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To Drink, or Not to Drink?

The health benefits — and risks — of alcohol

It's hard to know what to think about the recommendations for alcohol consumption when the narrative around it changes like the wind.

Numerous studies have come out in support of moderate alcohol consumption because of its potential health benefits only to be countered by similar studies arguing that it's actually more harmful than beneficial.

And it's not just conflicting research that make decisions about alcohol difficult; other related factors, such as your age, gender and overall health, can further complicate the issue.

So is it OK to have a glass or two of red wine with dinner? Or to enjoy a few beers at the ballgame? 

Here, Pablo Quintana, MD, an internal medicine specialist at Rush University Medical Center, explains how alcohol affects your body — both positively and negatively — why all alcohol isn't created equal, and how to make the right choices for your personal health.

How much alcohol is too much?

The recommendations and guidelines set forth by the government and health agencies for alcohol consumption are generally based on low to moderate intake. "Here in the U.S. that means a maximum of one drink per day for women, and two per day for men," Quintana says.

The recommendations are lower for women because they generally weigh less, so they have less tissue to absorb alcohol, and they have a smaller body composition with less water, so the alcohol doesn't disperse as well as it does for men. These factors make women more susceptible to the effects of alcohol, and it takes smaller amounts to affect them.

Heavy drinking is a little bit harder to quantify, but according to the guidelines, consuming more than 14 drinks per week for men and seven drinks per week for women is considered excessive.

These recommendations are, of course, based on the assumption that a person is pretty much healthy, with no underlying issues.

But, as Quintana points out, many people do have some type of medical condition — or multiple conditions — especially as they get older. And your specific issues can make drinking more perilous. For instance, alcohol has been identified as a common trigger for chronic conditions like asthma and migraines.

Here are some other possible health benefits and risks:

The potential benefits of moderate drinking

Heart health. Some research has found that red wine improved cardiovascular health — a little.

"A few prospective studies have shown that patients who drink a low to a slightly moderate amount of alcohol do have an overall slightly reduced risk of coronary artery disease," says Quintana, but he cautions that alcohol should not be seen as a substitute for healthy behaviors that are proven to reduce risk significantly, such as eating right, exercise regularly and quitting smoking.

Controlling cholesterol. In some studies, moderate red wine consumption has been linked to increased levels of high-density lipoproteins (HDL) or good cholesterol, which may be helpful in preventing blood clots that can reduce the risk of heart attack or stroke.

Red wine contains a compound called resveratrol that reportedly has antioxidant properties and is good at fighting pathogens that occur in the body. 

Beer, too, may help you manage your cholesterol. According to a recent study, moderate beer consumption may slow the decrease of HDL cholesterol over time. Just don't overdo it, because heavy beer consumption actually erases this positive effect.

Boosting bone health. Studies published in the Journal of the American Medical Association and Osteoporosis International found, respectively, that moderate beer drinkers were 38 percent less likely to have osteoporosis and had a 20 percent lower risk of hip fractures than non-drinkers. One possible reason: the dietary silicon found in beer, which plays a role in the growth and development of both bone and connective tissues.  

Whereas light or moderate alcohol consumption may be good for your heart, excessive drinking weakens the heart muscle.

The risks of too much alcohol

When alcohol is consumed in excess, however, the list of negatives tends to outweigh any potential health benefits.

Cancer. "Certain cancers have been linked to excessive alcohol intake. One in particular is hepatocellular cancer, which is a cancer of the liver. Certain esophageal cancers and gastrointestinal cancers have also been related to excessive alcohol use," Quintana says. "And not just cancer, but liver disease as well."

The reason: Excessive alcohol can damage cells in the body. When the cells try to repair themselves, DNA changes occur that can lead to cancer and disease.

Diabetes. Alcohol can affect blood sugar levels and interact with diabetes medications. So for diabetics, drinking too much can lead to hypoglycemia, or "insulin shock," or hyperglycemia, an excess of insulin (see below for more on why diabetics should drink with caution).

Heart failure. Whereas light or moderate alcohol consumption may be good for your heart, excessive drinking weakens the heart muscle and can prevent it from pumping blood properly. So alcohol abuse can lead to serious cardiovascular conditions such as congestive heart failure.

Worsening health conditions in seniors. Although there haven't been many studies on the effects of varying amounts of alcohol use by seniors, heavy drinking can be potentially harmful.

Excessive alcohol damages brain cells and causes a vitamin B1 (thiamine) deficiency, which can impair memory and vision. "So it could lead to worsening dementia," Quintana says.

When sustained over a long period of time, alcohol abuse can also worsen other health conditions such as mood disorders, osteoporosis and high blood pressure, according to the National Institute on Aging. And, of course, drinking too much can lead to falls and broken bones, which are always a concern for seniors.

What you drink makes a difference

Just as important as how much alcohol you're consuming is the type, which can affect you in a variety of ways based on the following factors:

Alcohol content

Beer, wine and hard liquor all contain different amounts of alcohol. According to the National Institute on Alcohol Abuse and Alcoholism, a standard drink in the United States contains approximately 14 grams of pure alcohol. Here's what one standard drink looks like for each type of alcohol:

● 12 ounces of regular beer = about 5 percent alcohol
● 5 ounces of wine = about 12 percent alcohol
● 1.5 ounces of distilled spirits = about 40 percent alcohol

Calories (specifically, carbs)

In addition to the alcohol content, keep an eye on the calories you're drinking.

For example, beer has a high amount of carbohydrates, and some types of beer are high in calories as well. "But most beers have a lower alcohol percentage compared to wine or hard drinks, which usually leads to drinking more of it. And that can affect the body in many negative ways, such as making you gain weight," Quintana says.

Since carbohydrates are broken down into simple sugars in the body and absorbed into the bloodstream, drinking beer in excess can also affect your insulin levels, as mentioned earlier.

Too much beer can cause a drop in blood glucose levels because alcohol prevents the liver from producing glucose. Although the liver can produce glucose if blood sugar drops too low, once these emergency stores are used up, more can’t be made right away if a person with Type 1 diabetes drinks too much. This in turn can lead to dangerously low blood sugar levels. For those with Type 2 diabetes, blood sugar levels increase, which can also be dangerous.

"So if you have diabetes, you obviously should not consume a lot of these carbohydrates," Quintana explains.

What you mix in

Mixers enhance the taste of alcohol, but use them with caution. You probably don't think much about it, but many mixers add sugar and calories to your drink.

For instance, 5 ounces of simple syrup — a common ingredient in mixed drinks — will add 45 calories. Five ounces of Cointreau, found in Cosmos and margaritas, contain 47 calories. Those numbers might seem small, but they increase the total calories and sugar you’re consuming, especially if you have more than one drink.

If you're diabetic or pre-diabetic, you should definitely avoid sugary mixers (and, for that matter, sweet wines or liqueurs). To add flavor without sugar and calories, club soda, diet soda, or lemon or lime juice are smart choices.

And although it's a popular trend, you should never mix alcohol and energy drinks.

According to the Centers for Disease Control and Prevention (CDC), since energy drinks contain a high amount of caffeine, when they're added to alcohol, they subdue the depressant effects of alcohol so drinkers feel more alert. Because they feel more alert, drinkers may assume they're less affected by alcohol and in turn consume more alcohol. This increases their likelihood of being impaired, and their risk for serious injury and risky behavior.

Make informed decisions about drinking

At the end of the day, determining if alcohol is good or bad for you requires making sound decisions with respect to your health.

"If you don't have any health conditions, it's safe to say that following the guidelines of low to moderate intake should not cause a problem with your health — and may even positively affect it," Quintana says.

These are some notable exceptions, where it's recommended that you avoid alcohol altogether:

● Those with a family history of alcohol abuse
● Pregnant and breastfeeding women*
● People with health conditions such as ulcers or liver conditions
● Women at risk for breast cancer
● Those on medications that may interact with alcohol

"My strongest advice, and the safest thing to do, is always discuss this with your health care provider to determine if it's safe to drink alcohol or not," Quintana says. "It's definitely not something you should take a chance on if you're uncertain."

*Pregnant and breastfeeding women should never drink excessively. But according to a study published in the journal BMJ Open in 2017, there hasn't been enough research to determine whether light alcohol consumption can potentially harm a baby in utero, or whether there is a "safe" level of alcohol a woman can drink during pregnancy. So the Centers for Disease Control and Prevention recommends that pregnant women avoid drinking completely.

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