When it comes to your health, is it better to drink or not to drink?
It's becoming an even more complicated question, especially in the wake of several recent studies linking even a little drinking of alcohol to a higher risk of cancers.
While the experts disagree on some answers, they do agree that no one who has or had a problem with alcohol dependency should drink, nor should any woman who is pregnant. Here is what else they had to say about alcohol and health:
From a health point of view, what is the best advice you would give about drinking alcohol now?
"There's no one answer; it has to be individualized according to the specific person," says Arthur Klatsky, MD, a former practicing cardiologist and now an investigator for Kaiser Permanente's division of research in Oakland, Calif. He has published numerous studies on alcohol and health, especially heart health.
The research on alcohol's effect on health suggests both harm and benefits, says Gary Rogg, MD, an internal medicine specialist at Montefiore Medical Center and assistant professor and assistant director of the department of internal medicine at Albert Einstein College of Medicine, New York. "The studies show links to breast cancer [and] links to liver cancer [with alcohol intake],'' he says, as well as to other cancers. "If you reduce alcohol intake you can reduce the incidence of head and neck cancer and colorectal cancer. Having said that, there seems to be a benefit with [alcohol] and heart disease."
What is the best advice about drinking alcohol if you only consider alcohol's effect on heart health?
Again, there is not a one-size-fits-all answer, Klatsky says. He gives hypothetical case histories to make the point.
Take a 60-year-old man who has given up smoking but has a family history of heart attacks, a less-than-ideal cholesterol level, and no dependency problems with alcohol. If he likes a glass of wine with dinner, Klatsky says, "this man is better off continuing."
But a 25-year-old health-conscious woman with no risk factors for heart disease who drinks very little should not boost her wine intake just for heart health, Klatsky says. "It is not going to do any good heart-wise for 40 or 50 years."
For men 40 and older and women 50 and older "there are benefits [from alcohol] for heart health," he says. He's talking about moderate drinking, defined by the U.S. Department of Agriculture as no more than one drink a day for women and no more than two drinks a day for men. A drink is 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof spirits.
What is the best advice about drinking alcohol if you only consider alcohol and cancer risk?
While recent studies about alcohol and cancer risk have uncovered new potential links, research about alcohol's effect on cancer risk date back many decades, says Susan Gapstur, PhD, MPH, vice president of epidemiology for the American Cancer Society, Atlanta. "There is a very clear link between alcohol consumption and cancer of the head and neck, particularly among cigarette smokers."
"We can confidently say that even moderate alcohol consumption is associated with a modestly higher risk for breast and colorectal cancer," she says. Her advice: "If you don't drink there is no reason to start. If you are someone who drinks and you're a woman, limit drinking to one a day; if a man, to two a day.''
If you are at high risk for cancer, she adds, you might consider limiting your alcohol intake to less than that.
A family history of some cancers might be reason to cut down or avoid alcohol, Rogg tells patients. "I think [for] people who have a family history of breast cancer or head and neck cancer, it would be much more advisable to abstain," he says, with the exception of special occasions such as an anniversary party. He makes that recommendation for men and women.
But those with a family history only of heart disease, he says, may be helping themselves by moderate drinking.
Those who have been diagnosed with head and neck cancer should completely abstain from alcohol, says Ellie Maghami, MD, a head and neck oncology surgeon at the City of Hope Comprehensive Cancer Center, Duarte, Calif. Alcohol combined with tobacco especially boosts the risks for head and neck cancers, Maghami says.
Are some risks and benefits of alcohol different for women than for men?
Research suggests there is a gender gap when it comes to drinking alcohol and health risks, but experts tend to disagree on the extent of it. For instance, Klatsky says, "even light to moderate drinking is associated with female breast cancer. [But] for men we could say light to moderate drinking in all likelihood is not related to risk of cancer. It's not protective but it won't increase risk.''
That may be generally true, Rogg says, but other individual factors, such as living in an area where pollutants are at a high level, may boost cancer risk.
Besides heart health and cancer risk, are there any other established links between alcohol and health?
Yes, especially with heavy drinking. Heavy drinking and cirrhosis of the liver are linked, Klatsky points out. Excess alcohol can also cause what Klatsky calls "cirrhosis of the heart,'' a type of heart muscle damage. Too much alcohol can trigger high blood pressure and lead to strokes and heart rhythm disturbances, too, he says.
Drinking regularly may contribute to a weight problem or cause one. "Alcohol is an appetite stimulant," says Ravi Dave, MD, a cardiologist at Santa Monica-UCLA Medical Center and Orthopaedic Hospital and associate clinical professor of medicine at the University of California, Los Angeles David Geffen School of Medicine. "You tend to eat more."
On the plus side, drinking alcohol moderately seems to protect against dementia, Klatsky says, and type 2 diabetes.
What about the relaxation benefits of drinking alcohol?
They can be valuable, experts agree. "In low or moderate amounts, alcohol causes euphoria [and] reduction of stress," says Dave. Stress reduction is good for the heart, he says, but it's not a reason to take up drinking if you're a nondrinker.
You also need to take the setting into account, Rogg tells WebMD. ''If you are sitting at home and having, one, two, three glasses of wine, that's more of an escape," he says. But if you are out with friends, having a glass or two? "That may offer invaluable relaxation." The relaxation, in turn, may foster good attitudes, he says. "People with good attitudes and positive thinking seem to have better [health] outcomes."
A recent study of nearly 20,000 Japanese men ages 40 to 69 showed that the heart-health benefits of light to moderate drinking were more pronounced in those with high levels of social support.
Researchers think that's because those who drank with friends or co-workers not only socialized more but had healthier lifestyles in other ways, such as getting more exercise.
Does the type of alcohol matter?
Some studies show some types of alcoholic beverages may have healthier effects than others. For instance, a recent Kaiser study showed that people who drank one glass of wine a day (but not beer or liquor) had a 56% reduced risk of getting Barrett's esophagus, a condition that boosts the risk of esophageal cancer, compared to nondrinkers.
Some experts say red wine may be better for the heart than white due to antioxidants such as resveratrol found in greater amounts in red wine.
Other recent research hasn't shown differences, for instance, in red or white wine and the effect on breast cancer risk.
In the big picture, the pattern of drinking matters more, Klatsky says, than the type of beverage.
Is there a truly safe level of drinking alcohol?
Not a universally safe level, experts agree. "A safe level for one person may not be for another," Gapstur says.
"Nothing is absolutely safe for everybody," Klatsky says. But, he adds, "I think there is a sensible level of drinking.'' Sensible levels, though, must be tailored to the individual, Klatsky says.
And sensible doesn't mean "saving up'' whatever number of drinks is deemed reasonable per week and drinking them all at once, Gapstur says. Moderate doesn't mean ''save it up, put it in the bank," she says, referring to people who don't drink all week, then have multiple drinks at a single sitting on the weekends. That's binge drinking, and considered unhealthy.
Is it better, then, to drink only a little every day or moderately just a few times a week? Experts don't agree entirely. Rogg, for instance, advises his patients not drink more than two or three times a week. To be on the safe side, he suggests a glass of wine or other alcohol maybe twice a week.
But Klatsky says a healthier pattern for many people is to have a small amount nearly every day.
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