SPIRITUOSITY FOR A HEALTHY HEART: FACT OR MYTH?

Presumed benefits of alcohol consumption in improving cardiac health may be misplaced.

Spirituous is broadly defined as something which contains alcohol. Approximately fifty percent of adult patients, when counselled about lifestyle changes, bring up the topic of alcohol ingestion and its presumed benefits for a healthy heart. Thispresumption has been around for many years. Though unrelated to the exchange about alcohol, another issue that crops up during chats on life style changes is the role of meditation and other forms of transcendental techniques (broadly called spirituality) inorder to reduce stress, blood pressure and other risk factors of heart disease.

Motivated by these discussions, I decided to write about the varying perceptions on the role of spirituousity and spirituality in cardiovascular health. The first of this two-part series will discuss the association of alcohol and heart health. The question about alcohol and heart disease finds expression as one out of three questions,which are elaborated towards the end of this essay. Spirituality and its effects on cardiachealth will be discussed in the next writing.

It must be clarified that both spirituous and spiritual, as discussed here, refer to ageneric and broad sense of these terms, and do not refer to a specific type of alcohol or spirituality.

THE FRENCH PARADOX: IS IT FOR REAL?

The phrase “French paradox” refers to an epidemiological observation, made popular in 1991 by Serge Renaud, a scientist from Bordeaux University, France. He observed and subsequently hypothesised that the French, despite having similar dietaryand smoking patterns, as people residing in the rest of Europe or America, had better cholesterollevelsandalower incidence of heart attacks. The benefit was proposed to bedue to moderate alcohol consumption (particularly red wine) which led to an improvement in cholesterol levels (reduction in bad cholesterol and increase in good cholesterol) and due to the antioxidants in alcohol. Specifically, a compound named resveratrol in red wine was postulated to have anti-inflammatory and cholesterol lowering effects, thereby reducing atherosclerosis (the process of fat deposition in blood vessels). The observation, as expected, made instant news and became a basis for several books and TV shows about the benefits of alcohol in heart disease and therebyencouraged alcohol consumption. Red wine got scientific ratification and it became fashionable to justifythehealthbenefitsofsocial drinking.

Scientists, however, have a unique habit of critically analysing every hypothesis, often repeatedly. Studied over subsequent years, the French paradox was sadly found wanting in both the context and content. Contextually, as compared to other developedcountries, there was a flaw in the epidemiological collection and reporting of data. Thisled to an under-reporting of cardiovascular deaths as highlighted by another scientific study published in a reputed journal few years later. Content wise, alcohol consumptionwas given too much credit for the observed paradox. Though few in number, even studiesanalysing resveratrol directly, showed mixed results and were not definitely conclusiveabout its benefits. Finally, other variables including genetic factors or lifestyles such asmediterranean diet, better exercise habits, lower sugar intake, mindful eating and higher water consumption was not given their due importance.

Over the decades, the French paradox has largely been rejected with no definitiveascribable, evidencebased advantage of alcohol consumption on heart health.

OPINION OF SCIENTIFIC SOCIETIES

Both prominent professional societies in the field of cardiology – the American Heart Association (AHA) and the European Society of Cardiology (ESC) - have also issuedspecific guidelines regarding alcohol consumption. These guidelines include advisoriesfor patients after incorporating data from latest studies. The AHA 2021 dietary guidelines“do not recommend initiation of consumption of low amounts of alcohol in an effort toimprove cardiovascular outcomes. If one does consume alcohol, it is recommended tohave no more than 1 drink per day for women and 2 drinks per day for men”. ESC guidelines are similar to those issuedbyaha.

HEART HEALTH INCLUDES CONDITIONS OTHER THAN CORONARY ARTERY DISEASE (CAD)

Historically, concern about CAD (blockages in the blood supply to the heart) has dominated concerns and conversation about heart health. Society is less aware about other conditions which may be equally dangerous. This is changing now and over the past few decades other cardiological conditions are being recognized and people are becoming aware of them.

Alcohol has an unquestionable negative impact on many of these. Even in moderation, alcohol causes higher blood pressure, increases chances of atrial fibrillation (irregular heart rhythm), worsens the pumping action of heart (heart failure)and predisposes to congenital heart disease in children born to mothers who consumealcohol during pregnancy.

THREE COMMONLY ASKED

QUESTIONS (AND RECOMMENDATIONS)

Question 1 – Should one start consuming alcohol to improve cardiovascular health? The answer to this is an emphatic no! No professional body or society recommends alcohol as a primary prevention strategy for heart health.

Question 2 – Can one continue to consume alcohol if he/she is in good cardiovascular health? The answer to this has to be more nuanced.

If one is a controlledmoderate, non-binge drinker (as defined by AHA above) and can manage a few alcohol- free days in a week, he may continue alcohol consumption. This,however,isonlyasocial habit and should not be construed as a medical recommendation.

Question 3 – How soon after a cardiac event such as a heart attack can one start drinking? The correct answer to this question is never! One must try and never drink after a cardiac event. If one is obligated to, he must wait for at least 6-8 weeks after a cardiacevent before resuming alcohol consumption. Alcohol is a direct heart muscle irritant andcan rarely cause life threatening electrical abnormalities during the recovery phase of aheart attack.

As I conclude this writing, I am acutely aware that some of my friends who are aware of my teetotalism, might be tempted to conclude that this opinion was alwaysexpected from me. I can assure you that I’ve tried to be as scientific and unbiased in thiswriting as possible.