It’s no doubt that with the holidays approaching, and the weather getting colder people are upping their alcoholic drink intake, from work Christmas drinks to birthday celebrations and religious holidays. However, what is the actual effect of alcohol to the body?
Geographically, the interpretation of alcohol and its use is very much different and divided. Take Europe for example, in the mediterranean alcohol is considered something to be taken with a meal and to enjoy, while in the remainder it is more seen as a stress release and means of having fun, or even drinking to help against the cold winter months. The latter doesn’t actually hold scientifically, as when you drink your blood vessels dilate (vasodilation) causing you to lose more heat, but you feel temporarily warmer. Overall, the perception is significantly varied due to historical, cultural, and social differences. Say, drinking in a social context - it’s seen about enjoyment and a compliment to food as opposed to getting intoxicated. One of the many culture shocks I experienced when moving to England was the notion of Dry January, and being asked if I’m partaking in it when coming back from the Christmas break as a fresher. For those of you who do not know, Dry January started in the UK in 2013 and every year millions participate in it, what it entails is no drinking during the month of January. It’s become quite global, and most English-speaking countries have also “adopted” it alongside some in Europe.
Research has been very much divided and contradicting about the effects of alcohol on the body, as a risk factor for disease but also as an outcome. The CDC has reported that people who drink in moderation (i.e., 1 drink or less a day for women and 2 for men) are at lower risk of major cardiovascular events (heart attacks, strokes) when compared to those who either completely abstain or drink more. In the UK, the NHS advises for both men and women to not drink more than 14 units a week on a regular basis. The graph below should the unit reference for many drinks.
A recent systematic review and meta-analysis by Zhao et al., published in JAMA Network Open analysed 107 cohort studies, equating to more than 4.8 million participants found no significant reduction in risk of all-cause mortality for drinkers who drank less than 25g of ethanol per day (~ 2 standard drinks). A significantly increased risk of all-cause mortality was seen in females drinking 25 or more grams per day and in males drinking 45 or more grams per day. There is a famous graph called the J-Curve, which shows the relationship of drink consumption per day (in grams) against the relative risk of all-cause mortality. As you can see below its shape is the reason it’s called a J-Curve. You might be surprised with the fact that drinking a bit, is more beneficial than drinking nothing at all - or in other words not drinking is worse that drinking a bit. Making alcohol a true conundrum.
It’s important to be noted that this is all-cause mortality, meaning it includes cancer, heart disease, natural causes - basically anything and everything. So it may be that in some cases that mortality causes “cancel” each-other out.
As stated above, the literature has indeed been very contradicting for multiple decades, a notable academic is Tim Stockwell, which he has made his life’s work to understand the impact of alcohol on public health. Stockwell was also an author of the systematic review referenced earlier. There have been a lot of studies that both support and do not support the J-Curve. The issue with a lot of these studies and generally epidemiological studies relating to consumption of goods or habbits is that they tend to be in a single point in time. This many times does not paint the true picture, people may be embarrassed of admitting having drunk a bottle of wine in one day on a consecutive basis or not truly understanding how alcohol units translate into drinks and cocktails. Long-story short, self-reported alcohol consumption is certainly always underreported.
Evidently, outside of the physiological health impact, alcohol plays a big role in mental health as it is an addictive substance - to put it simply it’s a drug. There’s both a psychological addiction and a physical dependency associated with it when consuming alcohol in big quantities over an extended period of time. Although, alcohol is perceived as a “stress-reliever”, in many cases it can cause more anxiety - quite ironic isn’t it?
A friend, recently forwarded me this article titled “Stress Drinking Has a Gender Divide”. It discusses that alcohol dependency is a rising issue among women, especially the high-income and highly educated ones. Alcohol-related hospitalisations and deaths have been increasing faster in women than men, with the main contributors being stress and negative feelings. It’s speculated as previously women would be prescribed anti-anxiety meds, that this is now being replaced with alcohol. The pandemic catalysed this phenomenon of women’s “heavy drinking” which was already slowly rising, as reported by Rodriguez et al. recently.
This was also backed by a 2022 study carried out by Patock-Peckham et al., where they assessed if acute social stressor (Trier Social Stress Test, TSST) , a priming dose of alcohol, and participant sex impacted 90-minute ad libitum drinking. They split the participants into groups of 2-3 drinkers to stress (TSTT vs no TSST) and priming beverage (alcoholic vs. placebo) conditions. They all completed the 90-min ad libitum drinking period and were instructed not to exceed more than one alcoholic beverage per hour for optimal performance to model behavioral impaired control. The results showed that exposure to stress was associated with heavier ad libitum drinking. This effect was qualified by a three-way interaction; women who received a stressor and no prime dose (placebo) reached higher BACs, whereas men who received a stressor and a prime reached higher BACs. So, women did indeed drink more under social stress in the absence of a priming dose.
Clearly, the alcohol consumption per person has increased over time worldwide. The total alcohol consumption per capita (liters of pure alcohol, projected estimates, 15+ years of age) at a world level has increased from 5.48 in 2000 to 6.17 in 2018. If I have not been failed by technology, I have added two interactive world maps comparing the alcohol consumption in 2010 vs. 2018.
Evidently, alcohol is not something that will disappear from our lives, considering the deep historic and cultural aspect of it. Surely, the consumption of a glass of wine here and there combined with the social aspect is very beneficial to one’s mental health. Conversely, its long term and heavy consumption (abuse) is linked with addiction, disease, and early death undoubtedly. However, as Cleobulus of Lindius said “Moderation in all things”.
As usual, I have added the links below to the studies mentioned. I hope you enjoyed - See you next week! :)
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good job Sara! really enjoy reading your articles