You’re Better Off With Beer: Beer and Your Health

July 1, 2002 By Gregg Glaser

“Beer is proof that God loves us and wants us to be happy.”

So said Benjamin Franklin. Happy? Certainly. But healthy as well? Maybe.

The beneficial effects of drinking alcohol have been guessed at from the earliest days of humankind. When the nomadic hunter-gatherers of millennia ago began to settle down as farmers, they knew nothing about sanitation and maintaining a clean water supply. Water-borne diseases must have been widespread. But these same people may have realized empirically that if they drank their fermented beverages–beer and wine–illnesses were not as common. Scientists now know that the boiling of water in brewing, the alcohol present in both beer and wine and the natural acidity in both drinks will either kill or reduce the growth of illness-forming bacteria.

The health benefits of drinking of alcoholic beverages may have become even more significant, as people gathered in more and more crowded conditions. Beer was certainly safer to drink than plain water, from the Middle Ages right through to the Industrial Revolution. Brewers didn’t realize it, but in boiling the brew, they’d stumbled on the most fundamental of public health measures.

As a further endorsement of alcohol’s beneficial use to humans, beer and wine became a part of almost every religion’s sacraments, holidays and feasts. In Europe after the fall of the Roman Empire, the Catholic Church, in the form of its monks and nuns, became the proprietor of vineyards and the provider of wine and beer. Beer, in particular, added nutrients and vitamins–as well as pleasure–to an otherwise sparse diet. Many monasteries continue their brewing pursuits to this day.

Since the beginning of the 20th century, doctors and researchers have sought scientific evidence to understand the association between alcohol and human health. As the studies pile up, we can say something we wouldn’t have said twenty years ago: you’re better off including alcohol in your diet than not. And beer is a natural choice for the health-conscious 21st century.

Alcohol and the Heart

Observers have long suspected that drinking alcohol was somehow good for the heart. Just how good and why, they weren’t sure until late in the 20th century. To date, over sixty studies throughout the world have investigated in detail if drinking alcoholic beverages did indeed lead to more healthy hearts, and how.

Alcohol and the Elderly

A study conducted in New Haven, CT, between 1982-1996 found that moderate alcohol consumption was associated with decreased risk of heart failure among the elderly.

Dr. Jerome L. Abramson of Emory University and his team of researchers studied 2,235 elderly men and women with an average age of 74. They found that compared to non-drinkers, those in the group who drank at least 1.5 drinks daily had a 20-50 percent less chance to develop heart failure.

Another study on the effects of drinking alcohol and aging conducted in Germany also found that alcohol was good for the heart. Dr. Wolfgang Koenig of the University of Ulm’s German Center for Research on Aging published a report in the July 2001 issue of Epidemiology. Dr. Koenig and his researchers studied 800 men and women, one-third of whom had established heart and blood vessel problems. Blood samples were collected and the results showed that alcohol improves the balance of lipids (fats) in the blood, and reduces blood’s tendency to clot.

It turned out that alcohol drinkers had higher levels of high-density lipoprotein (HDL) cholesterol, often called the “good” cholesterol, which is a protective form of blood fat. The alcohol drinkers also had lower levels of fibrinogen, a protein that promotes blood clots, as well as elevated levels of other molecules (platelets) that prevent the clotting and stickiness of blood cells.

Beer or Wine?

The discovery–or re-discovery– that alcohol consumption might be good for you emerged in the early 1990s in a phenomenon known as the “French paradox:” the observation that, although the French diet is higher in fat than ours, rates of coronary disease are lower than in the United States.

Research initially suggested that the red wine that adds so much pleasure to a French meal also helps protect French hearts. Chemical compounds called flavinoids, found in large amounts in the seeds and skins of red grapes, appeared to have positive effects on cholesterol levels (both raising the levels of “good” and decreasing the levels of “bad” cholesterol) and reducing blood platelet aggregation.

Red wine staked out its territory as the “healthy” alcoholic beverage.

Dutch researchers in 2000 offered evidence to counter the widely held belief that red wine was better for the heart than beer. The Dutch study, led by Dr. Henk Hendriks of the TNO Nutrition and Food Research Institute, studied 11 healthy men who drank four glasses of either beer, red wine, spirits or water with dinner for three months. They switched beverages every three weeks. Despite the small number of subjects in the study, the results were striking.

The men showed a 30 percent increase in vitamin B6 in their blood plasma after three weeks on beer. Drinkers of red wine and Dutch gin received only one-half the increase in the vitamin. B6 prevents the body from building up high levels of homocysteine, a chemical linked to an increased risk of heart disease. Homocysteine levels did not increase in the beer drinkers, but rose for those who drank wine or spirits

A somewhat similar study in Denmark also addressed the “red wine v. beer is better for your heart” debate. The Danish Brewers Association reported that beer works as well as wine in preventing heart disease. “It cannot be proved that there is any health advantage to drinking red wine, for example, rather than beer,” according to the study by the Institute of Epidemiology and Social Medicine at the University of Muenster. “Studies indicate that light to moderate alcohol consumption from beer, wine or spirits is associated with a reduction in all-cause mortality, owing primarily to a decreased risk of coronary heart disease.”

Folate and B-Vitamins

In the Czech Republic, a great beer drinking nation, a study published in the July 2001 issue of the European Journal of Clinical Nutrition attributed beer’s health effects on the heart to its folate content.

Dr. O. Mayer Jr. and colleagues from the Center of Preventative Medicine at Charles University in Pilsen wrote in their report: “Moderate beer consumption may help to maintain the total homocysteine levels in the normal range due to high folate content. Folate from beer may…contribute to the protective effect of alcohol consumption on cardiovascular disease in population(s) with generally low folate intake from other nutrients.” (It sounds like the Czechs aren’t eating their leafy vegetables.)

The Czech study measured blood levels of folate, vitamin B6 and vitamin B12 in 543 men and women between 35-65 years of age who drank more than 6.3 ounces of alcohol weekly. Since Pilsen is home to Plzensky Prazdroj, brewer of the world-famous golden lager Pilsner Urquell, it’s no surprise that the overwhelming majority of these test subjects were beer drinkers. The B-vitamins measured came from the yeast used to ferment beer, and the beer drinkers had the lowest blood levels of homocysteine and the highest levels of folate.

Alcohol After a Heart Attack

The April 18, 2001 issue of the Journal of the American Medical Association published a study that found that drinkers of alcohol had a lower risk of dying from a heart attack. The study, led by Dr. Kenneth J. Mukamal of Beth Israel Deaconess Medical Center in Boston, studied 1,913 patients at 45 hospitals between 1989-1994. Each patient had been hospitalized with a heart attack. The report concluded that moderate drinkers had a 32 percent lower risk of dying from a heart attack than those who didn’t drink alcohol. Moderate drinkers, according to the researchers, were defined as people who drank at least seven drinks a week. Light drinkers (less than seven drinks a week) had a 21 percent lower risk. The findings were similar for men and women.

As in other studies, Dr. Mukamal’s team found that alcohol helps prevent heart disease by boosting levels of HDL cholesterol and by thinning the blood or reducing insulin resistance.

Alcohol and Stroke

In the September 2001 issue of Stroke magazine, Dr Kenneth Mukamal, who had previously reported on alcohol’s effects on the heart, found that light to moderate alcohol consumption is associated with fewer brain lesions and so-called silent strokes. Dr. Mukamal wrote that as a blood thinner, alcohol improves blood circulation in the brain and offers protection from silent strokes caused by tiny blood clots.

In the study, 3,376 people aged over 65 were given MRIs to determine their overall brain health. Dr. Mukamal broke the test subjects down into six groups: abstainers, former drinkers, very light drinkers (less than one drink a week), light drinkers (one to six drinks a week), moderate drinkers (seven to 14 drinks a week) and heavy drinkers (more than 15 drinks a week).

The results showed that light and moderate drinkers had the fewest white-matter lesions; heavy drinkers had the most. The fewest signs of silent strokes were suffered by heavy drinkers, followed by light and moderate drinkers, but the heavy drinkers were also more likely to have brain atrophy. “Overall, we found that non-drinkers have the most strokes and white matter disease. Light to moderate drinkers have fewer strokes and the least amount of white matter disease, but somewhat greater atrophy. Moderately heavy drinkers had the fewest strokes but more white matter disease and the most atrophy.”

Another study to highlight the brain as well as heart health was conducted by Dr. Monique M. B. Breteler of the Erasmus University Medical School in Rotterdam, the Netherlands. The study found that “light to moderate alcohol consumption reduces the risk of coronary heart disease and stroke.” The six-year study followed 7,983 individuals aged 55 years and older and determined that the effect was the same regardless as to the source of alcohol.

The researchers believe the results may be due to one or both of two reasons: 1) the ethanol in the alcohol might thin the blood and lower cholesterol, thereby reducing the chance of vascular dementia; 2) alcohol may release acetylcholine in the hippocampus, an area of the brain that facilitates learning and memory. Moderation, according to the study, is defined as one to three drinks a day.

Alcohol and Brain Function

Alcohol may not only be good for the heart. The noggin may benefit as well.

A study conducted by Dr. Guiseppe Zuccala of the Catholic University of the Sacred Heart in Rome found that moderate alcohol use may protect the brain from mental decline associated with aging. In the report published in the December 2001 issue of Alcoholism: Clinical & Experimental Research, Dr. Zuccala studied the mental abilities and alcohol use of nearly 16,000 Italian men and women over the age of 65: approximately 8,700 regular drinkers, and 7,000 non-drinkers. Moderate use of alcohol was associated with a 40 percent lower risk of mental impairment. Dr. Zuccala postulated that the reasons for the difference may be alcohol’s beneficial effects on blood pressure and blood flow or perhaps the slowing of arterial disease.

A Dutch study published this year in The Lancet found an association between moderate alcohol consumption, cardiovascular health, and the chance of age-related mental deterioration. Dr. Monique M. B. Breteler and her colleagues at the Erasmus University Medical School in Rotterdam, found that “light to moderate alcohol consumption reduces the risk if coronary heart disease and stroke,” and hypothesized that it “might also affect the risk of dementia.”

The researchers believe the results may be due to one or both of two reasons: 1) the ethanol in the alcohol might thin the blood and lower cholesterol, thereby reducing the chance of vascular dementia; 2) alcohol may release acetylcholine in the hippocampus, an area of the brain that facilitates learning and memory. The six-year study followed 7,893 individuals aged 55 years and older and determined that the effect was the same regardless as to the source of alcohol. Moderation, according to the study, is defined as one to three drinks a day.

At Indiana University in the United States, medical geneticist Dr. Joe Christian observed 4,000 male twins for 20 years to determine if moderate drinking affected the brain. He administered psychological tests to the brothers at ages 66 and 76 and found no harm done from moderate drinking. It turns out that brothers who drank moderately–one to two drinks a day–scored higher on mental skills tests than those who drank less than one drink a day or more than two drinks. Moderate drinking was deemed helpful in improving memory, problem solving and reasoning ability.

As part of the ambitious Nurses’ Health Study at Harvard University, another paper by Dr. Meir Stampfer, published in the New England Journal of Medicine in 2001, determined that moderate drinking of alcohol seemed to preserve the mental abilities of older women. From 1995 to 1999, Dr. Stampfer interviewed over 9,000 women between the ages of 70-79. He measured their mental functions using seven different tests and collected information about their alcohol use in 1980, which was updated through 1994. The results showed that women who drank moderately had significantly better scores on five of the seven tests, as well on a global score that combined the seven tests.

Alcohol Metabolism

Dr. Meir Stampfer, of Brigham & Women’s Hospital in Boston and the Harvard School of Public Health, reported in February 2001 in the New England Journal of Medicine that there was a difference in the way people metabolize alcohol and that this difference could help explain some of the variation between people in alcohol’s beneficial effects on the heart.

Dr. Stampfer and his team identified two forms of the gene that produces alcohol dehydrogenase, the enzyme that breaks down alcohol. One form of the gene is associated with a slower rate of alcohol metabolism than the other. People who have this gene and who are moderate drinkers retain higher levels of HDL cholesterol and face about half the risk of heart attack than drinkers without the gene. “This is kind of a poor person’s randomized trial,” said Dr. Stampfer. “The gene is basically distributed at random with respect to behavioral characteristics, including alcohol consumption. So you can’t argue that people with this gene exercise more or have a better diet.” The study’s subjects were 396 male doctors who had suffered heart attacks and 770 controls who had not.

A Little Bit of This/A Little Bit of That – Beer Helps

At the University of Texas Southwestern Medical School, Dr. Margo A. Denke, an Associate Professor of Medicine, conducted clinical research on the health effects of alcohol, and beer in particular. The results of her 2001 study found that moderate consumption of alcohol can lower risk of heart disease and stroke. “The majority of more recent large population-based studies have observed that moderate drinking in the range of one to three drinks daily is associated with a 30-40 percent lower rate of coronary heart disease compared to non-drinking,” wrote Dr. Denke. She cited several reasons for her findings.

* alcohol increases HDL and this could account for 30-50 percent of the moderate alcohol consumption benefit

* alcohol increases bleeding time, acting as blood thinner and reducing the risk of coronary thrombosis

* alcohol lowers insulin levels, which is good for non-diabetics because it reduces the chance of developing atherosclerosis, or hardening of the arteries

Dr. Denke believes that beer is a more beneficial alcoholic drink than spirits because beer contains many more nutrients per serving, such as protein and B-vitamins and minerals such as magnesium, cadmium and iron. She found that one to two beers a day provides 14 percent of dietary calories, 11 percent of dietary protein, 12 percent of dietary carbohydrates, nine percent of dietary phosphorus, seven percent of dietary riboflavin and five percent of dietary niacin.

Polyphenols in beer, also found in abundance in red wine, are also beneficial for their antioxidant properties that reduce LDL cholesterol (the “bad” cholesterol) oxidation. Researchers in Denmark have studied the effect of polyphenols in red wine on heart health and concluded that only red wine produced enough of these compounds to be of benefit. Dr. Denke, however, has concluded that beer contains similar levels of polyphenols to red wine, and four to five times as much as white wine. (The Danish researchers agree with Dr. Denke on the white wine findings). Dr. Denke also points out that there are also several polyphenols in hops that have been shown to reduce test tube growth of human cancer cells.

Finally, Dr. Denke reports that beer has isoflavinoids, which are a class of so-called phytoestrogens: plant compounds that mimic the activity of the female hormone estrogen. Isoflavinoids have been found to inhibit test-tube growth of prostate, breast and colon cancers.

Alcohol and Women’s Health

Two studies released this year deal solely with the effects of drinking alcohol on women’s health.

A study published in the Archives of Internal Medicine confirmed the benefits for women of drinking alcohol. Data was collected from more than 70,000 nurses aged 25-42 whose health histories were tracked from 1989. The study found that younger women who drink two or three alcoholic beverages a week have a lower risk of developing high blood pressure than women who do not drink alcohol. The women in the group who drank two or three alcoholic drinks a week had a 14 percent lower risk of developing high blood pressure than those who didn’t drink at all. (In this study, a drink was defined as either 12 ounces of regular beer, four ounces of wine or 1.5 ounces of liquor.)

A study of post-menopausal women found that alcohol helps lower cholesterol levels. The study, led by Dr. David J. Baer, a research physiologist affiliated with the United States Department of Agriculture’s Human Nutrition Research Center and published in the American Journal of Clinical Nutrition, included 51 healthy women with an average age of 60. Each woman was randomly assigned to one of three eight-week dietary programs. Those on the control diet drank no alcohol, some drank one drink a day and the third group drank two drinks a day. The women’s cholesterol and triacylglyceride levels were measured before, during, and after the study.

Dr. Baer’s team’s findings showed that the women who drank one drink a day reduced their triacylglyceride level by eight milligrams and their LDL cholesterol level by four milligrams. The women who drank two drinks a day increased their HDL by three milligrams. “The epidemiologic data suggest that increasing consumption above one or two drinks per day is detrimental and not protective,” said Baer. “Higher intakes of alcohol appear to increase triacylglycerides and do not appear to improve cholesterol levels.”

Beer and the Kidneys

A Finnish-U.S. study of beer-drinking, middle-aged men was published in the American Journal of Epidemiology in 1999. The report stated that an increase in beer consumption may reduce the risk of developing kidney stones. Results showed that there was a 40 percent lower risk of kidney stones in beer drinkers, but the researchers were stumped as to whether the results were due to water, alcohol or hops.

Alcohol and Stress

Perhaps popping off to the pub relieves stress.

At Leeds University in the United Kingdom, Dr. Colin Gill’s research showed that the welcoming atmosphere of the local pub helps men get rid of the stresses of modern life and is vital for their psychological well-being. Dr. Gill said that rather than complain, women should encourage men to pop out for a beer. “Pub-time allows men to bond with friends and colleagues,” he said. “Men need break-out time as much as women and are mentally healthier for it.”

Dr. Gill added that men might feel unfulfilled or empty if they had not been to the pub for a week. The report, commissioned by alcohol-free beer brand Kaliber, surveyed 900 men on their reasons for going to the pub. More than 40 percent said they went for conversation, with relaxation and a friendly atmosphere being the other most common reasons. Only 10 percent listed alcohol as their primary reason.

In Spain, an alcohol and stress study was conducted at Autonoma Universidad in Madrid. Published results showed that moderate drinkers feel better about their health than non-drinkers. In Spain’s 1993 National Health Survey of 20,000 adults “the results showed that people who drank alcohol, including beer and spirits, were less likely to report ill health than people who abstained altogether,” according the report published in the British Journal of Epidemiology and Community Health. “Overall, the higher the consumption of total alcohol the lower the levels of subjective ill health.” Of the test subjects, 57 percent drank regularly, with the majority consuming one to two drinks a day. Those who drank regularly were less likely than those who didn’t to report “suboptimal” health.

How Much to Drink?

Quantity is the big question. How much should a person drink to benefit from the health effects of alcoholic drinks? The answer overwhelmingly given by all researchers and medical experts is to drink moderately. But, of course, the word “moderate” can be a bit vague.

At a conference on the effects of alcohol on health sponsored by the New York Academy of Sciences, Dr. Arthur L. Klatsky, a highly respected researcher on the epidemiology of alcohol, and Dr. Roger Ecker, a practicing physician, presented an “algorithm” for helping doctors advise patients on how much to drink. Their recommendations of moderate drinking for people who have coronary heart disease or two or more risk factors for it, are for one to three drinks a week for men between 21 and 39 years of age and women between 21 and 49. They further suggest that men 40 or older and women 50 or older consider adding moderate amounts of alcohol to their diets if they have heart disease or one or more risk factors for heart disease. Exceptions are made for pregnant women and recovering alcoholics and other preventive measures, such as stopping smoking, are also encouraged.

Dr. Harvey Finkel, Clinical Professor of Medicine at Boston University School of Medicine, studies the effects of alcohol on the heart. Dr. Finkel says that men should drink one- to three-ounce servings of alcohol a day (a standard drink being approximately one-half ounce of alcohol), with three drinks being the maximum, and that women should drink half that amount. He claims the difference in quantity is not due to the average differences in body weight between men and women, but due to the difference in men’s and women’s stomachs’ ability to break down alcohol. Dr. Finkel goes on to say that four drinks a day does more harm than good and that death rates are higher for heavier drinkers than for abstainers.

The American Heart Association Dietary Guidelines also recommend moderation in drinking alcohol. Their definition of moderation is an average of one to two drinks a day for men and one for non-pregnant women. A drink is defined as either 12 ounces of regular beer, five ounces of wine, 1.5 ounces of 80-proof spirits or one ounce of 100-proof spirits.

It is worth mentioning that on subjects ranging from the definition of “moderation” to the consumption of alcohol by pregnant or nursing women, US scientists tend to set lower limits than their European colleagues. There seems to be a suspicion in the American medical establishment that people will take any advice on the moderate consumption of alcohol as a license to abuse alcohol, which everyone agrees is bad for you.

Drink to Your Health

For many centuries and in many languages, we’ve raised our glasses to one another and toasted good health. Perhaps we realized subconsciously that our foam-topped mugs were packed with compounds that did us good; perhaps it was just wishful thinking.

Now, a century of observations, and two decades of hard-headed scientific examination have confirmed our best hopes: the beer that bring enjoyment, refreshment, and convivial times with friends can also contribute to a healthier life in which to enjoy those pleasures.

To your health!