 Healthy Steps to Alcohol Consumption
 Printer
Friendly
In most cultures, alcoholic beverages have been consumed since
prerecorded history for religious, medicinal, or recreational
purposes. Beer was used by the ancient Babylonians and wine by the
Hebrews in religious ceremonies. The community drank together to
achieve a sense of belonging and good fellowship. Medicinally, alcohol
has been used to relieve pain and to increase the appetite, and in
many cultures it is still considered an essential ingredient for good
health and a well-balanced meal. However, most cultures employing
alcohol had rigid guidelines as to what constituted responsible
drinking. Drunkenness was frowned upon and anyone displaying outward
signs of intoxication was often punished, in some cases even put to
death. These cultures, along with most present societies with
guidelines for responsible drinking and a cultural opposition to
drunkenness, have encountered few problems associated with alcohol
abuse. On the other hand, societies which ignore or encourage
drunkenness are plagued with behavior problems resulting from
drinking.
Research has revealed low incidence of alcoholism or alcohol abuse
among cultural groups who use alcohol as part of their daily lives. As
a rule these groups have developed attitudes and habits to foster
responsible drinking within their culture. Some of these attitudes
follow:
1. Children are exposed to alcohol early in life, within an
established family or religious context. Whatever the beverage, it
is served diluted and in small quantities, with consequent low
blood-alcohol levels.
2. The beverages used are commonly those containing large amounts
of non-alcoholic components (wines or beers), which help to retain
low blood-alcohol levels.
3. The beverage is considered mainly as a food and is usually
consumed with meals.
4. Parents present a constant example of moderate drinking.
5. No moral importance is attached to drinking. It is considered
neither a virtue nor a sin.
6. Drinking is not viewed as proof of adulthood or virility.
7. Abstinence is socially acceptable. It is no more rude or
ungracious to decline a drink than to decline a piece of cake.
8. Excessive drinking or intoxication is not socially acceptable
and is not considered stylish, comic, or tolerable.
9. Alcohol is not a prime focus for any activity.
10. Finally, and perhaps most importantly, there is wide and
usually complete agreement among members of the group on the ground
rules of drinking.
Many of the cultures adopting these attitudes have developed and
manufactured a particular alcoholic beverage to be used for
recreational or religious purposes. The Germans became known for their
beers, southern Europeans for wine, Russians for vodka. Each of these
beverages has contributed greatly to the economy of the culture, and
in many cases even influenced its politics.
In America, alcohol was enjoyed by puritan settlers. One of the
first industries to be established in the New World was a brewery. As
Americans began to move west, beer became too bulky to carry and
settlers switched to corn liquor and other distilled beverages used
both for medicinal and recreational purposes. However, as immigrants
of various cultural backgrounds began to arrive in this country, they
brought a wide variety of drinking habits and attitudes with them.
Over time, these conflicting attitudes caused disagreement about what
constituted responsible drinking. This lack of consensus led to
confusion about drinking laws, rights, and responsibilities. This in
turn produced the social ills associated with problem drinking.
Throughout the 10,000 or so years that humans have been drinking
fermented beverages, they've also been arguing about their merits and
demerits. The debate still simmers today, with a lively back-and-forth
over whether alcohol is good for you or bad for you.
It's safe to say that alcohol is both a tonic and a poison. The
difference lies mostly in the dose. Moderate drinking seems to be good
for the heart and circulatory system, and probably protects against
type 2 diabetes and gallstones. Heavy drinking is a major cause of
preventable death in most countries. In the U.S., alcohol is
implicated in about half of fatal traffic accidents. Heavy drinking
can damage the liver and heart, harm an unborn child, increase the
chances of developing breast and some other cancers, contribute to
depression and violence, and interfere with relationships.
Alcohol's two-faced nature shouldn't come as a surprise. The active
ingredient in alcoholic beverages, a simple molecule called ethanol,
affects the body in many different ways. It directly influences the
stomach, brain, heart, gallbladder, and liver. It affects levels of
lipids (cholesterol and triglycerides) and insulin in the blood, as
well as inflammation and coagulation. It also alters mood,
concentration, and coordination.
What's "Moderate"? What's "A Drink"?
Loose use of terms has fueled some of the ongoing debate about
alcohol's impact on health. In some studies, the term "moderate
drinking" refers to less than one drink per day, while in others it
means three or four drinks per day. Exactly what constitutes "a drink"
is also fairly fluid. In fact, even among alcohol researchers, there's
no universally accepted standard drink definition.
In the U.S., one drink is usually considered to be 12 ounces of beer,
5 ounces of wine, or 1½ ounces of spirits (hard liquor such as gin or
whiskey). Each delivers about 12 to 14 grams of alcohol.
The definition of moderate drinking is something of a balancing
act. Moderate drinking sits at the point at which the health benefits
of alcohol clearly outweigh the risks. The latest consensus places
this point at no more than one to two drinks per day for men, and no
more than one drink per day for women. This is the definition used by
the U.S. Department of Agriculture and the Dietary Guidelines for
Americans, and is widely used in the U.S.
Possible Health Benefits of Alcohol
Cardiovascular Disease
More than 100 prospective studies show an inverse association
between moderate drinking and risk of heart attack, ischemic
(clot-caused) stroke, peripheral vascular disease, sudden cardiac
death, and death from all cardiovascular causes. The effect is fairly
consistent, corresponding to a 20-45% reduction in risk.
The connection between moderate drinking and lower risk of
cardiovascular disease has been observed in men and women. It applies
to people who do not apparently have heart disease. It also applies to
those at high risk for having a heart attack or stroke or dying of
cardiovascular disease - people with type 2 diabetes and those with
angina (chest pain), a prior heart attack, or other forms of
cardiovascular disease.
The idea that moderate drinking protects against cardiovascular
disease is biologically and scientifically plausible. Moderate amounts
of alcohol raise levels of high-density lipoprotein (HDL, or "good"
cholesterol), and higher HDL levels are associated with greater
protection against heart disease. Moderate alcohol consumption has
also been linked with beneficial changes in a variety of factors that
influence blood clotting, such as tissue type plasminogen activator,
fibrinogen, clotting factor VII, and von Willebrand factor. Such
changes would tend to prevent the formation of small blood clots that
can block arteries in the heart, neck, and brain, the ultimate cause
of many heart attacks and the most common kind of stroke.
Does alcohol cause these benefits?
The most definitive way to investigate the effect of alcohol on
cardiovascular disease is with a large trial in which some volunteers
are randomly assigned to have one or more alcoholic drinks a day and
others have drinks that look, taste, and smell like alcohol but are
actually alcohol-free. Such a trial will probably never be done.
Nevertheless, the connection between moderate drinking and
cardiovascular disease almost certainly represents a cause-and-effect
relationship.
People who drink in moderation are different from non-drinkers or
heavy drinkers in ways that could influence health and disease. Part
of a national 1985 health interview survey showed that moderate
drinkers were more likely than non-drinkers or heavy drinkers to be at
a healthy weight, to get 7-8 hours of sleep a night, and to exercise
regularly. Researchers have statistically accounted for such
confounders, and they do not come close to accounting for the
relationship between alcohol and heart disease. This, plus the clearly
beneficial effects of alcohol on cardiovascular risk factors, makes a
compelling case that alcohol itself, when used in moderation, reduces
the risk of cardiovascular disease.
Beyond the Heart
The benefits of moderate drinking aren't limited to the heart. In
two large studies, gallstones and type 2 diabetes were less likely to
occur in moderate drinkers than in nondrinkers.
The social and psychological benefits of alcohol can't be ignored.
A drink before a meal can improve digestion or offer a soothing
respite at the end of a stressful day; the occasional drink with
friends can be a social tonic. These physical and psychic effects may
contribute to health and wellbeing.
Alcohol Metabolism
Metabolism is the body's process of converting ingested substances
to other compounds. Metabolism results in some substances becoming
more, and some less, toxic than those originally ingested. Metabolism
involves a number of processes, one of which is referred to as
oxidation. Through oxidation, alcohol is detoxified and removed from
the blood, preventing the alcohol from accumulating and destroying
cells and organs. A minute amount of alcohol escapes metabolism and is
excreted unchanged in the breath and in urine. Until all the alcohol
consumed has been metabolized, it is distributed throughout the body,
affecting the brain and other tissues.
The Metabolic Process
When alcohol is consumed, it passes from the stomach and intestines
into the blood, a process referred to as absorption. Alcohol is then
metabolized by enzymes, which are body chemicals that break down other
chemicals. In the liver, an enzyme called alcohol dehydrogenase (ADH)
mediates the conversion of alcohol to acetaldehyde. Acetaldehyde is
rapidly converted to acetate by other enzymes and is eventually
metabolized to carbon dioxide and water. Alcohol also is metabolized
in the liver by the enzyme cytochrome P450IIE1 (CYP2E1), which may be
increased after chronic drinking . Most of the alcohol consumed is
metabolized in the liver, but the small quantity that remains
unmetabolized permits alcohol concentration to be measured in breath
and urine.
The liver can metabolize only a certain amount of alcohol per hour,
regardless of the amount that has been consumed. The rate of alcohol
metabolism depends, in part, on the amount of metabolizing enzymes in
the liver, which varies among individuals and appears to have genetic
determinants. In general, after the consumption of one standard drink,
the amount of alcohol in the drinker's blood (blood alcohol
concentration, or BAC) peaks within 30 to 45 minutes. (A standard
drink is defined as 12 ounces of beer, 5 ounces of wine, or 1.5 ounces
of 80-proof distilled spirits, all of which contain the same amount of
alcohol.) Alcohol is metabolized more slowly than it is absorbed.
Since the metabolism of alcohol is slow, consumption needs to be
controlled to prevent accumulation in the body and intoxication.
Factors Influencing Alcohol Absorption and Metabolism
Food. A number of factors influence the absorption process,
including the presence of food and the type of food in the
gastrointestinal tract when alcohol is consumed. The rate at which
alcohol is absorbed depends on how quickly the stomach empties its
contents into the intestine. The higher the dietary fat content, the
more time this emptying will require and the longer the process of
absorption will take. One study found that subjects who drank alcohol
after a meal that included fat, protein, and carbohydrates absorbed
the alcohol about three times more slowly than when they consumed
alcohol on an empty stomach .
Gender. Women absorb and metabolize alcohol differently
from men. They have higher BAC's after consuming the same amount of
alcohol as men and are more susceptible to alcoholic liver disease,
heart muscle damage, and brain damage. The difference in BAC's between
women and men has been attributed to women's smaller amount of body
water, likened to dropping the same amount of alcohol into a smaller
pail of water. An additional factor contributing to the difference in
BAC's may be that women have lower activity of the alcohol
metabolizing enzyme ADH in the stomach, causing a larger proportion of
the ingested alcohol to reach the blood. The combination of these
factors may render women more vulnerable than men to alcohol-induced
liver and heart damage.
Medications. Chronic heavy drinking appears to activate the
enzyme CYP2E1, which may be responsible for transforming the
over-the-counter pain reliever acetaminophen (TylenolTM
) and many others) into chemicals that can cause liver damage,
even when acetaminophen is taken in standard therapeutic doses. A
review of studies of liver damage resulting from acetaminophen-alcohol
interaction reported that in alcoholics, these effects may occur with
as little as 2.6 grams of acetaminophen (four to five "extra-strength"
pills) taken over the course of the day in persons consuming varying
amounts of alcohol . The damage caused by alcohol-acetaminophen
interaction is more likely to occur when acetaminophen is taken after,
rather than before, the alcohol has been metabolized. Alcohol
consumption affects the metabolism of a wide variety of other
medications, increasing the activity of some and diminishing the
activity, thereby decreasing the effectiveness, of others.
The Dark Side of Alcohol
If all drinkers limited themselves to a single drink a day, we
probably wouldn't need as many cardiologists, liver specialists,
mental health professionals, and substance abuse counselors. But not
everyone who likes to drink alcohol stops at just one. While most
people drink in moderation, some don't. Problem drinking affects not
just the drinkers themselves, but may touch their families, friends,
and communities. According to the National Institute on Alcohol Abuse
and Alcoholism:
- 14 million Americans meet standard criteria for alcohol abuse or
alcoholism
- Alcohol plays a role in 1 in 4 cases of violent crime
- More than 16,000 people die each year in automobile accidents in
which alcohol was involved
- Alcohol abuse costs more than $180 billion dollars a year
On the personal level, heavy drinking can take a toll on the body.
It can cause inflammation of the liver (alcoholic hepatitis) and lead
to scarring of the liver (cirrhosis), a potentially fatal disease.
Heavy drinking can increase blood pressure and damage heart muscle (cardiomyopathy).
It has also been linked with several cancers, particularly those of
the mouth, throat, esophagus, and colon.
Alcohol also increases the risk of developing breast cancer.
Large studies have indicated that two or more drinks a day
increased the chances of developing breast cancer by 20%-25%. This
doesn't mean that 20% to 25% of women who have two drinks a day will
get breast cancer. Instead, it is the difference between about 12 of
every 100 women developing breast cancer during their lifetimes - the
current average risk in the US - and 14 to 15 of every 100 women
developing the disease. This modest increase would translate to
significantly more women with breast cancer each year. Adequate daily
intake of folic acid, at least 600 milligrams a day, can mitigate this
increased risk.
Even moderate drinking carries some risks. Alcohol can disrupt
sleep. Its ability to cloud judgment is legendary. Alcohol interacts
in potentially dangerous ways with a variety of medications, including
acetaminophen, antidepressants, anticonvulsants, painkillers, and
sedatives. It is also addictive, especially for people with a family
history of alcoholism.
Genes Play a Role
Twin, family, and adoption studies have firmly established that
genetics plays an important role in determining an individual's
preferences for alcohol and his or her likelihood for developing
alcoholism. Alcoholism doesn't follow the simple rules of inheritance
set out by Gregor Mendel. Instead, it is influenced by several genes
that interact with each other and with environmental factors.
There is also some evidence that genes influence how alcohol
affects the cardiovascular system. Alcohol dehydrogenase type 3
(ADH3), comes in two "flavors." One quickly breaks down alcohol, the
other does it more slowly. Moderate drinkers who have two copies of
the gene for the slow-acting enzyme are at much lower risk for
cardiovascular disease than moderate drinkers who have two genes for
the fast-acting enzyme. Those with one gene for the slow-acting enzyme
and one for the faster enzyme fell in between. It's possible that the
fast-acting enzyme breaks down alcohol before it can have a beneficial
effect on HDL and clotting factors.
Interestingly, these differences in the ADH3 gene do not influence
the risk of heart disease among people who don't drink alcohol. This
adds strong indirect evidence that alcohol itself reduces heart
disease risk.
Shifting Benefits and Risks
The benefits and risks of moderate drinking change over a lifetime.
In general, risks exceed benefits until middle age, when
cardiovascular disease begins to account for increasingly large share
of the burden of disease and death.
- For a pregnant woman and her unborn child, a recovering
alcoholic, a person with liver disease, and people taking one or
more medications that interact with alcohol, moderate drinking
offers little benefit and potential risks.
- For a 30-year-old man, the increased risk of alcohol-related
accidents outweighs the possible heart-related benefits of moderate
alcohol consumption.
- For a 60-year-old man, a drink a day may offer protection
against heart disease that is likely to outweigh potential harm
(assuming he isn't prone to alcoholism).
- For a 60-year-old woman, the benefit/risk calculations are
trickier. More than ten times as many women die each year from heart
disease than breast cancer - more than 500,000 women a year from
cardiovascular disease compared with 41,000 a year from breast
cancer.
However, studies show that women are far more afraid of developing
breast cancer than heart disease, something that must be factored into
the equation.
Balancing Act
Given the complexity of alcohol's effects on the body and the
complexity of the people who drink it, blanket recommendations about
alcohol should be out of the question. Because each of us has unique
personal and family histories, alcohol offers each person a different
spectrum of benefits and risks. Whether or not to drink alcohol,
especially for "medicinal purposes," requires careful balancing of
these benefits and risks. Your health-care provider should be able to
help you do this.
Your overall health and risks for alcohol-associated conditions
should factor into the equation. If you are thin, physically active,
don't smoke, eat a healthy diet, and have no family history of heart
disease, drinking alcohol won't add much to decreasing your risk of
CVD.
If you don't drink, there's no need to start. You can get similar
benefits with exercise (beginning to exercise if you don't already or
boosting the intensity and duration of your activity) or healthier
eating. If you are a man with no history of alcoholism who is at
moderate to high risk for heart disease, a daily alcoholic drink could
reduce that risk. Moderate drinking might be especially beneficial if
you have low HDL that just won't budge upward with diet and exercise.
If you are a woman with no history of alcoholism who is at moderate to
high risk for heart disease, the possible benefits of a daily drink
must be balanced against the small increase in risk of breast cancer.
If you already drink alcohol or plan to begin, keep it moderate -
no more than two drinks a day for men or one drink a day for women.
And make sure you get plenty of folic acid, at least 600 micrograms a
day.
|
