October 18, 2017
couple with martinis

Alcohol: What Moderation Means

by Berkeley Wellness  |  

People tend to have strong feelings and beliefs about alcohol—and for good reason. Muslims, Mormons and certain Christian churches forbid it. Buddhists disapprove of it. Other religions incorporate alcohol into rituals and take a more permissive line. Survey results vary, but about 35 percent of American adults drink no alcohol, 55 percent are light or moderate drinkers and 10 percent drink more than moderately. Alcohol is estimated to cause 90,000 deaths a year in the U.S., directly or indirectly, including more than 11,000 traffic fatalities. Treating alcoholism costs billions annually.

At the same time, drinking has some benefits. For many people, it is part of social, business and family life, an enjoyable and traditional accompaniment to food and celebrations. Medical science has a lot to say about alcohol. While doctors have long recognized the harm of too much alcohol, it has been used medicinally for centuries. It was once the only antiseptic and anesthetic in the surgeon’s kit.

Healthy maybe, confusing certainly

Researchers have found that drinking alcohol regularly, even in small amounts, reduces the risk of cardiovascular disease—the most common cause of death in the industrialized world. If Americans suddenly stopped drinking, thousands more deaths from heart disease would occur each year. Moderate alcohol intake also helps reduce the risk of some other disorders, including type 2 diabetes, gallstones and peripheral artery disease—perhaps even dementia.

Whether to drink is a personal decision. At the very least, alcoholic beverages cost money and add calories to the diet. More seriously, alcohol can cause accidents, family conflicts and medical problems. Keep in mind, too, that there’s little or no cardiovascular benefit for premenopausal women or for men under 40, since they are at much lower risk. If you already drink or think you might start, here are answers to some questions.

How does alcohol protect the heart?

The action is two-fold. Like aspirin, alcohol reduces blood clotting—a transient effect that persists for about a day. When consumed regularly, alcohol also raises levels of HDL (“good”) cholesterol over the long term; HDL removes cholesterol from arterial walls and helps prevent atherosclerosis (“hardening of the arteries”).

For heart health, is it best to drink every day?

It’s not clear what routine is best, except that small amounts of alcohol consumed regularly are better than larger amounts occasionally. Some research suggests that daily (or almost daily) drinking is best for the heart, others that drinking every other day is enough to get the benefits. Some studies have found that all it takes is half a standard drink a day. Drinking with meals is preferable, since that slows the absorption of the alcohol. In addition, people who drink at meals are more likely to drink moderately.

What’s a standard drink?

In the U.S. a “drink” is 5 ounces of wine, 12 ounces of beer or 1.5 ounces of 80-proof liquor, which all contain about 14 grams of pure alcohol (ethanol). Of course, these days people often serve much larger drinks, especially at bars and restaurants.

What’s moderate drinking? Are the recommendations the same in other countries?

Moderate drinking is the amount sufficient to confer heart benefits, while minimizing the dangers of heavier drinking. In the U.S. this is generally defined as up to one drink a day for a woman, up to two for a man. That comes from the government’s Dietary Guidelines for Americans, which specifies that this refers to the amount consumed on any single day, not the average over several days. Women are advised to drink less than men, largely because they tend to be smaller and have proportionately more body fat and less body water than men (alcohol is diluted in body water). Thus, a given amount of alcohol will result in a higher blood level of alcohol in women and cause more impairment.

The definition of moderation does differ from country to country. Australia, Denmark, and Finland, for instance, suggest a limit of two drinks a day for both genders (until 2009 the number for Australian men was four a day). French authorities suggest up to three drinks daily for men and women. In Canada the official recommendations about moderation vary from province to province. The definition of a standard “drink” also varies from country to country.

Most governments recommend abstinence for pregnant women or women trying to become pregnant. Alcohol can harm the fetus, and no one knows what amount, if any, is safe.

Aren’t these guidelines arbitrary?

They are just guidelines, not rules, since a given amount of alcohol can affect people differently, depending on body size, age and many other factors. Older people are affected more by alcohol, since their bodies don’t process it as well. And alcohol doesn’t mix well with many drugs older people take. Thus many governments recommend that people over 65 drink less than the official guidelines.

Also, drinking patterns matter. It is not okay to abstain during the week and then consume your whole weekly “quota” on the weekend. This is known as episodic heavy drinking, a term that has replaced “binge drinking.” Heavy drinking, even confined to special occasions, is dangerous.

Does moderate drinking pose health risks?

The serious health risks come mostly from heavy drinking: alcoholism, heart and liver disease, hypertension, certain cancers (of the breast, mouth, esophagus, larynx, liver and colon, for instance), osteoporosis, car crashes and other accidents. But even moderate drinking can affect coordination and impair your ability to drive, operate machinery, or swim. It also slightly increases the risk of breast and some other cancers; the combination of smoking and drinking multiplies the risk of oral cancers. Some people should not drink at all, including children, pregnant or breastfeeding women, people who cannot keep their drinking moderate and are at high risk for alcoholism, those with certain medical conditions and those taking medications that interact with alcohol.

A new study published in the American Journal of Public Health estimates that alcohol causes 3 to 4 percent of all cancer deaths in the U.S. (about 19,500 deaths each year). Most of the cancer-related deaths in women are from breast cancer, while most in men are from oral and esophageal cancer. The researchers estimate that at least half of the deaths occur in people consuming three or more drinks a day; about 30 percent in those averaging fewer than 1.5 drinks a day. On average, alcohol-related cancer deaths shorten lives by about 18 years.

Alcohol is clearly a double-edged sword.