Alcohol: weighing the risks versus the benefits

There is much confusion over whether alcohol is beneficial or detrimental to your health. The short answer is: It depends on your circumstances, including your family history and consideration of diseases you are at high risk of developing. Alcohol is one of the most widely used over-the-counter drugs.

Several new studies have been published, some touting alcohol’s health benefits with others warning of its risks. The diseases addressed by these studies include breast cancer, heart disease and stroke. It is important that context becomes the determining factor for alcohol intake.

Breast cancer impact

In a meta-analysis (group of 113 studies), there was an increased risk of breast cancer with daily consumption of alcohol (Alcohol and Alcoholism: published online March 29). The increase was a modest but statistically significant 4 percent, and the effect was seen at less than one drink per day. The authors warned that women who are at high risk of breast cancer should not drink alcohol or should drink it only occasionally.

It was also shown in the Nurses’ Health Study (an observational study) that drinking three to six glasses per week increases the risk of breast cancer modestly over a 28-year period (JAMA. 2011;306:1884-1890).

This study involved over 100,000 women. Even a half-glass daily of alcohol was associated with a 15 percent elevated risk of invasive breast cancer. The risk was dose-dependent, with one to two drinks per day increasing risk to 22 percent, while those having more than drinks per day had a 51 percent increased risk.

A drink several times a week may have the least impact on breast cancer, if you are going to consume alcohol. According to an accompanying editorial, alcohol may work by increasing the levels of sex hormones, including estrogen, and we don’t know if stopping diminishes the effect, although it probably does (JAMA. 2011;306(17):1920-1921).

Stroke effects

On the positive side, the Nurses’ Health Study demonstrated a decrease in the risk of both ischemic strokes (caused by clots) and hemorrhagic strokes (caused by bleeding) with low to moderate amounts of alcohol (Stroke: published online March 8). This analysis involved 83,578 women. Those who drank less than 0.5 glasses of alcohol daily were 17 percent less likely than nondrinkers to experience a stroke. Those who consumed 0.5 to 1.5 glasses a day had a 21 percent decreased risk of stroke, compared to nondrinkers.

However, women who consumed more experienced a decline in benefit, and drinking more than three glasses resulted in a nonsignificant increased risk of stroke. The reasons for alcohol’s benefits in stroke have been postulated to involve an anti-platelet effect (preventing clots) and increasing HDL (“good”) cholesterol. Patients shouldn’t drink alcohol solely to get the stroke protection benefits.

Heart effect

In the Health Professionals follow-up study, there was a substantial decrease in the risk of death after a heart attack from any cause, including heart disease, in men who drank moderate amounts of alcohol compared to those who drank more or were nondrinkers (Eur Heart J: published online March 28).

Those who drank less than one glass experienced a 22 percent reduction in risk, while those who drank one to two glasses saw a 34 percent reduction in risk. The authors mention that binge drinking negates any benefits. This study has a high durability spanning 20 years.

Alternative to alcohol for nondrinkers or in addition to alcohol for drinkers

An analysis of the Nurses’ Health Study recently showed that those who consumed more citrus fruits had approximately a 19 percent reduction in the risk of stroke (Stroke: published online Feb. 23). These results were similar to the reduction seen in the Nurses’ Health Study with modest amounts of alcohol.

The citrus fruits used most often in this study were oranges and grapefruits. Of note, grapefruit may interfere with medications such as Plavix (clopidogrel), a commonly used anti-platelet medication to prevent strokes (www.medscape.com). Grapefruit inhibits the CYP3A4 system in the liver, thus increasing the levels of certain medications.

Alcohol in moderation

Moderation is the key with alcohol. It is very important to remember that alcohol is a drug that has side effects, such as insomnia. The American Heart Association recommends that women drink up to one glass a day of alcohol.

I would say that less is more. To get the stroke benefits and avoid the increased breast cancer risk, half a glass of alcohol per day may be the ideal amount.

Moderate amounts of alcohol for men are up to two glasses daily, though one glass showed significant benefits. Remember, there are other ways of reducing your risk of these maladies that don’t require alcohol.

If you like to drink, it doesn’t mean you can’t and you can even garner advantages for your health. However, don’t force yourself to drink.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, go to the website www.medicalcompassmd.com and/or consult your personal physician.