on the bandwagon, undertaking large-scale observational studies to investigate St. Leger’s findings. For the most part, these new studies bore out his results. People who had one to two drinks per day tended to live longer and have fewer heart problems than those who had more or less. Study after study confirmed the conclusion that moderate alcohol consumption is associated with better heart health and longer life.

Red wine, white wine, beer or spirits?

Red wine tends to get the most attention when it comes to heart health. Noting that red wine contains a variety of antioxidants derived from grape skins, scientists have attributed “special” medicinal properties to red wine. In laboratory experiments, resveratrol and other red wine antioxidants do exhibit potentially beneficial properties. But the real importance of these chemicals is a matter of debate. The truth is that the “magic” ingredient in red wine—and in white wine, beer and spirits—is the alcohol. The best evidence suggests that cardiac benefits associated with wine stem from alcohol.

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How does alcohol help the heart?

The key mechanism for alcohol’s protective effect is its impact on HDL cholesterol. Higher levels of HDL (the good cholesterol) are associated with reduced risk of heart disease. Moderate alcohol consumption increases HDL by about 12 percent. By way of comparison, this extent of increase in “good” cholesterol is similar to the effect of an aerobic exercise program.A second property of alcohol that may reduce risk of heart attacks is its impact on blood clotting. Alcohol reduces blood clotting by reducing the viscosity or thickness of the blood, as well as by reducing the actions of platelets and certain proteins that cause blood to clot. This likely reduces the risk of clot formation in the heart’s arteries, which is the chief cause of heart attacks.

Alcohol and sex

Alcohol has different health effects on women and men. The effects of alcohol, both beneficial and adverse, occur at lower levels of intake in women. Thus, a woman drinking the same amount of alcohol as a man will wind up with a higher blood alcohol concentration, a result of her lower body weight and the fact that she metabolizes alcohol more slowly. While this may not seem fair, it is a medical fact.We have a special note of caution for women. A recent study suggested that alcohol increases a woman’s risk of developing breast cancer, liver cancer and rectal cancer. A woman with a personal history of one of these cancers or with a high risk (e.g. strong family history) should consider avoiding alcohol all together.

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Too much of a good thing

For men, the magic number for cardiovascular health is one to two drinks per day; for women, it is one. And, of course, pregnant women should not drink at all.We cannot ignore the risks of excessive alcohol. Moderate drinking with meals, as practiced in many Mediterranean countries, is the best strategy for optimizing the protective effects of alcohol. People who drink more than this increase their risks of a whole host of serious illnesses, ranging from cancer to liver disease to trauma from automobile accidents.

Our prescription

Available evidence suggests that moderate alcohol consumption can be part of a heart-healthy lifestyle. That said, we don’t recommend that teetotalers begin drinking for heart health. If you drink alcohol, drink in moderation. This means no more than two drinks per day for men and no more than one drink per day for women. A glass of wine (or beer or spirits) a day can be good for your heart.