If you don't remember your password, you can reset it by entering your email address and clicking the Reset Password button. You will then receive an email that contains a secure link for resetting your password
If the address matches a valid account an email will be sent to __email__ with instructions for resetting your password
Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School - The University of Queensland School of Medicine, New Orleans, LA
It has long been recognized that the problems with alcohol relate not to the use of a bad thing, but to the abuse of a good thing.Abraham Lincoln
The effect of alcohol (ethanol) consumption on health has been described as a double-edged sword because of its apparent abilities to cut deeply in either direction—harmful or helpful, depending on how it is used. In this issue of Mayo Clinic Proceedings, Ma et al
report that alcohol consumption, often referred to as “drinking,” when done regularly/frequently (≥3 d/wk) and habitually with a meal, correlates with lower risks of all-cause mortality and cardiovascular (CV) mortality.
The Ma et al study also reported that the overall amount of alcohol consumed revealed a J-shaped association with all-cause mortality, whereby people with low to moderate intake of alcohol had better life expectancy than those who abstained from alcohol, but those who drank larger quantities of alcohol had progressively higher mortality risks. Their study also found a positive linear association with cancer death—the more alcohol consumed, the higher the risk.
Notably, among the cohort following a “healthy drinking habit” defined as alcohol consumption on 3 or more days per week and in the context of a meal, the lowest risk of death during follow-up was seen in the people consuming 4 to 21 drinks per week.
The upper end of this longevity-boosting drinking range is higher than what was reported in a comprehensive meta-analysis of 83 prospective studies on alcohol comprising 599,912 individuals, which found that the lowest risks for all-cause mortality and major adverse CV events were seen at intakes of less than 100 g of ethanol per week, which is 7 or fewer drinks per week—generally considered to be light drinking (Figure 1).
Emerging Risk Factors Collaboration/EPIC-CVD/UK Biobank Alcohol Study Group Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies [published correction appears in Lancet. 2018;391(10136):2212].
The Ma et al study reconciled these discordant results by finding that adverse health effects of moderate alcohol intake appear to be mitigated by a “healthy drinking habit.”
Figure 1Associations of usual alcohol consumption with all-cause mortality and the aggregate of cardiovascular disease in current drinkers. Cardiovascular disease was defined as an aggregate of myocardial infarction, coronary heart disease, and stroke. Hazard ratios are adjusted for age, smoking, and history of diabetes and stratified by sex and EPIC (European Prospective Investigation into Cancer and Nutrition) center. From Lancet.
Emerging Risk Factors Collaboration/EPIC-CVD/UK Biobank Alcohol Study Group Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies [published correction appears in Lancet. 2018;391(10136):2212].
Previously, a routine of light to moderate alcohol consumption has been associated with decreased risk of mortality from CV disease, stroke, and, ultimately, all-cause mortality.
A large body of evidence, however, supports the presence of a threshold over which excessive alcohol intake and binge drinking become toxic to overall health, with increased risks of stroke, cancer, hypertension, atrial fibrillation (AFIB), heart failure, aortic aneurysm, and accidents/injury.
Indeed, the risk-to-benefit ratio for drinking is less favorable among younger individuals, who as a demographic group tend to be at higher risk for alcohol-related accidents and toxicity but at lower risk for CV disease compared with older cohorts.
Most people do not drink alcohol for its purported health benefits but rather to reduce stress and/or promote positive feelings. When alcohol is consumed before or with a meal, it is typically done in a social setting conducive to conversation and emotional bonding. Establishing and maintaining social bonds is a fundamental human drive, and people tend to value behaviors that foster interpersonal connections. Compelling evidence suggests that the quality and quantity of interpersonal relationships and social support also happen to be among the most powerful determinants of long-term mental and physical health.
Yet, solitary screen time—whether it be for work or entertainment—increasingly has been displacing time spent on in-person relationships and face-to-face companionship.
A randomized controlled study of 720 volunteers reported that people assigned to alcohol-consuming groups (3 drinks per person) experienced more social bonding than did groups consuming placebo “pseudoalcoholic” beverages that contained no ethanol.
The researchers found conclusive evidence that moderate alcohol intake in small group settings stimulates social interaction, increases the amount of time people spend talking to one another, and reduces displays of negative emotions.
Again, however, a large body of data indicates that chronic excessive alcohol consumption tends to have the opposite effect—triggering social strife, violence, and abuse on personal and societal levels.
Alcohol’s Role in the Traditional Mediterranean Diet
Alcohol, generally in the form of wine, with the main meal of the day is an integral part of the traditional Mediterranean diet. In a prospective observational study involving 5505 volunteers in the PREDIMED (Prevención con Dieta Mediterránea) trial, alcohol intake in the range of 5 to 15 g/d of ethanol (about 2 to 6 ounces of wine per day) was associated with significantly lower risk of incident depression compared with either abstainers or those drinking more alcohol.
The authors concluded that low to moderate alcohol intake, predominantly as wine, appeared to reduce the risk of depression, whereas heavier drinking was associated with an increased risk of depression.
In contrast, most studies have found that alcohol intake increases the incidence of AFIB in a dose-dependent manner, with a significantly higher risk apparent even with one drink per day.
A randomized controlled trial of 140 volunteers with paroxysmal or persistent AFIB who routinely consumed 10 or more alcoholic drinks per week reported that the group assigned to alcohol abstinence experienced a 58% lower burden of AFIB during 6 months of follow-up compared with individuals assigned to the group that continued to drink at their baseline levels.
In addition to its tendency to promote social bonding, light to moderate alcohol consumption appears to confer CV protection through improvements in insulin sensitivity and in high-density lipoprotein cholesterol and postprandial glucose levels.
Randomized placebo-controlled trials of healthy nondiabetic individuals reported that 1 to 2 drinks immediately prior to a meal will significantly reduce postprandial glucose and insulin levels (Figure 2). Tellingly, the familiar J-shaped association—a small to moderate dose provides benefit whereas larger doses cause harm—is seen with the interaction between alcohol intake and postprandial glucose, as well as alcohol intake and systemic inflammation.
Conversely, a modest dose of alcohol consumed before or with the evening meal is largely metabolized before falling asleep 3 or 4 hours later.
Figure 2Alcohol reduction of postprandial glucose levels. In this group of healthy individuals, 20 g of alcohol (approximately 1.5 drinks) in various beverages reduced postmeal glucose levels by up to 38%. From J Am Coll Cardiol,
Although light to moderate drinking may offer health benefits, a regular habit of consuming alcohol is a slippery slope that many people cannot safely navigate. It has been said that “willpower is soluble in alcohol,” which can make it difficult for many individuals to limit their consumption to 1 drink per day. Thus, health care professionals should never advise nondrinkers to start drinking for alcohol’s potential health benefits because of the paucity of randomized controlled trial data and the potential for alcohol abuse even among apparently low-risk people.
For individuals who choose to consume alcohol, a habit of light to moderate drinking 3 or more days per week is associated with better long-term health outcomes. Specifically, a glass of red wine before or during the evening meal appears to be safe.
However, most of the studies on alcohol and health are observational, and correlation does not prove causation. Moreover, self-reported alcohol intakes are notoriously unreliable, so this issue remains controversial and in need of more definitive studies on the topic.
References
Ma H.
Li X.
Zhou T.
et al.
Alcohol consumption levels as compared with drinking habits in predicting all-cause mortality and cause-specific mortality among current drinkers.
Emerging Risk Factors Collaboration/EPIC-CVD/UK Biobank Alcohol Study Group
Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies [published correction appears in Lancet. 2018;391(10136):2212].
To investigate the joint associations of amounts of alcohol consumed and drinking habits with the risks of all-cause mortality and cause-specific mortality.
00421-3&id=gr1.jpg){kind=link}
00421-3&id=gr2.jpg){kind=link}