Drink Wise

All about the healthy and not-so-healthy drinks

Health & Nutrition - - CONTENTS -

Hu­mans have been drink­ing al­co­holic bev­er­ages since an­cient times – even pre­his­toric times – and for many of us, they are part of so­cial and fam­ily life, an en­joy­able and tra­di­tional ac­com­pa­ni­ment to food and cel­e­bra­tions. At the same time, be­cause of its ef­fects on the ner­vous sys­tem, liver, and other or­gans, al­co­hol kills thou­sands ev­ery year, di­rectly or in­di­rectly in­clud­ing about as many traf­fic deaths and other fa­tal in­juries, and it dev­as­tates mil­lions of fam­i­lies. What’s more, al­co­hol-re­lated deaths oc­cur mostly among the rel­a­tively young, short­en­ing lives by an av­er­age of 30 years.

But, you may ask, aren’t those deaths and in­juries caused by heavy drink­ing? And aren’t they coun­ter­bal­anced by all the health ben­e­fits of mod­er­ate al­co­hol in­take, es­pe­cially for the heart? Aren’t we do­ing some­thing health­ful when we drink our glass of wine with din­ner? The fact is, com­pared to the known risks of al­co­hol, the pro­posed ben­e­fits have never been un­equiv­o­cally es­tab­lished, since they are based pri­mar­ily on ob­ser­va­tional stud­ies. Whether drink­ing mod­er­ately is ben­e­fi­cial is now be­ing de­bated more than ever, thanks to a few re­cent stud­ies and analy­ses that give some rea­son to be scep­ti­cal. Note on mod­er­a­tion: US ex­pert groups rec­om­mend that if people drink, they should do so in mod­er­a­tion, de­fined as no more than one drink a day for women or two drinks for men. Older people should prob­a­bly drink even less, since their bod­ies don’t process al­co­hol as well, and al­co­hol can in­ter­act with many drugs they take. A stan­dard drink is 5 ounces of wine, 12 ounces of beer, or 1½ ounces of 80-proof liquor, all of which con­tain about 14 grams of al­co­hol.

Why Al­co­hol Is Hard To Study

The pro­posed heart ben­e­fits are supported by lab re­search show­ing that even small amounts of al­co­hol re­duce blood clot­ting and vis­cos­ity – an ef­fect that per­sists for about a day – and raise lev­els of HDL (‘good’) choles­terol. Al­co­hol may also help im­prove blood ves­sel func­tion and re­duce in­flam­ma­tion. Ob­ser­va­tional stud­ies on al­co­hol fol­low groups of drinkers and non-drinkers and com­pare their health over time – valu­able re­search, but not de­fin­i­tive. Most have found that light or mod­er­ate drinkers tend to have less heart dis­ease and be health­ier than non-drinkers or heavy drinkers, but they don’t prove that the al­co­hol is the rea­son. For one thing, there may be some­thing else about the habits of people who choose to drink mod­er­ately that helps pro­tect them. In ad­di­tion, the stud­ies de­pend on par­tic­i­pants’ abil­ity to re­call and re­port how much they drank, which can be fuzzy, and the stud­ies usu­ally can’t take into ac­count the fact that drink­ing pat­terns may vary from per­son to per­son and may change over the years (these are prob­lems with most ob­ser­va­tional di­etary stud­ies). Also, dif­fer­ent types of al­co­holic bev­er­ages may have dif­fer­ent ef­fects on the body be­cause of the non-ethanol com­pounds they con­tain. In re­cent years, ques­tions have arisen about the ob­ser­va­tional find­ings sup­port­ing the po­ten­tial ben­e­fits of al­co­hol. One po­ten­tial ‘con­founder’ in most ob­ser­va­tional stud­ies is that non-

The as­so­ci­a­tion and be­tween al­co­hol r car­dio­vas­cula the sys­tem is com­plex. is Heavy drink­ing known to dam­age the heart, in­crease blood pres­sure, and cause other r car­dio­vas­cula prob­lems.

drinkers as a group in­clude many people who gave up al­co­hol for health rea­sons – dubbed the ‘sick quit­ter ef­fect’. Re­searchers try to rule that out by ad­just­ing the data in var­i­ous ways, but it’s dif­fi­cult to do so com­pletely. This prob­lem was ad­dressed in an anal­y­sis of 87 stud­ies, pub­lished in the ‘Jour­nal of Stud­ies on Al­co­hol and Drugs’. It found that the ap­par­ent re­duced mor­tal­ity rate seen among light to mod­er­ate drinkers dis­ap­peared when the com­par­i­son group was lim­ited to life­long ab­stain­ers or oc­ca­sional drinkers (that is, no for­mer drinkers). It’s hard to do ran­dom­ized clin­i­cal tri­als on al­co­hol (which could es­tab­lish ca­su­al­ity) be­cause that in­volve telling hun­dreds or thou­sands of people to stop or start drink­ing for months or years. Thus, news that the NIH (Na­tional In­sti­tute of Health) in US is start­ing a $100-mil­lion, mul­ti­year, in­ter­na­tional clin­i­cal trial to see whether mod­er­ate drink­ing can pre­vent car­dio­vas­cu­lar prob­lems has elicited so much in­ter­est. For six years, about 7,800 par­tic­i­pants, all at el­e­vated coro­nary risk, will ei­ther con­sume one al­co­holic drink a day or ab­stain from all al­co­hol. Re­sults are a long way off, how­ever, and they’re still un­likely to clearly answer all ques­tions about al­co­hol and heart health.

Re­cent Car­dio­vas­cu­lar Re­search

The as­so­ci­a­tion be­tween al­co­hol and the car­dio­vas­cu­lar sys­tem is com­plex. Heavy drink­ing is known to dam­age the heart, in­crease blood pres­sure, and cause other car­dio­vas­cu­lar prob­lems. Even if mod­er­ate al­co­hol in­take does de­crease the risk of heart at­tacks and con­ges­tive heart fail­ure, for in­stance, it may have ad­verse ef­fects on other as­pects of car­dio­vas­cu­lar health. For ex­am­ple, a study in the

Drink­ing, es­pe­cially heav­ier drink­ing, can cause falls, crashes, fam­ily a host con­flicts, and of med­i­cal prob­lems to and can lead al­co­hol de­pen­dence and abuse.

‘Jour­nal of the Amer­i­can Heart As­so­ci­a­tion’ found that even one drink a day can be ‘car­diotoxic’ and in­crease the risk of atrial fib­ril­la­tion and en­large­ment of one of the heart’s cham­bers, with the risk ris­ing with each daily drink. Bet­ter news for mod­er­ate drinkers comes from a re­cent ob­ser­va­tional study in ‘BMJ’, which fol­lowed 1.9 mil­lion healthy English people for an av­er­age of six years to ex­am­ine the ef­fect of var­i­ous lev­els of al­co­hol in­take on 12 heart con­di­tions. Light and mod­er­ate drinkers had a lower risk of is­chemic stroke, pe­riph­eral artery dis­ease, heart fail­ure, and sev­eral other heart con­di­tions, com­pared to life­long non­drinkers, for­mer drinkers, and heavy drinkers. They also had a lower risk of heart at­tacks than both groups of non-drinkers.

Do Mod­er­ate Drinkers Live Longer?

Yes, at least ac­cord­ing to a large, well-de­signed study in the ‘Jour­nal of the Amer­i­can Col­lege of Car­di­ol­ogy’, which fol­lowed 3,33,000 adults in the US for an av­er­age of eight years. Light or mod­er­ate al­co­hol in­take was as­so­ci­ated with re­duced car­dio­vas­cu­lar and all-cause mor­tal­ity rates com­pared to life­long ab­sten­tion (de­fined as fewer than 12 drinks in a life­time) and heavy drink­ing. This mor­tal­ity ben­e­fit was clear­est in people over the age of 60, fol­lowed by those be­tween the ages of 40 to 59; there was no ef­fect in younger adults. Heavy drink­ing, es­pe­cially in men, was linked to the high­est all-cause and cancer death rates, as was binge drink­ing.

Diabetes: A Clear Ben­e­fit?

Re­search has con­sis­tently linked mod­er­ate al­co­hol con­sump­tion to re­duced risk of diabetes, com­pared to ab­sten­tion or heavy drink­ing. This was con­firmed re­cently by a large Dan­ish ob­ser­va­tional study in ‘Di­a­betolo­gia’, which found the low­est risk of de­vel­op­ing diabetes in men con­sum­ing about 14 drinks per week and women con­sum­ing about nine

Al­co­hol is of­ten in a ma­jor fac­tor homi­cides, sui­cides, do­mes­tic vi­o­lence, In and child abuse. it preg­nant women, can cause se­vere harm to foe­tuses.

drinks per week, com­pared to non-drinkers. In terms of fre­quency, con­sump­tion of al­co­hol three or four days a week was linked to the low­est risk of diabetes. As in some prior stud­ies, wine was as­so­ci­ated with the great­est risk re­duc­tion, per­haps be­cause of the polyphe­nol com­pounds it con­tains, the re­searchers sug­gested.

The Cancer Con­nec­tion

It’s well known that al­co­hol in­creases the risk of a num­ber of can­cers, es­pe­cially at higher in­takes. In fact, the In­ter­na­tional Agency for Re­search on Cancer (part of the World Health Or­ga­ni­za­tion) clas­si­fies al­co­hol as a hu­man car­cino­gen. This was supported by a Har­vard anal­y­sis of 1,35,000 nurses and other health pro­fes­sion­als, pub­lished in ‘BMJ’. It found that over the course of two or three decades, heavy al­co­hol in­take in­creased the risk of esophageal, oral, liver, col­orec­tal, and breast can­cers. Light to mod­er­ate drink­ing was as­so­ci­ated with a ‘min­i­mally’ in­creased cancer risk over­all – for women, this was

Light or mod­er­ate al­co­hol in­take was as­so­ci­ated with re­duced car­dio­vas­cu­lar and all-cause mor­tal­ity rates com­pared to life­long ab­sten­tion (de­fined as fewer than 12 drinks in a life­time) and heavy drink­ing.

mostly breast cancer; for men the in­creased risk was seen only in smok­ers.

To Drink or not To Drink

Whether to drink al­co­hol is a per­sonal de­ci­sion and should be based on your cur­rent health, med­i­cal his­tory, fam­ily his­tory, age, sex, and other fac­tors. Drink­ing, es­pe­cially heav­ier drink­ing, can cause falls, crashes, fam­ily con­flicts, and a host of med­i­cal prob­lems and can lead to al­co­hol de­pen­dence and abuse. Al­co­hol is of­ten a ma­jor fac­tor in homi­cides, sui­cides, do­mes­tic vi­o­lence, and child abuse. In preg­nant women, it can cause se­vere harm to foe­tuses. And al­co­holic bev­er­ages add ‘empty’ calo­ries to the diet. If you don’t drink al­co­hol, there’s no def­i­nite health rea­son why you should start – there are bet­ter, surer ways (such as diet, ex­er­cise, weight con­trol, and to­bacco avoid­ance) to pro­tect your heart and over­all health. Some of the pro­posed health ben­e­fits of light to mod­er­ate drink­ing seem likely, though any ef­fect is prob­a­bly mod­est and will need to be con­firmed by clin­i­cal tri­als such as the NIH study men­tioned ear­lier. Stud­ies com­par­ing dif­fer­ent types of al­co­holic bev­er­ages have gen­er­ally found that they all have sim­i­lar health ef­fects, though wine has got­ten a boost from all the pos­i­tive re­search on the Mediter­ranean diet. Small amounts of al­co­hol con­sumed reg­u­larly ap­pear to be best for heart health. Keep in mind that there’s lit­tle car­dio­vas­cu­lar ben­e­fit for pre­menopausal women or for men un­der 40, since they are at low risk to start. Women at above- av­er­age risk for breast cancer – say, be­cause of fam­ily his­tory – should limit or avoid al­co­hol, as should people at high risk for cer­tain other can­cers. Some people should not drink at all, in­clud­ing chil­dren, preg­nant or breast-feed­ing women; people who can­not keep their drink­ing mod­er­ate and are at high risk for al­co­holism; and those tak­ing med­i­ca­tions that in­ter­act with al­co­hol. People with un­con­trolled hy­per­ten­sion, liver dis­ease, high triglyc­erides, ab­nor­mal heart rhythms, pep­tic ul­cers, sleep ap­nea, and cer­tain other con­di­tions should ask their doc­tors about the ad­vis­abil­ity of drink­ing.

If you don’t drink al­co­hol, there’s no def­i­nite health rea­son why you there should start – are bet­ter, surer diet, ways (such as ex­er­cise, weight con­trol, and to­bacco pro­tect avoid­ance) to your heart and over­all health.

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