The Grape, the Grains, and Your Cholesterol: Drinking (moderately) to your health, Watching your alcohol intake, Knowing the risks of ignoring the moderately part and Getting the scoop on the nutrients in alcohol.

The Grape, the Grains, and Your Cholesterol

In This Chapter

� Drinking (moderately) to your health

� Watching your alcohol intake

� Knowing the risks of ignoring the moderately part

� Getting the scoop on the nutrients in alcohol

Alcohol beverages are among mankind’s oldest home remedies and simple pleasures. The ancient Greeks and Romans called wine a gift from the gods — now that’s holding it in pretty high regard. As for distilled spirits, the Gaels (early inhabitants of Ireland) called them uisgebeatha (whis-key-ba). The French came up with eau de vie (o-duh-vee). And the Scandinavians dubbed the hard stuff aquavit (ah-kwa-veet). Take your pick — they all mean “water of life.”

The funny thing is that this translation may turn out to be a scientifically accurate description. Drinking moderate amounts of alcohol appears to benefit your heart. (No, that doesn’t mean you should start drinking if you’ve been abstaining from drinking up to now.)

Yes, excessive drinking is hazardous to your health, and you can read about that later on in this chapter, but first, the good stuff, including alcohol’s ability to lower your cholesterol.

Wait! One more thing. Throughout this chapter — and throughout this book — beer, wine, and spirits are called alcohol beverages, not alcoholic beverages. After all, who ever heard of a beverage that can drink enough to become an alcoholic?

Toasting to Your Heart

The Dietary Guidelines for Americans 2005 from the U.S. Department of Agriculture and Department of Health and Human Services is a primer for healthy eating (and drinking). So you may be interested to read that the guidelines state flat out that compared to nondrinkers, adults who consume one to two alcohol beverages a day appear to have a lower risk of coronary heart disease.

Clearly, the Guidelines’ authors, sober scientific ladies and gentlemen every one, have been doing their reading. Which is to say, they’ve been looking at a series of recent studies showing that moderate use of alcohol beverages has the following effects:

� Lowers total cholesterol

� Raises levels of “good” cholesterol (check out these high-density lipoproteins, also known as HDLs, in Chapters 2 and 3)

� Lowers blood pressure

� Relaxes muscles (including the heart muscle)

Okay, you’re right. Maybe that last bullet point doesn’t affect your cholesterol, but it does make you feel good. Does all this sound good enough for you to take a look at the data that convinced the experts? If so, keep reading.

Studying the studies

The evidence that moderate drinking benefits the heart comes from really reliable studies from real, reliable sources, such as the American Cancer Society (ACS), the American Heart Association (AHA), and the long-running, 70,000-women Nurses’ Health Study (NHS) from the Harvard Medical School, Harvard School of Public Health, and Brigham and Women’s Hospital in Boston. Hey, it don’t get more reliable than that, right?

Here are the studies of proof:

� Really Reliable Study #1: The ACS’s Cancer Prevention Study I (CPS-I) fol- lowed more than 1 million Americans in 25 states for 12 years. Analyzing the lifestyles of 276,802 middle-aged men and the circumstances of those who died during the study period, the researchers concluded that men who drink moderately lower their risk of heart attack — 21 percent lower for men who have one drink a day than for men who never drink. In addition, men who have one or two drinks a day are 22 percent less likely to die of a stroke.

� Really Reliable Study #2: An analysis of the data for nearly 600,000 women in CPS-I showed that, like men, women who drink occasionally or have one drink a day are less likely to die of heart attack than women who don’t drink at all.

� Really Reliable Study #3: In 2002, researchers at the NHS issued a new report on 70,891 women who were 25 to 42 years old when the study began in 1989. This time the subject was alcohol. The conclusion? Women who have one-quarter to one-half drink a day — in real life, this equals two or three drinks a week — are 15 percent less likely to develop high blood pressure than women who never drink. At the other end of the spectrum, women who have more than ten drinks a week are 30 per- cent more likely to have high blood pressure. The results were the same regardless of the type of drink (beer, wine, or spirits) the women preferred. Nice.

Subscribe to the NHS newsletter, which details the current progress of both the original Nurses’ Health Study and the Nurses’ Health Study II. Visit www.channing.harvard.edu/nhs/newsletters/index. shtml.

What happens as alcohol moves through your body?

How is it that alcohol beverages may benefit your heart, your blood vessels, and your cholesterol profile? First, a bit of physiology. Unlike other foods, which must be digested before your cells can absorb them, alcohol can flow directly through body membranes into your bloodstream.

For example, when you eat a burger, none of its protein, fat, carbs, vitamins, or minerals get into your bloodstream until the burger has made its way through your stomach and your small intestines.

The latest edition of Nutrition For Dummies (Wiley), which I also wrote, has an entire chapter on how alcohol affects your body. But for an outline of the path that the grape juice, oops, alcohol takes, check out these steps:

1. You take a sip of a really good merlot (or my personal favorite, Chianti).

2. Small amounts of alcohol immediately pass through the membranes of your mouth and throat into your bloodstream.

This process happens so fast that the alcohol reaches your brain within seconds of your sip.

3. Some of the alcohol goes directly from your stomach to your bloodstream.

4. Most of the alcohol goes from your bloodstream to all the organs (such as your heart) in your body.

5. Alcohol relaxes the heart muscles, reducing the force with which the muscle contracts (your heartbeat).

6. Your heart pumps out slightly less blood for a few minutes.

7. When your heartbeat slows and your heart pumps out less blood, a couple of things occur:

• Blood vessels all over your body relax, and your blood pressure goes down.

• Blood platelets — the particles that make it possible for blood to clot — become less sticky and less likely to clump together. For a while (oh, maybe an hour or so), your risk of blood clot-related heart attack and stroke goes down.

8. Your heart muscle’s contractions soon return to normal, but as the alcohol circulates through your body, your blood vessels may remain relaxed, and your blood pressure may remain low for as long as half an hour.

Although the immediate result of moderate drinking is beneficial, heavy drinking or alcohol abuse can raise your blood pressure over the long term.

Focusing on cholesterol

Lipoproteins, the fat-and-protein particles on which cholesterol travels, come in two varieties:

� HDLs (high-density lipoproteins) are labeled good because they carry cholesterol out of the body.

� LDLs (low-density lipoproteins) are called bad because they take cholesterol into your arteries.

But as Chapter 2 explains, when you’re talking lipoproteins, size is as important as type because large LDLs are less likely than small LDLs to make their way into arteries.

The Cardiovascular Health Study (CHS), funded by the National Heart, Lung, and Blood Institute (NHLBI) was designed to evaluate risk factors for heart disease in men and women 65 and older. Data from the 1,850-person study, which ran from 1989 to 1999, has served as a base for more than 400 research papers and 120 follow-up studies.

In 2007, a team of researchers from Beth Israel Deaconess Medical Center (Boston), the University of Pittsburgh, the University of Vermont (Burlington) and the University of Washington (Seattle) combed through the CHS’s data in search of medical gold. What they found was that men and women who consumed 7 to 13 drinks a week had the highest number of small LDLs, which have a higher chance of getting into the arteries, thus increasing their risk of blockage. Score another round for moderation — one to two drinks a day.

Identifying Alcohol’s Heart-Healthy Compound

If you’ve read the previous pages of this chapter, you’ve gathered that moderate drinking has a few benefits. But what exactly is in the alcohol beverages that does the trick? I’m glad you asked.

Unfortunately, the studies that show alcohol’s benefits for your heart and blood vessels don’t necessarily agree on exactly which kind of alcohol beverage or which constituent in the beverage makes moderate amounts of alcohol beneficial. Is it the alcohol itself? Or something else?

Surveying the studies

On the one hand, lots of studies show similar benefits with all kinds of alcohol beverages — beer, wine, and spirits — suggesting that the active ingredient may simply be the alcohol.

On the other hand, one or two studies have shown special benefits for beer. The best you can say about this development is that it’s just one or two studies; before accepting this as a medical gospel, you’d have to see — yes — more studies.

Grooving on grapes

Grape skins and pulp are rich in resveratrol, and grapes belong on a heart-healthy diet. Not only are they low in calories, they’re high in nutrients and yummy as all get out. A single serving of 20 green Thompson seedless or deep-red Tokay or Emperor grapes has 70 to 80 calories, 12 to 16 percent of the recommended daily allowance of vitamin C, and up to 84 percent of the potassium in 1⁄2 cup of orange juice. And there’s a teensy little bit of dietary fiber in the grape’s skin, plus astringent tannins that make your mouth pucker.

Maybe that’s why Mae West, your great-great- grandpa’s sex symbol, whose delightfully raunchy wit is available today on DVDs from the very modern Amazon.com, used to ask her beaus to “peel me a grape.” If you want to peel the grapes you toss into your fruit salad, choose American varieties such as the Catawba, Concord, Delaware, Niagara, or Scuppernong. These grapes are called “slipskins” because (surprise) the skin comes off easily. Peeling a European variety, such as an Emperor, Tokay, Malaga, Muscat, or Thompson, is more of a challenge. Here’s a little Euro-grape-peeling lesson:

1. Drop the grape into boiling water for a few seconds.

2. Then fish it out with a slotted spoon (to spare your fingers).

3. Finally, plunge the little darling into cold water.

The hot water makes the water under the skin expand so the skin swells; the cold water makes it burst and peel back.

Or you can just eat your grapes with the skin on.

Note: Ounce for ounce, you get more resveratrol from grape juice than from plain grapes. The darker the juice, the higher the resveratrol. Drink up! The following minitable shows you the nutrients in grapes and grape juice, depending on the kind of grapes you ingest.

On the third hand — there’re always more than two hands in this kind of discussion — the first hint of alcohol’s heart benefits showed up in France, where folks eat lots and lots of high-fat food — pâté! cheese! butter! — but generally have a lower rate of heart disease than people in the United States. Researchers eventually linked this situation, sometimes called “The French Paradox,” to the facts that (a) the French serve their fatty foods in very small portions, and (b) the French also drink lots and lots of wine.

Nothing in science is ever simple, is it?

Since researchers have turned their attention to the heart-healthy French, several studies have shown a correlation between low heart disease, favor- able cholesterol profiles, and red wine consumption. This research leads to the interesting possibility that the important ingredient in alcohol is actually something in the skin, pulp, and seeds of grapes — the parts of the fruit more widely used in making red wines. Ladies and gentlemen, meet resveratrol.

Zeroing in on resveratrol

Resveratrol is a flavonoid, one of a group of plant chemicals credited with lowering cholesterol and reducing inflammation of body tissues, such as the lining of blood vessels, thus reducing your risk of heart attack.

The juice from purple grapes has more resveratrol than the juice from red grapes, which has more resveratrol than the juice from white grapes. (Get the red wine connection?) To be even more specific, in 1998, a team of food scientists from the USDA Agricultural Research Service identified a native American grape, the muscadine, as an unusually potent source of resveratrol. About half of all muscadines grown in the United States are used to make grape juice. With that in mind, nondrinkers can get their resveratrol from grapes and grape juice. Don’t you love it when science serves up something for everybody?

Drinking in Moderation

So far in this chapter, we’ve been talking about the benefits of moderate drinking. Here’s what “moderate drinking” means, from the Dietary Guidelines for Americans:

� One drink a day for a woman

� Two drinks a day for a man

Damaging the liver

Alcohol has to be metabolized in the liver by ADH, which is found in the mitochondria (the cellular powerhouses that convert nutrients into energy-yielding molecules that fuel the cells) of the liver cells. If the amount of alcohol presented to the mitochondria exceeds the amount of alcohol the enzyme can detoxify, the alcohol poisons the mitochondria and causes the liver cell to die.

The first change in the liver is seen as fat depositing in the liver cells. If excessive alcohol ingestion is continued, alcoholic hepatitis (an inflammation within the liver cells) occurs.

If excessive ingestion of alcohol is stopped at either of these first two stages, the liver cells may return to normal.

The liver is one of the few regenerative organs in the body. If you surgically remove half of the liver, the body will regrow the half that’s removed. If, however, excessive alcohol ingestion continues, cirrhosis, the final stage of liver damage, occurs. Cirrhosis is a scarring of the liver cells that’s an irreversible stage of liver disease and frequently leads to death.

Why does moderate mean different things for men and women? It’s an enzyme thing. To metabolize (to get rid of, to use up) the alcohol you drink, your body calls on enzymes called alcohol dehydrogenases (ADH). You produce one form of ADH — gastric alcohol dehydrogenase (GADH) — in your stomach (where alcohol metabolism begins) and another form of ADH in your liver, the primary alcohol-metabolizing plant.

The average woman makes less GADH than the average man. As a result, more unmetabolized alcohol flows from her stomach into her bloodstream on its way to her liver. With more unmetabolized alcohol in her blood, the average woman is likely to become tipsy on smaller amounts of alcohol than is necessary to produce the same effect in the average man.

Most people (men as well as women) need a full hour to produce enough ADH to metabolize the amount of alcohol — 1⁄2 ounce — in one drink. But that’s an average: Some people still have unmetabolized alcohol circulating in their blood for as long as two to three hours after they take a drink.

Which brings me to the next question: What’s one drink? According to the American Heart Association, one drink equals

� 12 ounces of regular beer

� 5 ounces of wine

� 1.5 ounces of 80 proof distilled spirits

� 1 ounce of 100 proof distilled spirits

What makes these different amounts of beer, wine, and spirits equivalent? Each serves up approximately 15 grams of ethyl alcohol, the only alcohol used in alcohol beverages.

Checking Out the Risks, Too

Alcohol is a serious product. Having read this far, you know it has benefits. But you can assume that it also has risks. You’re right.

The following sections focus on the risks of alcohol consumption.

Alcohol and cancer

The same studies that applaud the effects of moderate drinking on heart health are less reassuring about the relationship between alcohol and cancer:

� The American Cancer Society’s Cancer Prevention Study I shows that people who take more than two drinks a day have a higher incidence of cancer of the mouth and throat (esophagus).

� Researchers at the University of Oklahoma say that men who drink five or more beers a day double their risk of rectal cancer.

� American Cancer Society statistics show a higher risk of breast cancer among women who have more than three drinks a week.

The reassuring note? With the exception of breast cancer, the damage appears to be linked to amounts of alcohol that exceed the moderate levels set by the Dietary Guidelines for Americans. For info on the moderate levels, see the “Studying the studies” section earlier in this chapter.

Alcohol and birth defects

Fetal alcohol syndrome (FAS) is a collection of birth defects including (but not limited to) low birth weight, heart defects, retardation, and facial deformities.

FAS has been documented only in babies born to women who experts describe as “chronic alcohol abusers who drink heavily during pregnancy.” No evidence ties the syndrome to one or two drinks during pregnancy, or even one or two drinks a week during pregnancy.

About 7 percent of the babies born in the United States each year have a birth defect. Often the parents of these children feel guilty even though their behavior had absolutely nothing to do with the birth defect. To make the case even stronger, the U.S. federal government requires that a warning about birth defects appear on all bottles of alcohol beverages.

To date, no solid scientific medical evidence says, “Avoid all alcohol while pregnant.” But human beings are complicated forms of life, and the possibility of lifelong guilt if you have a drink while pregnant and then deliver a child with birth defects isn’t worth the moment’s pleasure.

Alcohol and the morning after

The stories from the morning after a night of too much alcohol aren’t fiction. They’re a miserable physical fact.

If you ever have too much to drink one evening, the next morning you may experience many of the following symptoms:

� You’re thirsty because alcohol, a diuretic, has caused you to lose a lot of water through excessive urination.

� Your stomach hurts because alcohol irritates your stomach lining.

� You’re queasy because having your stomach irritated stimulates the release of extra stomach acid and histamine, the same immune system chemical that makes the skin around a mosquito bite red and itchy. (Who wouldn’t be queasy when her stomach looks like one big bug bite?)

� Your muscles ache because processing alcohol through your liver requires an enzyme normally used to convert lactic acid, a byproduct of muscle activity, to compounds you can use for energy. The extra lactic acid piles up painfully in your muscles.

� You have a headache. Alcohol dilates (relaxes) blood vessels, including some in your scalp. The dilated blood vessels swell, making your head hurt.

And when you’re talking headache, don’t forget the Red Wine Problem. When grapes ferment, their protein molecules split into fragments. One fragment, called tyramine, slows your body’s metabolism of alcohol, so alcohol keeps circulating through your bloodstream, causing a headache and other unpleasant sensations. Red wine has more tyramine than other kinds of alcohol.

A word to the wise

When experts talk about alcohol abuse, they don’t mean warming the vodka or chilling the brandy. The foodies among us may wince, but these gourmet gaffes aren’t the point. They mean allowing alcohol to interfere with your ability to enjoy a normal, productive life. If you or someone you know is drinking too much, too often, don’t miss this easy opportunity to find help.

1. Get up right now and walk over to your computer.

2. Turn it on.

3. Connect to the Internet.

What? You have broadband and it’s always

on? Well, skip this step and go to Step 4.

4. Go to this site: www.findtreatment. samhsa.gov.

You’re now looking at the Web site for the Substance Abuse & Mental Health Services Administration (SAMHSA), a division of the U.S. Department of Health and Human Services. This particular page enables you to find a treatment center right in your own backyard.

5. Click on the link to the treatment facility locator.

You get a map of the United States.

6. Click on your state, and a short question- naire pops up.

The nice folks at SAMHSA have already filled in your state.

7. Add your city.

City and state are required, but you can narrow your search by including your zip code, street address, and the radius around your home.

8. Click Continue to get a map of your neigh- borhood with the treatment centers clearly marked.

Try it. Your friends and loved ones will certainly cheer you on. If you don’t have Internet access readily available, try calling 800-662-HELP (4357).

These results are inevitable if you drink too much. Only time heals by enabling you to metabolize alcohol and eliminate it from your body. Hangover remedies or preventives are myths. For example, some people say that you should take an aspirin while drinking to avoid the headache, but the aspirin will intensify the irritation of your stomach lining. To avoid the morning after, drink moderately the night before.

Alcohol and sulfite sensitivity

Sulfur compounds (sulfites) are preservatives widely used to protect the freshness of products such as dried fruits. Some wines also contain sulfur compounds to slow down spoilage by yeasts still active in an aging wine.

Unfortunately, some people are sensitive or allergic to these compounds

and may experience potentially serious reactions if exposed to foods contain- ing sulfites. To avoid problems, the government requires all alcohol products containing sulfites to say so on the label. Sounds sensible to me.

An allergic reaction to sulfites can be life-threatening. If you experience intense itching, hives, swelling of your body, a “tight” feeling in your throat (due to swollen tissues), or breathing problems after drinking alcohol, go directly to the closest emergency room or call 911.

Alcohol and drug interactions

If you drink alcohol, even once in a while, when your doctor hands you a prescription, hand her a request for the lowdown on how the drug may interact with alcohol. The grape and the grain make some drugs stronger and reduce the effectiveness of others.

Table 10-1 lists some of the known interactions between alcohol and a few common prescription and over-the-counter (OTC) drugs. This short list gives you an idea of some of the general alcohol-drug interactions likely to occur, but it’s definitely not complete.

Always check with your doctor — or pharmacist — to be sure that your medication isn’t on the alcohol no-no list.

Rating Alcohol Beverages as Food

People make alcohol beverages from virtually every sugar-containing, carbohydrate food found on the planet, but the most common choices are cereal grains, fruit, honey, and potatoes. All these foods produce alcohol when fermented, but the alcohols have slightly different flavors and colors.

Counting content

No alcohol beverage is 100 percent alcohol. The beverage is always alcohol plus water and, if it’s a wine or beer, some residue of the foods from which it was made. You can tell how much alcohol is actually in an alcohol beverage through the following two ways:

� Alcohol by volume: Alcohol by volume measures the amount of alcohol as a percentage of all the liquid in the container. For example, if your container holds 10 ounces of liquid and 1 ounce of that liquid is alcohol, the product is 10 percent alcohol by volume. A simple equation: Alcohol content÷Total amount of liquid = Alcohol by volume.

The label on every bottle of wine and spirits sold in the United States must show the alcohol content as alcohol by volume (written as 12% alcohol by volume or Alc. 12% by vol. — check out Figure 10-1). When talking to each other, people who make and market alcohol beverages sometimes use the shorthand abbreviation ABV, but this isn’t permitted on beverage labels. For reasons too complicated to explain in less than, say, ten pages, using the term alcohol by volume or proof on beer bottles or cans is optional. Figure 10-1 shows you where to find the ABV on a typical wine label.

� Proof: The label may also show proof, an older way of measuring the alcohol in an alcohol beverage. Proof is two times the alcohol by volume. For example, an alcohol beverage that’s 10 percent alcohol

by volume is 20 proof. Simple equation: Alcohol by volume × 2 = Proof.

Counting calories

On its own, alcohol has no nutrients — zero, zilch, zip — other than energy (7 calories per gram), so distilled spirits such as whiskey have nothing to offer, nutritionally speaking, other than calories. Beer, wine, cider, and other fermented beverages contain some of the food from which they were made, so they also contain small amounts of proteins, carbohydrates, vitamins, and minerals.

Tables 10-3 and 10-4 show the nutrient content for one serving of several types of alcohol beverages. As you can imagine, the amounts listed here are averages. For example, some sweet wines may have higher amounts of carbohydrates (sugars) than this chart shows, but very dry (not sweet) wines have less. Just go with the flow.