Alcohol — Good or Bad?

There has been an age old debate between the alcohol industry, a variety of health professionals and those members of society more geared towards temperance, as to whether alcohol is good or bad for health.

There really should be no debate as to the health detriments of consuming 4 or more standard drinks of alcohol on a daily basis. One standard drink is considered to be 125 mL of wine, one midi of beer, or one non-grandfather’s nip of scotch. It is also important to note that 10 g of any form of alcohol is the equivalent of 70 cal. Thus, alcohol consumption should be part of estimating your normal daily caloric intake.

Other important facts to consider are that 80% of drug related deaths in our society are due to cigarettes, whereas 17% are due to alcohol. The 3% left are due to illegal drugs because they are hard to obtain.

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The health risks of excessive or binge drinking are well known but need to be detailed:

1. Liver — Most people connect quite excessive alcohol consumption with cirrhosis of the liver. Although this is true, it can also cause alcoholic hepatitis and even alcohol-induced diabetes. End-stage cirrhosis of the liver may also lead to oesophageal varices which can be associated with severe gastrointestinal bleeding and potentially liver failure which can cause what is known as hepatic coma.

2. Brain — Chronic alcohol ingestion can markedly increased dementia risk. It may also lead to 2 distinct brain syndromes known as Wernicke’s encephalopathy and Korsakoff’s psychosis. It may also lead to a peripheral neuropathy and a myopathy (muscle disorder).

3. Heart — Excessive alcohol can lead to ectopic heart beats. Especially when combined with hypertension, atrial fibrillation is very common. A recent study suggested that even one drink per day can increase the risk of atrial fibrillation by 5%. With each 10 g of alcohol the risk increases by 5%. The most serious consequence of excessive alcohol ingestion is a dilated cardiomyopathy. This is a relatively common cause of heart failure.

4. Cancer risk — Even low-dose alcohol has been associated with an increased risk of breast cancer in women along with oral and upper gastrointestinal cancers, and liver cancer.

5. Pancreatitis — A relatively common association with excessive alcohol and can lead to severe chronic abdominal pain, along with a malabsorptive state.

6. Osteoporosis and/or falls

7. Excessive alcohol consumption — Commonly associated with accidents, trauma, violence and suicide.

After all of this, you must ask are there any benefits? Interestingly, it is my view that low-dose alcohol does give some benefits but only if it is associated with proper dietary principles. All of the studies from the Mediterranean show a 50% reduction in cardiovascular disease and cancer when less then 3 standard drinks per day are combined with a Mediterranean diet. There have been other studies such as the Dubbo heart study performed by Professor Leon Simons from Saint Vincent’s Hospital and the Male Physicians Trial from Boston both showing a reasonable benefit from ingesting low-dose alcohol. The conclusion from most of these trials is that 1–3 standard drinks most days of the week, especially in the form of red wine may reduce cardiovascular disease by somewhere between 20–30%.

Firstly, let me make the point that in my opinion, it is irresponsible for any doctor to encourage a person to drink. But, if someone does enjoy a drink my advice is to pull back to the correct dose of (preferably) wine, and the evidence leans towards red wine. There are, however, 5 caveats:

1. The Walker suggested dose is 250 mls of red wine per day with at least one or 2 alcohol free days per week

2. You do not get double benefit for double the dose!

3. You cannot save that all up for Friday night

4. I am not trying to convince non-drinkers to start drinking

5. One in 20 people carry the gene for alcoholism and they should go nowhere near alcohol