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Alcohol – A Healthy Choice? (How Much and Which Type)

Without a doubt, one of the most common questions I am asked is on whether or not alcohol consumption is a good idea. And what I have determined, after a fairly extensive review of scientific literature, is that the answer to this question is “it depends”, and you will see why.

Before we get to the relationship of alcohol to brain health, let’s first take a look at what the research tells us about the relationship between alcohol consumption and cardiovascular disease.

Alcohol and Heart Health

The dangers of heavy alcohol consumption from a health perspective have been studied and described for centuries. Heavy drinking, as it relates to heart health, is clearly associated with damage to the heart muscle, elevated blood pressure, stroke, and heart rhythm abnormalities. These health risks stand in contrast to the body of research that shows the potential health benefits of light to moderate alcohol consumption, such as a reduced risk of cardiovascular problems like coronary artery disease.

A recent review in the Journal of Internal Medicine entitled, Alcohol and Cardiovascular Disease: Where Do We Stand Today? explored the extensive literature on this subject and concluded the following:

Lighter drinking – associated with reduced risk for:

  • Coronary artery disease
  • Stroke caused by a reduction in blood supply
  • Heart failure

Heavier drinking associated with increased risk for:

  • High blood pressure
  • Coronary artery disease
  • Heart rhythm abnormalities
  • Brain bleeding type stroke

In this review, the author determined that light alcohol consumption was less than three drinks per day. That means three cocktails, glasses of wine, or glasses of beer. Heavy alcohol consumption would be more than 3 standard servings per day. In attempting to understand why low-levels of alcohol consumption might actually be heart protective, the authors described several mechanisms that may be in play.

  • Alcohol is known to raise HDL cholesterol, the “good cholesterol”.
  • Low levels of alcohol consumption help reduce the stickiness of platelets in the blood. This may well prove helpful with respect to stroke as well as coronary artery disease.
  • Low levels of alcohol consumption are associated with a reduction in risk for type II diabetes as well as the oxidation to LDL, or “bad cholesterol.”
  • And finally, the authors did report that low levels of alcohol consumption are associated with decreased psychosocial stress. And this turns out to be very important, as we now recognize that psychosocial stress is associated with a variety of health risks well beyond the heart.

So the conclusion of this comprehensive review is that low-level alcohol consumption might well be a good idea whereas higher level seems to be associated with an increased risk for some pretty worrisome problems. We see this frequently when looking at data related to the effect of our lifestyle choices on our health. For example, moderate exercise seems to be better than no exercise, light exercise, or extreme exercise. This is a characterization of the “sweet spot” as it relates to so many of our everyday lifestyle decisions. Put in a more scientific way, this is called a “U-shaped curve.” Let’s look at such a curve as it relates to coronary artery disease and alcohol consumption:

What we see in this graph is an actual reduction of risk for coronary artery disease as alcohol consumption increases, but only up to a certain point. Thereafter, higher levels of alcohol consumption are associated with an actual increase in risk, and this increase continues right along with increasing alcohol consumption. So again, we are able to identify the “sweet spot,” shown here with the blue arrow. At least in this study, it looks like around 24 g of alcohol per day would be ideal. This is the amount of alcohol in 24 oz of regular beer, 10 oz of wine, or 3.0 oz of distilled spirits.

Alcohol and Brain Health

As alcohol consumption relates to the brain, we are fortunate that there have been some recent and incredibly extensive reviews of this interesting topic. For example, a new study recently appeared in the Journal, Frontiers in Nutrition that provides a comprehensive review of the role of alcohol in brain health and disease risk and also tries to tease apart the actual type of alcohol that is consumed in terms of how it relates to these issues. This is a powerful publication that sighted 182 references.

The authors made it very clear that a similar U-shaped curve relates alcohol consumption to dementia risk, and specifically to the risk for Alzheimer’s disease as well. In fact, they revealed that “Moderate drinking of 3 to 4 glasses per day (or 250-500ml per day) of red wine was associated with a fourfold diminished risk of Alzheimer’s disease and incident dementia when compared to those who drink less, or did not drink at all.” That’s right, a fourfold diminished risk. I think it was very fair of them to continue by stating, “Despite an overall positive association of red wine consumption with better cognitive health, whether people should start drinking or increase wine consumption to avoid dementia is still debatable.”

Reduced inflammation & free radical damage

Overall, this extensive report made quite clear that there are some very positive benefits for the brain with low to moderate alcohol consumption, especially as it relates to red wine. The report goes on to provide a large number of possible mechanisms by which red wine benefits the brain, which includes over 500 different compounds that have been identified in wines. These compounds include a large number of polyphenols, which are biologically active phytonutrients that provide us important antioxidant protection and also nurture our gut microbes.

Polyphenols also work to reduce inflammation, a process that has been recognized as a pivotal player in brain degeneration.

In addition, polyphenols found in red wine have been recently identified as having iron-chelating activity, meaning they can help reduce the presence of iron that might otherwise increase free radical type damage. Free radicals are damaging molecules that can inflict injury to proteins, fats, and even our DNA.

Finally, the authors indicated that other polyphenols found in red wine might actually help reduce the formation of amyloid protein in the brain. This is the abnormal brain protein that has been associated with Alzheimer’s disease and is the subject of aggressive pharmaceutical research.

Is Alcohol a Healthy Choice?

So how does all of this interesting science inform us in terms of what we should do as it relates to drinking alcohol? I’d say that the evidence presented by these researchers is quite clear that there is a benefit to low to moderate alcohol consumption. We live in a world where we often consider that if something is good, then more of it is better, but that mentality flies in the face of what is actually revealed by the scientific data. The U-shaped curve graphs clearly show us that, at least as it relates to alcohol, there truly is a sweet spot in terms of your heart, brain, and overall health.

So if you want to enjoy alcohol healthily, my recommendations are as follows:

  • Consuming a maximum of two or three glasses of wine per day (preferably red) seems to be associated with health benefits not only for the heart but for the brain as well. Choosing a low-alcohol wine (12.5% or less) can reduce the potential downsides of alcohol consumption.
  • Wine should be organic and biodynamically farmed. These wines will be free of pesticides, herbicides, and other chemicals that pose a risk to our health.
  • Choose a wine that is free of additives. Did you know the FDA allows 76 different additives to be added to wines without being labeled?
  • As with any food in your diet (and you knew this was coming), you should absolutely check the sugar content of the wines you consume. There are wines available now that are specifically tested for fructose and glucose (sugars). Look for wines that have less than 1g of sugar per liter.

“I cook with wine, sometimes I even add it to the food.”

– W.C. Fields


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  • John Perry

    Now that is truly amazing

  • Ruby Whitman

    What category does cider fall in to (5.00% volume)?

  • Pam Flores

    You are leaving out apoe4 carriers, for whom (studies indicate) alcohol increases neurotoxicity and is a very bad idea as it relates to the brain. Can you comment on this?

    • JohnWhitling

      https://www.ncbi.nlm.nih.gov/m/pubmed/29174637/

      This and similar technical studies listed on the right show you to be absolutely correct.

      In fact you can get polyphenols from all kinds of fruits and vegetables. Just eat some grapes or blueberries, etc. They are not some magic potion only found in alcoholic beverages. Also older studies on alcohol consumption use former alcoholics as their “non drinkers” category, so they are highly tainted IMO. Alcohol is a sugar which can cross the BBB. Other additives which may be beneficial does not magically make alcohol healthy. What a demeaning argument Dr Perlmutter makes here, and providing a link to a winery just makes it all the more suspect.

      • DubMasterAZ

        Exactly! I had posted a comment expressing similar concerns, but apparently the good doctor didn’t care for my comment which requested a response. Actually he did respond–by deleting my comment! Dr. Perlmutter is a neurologist and his article focuses on alcohol’s effects on heart and brain health. My deleted comment asked about effects on other organs such as the stomach, liver and kidneys which the article apparently did not take into account and also pointed out recent studies suggesting that the “safe” amount of alcohol consumption should be no more than 9 regular drinks per week for men and less for women. Therefore, at best, the article’s conclusions and recommendations are suspect and should really have come with some type of disclaimer.

        • JohnWhitling

          I am surprised that your comment was removed. You bring up good points about alcohol and organ damage, most obvious being liver disease. It’s disgusting how easily truth can be glossed over in media today. Is there more deception in play today than before the Internet? I think so ..

  • Ron

    Great article. We need to see total mortality, too.

  • Martine Victor

    FYI – a recent article in Mother Jones, “Did Drinking Give Me Breast Cancer?” outlines scientific evidence that links even moderate drinking to a 15% increase in breast cancer and elevates the risk in developing other types of cancer as well. I know the emphasis of your newsletters concerns brain health, but as you mention other well-known risks associated with alcohol consumption, it’s worth noting this one, especially for women. This scientifically established but little known aspect of alcohol consumption has been swept under the carpet by industry. Did Drinking Give Me Breast Cancer? – Mother Jones

    https://www.motherjones.com/politics/2018/04/did-drinking-give-me-breast-cancer/

  • Constantin Dinu

    A good article, I mean a scientific one, should separate the effect of alcohol from the fact of the other substances that are in wine as well as in grape juice. if you will research the literature, you will find out that some of the substances, such as reserveratrol, are in higher quantities in grape juice. Laboratory research, such as that presented at the WINEHEALTH The 2007 conference in Bordeaux, France, showed that Concord grape juice stimulated an arterial relaxation effect in a similar fashion to red wine. The French researchers also reported that the Concord grape juice induced a prolonged relaxation effect that has not yet been reported with red wine. On top of that, grape juice will lower the blood pressure and will not raise the tryglicerides as the alcohol in does!

  • JohnWhitling

    Ever wonder why we have such contradictory studies and such on alcohol? Perhaps this very current tail from Medscape will shed some light. Then you can make up your own mind about the “health effects” of alcohol.

    https://www.medscape.com/viewarticle/897352?src=wnl_edit_tpal&uac=179905PG&impID=1645621&faf=1

  • Alan

    USER BEWARE

    One important thing you left out, is that alcohol consumption has been linked to higher risk of several types of cancer including mouth, pharangeal, espophageal, breast, liver and bowel cancers.

    A 2010 study found that even one drink per day can increase a person’s risk of mouth or throat cancer by 20% https://www.ncbi.nlm.nih.gov/pubmed/20444641

    A 2011 meta-analysis from the Annals of Oncology looked at 61 studies and found that drinking >1 alcoholic beverage per day puts one at a significant risk. Conclusion from the authors: “This meta-analysis provides strong evidence for an association between
    alcohol drinking of >1 drink/day and colorectal cancer risk.” https://www.ncbi.nlm.nih.gov/pubmed/21307158

    In our bodies, alcohol (ethanol) is converted into a toxic chemical called acetaldehyde.

    It can cause cancer by damaging DNA and stopping our cells from repairing this damage. The International Agency for Research on Cancer have classified acetaldehyde formed
    as a result of drinking alcohol as being a cause of cancer, along with alcohol itself.
    Alcohol can cause highly reactive molecules, called Reactive Oxygen Species (ROS), to be produced in our cells. These molecules can damage the DNA, which could cause cancer to
    develop.

    Acetaldehyde also causes liver cells to grow faster than normal. These regenerating cells are
    more likely to pick up changes in their genes that could lead to cancer.

    Ethanol is broken down mainly by the liver, but lots of other cell types can do this as well.
    Some of the bacteria that live in our mouths and the linings of our guts are also able to convert ethanol into acetaldehyde.

    Alcohol can increase the levels of some hormones, such as estrogen. Hormones act as messengers in the body, giving our cells instructions such as when to divide. Unusually
    high levels of estrogen increase the risk of breast cancer.

    According to the UK Chief Medical Officer’s review of the evidence concluded that
    potential benefits only apply to women aged 55 and over who drink very little
    (about 5 units per week, which translates into just over 3 drinks per week). The new government guidelines clearly state that drinking for health reasons is not recommended.
    http://www.cancerresearchuk.org/about-cancer/causes-of-cancer/alcohol-and-cancer/alcohol-facts-and-evidence#alcohol_facts4

  • Steve Zamir

    The article did not mention about the interaction of alcohol with prescription drugs. i believe alcohol will put extra burden on a person’s liver who is on prescription medicine. And of course the more meds the worse the effect of alcohol on the liver.

  • Andy Roberts

    From my own personal experience as a former 1 beer a day and 2 or 3 glasses of wine per week, I am skeptical about the benefits. For almost a year, I have cut down dramatically and have much more energy and clarity of thought. Now I have an occasional beer or glass of wine. I think the social aspect is extremely important and may help reduce stress. Hard to say, but I am not convinced about health benefits.

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