(FORTUNE Magazine) – By now, most people know that the French have a low risk of heart disease despite their high-fat diet. It's called the French paradox, and it's widely believed to result from their generous consumption of wine, specifically red wine. At least once a week a patient will ask why we're not following the lead of the French and drinking ourselves to better health.

Good news first: Overall, people who consume moderate amounts of alcohol (up to one to two drinks a day) have a lower risk of heart disease and dying compared with those who don't touch the stuff. This is particularly true for anyone at increased risk for heart disease; it's less true for younger people.

The key, as you might expect, is moderation. With more than one or two drinks a day, the risk of dying rises above that of nondrinkers. And contrary to what one of my patients recently suggested, one to two drinks a day is not the same as seven to 14 on the weekend.

The benefits of alcohol are due, in part, to its ability to raise HDL ("good") cholesterol and thin out the blood. Since these effects are seen with all types of alcohol, is red wine really healthier than beer or spirits? Theoretically, yes. Wine contains phenolic compounds, such as resveratrol and quercetin, that act as antioxidants and are found mainly in the skins of the grapes. Red wine, unlike white wine, is made with the skins, and therefore believed to be healthier.

Although there might be a slight advantage of wine over other forms of alcohol, the benefits are largely thanks to alcohol per se, regardless of the type. But there may be other reasons for the purported benefits of wine. Wine is more often consumed with meals, which slows down absorption and provides nutrients. Also, while I don't mean to disparage fans of beer and Scotch, wine drinkers appear to lead a healthier lifestyle.

Now the bad news. Excess alcohol consumption kills more than 100,000 Americans each year. It raises blood pressure and triglyceride blood fats. It increases the risk of hemorrhagic stroke, pancreatitis, cirrhosis, and cancers of the liver, breast, mouth, esophagus, stomach, and possibly colon. It contributes calories with few nutrients, and it affects the absorption of many vitamins and minerals, notably folic acid and thiamine (which suggests that a multivitamin for those who drink alcohol regularly may not be a bad idea). In my ER days I saw the results of alcohol abuse many times: homicides, suicides, a neurologic condition called Wernicke-Korsakoff syndrome (people affected babble incoherently and can't walk straight), and, of course, car accidents.

Women weigh less than men and metabolize alcohol differently, so the recommendations are for no more than one drink a day for women and two drinks a day for men. People with hypertension, high blood triglycerides, abnormal heart rhythms, liver disease, or pancreatic disease, or those on medications that may interact with alcohol, should minimize their intake; women who are pregnant or are trying to become pregnant should avoid it altogether.

Back to the French. As well known as their high-fat intake is, there are other healthy aspects of the French diet and lifestyle distinct from wine consumption--smaller portions of food, fresh ingredients, lots of vegetables and fruits, and daily walks to the market, to name a few. But the French also have one of the world's highest rates of cirrhosis.

Here is the bottom line: Even if a daily drink or two may be healthy, I don't recommend alcohol for people who don't drink. Habits can sneak up and bite you; no one intends to become an alcoholic. If you choose to consume alcohol, the old adage of moderation makes sense. And if you're fortunate enough to enjoy a glass of 1990 Le Pin with good friends and a great meal, your arteries won't be the only thing smiling.

FOR MORE INFORMATION ON THIS TOPIC: Go to mayoclinic.com. Mayo Clinic offers Executive Health programs at Mayo Clinics in Jacksonville, Fla.; Rochester, Minn.; and Scottsdale, Ariz.