Alcohol and cardiovascular disease--more than one paradox to consider. Alcohol and type 2 diabetes--another paradox?

The French Paradox relates to the observation that mortality rates due to coronary heart disease are relatively low in France despite a diet rich in saturated fats. Another paradox linked to alcohol is the diverse associations of acute and chronic alcohol use with respect to insulin resistance, incidence of type 2 diabetes and incidence of cardiovascular disease in type 2 diabetes. Reports consistently suggest that the acute affects of alcohol induce a state of insulin resistance following either an oral and/or intravenous glucose load. Contrary to the acute alcohol studies is a large body of epidemiological evidence from cross-sectional studies which suggests that long-term exposure to alcohol is associated with an improvement in insulin sensitivity. Furthermore, a substantial number of prospective studies point to a protective role for light to moderate chronic alcohol intake against the development of diabetes as well as a protective effect of regular mild to moderate drinking against coronary artery disease in type 2 diabetic subjects.