Drinking story comes with a cautionary chaser

But Mukamal is leading a study that will randomly assign people to drink alcohol or an inactive lookalike for six months to see if there are heart benefits. Such studies are designed to exclude other possible explanations.

Mukamal thinks Holahan’s group did a good job accounting for such factors as general health, higher socioeconomic status, and more education among the middle-aged and older people in the study who drank up to three glasses of wine, beer, or liquor a day. The researchers also avoided the potential problem of lumping former heavy drinkers in with teetotalers by asking about alcohol history.

They still found a link between moderate drinking and lower mortality. After 20 years, non-drinkers were 49 percent more likely to die than moderate drinkers and heavy drinkers were 42 percent more likely to die.

But on an individual level, people have to weigh their own risks and benefits, Mukamal said. A significant body of research has connected alcohol indirectly to a reduced risk of heart disease. But other scientific evidence implicates alcohol in breast cancer.

“The benefits arising from alcohol almost certainly do not accrue equally to everyone in the population,” he said. “Two people sitting in front of you may have a very different risk of breast cancer and coronary heart disease and are potentially going to experience a different set of benefits from moderate drinking.”

Doctors and patients should discuss family history and current health. People may not know if they’ll become problem drinkers if they haven’t tried more than an occasional drink. There is also the all too common danger of car accidents. And on the plus side of the ledger, if someone’s cholesterol is already low enough, drinking won’t make much of a difference, Mukamal said.

“My hope is these sorts of studies, if nothing else, get physicians and patients talking about this,” he said.

Just remember to be frank with your doctor. Mukamal has a reason for his skepticism: If you tally up how much Americans say they drink, it doesn’t come close to how much alcohol is sold in the country.