Did you know that even small amounts of alcohol may harm your health? Many of us assume that alcohol poses health risks only when drinking is excessive. We think of the alcoholic with cirrhosis, gastrointestinal bleeding or acute pancreatitis. We don’t think of the possible association of moderate alcohol consumption with breast, liver and esophageal cancer or with heart disease like hypertension or atrial fibrillation. We remember prior recommendations claiming one drink a day for women and two for men are good for our cholesterol and heart.
Earlier studies found that moderate alcohol consumption resulted in a reduction of cardiovascular disease because of its antioxidant and anti-inflammatory effects. But before we delve deeper into the controversy about alcohol, we should consider that alcohol is a toxin. It is metabolized to acetaldehyde which damages DNA, and it also creates an oxidative stress that may also be carcinogenic. In 2022 the CDC published new data showing that alcohol caused 140,000 deaths/year. One in five deaths of 20-49 year olds is due to alcohol. Many of the alcohol associated deaths are due to motor vehicle accidents; but thousands are associated with chronic diseases. During the first year of the pandemic, alcohol related deaths increased by 25% (September 2, 2022 New England Journal of Medicine).
Yet, as the ravages of COVID recede, there seems to be little impact on drinking patterns. As a result of COVID a new disease has emerged to the forefront: Alcohol Use Disorder (AUD). AUD is not necessarily heavy drinking but alcohol in larger amounts over a longer time than intended. It may include a strong desire to cut down or unsuccessful attempts to cut down. It is easy to see how this happened during COVID: We were homebound, isolated, stressed, and at the end of the day a drink seemed like a good way to relax. But that drink turned into several, and before long several became habit.
Since the controversies about alcohol use have been reignited, there are two schools of thought, each stating their own case. However, the reality is that there are no randomized studies to support either side. What we’re left with are observational studies showing associations between alcohol consumption and disease or health. The relative impact of other behaviors, such as smoking on one side and healthy diet and exercise on the other, are not necessarily considered. So what should we do with the evolving and at times contradictory information?
Two thirds of Americans say they drink and that the occasional glass of wine enhances a good meal or occasion. The CDC says that one drink a day for women and two for men is considered moderate. But remember that a drink is not a tumbler full of whiskey or a wine glass filled to the brim. When I measure 5oz (“a glass” of wine) in my wine glasses, the level is about one third full. When it comes to healthy drinking, one size does not fit all. There isn’t medical consensus about how much alcohol is safe. Talk with your doctor about the relative risk (do you have breast cancer for example) or benefit of alcohol.
For people who want to cut back on alcohol, first consider the circumstances in which you drink. Is it with the evening news, a partner, during dinner, or as a night cap to put you to sleep? When alcohol has become a habit, cutting back may require a change in circumstances or environment. Instead of the cocktail before dinner, take a walk or meet with a friend for tea. Instead of a drink before bed, try yoga or meditation.
Concord is lucky to have many support groups to help people cut back on drinking. These include AA, support groups and addiction treatment at Emerson Hospital, counseling and support through the Council on Aging, or pastoral care through a church or synagogue. Meanwhile try to make conscious informed decisions about your own drinking habits, and stay tuned to the research that will more definitively direct us in the years ahead.
