A common question I get from my patients at Parsley Health is "How much alcohol is too much alcohol?" For each of them, the answer is different. Because as with most health issues, alcohol consumption needs to be put into the context of the individual.
Ask yourself how much you drink in a week. How many drinks total? What types of drinks are you consuming: beer, wine, whiskey, vodka, mixed drinks? How much do you usually drink in one drinking period? Now consider the fact that most people tend to underestimate how much they drink. In fact, medical students are taught to roughly double the amount that the average patient will share with them.
The facts about alcohol and your health
Scientifically, it’s fairly well-accepted that moderate drinkers may actually be healthier as a group than people who drink heavily or don't drink at all. However, the way doctors and spring-breakers define “moderate” alcohol consumption varies greatly and also depends on gender. Besides men being generally larger than women, they also have more of an enzyme that digests alcohol in the stomach, meaning less alcohol actually enters their blood stream per drink.
In technical terms, moderate alcohol consumption is defined as no more than two drinks per day for men and one drink per day for women. (Sorry, ladies.)
Heavy drinking is described as more than 14 drinks per week or four drinks per occasion for men, and more than seven drinks in a week or three drinks per occasion for women. (Again, sorry ladies.)
Binge drinking is medically defined as five or more drinks in one drinking occasion for men and four or more drinks in one drinking occasion for women. And heavy drinking or binge drinking can significantly increase your risk for developing health problems and alcohol abuse–related issues.
Now consider that fact that a standard drink size is 14-15 grams of alcohol, which is roughly equivalent to 12 ounces of beer, five ounces of wine or one ounce of hard alcohol. It’s pretty easy to measure drinks when you’re thinking in terms of a bottle of beer, but how much wine is actually in your glass? A what if it’s continuously being topped off by an overly generous waiter or bartender?
First, the bad news
Excessive alcohol consumption is linked to a number of concerning health matters. While you may not always drink to excess, frequently crossing the line still puts you at a greater risk for developing many of the health problems associated with excessive drinking, such as cardiovascular disease (heart disease, hypertension, peripheral vascular disease, stroke and arrhythmias), liver and kidney dysfunction, pancreatitis, and osteoporosis. It also increases your risk for having an accident.
Unfortunately, moderate drinkers aren't getting a free pass, either. Moderate alcohol consumption is associated with an increased risk of certain cancers, including breast, esophageal, and liver. And perhaps most profoundly, heavy drinkers and their families tend to have decreased quality of life.
Now, the good news
On the other hand, moderate alcohol consumption can be associated with health benefits and perhaps even a self-perceived higher quality of life. Moderate drinkers have lower overall mortality and tend to have reduced cardiovascular disease (including heart attacks and strokes), as alcohol has a cardio-protective effect—even for those with preexisting hypertension. In fact, light to moderate alcohol consumption may protect against heart failure and reduce the risk of developing diabetes mellitus, metabolic syndrome, and peripheral vascular disease. That said, these benefits are mostly generalizations. And exactly what a healthy dose of alcohol looks like has yet to be determined; the largest studies to date suggest it's between one half to a full alcoholic beverage per day (for both men and women).
Deciding what's right for you
So should you drink? That depends. There's clear evidence that alcohol can be both healthy and unhealthy based on the relative dose and frequency. But even in moderation, alcohol can get in the way of your goals or personalized health plan. When one of my patients at Parsley Health is looking to lose weight or maintain a healthy weight, I always tell them that alcohol is low-hanging fruit. Alcoholic beverages have very little, if any, nutritional value but contain significant and unnecessary calories. Alcoholic beverages—weighing in at 100-150 calories each—are an easy way to shoot yourself in the foot. If you’re enjoying mixed drinks, the calorie count is even higher. I commonly see individuals lose 5 to 10 pounds just by cutting back on alcohol. Alcohol can also disrupt your gut health, particularly if you suffer from gastrointestinal issues. It has also been shown to hamper your sleep by denying you the deep and restorative phases that your body needs to rebuild itself.
Choosing your alcohol wisely
If you do drink, what type of alcohol should you choose? If you aren’t feeling well in general or have gut issues, avoid beer and whiskey as they often contain gluten and wheat. While wine earns praise for its resveratrol and mineral content, it contains too much sugar to be considered healthy. The “cleanest” and least-inflammatory choices are vodka, tequila, and mezcal. Here are some tips for sipping this summer:
1. Keep it simple.
Consider drinking your liquor without chasers or mixers, which add extra calories and are full of sugar. Instead, try seltzer water with a splash of lemon or lime.
2. Remember that the type of alcohol matters.
Reduce or avoid drinking beer and wine in favor of cleaner alcohols.
3. Pay attention to amounts.
A “good pour” may not be so good. Note how many ounces or grams of alcohol are going into your drinks.
4. Follow the “2 and 10" or "1 and 5" rules.
For men, limit yourself to two drinks in any sitting and 10 drinks per week. For women, it's no more than one drink per sitting and five a week.
For each ounce of alcohol consumed, you should drink eight ounces of water. This will keep you from becoming dehydrated, improve your body’s ability to metabolize the alcohol, ward off over-intoxication, and help you feel better the next morning.
6. Drink responsibly.
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Dr. Egler is board certified by the American Board of Family Medicine and has completed the certification training with the Institute of Functional Medicine. Currently, Dr. Egler serves as the Medical Director of Parsley Health Los Angeles. He graduated from Drexel University School of Medicine in Philadelphia and completed his residency training at the University of Colorado in Denver. He subsequently completed a fellowship in Academic Medicine/Faculty Development at UCLA before practicing the full spectrum of family medicine in a group practice in South Lake Tahoe for five years. Dr. Egler then returned to academics as an assistant clinical professor and residency director of health information technology at the University of Southern California for the next five years. During this time he obtained a master’s degree in spiritual psychology, which bridged the gap for him from conventional medicine to a more integrative health practice.