Alcohol & Your Health:
Alcohol and Your Health
Recommendation for:
___________________________________________________
Date: __________________
Healthcare professional:
___________________________________________________
For your health, I advise you to:
[ ] Cut back on your use of alcohol
[ ] Abstain from alcohol
Specific ways this this may benefit your health:
___________________________________________________
___________________________________________________
___________________________________________________
What Level is Safe for You?
Introduction
Nutrition, Metabolism, Weight, and Sleep
Cancer Risk
Gastrointestinal Health
Heart Health
Brain Health
Women’s Health
Other Health Concerns
Alcohol and Your Health
References
1
3
5
6
7
9
11
13
14
15
Introduction
There are a lot of mixed messages about the effects of alcohol on your
health. There is no “one size fits all” recommendation about how much
you should drink. This booklet gives you information to discuss with
your doctor about the health benefits and risks of alcohol for you.
At-Risk Drinking
“At risk drinking” is the repetitive use of alcohol with an increased risk
for developing an alcohol use disorder.3 Alcohol use disorder is the
current term for what has been called “alcoholism” or “alcohol dependence” in the past.4 The National Institute on Alcohol Abuse and Alcoholism (NIAA) definition of “at-risk” drinking is more than 4 drinks per
day for men and more than 3 drinks per day for women.3 We will use
this same level of drinking to define a “heavy drinker”. While many
heavy drinkers are not dependent on alcohol, alcohol consumption at
this level is proven to cause damage to your body.
Some people would be best off never drinking alcohol due to medical
conditions. This includes women who may be pregnant and anyone
with liver or pancreatic disease, porphyria, hypertriglyceridemia, idiopathic cardiomyopathy, congestive heart failure, cerebral hemorrhage
or degenerative neurologic conditions.5
No one should be encouraged to drink more because of potential health benefits.
Potential for risk still outweighs possible benefits.1
Moderate Drinking
Moderate drinking means no more than:1
• 1 drink per day for women / 2 drinks per day for men
• 3 drinks on one occasion for women /
• 4 drinks on one occasion for men
In order to be considered a low-risk drinker, you must remain within
both of these limits. 2
A “hangover” is your body’s way of
telling you that you overdid it.
Symptoms include nausea, vomiting,
headache, thirst, fatigue and cognitive
deficits that may affect your ability to
be productive at school or work.6
Nutrition, Metabolism, Weight, and Sleep
Nutrition, Metabolism and Weight Control:
Sleep:
• Alcohol contains empty calories that can contribute to weight
gain.6
• Alcohol makes people feel drowsy and allows them to fall asleep
more quickly; however, the quality of sleep is reduced. After falling
asleep, you will spend less time in REM and deep sleep and will wake
up more frequently.6
• Weight gain is more likely with higher levels of alcohol consumption (more than 2 drinks per day).7
• However, women that drink alcohol at moderate levels have a lower
average body weight than those who abstain – by 2.1-2.2 kg!.8
• Alcohol may interfere with your body’s ability to absorb & store
folic acid and Vitamins A, B1, B3 and B6.6
• Alcohol causes decreased bone density, leading to increased risk of
fracture.6
• Alcohol consumption leads to increased cortisol (stress hormone)
and decreased thyroid hormones.6
• Those with sleep apnea should not drink alcohol before bed
because it relaxes the upper airway and can worsen the apnea.6
• After drinking, your body experiences a number of changes including: appetite stimulation, increased blood pressure, and increased
triglycerides.9
No one should be encouraged to drink more because of potential health benefits.
Potential for risk still outweighs possible benefits.1
Cancer Risk
Gastrointestinal Health
Alcohol has been associated with an increased risk of liver, oral,
esophageal, laryngeal, stomach, colo-rectal, breast, ovarian and prostate cancers.10 There is no safe level of alcohol consumption in terms of
cancer risk.10
Alcohol use can cause gastrointestinal bleeding. It is one of the most
common causes of hemorrhagic gastritis.6
Consuming 2 drinks per day was associated with the
following increases in cancer risk over non-drinkers:
• Pancreatitis is three times more common in heavy alcohol users than
the general population.6
• 75% higher risk of oral cavity and pharyngeal cancers
• 51% higher risk of esophageal cancers
• 38% higher risk of laryngeal cancer
– this risk increased in those who also used tobacco
• 31% higher risk of breast cancer (learn more about the risk of
breast cancer under Women’s Health)
• 11% higher risk of ovarian cancer
• 8% higher risk of colon/rectal cancer
• 7% higher risk of stomach cancer
• 5% higher risk of prostate cancer
Whiskey causes
esophageal
cancer at a
higher rate
than beer or
wine.6
Pancreatitis
• Those who drink 2 drinks or less per day have the same risk as nondrinkers.11
• Risk continues to increase with progressively higher alcohol
consumption.11
Liver Disease
Three forms of liver disease are related to alcohol: 6
• Fatty liver
• Alcoholic hepatitis
• Cirrhosis
• These diseases are seen at drinking levels starting at 2 drinks per day
for women and 4 drinks per day for men over a period of 10 years.6
• The 4-year mortality of alcoholic hepatitis with cirrhosis is 60%.6
No one should be encouraged to drink more because of potential health benefits. Potential
for risk still outweighs possible benefits.1
Heart Health
Heart Attacks
• Drinkers have a lower risk of non-fatal heart attack than those who
abstain.12 Light and moderate drinkers (less than 2 drinks/day in men
and 1/day for women) had lower risks of fatal heart attacks than those
who abstain or those who drink heavily.12
• One drink every other day is sufficient to attain cardioprotective
effects11 – drinking more than 1.5 drinks per day does not provide
additional benefit.11
• Regularly consuming 5 or more drinks per day13 or regularly
becoming intoxicated increases the risk of fatal heart attack more
than those who do not drink at all.14
• Some studies have shown that wine is more protective against
heart attacks and blood vessel disease.12
• The beneficial effects of alcohol on blood vessels may be due to its
ability to increase HDL (good) cholesterol and decrease clotting.12
High Blood Pressure
• Increased alcohol consumption correlates to higher blood pressures.
• Women who drink very small amounts have lower blood pressures
than those who drink moderate amounts or do not drink at all.12
• One week of abstinence in a heavy drinker can improve elevated
blood pressure.12
• Decreasing alcohol use or abstaining is as effective in lowering
blood pressure as losing weight, exercising or reducing sodium.12
• High amounts of alcohol consumption interfere with the treatment
of high blood pressure with prescription drugs.12
• Patients with high blood pressure who drink 3 or more alcoholic
beverages per day should decrease their intake to improve their blood
pressure.12
Other Heart Issues
• Irregular heart rhythms such as atrial fibrillation can be caused by
binge drinking even in those with otherwise healthy hearts15 – this risk
increases when drinking 3 or more alcoholic beverages per day.11
• For those who have a history of atrial fibrillation even moderate drinking can increase the risk of reoccurrence.11
• Those who drink more than 6 alcoholic beverages per day have a high
incidence of sudden cardiac death even without pre-existing ischemic
heart disease.13
• Those who drink 6 or more drinks per day or frequently binge drink
over a period of 5 years or more are at risk for dilated cardiomyopathy.6
No one should be encouraged to drink more because of potential health benefits. Potential
for risk still outweighs possible benefits.1
Brain Health
Stroke
• One study has shown that middle-aged males who have had even a
single hangover in the past year had an increased risk of stroke.16
There are two types of strokes:
Hemorrhagic stroke (bleeding in the brain)
• Heavy drinkers have an increased risk for hemorrhagic stroke.17
• Amongst heavy drinkers, women had 4.5x the risk of a non-drinker,
while men had almost 2x the risk for hemorrhagic strokes.17
• However, women that drink at low levels are protected against
hemorrhagic stroke: the greatest protective effect was found at less
than 1 drink per day - the same did not hold true for men.17
Ischemic stroke (not enough oxygen getting to the
brain)
• About 1 drink per day provides the highest level of protection
against ischemic stroke.17
• Increasing drinking beyond one drink per day increases the risk
of ischemic stroke progressively.17
Mental Health
• The relationship between alcohol, depression and suicide is complex and hard to define.18
• Heavy drinkers have 5x the risk of suicide as moderate drinkers.18
• Almost a third (28-29%) of American suicide victims had evidence
of alcohol in their blood.18
• There is evidence to support alcohol abuse or dependence causing
major depression.19
Other effects on your brain
• In adults over 55, drinking at a moderate level (1-3 drinks per day) was
associated with a lower risk of dementia – particularly vascular
dementia.20
• Heavy social drinkers perform worse on tests of executive function
than light drinkers.21
• Aspects of everyday memory are affected in heavy drinkers even if
they are not dependent on alcohol.21
• Long term heavy alcohol use causes deficits in cognition – especially
executive function and memory.22
No one should be encouraged to drink more because of potential health benefits. Potential
for risk still outweighs possible benefits.1
Women’s Health
While most of the information in this booklet holds true for both
genders, there are some differences.
Breast cancer
• The risk of breast cancer increases progressively with the amount of
alcohol consumed per day.13
• Heavy drinking during pregnancy can cause Fetal Alcohol Syndrome –
small heads, changes in the appearance of the face, ears, teeth and
mental retardation.6
• Fetal alcohol spectrum disorders can occur at much lower levels of
alcohol consumption – it is characterized by low birth weight, low IQ,
hyperactive behavior and cognitive deficits.6
• 1 drink per day increases the risk of breast cancer between 4-9%.13
• Exposure to alcohol during the prenatal period has been associated
with prematurity and low birth weight.26
• More than 3 drinks per day increases the risk of breast cancer by
40-50%.23
Other Risks for Women
• Postmenopausal women on hormone replacement therapy (HRT)
have an even greater risk increase.13
• Women have significantly higher risks of liver and esophageal cancer
than men consuming the same amount of alcohol.10
• Adequate intake of folate can lessen the effect alcohol consumption has on increased breast cancer risk.24
• Ovarian cancer risk increased 11% in women drinking 2 alcoholic
drinks per day.10
• In regards to risk for breast cancer, women should not drink more
than 1 alcoholic beverage per day and women at an increased risk for
breast cancer due to personal or family history should avoid alcohol
entirely or only consume it on rare occasions.24
• Women drinking at light levels (less than 1 drink per day) have
lowered risk of increased blood pressure and hemorrhagic stroke compared to women that abstain or drink at higher levels.12
Pregnancy
• Each year five percent of American women aged 15-44 have an
unintended pregnancy.27
• Many women do not know they are pregnant until they are 4-6
weeks along23 and unintentionally expose their babies to alcohol
before realizing they are pregnant.25
• Alcohol use during pregnancy is one of the leading preventable
causes of birth defects and developmental disabilities in the US.25
• Women drinking at heavy levels have an increased risk of hemorrhagic
stroke – double the increased risk as men.17
No one should be encouraged to drink more because of potential health benefits. Potential
for risk still outweighs possible benefits.1
Other Health Concerns
References
• Nerve damage from alcohol can cause erectile dysfunction.6
1. Alcohol Screening and Counseling: An effective but underused health service. CDC Vital
Signs. January 2014.
• The risk of Community Acquired Pneumonia increases by 30% in
those who drink 5 alcoholic beverages per day.11
• Psoriasis is associated with alcohol use – abstinence is related to
remission and beginning to drink alcohol again after a period of
abstinence is related to recurrence of symptoms.11
• Epilepsy has been associated with alcohol consumption – especially at high levels.11
2. What's low-risk drinking?. Rethinking Drinking.
http://rethinkingdrinking.niaaa.nih.gov/isyourdrinkingpatternrisky/whatslowriskdrinking.
asp. Accessed March 29, 2015.
3. Papadakis MA, McPhee SJ. Current Medical Diagnosis and Treatment, 52 e. New York, NY:
McGraw-Hill; 2013.
4. Alcohol Use Disorder: A Comparison Between DSM-IV and DSM-V. NIH Publication.
November 2013: 13-7999.
5. Pearson TA, Terry P. What to advise patients about drinking alcohol. JAMA. 1994; 272:
957–58.
• Tuberculosis has been consistently linked to drinking 3-4 drinks
per day – 3x the risk of non-drinkers.11
6. Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J. Harrison's Principles of
Internal Medicine, 18 e. New York, NY: McGraw-Hill; 2012.
• Numbness and tingling of the arms and legs (Peripheral Neuropathy) is seen in 10% of those with “alcohol use disorder”.6
7. Sayon-Orea C, Martinez-Gonzolez MA, Bes-Rastrollo M. Alcohol consumption and body
weight: a systematic review. Nutrition Reviews. 2011; 69(8):419-431.
• Alcohol may cause muscle weakness (myopathy) that may be
permanent even after abstaining.6
• Thiamine deficiency from chronic drinking can lead to vision
changes, loss of coordination, mental impairment, memory loss and
psychosis.6
8. Williamson DF, Forman MR, Binkin NJ, Gentry EM, Remington PL, Trowbridge FL. Alcohol
and Body Weight in United States Adults. Am J Public Health. 1987; 77:1324-1330.
9. Babor T, Rehm J, Jernigan D, Vaeth P, Monteiro M, Lehman H. Alcohol, diabetes, and
public health in the Americas. Rev Panam Salud Publica. 2012;32(2):151–5.
10. Bagnardi V, Blangiardo M, La Vecchia C, Corrao G. A meta-analysis of alcohol drinking
and cancer risk. British Journal of Cancer. 2001; 85(11): 1700–1705.
11. Rehm J, Ballunas D, Borges GLG, et al. The relation between different dimensions of
alcohol consumption and burden of disease: an overview. Addiction. 2010; 105:817-843.
12. Klatsky, AL. Alcohol, Coronary Disease and Hypertension. Annu. Rev. Med. 1996;
47:149–60.
13. Room R, Babor T, Rehm J. Alcohol and Public Health. Lancet. 2005; 365:519-530.
14. Carrao G, Rubbiati L, Bagnardi V, Zambon A, Poikolainen K. Alcohol and coronary heart
disease: a meta-analyis. Addiction. 2000; 95(10):1505-1523.
15. Puddey IB, Rakic V, Dimmitt SB, Beilin LJ. Influence of Pattern of drinking on cardiovascular disease and cardiovascular risk factors - a review. Addiction. 1999; 94(5):649-663.
16. Rantako SH, Laukkanen JA, Sivenius J, Kauhanen J, Kurl S. Hangover and the risk of
stroke in middle-aged men. Acta Neurol Scand. 2013;127: 186–191.
17. Patra et al. Alcohol consumption and the risk of morbidity and mortality for different
stroke types - a systematic review and metaanalysis. BMC Public Health. 2010; 10:258.
18. Pompili M, et al. Suicidal Behavior and Alcohol Abuse. Int J of Environmental Research
and Public Health. 2010; 7: 1392-1431.
19. Fergusson DM, Boden JM, Horwood LJ. Tess of Causal Links Between Alcohol Abuse or
Dependence and Major Depression. Arch Gen Psychiatry. 2009; 66(3): 260-266.
20. Ruitenberg A, van Swieten JC, Witteman JCM, et al. Alcohol consumption and risk of
dementia: the Rotterdam Study. Lancet. 2002; 359: 281-286.
21. Montgomery C, Fisk JE, Murphy PN, Ryland I, Hilton J. The effect of heavy social drinking
on executive function: a systematic review and meta-analytic study of existing literature
and new empiric findings. Hum. Psychopharmacol Clin Exp. 2012; 27: 187–199.
22. Silveri MM. Adolescent Brain Development and Underage Drinking in the United States:
Identifying Risks of Alcohol Use in College Populations. Har. Rev. Psychiatry. July/August
2012: 189-200.
23. Seitz HK, Pelucchi C, Bagnardi V, La Vecchia C. Epidemiology and Pathophysiology of
Alcohol and Breast Cancer: Update 2012. Alcohol and Alcoholism. 2012; 47(3): 204-212.
24. Larsson SC, Giovannucci E, Wolk A. Folate and Risk of Breast Cancer: A Meta-analysis. J
Natl Cancer Inst. 2007; 99: 64-76.
25. Floyd RL, Weber MK, Denny C, O'Connor MJ. Prevention of Fetal Alcohol Spectrum
Disorders. Developmental. Disabilities Research Reviews. 2009; 15: 193-199.
26. Truong KD, Reifsnider OS, Mayorga ME, Spitler H. Estimated Nmber of Preterm Births
and Low Birth Weight Children Born in the United States Due to Maternal Binge Drinking.
Matern Child Health J. 2013; 17:677-688.
27. Finer LB, Zolna MR. Shifts in Intended and Unintended Pregnancies in the United States,
2001-2008. Am J Public Health. 2014; 104 (S1):S43-S48.
Page 3 photo courtesy of Tanvir Alam at flickr.com/photos/slimmingtipsblog/14340262656
Page 5 photo courtesy of Arnoooo at flickr.com/photos/studiobeeldruis/2722616697
For more information about alcohol and drug prevention in Colorado,
visit www.ImprovingHealthColorado.org.
For health professionals interested in training on how to provide
alcohol screening and brief counseling to their patients, contact
Peer Assistance Service, Inc. at [email protected] or
(303) 369-0039, ext. 245.