12. ALCOHOL

Colloquially, when people talk about alcohol they are referring to ethanol, which is what is found in alcoholic beverages. Chemically speaking, ethanol is only one member of a large family of compounds known as alcohols. You are probably familiar with some of the other family members, such as isopropyl alcohol, also known as rubbing alcohol, or ethylene glycol, which is commonly used in antifreeze. But as useful as these other compounds are, ethanol’s combination of disinfectant, psychoactive, and nontoxic properties have made it humanity’s longtime favorite. It is the only kind of alcohol that you should consider imbibing, and you should consider it carefully.

Ethanol is the by-product of the fermentation of sugar by yeast. Humans have been taking advantage of this process to make alcoholic beverages since time immemorial. Alcohol has been used medicinally, ritually, and recreationally for thousands of years. It continues to play a social role in many cultures worldwide and is a huge global industry. But for as much as we like it, humanity’s relationship with alcohol has been fraught with struggle, and alcohol consumption has a very dark side.

As a drug, alcohol has system-wide effects on the body. Notably, it reduces inhibition and increases sociability, impacts judgment, impairs motor function, increases reaction time, acts as a diuretic, and dilates blood vessels. In high doses it can cause vomiting, dizziness, unconsciousness, amnesia, respiratory depression, and decreased heart rate. Acute alcohol poisoning can be fatal. It is, in fact, fatal for about six Americans every day. Of course, alcohol is also addictive and is the most commonly abused substance in the United States.

Heavy alcohol use taxes the liver, and cirrhosis is a common and well-known side effect. Wernicke-Korsakoff syndrome is a less well-known but equally serious condition that is secondary to chronic alcoholism. This disorder, which is a type of dementia, is the result of thiamin deficiency. Alcohol interferes with the body’s ability to absorb B vitamins, such as thiamin and folate. Malabsorption of folate may partially account for another of alcohol’s adverse side effects—increased cancer risk. Alcohol consumption increases the risk of a number of cancers including breast, colon, rectum, liver, mouth, esophagus, and larynx.

In addition to these direct physiological effects, alcohol is associated with a range of negative social outcomes. Domestic violence, child abuse, sexual assault, and accidents, especially motor vehicle accidents, are all made more likely by alcohol. Pretty much any way you look at it, the world would be a safer place without alcohol.

Even so, as a species, humans are very unlikely to give up alcohol. And at this point, you might be mentally protesting that some positive health outcomes are associated with moderate alcohol use. Everyone has heard somewhere that drinking a glass of red wine is good for the heart. It’s true that alcohol may have protective benefits against stroke, diabetes, and coronary heart disease. Some studies have shown that moderate drinkers have a reduced mortality risk compared to both heavy drinkers and abstainers. Unfortunately, reanalysis of some of these studies has shown that when other factors are accounted for, moderate drinkers really don’t have any mortality advantage. Furthermore, the risks associated with alcohol consumption are so great that they outweigh any potential cardiovascular benefits. This being the case, no one is recommending that anyone start drinking alcohol for health reasons. If you have safe drinking water available, there really aren’t a lot of medically sound reasons to drink alcoholic beverages. The only reason to drink alcohol is because you enjoy it. But drinking isn’t really going to be fun if it kills you, so you should drink in moderation.

You might think you’re a moderate drinker, but are you? The recommendation for moderate alcohol consumption is one standard drink a day for a woman and two drinks a day for a man younger than 65. If you’re a man older than 65, you also only get one drink a day. This doesn’t seem fair, but physiology isn’t fair. Women and men metabolize alcohol differently because of different body composition; this is the same for older people as compared to younger people. And back to that idea of a standard drink. One drink is 12 ounces of 5% alcohol by volume (ABV) beer, 5 ounces of wine, or 1.5 ounces of liquor. If you drink a pint of craft beer with 7% ABV, you are having more than one drink. If you are a woman and drink four or more drinks in two hours, or if you are a man and drink five or more drinks in the same amount of time, you are binge drinking.

Of course, there are some times in life when you should abstain completely. There are some medications, painkillers and allergy pills for example, that do not mix well with alcohol. If you’re taking any medications—prescription, over-the-counter drugs, or herbal—ask your doctor before you imbibe. Another time to teetotal is during pregnancy. This has been standard medical advice for many years, but recently women have been feeling a bit more relaxed about having one glass of wine. It is understandable to want to relax with a buttery chardonnay, but it’s probably not a great idea. The official medical line is, “there is no known safe amount of alcohol during pregnancy.” That doesn’t mean there isn’t a safe amount, but we don’t know what it is, and it would be unethical to run a clinical trial to find out. That is because it is well known that alcohol can have profound, life-long consequences for an unborn child, including fetal alcohol syndrome. In addition, pregnancy isn’t a static condition but a complicated process. There may be some times during gestation that alcohol will be more likely to do damage to the fetus than at other times. It probably isn’t worth the risk. Reference the above comment about the general unfairness of physiology. Once that baby is born, he or she should also refrain from drinking alcohol until adulthood. Teenagers may have already achieved their adult height, but they have not yet achieved their adult brains. Drinking during this period of life can have permanent negative impacts on cognitive function.

If you enjoy wine tasting or martinis or craft beers, all of the above can seem like a downer. Life can be that way. In the end, you have to define your own priorities for your life and balance health concerns with life’s pleasure. Cheers.

SUMMARY

Preventability (85)

Unless you already have an alcohol dependency, you can choose whether you want to imbibe and how much. So the preventability score is high. On the other hand, you can’t control whether other people drink, and other people’s drinking habits can have profound effects on your life, so preventability isn’t perfect.

Likelihood (65)

Many people enjoy the occasional drink without a problem, but the incidence of alcohol-related trouble is quite high.

Consequence (90)

The consequences of excessive alcohol consumption range from a bad headache, to liver damage, to domestic violence, to death. The potential negative outcomes are so many and so severe that the consequence score is high.

REFERENCES

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