Alcohol is a highly accepted and commonly abused addictive substance in America. Fueled by a nearly 2 billion dollar annual marketing budget it’s no surprise that alcohol seems to be ubiquitous in adult society. There is also no lack of “evidence” touted to support the use of alcohol for potential health benefit. As a health optimization expert and advocate I began to question the benefits of alcohol in my own life and for my patients years ago. What I learned is that alcohol is not consumed on the scale I had been lead to believe, the health benefits are questionable at best and the dangers are grossly under reported.
First the truth behind the statistics. While the National Institutes of Health (NIH) reports that 90% of the American population will drink at some point in their life only 50% reported drinking more than once a month. While half of the American adult population is a staggering number of people it also demonstrates that half of us are NOT drinking regularly. Despite this, US alcohol sales of over 220 Billion in 2016 demonstrate that consumption is common and recently on the rise.
Alcohol became a regular part of my life during college like so many others. Like many of my patients I used it as a tool for stress relief, celebration and eventually for nearly any reason. Fortunately, I was able to separate it’s use from my professional and family life but when responsibilities allowed alcohol was a part of the plan. As my health started to wane early in my orthopedic practice I quickly realized that alcohol was an easy target to eliminate and course correct. However, I found moderation difficult and ultimately realized that abstinence was the only way to eliminate the risk of alcohol from my life. Now with more than a year of sobriety I enjoy talking about my journey and providing guidance and support for those struggling with their own drinking.
Now the good news about alcohol. It’s not the resveratrol in wine or the antioxidants in IPA which should be touted as the single reason that a drink can be a part of an optimized life. There are much better sources of both of these. What could be considered however is simply the experience. Alcohol is part of a ritual. A ritual that results in stress relief, winding down and when done by the right person an improved sense of connection and community. For men that can consume a single drink (12oz beer, 5oz wine, 1.5oz liquor) in an evening and experience a sense of relaxation and calm from the adrenal stress axis a drink may provide benefit. Women it seems will have to weigh this potential benefit with the cancer associations discussed below.
Now the scary. In a 2010 study published in The Lancet alcohol was found to be the most harmful drug overall in English society. More harmful even than heroin, crack cocaine and methamphetamines. They took into account the impact of alcohol on both the user and those around them. With 95,000 deaths contributed to alcohol use annually in the united states it ranks third in the list of preventable causes of death behind tobacco and diet. Even light drinking is associated with cancers of the mouth and esophagus in both sexes and a striking association with breast cancer in women. This shouldn’t be surprising though. Alcohol is an antiseptic and known carcinogen. The first step of metabolism of the ethanol creates acetaldehyde an even more potent carcinogen. After consumption of any quantity of alcohol your body shifts all of its metabolic processing power to breaking down the ethanol and ridding your body of it and it’s metabolites. Ever feel like you’re body’s thermostat is on high after having a few? That’s your body trying to metabolize the poison as quickly as it can. It’s no surprise that your body prioritizes getting alcohol our of your system but it does so at a cost.
That cost is paid in metabolic flexibility. I strongly believe that the ability to burn both stored carbohydrates in glycogen and stored dietary fat in lipids is key to being metabolically optimized. Alcohol consumed on a regular basis can limit our capacity to be metabolically dynamic by reducing the bodies capacity to burn stored fat fuel. This effect can last for hours and up to days depending on the quantity consumed. This can have an impact on weight management for those struggling to control BMI. The shift in metabolism also results in more carbohydrates being converted to the storage form of dietary fat (fatty acids in triglycerides) and circulating in the blood stream. This change results in an increase in the risk of heart disease in many drinkers. Not what you remember seeing in the headlines?
The literature on alcohol consumption can be very misleading. News stories are written about studies that show benefit because they generate more clicks than stories about studies showing harm. People will run from fear and most people know they drink more than they should They don’t want to see the truth if it means they have to drink less.
Most of my patients admit that their behaviors change after drinking. Alcohol is similar to sugary beverages in that consumption of the energy associated with the drink does produce satiety or reduce food consumption when consumed during a meal. In fact, a paradoxical increase in consumption and a shift toward eating dense carbohydrates and sugary processed foods appears to be the trend. This explains the less reported associations of drinking with obesity particularly with beer.
Not surprisingly when drinking an antiseptic there is an impact to the gut. Our microbiome plays a tremendous role in our health and we are only beginning to uncover the implications to damaging the bacteria in our gut. Alcohol alters the microbiome with even light drinking and is associated with SIBO (small intestinal bacterial overgrowth). Consumption of even a single drink will alter the permeability of the gut possibly leading to leaky gut, inflammation and immune dysfunction.
Lastly, people frequently report that they drink to get better sleep. While taking a sedative can help you fall asleep the sleep quality and quantity are generally not improved. Most of our patients track their sleep with an Oura ring or similar wearable device. These devices repeatedly confirm that time in bed may be longer but sleep quantity is actually shorter due to frequent awakenings (usually not remembered). Sleep quality, REM sleep, deep sleep and other recovery metrics are negatively effected and sometimes decimated by as little as two drinks. Review this talk for more on sleep in general.
From an optimization perspective consuming anything that increases your risk for cancer and death seems like a non starter. Combine that with the metabolic effect, gut damage, microbiome alteration and sleep impact and I see little reason to consider alcohol a positive influence on anyone’s life, especially women. I understand the perceived social implications of not drinking but I can tell you from first hand experience that the only people who would give you a hard time about not drinking are those that fear their own habits and are looking for support in pursuing them. Your strength exposes their weakness. That person needs you to be a role model and probably needs to look at their own purpose and habits a little closer. I have chosen to be a role model for my family and patients in this regard. I am now confident without a doubt that alcohol doesn’t serve me in any form but only you can decide for yourself. Try 30 days without alcohol in your life and feel the impact. It may surprise you.
There are a number of resources available for alcohol cessation. For those that want to explore cutting back or sobriety I recommend the approach by author Annie Grace. Her first book This Naked Mind is a great review of alcohol and presents a nice approach to cutting back. She has developed multiple resources that can be explored here. Additional free resources can also be found here. If you think you have a problem with alcohol I strongly encourage you to reach out for help.