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Alcohol and Health:
Distilling the Risks and Benefits

Alcohol-related problems -- from alcoholism to drunk driving -- kill roughly thousands each year. And they cost billions annually in treatment, lost productivity and other direct and indirect expenditures.

Some 14 million Americans, or about 7.4 percent of the population, are alcoholics. Millions more binge drink and otherwise abuse alcohol.

Those grim statistics suggest drinking is a scourge. But wait, you say. Isn't some alcohol good for me? What about those reports that a little alcohol each day is a boon to the heart?

If you're confused about the point where healthful, moderate drinking becomes unhealthy, heavy consumption, you're forgiven. With all the research on the effects of alcohol, it's hard to know when to keep sipping and when to stop.

And with April designated as Alcohol Awareness Month, now's a good time to set the record straight.

"There is a lot of gradation" in drinking, says Lorraine Gunzerath, chief of the strategic research planning branch at the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

Complicating matters, a person's genetic makeup likely has much to do with not only how well he or she tolerates the harmful effects of alcohol, but also how much they're body responds to the beneficial impact of drinking.

For all the vagaries of tippling, scientists do know a great deal about what happens to those who overdo it.

First, some rules of thumb: Scientists define risky drinking, which can impair judgment and coordination, as consuming enough alcohol to drive the blood alcohol content (BAC) to between 0.05 and 0.08, the legal limit recommended by the National Highway Traffic Safety Administration. In general, a 160-pound man would have a BAC of 0.05 after consuming two drinks in a short period of time. For a 140-pound woman, the same two drinks would result in a BAC of 0.07.

Binge-drinking bouts are concentrated sprees that drive the BAC above 0.08; they're defined as five drinks in two hours for men and 4 to 4.5 drinks over that span for women. And heavy drinking is alcohol consumption that consistently sends BAC to 0.08 or higher.

U.S. health officials define moderate drinking as up to two drinks a day for men and one drink a day for women (pregnant women should abstain completely.) A standard drink can come in the form of a 12-ounce beer, a 5-ounce glass of wine, or a 1.5-ounce cocktail of 80-proof liquor.

Chronic, heavy drinking's most obvious victim is the liver. Cirrhosis of the liver is the buildup of scar tissue that results from long-term poisoning with alcohol. A healthy liver can break alcohol down into harmless starches and sugars within a matter of hours, Gunzerath says. But one of the initial breakdown products of alcohol is a toxic substance called acetaldehyde. [Some people are missing a gene that helps them neutralize acetaldehyde, and as a result they become quite ill immediately after drinking.]

Gradually, scars in the liver block blood flow throughout the organ and hinder its performance as a waste treatment center. Cirrhosis is the country's 12th-leading cause of disease-related death, claiming 26,000 lives each year, according to the National Institutes of Health.

Drinking also has been clearly linked to several forms of cancer that affect the digestive tract and airways, starting in the mouth and moving down into the esophagus. Even people who use mouthwashes that contain high concentrations of alcohol are vulnerable to some of these tumors, scientists have found.

Alcohol may increase the risk of stomach and pancreatic cancers, as well as colorectal tumors, although probably in conjunction with smoking. Heavy drinking may also raise a woman's risk of breast cancer, although the evidence here isn't strong.

That's the bad news. The glass-half-full side of alcohol consumption is this: People who consume alcohol moderately appear to gain some protection against heart disease, the nation's leading killer.

Alcohol might protect the heart and blood vessels in at least two ways. It increases blood levels of high-density lipoprotein cholesterol (HDL), the so-called good form of blood fat. And, alcohol thins blood, thus making it less likely to clot.

That should, in theory, shield drinkers from strokes, a leading cause of death and disability. Some studies have found such a protective effect from light-to-moderate drinking.

One recent study, for example, found older drinkers cut their risk of strokes, but at an intriguing -- and still undefined -- cost: A shrinking brain. "There may very well be a trade-off between improvements in blood vessel problems and direct injury to brain cells and brain shrinkage," says Dr. Kenneth Mukamal, a Harvard University internist who researched the issue.

However, a study in younger people turned up no reduction in stroke risk from light-to-moderate drinking.

"We're at an interesting point where the information that we have is hard to put together because it seems to be conflicting," Mukamal says. "On the one hand, we see some negative effects even at light to moderate amounts [of alcohol]. But on the other hand, studies show that [these drinkers] have a lower risk of stroke than non-drinkers or heavy drinkers. Finding the balance of these risks and benefits on the brain is still a challenge for us."

As Gunzerath points out, even if alcohol does ward off heart attacks and strokes, drinking may simply trade liver trouble and cancers for fewer cardiovascular problems.

The American Heart Association doesn't recommend that non-drinkers take up alcohol. But the group does advise people who consume alcohol to do so moderately. The NIAAA, a division of the National Institutes of Health, recommends people 65 and older consume no more than one drink a day.

But at least one researcher says U.S. drinking guidelines are rooted as much in relative morality as they are in science.

Ruth Engs, an Indiana University researcher who studies "clean living" movements, says America is far more conservative about alcohol than other countries. In Britain, for example, moderate drinking is considered to be up to 21 drinks per week for men and 14 per week for women -- in other words, about twice as much as in this country.

"Alcohol is a forbidden fruit, it's something you can't touch," Engs says.

One result of this ambivalence toward alcohol is that health officials are reluctant to promote its benefits, Engs says. "I think unless you're an alcoholic and have a compulsive behavior, a drink a day is probably a good idea based on all the medical evidence," she says. "At least 200 to 300 studies [show] a small amount of alcohol is very beneficial."

Gunzerath says the federal government is funding several key areas of research into the effects of alcohol on health. They include:

  • Looking for factors behind underage drinking, including what makes adolescents interested in alcohol and what health effects, if any, are unique to teens and children.
  • Developing medications to combat alcoholism and to blunt the tissue damage from alcohol.
  • Looking for chemicals called biomarkers that may show which people are more sensitive to the harm or benefits of alcohol. Such markers could predict, for example, who is likely to become an alcoholic or to suffer liver damage from excess consumption.

More information

For more on alcohol and health, visit the National Institute on Alcohol Abuse and Alcoholism.


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