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Throughout the 10,000 years or so that humans have been drinking fermented beverages, they have also debated their benefits and drawbacks. The debate continues to rage, with people debating whether alcohol is good or bad for them.

It’s safe to say that alcohol is a tonic as well as a poison. The main difference is in the dosage. Moderate drinking appears to be beneficial to the heart and circulatory system, and it may help prevent type 2 diabetes and gallstones. In most countries, heavy drinking is a leading cause of preventable death. In the United States, alcohol is involved in roughly half of all fatal traffic accidents. [1] Heavy drinking can damage the liver and heart, harm an unborn child, increase the chances of developing breast and some other cancers, contribute to depression and violence, and interfere with relationships.

Alcohol’s two-faced nature shouldn’t come as a surprise. The active ingredient in alcoholic beverages, a simple molecule called ethanol, affects the body in many different ways. It directly influences the stomach, brain, heart, gallbladder, and liver. It affects levels of lipids (cholesterol and triglycerides) and insulin in the blood, as well as inflammation and coagulation. It also alters mood, concentration, and coordination.

What’s Moderate Alcohol Intake? What’s a Drink?
Loose use of the terms “moderate” and “a drink” has fueled some of the ongoing debate about alcohol’s impact on health.

In some studies, the term “moderate drinking” refers to less than 1 drink per day, while in others it means 3-4 drinks per day. Exactly what constitutes “a drink” is also fairly fluid. In fact, even among alcohol researchers, there’s no universally accepted standard drink definition. [2]

In the U.S., 1 drink is usually considered to be 12 ounces of beer, 5 ounces of wine, or 1½ ounces of spirits (hard liquor such as gin or whiskey) (hard liquor such as gin or whiskey). [3] Each delivers about 12 to 14 grams of alcohol on average, but there is a wider range now that microbrews and wine are being produced with higher alcohol content.

a glass of wine next to a glass of beer
Is Red Wine Better?
Some experts have suggested that red wine makes the difference, but other research suggests that beverage choice appears to have little effect on cardiovascular benefit.
The definition of moderate drinking is something of a balancing act. Moderate drinking sits at the point at which the health benefits of alcohol clearly outweigh the risks.

The latest consensus places this point at no more than 1-2 drinks a day for men, and no more than 1 drink a day for women. This is the definition used by the U.S. Department of Agriculture and the Dietary Guidelines for Americans 2020-2025, [3] and is widely used in the United States.

The Dark Side of Alcohol
Not everyone who likes to drink alcohol stops at just one. While many people drink in moderation, some don’t.

Red wine splashing out of glassHeavy drinking can take a toll on the body. It can cause inflammation of the liver (alcoholic hepatitis) and lead to scarring of the liver (cirrhosis), a potentially fatal disease. It can increase blood pressure and damage heart muscle (cardiomyopathy) (cardiomyopathy). Heavy alcohol consumption has also been linked to several cancers: according to the World Cancer Research Fund and the American Institute for Cancer Research, there is convincing evidence linking alcohol to cancers of the mouth, pharynx, larynx, esophagus, breast, liver, colon, and rectum. [4] According to the International Agency for Research on Cancer, high levels of ethanol in alcohol and acetaldehyde, a chemical formed from the breakdown of ethanol, are carcinogenic to humans. [5] The risk is increased for drinkers who also smoke or eat poorly.

Problem drinking affects drinkers’ families, friends, and communities as well. The National Institute on Alcohol Abuse and Alcoholism, among others, states:

In 2014, approximately 61 million Americans were classified as binge drinkers (5 or more drinks on the same occasion at least once a month) and 16 million as heavy drinkers (5 or more drinks on the same occasion on 5 or more days in one month). [6]
One in every three cases of violent crime involves alcohol. [7]
More than 10,000 people were killed in alcohol-related car accidents in 2015. [8]
Alcohol abuse costs approximately $249 billion per year. [9]
Even moderate drinking poses some dangers. Alcohol can interfere with sleep and one’s ability to make sound decisions. Alcohol interacts dangerously with a wide range of medications, including acetaminophen, antidepressants, anticonvulsants, pain relievers, and sedatives. It is also addictive, particularly for those who have a family history of alcoholism.

Alcohol Increases the Risk of Breast Cancer
There is compelling evidence that alcohol consumption increases the risk of breast cancer, with the amount consumed increasing the risk. [10-14]

A large prospective study that followed 88,084 women and 47,881 men for 30 years discovered that even one drink per day increased the risk of alcohol-related cancers in women (colorectum, female breast, oral cavity, pharynx, larynx, liver, esophagus) in both smokers and nonsmokers. One to two drinks per day in nonsmokers was not associated with an increased risk of alcohol-related cancers. [15]
Researchers discovered that having 2-5 drinks per day compared to no drinks increased the chances of developing breast cancer by up to 41% in a combined analysis of six large prospective studies involving more than 320,000 women. It made no difference whether the alcohol was wine, beer, or hard liquor. [10] This does not imply that 40% of women who consume 2-5 drinks per day will develop breast cancer. It is the difference between approximately 13 of every 100 women developing breast cancer during their lifetime (the current average risk in the United States) and 17 to 18 of every 100 women developing the disease. This modest increase would result in significantly more women being diagnosed with breast cancer each year.
A lack of folate in the diet or folic acid, its supplement form, raises women’s risk of breast cancer. [14] Folate is required for the production of new cells as well as the prevention of DNA changes. Folate deficiency, which can occur as a result of heavy alcohol consumption, can cause changes in genes that can lead to cancer. Alcohol also raises estrogen levels, which helps certain breast cancer cells grow. When taking at least one drink of alcohol per day, an adequate intake of folate, at least 400 micrograms per day, appears to reduce this increased risk. [16, 17]

In the Nurses’ Health Study II cohort of 2866 young women with an average age of 36 who were diagnosed with invasive breast cancer, researchers discovered a strong association between three factors: genetics, folate intake, and alcohol. Those with a family history of breast cancer who drank 10 grams or more of alcoholic beverages daily (equivalent to 1 or more drinks) and consumed less than 400 micrograms of folate daily nearly doubled their risk (1.8 times). Women who drank this amount of alcohol but had no family history of breast cancer and consumed at least 400 micrograms of folate daily had no increased risk of breast cancer. [14]
Alcohol and Folate
The Effects of Alcohol on Weight Gain
One serving of alcohol contains 100-150 calories on average, so even a moderate amount of three drinks per day can contribute 300+ calories. Mixed drinks with juice, tonic, or syrups contain more calories, increasing the risk of weight gain over time.

However, a four-year prospective study of nearly 15,000 men found only an increased risk of minor weight gain with higher alcohol intake. [19] Those who increased their alcohol intake by two or more drinks per day gained a little more than a half-pound more than those who did not change their alcohol intake. It was discovered that calorie intake (not from alcohol) increased in tandem with alcohol consumption.

Alcohol’s Potential Health Benefits
What are some of the potential health benefits of moderate alcohol consumption?

Cardiovascular Illness
More than 100 prospective studies show a link between light to moderate drinking and an increased risk of heart attack, ischemic (clot-caused) stroke, peripheral vascular disease, sudden cardiac death, and death from any cause. [20] The effect is fairly consistent, resulting in a risk reduction of 25-40%. However, drinking more than four drinks per day increases the risk of hypertension, abnormal heart rhythms, stroke, heart attack, and death. [5, 21-23]

Prospective Studies on Alcohol and Heart Disease
Moderate drinking has been linked to a lower risk of cardiovascular disease in both men and women. It applies to people who do not have heart disease, as well as those who are at high risk of having a heart attack or stroke or dying from cardiovascular disease, such as those who have type 2 diabetes, [32, 33] high blood pressure, [34, 35] or who have existing cardiovascular disease. [34, 35] The advantages also apply to the elderly. [36]

Moderate drinking protects against cardiovascular disease makes biological and scientific sense. Moderate alcohol consumption raises HDL (or “good” cholesterol) levels [37], and higher HDL levels are associated with greater protection against heart disease. Moderate alcohol consumption has also been linked to beneficial changes ranging from improved insulin sensitivity to improvements in blood clotting factors such as tissue type plasminogen activator, fibrinogen, clotting factor VII, and von Willebrand factor. [37] Such changes would help to prevent the formation of small blood clots that can block arteries in the heart, neck, and brain, resulting in many heart attacks and strokes.

Drinking Habits Are Important
What you drink (beer or wine) does not appear to be nearly as important as how you drink. Having seven drinks on a Saturday night and then not drinking for the rest of the week is not the same as having one drink a day. Although the weekly total is the same, the health implications are not. Alcohol consumption on at least three or four days per week was found to be inversely related to the risk of myocardial infarction among participants in the Health Professionals Follow-up Study. The amount consumed, whether less than 10 grams per day or more than 30 grams, did not appear to be as important as the frequency of consumption. [25] Danish men followed a similar pattern. [38]

A review of alcohol consumption in women from the Nurses’ Health Study I and II discovered that women who drank less alcohol (about one drink per day) spread out over four or more days per week had lower death rates from any cause than women who drank the same amount of alcohol but only on one or two days. [39]

A large trial in which some volunteers were randomly assigned to have 1 or more alcoholic drinks per day and others had drinks that looked, tasted, and smelled like alcohol but were actually alcohol free would be the most definitive way to investigate the effect of alcohol on cardiovascular disease. Many of these trials have been conducted for weeks, months, and even up to two years to look at blood changes, but no long-term trial to test the effects of alcohol on cardiovascular disease has been conducted. The National Institutes of Health recently funded a successful effort in the United States to launch an international study. Despite the fact that the proposal was peer-reviewed and that initial participants were randomly assigned to drink in moderation or abstain, the NIH decided to halt the trial due to internal policy concerns. Unfortunately, a future long trial of alcohol and clinical outcomes may never be attempted again, but based on all available evidence, the link between moderate drinking and cardiovascular disease almost certainly represents a cause-and-effect relationship.
Away from the Heart
The health benefits of moderate drinking do not stop there. Gallstones [40, 41] and type 2 diabetes [32, 42, 43] were less likely to occur in moderate drinkers than in non-drinkers in the Nurses’ Health Study, the Health Professionals Follow-up Study, and other studies. The emphasis is on moderate drinking, as it is elsewhere.

A meta-analysis of 15 original prospective cohort studies that followed 369,862 participants for an average of 12 years found that moderate drinking (0.5-4 drinks per day) reduced the risk of type 2 diabetes by 30%, but there was no protective effect in those drinking less or more than that amount. [32]

Alcohol has numerous social and psychological benefits that cannot be overlooked. A drink before a meal can help with digestion or provide a soothing respite at the end of a long day; a drink with friends can be a social tonic. These physical and social consequences may also have an impact on health and well-being.

Genes Have an Impact
Twin, family, and adoption studies have conclusively demonstrated that genetics plays a significant role in determining an individual’s alcohol preferences and likelihood of developing alcoholism. Alcoholism does not adhere to the simple rules of inheritance established by Gregor Mendel. Instead, it is influenced by a number of genes that interact with one another as well as environmental factors. [1]

In addition, there is some evidence that genes influence how alcohol affects the cardiovascular system. Alcohol dehydrogenase is an enzyme that aids in the breakdown of alcohol. One variant of this enzyme, known as alcohol dehydrogenase type 1C (ADH1C), comes in two “flavors”: one that breaks down alcohol quickly and the other that does so slowly. Moderate drinkers with two copies of the slow-acting enzyme gene have a much lower risk of cardiovascular disease than moderate drinkers with two copies of the fast-acting enzyme gene. [44] Those who have one gene for the slow-acting enzyme and one for the faster enzyme fall somewhere in the middle.

It’s possible that the fast-acting enzyme degrades alcohol before it can benefit HDL and clotting factors. Surprisingly, differences in the ADH1C gene have no effect on the risk of heart disease in people who do not consume alcohol. This adds to the strong indirect evidence that alcohol reduces the risk of heart disease.

Benefits and risks are shifting.
White wine being poured from a bottle into a Alcohol benefits and risks of moderate drinking change over time. In general, risks outweigh benefits until middle age, when cardiovascular disease begins to account for an increasing proportion of the disease and death burden.

Moderate drinking provides little benefit and poses significant risks to a pregnant woman and her unborn child, a recovering alcoholic, a person with liver disease, and people taking one or more medications that interact with alcohol.
The increased risk of alcohol-related accidents outweighs the potential heart-related benefits of moderate alcohol consumption for a 30-year-old man.
A drink a day may offer protection against heart disease that outweighs potential harm for a 60-year-old man (assuming he is not prone to alcoholism).
The benefit/risk calculations are more difficult for a 60-year-old woman. Heart disease kills ten times as many women as breast cancer (460,000) each year (41,000). However, studies show that women are far more afraid of developing breast cancer than heart disease, which must be considered.
The Bottom Line: Risks and Benefits Must Be Balanced
Given the complexities of alcohol’s effects on the body and the complexities of the people who consume it, blanket alcohol recommendations are out of the question. Because each of us has a unique personal and family history, alcohol presents a different set of benefits and risks to each of us. Whether or not to drink alcohol, particularly for “medicinal purposes,” necessitates careful consideration of the benefits and risks.

This should be possible with the assistance of your healthcare provider. Your overall health and the risks of alcohol-related conditions should be considered.
If you are thin, physically active, do not smoke, eat a healthy diet, and do not have a family history of heart disease, drinking alcohol will not reduce your risk of cardiovascular disease significantly.
There’s no reason to start drinking if you don’t already. Similar benefits can be obtained through exercise (starting to exercise if you don’t already or increasing the intensity and duration of your activity) or healthier eating.
A daily alcoholic drink may reduce your risk of heart disease if you are a man with no history of alcoholism who is at moderate to high risk. Moderate drinking may be especially beneficial if your HDL levels are stubbornly low despite diet and exercise.
If you are a woman with no history of alcoholism who is at moderate to high risk for heart disease, the potential benefits of a daily drink must be balanced against the small increase in breast cancer risk.
If you already drink alcohol or plan to start, limit yourself to no more than two drinks per day for men and one drink per day for women. Also, make sure you get enough folate, at least 400 micrograms per day.
Do the benefits outweigh the risks? should be between 200-300 words. Use credible references to support your position (in-text citations and a reference list) in APA format.)

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