I hate to be the bearer of bad news, but the answer is a resounding no, alcohol doesn’t seem to be good for your health at all.
At least based on new emerging research in 2022.
This new research is counter to the narrative that seems to have permeated over the last decade. In fact, even whilst putting this together, I was surprised just how much the research is contrary to my recommendations when it comes to alcohol consumption for healthy people.
So much so, the lead author of a study looking at alcohol and cardiovascular disease, Dr Rudolph Schutte, expressed in an interview that “health benefit from low to moderate alcohol consumption is the biggest myth since we were told smoking was good for us.”[1]
In this article, we will look at some of the ways alcohol affects your body. The focus will be on your digestive system and mental health while also looking at how even low to moderate alcohol consumption could lead to an earlier chronic disease diagnosis, such as cardiovascular illness and cancer risk.
Alcohol consumption and sales have increased exponentially across most regions, especially those that experienced lockdown-based interventions during and post-COVID-19.[2]
To put this in context, estimates from various studies have increased online alcohol sales in the United States between two hundred and sixty-two per cent[3] and a massive four hundred per cent[4] during COVID-19 in 2020.
Australia[5], Hong Kong[6] and Singapore[7] all saw Increases in alcohol consumption.
Let’s be real here. I don’t think anyone reading this is surprised about these statistics. Are you?
However, the long-term effects of increased alcohol consumption over just one year can drastically affect your chances of developing health complications later on in life.[8]
This article isn’t the time to get worried; let’s look at how alcohol affects our bodies.
Alcohol is taken straight to the liver after entering the body via the small intestine.
The liver deals with more than ninety per cent of alcohol. In the liver, it meets enzymes, aldehyde dehydrogenase (ALDH) and alcohol dehydrogenase (ADH). These enzymes break down the alcohol in the liver and prepare it for elimination from the body.
If you’re new to how enzymes work, it’s easy to think of enzymes added to laundry powders. Enzymes would be responsible for breaking down the stains on your clothes, and this is how enzymes work in the body. Their job, in general terms, is to break things down.
The enzymes mentioned above and their effectiveness at their job are the first places where genetics play a role in how your body breaks down alcohol in contrast to someone else.[9]
For example, one person with minor changes in the gene that expresses alcohol dehydrogenase may be a little less effective at breaking down alcohol than someone who doesn’t. Some estimates suggest that this and other factors mentioned below can affect alcohol metabolism up to three-fold between individuals.[10]
The effectiveness of these enzymes is also one of three main factors that influence blood alcohol concentration. This process determines how drunk you get.
Other factors that influence blood alcohol concentration include how much food is in your stomach, how quickly you drink, and what you’re drinking.[11]
For example, fizzy drinks, such as champagne, whiskey, and soda, tend to get into the system quicker than port. Carbohydrates, on the other hand, can affect the absorption of alcohol out of the stomach so much that blood concentration levels may only reach a quarter of the level achieved on an empty stomach.[12]
Body fat percentage will also affect the absorption of alcohol into the tissues, so women achieve higher peak blood alcohol concentrations than men when given the same amount of alcohol.[13]
It explains why that guy Scott from marketing can drink so much and act normal.
But rest assured, Scott’s body is still experiencing the same things in the end.
Once the enzymes have completed the first stage of their job, the alcohol is turned into a toxic substance called acetaldehyde. But no damage is done. In healthy people, the body creates a harmless substance called acetate.
For some fifty per cent of Japanese people and some Asian people, fractions of the enzyme that breaks down acetaldehyde do not exist. The consequence can mean alcohol consumption can quickly lead to symptoms such as flushing, nausea and headaches, considered mainly due to increased acetaldehyde.[14]
Increasing acetaldehyde levels also interfere with fat-soluble vitamins such as Vitamin A and D[15] and decrease intestinal absorption of other nutrients such as glutamine, one of the vital amino acids for digestive function.[16]
Unfortunately, that’s not where it ends when it comes to the byproducts of the breakdown of alcohol in the body.
The downstream molecules left over from alcohol metabolism begin to create problems for the body.
If you’re a regular reader of articles on this site, you would be familiar with how often I mention the importance of balance or homeostasis to the body. For example, stress and its effect on the body is a deviation from the body’s preferred state.
Alcohol and its effect on the body can be considered the same way. Often the extent that the body has to go to to bring the body back to balance ends with undesirable consequences and byproducts.
In the case of alcohol, we see oxygen levels in the liver decrease, cells and metabolic byproducts interact to form more toxic molecules and molecules that amplify the cell damage across the body increase exponentially. These molecules, in particular, cause a significant increase in what can only be described as a rust-like process on the tissues of the body, speeding up the ageing process.
Most of this radiates out from the liver, which immediately affects metabolism. Alcohol intake can cause either high or low blood sugar levels depending on where the glucose stores are, increase triglycerides, and increase fatty liver formation.[17]
This metabolic effect contributes to some of the most prevalent chronic conditions we see in 2022, such as metabolic syndrome.
Alcohol can be directly responsible for four out of the five characteristics of metabolic syndrome in heavy drinkers but can be protective in low to moderate drinkers.[18]
If you are new to metabolic syndrome, it is a condition that affects a quarter of the world’s population.[19] The syndrome groups commonly found metabolic issues, such as high BMI, high fasting glucose, high triglyceride and LDL levels and high blood pressure.
Higher levels of alcohol consumption contribute to all of these independent characteristics, such as high blood pressure, imbalanced cholesterol levels and obesity.[20]
In contrast, it seems that low to moderate consumption can be protective in some ways against the development of metabolic syndrome.[21] This study at least offers some positive news, even though it was done in 2004, although I wonder whether, over time, these results might change.
Moving forward with how alcohol can affect different conditions, let’s look at alcohol and the digestive system.
Research around the role that alcohol can play in IBS is mixed, but what about its role in creating functional digestive problems.
We’ve spoken earlier in the article about alcohol’s role in nutrient absorption, but alcohol can also increase intestinal permeability or what’s commonly known as “leaky gut.”[22]
Compounding this leaky gut problem, alcohol consumption promotes an imbalance in the bacterial environment, causing the bacterial overgrowth of undesirable gram-negative bacteria. These gram-negative bacteria then release toxic byproducts that can cause inflammation and activate the immune system.[23] [24]
The mechanism of how alcohol consumption contributes to these problems is still up for interpretation. Animal studies have shown that alcohol can decrease the ratio between Lactobacillus and Bifidobacterium and increase undesirable bacteria.[25]
Beyond this, the role that alcohol can play in digestive function is a sustaining factor. For example, alcohol can damage the muscles between the oesophagus and the stomach, the same muscles that protect you from heartburn.[26]
It seems like a lot of inflammation, the effects on the digestion can then radiate to the brain.
As alcohol crosses the blood-brain barrier and enters the brain quickly, long-term alcohol consumption activates the immune system within the brain. An immune response called neuroinflammation. Neuroinflammation has been implicated in many mental health conditions such as depression, anxiety, and schizophrenia. Pain-sensitive conditions such as fibromyalgia have also seen neuroinflammation present.[27]
Along with influencing the brain’s immune system, alcohol interacts with the excitatory chemicals in the brain, such as serotonin (the good mood chemical) and dopamine (the pleasure chemical) and the inhibitory ones, such as GABA.[28]
The balance between the excited and inhibited brain chemicals best describes how short-term and long-term alcohol use affects the brain. Firstly, in the short term, alcohol consumption primes the brain towards the more inhibitory neurotransmitter, GABA.
If you’re new to GABA, I explain to patients that its job is to shepherd the excited kids, like serotonin and dopamine together when it’s time to relax.
Various popular mental health prescriptions such as sleeping pills such as zolpidem and anticonvulsant drugs affect the GABA system. This action on GABA explains why alcohol is a relaxant to most and why alcohol can be confused for being a good sleep aid (we’ll get to why it isn’t next).
Over time, with continued consistent alcohol consumption, this leaning towards an inhibitory effect has the brain looking to rebalance things, increasing the amount of excitatory activity.[29]
This search for balance has a two-fold effect. The first is that it requires more alcohol to initiate the relaxing effect due to the competition between the excitatory and inhibitory systems. Secondly, when alcohol consumption decreases, the effects your brain feels necessary to keep the balance leave you feeling overstimulated, especially in the withdrawal process for recovering alcoholics.[30]
So, alcohol is proven to help me relax; why did you say it isn’t good for sleep?
One of my favourite quotes that characterise alcohol’s role in sleep is as follows:
“A lie is sweet in the beginning and bitter in the end. Truth is bitter in the beginning and sweet in the end.”
In this first part of the night, alcohol can help you get to sleep, increase sleep quality and non-REM sleep. Sounds good, right? Then sleep is disrupted heavily in the second half of the night. This disruption can see increased levels of wakefulness alongside lighter sleep which leads to waking to feel less refreshed.[31]
Depending on the type of alcohol consumed before sleep, low blood sugar can also contribute to why people wake early or unrefreshed.[32]
So, this means that whilst you feel as if alcohol is helping you at the beginning of the night, it is, in reality, throwing out your sleep-wake cycles, making it harder for you to sleep the next night. Sweet in the beginning but bitter in the end.
Now good sleep is also essential not only for the quality of your day but also to help stop you from dying earlier. Many studies confer an increased risk of cardiovascular disease with shortened or poor sleep quality and duration.[33] The connection between alcohol and cardiovascular disease seems to drive the argument we brought up at the beginning of the article.
Is the health benefit from low to moderate alcohol consumption the biggest myth since we were told smoking was good for us?
It’s certainly a big statement, isn’t it? And it’s mainly from a study released last month that included a sample of more than 350,000 people, 333,000 of which drank alcohol. The participants were followed over seven years, tracking their alcohol consumption and hospitalisation for cardiovascular events.
The results?
The study found that for the participants who drank below 14 units per week, the recommended limit offered by the UK’s health authorities, every added pint of beer at four per cent, proof increased their cardiovascular risk by a whopping twenty-three per cent.[34]
The study concluded that even low to moderate alcohol intake increased your risk of a cardiovascular event.[35]
So, what do you think, is there a happy place with alcohol?
In Hong Kong, where bars and restaurants have been asked to close permanently or early, sharing a drink with friends or family has become a port in a storm.
Can you then make decisions for your future self and still take measures to protect your health over the long term?
It seems like a million-dollar question; This is already the longest article I’ve written so far because there’s so much to cover.
I think there is a happy place. And this is from someone who hasn’t had a drink for seventeen years. If you’re sick, drinking regularly isn’t likely to help—especially binge drinking.
Suppose you feel that your irritable bowel symptoms and mental health symptoms are worse the next day after having a drink. In that case, that’s a message to listen to until you feel better and your physical and mental capacity is better.
If you are male and over forty and don’t get regular blood tests, I would assess your situation to personalise your choices a little more.
In conclusion, even from the length of this article, it’s clear that we are still in a grey area when it comes to whether or not alcohol is good or bad for you over time.
But is that going to stop you anyway?
It should if your body is dealing with something at the same time. That could be as simple as feeling run down after a big week or as complex as irritable bowel syndrome.
Hope it helps x
References
[1] Dr Rob Hicks. Current ‘Safe’ Alcohol Consumption Levels Potentially Harmful – Medscape – Jan 31, 2022. https://www.medscape.com/viewarticle/967567?reg=1, viewed 7th April 2022.
[2] Rossow I, Bartak M, Bloomfield K, et al. Changes in Alcohol Consumption during the COVID-19 Pandemic Are Dependent on Initial Consumption Level: Findings from Eight European Countries. Int J Environ Res Public Health. 2021;18(19):10547. Published 2021 Oct 8. doi:10.3390/ijerph181910547
[3] Pollard, Michael & Tucker, Joan & Green, Harold. (2020). Changes in Adult Alcohol Use and Consequences During the COVID-19 Pandemic in the US. JAMA network open. 3. e2022942. 10.1001/jamanetworkopen.2020.22942.
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[5] https://csrm.cass.anu.edu.au/research/publications/alcohol-consumption-during-covid-19-period-may-2020, viewed 7th April 2022.
[6] https://www.chp.gov.hk/files/pdf/ncd_watch_december_2020.pdf, viewed 7th April 2022.
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