Last week I met a lovely couple in their late fifties who came to establish their care with me at my office. They both had been diligent about keeping up with regular checkups and with preventive screening tests and lab work.
During a routine physical exam with the husband, I noted that he had an irregular heartbeat, and a subsequent EKG showed atrial fibrillation. This is a cardiac rhythm that can lead to a stroke, if not treated. His blood pressure was mildly elevated, which apparently is always a little high when he goes to the doctor. As we talked, I learned that he does not check his blood pressure at home. And as I probed a little further, asking about their lifestyle, I discovered that for years, the couple shared a bottle of wine each day. This was part of their nightly, winding-down routine. When I mentioned that alcohol likely contributed to his arrhythmia and blood pressure elevation, he and his wife were shocked.
The French paradox
For years we believed that drinking in moderation could lead to optimal health. The well-publicized French paradox showed that it worked for them. Though the French tend to drink a lot of wine, they were found to have low cardiovascular risk, despite their fondness for cheese and a diet rich in saturated fat.
There are health benefits of moderate alcohol consumption. For example, drinking moderately can reduce the risk of developing and dying from heart disease. Though if you’re at risk for heart disease, there are other more effective ways to reduce your risk such as being physically active and eating a diet low in animal protein. Moderate alcohol consumption can also possibly reduce your risk of ischemic stroke and developing diabetes.
However, even moderate drinking has its health risks, and the risks are similar, whether you have a few drinks on the weekends, or drink in moderation during the week. In older adults, alcohol can increase the risk of balance problems and falls, leading to severe injuries and fractures. And there’s a slight increase in risk of esophageal cancer. People with liver or pancreatic disease, or congestive heart failure, should not drink alcohol. And those who’ve experienced a hemorrhagic stroke should also avoid drinking.
Some prescription and over-the-counter medications can be affected by alcohol, so this is something you should discuss with your physician. Alcohol can intensify medication side effects, or decrease the effectiveness of the medication. And in some situations, alcoholic beverages might make a drug harmful.
Moderate and heavy drinking
What is considered moderate alcohol consumption? Moderate drinking is defined as one drink for healthy women and two drinks for healthy men. (For men age 65 or older, however, it’s generally recommended they cut back to one drink per day.) One drink is defined as 12 ounces of beer, or 1.5 ounce of a distilled spirit, or 5 ounces of wine. Generally, each drink has about 14 gm of alcohol.
Heavy drinking for women of all ages and men older than 65 is defined as consuming more than three drinks in one day, or seven drinks in a week. For men under the age of 65, heavy consumption means having more than four drinks in a day, or 14 drinks a week.
Heavy drinking can cause high blood pressure, arrhythmias, heart failure and stroke. It can also lead to liver disease and pancreatitis. If you drink more than three drinks a day, it can increase your risk of certain cancers such as breast, colon, esophageal and liver cancers.
In 1988, the World Health Organization classified alcohol as a carcinogen. It can also weaken your immune system and make one susceptible to diseases. Chronic drinkers can be at risk for developing infections such as pneumonia and tuberculosis. If you only drink on occasion, but happen to drink a lot, the risk for developing infections can exist up to 24 hours later. A 2018 study published in The Lancet revealed the upper limit of alcohol that can be safely consumed is 100mg/ week for both women and men. (This is different from U.S. guidelines, and significantly lower than many of the European countries.)
There are many factors that contribute to the effect of alcohol on your body, and additional studies are needed to determine the health effects of alcohol. If you don’t drink, I wouldn’t start for its potential health benefits. If you enjoy imbibing and you’re healthy, chances are you can continue drinking light to moderate amounts of alcohol. And if you’re unsure, check with your doctor.
Rajina Ranadive, M.D., is a board certified internal medicine physician with the St. Joseph’s Medical Group. She is also the medical director of the Petaluma Post-Acute Rehab. She can be reached at (707) 763-0802
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