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Weighing the Benefits and Risks of Alcohol

Drinking alcohol in moderation may reduce your risk for heart disease and other cardiovascular system illnesses, according to recent studies. On the other hand, alcohol dependence devastates many individuals and families and there is evidence linking alcohol and breast cancer.

For many people, the decision whether to drink alcohol has never been more complicated.

The following facts can help you decide whether to drink or not. While reviewing this article, remember that if you do not currently drink, you should not begin drinking for the slight health benefits that alcohol might afford.

Okay in moderation

Evidence that moderate drinking—defined as no more than one drink a day for nonpregnant women and all people older than 65, and two drinks a day for younger men—can have coronary benefits continues to grow. (A standard drink is 12 ounces of beer, 4 to 5 ounces of wine or 1 to 1-1/2 ounces of hard liquor, approximately 15 grams of ethanol.)

Alcohol helps the cardiovascular system by raising levels of HDL ("good") cholesterol, which may prevent plaque buildup in the heart's arteries. Alcohol also lowers the risk of blood clots in heart arteries by affecting blood platelets. Several studies suggest that in pre- and postmenopausal women, light to moderate alcohol consumption may increase estrogen in the blood, and this may help protect against heart disease.

Most coronary benefits come from the alcohol itself, researchers believe. In addition, specific antioxidants found in red wine and some grapes may provide additional protection.

Alcohol and weight

Alcohol can pack on extra pounds in certain people.  A 2010 study in the Archives of Internal Medicine suggests that normal weight women who drink in moderation have a lower risk of obesity and seem to gain less weight than those who abstain. There are 7 calories per one gram of alcohol, and that translates to between 100 and 150 calories for just the alcohol in a typical beer, wine or spirits.

Alcohol and brain function

Some researchers believe that moderate drinking may protect blood vessels in the brain in a similar way to how it protects blood vessels in the heart against heart disease. A 2009 study found that moderate drinking in the elderly was associated with a significantly decreased risk for dementia compared to abstainers. Importantly, however, is that elderly individuals who already had some level of cognitive decline, and who used any amount of alcohol, had significantly faster rates of further decline.

Risky in excess

Though the news about alcohol's benefits is exciting, the downside of drinking also is well-documented. For healthy people with chronic diseases, or risk factors for physical or mental problems, the risks seem to be greatest with heavy drinking. (Heavy drinking is defined as having more than two drinks a day over an extended period of time if you are a man younger than 65, or more than one drink a day if you are a woman, or a man 65 or older.) Be sure to consider the risks:

  • Chronic heavy drinking can cause potentially fatal conditions, including damage to the brain, heart or liver; high blood pressure; diabetes; stroke; alcohol dependence; and chronic depression. Women have a higher risk of developing problems from drinking, because the alcohol in a woman's bloodstream usually reaches a higher level than in a man's, even when both drink the same amount.

  • Chronic heavy drinking increases the risk for osteoporosis. This is especially true for young women, whose bones are still developing. Chronic heavy alcohol use in adulthood can harm bone health.

  • Heavy drinking is associated with dangerous behaviors, such as smoking and drinking while driving.

  • Drinking even a small amount of alcohol while pregnant can cause learning and behavioral problems, and birth defects, including mental retardation. Do not drink while you are pregnant.

  • Alcohol is associated with increased risk for some cancers, including those of the lung, liver, breast, throat, mouth, larynx and esophagus.

  • More than 150 prescription and over-the-counter medications interact negatively with alcohol. It's important to pay careful attention to the potential for an alcohol-medication interaction. For example, three or more alcohol drinks per day while taking medications containing acetaminophen (Tylenol) can increase your risk for liver damage or produce acute liver failure.

  • Heavy alcohol use is known to affect memory and may increase the risk for Alzheimer's disease. This risk is higher in women because they are more vulnerable than men to brain damage from alcohol use. Although studies have shown an association between certain modifiable lifestyle factors such as abstaining from alcohol use and a reduced risk for Alzheimer’s disease, the National Institutes of Health says that researchers still aren’t sure whether these factors can actually prevent the disease.

Weigh the risks

Will drinking do you more good than harm? To decide, consider these factors:

  • Older people should be aware that they may feel the effects of drinking after only small amounts of alcohol due to physical changes associated with aging, warns The National Institute on Alcohol Abuse and Alcoholism (NIAAA). In addition, many older people take medications that can interact with alcohol, or have conditions that could be made worse by alcohol. The NIAAA advises older men and women to limit themselves to one drink per day.

  • Your family history. You may benefit from the protective effects of alcohol if members of your immediate family have had heart disease. But abstinence may be the best choice if there's a family history of cancer or alcoholism.

  • Personal history. Avoid alcohol if you've abused drugs or alcohol before, are pregnant or are trying to conceive. Doctors often use a simple questionnaire to help screen patients for alcohol abuse. Called CAGE, it is a four-question test that takes about a minute to complete. The questions are: Have you tried to cut down on your drinking? Have you been annoyed or angered by others' criticizing your drinking? Have you felt guilty about your drinking? Have you used alcohol to steady the nerves or to reduce the effects of a hangover (an eye-opener)? (CAGE refers to the questions' main themes: Cut down; Annoyed; Guilty; Eye-opener.) A score of two "yes" answers generally indicates a problem with alcohol, although even one "yes" answer may be enough to trigger a discussion with your health care provider.

  • Health conditions, such as high blood pressure, heart conditions, liver disease, ulcers, osteoporosis, acid reflux disease or sleep disorders, can be made worse by alcohol.

  • Taking prescribed medications. Many medications interact with alcohol. These interactions may result in increased risk of illness, injury and even death. Examples are sleeping pills, antihistamines, antidepressants, anti-anxiety drugs, some painkillers, and medicines for diabetes, high blood pressure and heart disease. If you take prescribed medications, talk to your health care provider or pharmacist about how they might interact with alcohol.

  • The risk of sexual victimization and dating violence is associated with the amount of alcohol women drink, according to NIAAA.

  • Other risk factors. Talk with your doctor to size up your overall risks and decide how using alcohol would affect you over time.