It’s noncontroversial to state that alcohol is both a tonic and a poison. The difference lies mostly in the dose. Moderate drinking seems to be good for the heart and circulatory system and probably protects against type 2 diabetes and gallstones. Heavy drinking is a major reason for preventable death in most countries. In the U.S., alcohol is involved in about half of fatal traffic accidents. Heavy drinking can damage the liver and heart, harm an unborn child, increase the chances of developing breast and some other cancers, contribute to depression and violence, and interfere with relationships.
Alcohol’s two-faced nature shouldn’t come as a surprise. The active ingredient in alcoholic beverages, a simple molecule called ethanol, affects the body in many different ways. It directly influences the stomach, brain, heart, gallbladder, and liver. It affects levels of lipids (cholesterol and triglycerides) and insulin in the blood, as well as inflammation and coagulation. It also alters mood, concentration, and coordination.
What’s Moderate Alcohol Intake?
The loose use of the terms “moderate” and “a drink” has fueled some of the ongoing debate about alcohol’s impact on health.
In some studies, the term “moderate drinking” refers to less than 1 drink per day, while in others it means 3 to 4 drinks per day. Exactly what constitutes “a drink” is also fairly fluid. Even among alcohol researchers, there’s no universally accepted standard drink definition.
In the U.S., 1 drink is usually considered to be 12 ounces of beer, 5 ounces of wine, or 1½ ounces of spirits (hard liquor such as gin or whiskey). Each delivers about 12 to 14 grams of alcohol on average, but there is a wider range now that microbrews and wine are being produced with higher alcohol content.
The latest consensus places this point at no more than 1-2 drinks a day for men, and no more than 1 drink a day for women. This is the definition used by the U.S. Department of Agriculture and the Dietary Guidelines for Americans 2020-2025 and is widely used in the United States.
Alcohol and Weight Gain
One serving of alcohol on average contains 100-150 calories, so even a moderate amount of 3 drinks a day can contribute 300+ calories. Mixed drinks that add juice, tonic, or syrups will further drive up calories, increasing the risk of weight gain over time.
However, a prospective study following almost 15,000 men over four-year periods found only an increased risk of minor weight gain with a higher intake of alcohol. Compared to those who did not change their alcohol intake, those who increased their intake by 2 or more drinks a day gained a little more than a half-pound. It was noted that calorie intake (not from alcohol) tended to increase along with alcohol intake.
Possible Health Benefits of Alcohol
- Cardiovascular Disease
More than 100 prospective studies show an inverse association between light to moderate drinking and risk of heart attack, ischemic (clot-caused) stroke, peripheral vascular disease, sudden cardiac death, and death from all cardiovascular causes. The effect is fairly consistent, corresponding to a 25-40% reduction in risk. However, increasing alcohol intake to more than 4 drinks a day can increase the risk of hypertension, abnormal heart rhythms, stroke, heart attack, and death.
The idea that moderate drinking protects against cardiovascular disease makes sense biologically and scientifically. Moderate amounts of alcohol raise levels of high-density lipoprotein (HDL, or “good” cholesterol), and higher HDL levels are associated with greater protection against heart disease. Moderate alcohol consumption has also been linked with beneficial changes ranging from better sensitivity to insulin to improvements in factors that influence blood clotting, such as tissue-type plasminogen activator, fibrinogen, clotting factor VII, and von Willebrand factor.
Such changes would tend to prevent the formation of small blood clots that can block arteries in the heart, neck, and brain, the ultimate cause of many heart attacks and the most common kind of stroke.
- Gets You More Active
Moderate drinkers are far more likely to exercise than people who don’t drink. And they may even get more healthy effects from it. On the flip side, the more you exercise, the more likely you are to drink now and then. Scientists don’t know exactly where this link comes from.
- Prevents Kidney Stones
Regular moderate drinkers are less likely to get kidney stones — 41% less likely for those who drink beer, 33% for wine drinkers. Part of the reason may be that alcohol, like caffeine in coffee and tea, makes you pee more often. That helps clear out the tiny crystals that form stones. Drink too much, though, and you can get dehydrated, and that increases your risk of kidney stones along with other health problems.
- Makes You More Social
Good friends are good for you. And people who have a drink or two together — rather than, say, sodas — are likely to spend more time talking. They’re also more likely to share smiles and keep everyone involved in the conversation. But don’t overdo it — it’s called happy hour for a reason.
- Gives Your Sex Life a Boost
Intimacy helps you deal with stress, and a little alcohol may move things along. In one study, women who had one or two glasses of red wine a day said they had more desire, arousal, and sexual satisfaction than those who didn’t. Those who drank more reported no change. A drink also may help raise a man’s testosterone levels, which makes both men and women friskier. But men who drink too much can lose the desire and the ability to have sex.
- Helps Your Brain
A drink or two a few times a week may make you less likely to get Alzheimer’s disease. Moderate drinking may also reduce the risk of stroke and heart disease — both of which can speed up the effects of Alzheimer’s.
- Balances Blood Sugar
That happy-hour cocktail or glass of wine with dinner may make you less likely to develop type 2 diabetes. Scientists aren’t sure why exactly, but it might be that a drink or two helps your body deal with high blood sugar levels healthily.
Shifting benefits and Risks
The benefits and risks of moderate drinking change over a lifetime. In general, risks exceed benefits until middle age, when cardiovascular disease begins to account for an increasingly large share of the burden of disease and death.
- For a pregnant woman and her unborn child, a recovering alcoholic, a person with liver disease, and people taking one or more medications that interact with alcohol, moderate drinking offers little benefit and substantial risks.
- For a 30-year-old man, the increased risk of alcohol-related accidents outweighs the possible heart-related benefits of moderate alcohol consumption.
- For a 60-year-old man, a drink a day may offer protection against heart disease that is likely to outweigh potential harm (assuming he isn’t prone to alcoholism).
- For a 60-year-old woman, the benefit/risk calculations are trickier. Ten times more women die each year from heart disease (460,000) than from breast cancer (41,000). However, studies show that women are far more afraid of developing breast cancer than heart disease, something that must be factored into the equation.
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