Is There an Ideal Dose of Alcohol?

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March 11, 2014

As part of an annual physical, among the questions I ask patients are, “Do you smoke?”, “Do you drink?”. Several times in the past few months, patients have mentioned drinking amounts that are well above the recommended limits. Unfortunately, the popular press, by touting the benefits of red wine, has promoted the idea that red wine is ‘good for you’. And what has happened is that people start to think that if some wine is good for you, more wine must be better. What they don’t realize is that many common symptoms, such as depression, memory issues, sleep disturbances, moodiness, erectile dysfunction and increased anxiety before their next drink, may all be related to their drinking. Although in the short term, alcohol may help you to relax, in the long run, it is a depressant and interferes with normal sleep patterns and other body functions.

Let’s clarify the Dietary Guidelines for Americans: “It is not recommended that anyone begin drinking or drink more frequently on the basis of potential health benefits because moderate alcohol intake also is associated with increased risk of breast cancer, violence, drowning and injuries from falls and motor vehicle crashes.” So don’t feel obliged to drink for supposed health benefits. It is much more beneficial and less risky to exercise, eat a nutritious diet, get adequate sleep and socialize. Should you choose to drink, it is recommended that women and people over 65 years old limit themselves to 1 drink a day and men to two drinks a day. More on that differential in a little while.

You might be surprised to learn that a ‘standard drink’ refers to 0.6 ounces of pure alcohol. This is the amount in one 12-ounce beer or wine cooler; one 5-oz glass of wine (yes 5 ounces – just over a 1/2 cup by kitchen measure – see the 5 oz servings pictured below), or 1.5 oz of 80 proof distilled spirits or liquor (gin, rum, vodka or whiskey). Mixed drinks contain variable amounts of alcohol, so one mixed drink may be the equivalent of 2 ‘standard’ drinks. You can see how those who consider themselves ‘social drinkers’ can be ‘moderate drinkers’ by medical standards. In the cases of these recent patients, when they stopped to think about how many ‘standard’ drinks they were having, they realized that their intake had gotten out of hand.  

The amount a person can safely drink depends on age, weight, sex, genetics, food intake, how quickly the alcohol was consumed and the use of other drugs or medications. All of these factors affect how the alcohol is metabolized and what its effect on the body will be. Why are men ‘allowed’ more alcohol than women? Because women are affected more by a given amount of alcohol — for several reasons. They have lower levels of the enzyme that is needed to metabolize or break down the alcohol. Their bodies generally have a lower water content to dilute the alcohol, and a higher relative fat content, which retains the alcohol and exposes the body to it for a longer period of time. They are more likely than men to develop liver disease or brain damage from the alcohol. They are also more susceptible to osteoporosis, falls and hip fractures, infertility and miscarriages, and high blood pressure and heart disease. All people who drink moderately are also at increased risk for motor vehicle accidents and drowning.

And those don’t even include the longterm health problems that result from years of heavy drinking — cirrhosis; pancreatitis; cancers involving mainly the liver, mouth, throat, larynx, and esophagus; high blood pressure and psychological disorders.

Smaller and older women may have greater and faster responses to the effects of alcohol and should drink even less than the guidelines noted above. Women who drink to intoxication are at greater risk for sexual assault. It has been shown that more often than in men, women use alcohol to deal with negative feelings or cope with problems, including grief or violence. They rely on the sedative effect of alcohol, but it sets them up for further problems with dependence and depression.

While we’re on the subject of women and alcohol, I’d like to stress that there is no safe level of alcohol in pregnancy. One percent of births in the US are affected by fetal alcohol spectrum disorders, which include babies who are born prematurely or with low birth weight, who have problems eating and sleeping, learning disabilities, or behavioral, vision or hearing problems. Women who have been abused in childhood or adulthood are more likely to use and abuse alcohol. In turn, women who drink to intoxication are at greater risk for sexual assault and unwanted pregnancies.

The one-two punch for women is that they are more vulnerable to the bad effects of alcohol and also less likely to seek help. They tend to shy away from treatment programs and try to ascribe their difficulties to depression, anxiety or family issues. In addition, they might have childcare issues that make seeking help more difficult.

We are aware that some families have a genetic predisposition to alcohol addiction. In general, women become addicted more easily than men, and there is no age limit – half of all cases of alcoholism in women begin after age 59.

“Moderate” drinking is up to one standard drink a day for women (now you know how little that is) and two a day for men. “Heavy” drinking is anything over than that. And averages are not allowed here – so no drinks during the week with 3 or 4 on the weekend is still heavy. Binge drinking, by definition, is 4 drinks on a single occasion for women or five for men. This pattern is particularly of concern in college students. In addition to the health risks already mentioned, binge drinking increases the risk for unwanted and unplanned sexual activity, pregnancy and acquiring sexually transmitted diseases. The risk of binge drinking isn’t limited to youth. There’s an article in today’s Washington Post about how binge drinking in moderate drinkers age 55-65, decreases their life expectancy.

What about the ‘legal’ limit regarding driving? In the United States, this is 0.08% or 80 mg/dL. However, drivers under 21 years old are not allowed to drive with ANY level of alcohol. For anyone, reaction time, judgment and coordination are affected at levels below the “legal” limit.

If you’re concerned about your own drinking or someone you know, contact a physician. Be aware that stopping alcohol suddenly has its own risks. Withdrawal can be associated with behavioral changes, seizures and death, and should be done under the guidance of a medical professional. Many hospitals have out-patient programs to guide people through withdrawal and follow-up counseling. Just as we see with nicotine addiction, sometimes several attempts are required, but people can ultimately be successful.   The National Drug and Alcohol Treatment Referral Routing Service is available at 1-800-662-HELP. This service can provide you with information about treatment programs in your local community and allow you to speak with someone about alcohol problems.

So if you enjoy alcohol, continue to enjoy it and drink responsibly, trying to follow the Dietary Guidelines.  If you don’t enjoy it, there’s no need to drink it as if it’s medicine!

References:

From cdc website: www.cdc.gov/alcohol/faqs.htm

Also refer to http://www.cdc.gov/alcohol/fact-sheets/womens-health.htm for info re: risks in women

U.S. Department of Agriculture and U.S. Department of Health and Human Services. In: Dietary Guidelines for Americans, 2010. Chapter 3 – Foods and Food Components to Reduce Adobe PDF fileExternal Web Site Icon [PDF-967KB]. 7th Edition, Washington, DC: US Government Printing Office; 2010, p. 30–32.

http://www.samhsa.gov/Treatment/

http://www.washingtonpost.com/national/health-science/older-binge-drinkers-face-a-higher-death-risk-than-those-who-spread-their-drinking-out/2014/03/10/156ebc00-a4a9-11e3-84d4-e59b1709222c_story.html

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