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Tag: alcohol

  • Alcohol Dose and Mortality (Remedy or Poison?)

    Alcohol dosing and total mortality in men and women: an updated meta-analysis of 34 prospective studies. Arch Intern Med. 2006 Dec 11-25;166(22):2437-45. Di Castelnuovo A, Costanzo S, Bagnardi V, Donati MB, Iacoviello L, de Gaetano G. [FREE FULL TEXT]

    Abstract
    BACKGROUND:
    Moderate consumption of alcohol is inversely related with coronary disease, but its association with mortality is controversial. We performed a meta-analysis of prospective studies on alcohol dosing and total mortality.

    METHODS:
    We searched PubMed for articles available until December 2005, supplemented by references from the selected articles. Thirty-four studies on men and women, for a total of 1 015 835 subjects and 94 533 deaths, were selected. Data were pooled with a weighed regression analysis of fractional polynomials.

    RESULTS:
    A J-shaped relationship between alcohol and total mortality was confirmed in adjusted studies, in both men and women. Consumption of alcohol, up to 4 drinks per day in men and 2 drinks per day in women, was inversely associated with total mortality, maximum protection being 18% in women (99% confidence interval, 13%-22%) and 17% in men (99% confidence interval, 15%-19%). Higher doses of alcohol were associated with increased mortality. The inverse association in women disappeared at doses lower than in men. When adjusted and unadjusted data were compared, the maximum protection was only reduced from 19% to 16%. The degree of association in men was lower in the United States than in Europe.

    CONCLUSIONS:
    Low levels of alcohol intake (1-2 drinks per day for women and 2-4 drinks per day for men) are inversely associated with total mortality in both men and women. Our findings, while confirming the hazards of excess drinking, indicate potential windows of alcohol intake that may confer a net beneficial effect of moderate drinking, at least in terms of survival.

    My last blog on the effects of drinking alcohol and the prevention of obesity results, in women, were were highest in the 15-30 (~1-2 drinks) grams per day and  >30 grams (>2 drinks) per day group. This amount was higher than what I recall as the general recommendations of one drink a day for a woman and two per day for a man being the ideal amount for overall health benefits and longevity, from when I researched it for my own health back in college. At the time, I was exploiting the French paradox to counteract the high calorie diet was I using to gain weight for weightlifting. In my recent blog I also mentioned that I had read recommendations that were higher than the 1-2 drink recommendations.  I think such recommendations come from the abstract of the above paper, which I don’t feel is the best interpretation of the findings.

    Reading the paper, it looks like women are indeed healthier with up to two drinks per day, and men are so with up to four drinks per day. Even so, when you get into the details at the upper limits of two and four drinks respectively, people aren’t much healthier. When you read the details in the paper itself, it seems that ‘healthier’ and ‘healthiest’ are not quite the same thing. The big thing with alcohol and health is what’s being called a “J-curve.” The J-curve being a meaningful curve downward slope in mortality with moderate drinking, and then follows an onward and upwards turn in health risks when drinking becomes heavy. With moderate drinking, the cited benefits include increased HDL cholesterol, increased fibrinolysis, decreased platelet aggregation and coagulation factors, improved endothelial function, and reduced inflammation. With heavy or binge drinking, the problems become severe including increases in cardiovascular disease, cirrhosis, various cancers, violence, and accidents which the World Health Organization says kills ~2.5 million people per year.

    The reversion point (the upper limit for which the protection of alcohol was no longer statistically significant)  for women was 18 grams of alcohol per day, which is towards the lower end on what was found reasonably effective in preventing obesity, while in men it was found to be 38 grams. However, at the bottom of the J, the healthiest point was right at about 5 grams per day, which is less than half of a standard 14 gram USA drink per day. The health benefits were still pretty good at 10-15 grams which gives you your 5 oz glass of wine, and by 20-30 grams the reduced risk of mortality was used up. Anything beyond that amount, the health risks started to increase relative to not drinking at all. The numbers are all a bit fuzzy because they were based on a number of studies with varying numbers of additional factors included or adjusted for, but the overall gist was consistent. For men, the bottom of the J-curve was in the range of 5-15 grams (one drink region), which was still better than not drinking at two drinks per day, but above 30-60 grams per day the health consequences started to increase. The range for men was also pretty wide and varied by country, which might have to do with differences in drinking habits, genetics, or lifestyle.

    So all that reading and it just brings me back to what my research on the topic found years ago, probably a small to a full drink per day is best for women, ans 1-2 per day for men. Pushing the drinks up to two per day for women and four per day for men isn’t bad, but is moving into the point where the remedy starts to become a poison, which is a bit of a buzzkill, haha.

    Thanks for reading my blog. If you have any questions or comments (even hostile ones) please don’t hesitate to ask/share. If you’re reading one of my older blogs, perhaps unrelated to neck or back pain, and it helps you, please remember SpineFit Yoga for you or someone you know in the future.

    Chad Reilly is a Physical Therapist, obtaining his Master’s in Physical Therapy from Northern Arizona University. He graduated Summa Cum Laude with a B.S. Exercise Science also from NAU. He is a Certified Strength and Conditioning Specialist, and holds a USA Weightlifting Club Coach Certification as well as a NASM Personal Training Certificate. Chad completed Yoga Teacher Training at Sampoorna Yoga in Goa, India.

  • Alcohol Fights Fat (in moderation)

    Alcohol consumption, weight gain, and risk of becoming overweight in middle-aged and older women. Wang L, Lee IM, Manson JE, Buring JE, Sesso HD. Arch Intern Med. 2010 Mar 8;170(5):453-61. [FREE FULL TEXT]

    Abstract
    BACKGROUND:
    The obesity epidemic is a major health problem in the United States. Alcohol consumption is a source of energy intake that may contribute to body weight gain and development of obesity. However, previous studies of this relationship have been limited, with inconsistent results.

    METHODS:
    We conducted a prospective cohort study among 19 220 US women aged 38.9 years or older who were free of cardiovascular disease, cancer, and diabetes mellitus and had a baseline body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) within the normal range of 18.5 to less than 25. Alcoholic beverage consumption was reported on a baseline questionnaire. Body weight was self-reported on baseline and 8 annual follow-up questionnaires.

    RESULTS:
    There was an inverse association between amount of alcohol consumed at baseline and weight gained during 12.9 years of follow-up. A total of 7942 (41.3%) initially normal-weight women became overweight or obese (BMI > or =25) and 732 (3.8%) became obese (BMI > or =30). After adjusting for age, baseline BMI, smoking status, nonalcohol energy intake, physical activity level, and other lifestyle and dietary factors, the relative risks of becoming overweight or obese across total alcohol intake of 0, more than 0 to less than 5, 5 to less than 15, 15 to less than 30, and 30 g/d or more were 1.00, 0.96, 0.86, 0.70, and 0.73, respectively (P( )for trend( )<.001). The corresponding relative risks of becoming obese were 1.00, 0.75, 0.43, 0.39, and 0.29 (P( )for trend( )<.001). The associations were similar by subgroups of age, smoking status, physical activity level, and baseline BMI.

    CONCLUSION:
    Compared with nondrinkers, initially normal-weight women who consumed a light to moderate amount of alcohol gained less weight and had a lower risk of becoming overweight and/or obese during 12.9 years of follow-up.

    My comments:

    I’ve been aware of the health benefits of moderate daily alcohol consumption since college when I first read about the French paradox. At the time, I was eating 5000 calories a day to gain weight for weightlifting and wanted to make sure I didn’t have a coronary. During that time, they thought the tannins,or anti-oxidents, in the red wine was responsible for the cardio-protective effects and I went from being a teetotaler to a wine drinker. Over the years it was found that it’s the alcohol itself that improved lipid profiles, and  because of this I added a greater variety of drinks to my dinner.

    I was having a conversation with someone about the health effects of alcohol and she said what about weight loss? I told them that moderate drinking was about health, not weight loss.  Still it made me wonder, so I did a pubmed search, and while I wasn’t able to find anything regarding short term weight loss, I did find a number of studies describing the prevention of weight gain over the years. So because of these findings, one might consider that ‘relative’ weight loss.

    What I thought was most interesting about the above study was they not only found alcohol helped lessen weight gain and lower the risk of obesity, but they also quantified it by amount and to a lesser extent type of alcohol. Looking at all the graphs and tables in the study it was a bit of a toss up as to what amount was better, 15-30 grams per day or >30 grams per day, but those amounts were considerably better than lesser amounts and none. If it were me, I would split the difference and aim right at 30 grams per day, as less is maybe not as good, as my recollection was that research found the health consequences (like cirrhosis) start to increase as drinking becomes more than moderate. Still the general recommendation has always been 1 drink per day for women and 2 per day for men as being most healthful, but I do see the amounts creeping higher in more recent papers. So, if the standard drink in the US is 14 grams of alcohol, and that’s a standard 12 oz beer, 5 oz of wine or a 1.5 oz shot, it looks like the sweet spot for women is closer to 2 drinks per day than just one. [8-21-15 edit, that for health 1 drink per day for women, and 1-2 for men still looks ideal]

    Also, the red wine seems slightly better per the human studies.  In this review, I saw it cited that rats gain less weight on red wine, however when I looked up the cited study, on the contrary to how it was cited the rats that drank regular ethanol gained slightly less weight than the ones that drank the red wine and the ethanol drinking rats had greater fat cell aromatase expression than the red wine rats, which was thought to be the primary mechanism of action, and kind of sinking the superiority of the red wine concept. It’s a good lesson to see that you can’t always trust what’s written in a review, and you can’t always trust abstracts either.

    It seems to me that red wine growers have a more powerful political lobby than white wine, beer, and spirits, and it’s my suspicion that as things might play out much the same regarding the effects of alcohol on fat cells. This paper tended to show red wine was maybe ever so slightly better, but not by much, and the differences weren’t significant. A lot of people ‘seem’ to think that red wine works better, even if it doesn’t. Whenever I talk about the health effects of moderate alcohol consumption, even with evidence now being pretty overwhelming, people still look at me funny. If I say “red wine” and they are all like, “of course red wine is good for you.”  I think the meme that red wine is healthy is well established, while alcohol being healthy isn’t yet, such that if there are any real differences in health or weight gain by type of alcohol, it might be that those drinking red wine are generally more health conscious, in comparison to beer or whisky drinkers. However, wine has less calories than most beers and mixed drinks, but straight shots still have less. I suspect you don’t have to drink, as per the French paradox, with your pinky sticking out. Still, ~30 grams of alcohol, or ~2 drinks per day looks best for the prevention of obesity, at least per this paper.

    As always, if you have any further questions or need for clarifications, please don’t hesitate to ask. Being aware that some of my blog ideas are contentious and occasionally a bit out of the field of my expertise, I encourage my readers to come forth with any questions/comments that are of interest or concern. Your comments are valued and welcomed.

    Chad Reilly is a licensed physical therapist, located in North Phoenix, practicing science based medicine with treatment protocols unique and effective enough to proudly serve patients from Phoenix, Scottsdale, Mesa, Chandler, Tempe, Peoria, and Glendale.