17 Feb Your Well-Being: To Drink or Not to Drink?

Recent studies show that even moderate alcohol consumption may not be healthy

By Leslie Pepper

Have you been enjoying a daily glass—or two—of wine, thinking you’re doing something good for yourself? That’s not surprising, as for years, Americans have been getting the message that moderate drinking is healthy for your heart.

But the paradigm on alcohol and health may be shifting, as a nightly glass of Merlot might not be healthy after all, according to a series of recent studies. In January, outgoing US Surgeon General Vivek Murthy, MD, said alcohol should carry a warning label noting its link to cancer, like cigarettes.

As people become more aware of the risks, alcohol consumption has hit a 90-year low in the United States. Just 45 percent of Americans drink, according to a recent Pew study.

“The risk of dying from alcohol-related causes starts in as little as one drink a day for both men and women, with the risks of seven types of cancer increasing with any use of alcohol,” says Christopher W. Kahler, PhD, director of the Center for Alcohol and Addiction Studies at Brown University. “Evidence that the risk of breast cancer increases at even low levels of drinking is particularly strong.”

That means that nobody should start drinking or continue to drink because they believe it has health benefits, he says. 

Conflicting information

But should you stop drinking altogether? The evidence is still conflicting, says Bubu A. Banini, MD, PhD, assistant professor of medicine (digestive diseases) at Yale School of Medicine.

“Some studies have shown that moderate alcohol use is linked to a lower risk of heart disease and stroke,” says Banini.

So why all the inconsistent information? A number of reasons contribute to the confusion. First, the way we’ve studied alcohol and health has been problematic. Double-blind studies, in which neither the participants nor the researchers know who gets an intervention and who receives a placebo, are considered the gold standard in health studies: the anonymity removes any possibility of bias. But double-blind studies on alcohol’s effects on health don’t exist. After all, it would be tough to “blind” who in a group is drinking alcohol and who is drinking, say, clear juice.

Because of this, the studies that have been done on alcohol and heart disease have been mostly observational. But observational studies are prone to several limitations, stresses Banini. For example, when looking at groups of people who did and didn’t drink alcohol, the groups are so different (in behavior, genetics, age, weight, the presence of diabetes or hypertension, etc.), that the benefits that have been attributed to drinking may just as likely have been the result of other differences between teetotalers and moderate drinkers. And even if you look within the group of nondrinkers, there are differences: some people have no history of drinking, while others have had moderate or significant alcohol use before quitting.

Additionally, the beneficial effects of moderate alcohol use are thought to be due mainly to antioxidants in red wine. “It is worthy of note, however, that these antioxidants may also be derived from nonalcoholic sources such as grapes, blueberries, and certain other foods,” says Banini.

Because of all of this confusion, experts disagree on what amount of alcohol, if any, is safe or healthy to consume.

Health and other concerns

We do know categorically that alcohol can be dangerous in several ways, including the following:

• Driving. Even a small amount of alcohol can delay reaction time and overall judgment, depending on your weight, how quickly you drink, whether you have food in your stomach, and more. According to the Centers for Disease Control and Prevention, 32 people in the United States are killed every day in crashes involving an alcohol-impaired driver. That translates to one death every 45 minutes.
• Weight. One serving of alcohol on average contains 100 to 150 calories, so even a moderate amount of alcohol can add 300 or more calories to your daily total. Mixers like sodas, juices, or syrups will tack on more empty calories.
• Liver damage. A study examining the livers of over 3,500 adults found that as daily alcohol intake increased, so did the accumulation of fat in the liver. The researchers concluded that their results implied that “there is not a ‘safe threshold’ below which there are no toxic effects of alcohol.” 
• Dependence. Many people use alcohol as a way of unwinding after a difficult day, but it can also be a way of self-medicating anxiety or depression. And this can make things worse in the long run, as more drinking can lead to further deterioration of your mental health.

Some recent studies have been adding to the health concerns about alcohol use.

A US Surgeon General’s Advisory released earlier this year states that excessive levels of alcohol consumption increase the risk for six different kinds of cancer: certain types of head and neck cancer, esophageal squamous cell carcinoma, and breast, colorectal, liver, and stomach cancers. For some cancers, like breast, mouth, and throat cancers, evidence shows that this risk “may start to increase around one or fewer drinks per day.”

Another recent study found that even low-risk drinking was associated with higher mortality among older adults with health-related or socioeconomic risk factors. And interestingly, researchers found no reduction in heart disease deaths among light or moderate drinkers, regardless of their health or socioeconomic status, when compared with occasional drinkers.

So what are we to do with all these conflicting conclusions?

“I believe that the scientific evidence is evolving as we become privy to more robust and long-term data, allowing us to gain a better understanding of long-term risks and potential effect of modifiers,” says Banini. “In general, the recommendation is not to start drinking in order to improve your health, as more effective strategies exist,” she adds.

How much is too much?

Current US dietary guidelines recommend that people limit their consumption of alcoholic beverages. So if you choose to drink, do so in moderation, which is defined as two drinks per day for men and one drink for women. “But keep in mind that this level of alcohol use is considered moderate and can increase the risk of certain diseases, such as cancers,” says Banini.

If you want to cut down or stop drinking altogether, Kahler suggests the following:

• Decide why you’re taking this step and write it down so you can refer to it when you need to. Monitor and keep track of your drinking and see if you notice a pattern. Set limits and goals that you would like to achieve.
• Make a plan for trigger situations. If you usually drink or drink too much at parties, bring a big Stanley cup filled with water and lemon that you can sip on all night. If you drink, alternate every cocktail with a mocktail and make sure you continue to eat. If being home alone is when you usually have a few glasses of wine, keep your home alcohol-free. 
• Plan plenty of social activities where drinking is rare, like going to the gym with friends, playing bingo at your local community center, and hosting a monthly book club at your home.
• Cutting down on alcohol may be difficult to do by yourself. Find help at alcoholtreatment.niaaa.nih.gov/. EW

Leslie Pepper is a health writer based on Long Island, New York.