Alcohol and health: To drink or not to drink

With the end of the year almost here, most of us have social events to attend, which in many cases means increased alcohol consumption. If you wonder what’s the relationship between alcohol and health, read on.

Alcohol, a drug and a nutrient

Alcohol is one of the most prevalent socially accepted drugs. It is also a nutrient, in the sense that it contributes to energy intake. Each gram of alcohol contributes 7 kilocalories (29.3 kilojoules) per gram. Compare this to 4 kilocalories (16.7 kilojoules) per gram of carbohydrate or protein and 9 kilocalories (37.7 kilojoules) per gram of fat.

To put these numbers into perspective, a standard drink is a volume that contains 10 grams (12.5ml) of alcohol. This equals to 70 kilocalories or 293 kilojoules just from the alcohol, to which you should add calories from other macronutrients (e.g. sugar) present on the drink. Also note that regular-sized cans/bottles of beer, cider and pre-mixed drink and glasses of wine all contain more than 1 standard drink. Ditto for cocktails which contain more than one shot of spirits or liqueur. Bottom line: the calories add up.

Nutrients in alcoholic beverages

Besides alcohol, many alcoholic drinks contain carbohydrate (mainly sugar). Some might contain some fat and/or protein (which also contribute to total kilojoules) and/or caffeine.

Comparing alcoholic drinks is tricky due to the wide variability in serving sizes and alcoholic percentage. Below are a couple of charts comparing different drinks per 100g, using data from the AUSNUT database (1).

The chart below has the volume adjusted to typical serving sizes: 375ml for beer, ciders and mixed drinks, 250ml for cocktails, 150ml for wine, 50ml for fortified drinks and liqueurs, 30ml for spirits.

Standard drinks

In Australia, alcoholic beverage labels must include the number of standard drinks. The same applies for imported beverages. If you come across a bottle that does not have this on the label, you can calculate it with this formula:

# standard drinks = volume (ml) * % alcohol * 0.789

Example: # standard drinks in a 375ml can of beer that has 4.8% alcohol = 0.375 * 4.8 * 0.789 = 1.4 standard drinks

Alcohol and health

You’ve probably heard that drinking a glass or two of wine a day is good for you. However, alcohol consumption has also been link to detrimental effects on health. The Australian Dietary Guidelines (2) are informed by a large body of evidence. Below is a summary of the potential effects of drinking.

Positive

• Moderate consumption of alcohol (1 standard drink for women, 1.5 to 2 for men) may reduce risk of cardiovascular disease, increase HDL cholesterol and have a mild anti-coagulant effect.
• Some alcoholic beverages, such as wine, contain bioactive flavonoids, which may be beneficial for health.

Negative

• Consumption of alcohol is associated with increased risk of breast and oesophageal cancer.
• Heavy drinking can affect the structure of the brain in young adults, leading to cognitive impairment.
• Alcoholics can develop Wernicke-Korsakoff syndrome due to thiamine deficiency. Symptoms include: disturbances in gait, paralysis of eye muscles and irreversible memory loss.
• Alcohol can raise blood pressure and increase the risk of arrhythmias, shortness of breath, some types of cardiac failure, haemorrhagic stroke and other circulatory problems.
• Alcohol interferes with glucose metabolism due to its effect on insulin and glucagon. This is particularly important for people with diabetes.
• Alcohol consumption can be associated with the consumption of junk food, energy drinks, added sugars, etc.

Having said that, drinking alcoholic beverages might confer health benefits that go beyond the physiological effects of their components. For example, for some people having a few drinks with loved ones might decrease stress and strengthen community bonds.

Guidelines

The current guidelines from the National Health and Medical Research Council are as follows (3):

“Guideline 1: Reducing the risk of alcohol-related harm over a lifetime

The lifetime risk of harm from drinking alcohol increases with the amount consumed.

For healthy men and women, drinking no more than two standard drinks on any day reduces the lifetime risk of harm from alcohol-related disease or injury.

Guideline 2: Reducing the risk of injury on a single occasion of drinking

On a single occasion of drinking, the risk of alcohol-related injury increases with the amount consumed.

For healthy men and women, drinking no more than four standard drinks on a single occasion reduces the risk of alcohol-related injury arising from that occasion.

Guideline 3: Children and young people under 18 years of age

For children and young people under 18 years of age, not drinking alcohol is the safest option.

A. Parents and carers should be advised that children under 15 years of age are at the greatest risk of harm from drinking and that for this age group, not drinking alcohol is especially important.
B. For young people aged 15−17 years, the safest option is to delay the initiation of drinking for as long as possible.

Guideline 4: Pregnancy and breastfeeding

Maternal alcohol consumption can harm the developing foetus or breastfeeding baby.

A. For women who are pregnant or planning a pregnancy, not drinking is the safest option.
B. For women who are breastfeeding, not drinking is the safest option.”

Recommendations

In addition from following the guidelines above, consider the following recommendations:

• If you have problems controlling your alcohol intake or have health conditions that are affected by alcohol (e.g. liver issues, alcohol metabolism deficiencies, severe gout), it would be better for you to don’t drink at all.
• If you don’t want to drink but feel social pressure, order sparkling water with ice and lime or lemon.
• If you choose to drink:
  • If alcohol triggers you to eat junk food, drink less frequently. Note that this doesn’t give you permission to binge drink. Also, don’t keep junk food in your house.
  • Drink at least one glass of water for every alcoholic beverage.
  • Avoid beverages that have added sugar or caffeine.
  • Don’t drink something if it doesn’t agree with you. For example, if you have histamine intolerance, you might want to avoid wine and beer. If tequila gives you headaches, stay away from it.
  • If you have blood glucose control issues or are following a low carbohydrate diet, your best options are spirits (on the rocks or mixed with sparkling water), red wine and dry white/sparkling wine.
  • If you have Coeliac Disease or gluten intolerance and want to drink beer, there are a couple of gluten-free alternatives available in major bottle shops and some pubs: O’Brien and Wilde. Cider is also gluten-free but much higher in sugar.
  • Avoid drinking right before going to bed because alcohol interferes with sleep quality.

More information and useful calculators can be found at drinkwise.org.au.

References

1. Food Standards Australia New Zealand. AUSNUT 2011–13 – Australian Food Composition Database. 2014 [Available from: http://www.foodstandards.gov.au].
2. National Health and Medical Research Council. Australian Dietary Guidelines. Canberra: National Health and Medical Research Council; 2013.
3. National Health and Medical Research Council. Australian guidelines to reduce health risks from drinking alcohol. Canberra: Commonwealth of Australia; 2009.
4. Australian Bureau of Statistics. 43640DO004_20112012 Australian Health Survey: Nutrition First Results – Foods and Nutrients, 2011–12 – Australia. 2014.

[Photo by Moss on Unsplash]

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