Tuesday, December 14, 2010

Feature Article: Alcohol

            A topic that comes up every time I give a nutrition lecture, start with a private client or meet a doctor’s referral is alcohol.   Here are some of the most typical questions:

Is alcohol good for you or bad for you?
What is considered a drink?
Can I drink alcohol if I want to lose weight?
Does it have to be red wine only?

            I figured I’d use this post to answer these questions and more.  Alcohol continues to be an interesting and controversial subject.   However, current research has taught us much about the effects of alcohol consumption on our health.

Basic Information On Alcohol
            Humans have been drinking some form of a fermented beverage for over 10,000 years.   The main active substance in alcohol containing drinks is ethanol.  Ethanol exerts a direct influence on the stomach, brain, heart, gallbladder as well as the liver.  It has an effect on inflammation, blood coagulation, insulin sensitivity, serum cholesterol and triglycerides.  As many of us know, it also has a direct effect on mood, concentration, coordination and most definitely, judgment.  

Alcohol contains 7 calories per gram.  As a reference, carbohydrate and protein have 4 calories per gram while fat contains 9 calories per gram.  A drink generally contains 12-14 grams of alcohol which equates to 12 ounces of beer, 5 ounces of wine and 1.5 ounces of hard liquor. 

Health Effects
            Alcohol’s impact on human health is a rather complicated issue.  Depending on the dose, alcohol is either extremely healthful or quite literally a poison.  Heavy drinking causes severe damage to the liver and heart, increases risk of a number of cancers and is involved in roughly half of all fatal traffic accidents.    For those individuals prone to alcoholism, excessive drinking can destroy virtually every aspect of their life.

            However, the health benefits of a moderate consumption of alcohol are undeniable.   Let’s start with the heart.   There is strong evidence that alcohol increases HDL cholesterol which is probably why it is associated with a reduced risk of coronary heart disease. (1)  Alcohol also improves the factors that influence clotting which is probably why it is associated with a reduced risk of stroke. (1) Finally alcohol tends to improve insulin sensitivity and there is evidence that it reduces the risk of type 2 diabetes. (2)

            Many wrongly feel that the benefits are only from red wine due to the antioxidants in the grapes.  This is not the case.  In our cohorts at Harvard, similar benefits were found for wine, beer and hard liquor, so feel free to drink what you like.

            So what is considered moderate consumption?  1-2 drinks per day for men and 1 drink per day for women.  You need consistent intake here, you can’t save all 7 of your drinks for Saturday night at the bar, you have to drink on a just about daily basis to get these benefits.  One other thing to mention is that even a moderate consumption of alcohol has been associated with an increase risk of breast cancer in women, about 40% increased risk with 2 drinks per day (3).  However, getting enough folate seems to minimize this risk.

Alcohol And Weight
            I hate to complicate things further but I have found that alcohol can have a profound influence on your ability to lose weight.  Alcohol provides 7 calories per gram and if you have 1-2 drinks every day, trust me, the calories begin to add up.  I have read that alcohol also slows down your metabolism but I haven’t really seen a lot of hard evidence that this is true.  What I can say is true, in my experience and others, is that after a few drinks we all develop a kind of “You only live once” mentality and the late night fast food stop or trip to the diner becomes all but inevitable.  

            If you work with me privately or read my book on weight loss, you know that to limit alcohols affect on weight, I restrict my clients to 4 alcohol containing drinks per week.  This way you get some of the benefits of drinking without the negative effect on your weight.

Take Home Message
            At the end of the day, the recommendation for alcohol use depends on the individual.  Drinking in moderation (1-2 drinks for men per day and one drink for women per day) has definite health benefits.  If you have a family history of alcoholism, it’s probably a good idea not to start drinking if you currently aren’t.  If you are a female, make sure you get adequate folate if you drink even moderately to help reduce any increased risk of breast cancer.  If you want to lose weight, limit yourself to a maximum of 4 drinks per week.  This way you are obtaining some of the benefits without sabotaging your weight loss efforts.

References
1) Annals of Epidemiology 2007 175:24-31.
2) Diabetes Care 2005 28:719-25.
3) Journal of the American Medical Association 1998 279:535-40.

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