The Perils of Moderate Drinking – Especially for Women

Congratulations, you survived “Dry January” and kicked the bottle entirely, proving to yourself that you weren’t beholden to your drinking habit – well, at least for a month anyway. But my worry is, for far too many people, “Dry January” is just a lead-in to “Wet February” and “Soaked March,” in other words, an invitation to release the cocktail Kraken.

Don’t get me wrong. Giving up alcohol even for a month is a lot better than surfing thru January on a nightly wave of red wine. The best-case scenario is that temporary abstinence creates a mental space for drinkers to re-examine their habit which, especially during the pandemic, may have ratcheted up to obviously problematic levels.

Though it hardly needs to be said, if your alcohol use has gotten to the point where it’s interfering with everyday life, at home or at work, that’s a problem that requires seeking out the help of a health-care professional or an addiction recovery group. Right now.

So, what if your drinking doesn’t quite fall into what most would consider a problem, but more of a relaxing, end-of-day ritual? Here too, I urge you – and particularly women – to take a hard, clear-eyed look at how alcohol bashes the health of your body – even if you are doing everything else ‘right’ – and start taking steps to end this very unhealthy relationship. To get started, here’s some food for thought:

The upside of downsizing your drink.

Whether you jumped on the dry January bandwagon or not, regular drinkers, whenever they decide to take a break, will likely discover that, off the sauce, a lot of things change relatively quickly. They feel more energetic – alcohol suppresses the central nervous system and its diuretic effect leads to dehydration and the dreaded hangover. They have an easier time maintaining a healthy weight – alcohol contains a whopping 7 calories a gram, not including the added sugar in cocktails. And losing all or part of the next day after drinking to feeling out-of-sorts is hardly conducive to making healthy diet and exercise choices. Not to mention, alcohol disrupts the gut microbiome so saying goodbye to it, even temporarily, can also mean tamping down the all-too-common IBS-type symptoms that drinking alcohol can bring.

But Doc, I drink responsibly!

First up, what’s considered moderate or ‘responsible’ alcohol intake can vary wildly from one person to the next, but there’s also an important facet of the alcohol story that I, and a lot of other doctors who follow the most recent research, are becoming increasingly tuned into – the health risks attached to “responsible” drinking. I’m talking about my patients and readers who aren’t aware that they have any significant symptoms tied to their alcohol consumption. They may even be staying within the government health recommendations, not exceeding one alcoholic drink per day for women, two drinks a day for men. So what constitutes a drink? Probably less than you think. A “drink” is considered to be: a 12-oz. beer or a 5 oz. glass of wine or 1 ½ oz. of hard liquor.

In other words, it doesn’t take much alcohol to cause trouble, and the evidence is building up that while you may feel fine today, you could pay a serious health cost tomorrow. Moderate drinking is a good thing only when compared with heavy drinking. It doesn’t do nearly so well when it goes head-head against not drinking at all, or the occasional glass of wine at dinner or a special event.

The old conventional wisdom missed the mark – and misguided millions.    

The reason that the whole idea of ‘moderate’ drinking got the stamp of approval from the medical establishment goes back to older research that suggested that moderate drinkers had a lower incidence of heart disease than abstainers. Doctors came up with reasons to explain drinking’s supposedly heart-healthy effect, among them the idea that it raised HDL (“good”) cholesterol levels and, in the case of red wine, gave you a dose of the antioxidant compound resveratrol. Now, it looks like that research got the cause and effect wrong. The moderate drinkers were likely healthier because they were more apt to be doing truly heart-healthy things, like exercising and having an active social life, which certainly don’t require drinking.

‘Moderation’ still means heart damage.

The emerging research picture is that seemingly modest alcohol consumption can take a toll inside the body that adds up year after year, invisibly increasing the risk of life-threatening diseases. Yes, the more you drink, the more damage you’re doing to yourself. But a Harvard study last year looked at data from over 370,000 people and concluded that “alcoholic consumption of all amounts was associated with increased cardiovascular risk.” We’re talking a higher risk for a range of heart issues: heart attack, stroke, high blood pressure and the common heart rhythm irregularity, atrial fibrillation or “a fib.”

Trouble is, alcohol promotes systemic inflammation – at the cellular level, we call it “oxidative stress” – which can, over time, injure the lining of the blood vessels, leading to higher blood pressure and, ultimately, heart disease. For my patients who already have a cardiac risk factor, like hypertension, I recommend not going beyond the occasional drink, at most.

The cancer connection cannot be overlooked.

While the general public may only just be waking up to the connection, doctors are well-aware that “problem” drinking can increase the risk of a number of cancers: head and neck; esophageal; liver; breast; and colorectal. But an Italian metanalysis crunched the numbers from a number of cancer studies, and found that the risk for liver cancer began to go up when alcohol consumption hit the three drinks-a-day level, not most people’s idea of self-destructive, out-of-control drinking. So, if, for example splitting a bottle with your partner over dinner a few nights a week is your norm, you’re both likely playing with fire in the long-term, and putting your ‘healthspan’ in harm’s way.

The liver is detoxification central, so stop beating it up.  

The liver is the primary organ responsible for detoxifying what comes into the body. When it’s faced with the nasty job of metabolizing alcohol, it creates a breakdown product called acetaldehyde which is toxic to your DNA and even prevents your body from repairing the damage. That’s why symptoms of alcohol abuse can show up most anywhere in the body – nearly all our cells contain DNA -- and it’s also why the liver is the organ that typically absorbs the biggest blow when you drink.

The knock-out punch is alcoholic liver disease, progressing from “fatty liver” to life-threatening cirrhosis, an irreversible scarring of the liver. One recent review of the medical literature found that as little as two drinks a day over a period of five years could negatively impact the liver. At the other end of the booze spectrum, 90% of people who had over four drinks a day show signs of fatty liver. Pretty bad odds.

Women’s bodies handle booze differently than men’s.

Ever wonder why the “recommended” maximum alcoholic intake for women is half what it is for men, clocking in at just one drink a day? It’s not just that, on average, men weigh more. Women’s bodies contain, again on average, more fat and less water than men’s. Less water means the female body is less good at diluting the alcohol in the system and more fat means the body holds on to it longer, exposing the internal organs to higher doses of the toxic stuff. To top it off, women have less of a specific enzyme that breaks down the alcohol before it hits the bloodstream. All good physiological reasons for women to be extra cautious when it comes to booze. Think of it this way: a woman’s single drink does the damage of a man’s two —and that’s very sobering thought.

The pandemic hangover has taken a toll on women’s health.

Women, as most would agree, took a massive psychological hit during the worst of the pandemic. Many of my patients faced the almost impossible job of juggling their kids’ “virtual” schooling from home, often while juggling their own careers in a suddenly Zoom-packed world. The national drinking stats reflected the pressure-cooker atmosphere of that period. One study found that that during the pandemic period, women’s binge drinking went through the roof, an increase of over 40% in the number of days the women in the survey consumed four or more drinks over a couple of hours.

All that uptick in women’s drinking habits is a disturbing trend, especially considering the physiological vulnerability we just discussed. Not only does drinking do its damage cumulatively, over time, but also from single bouts of over-indulgence, when blitz your liver in a toxic bath of way too much alcohol. So, if you drink little or nothing during the working week and throw back five or seven drinks socializing over the weekend, you are not meaningfully staying within those government recommendations – your just fooling yourself.

Start downshifting your drink -- and think ‘mindful drinking’.

I personally don’t drink alcohol and if I had my way, my patients wouldn’t either. But I know that’s not realistic for everybody. What I do advocate is replacing “moderate drinking” – being plugged into a one or two drink-a-night habit for no particular reason– with “mindful drinking.” What I mean by that is, if you’re going to have a drink, do it to enhance a meal or to lend a celebratory flavor to a social get-together. You’ll find you’ll drink less and enjoy it more. How else to downshift your drink? Here are a few techniques to try:

  • Go out with friends frequently? Skip the ‘pre-gaming’ as in don’t drink before you arrive at a party or social event. Once you’re at the event, order non-alcoholic mocktails throughout the night, or, at minimum alternate, with 2 mocktails for every 1 cocktail.
  • Everyone doing shots at the bar? Just say no thanks, or excuse yourself for a few minutes to extract yourself from the alcohol-focused activity. In a pinch, or if others are pressuring you to drink, you can also say you’re on a ketogenic diet so you’re avoiding alcohol ‘for now.’
  • More of a wine with dinner drinker? If it’s the taste of wine that you enjoy with a good meal, then check out the non-alcoholic wine aisle of your favorite brick and mortar store or online shop. Never has it been easier to find truly delicious, alcohol-free versions that taste just as good as the alcoholic ones.
  • Hard liquor doesn’t need to be hard. If you’re a longtime fan of cocktails made with bourbon, tequila or bitters, within the past few years excellent alcohol-free spirits alternatives – some made with adaptogens, prebiotics and even CBD –  have hit the market which do the taste trick without messing up your organs, your head or your microbiome – that sounds like a win to us!
  • Keep yourself honest. Get real about how much you drink and track it. Write it down, get an app to help you track it, or send yourself voice notes, whatever works for you – but be truthful about how much you’re drinking. From there, start setting small goals for yourself, as in limiting your intake each week, and lower your limit over time until you get to zero.
  • Be kind to yourself and your organs. Start offloading the contents of your liquor cabinet either all at once or over time. No matter how you do it, the bottom line is that you don’t need to keep it in the house anymore.

Longevity Reading