At a recent meeting of the Coronary Artery Disease Research Association¹ a distinguished cardiologist talked to the mainly lay audience on the benefits of red wine. Fashions in medicine change. Doctors of my father´s generation prescribed alcoholic drinks for many different health problems and in doing so were following the example set by their predecessors since the days of Hippocrates and the Romans.

Fifty years ago all the advantages of alcohol were forgotten and the opinion of the medical profession became as strict as those of a non-conformist Victorian minister. Many patients, especially those at risk of heart disease, must have suffered. When in the early 1980s I talked on the radio about the advantages of alcohol, another chat show programme host was so shocked that he referred to my comments - now accepted by the overwhelming majority of doctors and scientists - as being those of an irresponsible drunken Dr O´ Booze. Only the bankruptcy of the radio station halted the libel action.

Alcohol is back in fashion as an aid to health. There is a difference. It is moderate drinking that saves lives, whereas excessive drinking may kill. Tee totallism may not allow someone to live a long, healthy, intellectually active life, which they could equally have enjoyed if they had had the odd glass or two, but unlike heavy drinking, it won´t shorten it.

The inevitable questions asked by patients when told about the advantages of alcohol are what constitutes modest drinking it is important to choose the right drink and whether, if someone settles for wine, the type and colour are significant.

The amount that someone can drink with benefit varies. Women, who metabolise alcohol in a slightly different way from men, can in general drink a third less. The amount they can take without suffering ill effects is also related to their hormone balance and varies throughout their cycle. Although women become drunk more quickly and sober up more slowly than men, they have one important advantage: the benefits to a woman´s heart and arteries, if she drinks modestly, is greater than it would have been had she been a man. In men who drink in moderation, the reduction in the coronary rate is about forty per cent; for women - according to recent research from New Zealand - it may be as much as sixty to eighty per cent.

Tall, muscular people are able to drink more without adverse effects than short, plump ones. Drinking with food and when sitting down are less likely to cause trouble than drinking while standing at the bar. It used to be thought that regular drinkers, who had never indulged to the point at which they suffered liver damage, could increase by a quarter their ability to hold drink without becoming drunk. Research conducted by the Medical Research Council has showed that this was an underestimate. The hardened, but not drunken, tippler could drink a third more than his or her teetotal friend without suffering ill effects. The maximum benefits for the average woman, if such a person exists, is achieved by taking one or two glasses of wine a day or its equivalent in other alcoholic drinks. For a man, the greatest overall advantage to health is attained for those who drink up to four small glasses of wine a day. These recommendations are made so that the mythical average person would be unlikely to suffer damage from alcohol and would receive maximum benefit. The benefit that would be reaped by the heart and arteries is achieved by taking rather more (but not excessive) amounts of alcohol, but the downside is that there is a greater risk to other aspects of health.

All alcohol in moderation has benefits for nearly everyone. There are a few exceptions, including those with epilepsy, schizophrenia, pancreatitis and liver disease. Pregnant women should drink only one or two small glasses of wine a week.

Red wine confers more advantages on health than white wine, beer or spirits but this doesn´t imply that all drinks other than wine are not health-giving. The advantages of red wine over white, stems both from the way it is made (the skin in red wine plays a more important role in its preparation), where the grapes are grown - a warm but damp climate is necessary to nurture them so that the resulting red wine is cardio-protective - and by the process of manufacture. The healthiest wine is a comparatively new one that has been made by an old-fashioned process. Any attempt to hurry the development of a wine by prematurely ageing it removes some of its medicinal value.

The reason why red wine is better for the heart and arteries than white, or other alcoholic drinks, is related to the antioxidants it contains. These are dependent on the polyphenols and flavonoids in the wine. Some of their formation may vary according to the nature of the soil, but most are derived from the biological systems that are active on the grape´s skin. If the grape skins are baked in a relentlessly hot sun every day, as happens in many parts of the New World where wines are made, the natural processes taking place on the skin are halted. Good wines from the doctor´s viewpoint, but not necessarily the wine experts, are likely to have grown in warm, but moist areas. This allows a variety of fungi and moulds to flourish on the grape and thereby increase its polyphenol level. No one part of the world has a monopoly of these areas, but there are more with the right microclimates in France, Germany, parts of Italy and some of the valleys in China and Argentina than in sun-baked New World vineyards.

Alcohol in all forms makes blood less likely to clot readily and it increases the amount of heart-protecting good cholesterol and reduces the amount of the artery-damaging pernicious form of cholesterol. It improves the health of the lining of the arteries. The antioxidants in alcohol have many other advantages, but once the intake rises, the benefits conferred on the arteries are obscured by the damage to a person´s general health by obesity, liver disease, pancreatitis and even dementia.

¹The Coronary Artery Disease Research Association supports study into arterial disease at the Royal Brompton Hospital in London, arguably the most prestigious chest and heart hospital in the UK.

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