Women and alcohol: Weighing risks vs benefits

With each scientific report on the potential health benefits of drinking wine (or other alcohol), another comes along to warn of alcohol’s dangers. Recent studies find that substances in red wine help prevent heart attack and stroke. Researchers warn moderate alcohol use can increase the risk of breast cancer, then a new study says light to moderate drinking has little effect on risk. Studies caution that heavy drinking may lead to cognitive decline, but new data finds women who enjoy a daily glass of beer or wine have sharper minds as they age compared to abstainers. It’s hard to know what to believe.

Biology Influences Risk

Women face increased risks because they are generally smaller and weigh less than men, so the same amount of alcohol becomes more concentrated in a smaller body mass. Women also have a higher percentage of body fat and less body water than men. Since alcohol dissolves more easily in water than fat, this also leads to higher concentrations in a woman’s body.

But the important difference is the way women process alcohol. Studies show that women produce less of a stomach enzyme called alcohol dehydrogenase (ADH) that breaks down alcohol before it enters the blood stream. ADH is also 58 percent less active in women. The result: Women break down alcohol more slowly than men, so more of it gets into the bloodstream to damage the liver, brain, and other organs.

"Although women start drinking at a later age than men, they get more significant blood alcohol levels at a lower level, and the damage is more profound," says Robert Millman, MD, director of the alcohol and drug abuse service at the Weill Cornell Medical Center in New York. "Evidence is now accumulating that women develop problems such as fatty liver, hypertension, gastric bleeding and peptic ulcers, and cirrhosis at a faster rate than men at lower levels of consumption. Women also suffer greater declines in cardiac function and working memory."

Alcohol: Women vs Men

Research suggests that women are truly more vulnerable than men to the following alcohol-related health conditions:

• Liver damage. Researchers have found that compared with men, women develop alcohol-induced liver disease over a shorter period of time and after consuming less alcohol. Women metabolize alcohol more rapidly in the liver than do men, a factor that may play a part in their increased risk of liver damage. Findings also suggest that women are more likely than men to develop alcoholic hepatitis and to die of cirrhosis of the liver.

• Brain damage. Women may be more vulnerable than men to alcohol-induced brain damage. Using magnetic resonance imaging (MRI), researchers have found that a brain region involved in coordinating multiple brain functions is significantly smaller among alcoholic women than among both nonalcoholic women and alcoholic men. Chronic alcoholism damages parts of the brain used for learning and memory.

• Heart disease. Although there’s some consensus that men who consume up to two alcoholic drinks a day have a lower death rate from coronary artery disease than do heavier drinkers and abstainers, in women a similar benefit is seen with just one drink a day. Larger amounts aren’t clearly beneficial or safe for women. Among heavier drinkers, rates of alcohol-associated heart muscle disease (cardiomyopathy) are similar for women and men. But because women’s lifetime alcohol use is 60 percent lower than men’s, there’s concern that women are more susceptible to heart damage even though they drink less alcohol than men do.

• Breast cancer. More than two drinks a day increase the risk of breast cancer for women, especially for those taking hormone therapy. Alcohol seems to raise estrogen levels and estrogen is known to fuel the growth of breast cancer cells.

The percentage of chronic disease that can be directly attributed to alcohol is staggering. "Seventy-five percent of cases of esophageal cancer can be attributed to alcohol and half of all cases of pancreatitis, cirrhosis, and chronic hepatitis may be due to alcohol use," says Richard Saitz, MD, associate director of the Clinical Addiction Research and Education (CARE) Unit at Boston University Medical School. In fact, alcoholism is the third largest killer in the United States, ranking behind heart disease and cancer. However, if traffic fatalities and death-certificate diagnoses related to alcohol use were included in the statistics, alcoholism could be recognized as the No. 1 killer in the US.

Moderation Is Key

There’s a flip side to this story. Studies suggest that moderate consumption of alcohol may be beneficial to your health, particularly your heart. These findings make it even more confusing when making a decision about the use of alcohol. What’s key here is moderation. One drink a day may be OK, even healthy, for some women. For people aged 65 and older, the US National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines moderation as one drink a day or less for women and two for men. One drink is defined as 12 ounces of beer, 5 ounces of wine or 1.5 ounces of 80-proof distilled spirits (please refer to diagram).

The NIAAA recently issued a position paper on the risks and potential benefits of moderate alcohol consumption, based on a review of current scientific knowledge. The NIAAA’s conclusion: Except for women at particular risk (such as those at high risk of breast cancer), having one alcoholic drink per day is "unlikely to increase health risks."

The position paper stated that moderate use was associated with a 10-percent increase in the risk of breast cancer for women who had one drink per day, and a higher risk for those with a family history of the disease and those on hormone therapy. While alcohol can lead to weight gain, moderate consumption appears to be associated with a reduced risk of diabetes and metabolic syndrome (both of which often develop from obesity). The review also found that alcohol seems to help the body better utilize insulin. Although elderly drinkers reach higher blood alcohol concentrations at lower levels of consumption than younger drinkers, the NIAAA found no evidence that moderate alcohol consumption caused cognitive impairment.

"Drinking patterns are as important as total consumption, not only in terms of alcohol’s benefits but also its harmful consequences," the NIAAA paper said. "Risks for alcohol abuse and/or dependence jump dramatically … for women who exceed three drinks per occasion." The American Heart Association (AHA), in its official position, also states that moderate alcohol consumption may reduce the risk for heart disease, but heavy drinking is associated with many health problems, including high blood pressure, obesity, stroke, breast cancer, suicide, alcohol abuse, and accidents.

The Bottom Line

If you decide to drink, keep in mind that drinking alcohol on an empty stomach speeds its absorption. Don’t drive after drinking. To lessen your chances of risky drinking, consider the following:

• Do not drink alcohol every day. Avoid making a glass of wine or other alcohol drinks a nightly "ritual."

• If you drink socially, limit yourself to one or two drinks and alternate with nonalcoholic beverages.

• Never consume more than three alcoholic drinks on a single occasion.

• If you are worried about your alcohol consumption, or have tried to cut back and can’t seem to, seek counseling.

Some people shouldn’t drink any alcohol. This includes pregnant women and individuals with liver disease or other medical conditions affected by alcohol. In addition, people using certain medications, including many prescription as well as over-the-counter drugs, shouldn’t consume alcohol.

Drinking more alcohol than the recommended one drink a day raises your stakes, putting you at increased risk of adverse health consequences. If you do drink and you’re healthy, there’s no need to stop as long as you drink responsibly and in moderation. If you don’t drink alcohol already, starting now isn’t likely to result in health benefits.