Alcohol and Cholesterol: Can a Drink a Day Really Help Your Heart?

Common Wisdom Says That Alcohol, Particularly Wine, Is Good for Your Heart & Cholesterol Levels

Dan
Dan
January 14, 2019

What effect does alcohol, particularly wine, have on your cholesterol and lipid values? The damage alcohol does to your liver, stomach, and brain – among other organs and body parts – is well documented. However, its effect on lipid values such as cholesterol has long been debated, along with its overall influence on the health of your heart.

“What is the Effect of Alcohol on Your Cholesterol?”

How difficult a question can it be?

Well, entering it into a well-known search engine and diving head first into the results may soon leave you more baffled then you were to begin with. This is largely down to the fact that results seem to differ drastically from one study to the next, a reflection of how difficult it is to pinpoint the effects of one specific element of a diet.

To untangle the web of confusion, let’s first take a moment to understand what cholesterol actually is.

What is Cholesterol?

Your total cholesterol level comprises of both “good” high-density lipoproteins (HDL cholesterol) and “bad” low-density lipoproteins (LDL cholesterol). Cholesterol is a vital component in several processes, including cell building and hormone production. Too much LDL cholesterol, however, accelerates the build-up of fat on the inside of artery walls called atherosclerosis. Atherosclerosis is a major risk factor for cardiovascular disease and other heart complications.

It is a type of lipid, chemicals in the body that are typically fats and oils. One of the other key lipids is a fat called triglyceride.


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When you eat or drink, your body converts unused calories into triglycerides in order to store the energy so that it can be released between meals. Triglycerides account for the majority of your body fat, hence why consuming more calories than you burn is widely believed to contribute to weight gain (the issue of calories’ role in weight gain/loss is hotly debated, but that is a topic for another post).

There are plenty of lipids aside from cholesterol and triglycerides, but it is those that are generally used to measure your lipid profile (also known as a lipid panel). Lipids are essential, but too much or too little of certain types can increase your risk of complications, particularly with your heart.

Cholesterol and triglycerides are measured in milligrams per decilitre (ml/dL). According to Cleveland Clinic, target values are:

  • HDL cholesterol:
    ◦ Greater than 40 ml/dL
  • LDL cholesterol:
    ◦ Lower than 70 mg/dL for those at very high risk of heart disease
    ◦ Lower than 100 ml/dL for those at high risk of heart disease
    ◦ Lower than 130 ml/dL for those at low risk of heart disease
  • Triglycerides:
    ◦ Lower than 50 mg/dL

Your lipid profile may be used by your physician to help determine the best diet, exercise, and medication regime best suited to mitigate the risk of cardiovascular problems.

So, where does alcohol fit into the picture?

Alcohol, Cholesterol, & Triglycerides

With a few exceptions – such as the odd glass of eggnog or cream liqueur you may have enjoyed over the festive season – alcoholic drinks do not contain cholesterol.

They do, however, contain calories, and therefore have an effect on your triglycerides.

Certain drinks contain other ingredients, such as antioxidants, that may also play a role when it comes to cholesterol. The compound that makes an alcoholic drink alcoholic, ethanol, may also influence matters.


Bear in mind that, in the US, moderate alcohol consumption is considered to be up to one standard drink per day for women and up to two for men, with a standard drink being:

  • 12 oz (355 ml.) beer (5% alcohol)
  • 5 oz (150 ml.) glass of wine (12.5% alcohol)
  • 1.5 oz (45 ml.) of 80 proof liquor (40% alcohol)

In each case, the amount of pure alcohol consumed is 0.6 fl oz (14 grams). Guidelines differ from country-to-country; a standard drink may be considered to have anywhere between 8-20 grams of pure alcohol, depending where you are.

If you drink more than these quantities, it is generally accepted that the negative effects of alcohol outweigh any positives that may exist, especially if you do so regularly and/or by a large amount.


Alcohol’s Effect on Cholesterol

Ethanol is the specific type of alcohol that is ubiquitous in alcohol drinks. Over the years, a substantial body of evidence that moderate consumption of any alcoholic drink lowers the risk of coronary artery disease has accumulated, which is partly attributed to its effect on cholesterol.

Even a study published last year, in which the authors say no amount of alcohol is good for you, acknowledged the cardiovascular benefits of moderate drinking.

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A possible explanation is that alcohol appears to boost concentration of apolipoprotein A (apoA), a compound plays in important role in transporting “good” HDL cholesterol, as well increasing transport rates. This subsequently reduced LDL cholesterol levels, as the HDL is more effective at removing it from the bloodstream.

Improvements in other lipid-related biomarkers, including HDL cholesterol itself, have also been identified.

Such studies suggest that alcohol delivers these benefits regardless of the specific type of drink. In one of the studies, vodka was the drink of choice, while others use beer, wine, and other spirits.

However, for each study that concludes all alcoholic beverages are equal when it comes to their effect on cholesterol, another suggests that some are more equal than others. In particular, red wine is often highlighted as the most effective.

Wine: Is Resveratrol the Key?

“It’s good for my heart” is a sentence many people have uttered as they pour themselves another helping of vino, but what evidence is there to support this conventional wisdom?

The Mediterranean Diet is often lauded for its health benefits, particularly regarding heart disease. A 2017 study is one of many that specifically identify its positive effect on cholesterol and overall lipid levels.

One of the staples of the diet is a moderate helping of red wine.

The idea of wine being good for cardiovascular health has for many years been used as a possible explanation for The French Paradox, a term coined in the 1980s concerning the relatively low levels of coronary heart disease in France despite the nation’s high consumption of saturated fat.

The key question, of course, is whether the wine actually contributes to either phenomenon or is simply carried along by the other healthy aspects of the respective diets and lifestyles.

It has been suggested that polyphenols found in wine (vastly more so in red than white) may be the key. One such polyphenol that is found in grape skins, resveratrol, has had been shown to have a positive effect on the cardiovascular health of mice.

Unfortunately, researchers cannot agree whether resveratrol benefits humans in a similar manner. A number of studies – which you can read about here – have found evidence that it does.

However, the resveratrol supplements are often 150mg or above, while a standard glass of even the most resveratrol-laden red wine will only pack around 0.5mg. Many researchers therefore dismiss the notion that the amount of resveratrol in red wine can have noticeable benefits.

Resveratrol is far from the only polyphenol found in wine, however…

Flavonoids and Antioxidants in Wine

Perhaps the secret to wine’s supposed cardiovascular benefits lies in polyphenols known as flavonoids, such as the catchily-named quercetin and catechin. As with resveratrol, red trumps white for flavonoids.

These flavonoids have been shown to protect “LDL against copper ion-induced oxidation.”

While LDL is considered the “bad” cholesterol, there is evidence suggesting that LDL cholesterol is at its worst when it is oxidized. When oxidized, LDL cholesterol has been linked to the acceleration of atherosclerosis and a subsequent increase in one’s risk of coronary artery disease.

However, while “oxidative stress – an imbalance between pro-oxidants and antioxidants, in favor of the former – is an important contributory factor to the atherogenic process,” studies relating to antioxidant supplements and antioxidant-rich diets have been wildly inconsistent. On top of that, promising results from in vitro (which literally means in the glass) experiments and animal tests have not always been reproduced in human in vivo (meaning: in the living) tests.

This is likely because the human body is extremely efficient at metabolizing these polyphenols, so only a small amount ever fulfils its potential as an antioxidant.

A rather anticlimactic conclusion we can draw from all of this is that there are many unknown factors regarding the human processes surrounding oxidisation and its subsequent impact on atherosclerosis.

It is therefore difficult to determine, with any great conviction, whether wine, the polyphenols contained within it, and its antioxidant role regarding LDL cholesterol really provides any health benefits.

Solving these mysteries is something of a two-pronged process. On the one hand you have researchers using observational studies to identify patterns, cause, and effect, and on the other you have those diving ever deeper into the underlying mechanisms.

For the time being, it is fair to say that a moderate amount wine, preferably red, can certainly form part of a healthy diet and cholesterol levels your heart will appreciate. This is particularly evident with the Mediterranean diet, of which red wine is a staple.

However, discovering quite why red wine seems to have a more profound effect than other alcoholic drinks may take a while yet.

Should You Drink Alcohol?

The body of evidence supporting the theory that alcohol – and red wine in particular – has a positive effect on cholesterol, and cardiovascular wellbeing in general, is compelling. Both ethanol, found in all alcoholic drinks, and polyphenols, most plentifully found in red wine, have been identified as possible drivers of these benefits (even if the specific processes are not fully understood).

BUT

There is also evidence to suggest that even moderate drinking comes with risks that may outweigh those benefits. Logic suggest this is particularly true for individuals who already have healthy cholesterol levels and are not at an increased risk of cardiovascular disease in the first place, but perhaps have a higher risk of developing other diseases that alcohol can exacerbate (take, for example, a young lady who has little risk for heart disease but is naturally at risk for breast cancer – for which alcohol is a risk factor).

Taking highly personal factors such as a history of alcohol or substance abuse into consideration, it becomes even clearer why there is no ‘one-rule-fits-all’.

One must also remember than any benefits alcohol may have are only gained when drank in moderation. Exceeding these boundaries, especially heavily and/or regularly, is unequivocally detrimental to your health in a multitude of ways (including cholesterol, some studies suggest).

Ultimately, alcohol is but one factor of your diet and lifestyle and cannot be relied upon to provide significant health benefits.

As wishy-washy as that may sound as a conclusion, it is reflected in the advice offered by almost every expert, health professional, and organization, which can be summarized rather succinctly:

  • If you do not drink alcohol, the possible benefit to cholesterol levels and cardiovascular health is not significant enough that you should start.
  • If you do drink, doing so in moderation will mitigate the risk of alcohol-related health issues, while potentially having a positive effect on your cholesterol and risk of heart disease.

If you fall into the latter of those, making red wine your tipple of choice may be the best way of improving your cholesterol levels and reducing your risk of cardiovascular disease, when combined with a healthy diet and positive lifestyle choices.


Take a look at some of the other posts on the MyTherapy blog:

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