Can’t Win For Losing

This morning while eating breakfast I came across a story in the newspaper announcing that an occasional glass of wine can increase a woman’s chance of developing breast cancer by 15%. I immediately rushed across the room to where my wife was standing and swatted the Cabernet Sauvignon Napa Valley 2007 out of her hand before she had a chance to take her first deadly sip. Her mouth dropped open and her eyes gleamed with what I’m sure was gratitude for my quick thinking and decisive action. The next moment, though, the fact that I’m a heart doctor popped into my head and I recalled that we cardiologists have been promoting the heart-friendly attributes of regular wine ingestion for years. Much to my wife’s confusion, I quickly retrieved a new glass from the cupboard and poured her a 2007 James Berry Vineyard Paso Robles and encouraged her to slurp it down with utmost exigency. Whew! Another heart attack averted.

Okay, so I made up most of that story. My wife would never drink wine first thing in the morning—it would interfere with her usual morning ritual of Red Bull-Vodka-Bloody Mary mix.

The part about the newspaper article is true, however. Sure enough, researchers at Harvard (Where else? Leave it to East Coast elites to study wine. What will they evaluate next? The effect of Brie ingestion on prostate cancer? I guess we’ll have to look to the scientists in Milwaukee for guidance on beer intake.) found that women who drink as few as 3 to 6 glasses of wine a week had a modest rise in the risk of breast cancer. We’d previously known that more egregious intake of alcohol was a breast cancer risk but this is the first study confirming that wine at even low dose can be deleterious. The study, published in this month’s Journal of the American Medical Association, both helps us better understand how to prevent breast cancer and throws a wrench into what used to be a pretty straightforward recommendation about how to avoid heart attacks.

Heart doctors have been recommending red wine for years. A glass with dinner every night is known to cut your chance of dying from a heart problem by about 25%, owing largely to the high concentration of the antioxidant resveratrol found in grape skins as well as alcohol’s intrinsic ability to raise the protective form of cholesterol (HDL). Nearly all cardiologists agree on the beneficial effect of modest red wine use.

So what is a woman to do? Drink wine and you’ll get breast cancer. Avoid it and you’ll drop dead of a heart attack. Worry about the whole issue too much and you’ll get an ulcer.

The real treatment needed is just a good dose of common sense. Life is full of medical ambiguities. As a cardiologist I recommend regular exercise. Running for a half hour a day will cut the risk of heart disease, prevent obesity and diabetes, and improve longevity. Talk to other doctors, however, and you’ll get a different story altogether. The orthopedist will tell you that running is bad for the joints and will lead to the need for knee replacement. The dermatologist will admonish you for the time you spend outside in the sun and scare you with the threat of skin malignancy. A trauma surgeon will remind you of every case she’s ever seen of runners being clipped by inattentive drivers. The bariatric surgeon will chide you for cutting into his business.

We see the same thing with various pharmaceuticals. We cardiologists love beta-blocker medications, but the allergists, asthma specialists, and urologists would just as soon see this class of drugs disappear. Warfarin thins the blood and prevents strokes (good) but also thins the blood and promotes bleeding (bad). Most drugs work by poisoning some enzyme or bodily function in order to promote a more favorable enzyme or bodily function.

So what do you do? Well, I suppose you could lock yourself in your bathroom for the rest of your life and avoid every bad thing that we doctors say is bad. Sure enough, with that strategy you’d never succumb to cirrhosis, basal cell skin cancer, or get run over by a car while out jogging. Just don’t forget that in any given year you stand a 1 in 807,349 chance of drowning in your own bathtub.

Here’s my advice. Avoid the things that pose a clear risk to life and limb: smoking, excessive drinking, driving without a seatbelt, biking without a helmet, living in Nebraska in the winter, etc. For everything else you’ve got to use your best judgment. One approach to the wine dilemma would be to ask yourself what you care about more: avoiding breast cancer or heart attacks. I disagree with that approach. My recommendation is that you simply ask yourself how much you enjoy a glass with dinner. If a sip of cabernet brings happiness to your life then forget about all our warnings and enjoy it.

The medical establishment is forever putting out warnings, guidelines, recommendations and exhortations, often contradicting established medical dogma. In the end you just have to take all the conflicting information with a grain of salt.

Just not too much salt. That stuff will kill you.