The holiday season is a particularly stressful time for many people – and this year has been extra, as the kids say. One theme I often see in my patients is a tendency to use alcohol to relax. Most do not realize they are consuming a moderate or heavy amount of alcohol and many are not aware of the various health effects associated with each. Especially during this season and with alcohol sales soaring in Virginia, I feel compelled to provide a public service announcement. On September 3rd, the Washington Post wrote: “The Virginia Alcohol Beverage Control Authority brought in $1.2 billion in revenue during the 2020 fiscal year in a nearly $120 million increase from the previous year, even as the coronavirus pandemic left restaurants and bars shuttered for months.” As a health care provider, while not shocking, this is concerning, especially given the known, deleterious health effects of alcohol on the immune system.

When we talk about alcohol and its effect on the body positive or negative, we really need to consider the amount we are talking about. A standard alcohol drink is 14 grams of alcohol which equals 12 ounces of beer (~5% alcohol), 8.5 ounces of malt liquor (~9% alcohol), 5 ounces of wine (~12% alcohol), 3.5 ounces of fortified wine (ie sherry or port), or 1.5 ounces of liquor (distilled spirits, 40% alcohol). Moderate alcohol consumption for women is, as considered by the USDA, to be no more than one standard alcoholic drink per day and for men no more than two standard alcoholic drinks/day. Heavy alcohol consumption for women is considered, by the USDA more than 7 standard alcoholic drinks per week or more than 3 standard alcoholic drinks in one day and for men more than 14 standard alcoholic drinks per week or more than 4 standard alcoholic drinks in a day.

Light to moderate alcohol consumption has some likely effect in cardiovascular disease, where it has been shown to reduce risk of plaque build-up and heart attack and deaths from heart disease. One to two alcoholic drinks/day increases protective HDL and Apo A1 cholesterol, decreases LDL, triglycerides and ApoB (an inflammatory cholesterol fraction), decreases factors that influence blood clotting, may decrease systolic blood pressure, has been shown to reduces inflammatory marker blood biomarker, hsCRP. However, light to moderate consumption does not seem to have any effect in men with already established coronary heart disease. This is a major caveat to be aware of as many people in the US already have evidence of established heart disease and with the obesity epidemic we are seeing heart disease in children. About half of all Americans are at risk for heart disease and heart disease is the leading cause of death in the United States. 

Although red wine has been touted as ‘better’ than other forms of alcohol there is no conclusive evidence from clinical studies. Often people point to the polyphenol resveratrol that is in red wine as a reason to drink. However, you would have to consume a TON of red wine to get any benefit from the resveratrol in it. Most of the resveratrol in supplements is not from grapes, but from Japanese knotweed - an herb that grows like a weed in the US. Also, most of the research on the single ingredient resveratrol is insufficient. However, Japanese knotweed with all of its many phytochemicals is a wonderful herb that has been used in Traditional Chinese Medicine for centuries for its properties that have immune supportive effects and anti-inflammatory effects. 

Additionally, fruits and veggies generally have more polyphenols than wine. Most people would do better to focus on getting 5-10 servings of veggies and a few fruits per day and herbals teas and avoid drinking alcohol. One of my absolute favorite herbals teas of late is Holy Basil or Tulsi – as it has both a calming and gentle energy boosting or stress managing effects as an adaptogen herb.

I have a lot of patients with estrogen dominance, which is having too much estrogen in ratio to progesterone which contributes to many common PMS and other female health concerns. Alcohol only exacerbates these symptoms. Additionally, I have many patients at increased risk for breast cancer, sleep disturbances and symptomatic menopause. I generally advise limiting alcohol in these populations. 

While many people use alcohol to help relax before bed, the medical evidence shows alcohol to be disruptive to the sleep cycle. Magnesium chelates, Epson salt baths, meditation area some examples of more effective and less harmful choices to help get relaxed before bed or to get relaxed in general. Stress cannot be drunk away, as a culture the research shows that we all may benefit even when a small group of individuals takes some time daily to meditate. No time for meditation? Consider tapping or the Emotional Freedom Technique, which is a simple and often effective method for helping to relieve mild stress and worry. 

Known risks of over consumption or dependence include: central nervous system effects (kills your brain cells, as alcohol is a cellular toxin), cirrhosis (liver inflammation and damage), malnutrition, and mouth/esophageal/ laryngeal/liver cancer. More than two drinks per day can increase the risk of cardiovascular disease and overall mortality. Light to moderate consumption can increase risk of hemorrhagic stroke. In women, one or more alcoholic drinks per day might increase risk of breast cancer by 2 to 15% and increase mortality from breast cancer as much as 30% (especially if daily intake of folate is 300 mcg or less). Alcohol consumption can also increase asthma and migraines in those sensitive to sulfites/ yeast. 

I have many patients with acid reflux who are drinking 1-2 drinks every night, possibly along with caffeine, and often soda. While it is no surprise to me, they are often pleasantly surprised when their acid reflux resolves after eliminating these known triggers. 

Because alcohol increases your liver’s detoxification pathway alcohol consumption, it can disrupt the metabolism of many medications. Birth control is a good example of this, it is not as effective when drinking alcohol, so using a second method of birth control during these times is particularly important if trying to prevent pregnancy. There are many other medications affected by alcohol consumption and if you take medications you should be sure to check with your doctor or pharmacist to see if any can be consumed with alcohol. 

If you have pre-diabetes or diabetes, you might consider reducing your alcohol consumption. While light drinking can contribute to low blood glucose, heavy drinking can cause insulin resistance, which leads to the development of type II diabetes. Heavy drinking can cause inflammation of the pancreas and destroy the pancreas’ ability to make insulin, leading to diabetes. Alcohol is nutrient light and high caloric. “One pint of lager can be equivalent to a slice of pizza.” Over-consumption can contribute to weight gain and obesity, an independent risk factor for many diseases.

A final note during this season is that alcohol consumption weakens the body’s immune system making it more susceptible to disease and infection. Drinking more than 3-4 drinks on a single occasion will suppress the immune system even up to 24 hours later. Chronic drinkers have higher rates of diseases like pneumonia and tuberculosis.

For further reading on this topic, Harvard’s Nutrition Source has a thorough summary of the research on alcohol and its effect on the body: http://www.hsph.harvard.edu/nutritionsource/alcohol-full-story/

Dr. Sarah is passionate about educating patients and getting to the root cause of their chronic, troubling symptoms; often alcohol is often a culprit that has not been thoughtfully considered. Dr. Sarah is honored to be a collaborative partner in her patient’s health at her practice Collective Health Center, in downtown Leesburg, Virginia. As the saying goes, ‘it takes a village’ – particularly when sensitive issues, such as dependence are involved, the primary care provider, the behavioral health specialist, the naturopathic doctor and others may need to work together to help get patients back on the road to wellness.