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Although the amount of alcoholic beverage consumed varies in volume from a shot glass of whisky to a 12 ounce can of beer, the amount of actual alcohol in the average drink is almost always about the same regardless of whether the drink is wine, beer, or spirits. Thus, for example, the high concentration of alcohol in whiskey compensates for the small volume of whiskey consumed in one drink.
The consumption of alcoholic beverages, depending on frequency of use and quantity ingested, can be associated with a wide variety of health problems. In the extreme, an episode of heavy drinking can lead to sensory impairment, nausea, vomiting, subarachnoid hemorrhage (bleeding into the space between the brain and the middle membrane covering the brain), increased risk of vehicular and other accidents, and even central nervous system shut down (sometimes followed by death).
On the other hand, light drinking (one to two drinks per day) can benefit health. For example, light drinking is associated with possible improvement in glucose tolerance;1,2,3,4 possible reductions in the risk of gallstones5 and non-hemorrhagic stroke;6 clear reductions in coronary artery disease deaths, indices of platelet aggregation, and increases in HDL cholesterol;7 and decreased overall mortality.8 However, even light drinking might increase the risk of breast cancer in women.9
When alcohol is consumed in greater than moderate amounts (moderate drinking is generally defined as two drinks per day in women or three drinks per day in men), it has been associated with a wide variety of health problems. If you drink in greater than moderate amounts and want to reduce your risk of these health problems, you should reduce the amount of alcohol you drink (and in some cases avoid alcohol entirely).
Warning to pregnant women: Even minimal alcohol ingestion during pregnancy can increase the risk of health problems in a woman's unborn child, including fetal alcohol syndrome, decreased birth weight, and infant leukemia.10 Pregnant women should avoid alcohol completely.
Health Problems Associated with Excessive Alcohol Intake
(The following list is comprehensive, although not necessarily exhaustive. Contact your health care professional for more information.)
Alcoholism is a disorder characterized by a pathological pattern of alcohol use that causes a serious impairment in social or occupational functioning. Almost all doctors agree that alcoholics must stop drinking completely in order to overcome the addiction.
Beri beri is a deficiency disease caused by inadequate intake of vitamin B1 (thiamine). Vitamin B1 deficiency can be partly a consequence of chronic alcohol consumption11 and is relatively common in those who chronically abuse alcohol.
Brain Damage (Alcoholic Cerebellar Degeneration)
Degeneration of the cerebellum--a part of the brain--occurs frequently in chronic alcoholics. This primarily affects the ability to walk, though other symptoms can occur.12 People with alcoholic cerebellar degeneration must avoid all alcohol and require supplementation with B vitamins.
Cancer is a general term for more than 100 diseases that are characterized by uncontrolled, abnormal growth of cells. Cancer is the second leading cause of death in Americans. Chronic alcohol use has been linked to adenomatous polyps and cancers of the breast, colon, larynx, liver, mouth, pharynx, rectum, esophagus, and stomach.13 Even light alcohol consumption increases the risk of breast cancer.14
Cardiac arrhythmia is a disturbance of the electrical activity of the heart that manifests as an abnormality in heart rate or heart rhythm. This condition is more likely in those who drink heavily.15
Cardiomyopathy is a general term for conditions affecting the heart muscle and leading to decreased ability of the heart to pump blood. Chronic alcohol use is associated with a risk of alcohol-induced cardiomyopathy.16
Severe damage to the liver which impairs its function is known as cirrhosis. Alcoholism is the leading cause of cirrhosis.17
People with diabetes cannot properly process glucose, a sugar the body uses for energy. As a result, glucose stays in the blood, causing blood glucose to rise. At the same time, however, the cells of the body can be starved for glucose. Diabetes can lead to poor wound healing, higher risk of infections, and many other problems involving the eyes, kidneys, nerves, and heart.
Moderate drinking in healthy people appears to improve glucose tolerance.18,19,20,21 However, alcohol has been linked to a worsening of glucose tolerance in the elderly22 and in diabetics23 in some reports. Diabetics who drink have also been reported to have a higher risk for eye24 and nerve damage.25
Questions remain about where the line should be drawn regarding alcohol intake. For healthy people, light drinking will not increase the risk of diabetes, but heavy drinking might, and should be avoided. Until more is known, people with diabetes should also limit alcohol intake, probably to two drinks per day. Total avoidance of alcohol in diabetics who are not suffering from alcoholism, liver disease, gastritis, ulcers, and other conditions made worse by alcohol might actually be counter productive. In one report, older people with type 2, or non-insulin dependent diabetes mellitus, who drank daily but moderately had a dramatically lower incidence of deaths from heart disease compared with non-drinkers.26 This outcome is not surprising because moderate alcohol intake is associated with protection from heart disease in most other reports. This finding may be of particular importance because heart disease is the leading killer of people with diabetes.
Dysmenorrhea, or painful menstruation, is classified as either primary or secondary. Primary dysmenorrhea occurs within a couple of years of the first menstrual period. The pain tends to decrease with age and very often resolves after childbirth. Secondary dysmenorrhea is commonly a result of endometriosis, starts later in life, and tends to increase in intensity over time.
Some nutritionally oriented physicians advise that alcohol should be avoided by women experiencing menstrual pain because it depletes stores of certain nutrients and alters the metabolism of carbohydrates--which in turn might worsen muscle spasms. Alcohol can also interfere with the liver's ability to metabolize hormones. In theory, this might result in elevated estrogen levels, increased fluid and salt retention, and heavier menstrual flow. Despite these theoretical arguments, however, most27,28 studies have found no link between drinking alcohol and dysmenorrhea.29
Gastritis is a broad term for inflammation or irritation of the inner lining of the stomach and, in some cases, may lead to an ulcer. Alcohol use can cause or exacerbate gastritis and this disease is common among alcoholics.30, 31
Alcohol use can increase the risk of gastroesophageal reflux (the return of stomach contents back up into the esophagus).32 This frequently causes heartburn because of irritation of the esophagus by stomach acid.
Gout is a form of arthritis that occurs when crystals of uric acid accumulate in a joint, leading to the sudden development of pain and inflammation. Individuals with gout either overproduce uric acid or are less efficient at eliminating it. The big toe is the most commonly afflicted joint to accumulate uric acid crystals, although other joints may be affected. Avoiding alcohol, particularly beer, can reduce the number of attacks of gout.33,34
Hemorrhagic stroke occurs when an artery leaks blood into the brain, causing compression, displacement, and death of nerve tissue. This type of stroke is more likely in those who drink.35
Hepatitis Although the liver disease hepatitis is often caused by infectious and other non-alcohol related causes, hepatitis is also linked to long-term alcohol abuse.36
Homocysteine (High) Homocysteine, a normal breakdown product of the essential amino acid methionine, is believed to exert a number of toxic effects in the body. A growing body of evidence suggests that an elevated homocysteine level is a risk factor for heart disease, independent of other known risk factors such as elevated serum cholesterol and hypertension;37, 38 however, in some research the link has appeared only in women.39 People who chronically use alcohol have been reported to have elevated homocysteine levels.40
Hypertension is the medical term for high blood pressure. The primary cause(s) of most hypertension remains unknown. However, many studies have found a relationship between alcohol consumption and blood pressure. A recent review of the research reported that above the equivalent of approximately three drinks per day, blood pressure increases in proportion to the amount of alcohol consumed.41 Whether one or two drinks per day meaningfully increases blood pressure remains unclear.
The technical meaning of hypoglycemia is low blood sugar. Common symptoms are fatigue, anxiety, headaches, difficulty concentrating, sweaty palms, shakiness, excessive hunger, drowsiness, and depression. In a preliminary report, some people with hypoglycemia were reported to improve when they eliminated alcohol from their diets.42
Alcohol intake, including single episodes of moderate consumption, interferes with a wide variety of immune defenses.43,44 Alcohol's immune-suppressive effect may be one mechanism for the association between alcohol intake and certain cancers45 and infections.46,47 However, moderate alcohol consumption (up to three to four drinks per day) has been associated with either no risk48 or a decreased risk for upper respiratory infections in young non-smokers.49
Even moderate drinking in women has been linked to an increased risk of infertility in some,50 although not all, research.51 Until more is known, women wishing to conceive should probably avoid alcohol.
Leaky Gut Syndrome
Alcohol is known to increase permeability of the gastrointestinal tract. Such changes associate with high levels of a toxic substance called endotoxin, which has been linked to a variety of diseases. Some research suggests that leaky gut caused by excessive alcohol intake in some but not all drinkers is the cause of cirrhosis. This may explain why some alcoholics eventually develop liver disease.52
Macular Degeneration The macula is a portion of the retina in the back of the eye. Degeneration of the macula is the leading cause of irreversible blindness in elderly Americans.53 Total alcohol consumption has not been linked to macular degeneration in most studies.54,55 However, one research group has linked beer consumption to macular degeneration,56,57 and in one of two trials, wine drinkers were found to have a significantly lower risk of macular degeneration compared with people not drinking wine.58,59 Most doctors consider these reports too preliminary to suggest either avoiding beer or increasing wine consumption.
Some of the nutritional deficiencies associated with alcoholism can be caused by a poor diet--a factor that needs correction on an individual basis. Improving the overall diet should be done in conjunction with a nutritionally oriented doctor. Sometimes liver or pancreatic disease associated with alcoholism also contributes to nutritional deficiencies, as does alcohol-induced damage to the lining of the gastrointestinal tract. These problems require medical assessment and intervention.
Alcoholism is the leading cause of inflammation of the pancreas (pancreatitis)--a condition that can be life-threatening.60
Peptic ulcers are erosions in the stomach or duodenum (the first part of the small intestine). Ulcers can be caused or exacerbated by alcohol use. Alcohol increases stomach acidity, which can interfere with the healing of an ulcer.61
One of the conditions that can trigger photosensitivity--porphyria cutanea tarda--has been linked to alcohol consumption.62 Until more is known, people with this form of porphyria should avoid alcohol.
Premenstrual Syndrome (PMS)
Many premenopausal women suffer from symptoms of premenstrual syndrome (PMS). These symptoms typically begin at the end of each monthly cycle and resolve with the start of menstruation. Alcohol can affect hormone metabolism, and alcoholic women have been reported to be more likely to suffer PMS than are non-alcoholic women.63
Psoriasis is a common skin disease that produces silvery, scaly plaques. Ingestion of alcohol appears to be a risk factor for psoriasis in men but not women.64, 65 It would therefore be prudent for men with psoriasis to drink moderately, if at all.
Acute Respiratory Distress Syndrome
Acute respiratory distress syndrome in adults occurs in critically ill patients and is an often fatal disease involving abnormal lung function. A past history of chronic alcohol abuse has been reported to significantly increase the risk of suffering from this condition.66
Most studies indicate that people with elevated triglycerides (a type of fat in the blood) are at higher risk of heart disease. While moderate drinking does not affect triglyceride levels, heavy drinking is believed to be the second most prevalent cause (after diabetes) of elevated triglyceride levels.67 Alcoholics with elevated triglyceride levels should deal with the disease of alcoholism.
Wernicke's Encephalopathy/Wernicke Korsakoff Syndrome
Deficiencies in vitamin B1 (thiamine) sometimes go beyond the normal scope of beri-beri to affect the central nervous system. The resulting conditions--Wernicke's encephalopathy and Wernicke Korsakoff syndrome--are generally caused by the combination of heavy alcohol consumption, lack of dietary vitamin B1, and genetic predisposition. Common symptoms include disorientation, inability to walk normally, confusion, and paralysis of the muscles governing eye movement.68 People suffering from either Wernicke's encephalopathy or Wernicke Korsakoff syndrome need immediate medial treatment with intravenous or intramuscular vitamin B1 and must avoid all intake of alcohol.
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19. Facchini F, Chen Y-DI, Reaven GM. Light-to-moderate alcohol intake is associated with enhanced insulin sensitivity. Diabetes Care 1994;17:115.
20. Rimm EB, Chan J, Stampfer MJ, et al. Prospective study of cigarette smoking, alcohol use, and the risk of diabetes in men. BMJ 1995;310:555-9.
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22. Goden G, Chen X, Desantis R, et al. Effects of ethanol on carbohydrate metabolism in the elderly. Diabetes 1993;42:28-34.
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34. Scott JT. Alcohol and Gout. BMJ 1989;298:1054.
35. Camargo CA. Case-control and cohort studies of moderate alcohol consumption and stroke. Clin Chim Acta 1996;246:107-19.
36. Brechot C, Nalpas B, Feitelson MA. Interactions between alcohol and hepatitis viruses in the liver. Clin Lab Med 1996;16:273-87.
37. Stampfer MJ, Malinow R, Willett WC, et al. A prospective study of plasma homocysteine and risk of myocardial infarction in US physicians. JAMA 1992;268:877-81.
38.Bostom AG, Silbershatz H, Rosenberg IH, et al. Nonfasting plasma total homocysteine levels and all-cause and cardiovascular disease mortality in elderly Framingham men and women. Arch Intern Med 1999;159:1077-80.
39. Folsom AR, Nieto J, McGovern PG, et al. Prospective study of coronary heart disease incidence in relation to fasting total homocysteine, related genetic polymorphisms, and B vitamins. Circulation 1998;98:204-10.
40. Hultberg B, Bergland M, Andersson A, Frank A. Elevated plasma homocysteine in alcoholics. Alcoholism Clin Exp Res 1993;17:687-9.
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50. Grodstein F, Goldman MB, Cramer DW. Infertility in women and moderate alcohol use. Am J Public Health 1994;84:1429-32.
51. Florack EIM, Zielhuis GA, Rolland R. Cigarette smoking, alcohol consumption, and caffeine intake and fecundability. Prev Med 1994;23:175-80.
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55. Ajani UA, Christen WG, Manson JE, et al. A prospective study of alcohol consumption and the risk of age-related macular degeneration. Ann Epidemiol 1999;9:172-7.
56. Moss SE, Klein R, Klein BE, et al. Alcohol consumption and the 5-year incidence of age-related maculopathy: the Beaver Dam eye study. Ophthalmology 1998;105:789-94.
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58. Obisesan TO, Hirsch R, Kosoko O, et al. Moderate wine consumption is associated with decreased odds of developing age-related macular degeneration in NHANES-1. J Am Geriatr Soc 1998;46:1-7.
59. Ritter LL, Klein R, Klein BE, et al. Alcohol use and age-related maculopathy in the Beaver Dam Eye Study. Am J Ophthalmol 1995;120:190-6.
60. Suda K, Shiotsu H, Nakamura T, et al. Pancreatic fibrosis inpatients with chronic alcohol abuse: correlation with alcoholic pancreatitis. Am J Gastroenterol 1994;89:2060-2.
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63. Halliday A, Bush B, Cleary P, et al. Alcohol abuse in women seeking gynecologic care. Obstet Gynecol 1986;68:322-6.
64. Poikolainen K, Reunala T, Karvonen J, et al. Alcohol intake: a risk factor for psoriasis in young and middle aged men? BMJ 1990;300:780-3.
65. Monk BE, Neill SM. Alcohol consumption and psoriasis. Dermatologica 1986;173:57-60.
66. Moss M, Bucher B, Moore FA, et al. The role of chronic alcohol abuse in the development of acute respiratory distress syndrome in adults. JAMA 1996;275:50-4.
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68. Beal MF, Martin JB. Nutritional and Metabolic diseases of the nervous system. In: Harrison's Principles of Internal Medicine 14th ed, Fauci AS, Braunwald E, Isselbacher KJ, et al. eds, McGraw-Hill, New York, 1998, p2451-7 [review].
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