Recent research makes it clear that any amount of
drinking can be detrimental. Here’s why you may want to cut down on your
consumption.
Sorry to be a buzzkill, but that nightly glass or two of
wine is not improving your health. After decades of confusing and sometimes contradictory
research (too much alcohol is bad for you, but a little bit is good; some types
of alcohol are better for you than others; just kidding, it’s all bad), the
picture is becoming clearer: Even small amounts of alcohol can have health
consequences.
Research published in November revealed that between 2015
and 2019, excessive alcohol use resulted in roughly 140,000 deaths per year in the United States. About 40
percent of those deaths had acute causes, like car crashes, poisonings and
homicides.
But the majority were caused by chronic conditions attributed to
alcohol, such as liver disease, cancer and heart disease.
When experts talk about the dire health consequences
linked to excessive alcohol use, people often assume that it’s directed at
individuals who have an alcohol use disorder. But the health risks from
drinking can come from moderate consumption as well.
“Risk starts to go up well below levels where people
would think, ‘Oh, that person has an alcohol problem,’” said Dr. Tim Naimi,
director of the University of Victoria’s Canadian Institute for Substance Use
Research. “Alcohol is harmful to the health starting at very low levels.” If you’re wondering whether you should cut back on your
drinking, here’s what to know about when and how alcohol impacts your health.
How do I know if I’m drinking too much?
“Excessive alcohol use” technically means anything above
the U.S. Dietary Guidelines’ recommended daily limits. That’s
more than two drinks a day for men and more than one drink a day for women.
There is also emerging evidence “that there are risks
even within these levels, especially for certain types of cancer and some forms
of cardiovascular disease,” said Marissa Esser, who leads the alcohol program
at the Centers for Disease Control and Prevention.
The recommended daily limits are not meant to be averaged
over a week, either. In other words, if you abstain Monday through Thursday and
have two or three drinks a night on the weekend, those weekend drinks count as
excessive consumption. It’s both the cumulative drinks over time and the amount
of alcohol in your system on any one occasion that can cause damage.
Why is alcohol so harmful?
Scientists think that the main way alcohol causes health
problems is by damaging DNA. When you drink alcohol, your body metabolizes it
into acetaldehyde, a chemical that is toxic to cells. Acetaldehyde both
“damages your DNA and prevents your body from repairing the damage,” Dr. Esser
explained. “Once your DNA is damaged, then a cell can grow out of control and
create a cancer tumor.”
Alcohol also creates oxidative stress, another form of
DNA damage that can be particularly harmful to the cells that line blood
vessels. Oxidative stress can lead to stiffened arteries, resulting in higher
blood pressure and coronary artery disease. “It fundamentally affects DNA, and that’s why it affects
so many organ systems,” Dr. Naimi said. Over the course of a lifetime, chronic
consumption “damages tissues over time.”
Isn’t alcohol supposed to be good for your heart?
Alcohol’s effect
on the heart is confusing because some studies have claimed that small
amounts of alcohol, particularly red wine, can be beneficial. Past research
suggested that alcohol raises HDL, the “good” cholesterol, and that
resveratrol, an antioxidant found in grapes (and red wine), has
heart-protective properties.
However, said Mariann Piano, a professor of nursing at
Vanderbilt University, “There’s been a lot of recent evidence that has really
challenged the notion of any kind of what we call a cardio-protective or
healthy effect of alcohol.” The idea that a low dose of alcohol was heart healthy
likely arose from the fact that people who drink small amounts tend to have
other healthy habits, such as exercising, eating plenty of fruits and
vegetables and not smoking. In observational studies, the heart benefits of
those behaviors might have been erroneously attributed to alcohol, Dr. Piano
said.
More recent
research has found that even low levels of drinking slightly increase
the risk of high blood pressure and heart disease, and the risk goes up
dramatically for people who drink excessively. The good news is that when
people stop drinking or just cut back, their blood pressure
goes down. Alcohol is also linked to an abnormal heart rhythm, known
as atrial
fibrillation, which raises the risk of blood clots and stroke.
What types of cancer does alcohol increase the risk for?
Almost everyone knows about the link between cigarette
smoking and cancer, but few people realize that alcohol is also a potent
carcinogen. According to research by
the American Cancer Society, alcohol contributes to more than 75,000 cases of
cancer per year and nearly 19,000 cancer deaths.
Alcohol is known to be a direct cause of seven different cancers: head and neck cancers (oral
cavity, pharynx and larynx), esophageal cancer, liver cancer, breast cancer and
colorectal cancer. Research suggests there may be a link between alcohol and
other cancers as well, including prostate and pancreatic cancer, although the
evidence is less clear-cut.
For some cancers, such as liver and colorectal, the risk
starts only when people drink excessively. But for breast and esophageal
cancer, the risk increases, albeit slightly, with any alcohol consumption. The
risks go up the more a person drinks. “If somebody drinks less, they are at a lower risk
compared to that person who is a heavy drinker,” said Dr. Farhad Islami, a
senior scientific director at the American Cancer Society. “Even two drinks per
day, one drink per day, may be associated with a small risk of cancer compared
to non-drinkers.”
Which condition poses the greatest risk?
The most common individual cause of alcohol-related death
in the United States is alcoholic liver disease, killing about 22,000 people a year. While the risk rises as people age
and alcohol exposure accumulates, more than 5,000 Americans in their 20s, 30s
and 40s die from alcoholic liver disease annually.
Alcoholic liver disease has three stages: alcoholic fatty
liver, when fat accumulates in the organ; alcoholic hepatitis, when
inflammation starts to occur; and alcoholic cirrhosis or scarring of the
tissue. The first two stages are reversible if you stop drinking entirely; 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 emerge until the liver has been severely damaged.
The risk of developing alcoholic liver disease is
greatest in heavy drinkers, but one report stated
that five years of drinking just two alcoholic beverages a day can damage the
liver. Ninety percent of people who have four drinks a day show signs of
alcoholic fatty liver.
How do I gauge my personal risk for alcohol-related
health issues?
Not everyone who drinks will develop these conditions.
Lifestyle factors such as diet, exercise and smoking all combine to raise or
lower your risk. Also, some of these conditions, such as esophageal cancer, are
pretty rare, so increasing your risk slightly won’t have a huge impact.
“Every risk factor matters,” Dr. Esser said. “We know in
public health that the number of risk factors that one has would go together
into an increased risk for a condition.” A pre-existing condition could also interact with alcohol
to affect your health. For example, “people who have hypertension probably
should not drink or definitely drink at very, very low levels,” Dr.
Piano said.
Genes play a role, too. For instance, two genetic
variants, both of which are more common in people of Asian descent, affect how
alcohol and acetaldehyde are metabolized. One gene variant causes alcohol to
break down into acetaldehyde faster, flooding the body with the toxin. The
other variant slows down acetaldehyde metabolism, meaning the chemical hangs
around in the body longer, prolonging the damage.
So, should I cut back — or stop drinking altogether?
You don’t need to go cold turkey to help your health.
Even reducing a little bit can be beneficial, especially if you currently drink
over the recommended limits. The risk “really accelerates once you’re over a
couple of drinks a day,” Dr. Naimi said. “So, people who are drinking five or six drinks a day, if they can cut back
to three or four, they’re going to do themselves a lot of good.”
Light daily drinkers would likely benefit by cutting back
a bit, too. Try going a few nights without alcohol: “If you feel better, your
body is trying to tell you something,” said George Koob, director of the
National Institute on Alcohol Abuse and Alcoholism.
Notably, none of the experts we spoke to called for
abstaining completely, unless you have an alcohol use disorder or are pregnant.
“I’m not going to advocate that people completely stop drinking,” Dr. Koob
said. “We did prohibition, it didn’t work.” Generally, though, their advice is, “Drink less, live
longer,” Dr. Naimi said. “That’s basically what it boils down to.”
-Dana G. Smith
NY Times, January 13, 2023
