July 31, 2000 -- Doctors have known for some time that a drink (or two) a day may keep heart disease away -- at least for healthy adults. However, doctors were in the dark about alcohol's effects on diabetics. Now, back-to-back studies of nurses and physicians suggest that the same benefit can be found among diabetics who are light to moderate drinkers.
This is an important finding, say experts, because diabetics have a very high risk for heart disease and death from heart attacks. The new findings are reported in the Aug. 1 issue of Circulation: Journal of the American Heart Association.
But Caren G. Solomon, MD, MPH, lead author of one of the studies, tells WebMD that she wants to make it very clear that "this is not an excuse to go out and party." Solomon says the roughly 5,100 diabetic women she studied are women who "don't drink a lot." Solomon looked specifically at type 2 diabetes, which usually occurs later in life in people who are overweight.
She says, too, that the findings are based only on observation: "I wouldn't routinely advise alcohol consumption as a way to reduce [heart disease] risk, but this does suggest that alcohol is not absolutely taboo for diabetic patients." Solomon, who is an assistant professor of medicine at Harvard Medical School in Boston, says the women were all diagnosed with diabetes at age 30 or older and were then followed from 1980 through 1994.
Umed A. Ajani, MBBS, MPH, lead author of the other study, tells WebMD that many physicians have worried that alcohol may affect levels of sugar in the blood of diabetics. He says, however, that findings suggest that moderate drinking, as defined by the American Diabetes Association (ADA), during meals "appears to offer a benefit." The ADA defines moderate drinking as 12 ounces of beer, five ounces of wine, or one and a half ounces of distilled liquor, such as scotch or vodka.
Ajani says that many heart experts think alcohol protects the heart by increasing the level of HDL, the so-called "good" cholesterol. Many diabetics have problems with cholesterol levels, he adds. Ajani says that among the nearly 2,800 physicians with diabetes who participated in the study, those who reported moderate alcohol consumption had a 40% decreased risk of death from heart disease compared to those who didn't drink.
William Kannel, professor of medicine at Boston University School of Medicine, tells WebMD, "Most of the measures recommended for the general population seem to provide an even greater benefit in the diabetic." He says, for example, that controlling high blood pressure in diabetics results in a "an even greater risk reduction than in the nondiabetic."
"The important message here is that diabetes itself is a very hazardous condition for [heart] health and, in fact, diabetics seem to have a very high risk of bad outcomes." For that reason, says Kannel, diabetic patients should be very carefully monitored. Kannel was not involved in these studies but is the former director of a landmark study on heart disease called the Framingham Study.
But, Kannel says, "I wouldn't recommend alcohol for any segment of the population without stressing the need for moderate intake ... diabetic patients also need further attention toward control and avoidance of smoking, as well as good blood pressure and [cholesterol] control."
Timothy J. Regan, MD, writes in an editorial accompanying the study by Solomon that the "patient who is abstinent or using light to moderate amounts of alcohol should discuss the risks and benefits of alcohol consumption with a physician." Regan tells WebMD that he has some concern about the possible abuse of alcohol by patients who may misinterpret these latest studies. Additionally, he says, "Some published data suggest that at two drinks a day, a woman's risk of breast cancer increases." Regan is professor of medicine at the University of Medicine and Dentistry of New Jersey in Newark.
In a second editorial, William S. Weintraub, MD, professor of medicine at Emory University School of Medicine in Atlanta, writes that "it would seem that moderate alcohol consumption is safe and may be beneficial from the point of view of [heart disease] risk in selected populations, both diabetic and nondiabetic. However, there is probably not sufficient evidence to recommend alcohol consumption to decrease risk in any population."
Ajani and Solomon both say that it is too soon to issue across-the-board recommendations. The take-home message, they say, is that diabetics should discuss the potential benefits as well as the risks of drinking with their doctor.