Alcohol has been called the Jekyll and Hyde of health, which summarizes the age-old dispute about the pros and cons of drinking. As scientists have accumulated information about how alcohol affects the human mind and body, a balanced picture is starting to emerge. A study may add some color to the picture, since it raises the hope that red wine may reduce the risk of prostate cancer.

Alcohol and health

On the positive side of the ledger, moderate alcohol use is associated with protection against atherosclerosis, the disease that puts cholesterol-rich plaques just where they are least welcome, in the walls of the arteries. Although many studies of men and women from around the world report a substantial benefit from alcohol, three Harvard studies are particularly relevant to American men. The Health Professionals Follow-up Study, the Physicians’ Health Study, and the Harvard Alumni Study have all reported that men who drink modestly enjoy substantial protection against angina, first heart attacks, recurrent heart attacks, sudden cardiac death, and ischemic strokes. The magnitude of protection varies with the problem but ranges from 20% to 56%. And the Harvard studies report other possible benefits of low-dose alcohol, including a reduced risk of diabetes, symptomatic benign prostatic hyperplasia (BPH), and erectile dysfunction.

That’s the good news. The bad news is that alcohol gets the blame for almost 100,000 deaths in the United States each year. Liver disease and accidents are among the biggest alcohol-related problems, but others include high blood pressure, damage to the heart muscle, brain damage, pancreatitis, osteoporosis, intestinal bleeding, and cancers of the mouth, voice box, and upper digestive tract. Alcohol has also caused countless psychosocial and economic problems.

Is alcohol a boon or a bane? It depends on who drinks, how much he drinks, and when he drinks. People who are at risk for alcohol abuse should shun it, as should patients with liver disease and those who require medications that may interact adversely with alcohol. No one should drink before driving or operating hazardous machinery. Above all, people who choose to drink must keep the “dose” right. For men, that means one to two drinks a day, counting 1½ ounces of liquor, 12 ounces of beer, or 5 ounces of wine as one drink; for women, it’s half as much.

Alcohol vs. alcohol

When it comes to the harmful effects of alcohol, a drink is a drink is a drink. All alcoholic beverages are equally harmful if they are consumed by the wrong person, in the wrong amount, or at the wrong time. When it comes to potential benefit, though, the situation is a bit more complex. Some studies give the edge to red wine, while a few attribute extra benefit to other forms of alcohol. But most studies call it a three-way tie. Back in 1991, for example, the Health Professionals Follow-up Study found that wine, beer, and liquor were equally protective. A few years later, the Physicians’ Health Study agreed, adding that all three beverages produced similar beneficial elevations in HDL (“good”) cholesterol levels. And a meta-analysis of 25 studies that compared the effects of wine, beer, or spirits on cardiac risk reported that all were equally beneficial as long as the dose was right.

Lifestyle, alcohol, and prostate cancer

Although prostate cancer is the most common internal malignancy in men, scientists do not yet understand its causes. Heredity certainly plays a role, but lifestyle factors are also very important. Diet has received the most attention. The leading culprit is saturated fat from animal sources such as red meat and whole dairy products. Although the data are less clear, very high consumption of calcium or alpha-linolenic acid (the omega-3 fat found in flaxseed and canola oil) may also boost risk. On the other hand, tomatoes and other vegetables, whole grains, nuts and seeds, fish, and soy are all on the “good” list. Among the nutrients, selenium (a mineral) and lycopene (an antioxidant in the beta carotene family) may reduce risk. Obesity increases risk, while exercise may lower it. Most studies report little impact from smoking, but it’s a moot point since no man (or woman) should smoke. As for sexual activity, one study reported that having multiple female sexual partners may increase risk, but another linked frequent ejaculation to protection.

Since prostate cancer is complex and incompletely understood, it’s no surprise that studies of alcohol and prostate cancer have produced mixed results. Although some research implicates heavy drinking as a risk factor, most studies find no link between drinking and the disease. In fact, a meta-analysis of 33 individual research papers concluded that drinking had no effect on a man’s risk of prostate cancer. But that’s not the end of the story. Most investigations of alcohol and prostate cancer lump all forms of alcohol together. A new study, though, suggests that may be a mistake.

Seeing red

Researchers at the Fred Hutchinson Cancer Research Center in Seattle investigated alcohol and prostate cancer in 1,456 men between 40 and 64 years of age. Each man underwent a personal evaluation and answered detailed dietary questionnaires. The scientists collected information about many factors that might influence the risk of prostate cancer, including age, race, family history, height, weight, daily caloric intake, marital and sexual history, tobacco use, and occupational and lifestyle factors. Every man’s medical history, including his screening tests for prostate cancer, was evaluated. All the cases of prostate cancer were graded for the aggressiveness of the disease and staged for its extent. Finally, all the men provided detailed information about their alcohol consumption.

The results confirmed many findings of previous studies: The risk of prostate cancer was increased in men with a family history of the disease, in African Americans, in men with a high caloric intake, in current smokers, and in men who had many female sexual partners in the course of their lives. In addition, most of the men had localized disease of moderate aggressiveness (Gleason grade 5–7). In all these respects, the men in the Seattle study were similar to other Americans with prostate cancer.

At first, the results for alcohol consumption may also seem similar to many earlier studies of alcohol and prostate cancer: There was no relationship between overall alcohol consumption and risk. But the scientists went one step further by evaluating each type of alcoholic beverage independently. The results showed that heavy beer drinking (35 or more a week for eight years or longer) appeared to increase risk. In contrast, wine drinking was linked to a reduced risk of prostate cancer. And when white wine was compared to red, most of the benefit was attributed to red. Even low amounts seemed to help, and for every additional glass of red wine per week, the relative risk declined by 6%. In all, men who averaged four to seven glasses of red wine per week were only 52% as likely to be diagnosed with prostate cancer as those who did not drink red wine. In addition, red wine appeared particularly protective against advanced or aggressive cancers.

Why red wine?

Doctors don’t know the answer. But much of the speculation focuses on chemicals that are absent in other alcoholic beverages, including various flavonoids and resveratrol. These components have antioxidant properties, and some appear to counterbalance androgens, the male hormones that stimulate the prostate. In test tube experiments, flavonoids reduce PSA production by prostate cancer cells, suggesting a decrease in cellular activity, and resveratrol damps down the activity of the genes that promote cell growth. Resveratrol also induces prostate cancer cell death by a process called apoptosis (cell suicide).

Bottoms up?

Many doctors are reluctant to recommend alcohol for health, fearing that their patients might assume that if a little alcohol is good, more might be better. They have a point, but men who enjoy alcohol and can drink moderately and responsibly may benefit from a lower risk of heart attack, stroke, diabetes, and cardiac death. Although red wine has theoretical advantages, it has not been proven superior to other forms of alcohol when it comes to fighting cardiovascular disease.

Prostate cancer may be different. The Seattle study raises the hope that red wine may help reduce the risk of prostate cancer. It’s only one study, and a rather small one for this kind of analysis. Although it’s far too early to endorse red wine for the prostate, the study is bound to mark an outpouring of new research.

Any volunteers?

Last Updated: 06/07