Alcohol and Health


The saddest aspect of life right now is that science gathers
knowledge faster than society gathers wisdom.
Isaac Asimov

Are you one of those people that finishes off a difficult day at work with a cold beer or a glass of Cabernet? If so, is your mindset focused on stress reduction or finding tranquility in this turbulent world?

I know that feeling. For many years, I returned home from a busy office or hospital schedule to enjoy a beer or a glass of wine with dinner. Occasionally, one drink would lead to another and sometimes even a third if the night was still young or the stress was still intense. As a Cardiologist, however, I always had the feeling that alcohol was serving both a therapeutic and a medicinal purpose. My prevailing belief was that small amounts of alcohol reduced stress, improved sleep and had a beneficial effect on long-term health. Much of this information was magnified when the Mediterranean diet became popular and red wine became an addition to the evening ritual.

A few years ago, I decided to give up all alcohol after a prayer was answered. Surprisingly, my stress level did not increase nor did my post-work mood deteriorate. In addition, I lost weight and I felt much more energetic. I may also have become more pleasant to be around, but that is still to be determined! It was not an easy transition, but my avoidance of alcohol has persisted to this day. I know that I am happier for the change.

As I began to research this transition, more information and more clinical studies became available. It is now clear that my response was not unique. There are many physiologic and hormonal factors that are likely at play, and I believe that it is important to share this information for anyone who might be contemplating the lifestyle alternative that I chose.

I do not want to suggest at the onset that a small amount alcohol is intrinsically bad. I will let you make your own decision. I did not personally have an alcohol “problem”, but I must emphasize that my lifestyle choices have become more focused as I age. I also feel the need to practice what I preach when I speak to patients about their health-related issues. I believe that it is critically important for everyone to regularly review their lifestyle habits and make modifications as they refine their long-term health. I am a firm believer that this approach is as important as periodically assessing financial matters. Too often, poor health later in life steals our most valuable and irreplaceable commodity: our time. Making a conscious choice to make our remaining years happy and healthy will require good habits and self-discipline.

Alcohol is a very common theme in social interactions. A glass of wine with family or a few beers with friends at a local bar while watching a game constitute a normal part of adult life. Alcohol in moderation is a common habit for many people. There is an assumption that restraint with alcohol consumption will not have any significant harmful long-term effect. This assumption may need to be reassessed if you look at the true effects of alcohol on the human body.

We know that alcohol is absorbed rather quickly from the G.I. tract. The effects can be felt within a few minutes in most individuals. Even though there is a variable number of calories ingested during alcohol use, there is no nutritional value associated with its consumption. Alcohol is a sugar and its presence in the bloodstream results in a release of insulin from the pancreas to facilitate the movement of sugar into the cell. Alcohol is broken down primarily by the liver and to a lesser extent by the G.I. tract and the kidneys. The initial byproduct is called acetaldehyde. Acetaldehyde exerts no beneficial effect on the human body. It is a toxin. These aldehydes are subsequently broken down to a substance called acetyl CoA. In the process of breakdown, a mitochondrial energy source known as NAD is consumed and NADH is produced. This is very important because NAD is necessary for energy production and glucose breakdown. In effect, alcohol consumption disrupts our blood sugar, robs us of valuable energy and creates a toxic product. It is not such an appealing nectar when you look at it from this perspective.

There are two metabolic processes in our cells that are important for blood sugar control. Glycolysis is the metabolic pathway that facilitates the breakdown of sugar into usable energy in the cells. Gluconeogenesis is the process of producing sugar from various non-sugar cellular breakdown products and primarily takes place in the liver. (Remember that although the brain constitutes only 2% of the total body weight, it consumes 20% of the glucose in our body at any given time. The brain is dependent on glucose as its primary energy source.) When we ingest alcohol, insulin is released, and it does two things: It lowers blood sugar and it “turns down” gluconeogenesis in the liver. This dual process increases the risk of low blood sugar if other calories are not available. This is particularly dangerous for diabetic patients or in people who are in the fasting state. As alcohol is broken down, the excess NADH that is produced can also block glycolysis and gluconeogenesis. This additional double effect may ultimately starve the brain of vital glucose and motivates us to seek food. We know that alcohol use can lead to poor choices and the ingestion of unhealthy and fatty foods further contributes to the risk of weight gain and poor health.

A separate pathway of alcohol breakdown in our body releases inflammatory components known as reactive oxygen species that have an adverse effect on our body. In addition, the breakdown of alcohol in our GI track can lead to bacterial overgrowth of certain gram-negative bacteria. These bacteria produce their own pro-inflammatory products that can have a detrimental impact on our liver and other vital organs. Conversely, alcohol use can reduce a protective gut bacteria (Akkermansia muciniphila) that has beneficial effects on reducing obesity, diabetes and gut inflammation.

Alcohol also appears to increase cortisol levels. Cortisol is the stress hormone that we need for daily performance, but regular alcohol consumption can lead to chronic cortisol elevation. This can have a significant negative effect on our body. Overstimulation of cortisol production can cause a syndrome known as adrenal fatigue that makes us to feel chronically tired. In addition, even small amounts of alcohol can fragment our sleep during the night and reduces our REM sleep (dream sleep). Sleep deprivation is a major factor in poor health outcomes. A concerning practice on college campuses is the combination of caffeine-powered drinks with alcohol. This combination can have a disastrous effect on sleep and can also lead to significant alcohol intoxication by blunting the sedating effects of alcohol.

Why did I take you on this extended journey of physiology and biochemistry? Primarily, it is to inform you that there is no true calming effect of moderate alcohol consumption. In the long term, it may have the exact opposite effect. Sleep disorders, elevated cortisol, fat deposition and promotion of inflammatory cellular activity are not healthy for our bodies and do not promote longevity.
It has been widely reported from various observational studies that moderate alcohol use has a beneficial effect on long term survival. Almost all these studies rely on accurate reporting of alcohol consumption by its participants. Sadly, my experience in a clinical setting suggests that patients frequently under-report alcohol consumption. In addition, the volume of wine or spirits consumed and measured can have wide variations depending on who is preparing the drink. This makes accurate scientific deductions more difficult. What we do know is that those cultures that exhibit longevity in the Blue Zones study seem to incorporate small amounts of alcohol into their lifestyle. This suggests a causal relationship between alcohol and healthy aging, but these populations also ate a very healthy diet, maintained an active lifestyle, avoided smoking and had high levels of social interaction. Conversely, a very large Global Burden of Disease Study reported in the Lancet in 2018 concluded that health outcomes were best when alcohol consumption was minimal or absent. A more recent 2022 brain imaging study from the UK Biobank revealed a significant negative effect on brain volume and microstructure in individuals who consumed even small amounts of alcohol. As the frequency of dementia increases in our society, this study should give pause to anyone who takes alcohol consumption lightly.

So where does this leave us as we contemplate our own personal alcohol use in the future. Here is a summarize my own thoughts, so that you can obtain a proper perspective of what has been discussed.

  1. Alcohol has a significant impact on world health and results in 2.8 million excess deaths each year. (Global Burden of Disease data)
  2. Alcohol is the 7th leading risk factor for death.
  3. Only 10% of the US population reports no alcohol use. 22% of drinkers report that they occasionally drink too much.
  4. Alcohol has no nutritional value but can raise or lower blood sugar.
  5. Even small amounts of alcohol can disrupt fine motor skills, alter sleep patterns and enhance stress hormones.
  6. Alcohol use tends to promote an inflammatory response.
  7. Alcohol can aggravate diabetes, high blood pressure, sleep apnea and gut issues. It promotes fat deposition and is a direct liver toxin.
  8. In the absence of other healthy lifestyle habits, alcohol may not enhance longevity.
  9. Many individuals tend to minimize their alcohol consumption to health care providers. Be honest in your own assessment.
  10. Very small amounts of alcohol (1-2 drinks per week) may not be harmful but even modest regular alcohol use appears to be associated with diminished longevity and results in measurable harmful effects to our brain.

I realize that free advice may be worth nothing to those who receive it. On the other hand, what started out as an answered prayer has given me the revelation that wisdom can be a gift that begins with self-reflection and the pursuit of knowledge. I invite you to reflect on your own lifestyle and determine if alcohol is a benefit or a hidden burden. I also suggest that you pray about it.