The Alcohol Debate: Should You or Shouldn't You?
How drinking affects your health
By Kathleen Zelman, MPH, RD, LD
WebMD Weight Loss Clinic
Reviewed By Charlotte E. Grayson, MD
Has a daily drink replaced the apple a day as a way to keep the doctor away?
Scientists have long touted the heart benefits of drinking small amounts of alcohol. Newer studies have credited moderate drinking with everything from helping to keep our minds sharp as we age to lowering our risk of developing diabetes.
In fact, the new U.S. dietary guidelines give many of us official permission to enjoy one to two drinks daily.
This is great news for folks who follow the French lifestyle of sipping a glass of wine with dinner, or who enjoy an evening cocktail. But what about teetotalers -- should they start drinking? Are there some people who shouldn't drink, under any circumstances? And how do you balance the health effects of alcohol with its high calorie count?
Since some 55% of U.S. adults drink alcohol according to the CDC, it's important to understand how it affects our health. To get some answers, WebMD talked to experts about alcohol's risks and benefits and its place in a healthy diet.
Does It Help or Hurt?
Drinking alcohol can be good for your health, but it can also be harmful. It all depends on how much you drink, your age, and other factors.
There's no denying that too much alcohol can lead to serious problems. Excess alcohol can increase your risk of:
- Liver disease
- High blood pressure
- High blood fats (triglycerides)
- Heart failure
- Fetal alcohol syndrome (if you're pregnant)
- Certain cancers
- Injury, violence, and death
And, of course, drinking too much alcohol piles on the calories, which can lead to obesity and a higher risk for diabetes.
For some segments of the population, alcohol can lead to many health problems. Those who should not drink include:
- Pregnant and breastfeeding women
- Women at risk for breast cancer
- People with family histories of alcohol abuse
- Children and adolescents
- People taking medications that can interact with alcohol
- Those with health conditions such as liver problems or ulcers
- Anyone requiring skill or coordination to perform a task
According to the U.S. Dietary Guidelines, in middle-aged and older adults, moderate consumption is associated with the lowest all-cause mortality (that is, the rate of death from all causes). But in younger adults, alcohol consumption provides little, if any, health benefits, according to the guidelines. Instead, it's associated with a higher risk of serious injury or death.
The CDC has reported that excessive drinking causes more than 75,000 deaths from various causes in the U.S. each year. And what exactly is "excessive"? For men, it's an average of more than two drinks daily, or more than four drinks at one time, according to the CDC. For women, it's an average of more than one drink per day or more than three drinks at one time.
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Alcohol's effects on the heart -- for both men and women -- are well documented. Studies have shown that moderate drinking can raise levels of "good cholesterol," which helps prevent harmful blood clots and helps keep blood flowing smoothly through our bodies, reducing risks of heart attack and stroke.
In fact, moderate drinking can increase "good cholesterol" levels by as much as 20%, if it's accompanied by a healthy diet and regular physical activity, says Harvard researcher Eric Rimm, DrS.
That's similar to the improvement you might see by taking cholesterol medication or running a half-marathon, Rimm says. (He's quick to point out that exercise has many other health benefits and that alcohol should never replace exercise.)
Research has also suggested that moderate drinking can increase insulin sensitivity, which can reduce the risk of diabetes, among other things. But the empty calories in alcohol can be a problem, as there is a link between type 2 diabetes and excess weight.
Rimm, who has reviewed several large studies, has found a delicate balance between the risks and benefits of alcohol and its impact on diabetes. However, he says, "there appears to be a reduction in risk of type 2 diabetes in adults who consume moderate amounts of alcohol."
Recent research also suggests that women who enjoy a little alcohol may be more likely to keep their minds sharp as they age.
A study published in The New England Journal of Medicine earlier this year evaluated the mental abilities of 12,480 women aged 70-81. The researchers found that moderate drinkers had a 23% reduced risk of mental decline compared with nondrinkers.
What Type, How Much, and When?
According to the experts, it doesn't make too much difference whether you prefer wine, beer, or spirits.
"The research evidence points to ethanol -- or the alcohol component -- of beer, wine, or spirits as the substance that can help lower cholesterol levels, increase HDL (good cholesterol), and improve insulin sensitivity in overweight individuals," Rimm says.
It's how much you drink that really matters. The U.S. Dietary Guidelines and the American Heart Association define moderate drinking as one drink for women and two for men per day -- not averaged over the week. (One drink is defined as 5 ounces of wine, 12 ounces of beer, or 1.5 ounces of 80-proof distilled spirits such as vodka.)
When you drink is also important, says Alice Lichtenstein, DrS, a professor at Tufts University. If you do consume alcohol, it's best to have it with meals, she says.
Some studies have suggested that drinking alcohol without eating raises the chance of developing high blood pressure.
Also, "alcohol can stimulate the appetite, so it is better to drink it with food," says Arthur Agatston, MD, a cardiologist and author of the popular book The South Beach Diet. "When alcohol is mixed with food, it can slow the stomach emptying time and potentially decrease the amount of food consumed at the meal."
And what about people who don't drink at all? The experts agree that, though alcohol has some health benefits, it's not a good idea to start drinking if you don't already.
The new U.S. dietary guidelines point out that there are many ways to reduce the risk of chronic diseases besides moderate drinking, including:
- Eating a healthy diet
- Quitting smoking
- Maintaining a healthy weight
Those Extra Calories
Alcohol is fairly high in calories, but provides few essential nutrients.
The benefits of moderate drinking do not outweigh the risks of being overweight, says Theresa Nicklas, DrPh, a member of the dietary guidelines advisory committee. So if you have a drink, you should budget it into what the U.S. dietary guidelines call your "discretionary calories" -- the ones you have left over after you eat all the nutritious foods you need.
The problem, says Nicklas, is that most Americans are sedentary, so their calorie needs are relatively low. For example, someone on an 1,800-calorie eating plan only has 195 discretionary calories per day -- the equivalent of one 9-ounce glass of wine (and that leaves no room for sweets or other treats).
And, of course, when you drink too much alcohol, it's hard to get all the nutrients you need without taking in too many calories. Heavy drinkers who substitute alcohol calories for nutritious foods run the risk of malnutrition.
Another problem, according to National Institutes of Health researcher Rosalind Breslow, PhD, is that "liquid calories from alcohol do not satisfy hunger." She notes that drinks made with high-calorie mixers, like pina coladas and white Russians, can have as many as 400 calories apiece.
The best bet for people who want to enjoy a drink most days is to get more physical activity, Nicklas says. She points out that the benefits of regular physical activity are much greater than those of moderate drinking, and she advises everyone to strive for at least 30 minutes daily.
The Bottom Line
More research remains to be done on the relative risks and benefits of drinking alcohol.
But the bottom line is that to get any health benefits from alcohol, we must drink responsibly. That means having no more than 1-2 drinks per day, having them at mealtime and as part of an overall healthy diet, and making sure you aren't exceeding your calorie needs.
SOURCES: The New England Journal of Medicine, Jan. 20, 2005. Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2005. American Heart Association Science Advisory: Wine and Your Heart, 2001. Archives of Internal Medicine, 2003; 263. Theresa Nicklas, DrPh, professor of pediatrics, Baylor College of Medicine; member, dietary guidelines advisory committee; Alice Lichtenstein, DSc, Gershoff Professor, Friedman School of Nutrition Science and Policy, Tufts University. Eric Rimm, DrS, professor of epidemiology and nutrition, Harvard School of Public Health; Arthur Agatston, MD, FACC, associate professor of medicine, University of Miami School of Medicine; author, The South Beach Diet. Rosalind Breslow, PhD, researcher, National Institute on Alcohol Abuse and Alcoholism. Monica Gourovitch, PhD, senior vice president for scientific affairs, Distilled Spirits Council. WebMD Feature: Beer, Wine Liquor - The New Health Drinks?, by Jennifer Warner, published June 14, 2002. WebMD Medical News: Drinking Too Much Claims 75,000 Lives a Year, by Jennifer Warner, published Sept. 23, 2004. WebMD Medical News: Moderate Alcohol May Improve Diabetes, by Salynn Boyles, published June 1, 2004. WebMD Medical News: Alcohol Without Food Boosts Blood Pressure, by Miranda Hitti, published Dec. 21, 2004.
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