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Does alcohol harm your health? Does it offer any benefits? Could it compromise your immune system? Cause muscle loss? Contribute to the “Quarantine 15”?

You do not need to drink. You can drink and still be healthy. But if you drink too much or too often, you dramatically increase your risk of certain disease.

About two billion people drink alcohol on a daily basis. In moderate amounts, it could be somewhat beneficial, for some people. Higher intakes can lead to short- and long-term problems. 

Here’s what you to know about the health risks and benefits of alcohol — and why if you’re going to drink, red wine might be your best option.

Alcohol Basics

In the United States, heavy alcohol consumption causes about 80,000 deaths per year. At the time of this writing, there are 76,000 recorded deaths from COVID-19 in the United States (assuming all of the stated causes of death from COVID-19 are legit, which is questionable based on the news at the time of this writing). That’s almost the same number, and it happens every year!

Each year 2.5 million people die from alcohol abuse and its related morbidities worldwide, making alcohol-related deaths among the highest preventable causes of death, and the greatest cause of premature death and disability in men between ages 15 and 59.

World Health Organization

Before getting to the health risks and benefits of drinking, I want to first address some common questions, and level-set the meaning of phrases like “moderate alcohol consumption” or “what is a serving of alcohol.”

How much alcohol do people drink?

The United States ranks No. 48 on the list of countries with the highest per capita alcohol consumption. The average American drinks 9.2 liters of alcohol per year. That’s pure alcohol, not alcoholic beverages.

Based on Centers for Disease Control and Prevention (CDC) data, about 46 percent of women and 58 percent of men reported drinking alcohol in the previous 30 days; 12 percent of women reported binge drinking three times per month, while 23 percent of men said they do it five times per month.

Beer is the common type of alcohol people drink, making up 50 percent of our consumption; wine consists of 17 percent and spirits or hard liquor making up the remaining 33 percent.

How much alcohol is OK to drink?

A serving of alcohol is:

  • A 12-ounce bottle of beer
  • A 4-ounce glass of wine
  • 1.5-ounce of spirits

Researchers typically categorize people into four groups: abstainers, moderate drinkers, heavy drinkers, or binge drinkers.

Category Drinks Allowed
Moderate Drinker Women: Up to 1 drink per day
Men: Up to 2 drinks per day
Heavy Drinker Women: 8 or more drinks per week
Men: 15 or more drinks per week
Binge Drinker Women: 4 or more drinks in an single occasion
Men: 5 or more drinks in a single occasion

Of course, certain alcoholic beverages vary in their alcohol content.

Why do women have a lower alcohol tolerance than men?

For the same alcoholic beverage, men can typically drink more than women before experiencing the same effects. There are three reasons for this difference in alcohol tolerance:

  1. Women have lower levels of alcohol dehydrogenase (AHD). AHD is an enzyme in our liver and stomach that breaks down alcohol. With less of the enzyme available, women end up with greater amounts of alcohol in the blood when consuming an equal amount as men. The difference in AHD levels is the most significant cause of the variance in alcohol tolerance.
  2. Men tend to have more body water. Body water helps disperse alcohol, diluting its effects.
  3. Men tend to weigh more. With greater body weight, there is more tissue to absorb the alcohol.

Health advocates sometimes suggest that alcohol affects women differently during their cycle. Though women tend to prefer alcohol in the luteal phase (just before getting their period), the research does not show that their tolerance changes during their cycle.

What makes red wine unique?

Of all the types of alcohol, red wine provides the most potential health benefits, though its debatable as to whether adding red wine to an already healthy diet would provide any additional benefit.

Red wine contains more than 500 compounds. Polyphenols are the most prominent outside of water and ethanol. About 5 to 10 percent of polyphenols are absorbed through the small intestine; the remaining reach the colon, where they can affect the bacteria there.

Polyphenols are divided into two groups:

  1. Flavonoids
  2. Nonflavonoids

Of all the polyphenols in red wine, the most compelling, health-enhancing compounds are quercetin (a flavonoid) and resveratrol (a nonflavonoid).

The health benefits of quercetin include:

  • Reductions in allergies and asthma
  • Antioxidant support
  • Reduced inflammation
  • Healthier blood pressure
  • Cognitive-health support
  • Enhanced immune function, including reduced symptoms of viral infections

The health benefits of resveratrol include:

  • Improved blood pressure
  • Slowed progression of atherosclerosis
  • Reduction in risk of stroke, heart attacks, and heart failure

People who drink moderate amounts of red wine have a 20 to 30 percent reduction in all-cause mortality risk.

Health Benefits and Risks

Though there appear to be a number of health benefits associated with low-to-moderate alcohol consumption, it’s important to remember that individuals metabolize alcohol differently. Also, don’t forget that alcohol is a toxin.

If you have pre-existing conditions, or take medications, check with your healthcare provider before drinking. Alcohol can also be bad news when consumed while taking some over-the-counter medications.

In the following sections, we’ve outlined the pros and cons of alcohol as it relates to various functions and systems in the body.

Hormones

Summary: A moderate intake consumed once in a while could have a slightly positive effect on testosterone, but not other hormones. Regular drinking or heavy drinking negatively affects testosterone, estradiol, growth hormone, and cortisol levels.

A single occasion of moderate alcohol consumption raises testosterone in both men and women. The effect is even greater for women who take oral contraceptives.

Interestingly, those beer commercials that show fit and healthy people working out and then drinking afterward send the wrong message: Intense exercise followed by heavy drinking suppresses testosterone.

Chronic or heavy drinking not only lowers testosterone, but can also raise cortisol (more on that below).

One study showed a higher intake of alcohol lowered testosterone levels by 23 percent in the 10 to 16 hours after drinking. Another showed a decrease of 27 percent at 12 hours afterward.

Research on estrogen is mixed. Some shows that estrogen levels can fall with alcohol consumption, and others show it doesn’t change. However, estradiol (an estrogen hormone) can increase by as much as 300 percent.

Growth hormone decreases as blood-alcohol levels increase. Growth hormone is important for physical recovery, fat metabolism, cortisol regulation, and the development and maintenance of lean body mass.

Cortisol levels also increase with higher intakes, or chronic drinking. Cortisol simulates muscle breakdown, as well as development of belly fat. Alcohol really can cause a beer belly.

At an extreme, heavy drinking — and the sustained high levels of cortisol — can cause Cushing Syndrome.

Body Composition

Summary: Alcohol could easily lead to body-fat gain and muscle loss by influencing food choices, reducing protein synthesis, and increasing protein breakdown and cortisol secretion.

Drinking decreases inhibitions, stimulates ghrelin, and suppresses leptin.

Ghrelin is the hormone that makes you feel hungry, while leptin causes satiation. Combine an increased appetite with the quieting of the voice that encourages you to avoid unhealthy food, and what happens? Drinking can to eating junk food.

Just like that, the positive results you get from eating well Monday through Friday can get wiped out by the poor choices made over the weekend.

Not only does drinking change your eating patterns, it also affects muscle growth and loss.

Intoxication decreases protein synthesis by 15 to 20 percent.

When combined with a meal, drinking can lower the protein-synthesis effects (the process in which cells make protein) of the food by 30 percent.

In animal research, ethanol consumption increases myostatin, which suppresses muscle growth.

Heart Health

Summary: Moderate drinking can provide some heart-health benefits. These are the most compelling from red wine, though pure ethanol can also offer some benefit. However, in chronic or heavy doses, those benefits would be wiped out by other health problems.

Based on population-based research, those who drink moderate amounts of alcohol are less likely to develop or die from cardiovascular disease.

Those who drink low to moderate amounts of alcohol appear to have a 20 to 40 percent lower chance of developing CVD.

Alcohol can improve blood-cholesterol levels. It may also be beneficial for those with high blood pressure, as it is a vasodilator. This means it increases the size of blood vessels, which can lower blood pressure in the short term.

Over the long term, however, the consumption of alcohol seems to increase blood pressure. If additional research proves that out, it would mean regular alcohol consumption could increase one of the most significant risk factors for cardiovascular problems.

Stress raises the risk of cardiovascular disease. For some people, an evening drink helps them relax. It’s possible that moderate drinking lowers stress enough to have a positive effect on heart health.

How Alcohol Impacts Heart Health

Benefit for Heart Health Effects on Heart Health
Improved lipid profiles Increases HDL cholesterol
Reduces LDL cholesterol
Reduced inflammation Reduced leukocyte interaction with adhesion molecules
Reduces C-reactive protein
Improved regulation of blood vessel tone Increases nitric oxide (NO) release
Decreased blood coagulation Decreases platelet aggregation
Increases fibrinolysis
Improved insulin sensitivity Increases insulin-mediated glucose uptake

Inflammation

Summary: At moderate levels, ethanol lowers inflammation, which could positively affect cardiovascular health and immune function, and reduce the risk of certain degenerative diseases.

Moderate drinking can lower inflammation levels. Red wine lowers inflammation more than gin, which suggests the compounds in red wine have an additive effect on inflammation compared to ethanol alone.

Healthy adults who regularly consume a low to moderate amount of beer or red wine could be less prone to infections, and an anti-inflammatory effect could be one explanatory factor of the protective effects of moderate consumption on CVD.

Romeo J, et al.

Blood Sugar and Diabetes

Summary: Epidemiological research shows low to moderate drinkers have lower risks of type 2 diabetes, but those with blood-sugar problems or diabetes should exercise caution when choosing to drink.

Based on population-based research, such as the Nurses’ Health Study, low-to-moderate drinkers have a lower risk of developing type 2 diabetes. However, that doesn’t make drinking a good idea for managing blood sugar.

Alcohol disrupts the body’s ability to maintain ideal blood-glucose levels. In the short term, drinking can cause hypoglycemia or low blood sugar.

Consuming high doses of alcohol also shuts down the muscles’ ability to store glycogen (or carbohydrates) as efficiently as they should.

When alcohol is consumed with a high-carbohydrate meal, insulin can be secreted at excessive levels, which can lead to very low blood sugar. The short-term fall in blood sugar could be detrimental for someone with pre-existing blood-sugar issues or diabetes.

Long-term or heavy consumption can have the opposite effect, raising blood-sugar levels.

Sleep Quality

Summary: For the most part, drinking negatively affects sleep quality. Though those who drink a low-to-moderate amount on a regular basis can regain some of their sleep quality, alcohol’s effect on sleep is a risk for the body and brain alike.

Though many people think drinking helps with sleep, research doesn’t support this.

Alcohol can help people fall asleep easier, but they don’t experience the health benefits of sleep that come from deep and REM sleep. When deep sleep is reduced, growth hormone doesn’t peak, which compromises physical recovery, fat metabolism, and tissue repair.

Reduced REM sleep affects learning, memory, and other cognitive functions. It’s little surprise that chronic alcohol consumption is associated with dementia and other neurodegenerative diseases.

If you drink a moderate amount on a regular basis, your body may adapt over time, and your sleep quality could return to normal. For those who drink only on occasion, sleep quality is usually compromised on the nights they drink.

Immune Function

Summary: Heavy drinking suppresses your immune system and can be especially detrimental for your respiratory system. On the other hand, moderate drinking seems to strengthen your immune system.

Research shows moderate drinkers are less likely than abstainers to experience symptoms of the common cold — or even get infected by the rhinovirus. Another study showed that wine consumption, specifically, reduced the occurrence of the common cold.

Though moderate intakes might be beneficial, that doesn’t mean “a drink a day keeps the doctor away.”

Ethanol:

  • Impair the ability of white blood cells to migrate to sites of injury and infection.
  • Induce abnormalities of T and B lymphocytes, which are natural killer cells and macrophages (large white blood cells that are an important part of our immune system).
  • Alter cytokine production, which is important for cell signaling.

Alcohol’s impact on T cells and B cells increases the risk of infections (e.g., pneumonia, HIV infection, hepatitis C virus infection, and tuberculosis), impairs responses to vaccinations against such infections, exacerbates cancer risk, and interferes with delayed-type hypersensitivity. In contrast to these deleterious effects of heavy alcohol exposure, moderate alcohol consumption may have beneficial effects on the adaptive immune system, including improved responses to vaccination and infection.

Pasala S, et al.

Alcohol intake weakens the mucosal lining of the lungs by suppressing immune function itself, as well as by depleting levels of glutathione (an antioxidant).

It also reduces zinc, a critical mineral for stopping the replication of viruses.

One of the benefits of quercetin is that it helps get zinc into the body’s cells, where it can do its job. Unfortunately, if you don’t consume enough zinc through diet or use a zinc supplement — or if you drink enough alcohol to lower the zinc you do have — your ability to combat viruses can be compromised.

Ethanol also impairs the function of fibroblasts, cells that aid in wound healing.

An animal study showed that four weeks of consistent alcohol consumption reduced immune cells on the skin by 30 to 50 percent.

With fewer immune cells available, it’s easier for pathogens to infect the skin without detection. It would be like cutting the number of soldiers in a battle in half even though all of the soldiers are needed to win the battle.

Fortunately, after 30 days of abstinence from alcohol, immune-cell function can return to normal.

Physical Performance

Summary: There is no benefit of alcohol in terms of physical or athletic performance.

Alcohol negatively affects performance in a number of ways.

First, it reduces calcium function in muscle contraction, which reduces strength (not that most people would drink just before a training session or event). It also lowers hydration levels and is a far greater diuretic than caffeine.

Each gram of alcohol consumed leads to production of 10 mL of urine. As mentioned above, it also causes vasodilation (the widening of blood vessels). This is seen as a potential benefit in terms of heart health, but it can also lead to an increase in fluid loss.

The effects of fluid loss are most obvious the morning after a night of drinking to excess.

As the body becomes more dehydrated, it changes the fluid levels in the skull. When the tissues inside the skull become dehydrated, they shrink in size. As they do, it adds tension to the skull itself, causing a headache.

Alcohol also disrupts the body’s ability to regulate core temperature. If it can’t maintain an optimal internal temperature, such cooling itself in heat or warming itself in cold, performance drops.

A major goal of post-exercise recovery is to increase protein synthesis. Simply put, increased protein synthesis means creation of new muscle. Alcohol reduces protein synthesis, and the more people drink, the less protein synthesis they’re able to achieve.

Cancer

Summary: Alcohol significantly increases the risk of multiple cancers, especially for the body parts connected to consuming, digesting and metabolizing alcohol. There’s also a strong correlation between drinking and breast cancer.

Any tissues that come in contact with alcohol seem to be at risk for the development of cancer, especially for regular or heavy drinkers.

Head and neck cancers increase by 1.8 to 2.6 times. Esophageal-cancer risk is 1.3 times higher for light drinkers and five times higher for heavy drinkers.

Alcohol is a toxin. As such, the liver carries the burden in metabolizing it. Compared to those who never drink alcohol, light drinkers are 1.45 times more likely to develop liver cancer. Moderate and heavy drinkers are 3.03 and 3.6 times more likely, respectively, to develop the condition.

Even light drinking significantly increases breast cancer risk in women. Though it could be related to carcinogens, there’s also strong evidence that alcohol affects sex hormones in women, which could cause breast cancer cell development.

Micronutrient Deficiencies

Summary: Chronic or heavy drinking contributes to micronutrient deficiencies, which can contribute to diseases like cancer, suppress immune function, or worsen other pre-existing conditions.

The metabolism of alcohol reduces levels of vitamin A. Heavy drinkers may develop severe deficiencies, which can lead to a number of problems, including a decreased ability to see in the dark.

It also lowers magnesium levels. Magnesium is essential for brain, muscle, liver and vascular function, as well as hundreds of other functions in the body.

Magnesium is already a common deficiency for the population as a whole, but in regular or binge drinkers, it can be even more severe.

Aside from these two micronutrients, vitamins C, D, E, and K, the B vitamins, and calcium, iron, and zinc can also decline in heavy drinkers and alcoholics.

Summary

When it comes down to it, comparing the minor benefits to the larger risks makes it hard to suggest alcohol as part of a healthy nutrition plan — even if that alcohol comes from red wine.

That said, if you do choose to imbibe on occasion, it probably won’t do much damage, provided you’re not taking medications that interact with alcohol and you don’t have a pre-existing condition.

You don’t need to drink to be healthy. If you need to drink to be happy, you may find alcohol is hampering both your physical and mental health.

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Tom Nikkola, CSCS, CISSN

Tom Nikkola is the vice president of nutrition and virtual training at Life Time. With two decades of education, experience, and experimentation, he has come to realize that health and fitness is way easier than most people believe it to be.

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