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Regular drinking might explain the French paradox

BMJ 2004; 329 doi: (Published 02 December 2004) Cite this as: BMJ 2004;329:1308
  1. Raghav Chawla
  1. BMJ

    Drinking some alcohol every day is safer than having a week's worth in one go, alcohol specialists said at a meeting in London last week. The beneficial effects of a daily glass of wine may explain why French men and women can eat a diet high in fat yet have less heart disease than populations who eat more healthily.

    Binge drinking, especially among younger people, is becoming an increasing public concern because it can lead to traffic injuries, violence, and unwanted sex, said Professor Morten Grønbæk, director of the Centre for Alcohol Research in Copenhagen, Denmark. However, habitual binge drinking may cause adverse physiological changes, leading to serious health problems.

    For over a decade, scientists and doctors have argued that moderate intake of alcohol protects against coronary heart disease. However, a study published earlier this year that looked at the effects of the alcohol habits of 57 000 middle aged Danes on longevity suggests that the pattern of drinking may be just as important as intake (Addiction 2004;99:323-30).

    “We found that, for a given total level of alcohol intake, there is an increased risk of mortality for people who drink infrequently compared with those who drink frequently,” Dr Janne Tolstrup, principal author of the paper, explained to the BMJ.

    Researchers in Boston also reported an important link between regular drinking and reduced risk of coronary heart disease—in their paper published last year in the New England Journal of Medicine (2003;348:109-18). “The main conclusion of [that] paper is that, in terms of cardiovascular disease, it doesn't really matter how much you drink as long as you drink regularly,” said Professor Grønbæk. However, he warned, this finding had to be put into perspective, as the detrimental effects of a high alcohol intake may outweigh the cardiovascular benefits.

    The link between binge drinking and blood pressure has already been reported by researchers in Ireland, who found that Northern Irish men had entirely different drinking patterns from French men (Hypertension 2001;38:1361-6). “We found that in Belfast, for example, 66% of alcohol was consumed on Fridays and Saturdays, whereas in France it was consumed evenly throughout the week,” Alun Evans, professor of epidemiology at Belfast's Queen's University, told the BMJ. After adjusting for several potential confounders, the researchers found that blood pressure was higher among Northern Irish drinkers on a Monday and decreased until Thursday, whereas the French drinkers' blood pressure remained constant throughout the week. “The French pattern of drinking seems to afford cardioprotection, in contrast to the Northern Irish pattern,” concluded Professor Evans.

    Policy makers need to take account of this research when developing advice for the public, said Professor Grønbæk. “Binge drinking is a serious problem that is on the rise, especially among young people,” he told the BMJ. “[Prevention efforts] should focus more on a daily intake that should never be exceeded rather than on the weekly intake of alcohol.”