Alcohol: Friend or Foe?

Alcohol has somehow managed to take a significant place in our society. Primarily in the form of ethyl alcohol (ethanol), it has occupied an important place in the history of humankind for at least 8,000 years. In most Western societies, at least 90% of people consume alcohol at some time during their lives, and 30% or more of drinkers develop alcohol-related problems. Severe alcohol-related life impairment, alcohol dependence (alcoholism), is observed at some time during their lives in about 10% of men and 3-5% of women. An additional 5-10% of each sex develops persistent, but less intense, problems that are diagnosed as alcohol abuse. Here are a few helpful definitions:

Physicians operationally defined "light" drinking as 1.2 drinks/day, "moderate" drinking as 2.2 drinks/day, and "heavy" drinking as 3.5 drinks/day. Abusive drinking was defined as 5.4 drinks/day.

In the United States, one "standard" drink (or one alcoholic drink equivalent) contains roughly 14 grams of pure alcohol, which is found in: 12 ounces of regular beer, which is usually about 5% alcohol. 5 ounces of wine, which is typically about 12% alcohol. 1.5 ounces of distilled spirits, which is about 40% alcohol.

Most people are aware of the risks of alcohol use disorder in general, and of liver cirrhosis, but let us look closer and the relationship between alcohol consumption and a few common health conditions as you consider the role of alcohol in your health. Keep in mind, it is important to look at the global picture for you as an individual. Ask your physician for guidance, if needed.

Obesity

Alcohol can be associated with weight gain. One gram of alcohol contains 7 calories. For reference, 1 gram of carbohydrates or protein contains 4 calories. So, it contains almost twice as many calories per gram. Calories consumed in alcohol are usually not “counted” in a meal, meaning that the calories people consume in alcohol are usually in addition to those consumed in the food. Moreover, alcohol intake can stimulate additional food intake, further increasing the total calories consumed at one sitting. This is true for meals after the alcohol intake, too. It is not really known why alcohol consumption makes people eat more. Additionally, alcohol can make you feel less satisfied by food after you drink it, such as the next day. This is because alcohol reduces hormone related to satiety and satiation, or the gratification from food. It actually does the opposite of the newest anti obesity medications by reducing glucagon like peptide as well as leptin, opioid receptions, serotonin, and GABA. This is why you may crave “comfort food” after an episode of drinking. Alcohol intake can also impair sleep, and impaired sleep can further lead to weight gain, hunger, and reduced activity. For more information on alcohol and obesity, read here.

Cancer

Did you know that alcohol is considered a carcinogen? In 2007, it was concluded that there was sufficient evidence to classify alcoholic beverages as carcinogenic to humans, specifically for cancer of the colon, breast, oral cavity, and liver ad esophagus. All cancers showed evidence of a dose- response relationship, meaning the more you drink, the higher your risk. The mechanisms are unclear but it is suggested it could be due to increased estrogen concentration and the reduced ability to repair DNA related to changes in folate metabolism. For cancers of the digestive tract, it is likely caused by acetaldehyde which is in alcoholic beverages and a byproduct of ethanol metabolism.

Hypertensive Disease

For men, alcohol consumption has been consistently shown to have a detrimental effect on high blood pressure in a dose-dependent manner.

Ischemic Heart Disease

Alcohol intake has a reputation for being protective for the heart, but the relationship is more complex than that and is a highly debated topic. There are mechanisms for both help and harm. Light to moderate regular alcohol consumption has been linked to reduced risk and severity for new heart events and especially for fatal events, but most of this protective effect can be achieved with less than one standard drink of alcohol every other day (12 grams of pure ethanol). There is no benefit for consuming more than 20 grams of alcohol (less than 2 standard drinks) per day. The protective effect also assumes there is no heavy drinking, which not only cancels out the beneficial effect, but is related to an increased risk for ischemic heart disease. Chronic heavy alcohol use has certainly been related to adverse heart outcomes of several kinds, including ischemic heart disease, heart failure, and arrhythmias. So, if you every drink heavily, you are better off not drinking at all, since any heavy drinking at all is linked to detrimental effects due to increased clotting and easier pathway for fatal arrhythmias and sudden cardiac death.

Pneumonia

Heavy alcohol use increases the risk of pneumonia, a relatively common condition.

Liver disease

It is known that heavy drinking is associated with cirrhosis, but it also worsens any underlying liver condition. With the high prevalence of fatty liver related to obesity, alcohol consumption can add “insult to injury.”For more information on alcohol consumption and burden of disease, read here.

Depression

Like with many conditions that go together, the question commonly is, which came first? In this article examining the relationship between alcohol and depression, it was suggested that the current studies show a causal link between alcohol use and depression. This means that the one actually causes the other, instead of them just happening at the same time by chance. It found the presence of alcohol use disorder doubled the risk of major depression. It seems alcohol use causes depression, not that depression causes alcohol use, most often. The mechanism is likely due to changes in neurophysiology and dopamine induced by depression. Thee is also an increased risk of suicide associated with alcohol use. For more information on alcohol and depression, read here.

In summary, the protective effects of alcohol can be obtained with less than one drink every other day, and it is cancelled out by the occurrence of any heavy drinking. Many health insurance plans and health systems offer resources for addressing alcohol consumption. I encourage patients who are uncertain of the effect of alcohol on their own health to see for themselves by quitting completely for a period of time that is long enough to reasonably expect to see any benefits if they exist but short enough that they can commit to it. But, do not stop suddenly as that can be dangerous. You may be surprised at the difference that cutting this out can make for your health. If you would like to discuss, we are here as a resource.

Take Back Your Abstinence,

Valerie Hope-Slocum Sutherland, MD