Today we're going to consider some interesting information regarding alcohol. This is stuff that is hot off the press, and while most of it is favorable concerning the responsible use of alcohol, this should not be interpreted as a recommendation to go out and buy a keg.

First, a study in the Annals of Internal Medicine looked at the effect of alcohol use on the incidence, management, and complications of diabetes. With this, as with most studies, moderate alcohol use is defined as "one to two drinks per day". This could be two beers, two glasses of wine, or two "liquor drinks". Any more than that is considered to be "heavy consumption".

In this study, the results indicated that moderate alcohol consumption is associated with a reduced incidence of diabetes (fewer new cases). Interestingly, moderate diabetic alcohol drinkers had less incidence of heart disease than their non- drinking counterparts. And they had fewer complications of their diabetes. On the other hand, heavy alcohol use is associated with an increased incidence of diabetes. The reasons that this occurs are not well known, but the findings have been consistent over several large and well-done studies.

The New England Journal of Medicine recently published the results of a large survey derived from the Nurses' Health Study. This is an interesting group, in that 121,700 U.S. female registered nurses aged 30-55 years in 1976 were enrolled in an ongoing study. Various researchers have studied many different problems and diseases that have developed in these women over the past few decades, and much valuable information continues to be gleaned from this group.

This particular study looked at the effect of alcohol on the decline in cerebral functioning in this large group as they passed the age of 70. They were able to determine that the moderate use of alcohol was associated with at least a 20% reduction in this cognitive decline when compared to those women who did not drink. And interestingly, the type of alcohol did not matter. Wine, beer, whiskey. It made no difference. Once again, the mechanism that explains this outcome has not been determined. There is good evidence that shows that alcohol intake raises the HDL level (the "good" cholesterol) and that this might explain its positive effects on the development of heart disease. Also, alcohol acts as a sort of blood thinner, reducing some of the clotting factors in our blood. This might result in a reduction in the number and size of small blood clots that form and pepper our brain as we get older.

Again, the evidence that supports these outcomes has largely been consistent. The moderate use of alcohol can result in some positive health outcomes. One painful exception has to do with the development of gout. A large study published in the Lancet (a British medical journal), indicated that men who consumed more than one beer a day had at least a three-fold increased likelihood of developing gout than non-drinkers. The use of "spirits" was just behind beer, while wine drinkers had no increased risk, whether red or white. The study did not look at the development of gout in women, but is noted as being the first prospective study to confirm an association between alcohol intake and gout. All of you gout-sufferers out there, take note.

So, what are we to do with this information? The general consensus in the medical community is that if a person chooses to use alcohol and can do so responsibly (meaning "in moderation"), they should not be discouraged from doing so. On the other hand, heavy drinkers fall into another category, and need active help and treatment. Like most things, too much alcohol can cause a multitude of problems, both physically and emotionally. And those people who choose not to drink should be commended and not counseled to begin doing so.

As more information is gained from ongoing studies, perhaps the advice that we give our patients will become more specific and helpful. Stay tuned.