this reduction in heart disease risk results in a reduced mortality in middle-age and older adults who consume moderate amounts of alcohol.However,at high levels of consumption,the mortality from heart disease and other alcohol-related problems is increased.Wine consumption has been suggested as a reason for the lower incidence of heart disease in certain cultures.The Mediterranean diet,which has been associated with a reduced risk of heart disease,includes daily consumption of wine in moderation(see Chapter 1,Science Applied:How Epidemiology led to Dietary Recommendations for Heart Disease).And one explanation for the French paradox-the fact that the French eat a diet that is as high or higher in saturated fat that the American diet but suffer from far less heart disease-is the glass of wine they drink with meals.The particular benefit of red wine is likely due not only to the alcohol but also to the phytochemicals (phenols) it contains(see Figure F1.5).There are a number of ways that moderate alcohol consumption reduces the rick of heart disease.The most significant is its effect on HDL cholesterol.Moderate alcohol consumption can increase HDL cholresterol by 30% and is believed to account for about half of alcohol's protective effect.Alcohol also lowers the risk of heart disease by reducing platelet stickiness and levels of the blood-clotting protein fibrinogen. Both of these effects reduce the formation of blood clots that can block blood flow to the heart resulting in a heart attack.Smaller benefits have been attributed to alcohol's role in increasing insulin sensitivity and reducing inflammation.Although all of these effect have been documented,the benefit any one individual will gain from moderate alcohol consumption depends on his or her genetic background,health status,and overall lifestyle.The risk posed by alcohol depend on the consumer and the amount consumed.Some people should not consume any alcohol.For instance,women who are pregnant or trying to conceive should not consume alcohol because it can damage the fetus(see Chapter 14).Children and adolescents should not consume alcohol because they are more likely to suffer its toxis effect-drunkenness and poisoning leading to seizures,coma,and impair coordination and reflexes.Alcoholics should avoid alcohol they cannot restrict their drinking to moderate levels.Finally,individuals taking medications that can intract with alcohol should avoid alcohol.For everyone,the risks of excessive alcohol consumption outweigh the benefits.Whether or not the benefits of alcohol consumption outweigh the risk,drinking is a personal decision that must take into account medical and social issues It is not recommended that anyone begin drinking or drink more frequently to obtail alcohol's potential health benefits because even moderate alcohol consumption is associated with increased risk of breast cencer,violence,drowing,motor vehicle accidents,and injuries from falls.Those who do choose to drink should do so in moderation.Alcohol should be consumed slowly,no more than one drink every hours.Sipping,not gulping,allows the liver time to break down the alcohol that has aleady been consumed.Alternating nonalcoholic and alcohol drinks will also slow down the rate of alcohol intake and prevent dehydration.Alcohol absorption is most rapid on an empty stomach.Consuming alcohol with meals slows its absorption and may also enhance its protective effects on the cardiovascular system.Also,the effect of alcohol on HDL cholesterol levels is believed to be greater when the liver is processing nutrients from a meal.