Life and the liver

Alcohol is not only good for you, says Dr Thomas Stutaford; it also used to be available on Britain's National Health Service
My father, who taught me much about life and medicine, wasn’t a drinking man, as the term would be understood in the remoter parts of the Fens or marshes of East Anglia. From an early age I and my brothers always joined him in drinking beer at lunch time. As a night-cap, a very liberal measure of whisky was, he thought, a better hypnotic than any produced by the pharmaceutical companies. He recommended that his patients, if they could afford it, should take a glass of sherry or Champagne mid-morning, or if less well off, a glass of Guinness. It is well over 50 years since my father, long since dead, first invited me to join him in his study for his late evening whisky. I can still remember the occasion as if it was last week. I was about 15 or 16 at the time, at an age where today the thought of having a glass of whisky would appall a British social worker and probably produce the police in the United States. The whisky, which we drank neat, had that old-fashioned taste to it which I thought had disappeared until I tasted it again last year. In Skye it is still possible to buy Poit Dhubh distilled in the old, traditional way. As soon as I smelled it, I was transported back to my adolescence. My father was right; there is no better means of putting the day’s worries into perspective than a glass of whisky at night. It is not only a mild soporific but also an excellent tranquilliser, enabling domestic and professional worries to be forgotten before going to bed. It fits well into what is now in the best medical circles known as ‘sleep hygiene’, the tranquillising regime which has to be followed to ensure a good night’s sleep. He may have first learned of the value of whisky, like so many of his generation, in the trenches in the first world war, but his years in practice later confirmed all which he had been taught while medical officer to the first battalion of the Seaforth Highlanders. The health-giving properties of alcohol, when taken in moderation, were acknowledged long before the days of Hippocrates. Although the virtues of wine and beer were usually sung in ancient writings, the distillation of alcohol to make spirits had been discovered many hundreds of years ago, and there is evidence that the ancient Egyptians were not averse to a drop of the hard stuff. The assumption that a reasonable consumption of alcohol led to a longer and happier life was largely, but not entirely, unchallenged until a couple of hundred years ago. The industrial revolution, and the resulting social upheaval, saw an increase in drunkenness and with it a condemnation of all alcohol on health grounds which was largely unjustified. My father and grandfather, together with their nineteenth- and twentieth-century medical colleagues, had no hesitation in prescribing alcohol and it was still available on the National Health Service when I was a junior hospital doctor. The anti-alcohol movement in medicine gained pace from the 1950s onwards, in part as a response to the same trans-Atlantic misconceptions and prejudices which had given the United States Prohibition in the 1920s and 1930s. Ironically, just when British doctors were beginning to follow their American counterparts, other European research was starting to prove that which most of us already knew, that a regular steady dose of alcohol daily would make us less likely to die of heart disease – and many other diseases too – and that it would not only prolong our lives but would make us more intelligent and convivial in old age.Some of the first evidence of the advantages of alcohol came from the post-mortem room. In the 1950s and ‘60s several research surveys showed that when a patient had cirrhosis of the liver, they were more likely to have a healthy cardiovascular system than those whose livers were pristine. This raised the question as to what the heart and the arteries would look like in those drinkers who had never drunk so much that their livers suffered. Even the heaviest drinker only has, at most, one chance in five of developing cirrhosis. Following the rather morbid research in the morgue, others studied the association between heart disease and alcohol. Plotting drinking against survival on a graph, they found that there was a J-shaped curve. Teetotallers and very modest drinkers didn’t fare as well as those who had two or three drinks a day, those who drank more than six drinks a day might have healthier cardiovascular systems and a brighter brain in old age but they were more liable to die early from a host of other complaints.Patients proudly come and tell me that they only drink whisky, or any other drink, on a Friday or Saturday – they like to give their body a rest, they say, on other days. Unfortunately they have been misinformed, there is evidence that a modest daily intake is better for the health and there is little advantage in drinking on one night only. If the drinker overdoes it on the one night, even unwisely takes their miserly government weekly allowance at one sitting, they are very much worse off. Binge drinking is even bad for the cardiovascular system as the heart is apt to develop an irregular rhythm, and it makes the blood more likely to clot readily. On the other hand, regular steady daily moderate drinking makes the blood less likely to clot, and therefore a person less likely to have a coronary thrombosis or ischaemic stroke. Whisky’s beneficial effect on the arteries results from its ability to increase the amount of high density lipoprotein – the good cardioprotective cholesterol – in the blood. In addition, it makes the platelets, the small particles in the blood involved in clotting, less likely to stick together and form an unwanted dangerous clot, and decreases the amount of fibrinogen, another clotting agent. The reports of research which have shown that alcohol reduces the incidence of Alzheimer’s, and makes those who already have some dementia more cheerful and in touch, has come as welcome news. Puritanical doctors were initially dismissive of evidence that this was so but now extensive research in France, Australia and Scandinavia has confirmed original American investigations. The Australian work showed that even those who drank in youth but then abandoned alcohol before they reached later middle age were brighter than their contemporaries, brothers, even twins, who had never drunk at all. The Copenhagen study demonstrated that, provided alcohol wasn’t taken in great excess, the more regular the drinking, the less likely the patient was to suffer from dementia in old age. Should women be drinking whisky? It is well known that women during their reproductive years have drawn the short straw in so far as drinking is concerned. Women don’t have such an efficient metabolic system to deal with alcohol – they have of the less of the enzyme alcohol dehydrogenase – and they absorb it more quickly, hence they become drunk more rapidly and sober up more slowly. However, if they drink wisely, taking only about two thirds of what men do, and restrict their intake, albeit not to the cheese-paring levels suggested by the government, they are likely to live longer, and succumb less early to nearly all diseases. The only exception is breast disease but even this is in dispute. Extensive studies, followed up for many years, among tens of thousands of American nurses, British civil servants and a host of other groups have shown that a regular intake keeps women alive, too. One survey has shown that the greatest benefit to the heart from regular modest drinking in any group of people occurs in post-menopausal women. The argument about which drink is best for the health has run and run. The truth is that all alcohol is good for the overwhelming majority of people when taken in moderation. There are some unfortunate people who suffer from medical conditions who shouldn’t take it, even in small quantities, but they are rare. Although all alcohol is good in moderation, those drinks which have chemicals, known as polyphenols, in their constitution are rather better than those who do not. Polyphenols are naturally occurring substances which act as antioxidants; antioxidants help to keep the arteries clear and some of them may even have anti-cancer effects. This latter quality could account for the reason why very modest drinkers may have a lower incidence of some cancers, albeit that those who drink too much have a greatly increased likelihood of malignant disease. Polyphenols are found in their greatest strength in some red wines but not in all red wines, and they are no more pervasive in white wine than they are in most spirits or beers. The excellent news for whisky lovers is that polyphenols aren’t confined to red wines grown in the warm but moist areas of Europe but can also be found, as has recently been reported in the European Journal of Clinical Nutrition, following studies funded by the Medical Research Council, in a well-matured malt whisky.