Moderation in all things — maybe that is the key to health and happiness. The proverb certainly seems true for alcohol consumption.
Study after study has shown that moderate alcohol consumption is associated with good health. The evidence is strongest for protection against heart attack and stroke: There's an abundance of epidemiological data, as well as results showing that alcohol increases "good" HDL cholesterol and reduces factors in the blood, such as fibrinogen, that cause clotting and therefore make heart attacks and strokes more likely. Researchers have reported correlations with a lower risk of developing Type 2 diabetes, having gallstones and experiencing steep cognitive decline in old age.
The news isn't all good: Moderate drinking seems to increase the risk of colon and breast cancer, although women may be able to reduce the breast cancer risk some by increasing their intake of folate.
But watch out if alcohol consumption is immoderate. Benefits quickly vanish, and there's a long list of possible harms that take their place: serious liver disease (cancer and cirrhosis), high blood pressure, certain cancers, traffic accidents, violence.
When Harvard School of Public Health researchers analyzed preventable causes of death in the United States in 2009, they estimated that alcohol consumption was responsible for averting about 26,000 deaths each year from heart attack, strokes and diabetes, but that was outweighed by an estimated 90,000 deaths from liver disease, traffic accidents and other causes because of heavier consumption of alcohol.
What is moderate?
Moderate consumption in these discussions of alcohol's health effects has come to mean two drinks per day for men and one drink per day for women (the limit is higher for men because they are larger than women, on average, and metabolize alcohol differently). A drink is usually defined as a beverage that contains 14 grams of alcohol, so a 12-ounce bottle of beer that's 5 percent alcohol counts as a single drink, as does a 5-ounce glass of wine that's 12 percent alcohol, or 1.5 ounces of hard liquor that's 40 percent alcohol (80 proof).
This delineation of moderate alcohol consumption comes principally from epidemiological studies. It's the amount of alcohol consumption that seems to be most consistently correlated with health benefits.
But for the most part, the studies of alcohol and its health effects have been based on calculations of people's average daily consumption, not on their actual drinking patterns. Downing seven drinks one day a week is obviously not a good idea, even though that would average out to a drink a day.
But it's an open question whether the benefits of moderate alcohol consumption come from a pattern of drinking a small amount of alcohol on pretty much a daily basis, or whether drinking a bit more, but on three or four days of the week, might be just or nearly as healthful.
So what's considered heavy drinking? The National Institute on Alcohol Abuse and Alcoholism (NIAAA) definition is often used. For men, it's having more than four drinks in a single day or more than 14 in a week, and for women, it's having more than three drinks in a single day or more than seven in a week.
The lines are drawn there not because alcohol-related problems suddenly kick in, but because research shows that when people drink in those amounts, the likelihood of having an alcohol-related problem increases (the NIAAA also uses the term "at-risk" drinking). According to the NIAAA, about 1 in 4 American adults who drink more than the daily or the weekly limit has an alcohol abuse or dependence problem, and half of those who exceed both daily and weekly limits do. The NIAAA uses the term "low-risk" drinking — not moderate drinking — for alcohol consumption below both the daily and weekly heavy-drinking limits. A NIAAA survey showed that only about 2 percent of the people who stay within the daily and weekly limits have an alcohol abuse or alcoholism problem.
But consider this: A man could have three drinks a day four days a week — the equivalent of two six-packs of beer over four days — and still be within the NIAAA definition of low-risk drinking. Low risk is not no risk, and that amount of drinking can lead to alcohol-related problems.
Tips for cutting back
People who don't drink much sometimes worry that they're drifting into heavy-drinking territory: One glass of wine becomes two, then three. If you're one of them, or you want to cut back on your alcohol intake for any reason, the NIAAA has an interactive website, based on a booklet called "Rethinking Drinking," that's well worth checking out (rethinkingdrinking.niaaa.nih.gov).
The site has some tips for reducing alcohol intake. Here are some of them:
Keep track of how much you drink. Especially if you make a note of your intake as you're drinking, this will slow you down.
Pace yourself. Sip slowly. Keep an eye on the clock and limit yourself to one drink an hour.
Use drink "spacers" — nonalcoholic drinks between alcoholic ones.
Don't drink on an empty stomach. Food in the digestive tract slows down the absorption of alcohol.
Be quick with a "no, thank you" when you're offered a drink. Any hesitation allows for second thoughts and rationalization to accept the offer.
In the past year 71.8% of men over age 18 had at least one drink. 59.6% of women over age 18 did.
Of those past-year drinkers, most of the men had at least three drinks on any given day, whereas a majority of the women had one drink on any given day.
Source: National Institute on Alcohol Abuse and Alcoholism
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