Drinking any amount of alcohol is harmful to health

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Sorry to be a killjoy, but that one or two glasses of wine every night isn’t improving your health.

After decades of confusing and sometimes contradictory research (too much alcohol is bad for you, but a little is good, or some types of alcohol are better than others), the picture is now becoming clearer: even small amounts of alcohol can have health consequences.

Research published in November revealed that between 2015 and 2019, heavy drinking resulted in approximately 140,000 deaths per year in the United States. About 40% of these deaths had acute causes, such as car accidents, poisoning and homicides. But most were caused by chronic conditions attributed to drinking, such as cancer and liver and heart disease.

When experts talk about the dire health consequences of binge drinking, people often assume that this is a message to those with a drinking disorder. But the health risks from drinking can also come from moderate drinking.

“The risk starts to rise well before levels where people would think, ‘Oh, this person has an alcohol problem,'” says Tim Naimi, director of the Canadian Institute for Substance Use Research at the University of Victoria. “Alcohol is harmful to health from very low levels.”

If you’re wondering whether to cut back on your drinking, here’s what you should know about when and how alcohol affects your health.

How do I know if I’m drinking too much?

“Excessive alcohol use” technically means anything above the daily limits recommended by the United States Dietary Guidelines. That’s more than two drinks a day for men and more than one a day for women.

There is also new evidence “that there are risks even within these levels, especially for certain cancers and some forms of cardiovascular disease,” says Marissa Esser, who leads the alcohol program at the US government’s Centers for Disease Control and Prevention.

Recommended daily limits should also not be calculated on a weekly basis. In other words, if you abstain Monday through Thursday and have two or three drinks a night over the weekend, they should be considered binge drinking.

It’s both the drinks accumulated over time and the amount of alcohol in your system at any given time that can do harm.

Scientists think that the main way alcohol causes health problems is by damaging DNA. When you drink, your body breaks it down into acetaldehyde, a chemical that is toxic to cells. Acetaldehyde “damages your DNA and prevents your body from repairing the damage,” says Esser. “Once its DNA is damaged, a cell can grow out of control and create a cancerous tumor.”

Alcohol also creates oxidative stress, another form of DNA damage that can be particularly harmful to the cells that line blood vessels. This form of stress can lead to hardening of the arteries, resulting in higher blood pressure and coronary artery disease.

“It fundamentally affects DNA, and therefore affects many organ systems,” points out Naimi. Over a lifetime, chronic consumption “cumulatively damages tissue.”

Is there damage to the heart?

The effect of alcohol on the heart is confusing, as some studies claim that small amounts of alcohol, especially red wine, can be beneficial. Previous research has suggested that alcohol raises HDL, the “good” cholesterol, and that resveratrol, an antioxidant found in grapes (and red wine), has heart-protective properties.

However, says Mariann Piano, professor of nursing at Vanderbilt University, “There has been a lot of recent evidence that has really challenged the idea of ​​any kind of so-called cardioprotective or healthful effect of alcohol.”

The idea that a low dose of alcohol is heart-healthy probably stems from the fact that people who drink small amounts tend to have other healthy habits, such as exercising, eating lots of fruits and vegetables, and not smoking. In observational studies, the cardiac benefits of these behaviors may have been mistakenly attributed to alcohol, says Piano.

More recent research has found that even low levels of drinking slightly increase the chances of high blood pressure and heart disease, and the risk increases dramatically for people who drink to excess.

The good news is that when people stop drinking or simply cut back, their blood pressure drops. Alcohol is also linked to an abnormal heart rhythm known as atrial fibrillation, which increases the risk of blood clots and stroke.

For which types of cancer does alcohol increase the risk?

Almost everyone knows the link between smoking and cancer, but few people know that alcohol is also a potent carcinogen. According to research done by the American Cancer Society, alcohol contributes to more than 75,000 cases of cancer each year and nearly 19,000 deaths from the disease.

It is known as a direct cause of seven different cancers: head and neck (oral cavity, pharynx and larynx), esophageal, liver, breast and colorectal. Research suggests there may be a link between alcohol and other types of disease, including prostate and pancreatic, although the evidence is less clear.

For some cancers, such as liver and colorectal cancer, the risk only starts when people drink heavily. But for breast and esophageal cancer the risk increases, albeit slightly, with any alcohol consumption. The chances increase the more the person drinks.

“If someone drinks less, they have a lower risk compared to a heavy drinker,” says Farhad Islami, senior scientific director at the American Cancer Society. “Even two drinks a day, one drink a day, may be associated with a small risk of cancer compared with people who don’t drink.”

Which condition poses the greatest risk?

The most common single cause of alcohol-related death in the US is alcoholic liver disease, which kills an estimated 22,000 people each year. Although the risk increases as people age and exposure to alcohol accumulates, more than 5,000 Americans in their 20s, 30s and 40s die annually from this diagnosis.

The disease has three stages: alcoholic fatty liver, when fat accumulates in the organ; alcoholic hepatitis, when inflammation begins to occur; and alcoholic cirrhosis, or scarring of tissue. The first two stages are reversible if the person stops drinking completely, the third stage is not.

Symptoms of alcoholic liver disease include nausea, vomiting, abdominal pain and jaundice – a yellow tinge to the eyes or skin. However, symptoms rarely appear until the liver has been severely damaged.

The risk of developing alcoholic liver disease is higher among heavy drinkers, but one report said five years of drinking just two drinks a day could damage the liver. Ninety percent of people who drink four drinks a day show signs of alcoholic fatty liver.

How do I assess my risk for alcohol-related illnesses?

Not everyone who drinks will develop these conditions. Lifestyle factors such as diet, exercise, and smoking combine to increase or decrease your risk. Also, some of these conditions, like esophageal cancer, are quite rare, so raising your risk just a little bit won’t have a huge impact.

“All risk factors are important,” points out Esser. “We know in public health that the number of risk factors a person has combine to increase the risk of a condition.”

A preexisting condition can also interact with alcohol to affect your health. For example, “People who have hypertension probably shouldn’t drink, or definitely drink at very, very low levels,” Piano says.

Genes also play a role. For example, two genetic variants, both more common in people of Asian descent, affect how alcohol and acetaldehyde are metabolized. A variant of the gene causes alcohol to break down into acetaldehyde more quickly, flooding the body with the toxin. The other variant slows the metabolism of acetaldehyde, which means the chemical stays in the body longer, prolonging the damage.

Should I cut back or stop drinking altogether?

You don’t have to stop completely to help your health. Even cutting back a little can be beneficial, especially if you drink above recommended limits. The risk “really increases when you have a few drinks a day,” says Naimi.

“So people who have five or six drinks a day, if they can cut it down to three or four, they’ll do themselves a lot of good.”

Light daily drinkers would likely benefit from cutting back a bit as well. Try to spend a few alcohol-free nights. “If you feel better, your body is trying to tell you something,” points out George Koob, director of the National Institute on Alcohol Abuse and Alcoholism.

Notably, none of the experts we spoke to called for total abstinence unless you have an alcohol use disorder or are pregnant. “I’m not going to advocate for people to stop drinking completely,” says Koob. “We did the ban, it didn’t work.”

Generally, though, their advice is, “Drink less, live more,” says Naimi. “That’s pretty much what it boils down to.”

Translated by Luiz Roberto M. Gonçalves

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