Alcohol: How much is too much?

In my previous company, we used to discuss a lot of nutrition-related issues during the lunch-time. One of them was alcohol. Some of us justified social drinking, saying moderate consumption is not harmful at all and some, including meJ, discouraged its consumption saying that it has too many negative impacts on health. But we never reached any consensus.


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Just a few days ago, when a friend of mine asked me about the safe level of ethanol consumption, I started off by saying, “there is no optimal amount of ethanol!". Then I remembered our never-ending debate during the lunch-time and realized that this one-line answer will not be sufficient. So, here is my answer…
 

Definitely, there is no safe limit for consuming alcohol. Alcohol, as a beverage, has no nutritional advantage. It provides just empty calories (7 kcal/g) contributing to obesity. Excessive drinking suppresses appetite and interferes with absorption and metabolism of nutrients, leading to various nutritional-deficiency diseases. It has many adverse effects on health. It affects various organ systems like brain, heart, liver and stomach; it leads to cancer and affects the immune system as well. Adverse effects of excessive alcohol consumption are well known and everybody, including those who drink it, admits it.

But the curious part is about moderate or low alcohol consumption. What happens if a person drinks in low or moderate amounts? I liked the answer given by National Health and Medical Research Council of Australian government. It says ‘There is no level of drinking alcohol that can be guaranteed to be completely ’safe’ or ‘no risk’. Rather guidelines set out advice on the level of drinking alcohol that will enable healthy adults to keep their risk of alcohol-related accidents, injuries, diseases and death low both in the short and long term.’ The problem with alcohol is its addictive nature. About 10 to 15% of alcohol users develop alcohol dependence and become alcoholics.

So, Indian guidelines are very simple. ‘Avoid Alcohol. Those who drink should limit its intake.’ Maybe, it is thought that allowing a certain amount may act as an indirect way of promoting alcohol consumption. Unfortunately, it does not solve our problem. Many corporate meetings, business deals or parties are not complete without alcohol. Just saying ‘Avoid alcohol’ doesn’t stop people from drinking it. Hence, though it is not advisable to have it, those who still drink should at least know where to stop.

Unlike India, many other countries, where alcohol is a part of their culture, have defined moderate drinking or low risk drinking guidelines. So when we don’t have the definite guidelines, we go to WHO (World Health Organization) to seek help. WHO has given low-risk responsible drinking guidelines as follows. (Remember, these are low-risk guidelines.)

1.       Women should not drink more than two drinks a day on average.

2.       For men, not more than three drinks a day on average.

3.       Try not to exceed four drinks on any one occasion.

4.      Don’t drink alcohol in some situations, such as when driving, if pregnant or in certain work situations.

5.       Abstain from drinking at least once a week.

Men or women who consistently drink more than these recommended levels may increase the risk to their health.

There is no consensus, internationally, on a single standard drink size. It varies from 8 g to 14 g of pure ethanol. So to be on safer side, we can assume a standard drink size of 8g. Another reason for considering a lower level of ethanol is our genetics. Indian may have low tolerance towards alcohol consumption. INTERHEART study (A Global Case-Control Study of Risk Factors for Acute Myocardial Infarction, carried out in 52 countries) demonstrated that alcohol consumption (>1 drink per week) has no beneficial effect in the South Asian population and may actually have a harmful effect in Asian Indians in terms of heart disease risk. This was not the case with other populations. The result might be due to difference in pattern of drinking or type of drinking. It was not investigated further in the study.

Some studies show beneficial effect on heart from moderate alcohol consumption in certain populations. Unfortunately, we are not one of them. However, yet no public health guidelines support alcohol consumption on those bases.

The strengths of different types of alcoholic beverage vary significantly; beer contains 2-5% and wine 8-10% of alcohol; while brandy, rum and whisky contain much higher concentrations (30-40%). Check alcohol content before you consume.

So, to summarize, avoid alcohol. Those who do not drink please don’t start; it’s really not good for health. It is not advisable to drink alcohol. Those who drink should drink responsibly by following low-risk guidelines given by WHO.

No more than 24 g/day of ethanol on average for men, no more than 16 g/day for women and no more than 32g of ethanol on any single occasion. Binge drinking is equally harmful. Don't drink at least once a week.