ALCOHOL: Risks and benefits

Is alcohol good for your health? 

For many reasons, this is a question without simple or clear-cut answers. Drinking too much alcohol contributes to accidents and injuries and can lead to liver disease, high blood pressure, various cancers, and birth defects, among other health problems. However, moderate alcohol use may provide certain health benefits, particularly with regard to coronary heart disease. Understanding the possible risks and benefits of alcohol is essential to make an informed decision about alcohol use. 

HOW MUCH IS ONE DRINK? — Alcoholic drinks come in multiple forms and contain differing amounts of pure alcohol (ethanol). In the United States, one portion of alcohol is defined as approximately 10 to 15 grams of ethanol, which can be found in

• One 12 ounce bottle or can of beer (roughly equivalent to the 330 mL cans of beers sold in some countries)
• One 5 ounce serving of wine (about 150 mL)
• One shot (1.5 ounces) of 80-proof distilled spirits (about 50 mL) 

Moderate drinking is generally defined as 3 to 9 servings of alcohol per week, depending on age, sex, and other conditions. For example, the National Institute on Alcohol Abuse and Alcoholism defines ‘low-risk’ drinking as no more than three drinks on any single day and no more than seven drinks per week for women, and no more than four drinks on any single day and no more than 14 drinks per week for a man. 

HEALTH CONDITIONS AND ALCOHOL — Multiple studies suggest that consuming alcohol can affect the risk of developing certain health conditions. 

Cardiovascular disease — Cardiovascular disease, including disorders of the heart, blood vessels, and blood circulation, is the leading cause of death in the United States. However, several studies suggest that moderate alcohol use, as compared to heavy drinking or abstaining, decreases the risk of coronary heart disease (CHD). 

High blood pressure — People who consume more than two drinks per day have up to a twofold increase in the incidence of high blood pressure compared with nondrinkers. 

Heart attack — Drinking a moderate amount of alcohol is associated with lower risk of having a heart attack. Atrial fibrillation — Drinking several drinks at a single occasion, even among

individuals who otherwise drink safely, can induce abnormal heart rhythms, including atrial fibrillation. 

Peripheral vascular disease — Peripheral vascular disease can cause pain in the calves with walking, also known as claudication. Moderate alcohol use reduces the risk of peripheral artery disease in healthy men. 

Stroke — Alcohol consumption has been shown to affect the risk of stroke in contradictory ways, depending upon the amount of alcohol consumed and the type of stroke. Heavy alcohol use increases the risk of both ischemic and hemorrhagic stroke. Moderate alcohol use is associated with fewer ischemic strokes; the risk appears to be lowest in people who consume one drink or less per day. In contrast, the risk of hemorrhagic stroke appears to rise even with minimal alcohol use. 

Breast cancer — There is consistent evidence that breast cancer risk is higher for women consuming moderate to high levels of alcohol (three or more drinks/day) 

Cancers of the head and neck and digestive tract — Alcohol use has been linked to several types of cancer of the head and neck and digestive (gastrointestinal) tract, even at low levels of consumption. Cancer arising within liver cells (hepatocellular carcinoma) has been linked to alcohol use. This may be related to liver scarring (ie, cirrhosis) that occurs in people who consume excessive amounts of alcohol since cirrhosis is a major cause of hepatocellular carcinoma. However, even at low levels, drinking may increase the risk of hepatocellular cancer in people with inflammation of the liver (hepatitis) due to infection with certain viruses (ie, hepatitis C virus). People with chronic hepatitis should avoid alcohol. 

Cirrhosis — Low levels of alcohol do not clearly cause cirrhosis. Heavy drinking is generally required to cause cirrhosis in men in the absence of other factors. 

Gallstones — Moderate alcohol use has been shown to lower the risk of gallstones. 

Pancreatitis — Heavy drinking increases the risk of both sudden (acute) and long-term (chronic) inflammation of the pancreas (pancreatitis). 

Osteoporosis — Heavy drinking increases the risk of hip fractures because it increases the risk of both osteoporosis and falls. 

Pregnancy — There is a significant risk of birth defects related to use of alcohol use during pregnancy. Heavy drinking can cause fetal alcohol syndrome, which prevents normal growth, and may cause intellectual disability (mental retardation), malformations of the skull and face, and other findings.

Perception of health and quality of life — Excessive and frequent alcohol use reduces quality of life for individuals, their families, and others around them, potentially leading to failure at work or school, interpersonal problems, and physically hazardous situations. 

Accidents and trauma — Alcohol use increases the risks and severity of injury from motor vehicle accidents.Exposure to alcohol is generally measured in blood alcohol concentration (BAC) rather than drinks per day or week. In most of the United States, the legal BAC limit for driving is 0.08 percent, which corresponds to about 4 drinks for a 200 pound man and 2.5 drinks for a 150 pound woman. However, the risk of having an accident while driving doubles at a BAC of only 0.05 percent, and driving ability is impaired with BACs as low as 0.02 percent. 

Alcohol also increases the risk of injury from other sources. It has been shown to impair a pilot’s ability to fly and an operator’s ability to control a boat, bicycle, and snowmobile. In addition, occupational injuries, falls, drownings, burns, and hypothermia are more common in those who use alcohol, particularly in heavy drinkers. 

Violence — Alcohol is involved in more than one-quarter of all rapes, at least one-half of serious assaults, and one-half to two-thirds of all homicides. 

Suicide — Alcohol abuse is associated with an increased risk of suicide. Although moderate drinking does not appear to raise suicide risk, episodes of heavy drinking cause disinhibition that can increase suicide risk. 

IS ALCOHOL SAFE FOR ME? — The bottom line is that it is difficult to weigh the benefits and risks of alcohol. Nevertheless, several important conclusions can be drawn: 

• Beginning to drink alcohol may be inappropriate for people who have been lifelong abstainers. There is no evidence that lifelong abstainers who begin drinking in middle or older age will lower their risk of any disease. 
• The diseases that may be prevented by moderate drinking (eg, coronary heart disease and ischemic stroke) are most prevalent in older adults, men, and people with CHD risk factors (eg, hypertension, hypercholesterolemia, smoking, diabetes mellitus). For these groups, moderate alcohol use may reduce their risk of these conditions. 
• For young to middle-aged adults, particularly women, moderate alcohol use increases the risk of the most common causes of death, such as breast cancer and trauma. Men under age 45 years also may experience more harm than benefit from drinking. In these younger age groups, moderate alcohol use is unlikely to reduce the risk of dying.

Consuming less than one drink daily appears to be safe (that is, if not done before or while operating a car or heavy equipment), although even that level of drinking can be dangerous for some people (see next section). 

Reasons to avoid alcohol — Alcohol use is not recommended for individuals who: 

• Are younger than the legal drinking age (21 years in most states within the United States
• Are pregnant
• Have a personal or strong family history of alcoholism
• Have liver or pancreatic disease related to alcohol
• Have precancerous conditions of the digestive tract
• Operate potentially dangerous equipment or machinery (including cars, boats, planes, or construction equipment) 

Wine versus other alcoholic beverages — Some research suggests that wine provides the strongest protection against cardiovascular disease, possibly due to naturally occurring compounds known as flavonoids. In France, for example, death from CHD is lower than would be expected from the high 

rate of smoking and saturated fats in the diet; this “French paradox” has been attributed to frequent red wine consumption.However, other studies indicate that all alcoholic beverages offer cardioprotective benefits. Whether beverage type matters for specific diseases other than CHD remains uncertain, although most evidence suggests that it does not. 

A safe dose of alcohol — As mentioned above, for some people, no amount of alcohol is considered safe. However, for individuals without such conditions, the healthiest dose of alcohol appears to be in the range of 0.5 to 1 drink of alcohol daily. 

Gender differences — Established recommendations for safe levels of drinking do not address an “ideal” level of alcohol consumption. However, they advise

• No more than two drinks daily for men
• No more than one drink daily for women 

What is the best approach in my case? — The following guidelines may help in making an informed decision about alcohol use: 

• Consult a healthcare provider to determine the specific risks and benefits of alcohol use. Multiple factors must be considered in any such “risk-benefit analysis,” including age, sex, personal medical history, family history, diet, physical fitness, and certain lifestyle choices such as smoking, among others. 
• Women should not drink any alcohol during pregnancy; in addition, experts advise that women should stop drinking when trying to conceive.
• Never consume alcohol before or while driving or operating any potentially dangerous equipment. 

Never mix alcohol and certain medications: Overall, 25,000 emergency visits per year are a result of adverse drug reactions with alcohol 

1. Analgesics (pain medications) account for 50% of the problem. Opioids like Norco(hydrocodone/acetaminophen), Oxycontin (oxycodone ER), and Diladud (hydromorphone) are the biggest offenders. Alcohol enhances the inhibitory effects of opioids, which can increase sedation, leading to drowsiness and breathing suppression. 
2. Anxiolytics (sedatives). Using alcohol along with the class of medications known as benzodiazepines may result in emergency visits. Benzodiazepines include Ativan (lorazepam), Xanax (alprazolam), Valium(diazepam), and Klonopin (clonazepam). The sedative effect of these medications will be magnified when mixed with alcohol. 
3. Antidepressants. it has been noted that some people experience a marked change in alcohol tolerance during treatment with SSRI antidepressants like Paxil (paroxetine), Lexapro (escitalopram), and Celexa (citalopram). Mixing alcohol and antidepressants may have consequences, including lower inhibition for violence or sexual behavior, and sometimes impaired memory of the event. Additionally, excessive alcohol consumption among Wellbutrin (bupropion) users may increase the risk of seizures. 
4. Antipsychotics. Mixing medications like Zyprexa (olanzapine), Risperdal(risperidone), or clozapine with alcohol will increase the sedative effects of these medications. 
5. Erectile dysfunction (ED) medications. Mixing alcohol with medications like Cialis, Viagra and Levitra accounted for 4.5% of all male adverse drug reactions. These medications are vasodilators (they increase blood flow to lower blood pressure) and the effects are compounded when mixed with alcohol, which can also lower blood pressure. Dizziness, flushing, headache, and lower blood pressure are possible effects. 
6. Nonsteroidal anti inflammatory agents (NSAIDS). Medications like Motrin (ibuprofen), Aleve (naproxen), and Celebrex (celecoxib) Taking NSAIDS and drinking alcohol may increase your risk of gastrointestinal (GI) side effects, including GI bleeding especially for patients above 55 years.
7. Flagyl (metronidazole) is an antibiotic—and drinking ANY alcohol while you take it will result in a violent reaction with nausea and vomiting. 
8. Nitroglycerin and Isordil (isosorbide dinitrate) are two more vasodilators that lower blood pressure. Drinking alcohol while taking these can enhance their effects, which can cause your blood pressure to drop when you stand up. 
9. Diabetes medications. Mixing alcohol with insulin, glyburide, or glipizide can suppress the production of glucose by the liver, which can dangerously lower blood sugar in diabetics using these medications, which already carry a risk for hypoglycemia (low blood sugar). 
10. Coumadin (warfarin). The effect of alcohol on warfarin is unpredictable. If you do drink alcohol while taking warfarin, your international normalized ratio (INR) blood test needs to be closely monitored and adjusted.