Alcohol Consumption and Heart Disease Prevention: How Much is Enough?

The newspapers these days seem to be full of studies that tell us that alcohol may be good for certain things (like preventing heart disease and stroke) while telling us that it's bad for other things (like the liver and memory). I am often asked by my patients, their family members, or friends how much alcohol is the "right amount." As far as the cardiovascular system is concerned, there is no easy answer.

I do not counsel people to start drinking alcohol if they have no such inclination, and I certainly don't counsel anyone that has previously had a problem with alcohol to expose themselves to it once again. Additionally, if you have a strong family history of alcoholism, I would caution you that using alcohol to lower cardiovascular risk factors is not in your best interest.

Here is an easy set of questions to ask yourself (or anyone else) and an easy way to calculate your limits:

1. How much alcohol do you currently drink, and how does it affect you? If a single glass of wine makes you tipsy, or adversely effects you, you have reached your limit.

2. How large are you? Alcohol does most of its injury when the concentration in the blood is high. The larger you are, the more it takes to reach a high concentration; conversely, the smaller you are, the less it takes.

3. Does your family have a susceptibility to the effects of alcohol? People are genetically different from one another and metabolize medications (including alcohol) at different rates. Some people claim that they can't drink a lot without a problem, as and yet those same people can be knocked head over heels by a simple Benadryl tablet. If your family history suggests a low limit, expect you will have one too. Size and gender may be less important when it come to handling alcohol than our genetic history.

4. Are you mixing types of alcohol? There are no good scientific studies on this, but an old French proverb about "mixing grain and grape" or observations that beer and whiskey, or various other combinations can lead to strange illness and bedfellows has not been disproven.

5. What, and how much are you drinking? (One of my pet peeves in the office is when I ask a patient to estimate what and how much they drink. Most of the time, my patients don't have a clue). Perfect examples: "one drink a night" (mixed in a pitcher), "some wine and a cocktail" (a bottle of wine and an endless cocktail).

Here are some useful estimates for you:

A standard "shot" of whiskey is 45 cc, and if it is 86 proof (43% alcohol by volume), contains 19.35 cc of alcohol by volume: 100 calories.

Cocktails add calories to the above, a minimum is about an extra 75 calories for standard drinks, but add cream or an "umbrella" and you would do just as well with ice cream from the dietary point of view (and get extra calcium without any deterioration of your driving skills).

A wineglass is usually 6 oz (180cc), if it is 11% (most wines are 11-12%) it contains 19.8 cc of alcohol by volume, calories: 170 (120-270), sweet dessert wines have more calories).