Sorry to be a spoilsport, but a glass or two of wine every night won’t improve your health.
After decades of confusing and sometimes contradictory research (too much alcohol is bad for you, but too little is good for you, or some types of alcohol are better than others), the picture is now becoming clearer: even small amounts of alcohol can have health consequences.
Research published in November revealed that between 2015 and 2019, excessive alcohol consumption resulted in an estimated 140,000 deaths a year in the United States. About 40% of these deaths had acute causes, such as automobile accidents, poisonings and homicides. But most were caused by chronic conditions attributed to alcohol use, such as cancer and liver and heart disease.
When experts talk about the dire health consequences of binge drinking, people often assume this is a message for those with an alcohol-drinking disorder. But the health risks of drinking can result from even moderate consumption.
“The risk starts to rise well before levels where people would think, ‘Oh, this person has a drinking problem,'” says Tim Naimi, director of the Canadian Institute for Substance Use Research at the University of Victoria. “Alcohol is harmful to health at very low levels.”
If you’re wondering whether to cut back on your alcohol consumption, here’s what you should know about when and how alcohol affects your health.
How do I know if I’m drinking too much?
“Excessive alcohol consumption” technically means anything above the daily limits recommended by US dietary guidelines. That’s more than two drinks a day for men and more than one a day for women.
There’s also new evidence “that there are risks even within these levels, especially for some cancers and some forms of cardiovascular disease,” says Marissa Esser, who leads the alcohol program at the Centers for Disease Control and Prevention in the US. US government.
The recommended daily limits should also not be calculated on a weekly basis. In other words, if you abstain Monday through Thursday and have two or three drinks a night over the weekend, that should be considered binge drinking.
It’s both the drinks accumulated over time and the amount of alcohol in your system at any given time that can cause harm.
Scientists think the main way alcohol causes health problems is by damaging DNA. When you drink, your body breaks it down into acetaldehyde, a chemical that is toxic to cells. Acetaldehyde “damages your DNA and prevents your body from repairing the damage,” says Esser. “Once its DNA is damaged, a cell can grow out of control and create a cancerous tumor.”
Alcohol also creates oxidative stress, another form of DNA damage that can be especially damaging to the cells lining blood vessels. This form of stress can lead to hardening of the arteries, resulting in increased blood pressure and coronary heart disease.
“It fundamentally affects DNA and therefore affects many organ systems,” Naimi points out. Over the course of a lifetime, chronic consumption “cumulatively damages tissue”.
Is there any damage to the heart?
The effect of alcohol on the heart is confusing, as some studies claim that small amounts of alcohol, especially red wine, can be beneficial. Previous research has suggested that alcohol raises HDL, the “good” cholesterol, and that resveratrol, an antioxidant found in grapes (and red wine), has heart-protective properties.
However, says Mariann Piano, a professor of nursing at Vanderbilt University, “There’s been a lot of recent evidence that has really challenged the idea of any kind of so-called cardioprotective or health-promoting effect of alcohol.”
The idea that low doses of alcohol are good for the heart probably stems from the fact that people who drink small amounts tend to have other healthy habits, such as exercising, eating lots of fruits and vegetables, and not smoking. In observational studies, the heart benefits of these behaviors may have been incorrectly attributed to alcohol, Piano says.
More recent research has found that even low levels of alcohol consumption slightly increase the chances of high blood pressure and heart disease, and the risk increases dramatically for people who drink to excess.
The good news is that when people stop drinking or simply cut back, their blood pressure drops. Alcohol is also linked to an abnormal heart rhythm known as atrial fibrillation, which increases the risk of blood clots and strokes.
For which types of cancer does alcohol increase the risk?
Almost everyone knows the link between smoking and cancer, but few know that alcohol is also a potent carcinogen. According to research conducted by the American Cancer Society, alcohol contributes to more than 75,000 cases of cancer each year and nearly 19,000 deaths from the disease.
It is known as a direct cause of seven different cancers: head and neck (oral cavity, pharynx and larynx), esophageal, liver, breast and colorectal. Research suggests there may be a link between alcohol and other types of disease, including prostate and pancreatic disease, although the evidence is less clear.
For some cancers, such as liver and colorectal cancer, the risk only starts when people drink a lot. But for breast and esophageal cancer, the risk increases, albeit slightly, with any alcohol consumption. The chances increase the more the person drinks.
“If someone drinks less, they have a lower risk than a heavy drinker,” says Farhad Islami, senior scientific director at the American Cancer Society. “Even two drinks a day, one drink a day, may be associated with a small risk of cancer compared to people who don’t drink.”
Which condition presents the greatest risk?
The single most common cause of alcohol-related death in the United States is alcoholic liver disease, which kills approximately 22,000 people each year. Although the risk increases as people age and alcohol exposure accumulates, more than 5,000 Americans in their 20s, 30s, and 40s die each year from this diagnosis.
The disease has three stages: alcoholic fatty liver, when fat accumulates in the organ; alcoholic hepatitis, when inflammation begins to occur; and alcoholic cirrhosis, or tissue scarring. The first two stages are reversible if the person stops drinking completely, the third stage is not.
Symptoms of alcoholic liver disease include nausea, vomiting, abdominal pain, and jaundice — a yellow tinge to the eyes or skin. However, symptoms rarely appear until the liver has been severely damaged.
The risk of developing alcoholic liver disease is highest among heavy drinkers, but one report says five years of consuming just two drinks a day could damage your liver. Ninety percent of people who have four drinks a day show signs of alcoholic fatty liver disease.
How do I assess my risk of alcohol-related diseases?
Not everyone who drinks will develop these conditions. Lifestyle factors such as diet, exercise, and smoking combine to increase or decrease your risk. Additionally, some of these conditions, such as esophageal cancer, are quite rare, so a small increase in risk won’t have a huge impact.
“All risk factors are important,” Esser points out. “We know in public health that the number of risk factors a person has combine to increase their risk of a condition.”
A pre-existing condition can also interact with alcohol to affect your health. For example, “People with high blood pressure probably shouldn’t be drinking, or definitely drinking at very, very low levels,” Piano says.
Genes also play a role. For example, two genetic variants, both more common in people of Asian descent, affect how alcohol and acetaldehyde are metabolized. A variant of the gene causes alcohol to break down into acetaldehyde more quickly, flooding the body with the toxin. The other variant slows down the metabolism of acetaldehyde, meaning the chemical stays longer in the body, prolonging the damage.
Should I cut down or stop drinking altogether?
You don’t have to stop completely to help your health. Cutting back a bit can also be helpful, especially if you drink beyond the recommended limits. The risk “really goes up when you have a few drinks a day,” says Naimi.
“So people who have five or six drinks a day, if they can get it down to three or four, they’ll do themselves a lot of good.”
Even light daily drinkers would likely benefit from cutting back a bit. Try to spend a few alcohol-free nights. “If you’re feeling better, your body is trying to tell you something,” points out George Koob, director of the National Institute on Alcohol Abuse and Alcoholism.
Notably, none of the experts we spoke to called for total abstinence unless you have an alcohol use disorder or are pregnant. “I’m not going to argue for people to stop drinking completely,” says Koob. “We made the ban, it didn’t work.”
In general, though, their advice is: “Drink less, live more,” says Naimi. “That’s pretty much what it boils down to.”
Translated by Luiz Roberto M. Gonçalves
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