Is moderate drinking good for your health?

You’ve heard it before. “Let’s go for a drink!” and, if you’re like me, you happily oblige. 

Next thing you know, you’re slightly buzzed and contemplating another.

This critical decision point can mean life or death in some cases. It also mirrors back to us our relationship with alcohol.

If you’ve ever wondered about these things, keep reading. In this post, I share the pros and cons of drinking so you can make informed decisions about drinking in the future.

Definition of Drinking

Moderate Drinking is defined as 2 drinks or less in a day for men and 1 drink or less in a day for women (2020-2025 Dietary Guidelines for Americans)

Binge Drinking is defined as a pattern of drinking alcohol that brings blood alcohol concentration (BAC) to 0.08 percent which equals 5 or more drinks (adult male), or 4 or more drinks (adult female), in about 2 hours

Heavy (Or Excessive) Drinking is defined as the consumption of more than 4 drinks on any day or more than 14 drink per week for men and more than 3 drink on any day or more than 7 drinks per week for women

Alcohol Use Disorder is a DMS-V diagnosis defined as a chronic brain disorder marked by compulsive drinking, loss of control over alcohol use, and negative emotions when not drinking. AUD can be mild, moderate, or severe. Recovery is possible regardless of severity. 

Standard Drink 

in the United States, 14 g ethanol is considered a drink which is equivalent to 

•  12 fluid ounces beer (usually about 5% alcohol)
•  8-9 fluid ounces malt liquor (usually about 7% alcohol)or craft beer  
•  5 fluid ounces wine (usually about 12% alcohol)
•  1.5 fluid ounces (1 shot) of 80-proof distilled liquor 

Facts and Stats about Drinking

Alcohol is a very popular, yet controversial substance. The many variables that can either promote health or destroy it are mutlifactorial and consumption of alcohol is a very personal choice. 

*When researchers compared the amount of self-reported alcohol consumed to the national sales data, it was found that people are only drinking 30-40% of the alcohol they purchase. At first, this seems a good thing, except, where what happened to the other 60-70% of the alcohol purchased? Did it go down the drain?  Sent to Canada? Or perhaps people are grossly underestimating the amount of alcohol they are consuming.

Weighing the Risks

Drinking too much is bad. But what if we only had one or two?

Read on to see what the research says on this matter.

Benefits of Moderate Drinking

Polyphenols

Polyphenols, also known as phytochemicals, have antioxidant and antiinflammatory activity and the potential to prevent a number of diseases. Only beer and wine and beer contain polyphenols but red wine has the highest concentration. (Nutrients 2012 Jul;4(7):759). 

They work by reducing low-density lipoprotein (LDL) cholesterol oxidation, modulating cell signaling pathways, and reducing platelet aggregation (Nutrients 2012 Jul;4(7):759).

Red wine contains polyphenols such as anthocyanins and flavan-3-ols, resveratrol, cinnamates and gallic acid (Nutrients 2012 Jul;4(7):759).

Beer (including non-alcoholic beer) contains polyphenols such as benzoic acid derivatives and cinnamic acid, coumarins, catechins, di- and tri-oligomeric proanthocyanidins, prenylated chalcones and α- and iso-α acids derived from the hops (Nutrients 2012 Jul;4(7):759).

Based on a randomized, crossover feeding trial looking to evaluate beer’s effects on markers of cardiovascular risk in high CV risk men, moderate alcoholic and non-alcoholic beer consumption increases HDL’s antioxidant activity and the non-alcoholic fraction of beer reduces proinflammatory biomarkers involved in atherosclerosis (Nutrients 2019 Dec 30;12(1):doi:10.3390/nu12010108).

Resveratrol in Red Wine

Resveratrol is the most extensively researched. It is found in high concentration in red wine as well as many other foods such as the skin of red grapes and peanuts (Mol Nutr Food Res 2005 May;49(5):495).

Due to the way white wine is made (less time spent in contact with the skin) the polyphenol content is much lower and does not exert the same reported benefits as red wine.

Resveratrol has low bioavailability and is rapidly metabolized and excreted; blood levels depends on several factors such as dose, associated food matrix, or time of ingestion (Mol Nutr Food Res 2005 May;49(5):495).

In other words, you may not be getting all that much.

A randomized cross-over trial showed that moderate consumption of red wine, but not gin, decreases erythrocyte superoxide dismutase activity suggesting red wine has greater antioxidant effects likely due to polyphenol content (Nutr Metab Cardiovasc Dis 2011 Jan;21(1):46). Some research suggests that consumption of wine is associated with a healthier lifestyle and may skew the data.

Toast to for Resveratrol!

Due to the reported benefits of resveratrol, supplements are now available over the counter. However, like all supplements, resveratrol is unregulated by the Food and Drug Administration (FDA).

A recent review of the literature looking at supplement dosing showed a dose of 450 mg/day appears to be safe for a 60-kg person and that doses of 1,000 mg/day may induce adverse effects such as nephotoxicity and gastrointestinal problems. Doses at or above 1,000 mg/day has also been reported to affect cytochrome function and may interact with certain medications.

heart disease 

Multiple studies have looked at alcohol intake and heart disease risk. The research has concluded light to moderate drinkers ( <1 glass per day or 7 drinks per week for women) have a greater benefit than nondrinkers or heavy drinkers.

For the science geeks out there, it’s a J-shaped curve. For example, analysis of data from the Nurses Health Study (NHS) found moderate alcohol intake (1 drink/day or less) 3 to 4 days per week is associated with a lower risk of myocardial infarction (heart attack) among women, and that HDL cholesterol, fibrinogen, and HbA1c accounted for 75% of the association.(3)

Analysis of data from 10,893 European Americans in the Atherosclerosis Risk in Communities (ARIC) study found low to moderate alcohol consumption increased HDL (good cholesterol) and reduced triglycerides, total cholesterol and LDL (bad cholesterol)  (PLoS One 2016;11(2):e0148765). 

A Cochrane Review of the Literature determined that alcohol’s effect on blood pressure (BP) and heart rate (HR) seem to be related to amounts and elapsed time from consumption. It appears ≤12 hours after ingestion of any amount of alcohol there is a significant reduction in both systolic and diastolic blood pressures but an increase heart rates. Higher intakes of ≥ 30 g/day appear to initially lowering BP for up to 12 hours but later increasing both heart rates and BP (Cochrane Database Syst Rev 2020 Jul 1;7:CD01278).

Data from the Nurse’s Health Study found low to moderate alcohol intake (<15 g/day) is associated with a modestly reduced a risk of both hemorrhagic stroke and ischemic stroke in women (Stroke 2012 Apr;43(4):939).

glycemic control

Alcohol, when consumed with meals, has a positive effect on our blood glucose levels.

Moderate alcohol consumption during meals, appears to lower post-prandial glycemia and improve HbA1c and fasting insulin concentrations (Am J Clin Nutr 2007 Jun;85(6):1545).

In a randomized controlled study assessing the affect of alcohol on fasting and postprandial glycemia, researchers found patients with type 2 diabetes, initiation of moderate alcohol reduced fasting glucose but not postprandial (Diabetes Care 2007 Dec;30(12):3011).

gallstones

Moderat alcohol intake may even prevent gallstones!

Osteoporosis

There’s also some evidence to suggest moderate alcohol consumption could reduce the risk of osteoporosis in post-menopausal women.

It appears moderate alcohol intake improves bone mineral density but research has found that alcohol intake also increases risk of fracture. The contradiction of this statement may be related to the increased likelihood of trauma related to falls as a result of alcohol use since most of the data on falls occurs when intake exceeds the recommendations (Am J Med. 2008 May;121(5):406-18). However, light to moderate intake of alcohol by postmenopausal women may help to maintain bone mineral density (PLoS One 2017;12(6):e0180132).

Harms of Moderate Intake Drinking

misuse, addiction, or trauma

The use of alcohol to relieve stress may be a myth.

Studies looking at the effect of alcohol on affect (your mood or disposition) have consistently found no association. It is also thought that this believed association is what motivates individuals to drink and may ultimately lead to problem drinking, addiction, or traumatic incidents (Am J Drug Alcohol Abuse 2020;46(1):88). 

If misuse occurs, the chance of traumatic events increases.

For example, females are more susceptible to blackouts than males. Blackouts usually occur when blood alcohol concentration is 0.16-0.30% (1)

Speaking of Blood Alcohol Concentrations…

An altered state of mind and impaired judgment begins to occur with blood alcohol concentrations as low as 0.05%.

In the US, the max blood alcohol concentration while operating a vehicle is set at 0.08%.

According to the National Institute of Alcohol Abuse and Alcoholism, 0.08% is achieved in a binge drinking episode after a woman consumes 4 drinks in a 2-hour time frame (1).

Lastly, regular use may increase tolerance, and the chance of addiction, even at small doses (1). 

drug interactions  (prescription, nonprescription, and recreational drugs)t

Since this blog skews towards mental health…

psychotropics

Research has shown that for those being treated for mood disorders like depression, mixing alcohol with medications may result in drowsiness, dizziness; increased risk for overdose; increased feelings of depression or hopelessness (all medications); impaired motor control (quetiapine, mirtazapine); increased alcohol effect (bupropion); liver damage (duloxetine).

other medications

Mixing alcohol with other medications can cause nausea and vomiting, headaches, drowsiness, fainting, or loss of coordination. It can increase your risk for internal bleeding, heart problems, and difficulties in breathing. In addition, alcohol can make a medication less effective, or it may make the medication harmful or toxic to your body.

For a complete list of interactions and effects, see the National Institute of Alcohol Abuse and Alcoholism Harmful Interactions.

weight

Pure alcohol supplies 7 calories per gram with very few nutrients.

Most hard alcohol is mixed with various amounts of other ingredients such as soda, juice, and energy drinks, which may or may not contain added sugars.

Theoretically, since alcohol and any mixers have calories, they both count towards your total daily intake. If calorie intake exceeds your bodies needs, then the result is weight gain. (Nutrients. 2021 Aug 24;13(9):2927). However, much of the research on this topic lacks quality leaving the data inconclusive.

Lastly, poor judgment may lead to binge eating (most often high calorie, low nutrient-density foods), and if calories are over-consumed, the result is weight gain.

breast cancer

Any amount of alcohol increases a woman risk of breast cancer!

You read that right. Even on drink increases your risk.

Research has found a definite linear association between alcohol intake and risk of breast cancer. The proposed relationship is the effect alcohol has on circulating estrogen levels. A woman’s risk increases significantly with even one drink. For example, having 1 drink per day increases risk of breast cancer by 5 to 9 percent when compared with nondrinkers (Alcohol Clin Exp Res 2016 Jun;40(6):1166).

fertility

It’s no secret that drinking alcohol during pregnancy is not a good decision as there is a slew of negative consequences with even moderate amounts. But what about prior to conception? Does drinking moderate amounts impact fertility?

Research in this area is inconclusive.

One study determined that less than 14 servings of alcohol per week has no effect on fertility (BMJ 2016 Aug 31;354:i4262).

Another found that more than 7 drinks per week extended time to conception (Hum Reprod 2012 Feb;27(2):583).

Another, specific to women in later reproductive stages (> 30 years old), found a negative association between alcohol and infertility (Acta Obstet Gynecol Scand 2003 Aug;82(8):744).

If you are looking to conceive in mid-life, it is best to work with a fertility specialist.

The Bottom Line

Light to moderate amounts of alcohol has been deemed safe for consumption by adults but is it really?

In summary, light to moderate drinking may:

• Benefits
  • increase intake of polyphenols (primarily from red wine) which may reduce overall risk of disease
  • reduce risk of heart disease through decreased blood pressure, increased HDL, and antioxidant/anti-inflammatory activities
  • improve glycemic control
  • reduce risk of gallstones
  • slightly improve bone mass density and reduce risk of bone fracture in postmenopausal women
• Harms
  • eventually, or accidently, lead to misuse or addiction
  • interact with certain prescription, nonprescription, and recreational drugs
  • impair a person’s judgment enough to result in negative consequences
  • contribute excess calories negatively affecting weight
  • increase risk of breast cancer
  • interfere with conception or fetal development

Cheers, Witches! Let’s toast to YOU and all that you ARE and all the MAGIC you bring to the world!

Not sure if you drink too much? work with me to find out

References

1. National Institute of Alcohol Abuse and Alcoholism (NIAAA) at www.niaaa.nih.gov/  
2. Minzer, S., Losno, R. A., & Casas, R. (2020). The Effect of Alcohol on Cardiovascular Risk Factors: Is There New Information?. Nutrients, 12(4), 912. https://doi.org/10.3390/nu12040912
3. Kloner RA, Rezkalla SH. To drink or not to drink? That is the question. Circulation. 2007 Sep 11;116(11):1306-17. 

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