Go Red! Or is it Go White? Alcohol and Cholesterol

by Steven Kang, M.D. Health Professional

The French are renown for their exquisite cuisine and fashionable lifestyles. It's not too hard for us to imagine a French person sitting at a sidewalk café in Paris dining on foie gras, coq au vin, and heavy cheeses, sipping a fine Bordeaux, and smoking several cigarettes to finish off the meal. It also doesn't seem to be too difficult for us to imagine that same person later experiencing crushing chest pain while walking home and arriving at the nearest ER with a major heart attack.

However, in spite of, or more accurately because of this particular diet, the French in general have a lower overall death rate from heart disease than would be expected. This French paradox is believed to be a result of their regular consumption of red wine.

Several studies have now confirmed that drinking a moderate amount of alcohol (ethanol) decreases the risk of heart disease, heart attack, and stroke. There are several mechanisms to the health benefits of alcohol which include anti-inflammatory, antioxidant, and anti-blood clotting effects.

In particular, ethanol is known to improve cholesterol levels by increasing good HDL and other proteins that are beneficial to cholesterol metabolism. Ethanol inhibits a certain enzyme called cholesterol ester transfer protein (CETP). If this sounds familiar, it should since I mentioned it in a blog last month. A new class of synthetic drugs called CETP inhibitors are currently under investigation for their potential in significantly raising HDL levels and lowering the risk of heart disease.

One drug called torcetrapib was recently discontinued after it was shown to also be associated with high blood pressure and an increased risk of death. Ethanol is a naturally occurring CETP inhibitor and may raise HDL levels by 4mg/dl.

In addition to the ethanol, red wine also contains other substances found in the skin of the grapes that are antioxidants and anti-blood clotting chemicals. Does this mean that red wine is the cocktail of choice for heart protection? The answer is not fully known. It seems that all types of alcoholic beverages are associated with some heart benefit.

Some studies suggest that red wine may give more benefit than beer, but the jury is still out as to which drink is the best. I suppose we'll have to let Sam Adams, Charles Shaw, and Jim Beam figure that one out for us.

As with all good pleasurable things, gluttony leads to harm. "Moderate" alcohol consumption is generally defined as 3 to 9 drinks per week. For those of you who did not excel in the science of mathematics, a "double" counts as 2 drinks and not 1. Heavier alcohol use is associated with numerous health problems such as liver disease, pancreatitis, cancer (especially of the breast), osteoporosis, car accidents, and suicide.
Binge drinking also doesn't appear to offer much heart protection, let alone protection from bad personal choices.

In summary, moderate alcohol consumption on a regular basis does improve cholesterol levels and can lead to a lower risk of heart disease. Whether everyone should begin having a glass of wine with their low fat chicken and whole grain rice depends on each individual. If you are considering consuming alcohol for perceived health benefits, I would advise that you speak to your doctor first. Besides, he or she may have some good suggestions for a nice reasonably priced California cabernet.

Steven Kang, M.D.
Meet Our Writer
Steven Kang, M.D.

Steven Kang, M.D., is a general cardiologist and cardiac electrophysiologist who believes that the best way to treat heart disease is to prevent it. He wrote for HealthCentral as a health professional for Heart Disease, High Blood Pressure, and High Cholesterol.