Enjoy, but use your head

DOSSIERS
Alcohol and Diabetes  Enjoy, but use your head
Effects
Hypos
Alcohol not always bad

Source: Diabetes Vereniging Nederland  

A drop of beer on a sun-soaked pavement café, a drop of wine with dinner. Alcohol is part of our society. Diabetes per se is no reason to be total abstainer. That said, once you have diabetes, there’s one or two things that you have to watch out for.

“Oh, don’t be such a wimp!” How many times have you had that in your face when you gracefully declined an alcoholic kick in the head? It may seem as unsocial as it wants: if you have diabetes, you have to limit yourself a glass or two per day. We used to think otherwise. Back in the days when there was no insulin therapy, persons with diabetes were prescribed wine. Well, yes. Alcohol can lower the blood glucose. The wine therapy has, alas, failed the test of time; it had all kinds of negative effects for the liver, pancreas and nervous system. Nor is this the whole story regarding the downside of alcohol consumption.

From the mash to the beer

DOSSIERS
Brewing beer, the composition of beer  From the mash to the beer
The composition of beer
Nutritional aspects of beer
Nutrients in beer
Brewing beer
Different fermentation, different beer
Beer and the law
Light beers and low-alcohol beers

Barley was cultivated for the first time around 10,000 years ago. Together with other types of grain, a kind of grain mash was created which when mixed with yeast or leaven rose into dough from which bread was baked. It was discovered that when the dough rose, the starch present – originating from the grain – was converted into sugar, and then this was converted into alcohol. It is this alcohol that lies at the origin of the first beer preparations.
The first beer, brewed in Babylon, was semi-liquid. It was thick with the starch that had undergone a second fermentation.

For a long time beer was considered as drinkable bread and bread as edible beer.

Both have a common history and come from the same natural raw materials.
Wherever grain was cultivated, beer was brewed. In ancient times, beer was just as an important source of food as bread was. Not least because beer was rather safer to drink than the generally polluted river water.

The first beers were made from a mash of barley and emmer (a type of wheat) and contained little alcohol. Only when malting was discovered did beer contain more alcohol. A discovery that is attributed to the Mesoptamians in 3000 – 2000 BC.

 

Bacchic Medicine: Wine and Alcohol Therapies from Napoleon to the French Paradox

BOOKS

Wine, said Louis Pasteur, is the most healthful and the most hygienic of all beverages. Since antiquity, wine was believed to stimulate the appetite, aid digestion, and act as a general energiser in debility, and was prescribed for practically every complaint. In Bacchic Medicine Harry W Paul, professor of history at the university of Florida, charts in scholarly, though somewhat confusing and repetitive detail, the rise and fall of the French love affair with vinothérapie.

Beer and lung cancer: no connection

SCIENTIFIC RESEARCH
alcohol and body
24/04/2006

Dr. Marleen Finoulst
Canadian scientist Andrea Benedetti found a connection between beer consumption and lung cancer and made headlines with this controversial finding. According to her epidemiological study, recently published in ‘Cancer Causes and Control’ (March 2006), a moderate to excessive beer consumption increases the risk of lung cancer, while drinking wine supposedly reduces the risk. Benedetti bases her inquiries in approximately 3 700 men and women with lung cancer. Andrea Benedetti immediately relativizes her own research: her study is an epidemiological study, which means that no cause-and-effect relation is demonstrated. It would in fact be rather remarkable if that were possible. The higher incidence of lung cancer in the group of beer-drinkers arises from other factors.

Respect alcohol, respect yourself

SCIENTIFIC RESEARCH
alcohol and society
21/09/2005

While inappropriate or excessive drinking causes health and social damage, moderate drinking doesn’t.

The World Health Organisation states: “There are beneficial relationships with coronary heart disease, stroke and diabetes mellitus, provided low-to-moderate average volume of consumption is combined with non-binge patterns of drinking. For example, it is estimated that ischaemic stroke would be about 17% higher in the Eur-A sub-region [which includes the UK] if no one consumed alcohol” (World Health Report 2002).

Good news for diabetics

DOSSIERS
Moderate drinking reduces the risk of heart and circulatory disease Moderate beer drinking is good for the heart and blood vessels
How much should you drink for the maximum protective effect?
How is this protective effect explained?
More scientific research required
Discussion of the threshold value
Women are more sensitive to alcohol than men
Age and alcohol consumption
Beer, wine or spirits?
Good news for diabetics

Dozens of studies involving hundreds of thousands of test subjects have all showed a positive effect of moderate alcohol drinking on the incidence and mortality through heart and circulatory diseases. Practically all the studies involved healthy test subjects. Studies on the influence of alcohol in certain patient populations are scarce or even non-existent. A recent original study on the effects of alcohol on mortality through heart conditions in patients with maturity onset diabetes (diabetes type 2) is worth mentioning.
As a result of the increased sugar levels in their blood, diabetics have a higher risk of narrowing around the coronary arteries, resulting in possibly fatal heart conditions. In order to keep this risk as low as possible, diabetics are encouraged to maintain a strict and healthy diet. It now seems that there is also a place for moderate alcohol consumption in this healthy diet, and diabetics who drink a few glasses of alcoholic drinks a day run a lower risk of an early death as a result of heart conditions in comparison with diabetics who do not drink at all.
(JAMA 1999;282:239-246).

 

Beer, wine or spirits?

DOSSIERS
Moderate drinking reduces the risk of heart and circulatory disease Moderate beer drinking is good for the heart and blood vessels
How much should you drink for the maximum protective effect?
How is this protective effect explained?
More scientific research required
Discussion of the threshold value
Women are more sensitive to alcohol than men
Age and alcohol consumption
Beer, wine or spirits?
Good news for diabetics

The beneficial effects of moderate alcohol consumption are most notable in France where habitual drinkers of red wine have markedly fewer problems with heart and circulatory disease and have longer lives (the French paradox). When scientists found that it was mainly the alcohol in wine that was responsible for this protective effect, the relationship between other alcoholic drinks and heart and blood vessels came under examination. In the meantime studies have confirmed that moderate drinking of white wine, beer and spirits can favourably change the survival curve and reduce the risk of heart and circulatory diseases.

Some research groups have compared the effects of different alcoholic drinks with one another and have come to the conclusion that the beneficial effects on health were most pronounced with beer and wine consumption, and less so with spirits. Moderate drinkers of beer and wine have fewer problems with high blood pressure and are less often confronted with clogging of the coronary arteries and myocardial infarction than regular drinkers of spirits (1). A Belgian study (2). also showed that wine and beer have a comparable effect on heart and circulatory disease, but adds that the differences are difficult to investigate because different drinking habits are also coupled with different eating habits. For example, beer drinkers smoke more than wine drinkers and the more that is drunk the greater the fat consumption. According to a German research group, light to moderate beer drinking is better for the heart and blood vessels than drinking wine to the same extent (3)

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References:
(1)Alcoholic Beverage Preferance and Risks of Alcohol-Related Medical Consequences: a preliminary report from the National Longitudinal Alcohol Epidemiologic Survey; S.P. Chou et al. Alcohol Clinical & Experimental Research 1998;vol.22,nr.7.
(2)Wine and non-wine alcohol: differential effect on all-cause and cause-specific mortality; S. Sasaki, H. Kesteloot, Nutr. Metab. Cardiovasc. Dis. 1994;4:177-182.
(3)The Relation of alcohol intake to coronary heart disease and all-cause mortality in a beer-drinking population; U. Keil et al., Epidemiology 1997;8:150-156.

 

Age and alcohol consumption

DOSSIERS
Moderate drinking reduces the risk of heart and circulatory disease Moderate beer drinking is good for the heart and blood vessels
How much should you drink for the maximum protective effect?
How is this protective effect explained?
More scientific research required
Discussion of the threshold value
Women are more sensitive to alcohol than men
Age and alcohol consumption
Beer, wine or spirits?
Good news for diabetics

Scientists have in the meantime agreed that light to moderate alcoholic drinks have a protective effect on heart and blood vessels, and mortality as a result of these conditions is reduced. The question still remains as to how long a person has to drink before there is such a beneficial effect. The question remains unanswered for the time being. It can be taken that people who start drinking from their middle age enjoy the beneficial effect. A study on almost 500,000 men aged 56 on average confirmed that moderate drinking is beneficial for the heart and blood vessels and that the general mortality risk falls.
(N Engl J Med 1997;337:1705-14; copy in appendix)

Even more so, excessive drinking habits occur less in the older age groups where alcohol consumption has a more regular character.

 

Alcohol does not negate the detrimental effects of smoking!

That smoking causes serious damage to health is beyond dispute. Smokers run a greater risk of many types of conditions including heart and circulatory disease, lung cancer, etc. The risk of an early death is double in people who have smoked for a long time. The negative effects of smoking on the occurrence of heart and circulatory diseases on the one hand and general mortality on the other is far higher than the positive effect of moderate alcohol drinking. In other words moderate drinking can not be considered as compensation for smoking behaviour and does not in any way negate the harmful effects of smoking
(N Engl J Med 1997;337:1705-14)

 

Women are more sensitive to alcohol than men

DOSSIERS
Moderate drinking reduces the risk of heart and circulatory disease Moderate beer drinking is good for the heart and blood vessels
How much should you drink for the maximum protective effect?
How is this protective effect explained?
More scientific research required
Discussion of the threshold value
Women are more sensitive to alcohol than men
Age and alcohol consumption
Beer, wine or spirits?
Good news for diabetics

The quantity of alcohol that still has a beneficial effect on health differs according to age, gender and underlying disorders. Women, for example, are more sensitive to alcohol and become risk drinkers more quickly. Thus the World Health Organisation places the threshold at 21 drinks a week for men and at 14 per week for women. These thresholds are probably artificial and do not take account of individual differences nor the condition to be prevented .

This male/female difference influences the protective effect of alcohol on heart and circulatory disease and mortality by heart and circulatory disease. On the one hand, women already have a lower risk of heart and circulatory disease than men (thanks to the protective influence of the female hormone oestrogen), but on the other hand the alcohol concentration in the blood increases more quickly in women than in men when drinking the same quantity. In addition, it also has to be remembered that alcohol can increase the risk of breast cancer which somewhat offsets the effect on heart and circulatory disease with women.

A large scale prospective study in which more than 85,000 women between 34 and 59 participated, and where the above female specific factors were taken into account, showed that when consuming one to three alcoholic drinks a day the risk of heart and circulatory disease and the mortality through heart and circulatory disease was significantly reduced among women as well. The favourable effect on survival is most pronounced in women over 50 and in women who already have a high risk of heart and circulatory disease as a result of other risk factors such as smoking, obesity, too high a cholesterol level, etc. As soon as women drink more, their mortality risk increases as a result of diseases such as breast cancer.
(N Engl J Med 1995;332:1245-50; copy in appendix).

 

Discussion of the threshold value

DOSSIERS
Moderate drinking reduces the risk of heart and circulatory disease Moderate beer drinking is good for the heart and blood vessels
How much should you drink for the maximum protective effect?
How is this protective effect explained?
More scientific research required
Discussion of the threshold value
Women are more sensitive to alcohol than men
Age and alcohol consumption
Beer, wine or spirits?
Good news for diabetics

Researchers do not always seem to be on the same wavelength and sometimes reach different conclusions. This is to do with various factors that influence these study results, including age and sex of the trial subjects, the duration of the study, and the monitoring of the trial subjects, the country in which the study is done, etc.

Threshold value of two drinks a day:
Crique MH et al. Lipoproteines as mediators for the effects of alcohol consumption and cigarette smoking on cardiovascular mortality. Results from the Lipid Research Clinics Follow-up Study; Am. Journal of Epidemiology 1987;126:629-37.

Threshold value of 3 drinks a day:
Yano K et al. Coffee, alcohol and risk of coronary heart disease among Japanese men living in Hawaii. New Engl Journal of Med 1977;297:405-409.

Threshold value of 4 drinks a day:
Boffetta P et al. Alcohol drinking and mortality among men enrolled in an American Cancer Society prospective study. Epidemiology 1990; 1:342-348.

Threshold value of 6 drinks a day:
Klatsky et al. Alcohol and mortality, a ten year Kaiser-Permanence experience. Ann Intern Med 1981;95:139-45.

The confusion over the number of drinks that still correlate with a favourable effect on the heart and blood vessels occurs among both doctors and consumers. This is shown by a survey that the Artsenkrant / Le Journal du Médecin did in 1998 among Belgian doctors (791) and consumers (1,201). This showed that nobody disputes that one glass of wine or beer a day is healthy for the heart and blood vessels, and that the average population believes that five glasses a day increases the risk. Where exactly the threshold lies between protection and risk, however, opinion was divided. 7% of doctors and 16% of consumers thought that the threshold was at two glasses a day. Almost half of doctors thought that four glasses a day was just about okay, and one in three doctors believed that the threshold was at six glasses. Finally 9% of doctors believed that the risk of heart and circulatory disease only increases as of nine glasses per day !

What can certainly be said is that by far the most studies point in the same direction: moderate alcohol consumption reduces the risk of heart and circulatory disease and mortality by heart and circulatory disease. Whether you can have two, three or four glasses a day is still being debated, however.