Alcohol. It's Just Not That Good for You

I feel kind of ridiculous regarding the title of this blog post, but it's come to my attention that the general consensus believes that so long as you're not an alcoholic or binge drinking regularly, alcohol is no big deal.  One step further and a popular opinion is that moderate consumption should be part of your balanced diet because you know, health benefits.  Never have I been so fiercely verbally attacked (both in person and online) than when I have shared the simple notion that alcohol probably isn't good for you. Just like nutrition, it's on board with topics like religion and politics-- people hold their opinion of alcohol to such a high regard that they can't possibly stand the idea that their beliefs could be debunked. I don't have all the answers and maybe in the end these health benefit claims hold some truth, but I want you to reflect on the notion that consuming a substance that has been negatively linked to roughly 100 health conditions is in some way, beneficial?  Doubtful.

I understand the complexity of "shaming" alcohol.  Drinking is so engrained in many cultures, brings camaraderie to friendly gatherings and is used as a socially acceptable method to kick back and relax after a long hard day.  I don't doubt that to an extent, it has psychosocial benefits when consumed in moderation and in good company.  My purpose in writing this is to emphasize that your physical and mental health will likely be optimized from abstaining, or at least limiting to a couple servings of alcohol a week.  It's a gentle suggestion, and I'm not villainizing anyone who chooses otherwise.  I'm just sitting back and observing this somewhat alarming trend of justifying alcohol intake as "moderation is good for you" when in reality it can easily turn into substance abuse or dependency.  You know that old saying that some people have no idea how good their body is designed to feel? I think this is particularly true in regards to alcohol, yet I get looks of horror when I suggest cutting it out completely.  It's always worth a try, and likely your body and mind will thank you.

When it comes down to it, we just can't ignore the "bad." 

Here's some nitty gritty details-- Alcohol is estimated to contribute to about 80,000 deaths and greater than $200 million dollars in overall healthcare cost annually in the United States.  Roughly 10% of American adults meet criteria for alcohol use disorder (generally referring to drinking to a point that it causes problems in relationships, results in legal issues, interferes with daily work/home obligations, OR places oneself at risk for bodily harm due to drinking in conjunction with a dangerous activity such as driving or swimming.)  A "single drink" is typically much less than one would imagine, defined as 12 oz beer, 5 oz wine, or 1.5 oz of liquor. A person is considered a "risky" drinker if: men consume 15 or more standard drinks per week or 5 or more on an occasion, and for women 8 or more drinks weekly or 4 or more on an occasion. Aside from the acute risks of accidents, overdose, and complications related to withdrawal, chronic excessive intake has been associated with quite literally more than 100 health conditions, with liver cirrhosis and heart failure being the most lethal disorders in regards to chronic use.  

A recent publication in Lancet challenges the status quo of recommended limitations of alcohol, encouraging that we likely need stricter guidelines in the United States (Currently, men are encouraged to simply drink less than ~200g of alcohol per week, and women less than ~100g). This study combined 3 large data bases from 19 countries to assess the association between quantified alcohol intake and mortality; minimum mortality risk was associated with those individuals who drank less than 100g of alcohol per week (see figure with link to original paper). While any study based on association can have confounding variables, this particular analysis did a wonderful job at controlling for variables like metabolic factors, socioeconomic status, physical activity level, and occupation.

The Health Benefits. Are there really Any?

So far, any studies that suggest possible benefits to moderate alcohol consumption can't be reproduced. This is even true for the expected benefit of reducing heart disease risk; when data is re-analyzed to control for a number of other variables (age, gender, social and demographic factors) there seemed to be a "disadvantage" for the non-drinkers, thus making it appear as if they were at higher risk related to their alcohol intake. [if you have access to this paper, read it HERE.]  Additionally, studies suggesting benefits do not delineate between "never drinkers" and "former drinkers", thus making it difficult to tease out the long term effects of chronic alcohol use. 

I'm certain that this section will leave a few people uncomfortable, ready to fight with a single scientific paper in hand associating benefits of moderate drinking with condition x, y, or z.  I believe that 1) it IS possible that it could be a good thing and 2) there is strength in study reproducibility.  I'm open to reading any literature you may have for me, so long as you're open to my honest review and interpretation.

So what should I do?

From my well-read and clinical point of view, the risks of alcohol FAR exceed the benefits (including those psychosocial conditions of having a well rounded social life.)  You don't need alcohol to enhance any aspect of your life, and actually I'd expect that abstaining or significantly limiting intake might actually be the key to feeling your best on all accounts.  

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Take a good hard look at your drinking frequency and habits. What social constructs have you created that are dependent on consumption? Are you capable of not drinking and still having a good time? WHY do you feel it should be a requirement for your life? If you drink so much to put yourself in the "high risk" category (see above) are you ready to address if you're abusing?  (see table, from Friedmann, NEJM April 2013.)

I get it.  I love the occasional glass of wine sitting outside on a summer night, or a fun night out with maybe one too many drinks when my best friend is in town.  Some of my favorite memories are from times where alcohol was involved!  I just ask that we all reflect/ensure that an occasion does not become a habit that does not become a bigger problem.  Don't fall back on the false reassurance that "moderation is good for me" and really make the best decision when it comes to you, your body, your mind and drinking. You deserve to feel your absolute BEST every single day, and more likely than not, alcohol probably isn't part of that equation. Just make sure you're sober enough to do the math :-P

Sincerely,

Shanny DO