Since both my parents are alcoholics, I don't drink. Lately I have read a lot about the benefits of a glass of wine once a day or every other day. What is your opinion about this? -- Elizabeth West

First of all, I would like to commend you for making a wise decision to avoid drinking in light of your parents' alcoholism. Although we don't know for sure that alcoholism is inherited, there is no doubt that it runs in families. Genetic makeup may be partly responsible, but the risk also may be due to environment, growing up in a home where alcohol is available and heavy drinking is acceptable. Not every child of an alcoholic parent eventually develops a drinking problem, but it is true that the risk is greater than normal. (By the way, children of parents who abstain from alcohol also have a higher rate of alcoholism, which suggests absence of a good role model for appropriate use may be key.)

It is also true that drinking moderate amounts of alcohol does confer some health benefits, but there is a trade-off. Consider these pros and cons:

The "Pros":

Moderate drinking appears to protect against coronary artery disease and heart attack. Here, "moderate" means two drinks or less per day for men and one or less for women. These relatively small amounts of alcohol are believed to raise levels of HDL, the "good" cholesterol, and reduce the risk of blood clots forming in coronary arteries.

Moderate drinking--up to three drinks per day in this case -- may reduce an older person's risk of developing dementia including Alzheimer's disease . A recently-completed study in the Netherlands showed that it doesn't matter what you drink--wine, beer, liquor or a fortified wine such as sherry. However, no such protective effect was seen among heavy drinkers--those who guzzled four or more drinks per day.

The "Cons":

Even small amounts of alcohol may increase the risk of breast cancer, and the more women drink, the greater their risk. Among premenopausal women, alcohol may increase estrogen levels which, in turn, may promote breast cancer.

Moderate drinking during pregnancy may increase the risk of stillbirth as well as that of physical, mental and behavioral problems among the children of mothers who consume alcohol during pregnancy. The stillbirth data is new and comes from a recently published Danish study.

My feeling is that if you don't drink alcohol, you certainly shouldn't start for health reasons. You can reduce your risks of heart disease via diet and exercise, and recent evidence suggests that we may be able to protect against Alzheimer's and other forms of dementia by "exercising" our minds. My own drinking habits are quite modest. I like premium Japanese sake once in a while and, less often, a glass of good wine. Otherwise I am more likely to drink water or tea.

Dr. Andrew Weil

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