My understanding is that alcohol is not recommended for those of us with metastases - not sure why. Does anyone have more definitive information? Meanwhile, I am including an article in today's LA Times about the benefits of a daily drink and wondering what is appropriate.
http://www.latimes.com/features/heal...02.story?coll=
la-home-health
From the Los Angeles Times
A DRINK A DAY
Alcohol can be good for the heart -- not just occasionally, but often.
Still, doctors hesitate to recommend ...
By Susan Brink
Times Staff Writer
July 31, 2006
WHEN it comes to drinking alcohol for medicinal purposes, most
Americans get it wrong. Take a sampling of wine samplers at a recent
tasting in Santa Barbara.
"I usually drink wine, but not every day," says Mike White, 45. "Then
one day a week, I go big ╉ maybe half to three-quarters of a bottle."
╉ Wrong.
"I drink on the weekends only," says Soph! ie Ca lvin, 40. ╉ That's not
it either.
"I have a glass of wine when I take a bubble bath," says Mary Whitney,
40. "Every night." ╉ Getting close, but it might be better if she also
brought an entrée into the tub.
"I have a glass of wine with dinner each night. I like the taste,"
says Mark Biddeson, 52. "Or I'll have a beer instead sometimes,
depending on what I'm eating." ╉ Bingo! He's got it!
People drink to drown sorrows, celebrate victories, enhance a meal or
loosen up with friends ╉ not necessarily to protect their hearts.
Small wonder.
The folks who wag warning fingers over the dangers of trans fats, and
hail the benefits of leafy greens, are silent on alcohol. These public
health messengers ╉ who remind us to quit smoking, eat fresh fruits
and vegetables and exercise every day ╉ are not about to tell people
to start drinking.
Their reluctance comes even amid growing evidence that ! moder ate
drinking is beneficial. A study last week in the Archives of Internal
Medicine showed that light to moderate alcohol consumption in people
age 70 to 79 is associated with significantly lower rates of cardiac
events and longer survival. A week earlier, researchers reported in
the July 18 issue of the Journal of the American College of Cardiology
that moderate alcohol consumption may help ward off development of
heart failure.
Those studies join dozens of others showing that a drink a day for a
woman, two for a man, is good for heart health. Studies from at least
20 countries in North America, Europe, Asia and Australia consistently
show that moderate drinkers have rates of heart disease between 20%
and 40% lower than abstainers or heavy drinkers, according to the
National Institute on Alcohol Abuse and Alcoholism.
Other research is showing exactly how alcohol is beneficial ╉ and how
to use it to best effe! ct.
The guardians of public health aren't ignoring these data. They know
that for most people, alcohol can be good for the heart. But they also
know that for others, it can be a health and social disaster.
Most doctors err on the side of caution, believing that the risk to
the few outweighs the benefit to the many. They fear that some people
encouraged to drink moderately will end up going too far.
And crossing the line from moderate to abusive drinking not only
erases the heart health benefits, it introduces dozens of additional
health problems. In the former Soviet Union and parts of Eastern
Europe, for example, binge drinking was found to eliminate the rise in
HDL, the cholesterol that protects the heart, seen in moderate
drinkers, according to a 1998 study in the Journal of the Royal
Society of Medicine. In a 2001 study in the International Journal of
Epidemiology, weekend binge drinking in Lithuania was found ! to be
responsible for spikes in the numbers of deaths from heart disease
over the weekend.
"This is a true public health conundrum," says Dr. Thomas Pearson,
chairman of the department of community and preventive medicine at the
University of Rochester School of Medicine. "If you really want to
shift the alcohol balance toward the benefit, you'll concentrate on
responsible drinking among young people. It's in the 45-plus-year-old
where alcohol may be beneficial."
Predicting who would be helped, who might be hurt, by adding a drink
or two a day to the healthy-living formula is an age-related numbers
game. In the United States, an estimated 100,000 excess deaths a year
are attributed to alcohol, most of them in people younger than 45,
according to the Centers for Disease Control and Prevention.
And an estimated 7% to 10% of Americans are alcoholics or abusive
drinkers. They cannot drink moderately, and should not! drin k at all.
Last year, the CDC ranked alcohol as the third-leading cause of
preventable death in the country. Alcohol-related death and disability
results from organ damage, brain damage and hemorrhagic stroke as well
as injuries from accidents and violence. The estimated annual cost of
alcohol abuse, including lost productivity, is $185 billion.
On the other hand, if current drinkers all suddenly quit, losing the
protective benefits of alcohol, about 80,000 excess deaths would
occur, most of them among people older than 45, according to a 1997
study by Pearson in the journal Circulation. That's when people begin
to hit the heart disease years.
"I'm personally of two minds," says Dr. Kenneth Mukamal of Beth Israel
Deaconess Medical Center in Boston, an author of the paper on alcohol
and heart failure. "I'm a practicing primary-care doc. On the one
hand, the observational evidence is quite strong and consistent that !
p eople who drink moderately and regularly have at least a lower risk
of heart attack than people who don't drink at all."
But telling an adult in the habit of a drink or two after work, when
there's no plan to drive afterward, to continue the harmless habit is
one thing. Telling a 21-year-old to start drinking daily is another.
He simply sees too many drinking disasters to risk a blanket
recommendation.
Pearson adds: "Some of those people end up wrapping their cars around
trees or end up drinking 20 beers a day." Although no one knows if a
hint at a recommendation for daily, moderate drinking would send
increasing numbers of people on the road to alcoholism or alcohol
abuse, doctors and public health experts have erred on the side of
caution. It's possible, some say, that adults who have always been
teetotalers would start drinking and find out they like it a bit too
much. Others might use the recommendation as! an e xcuse to drink every
day, kidding themselves about how much they are actually drinking.
Now, however, the benefits of alcohol are proving increasingly hard to
ignore. A few researchers think that the evidence showing the benefits
of moderate drinking is strong enough to start advocating moderate,
regular drinking for mid-life adults who are responsible drinkers.
Lewis Perdue, author of "The French Paradox and Beyond," a book about
why people from France have lower rates of cardiovascular disease,
looked at NIAAA's numbers on the 20% to 40% reduction in rates of
heart disease among moderate drinkers and did the math. "Proper
knowledge and application of the scientific facts might save more than
200,000 people every year from dying of heart attacks," he wrote.
Dr. Curtis Ellison, director of the Institute on Lifestyle and Health
at Boston University School of Medicine, began examining links between
moderate drin! king and a protective cardiovascular effect in 1991. He
agrees that it's time to talk about the findings more openly.
"Nobody is saying that everyone should drink," Ellison says. "But
don't withhold the evidence. Informed people make better choices.
There is an intelligent way to drink ╉ small amounts every day. People
aren't stupid. They know when they're drinking inappropriately."
For most, the difference lies in when and how they drink. Daily, in
moderation, in middle age seems to be the ticket.
*
An effect on cholesterol
Alcohol, it's thought, might keep clots from forming, arteries from
constricting and platelets from becoming sticky.
The biggest proven benefit of moderate drinking is alcohol's effect on
cholesterol. Any alcoholic beverage slightly lowers LDL, the bad
cholesterol. More important, it significantly raises HDL, the good
cholesterol that protects against cardiovascular disease. I! n an
evaluation of data from the National Heart Lung and Blood Institute
Family Heart Study, Ellison found that moderate drinking raised
protective HDL in middle-aged adults three to four times more than did
exercise.
Some studies suggest that wine is better than other drinks at raising
HDL because of its antioxidant properties. Grape juice also has those
properties and has been shown to raise HDL, though someone would have
to drink a quart of juice to get the same protection as from one
serving of alcohol. But most researchers who have studied alcohol and
heart disease believe the main benefits come from alcohol itself, in
any form. "Red wine is not the only means by which you can get some of
these antioxidants," Pearson says. "I think it's mostly the alcohol."
Moderation and regularity of drinking seem to be key. "The vehicle
doesn't seem to particularly matter," Mukamal says. "What matters is
what beverage peopl! e con sume regularly. In France it's wine; in
Germany, beer; in Japan, sake."
Moderate drinkers may get a boost beyond raising HDL. Their blood is
less likely to form clots than the blood of abstainers or heavy
drinkers, and their bodies are better able to dissolve clots that
appear. Clotting is, in part, a response to chemicals released from
artery walls. In lab studies, exposure to alcohol diminishes the
production of substances that promote clotting, and stimulates
production of other substances that inhibit clotting.
The anti-clotting effect may be what argues most strongly for daily,
sensible imbibing because after a day or so, the effect goes away.
"Much of the protection for coronary heart disease seen in France is
due to the fact that most French adults tend to consume some alcohol
with their evening meal every day," Ellison says. "Their clotting
mechanisms remain in a favorable state all the time. The most rece! nt data show that daily drinking is the healthiest."
The benefit to moderate drinking comes with age. The new study on
heart failure, for example, was aimed at elderly people because risk
of the condition is high at their age. Fluid backs up in the lungs
because the heart isn't able to pump blood efficiently. Ankles swell
and breathing becomes difficult.
Typically, such patients have been told to abstain from alcohol,
largely because scientists knew that excessive drinking leads to the
development of a heart that is oversized, flabby and not able to
function properly ╉ the hallmarks of heart failure. If a lot of
alcohol was very bad, the thinking went, a little would be a little
bit bad.
But when Mukamal put it to the test by analyzing records of 5,595
Medicare recipients, he found that those who drank moderately, no more
than 13 drinks a week, had a lower risk of heart failure.
It's not clear why, bu! t a p otential explanation might be that alcohol
directly lowers the pressure of blood in the lungs and prevents them
from filling with fluid. For people on the verge of heart failure, the
effect might be enough to prevent its onset, Mukamal says. The
evidence isn't strong enough to recommend a daily drink, he says,
though physicians probably should stop automatically recommending
abstention from alcohol for people with heart failure.
It's uncertain whether drinking with food helps the heart, but
combining alcohol and food slows down the former's entry into the
bloodstream, making it less likely a person will feel drunk.
But moderate drinking is not risk free. That anti-clotting effect
could, in some, increase the risk of hemorrhagic stroke, or bleeding
in the brain. And some studies show a relationship between moderate
drinking and an increased risk of breast cancer, though results from
the Nurse's Health Study, a long! -runn ing study based at Harvard
Medical School of more than 84,000 nurses, indicate that women who had
adequate folate in their diet had no increased risk of breast cancer
from moderate drinking.
Most concerning is that when a person crosses the line from moderate
drinking to heavy drinking, the list of bad effects on the
cardiovascular system is pretty much all-inclusive: increased risk of
cardiomyopathy, high blood pressure, stroke and heart rhythm
irregularities.
Most studies on heart disease and alcohol are long-term observational
studies, including the Nurse's Health Study and the Framingham Heart
Study. Or they are laboratory studies of animals. A few human trials,
lasting no more than six to eight weeks, have found favorable effects
on blood cholesterol levels among moderate drinkers compared with
abstainers.
But the gold standard of research, a randomized clinical trial
comparing moderate drinkers w! ith a bstainers over a long period, is
probably not possible.
"You'd have to find people who are willing to drink but also willing
to be randomized not to drink," says Mukamal. They'd have to hold that
pattern for perhaps decades. Excluding alcoholics, problem drinkers or
people who might develop those problems would also be difficult or
impossible in a clinical trial. So the ultimate scientific proof of
the benefits of alcohol is elusive.
*
Cultural messages
The observational studies are building, but the public health
conundrum remains. The cultural messages in America, Pearson says, are
polarized and contradictory. "It's either 'Eat, drink and be merry,'
or 'Devil rum,' " he says. Good health, for most people, lies
somewhere in between.
"With alcohol, we're still suffering a hangover from our
fundamentalist Protestant roots," Perdue says. "And we've got this
nanny culture. Experts feel they kn! ow be st and have the right to tell
people what to do. We've got the idea that people don't know how to
deal with a mixed message."
It's not like that everywhere. A proposed study in Scotland, for
example, was going to look at heart attack survivors, giving half the
group a glass of wine daily, the other half a red-colored placebo.
"The doctors in Scotland said it was unethical to withhold red wine
from heart attack survivors," Ellison says. And in the United Kingdom,
physicians recommend, unless people do not drink for personal health
reasons including a history of alcoholism, that middle-aged and older
men and postmenopausal women consider a drink or two a day for health.
Our own American Heart Assn. more guardedly recommends: "If you drink
alcohol, do so in moderation."
*
(INFOBOX BELOW)
Knowing the limit
Moderate drinking is defined as one drink a day for women, two for
men. Here's wh! at th at looks like in a glass:
Wine: 5 ounces
Beer: 12 ounces
Spirits: 1.5 ounces