What is your relationship with alcohol?
Let me ask another way… if I told you that, after today, you would never be able to drink alcohol again…how would you feel? Devastated? Anxious? Panicked? Indifferent? Relieved?
The holiday season is here …and many Americans plan to drink alcohol at some point—whether as a coping mechanism for dealing with difficult family members; as a way to deal with uncomfortable social situations or social anxiety; as a way to “relax” or “de-stress”; as a way to “party” and “have a good time”; or simply to indulge as a celebratory elixir.
Let me be clear: I am not judging you if you do drink alcohol.
Alcohol is deeply embedded in the social fabric of American culture. Marketing campaigns have (successfully) made drinking alcohol seem cool, fun and sexy. You don’t have to “go to a bar”” to drink. These days, access to alcohol is so easy—from gas stations and grocery stores, like Shoprite, to Target and on-site at the workplace. You don’t even have to leave your house… 7 Eleven, for example, delivers food and booze right to your doorstep via their app! Alcohol is also a big money-maker at restaurants; among full-service restaurants, alcohol-based drinks represent 21% of total sales as of 2023 (1).
My point is that alcohol is EVERYWHERE, and it has been glamorized and normalized in film, television, media, advertising and social media.
Before you start pouring, however….it is important to understand the health risks and consequences of alcohol consumption—no matter how casual or “light”.
Physical Safety
Sexual violence. Approximately 50% of sexual assaults involve alcohol consumption by the victim, the perpetrator, or both (2, 3). Over the years, in my practice, I have had a number of female clients share their stories of having been raped while intoxicated or passed out.
The infamous P. Diddy “parties” should give us pregnant pause. Diddy was known for spiking bottles of alcohol with illicit substances that left his victims too drugged to defend themselves or unable to remember what had happened to them. Many victims—women, men and minors (at the time of the event)—have come forward with allegations of gross sexual abuse, sexual assault, forced sex and sex trafficking.
Homicide. Alcohol is often a contributing factor in homicides. I recently worked with Clara (not her real name), a 42-year-old mom with two young children whose husband was an alcoholic. She was struggling to process how much her marriage had deteriorated because her husband’s drinking had escalated over the last 7 months. After drinking, her husband would become extremely paranoid and, sometimes, violent towards Clara. Even though Clara had a safety plan that she had worked out with her therapist, she was reluctant to leave. She kept hoping that her husband would miraculously stop drinking. She expressed this to me—even as she sat in her car to hold our session because her husband was sleeping off an alcoholic rampage in their house.
According to a study published in the Journal of Criminal Justice, researchers found that, among 1,887 offenders who had committed murder, 50% were under the influence of alcohol at the time they killed their victim (4).
Why your body identifies alcohol as a toxin
Ethanol (the chemical name for alcohol) and water are the main components in beer, wine and spirits. One exception is very sweet liqueur, like amaretto or limoncello, where the sugar content can be higher than the ethanol content (5).
Ethanol is both water-soluble and fat-soluble, enabling it to pass into all cells and tissues of your body.
Alcohol can damage virtually every organ in your body—not just the liver—although the liver is a major target for alcohol-induced organ damage (6, 7).
Here’s how alcohol metabolism works: You drink alcohol. It travels to your gastrointestinal tract; is absorbed into your bloodstream; then travels to your liver. Most of the ethanol is broken down in the liver by an enzyme that transforms ethanol into a toxic compound called acetaldehyde, a known human carcinogen (cancer-causing), according to the World Health Organization. Another enzyme breaks down acetaldehyde to a less toxic compound called acetate, which is further broken down to carbon dioxide and water, mostly in tissues other than the liver (8).
Acetaldehyde is a toxic byproduct that results during the breakdown process of alcohol in the body. An increased level of acetaldehyde is implicated in the development of many diseases, including Alzheimer’s Disease and stroke, as well as the impairment of brain structure and function (9).
Although acetaldehyde is short-lived—meaning that it usually exists in the body only for a short time before it is further broken down into less toxic acetate—it can potentially cause significant damage to the liver. Some alcohol is also metabolized in the pancreas, brain and gastrointestinal tract, areas where acetaldehyde can also cause damage to cells and tissues (10).
So…how much alcohol can we “safely” consume?
In 2023, World Health Organization published this statement:
“When it comes to alcohol consumption, there is no safe amount that does not affect health (11).”
This means: drinking alcohol in any amount carries a health risk. And that risk goes up with every additional drink you take. For example, any amount of alcohol consumed increases risk of breast cancer and colorectal cancer (12).
The CDC defines “moderate drinking” as (13):
Women: 1 standard drink or less / per day
Men: 2 standard drinks or less / per day
One “standard” drink is (14):
–12 oz. of beer with 5% alcohol
–8 oz. of malt liquor with 7% alcohol
–5 oz. of wine with 12% alcohol
–A shot or 1.5 ounces of liquor (e.g., brandy, gin, vodka, rum, tequila) or distilled spirits (80-proof liquor = 40% alcohol)
Despite these guidelines, keep in mind that “moderate” for one person can be excessive for another.
No two people metabolize alcohol the same way. How alcohol affects you depends on multiple factors, including: gender (e.g., women feel the effects of alcohol more quickly and acutely than men); overall health; weight; family history of alcoholism; age; hormone status (e.g., whether women are premenopausal, perimenopausal or menopausal); stress level; genetics; ethnicity; medications taken; whether you drink alcohol with food or an empty stomach; and, of course, your personal tolerance level for alcohol.
If you choose to drink, it is important to understand the following…
Health Consequences of Alcohol Consumption
1. You ingest pesticides.
It is highly likely that bottle of conventional wine you’re drinking contains multiple pesticides.
Viticulture is challenging because wine grapes are susceptible to plant disease, fungal pests and insects. As a result, conventionally grown wine grapes are heavily sprayed with pesticides multiple times during vine developmental stages and grape production, as well as in winemaking (15). The most common pesticides detected in finished wines are mainly fungicides, such as fluopyram, boscalid, and cyprodinil, among others (16).
A 2018 European Union Report showed that pesticide residues could be found in more than 86% of grapes. In fact, multiple pesticides were reported in over 68% of some 2,181 tested grape samples (17).
According to the 2022 California Department of Pesticide Regulation report, the top 5 active ingredients applied to wine grapes (by pounds) include (18):
1) Sulfur fungicides / insecticides. Sulfur fungicides are associated with increased risk of esophageal cancer (19).
2) Oil.
3) 1,3-Dichloropropene. A fumigant, which produces gas or vapor to destroy pests, 1,3-Dichloropropene is likely a human carcinogen, or cancer-causing (20).
4) Glyphosate, a.k.a. Roundup. See more on glyphosate below.
5) Glufosinate-Ammonium. An herbicide and suspected endocrine (hormone) disruptor linked with reproductive toxicity; for example, adversely affecting male sperm quality (21).
In beer-making, barley, hop, water, and yeasts are the main ingredients. Barley and hop are highly susceptible to bacteria fungus, viruses and pests. As a result, they are heavily sprayed with pesticides; in particular, insecticides and fungicides, at various stages of growing and during post-harvest storage (22).
Roundup is the most commonly used agrichemical (herbicide) in the world. Glyphosate is the main active ingredient in Roundup. Today, it is virtually impossible to escape glyphosate contamination in food and drink, including beer and wine—even for organic producers. Glyphosate has been linked to cancer, especially non-Hodgkin lymphoma (23). Glyphosate acts like an endocrine (hormone) disruptor; for example, a study published in Food Chemical Toxicology found that glyphosate stimulated estrogenic activity linked with the growth of breast cancer cells (24).
2. You increase your risk for 6 types of cancer.
Here is an uncomfortable fact…excess alcohol consumption is linked with over 200 diseases and increases the risk for 6 different types of cancers (25): According to a recent survey, 51 percent of Americans are unaware that alcohol consumption increases the risk of certain types of cancer, including (26).
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- Certain types of head and neck cancers
- Esophageal cancer
- Stomach cancer
- Breast cancer
- Colorectal cancer
- Liver cancer
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3. You are unable to properly absorb nutrients.
Alcohol falls into the category of “empty calories”, meaning it has zero nutritional value. Not only that, chronic or heavy alcohol consumption can result in overall malnutrition by reducing the body’s ability to absorb nutrients or by increasing loss of nutrients (27).
For example, alcohol inhibits the absorption of vitamins, like thiamin (vitamin B1), vitamin B12, folic acid and vitamin A. Simultaneously, alcohol is a diuretic that increases urine output, which causes the loss of water-soluble minerals such as zinc, potassium and magnesium (28).
4. You are susceptible to having a leaky gut.
Chronic alcohol consumption can result in a disruption to your gut microbiome, also known as dysbiosis. This imbalance of microbiota results in more harmful “bad” gut bacteria outnumbering beneficial “good” gut bacteria and / or yeast overgrowth in the gut (29, 30).
When our gut barrier has tight junctions, this prevents toxins from entering our bloodstream.
However, regular alcohol consumption can create intestinal permeability, making it “leaky”. Over time, this can result in endotoxemia, which occurs when toxic byproducts from harmful gut bacteria escape through a leaky gut wall into the bloodstream, creating systemic inflammation, liver injury, other organ injuries (e.g., in the pancreas or kidneys), or worsened gastrointestinal symptoms, such as abdominal pain, bloating, nausea, diarrhea (31).
5. You can hurt your liver.
The liver is one of the hardest-working, multi-tasking organs in the body.
Among its many roles, the liver produces and secretes bile, a fluid that helps digest fats; metabolizes carbohydrates, fats and proteins; and produces substances that are essential for blood clotting (32).
The liver also filters and removes toxic substances—like alcohol—from the blood. However, the process of metabolizing alcohol creates acetaldehyde, a toxic byproduct, that damages liver cells.
Over time, liver function can become impaired and lead to alcohol-induced liver diseases, including (33):
–Alcohol-related fatty liver disease. When the liver metabolizes alcohol, it can lead to the build-up of fats in the liver, creating an enlarged liver that impairs proper liver function. About 90% of people who regularly consume excessive amounts of alcohol have fatty liver disease; it can even occur after drinking too much alcohol for as little as 2 weeks.
–Alcohol-related hepatitis. This stage is characterized by swelling and inflammation of the liver. Liver damage in the early stages of hepatitis can usually be reversed by abstaining from alcohol. However severe hepatitis can result in a rapid decline—even death.
–Alcohol-related cirrhosis. Cirrhosis occurs when the liver has become permanently damaged from alcohol, and scar tissue replaces healthy tissue. The liver is unable to function if scar tissue builds up beyond a certain point, and this type of damage cannot be reversed.
6. You can injure your lungs.
When it comes to chronic alcohol consumption, your lungs are especially susceptible to bacterial infections and acute lung injury (34). How? Alcohol can disrupt your upper and lower airways, impairing optimal immune response. Your lungs are less able to clear out inhaled pathogens, mucus and debris. Alcohol can also compromise the alveolar epithelial barrier, a thin layer of cells that lines the alveoli, tiny air sacs in the lungs, where gas exchange occurs. Glutathione is a master antioxidant that plays a vital role in protecting cells from oxidative stress and damage. Chronic alcohol consumption can deplete glutathione up to 80 to 90 percent in the alveolar epithelial lining fluid of the lungs, creating alcohol-induced oxidative stress, which can contribute to lung disease and/or infections, like pneumonia (35).
Chronic alcohol consumption means that the drinker’s airways are constantly exposed to high concentrations of alcohol vapor. The alcohol is then deposited and metabolized in the airways. This process leads to the formation of toxic byproducts, like acetaldehyde, which, in turn, can trigger inflammation (36).
In chronic drinkers, inflammation-induced changes in the upper airway are associated with poor oral hygiene; a greater susceptibility to cavities and gum disease; and increased risk of lung infections because of a compromised oral microbiome that has been taken over by bad bacteria (37).
7. Women: You increase your risk of breast cancer.
Sorry, ladies. That’s full stop.
“Moderate” alcohol consumption (apx. 1-2 drinks / day) has been linked with a 30-50% increased risk of breast cancer (38). Moderate alcohol consumption can raise estrogen levels and contribute to hormone-receptor-positive cancer.
In a study published in Current Breast Cancer Reports, researchers conducted a meta-analysis of 53 studies comparing women with light, moderate and heavy alcohol intake to women who did not drink alcohol at all. What they found: relative risk of breast cancer increased by 32% for women who had 3-4 drinks / day and by 46% for women who had 4 or more drinks / day. Even women whose alcohol intake was considered “light” (1 or less drink / day) had a 5% increased risk of breast cancer compared to non-drinkers (39).
More recently, the World Health Organization stated there is no “safe” level of alcohol consumption for cancer—and this applies to all alcoholic beverages (wine, spirits and beer), regardless of quality and price (40). The WHO also noted that many women remain unaware that breast cancer is the most common cancer caused by alcohol among women globally.
8. Men: You can end up with Low T.
Since the early 1980s, alcohol has been known to lower testosterone in men. In a study published in Pharmacological Biochemical Behavior, healthy men were given the equivalent of a pint of whiskey to drink every day for 30 days. Their testosterone levels were then compared to those of men with chronic alcoholism. (By the way, virtually all the alcoholic men had “low-normal” to “low” levels of testosterone). The testosterone levels of the healthy men began dropping after just 72 hours (3 days). By Day 30, the healthy men had testosterone levels similar to those of the alcoholic men (41).
Chronic, heavy drinking not only lowers testosterone levels in men, but can also cause the testes to shrink.
These changes can result in impotence, infertility and elevated estrogen levels (through aromatization— where the enzyme aromatase converts testosterone to estrogen) that lead to male breast enlargement and fat deposits in the hip area (42).
9. You shrink your brain. Literally.
According to a 2017 study published in the British Medical Journal, even moderate drinking is associated with adverse brain outcomes, including hippocampal shrinkage, an area of the brain involved in memory, learning and emotion (43).
Study participants consisted of a randomly selected subset of 527 men and women who had been participating in the Whitehall II Study cohort, which had been established in 1985 at University London College. The purpose of the original study, which included 10,308 British civil servants as participants, was to understand the relationship between socioeconomic status, stress and heart health. Sociodemographic, health and lifestyle variables (including alcohol use) were measured over a 30-year period at 5-year intervals.
In 1985, the average age of the 527 participants was 43, and none were dependent on alcohol. Over the next 30 years, these participants answered detailed questions about their alcohol intake and took tests to measure memory, reasoning, and verbal skills. They all underwent MRI brain imaging at the end of the study (44).
The results? Over a 30-year follow-up, even moderate alcohol consumption was associated with hippocampal atrophy (45). Hippocampal atrophy can also be an early characteristic of Alzheimer’s Disease (46).
Higher alcohol consumption (apx. 4 or more drinks / day) had an almost 6x higher risk of hippocampus shrinkage compared to non-drinkers, while moderate drinkers had a 3x higher risk compared to abstainers. Even “light” alcohol consumption offered zero brain-protective effects compared to not drinking at all.
10. You are at higher risk for contracting an STI (Sexually Transmitted Infection).
This seems like common sense. But, in an alcohol-fueled moment of lust, all logic can fly out the window. Alcohol lowers inhibitions and invites impulsive behaviors.
Studies show that alcohol use is associated with reckless sexual behaviors, including condomless sex and having multiple partners, which are linked to an increased risk of sexually transmitted infections or STIs (47).
On more than a few occasions, I have had female clients share their regrets about an alcohol-enhanced hook-up that left them dealing with genital herpes, chlamydia or bacterial vaginitis (BV).
One client, *Lara (*not her real name + minor details have been changed) was a 30-year-old woman who had attended a friend’s destination wedding in Mallorca last summer. With the wine and Champagne flowing at the reception, Lara surrendered to a night of passion with another wedding guest and engaged in condomless sex. The very next day, Lara experienced vaginal discharge and abdominal bloating. She tested positive for gardnerella vaginalis, which caused her bacterial vaginitis, and she was treated for it. Three months later, she engaged in another alcohol-induced night of condomless sex—this time with a friends-with-benefits partner. Two weeks later, Lara began experiencing intense pelvic pain and tested positive for another case of bacterial vaginitis for which she had to take 3 rounds of antibiotics. However, her pelvic pain and a swollen abdomen persisted for months, leaving Lara anxious about having pelvic inflammatory disease, an infection that could compromise her fertility. By the time we finished working together, Lara came to the realization that alcohol and hook-ups are a bad combination; her ability to have children was important to her; and, having to deal with an STI—alone—is neither “sexy”, “liberating” or “empowering”.
If you do drink…
1 Be honest about your relationship with alcohol. Do you need it to cope with stress, especially on a daily basis? How often do you drink? How difficult is it for you to NOT drink?
2 Reconsider whether you should drink at all, especially if you have a family history of alcoholism.
3 Choose organic or biodynamic wines or organic beers.
4 Be mindful of how much you are actually drinking…as in actually measure in a measuring glass. And drink less.
5 Try scheduling periodic breaks from alcohol.
6 Only drink alcohol WITH food.
7 If you drink more than intended, replenish with electrolytes. I like—and use–this brand.
8 Replenish your B vitamins and magnesium levels.
9 Consider doing post-holiday whole foods-based cleanse.
Sources
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