Sometimes I get some obviously “loaded” questions from patients. My favorites are alcohol-related. “Hey Doc, how much should I be drinking?” or “Drinking is healthy, right?” Typically these patients have heard a news story about red wine or alcohol having health benefits and take the information to mean they can drink as much as they want.
Alcohol consumption is a delicate subject among physicians. Obviously, we’ve all seen patients suffering from the effects of alcohol-abuse. While doctors consider alcoholism a disease with many serious health risks, moderate alcohol consumption is considered normal behavior, and certainly not a behavior we should heavily criticize. It’s a matter of degree, and that can be difficult for doctors to put in plain words. However, we’re going to try.
Alcohol in Research Studies
Every couple of months I hear a news story about the latest research results that extoll the health benefits of “moderate” drinking. The American Heart Association defines “moderate” alcohol consumption as “an average of one to two drinks per day for men and one drink per day for women.” A drink is defined as:
- 1 twelve ounce beer
- 4 ounces of wine, or
- 1.5 ounces of an 80 proof liquor
In most of the scientific literature, the definition of moderate drinking maintains this definition. Light drinking is usually less than half of a drink a day. And, believe it or not, heavy drinking in the research studies is anything over one drink a day for a woman and over two drinks a day for a man. Also, be aware that restaurant wine pours and mixed drinks typically contain more alcohol than a “drink.” (Obviously, a pint of beer is more than one drink.)
Why is it half as much for women? Usually people assume it is because women generally weigh less and therefore have less body mass to distribute the alcohol. This is not the case. Women have less alcohol dehydrogenase activity in their stomach lining. Alcohol dehydrogenase is an enzyme that breaks down alcohol, and less alcohol dehydrogenase in the wall of the stomach means women absorb more of the alcohol they drink. So drink for drink, a woman will absorb more alcohol than a man of the same weight.
All of the headline grabbing news about the health benefits of alcohol relates to “moderate” consumption so that’s what I will focus on in this article.
There has been continuous debate among the cardiologists about alcohol consumption and health benefits. Some cardiologists think we should prescribe alcohol to patients with a high risk of heart disease. Most disagree. In reviewing the literature, I have found that the cardiologists who are the main proponents of prescribing alcohol have not looked at the whole picture. As a cynical family doctor, I can see that despite all of the studies, we really don’t know that much about alcohol’s “beneficial” effect on our hearts.
Here’s what we do know. All the studies showing a benefit with “moderate” alcohol consumption are observational. They are not directly testing alcohol’s benefit, but rather they review health information from a large number of study participants and look for beneficial trends. These studies have observed that light to moderate alcohol is associated with a decreased risk of heart failure and heart attack when compared with heavy drinkers or people who do not drink alcohol. Moderate alcohol consumption has also been correlated with an increased HDL (the “good” cholesterol).
But, before you go out and start “moderate” drinking, you need to better understand “observational” studies. Researchers use statistics to relate certain observed habits with health outcomes. Basically, they look at people who have heart attacks and those that didn’t have heart attacks and try to find habits that might differentiate each group. This type of research can be helpful, but it can also be problematic.
Observational Studies: Not the Full Picture
The best example of the problems that can arise with this type of study is some recent hormone replacement research. It noted that women who took hormone replacement after menopause had less heart disease. The medical community, myself included, believed whole-heartedly that hormone replacement was the key to preventing heart attacks in women after menopause. Then, all that changed.
To test the hormone replacement hypothesis, a study was created that randomized women to either receive hormone replacement or receive a placebo. The women didn’t know which they were taking, their doctors didn’t know which they were taking, and the researchers didn’t know which they were taking.
Researchers had to stop the study early. Why? The women who ended up with the hormones were having heart attacks more often than the women who got the placebo. So despite the observational studies saying hormones prevented heart attacks, the hormone replacement was actually linked to heart disease. The results are important because they actually tested whether hormone replacement prevented heart attacks instead of trying to draw conclusions from observations about women with heart disease.
To date, all the studies that have found a benefit to moderate alcohol consumption in preventing heart attacks over not drinking are observational. There is no definitive study of alcohol and its direct relation to heart disease. The statisticians stand behind their data, but there are many critics of these studies. How could it be possible that the people who didn’t drink alcohol actually have a higher risk of heart disease? Well, lots of reasons. The people who were “abstainers” were not well described. Early studies lumped recovering alcoholics who were heavy smokers with people who had never drank alcohol. It is difficult to sort out the healthy, non-drinker group from recovering alcoholics, diabetics who were told not to drink, and individuals who don’t drink due to health problems and medication interactions. The observational results may not be the final answer.
Despite the observation that people who drink moderately might have lower rates of heart disease than those who do not drink, heavy drinking is still associated with many heart problems, including heart attacks, high blood pressure, irregular heart rhythms, and sudden death.
Alcohol’s Health Risks
1) Liver disease and liver cancer
Heavy drinking leads to irreparable scarring in the liver which can develop into cancer.
2) Gastrointestinal disease
Alcohol use is associated with higher risks of developing ulcers and pancreatitis.
3) Breast cancer
Even moderate drinking has been associated with an increased risk of developing breast cancer. One study found that 4% of breast cancer in developed countries can be attributed to alcohol.
4) Prostate cancer
Heavy drinking has been associated with a higher risk of developing prostate cancer.
5) Immune system suppression
Alcohol affects white blood cell function and can increase risk of developing infection. Disregulation of the immune system by alcohol can also lead to inflammation.
Heavy drinking has been associated with increased risk of death after a heart attack. Atrial fibrillation, a type of irregular heart beat, is associated with heavy drinking. Heavy drinking can also lead to a cardiomyopathy where the heart muscle is damaged, which can lead to heart failure. Drinking more than five drinks per day is also associated with a higher risk of sudden death from a dangerous heart rhythm called ventricular fibrillation.
Heavy drinking is associated with an increased risk for developing hemorrhagic (bleeding) strokes.
8) Blood pressure
Heavy drinking raises blood pressure and can cause strokes, heart attacks, and kidney disease.
Alcohol is linked to 100,000 deaths in the United States every year. Accidents, including fatal car accidents, are more frequent in drinkers than non-drinkers.
But, Doctor, I Don’t Want to Have a Heart Attack
Obviously, no one wants to have a heart attack. You can get the same observed benefits of moderate alcohol consumption by exercising, eating a SuperFoods-based diet, and lowering your stress. There are beneficial flavonoids and phytonutrients in red and white wine, but those beneficial micronutrients are also in grapes and grape juice. Actually, one study of wine’s effect on blood vessels compared drinking red wine to drinking non-alcoholic red wine. Drinking red wine with no alcohol resulted in a higher degree of beneficial arterial vasodilation than the red wine with alcohol.
1) Don’t feel you have to drink for general health reasons or for heart health. A good SuperFoods diet, high in antioxidants and plant micronutrients give you plenty of nutritional protection.
2) If you use tobacco, STOP! There is a strong correlation between social drinking and tobacco usage. Tobacco is bad.
3) If you are pregnant or trying to get pregnant DO NOT DRINK ALCOHOL!
4) Try nonalcoholic wine or nonalcoholic beer.
5) If you drink, drink in moderation — which means one drink maximum for women and two drinks maximum for men per day.
6) Alcohol is not a reasonable treatment for anxiety or stress, nor should it be used to help sleep.
7) Exercise and maintain a healthy weight.
8) Find healthy ways to lower your daily stress, like with yoga, meditation, or hobbies.