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ACSM'S Health & Fitness Journal:
doi: 10.1249/01.FIT.0000281220.16020.ed
Departments: You Asked For It: Question Authority

You Asked For It: Question Authority

Nieman, David C. Dr.P.H., FACSM

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David C. Nieman, Dr.P.H., FACSM, is professor and director of the Human Performance Laboratory, Appalachian State University in Boone, North Carolina, an active researcher, and author of several textbooks on health and fitness. Email your questions to: niemandc@appstate.edu.

Q: I EXERCISE FOR ABOUT 30 MINUTES NEARLY EVERY DAY, MAINTAIN A HEALTHY BODY WEIGHT, AND CONSUME A NUTRITIOUS BALANCED DIET. I AM CONFUSED, HOWEVER, ABOUT WHETHER MODERATE ALCOHOL CONSUMPTION IS AN ADDITIONAL HEALTHY HABIT FOR MEN LIKE ME TO FOLLOW.

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A: Good question. Although it is true that moderate amounts of alcohol lower the risk of coronary heart disease by approximately 20% to 50%, this benefit must be balanced against all the health risks. Let me explain.

More than 60 major studies have shown that coronary heart disease is less likely in moderate drinkers (1,2). The best evidence indicates that all alcoholic beverages are protective, with no special cardioprotective effects of red wine over beer or spirits (3). Alcohol seems to lower heart disease risk by increasing high-density lipoprotein cholesterol from 10% to 15% and reducing the likelihood for blood clots to form (1,2).

That's the good news, but here's the bad. Alcoholic beverages supply calories but few or no nutrients and, in excess, can cause many health problems, birth defects, accidents, violent crimes, and addiction. Alcohol affects almost every organ system in the body, especially the liver (where alcohol is broken down), but also the brain and nervous system, the stomach, and the intestines (1).

ACSM Photo/Angela C....
ACSM Photo/Angela C....
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Alcohol is the third leading cause of death in the United States, causing more than 100,000 deaths yearly from injuries, certain types of cancer, liver disease, and violence (4). Nearly half of the trauma beds in the United States are occupied by patients who were injured while under the influence of alcohol. Each year, alcohol-related motor vehicle crashes result in more than 16,000 deaths, one-third of them involving people younger than 25 years.

Researchers from Harvard report that, although alcohol consumption reduces risk of coronary heart disease for both men and women, "our society is so lacking in effective social controls on alcohol abuse and pays such a heavy price for its inadequate response that the thought of a public policy promoting alcohol consumption runs strongly against the grain, however much it might capture at least some hearts" (5). In other words, there are too many problems associated with drinking in our society to recommend a policy of "drinking for your heart." The cure would be far worse than the disease, at least at the population level.

The National Institute on Alcohol Abuse and Alcoholism reports that 14 million (7.4%) of American adults are either alcoholics or alcohol abusers (1). Approximately 7 in 10 men and 6 in 10 women ingest alcoholic beverages. The figure shows that most adults keep their intake of alcoholic drinks at light-to-moderate levels (6).

Figure. Alcohol cons...
Figure. Alcohol cons...
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There are several groups of people who should not drink alcoholic beverages at all (7):

* Children and adolescents.

* Individuals of any age who cannot restrict their drinking to moderate levels. This is a special concern for people recovering from alcohol addiction and people whose family members have alcohol problems.

* Women who are trying to conceive or who are pregnant. Major birth defects, including fetal alcohol syndrome, have been attributed to heavy drinking by the mother while pregnant. A safe level of alcohol intake during pregnancy has not been established.

* Individuals who plan to drive or take part in activities that require attention or skill. Most people retain some alcohol in the blood 2 to 3 hours after a single drink.

* Individuals using prescription and over-the-counter medications. Alcohol may alter the effectiveness or toxicity of medicines.

If you elect to drink alcoholic beverages, you should consume them in moderate amounts, which is defined as no more than two drinks a day for men and one drink a day for women. One serving of alcohol, commonly called a drink, delivers 0.5 oz of pure alcohol and is found in the following (7):

* 12 oz of regular beer (150 calories).

* 4 to 5 oz of wine (100 calories).

* 1.5 oz of 80-proof distilled spirits (100 calories).

* 10 oz of a wine cooler (140 calories).

The amount of alcohol in actual mixed drinks varies widely, however. Although a whiskey sour/highball has approximately 0.5 to 0.6 oz of ethanol, a dry martini has approximately 1 oz, and a Manhattan has 1.15 oz.

When ingested, alcohol passes from the stomach into the small intestine, where it is rapidly absorbed into the blood and distributed throughout the body. Peak blood alcohol levels are reached in fasting people within 30 minutes to two hours (1). As a rule of thumb, one standard alcoholic drink consumed within one hour will produce a blood alcohol level or content (called BAL or BAC) of 0.02 in a 150-lb male subject, but this varies depending on body size, sex, food taken along with the alcohol, and tolerance (i.e., less responsive to alcohol because of long-term use). Four to five beers consumed within one hour will cause the BAC to rise on average of 0.08 to 0.10, which violates the drinking and driving laws of most states.

The liver enzyme system takes three hours on average to clear the body of alcohol from two to three drinks. Go to www.intox.com where you can calculate BAC based on your body size and sex and types and quantities of alcoholic beverages consumed within a certain amount of time (click on "drink wheel").

If you avoid alcohol abuse, will moderate drinking make someone like you even healthier? If your concern is heart disease, then the answer is "yes" according to a recent study of more than 50,000 health professionals but only if you keep your intake to less than two drinks a day (8). However, if all measures of health and risk of disease are considered, most researchers report that there is no net health benefit in drinking alcohol, especially for someone like you that is lean, eats well, and exercises nearly every day.

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References

1. National Institute on Alcohol Abuse and Alcoholism. Tenth Special Report to the U.S. Congress on Alcohol and Health. U.S. Department of Health and Human Services, 2000. Available at: www.niaaa.nih.gov/.

2. Goldberg, I.J., L. Mosca, M.R. Piano, et al. Wine and your heart. A science advisory for healthcare professionals from the Nutrition Committee, Council on Epidemiology and Prevention, and Council on Cardiovascular Nursing of the American Heart Association. Circulation 103:472-475, 2001.

3. Mukamal, K.J., K.M. Conigrave, M.A. Mittleman, et al. Roles of drinking pattern and type of alcohol consumed in coronary heart disease in men. New England Journal of Medicine 348:109-118, 2003.

4. Mokdad, A.H., J.S. Marks, D.F. Stroup, et al. Actual causes of death in the United States, 2000. Journal of the American Medical Association 291:1238-1245, 2004.

5. Stampfer, M.J., E.B. Rimm, and D.C. Walsh. Commentary: alcohol, the heart, and public policy. American Journal of Public Health 83:801-804, 1993.

6. National Center for Health Statistics. Health, United States, 2006. Hyattsville, MD: 2006. Available at: www.cdc.gov/nchs.

7. U.S. Department of Health and Human Services and U.S. Department of Agriculture. Dietary Guidelines for Americans (6th ed.). Washington, DC: U.S. Government Printing Office, 2005.

8. Mukamal, K.J., S.E. Chiuve, and E.B. Rimm. Alcohol consumption and risk for coronary heart disease in men with healthy lifestyles. Archives of Internal Medicine 166:2145-2150, 2006.

© 2007 American College of Sports Medicine

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