We all know the saying, 'an ounce of prevention is worth a pound of cure,' yet are we keeping abreast of all the latest findings in food and beverages that can make a significant difference in our future health? Tapping into the wealth of research done on the common foods that most people consume can help us maximize our health and longevity.
Surprisingly, some foods previously seen as 'bad' now rank at the top of the 'good' list because of the numerous health benefits they provide. Chocolate and alcohol are now considered healthy foods for the heart, as well as other diseases, when consumed in moderation. Thinking outside the box is necessary to grasp some of the latest findings about our favorite and previously sinful indulgences.
Health by Chocolate
Believe it or not, dark chocolate is a health food. It is currently named as one of the seven healthiest foods you can eat for a healthy heart, right along with wine, fish, fruits, vegetables, garlic, and almonds (Dillinger et al., 2000). The cardiovascular benefits of dark chocolate are significant: it lowers blood pressure (Taubert, Roesen, & Schomig, 2007), reduces insulin resistance (Grassi, Lippi, Necozione, Desideri, & Ferri, 2005), and decreases inflammation (Sies, Schewe, Heiss, & Kelm, 2005). Most of the fat in dark chocolate is stearic acid, which, unlike other saturated fats, has no adverse effects on cholesterol levels because such a high proportion is converted to oleic acid. In fact, it appears to raise the level of high-density lipoprotein, the good cholesterol, while having no effect on low-density lipoprotein (Baba, Osakabe, Kato, & Natsume, 2007).
How does dark chocolate do all these amazing things? Researchers (Dillinger et al., 2000) have discovered that the cacao bean is nature's richest source of polyphenols, a class of phytonutrients with potent antioxidant activity and other therapeutic effects that outweigh the fat and sugar in this delicious treat. Flavanol, a polyphenol, stimulates production of nitric oxide, and nitric oxide acts as a vasodilator in the arteries, lowering blood pressure within a couple of weeks. A recent study (Hermann et al., 2006) documented that dark chocolate induces a rapid and significant improvement in endothelial and platelet functions. Endothelial dysfunction and platelet overactivation are a lethal combination, which is the cause of most heart attacks and strokes. Inflammation is reduced as cocoa flavanols lower concentrations of 5-lipoxygenase, which lowers the level of leukotrienes that are responsible for inflammation, pain, and allergic reactions (Schewe et al., 2001). Dark chocolate has the highest oxygen radical absorbance capacity of any food, and it is more potent than blueberries, raisins, spinach, broccoli, and red grapes (consumed all together) as an antioxidant (Dillinger et al.). Is there any doubt that dark chocolate is a 'food of the gods'?
Recommendations
Physicians who have read the research and see the value of this food recommend eating a daily dose of dark chocolate. Look for bars that contain at least 70% cocoa and eat 40 grams (1.5 ounces or half of a large bar) daily to reap the most benefits. The 225 calories need to be in place of, rather than in addition to, other foods to prevent weight gain. Just think, we can enjoy the smooth, creamy, comforting taste of dark chocolate and experience the 'feel good' pleasure that results from the increased levels of neurotransmitters, while protecting our hearts. Does it get any better than this?
Yes, it does get better. The encouraging news is that there are now cocoa standardized polyphenol supplements that are free of sugar and excess fat and calories. The minimum recommended dose is 30 mg to a maximum dose of 100-130 mg per day (Faloon, 2007). With the calories removed, there is no reason not to avail yourself of the many benefits of cocoa polyphenols.
Health by Alcohol
Alcohol (i.e., beer, wine, and distilled spirits) can also be viewed as a health food. The findings are consistent: daily moderate alcohol intake helps prevent almost all major illnesses and several minor ones, including the common cold. Doesn't this information just sound wrong given the horrors of addiction, driving under the influence accidents, lost lives, lost careers, declining health, fetal alcohol syndrome, domestic violence, and neglected families? How can something so destructive also have impressive redeeming qualities? And how could the advantages of alcohol be known for decades yet many are still not aware of the potential health benefits as well as the hazards of imbibing?
Numerous research studies conclude that moderate consumption of alcohol is associated with better health and longer life than either abstaining from alcohol or abusing alcohol. The medical evidence of this is based on a large number of studies of thousands of people (80,000 to 140,000) around the world, which was done decades ago. More than 10 years ago, a National Institute on Alcohol Abuse and Alcoholism study concluded:
The totality of evidence on moderate alcohol and coronary heart disease (CHD) supports a judgment of a cause-effect relationship. There are cardioprotective benefits associated with responsible, moderate alcohol intake. (Hennekens, 1996, p. 16)
In 1995, a World Health Organization Technical Committee on Cardiovascular Disease stated that the relationship between moderate alcohol consumption and reduced death from heart disease could no longer be doubted (Wilkie, 1997). Based on the medical evidence, noted investigator Dr. Curtis Ellison claimed: 'Abstinence from alcohol is a major risk factor for coronary heart disease' (2002, p. 7).
However, the benefits of alcohol are not limited to reductions in heart disease, according to Wiley and Comacho (1980). In addition to having fewer heart attacks and strokes, moderate consumers of alcoholic beverages are generally less likely to suffer hypertension or high blood pressure, Alzheimer's disease, and peripheral artery disease. Sensible drinking also appears to be beneficial in reducing or preventing a host of other illnesses, such as Parkinson's disease, osteoporosis, diabetes, rheumatoid arthritis, pancreatic and kidney cancers, erectile dysfunction, liver disease, and macular degeneration, among a host of other disorders (Wiley & Comacho).
Improved Brain Functioning and Alcohol
More recent studies have discovered that abstaining from alcohol and abusing alcohol are both risk factors for cognitive decline and dementia (Andel, Hughes, & Crowe, 2005). However, drinking alcohol in moderation is one of the strategies that can reduce the risk of cognitive decline and dementia in later life. A study of 1,018 men and women, ages 65-79 years, whose physical and mental health was monitored for an average of 23 years, found that drinking no alcohol, or too much, increased the risk of cognitive impairment (Anttila et al., 2004). Moderate drinking among older women can benefit memory, according to research funded by the National Institutes of Health (Stampfer, Kang, Chen, Cherry, & Grodstein, 2005). According to data from 12,480 women, ages 70-81 years, who participated in the long-term study, women who consumed alcohol moderately on a daily basis were about 20% less likely than abstainers to experience poor memory and decreased thinking abilities. In all cases, the group who drank scored better than the group who did not drink. Women who drank alcohol in moderation (defined as consuming up to two drinks of beer, wine, or spirits per day) also performed better on attention, concentration, psychomotor skills, verbal-associative capacities, and oral fluency assessments.
Recommendations
Recommendations for drinking alcohol for good health have to come with serious caveats given the problems of tolerance and dependence. The Nutrition Committee of the American Heart Association (Pearson, 1996) has specific recommendations and warnings regarding alcohol intake. One or two drinks per day are beneficial and safe for some people. To gain maximum health benefits, the consumer must drink moderate amounts of alcohol daily rather than sporadically. Unfortunately, there really can be too much of a good thing. Heavy drinking is associated with reduced longevity and increased risk of alcoholism, cirrhosis of the liver, and a multitude of other health and social problems. According to Pearson, the following people should abstain from alcohol for any reason: anyone with a family or personal history of alcoholism, teenagers, pregnant women, people on medications that interact with alcohol, and people with preexisting conditions that would be made worse by consuming alcohol (e.g., liver disease, pancreatitis, hypertriglyceridemia, porphyria, uncontrolled hypertension, and congestive heart failure).
Breast Cancer Risk
It is imperative that all women know the connection between breast cancer and alcohol before they begin their moderate daily intake for the known health benefits. Numerous studies have documented that women who consume 40 grams of alcohol (about three drinks) per day have a higher risk of breast cancer than do women who abstain from alcohol. However, a review of the research evidence done by Baglietto, English, Gertig, Hopper, and Giles (2005) found that women who drank alcohol and had a high folate intake were not at increased risk of breast cancer compared to those who abstained from alcohol. Research (Sellers, Kushi, & Cerhan, 2001) done by the Mayo Clinic with more than 40,000 women, ages 55-69 years, demonstrated that 400 �g of folic acid-the amount typically found in a multivitamin-appeared to offset this risk in women who drink moderately. Folic acid mitigates the negative effects of alcohol on estrogen metabolism in the liver. When folic acid is taken daily, the risk of breast cancer drops below that of alcohol abstainers.
Conclusion
The scientific medical fact is clear: drinking alcohol in moderation is associated with better health and greater longevity than is either abstaining or abusing alcohol. All of the many health benefits of drinking apply only to moderate consumption-never to heavy drinking. So what does all this research mean for the psychiatric advanced practice nurse? It is easy to get behind the dark chocolate because the only real risk is overindulgence and weight gain-albeit no small matter for most people. But what about alcohol consumption for our health? Even though the research data are abundant, most of us would be nervous to recommend that our family, friends, and clients take up daily drinking. We know too well the dangers of alcohol-both socially and for our health. A part of our job is dealing with the aftermath of addiction and withdrawal, and the medical decline of individuals who have a history of abusive drinking. How do we weigh the researched health benefits of alcohol and the potential dangers associated with drinking alcohol? Clearly there are no easy answers. But if a loved one or a client is at high risk for heart attack or stroke, it might be a consideration. At any rate, knowing there are choices and decisions to be made makes us better practitioners. Being aware of the research and the findings requires us to struggle with this issue regarding ourselves and those we treat. It is just another level of interpreting the data for implementation of treatment based on a thorough assessment of the risks and benefits. It is what we do every day if we are practicing evidence-based, outcomes-based health care.
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References
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[Author Affiliation]
Mary Paquette, PhD, APRN-BC
mary@artwindows.com
