Mr Kishore Date was a 60-year-old businessman who had recently suffered a heart attack. He was sitting across my desk with his wife and daughter, and we were discussing his plan of care. After about half an hour of going through his history and medications, we came to the point where we needed to discuss his lifestyle habits. When I asked him about alcohol consumption, he replied that he was an occasional drinker. Now, if you have been reading the book up to this point, you will know that I have become very wary of the word "occasional" where it comes to habits, since the word can be used very conveniently to suit the speaker. When I asked him to elaborate how many times a week he drinks, he replied, "Once." Sitting behind him, his young daughter waved three fingers frantically to correct her dad’s version. Mrs Date had no need to be subtle and corrected her husband that his idea of once a week was really thrice a week. A friendly family debate ensued, and I can safely say that I have witnessed hundreds of these debates, some of which are not very friendly.

Is alcohol good or bad for your heart?

The French have a much lower rate of heart disease than the Americans, even though their fat consumption is the same. This led to the coining of the term "French Paradox". Researchers have thought that the consumption of red wine may be one of the reasons for this phenomenon, and hence red wine has been the subject of maximum focus. It should also be noted that many of the studies have been sponsored by the wine industry in different parts of the world. The bulk of the evidence shows that when alcohol is consumed in moderation, it does have a beneficial effect on heart disease. However, before you take this sentence too literally, there are many clarifications that need to be made, the most important being that of the word "moderation".

In most areas of food consumption, especially soft drinks, the Indian version of large is probably half the size of the American version. At 7-Eleven stores in the United States, a Big Gulp beverage is about two litres, which is equal to seven cans of Coca Cola. And this is meant for one person. But in one area, the Indian version of large beats the American, and that is the size of a peg of alcohol. In India, one drink is 60 ml of liquor (such as whisky or vodka), while in America it is 45 ml. In alcohol content, 45 ml of liquor is equivalent to 150 ml of wine or 330 ml of beer. In the studies that have been conducted, moderate drinking is considered to be (up to) two drinks a day for men and one drink a day for women.

One always needs to be cautious by patients’ definitions, especially when it comes to alcohol. The other day I met Jayesh Rupani, the 48-year-old who told me that after bypass surgery the only problem he faced was that he could not control his laughter. Clearly, Jayesh was a jovial gentleman who lived life large (literally too, he was 114 kg). Since he was a restaurateur and nightclub owner, I was worried that alcohol consumption could be an "occupational hazard", and questioned him about it. He assured me that he just had one large drink a day. It turned out that he lived large in this aspect too, and considered a peg to be 75 ml. Now, that is large even by Patiala standards.

The other clarification that needs to be made is that while moderate drinking is shown to reduce heart disease, this is in specific reference to coronary heart disease. When taken in excess though, alcohol can lead to cardiomyopathy (swelling of the heart), and abnormal heart rhythms. Besides these, excessive alcohol may also lead to liver disease and has been recently implicated in some forms of cancer.

How does it work?

The beneficial effects of alcohol have been thought to be through raising good cholesterol (HDL), as well as through antioxidant properties. A lot of these antioxidant properties are obtained from the skin of the grape, which has a substance called resveratrol. The debate is whether the beneficial effects of wine are only because of the grapes, or whether there is some "special property" that wine possesses aside from the grapes. If it is only the grapes, then drinking grape juice could have the same beneficial effects, much to the happiness of many of my patients’ wives.

Besides these effects, alcohol is also theorised to reduce the clotting property of blood in the arteries, having a mini-aspirin effect.

So, should I drink or not?

My advice on this is very clear. If you do not drink currently, please do not start drinking with the idea that it is good for your heart. However, if you do enjoy a drink, then do so in moderation. I would personally define moderation as a maximum of one or two drinks, three days per week. A lot of my patients ask if they do not drink Monday to Friday, could they have six drinks on Saturday night. The answer to that is clearly no, and also, just to remind you, one drink is 45 ml of liquor.

Another common question is when can a person start drinking after a heart attack or interventional procedure. I would personally suggest waiting for a period of at least four weeks after the event.

Let me end with my favourite alcohol and heart disease story. My entire staff and I were at one of our colleague’s wedding reception at the Taj President Hotel in Mumbai, with many cardiologists in attendance. A lot of our patients were there too, including one of our oldest and dearest, Rusi Vimadalal. If you recollect, I had introduced Rusi to you in the chapter on nutrition, when he had complained that he did not want to eat only "ghaas-foos". Rusi had his angioplasty in 2003 and has been following up in our risk reduction programme ever since and progressing well. During the function, Rusi sidled up to me and very secretly pulled out something from his pocket. When he opened his hand, I was shocked to see a miniature bottle of Johnny Walker Black Label whisky in his palm. He told me he suspected the function would be "dry" and true to his boy scout's motto of "always be prepared", he did not leave home without his trusty companion. And to think I tell people never to leave home without a pedometer!