Alcohol - The risks

High risk
As the amount we drink and the number of times we drink increases, then so do the risks.

The risks to you:

Raised blood pressure which increases the risk of Stroke; stomach disorders; depression and
emotional disorders; cancers, particularly of the mouth, throat and gullet; hepatitis and cirrhosis of
the liver; malnutrition; accidents, at home, at work and on the roads; suicide.

The risks to your family:

Violence, accidents (perhaps influenced by you); less to spend on food; poor role model for children;
increased risk of divorce.

Advice
If you don't drink alcohol don't start!
If you do drink alcohol you can lower your health risks by cutting down or even stopping now.

If you drink less you will be less at risk from major illnesses, you will be less at risk from violence
and accidents, you will feel more healthy, and you will influence your family's healthy lifestyle.

HEALTH CONDITIONS AND ALCOHOL

Multiple studies suggest that consuming alcohol can affect the risk of developing certain health conditions.

Cardiovascular disease — Cardiovascular disease, including disorders of the heart, blood vessels, and blood circulation, is the
leading cause of death in the United States. However, several studies suggest that moderate alcohol use, as compared to heavy
drinking or abstaining, decreases the risk of coronary heart disease (CHD) and the most common type of stroke (ischemic
stroke) by 40 to 70 percent.

High blood pressure — People who consume more than two drinks per day have up to a twofold increase in the incidence of
high blood pressure compared with nondrinkers. However, the effect of drinking less than two drinks per day on high blood
pressure remains unclear. Heart attack — Drinking a moderate amount of alcohol is associated with lower risk of having a heart
attack.

Peripheral vascular disease — Peripheral vascular disease can cause pain in the calves with walking, also known as
claudication. Moderate alcohol use reduces the risk of peripheral artery disease in healthy men.

Stroke — Alcohol consumption has been shown to affect the risk of stroke in contradictory ways, depending upon the amount
of alcohol consumed and the type of stroke. A stroke occurs when brain tissue dies as a result of a sudden, severe disruption of
blood flow and insufficient oxygen. Strokes may be due to a blockage (ischemic stroke) or rupture and leakage (hemorrhagic
stroke) of one of the blood vessels supplying the brain.

Heavy alcohol use increases the risk of both ischemic and hemorrhagic stroke in all ethnic groups. Moderate alcohol use is
associated with fewer ischemic strokes; the risk appears to be lowest in people who consume one to two drinks per day. In
contrast, the risk of hemorrhagic stroke appears to rise even with minimal alcohol use.

Breast cancer — There is consistent evidence that breast cancer risk is higher for women consuming moderate to high levels of
alcohol (three or more drinks/day) compared with abstainers. Drinking as little as one to two drinks per day is believed to
increase this risk. (See
Taking folic acid (folate) may reduce the effect of alcohol consumption on breast cancer, suggesting that women who drink
alcohol may benefit from a daily multivitamin fortified with folic acid.

Cancers of the head and neck and digestive tract — Alcohol use has been linked to several types of cancer of the head and neck
and digestive (gastrointestinal) tract, even at low levels of consumption. People who drink and smoke have a greater risk than
would be expected from either factor alone.

Cancer arising within liver cells (hepatocellular carcinoma) has been linked to alcohol use. This may be related to liver scarring
(ie, cirrhosis) that occurs in people who consume excessive amounts of alcohol since cirrhosis is a major cause of hepatocellular
carcinoma. Low levels of alcohol do not clearly cause cirrhosis.

However, even at low levels, drinking may increase the risk of hepatocellular cancer in people with inflammation of the liver
(hepatitis) due to infection with certain viruses (ie, hepatitis C virus). People with chronic hepatitis should avoid alcohol

Cirrhosis — Low levels of alcohol do not clearly cause cirrhosis. Heavy drinking (at least five drinks daily) is generally
required to cause cirrhosis in men.

Gallstones — Moderate alcohol use has been shown to lower the risk of gallstones. However, heavy drinking may reverse this
benefit.

Pancreatitis — Heavy drinking increases the risk of both sudden (acute) and long-term (chronic) inflammation of the pancreas
(pancreatitis). Osteoporosis — Heavy drinking increases the risk of hip fractures because it increases the risk of both
osteoporosis and falls.

Pregnancy — There is a significant risk of birth defects related to use of alcohol use during pregnancy. Heavy drinking can
cause fetal alcohol syndrome, which prevents normal growth, intellectual disability (mental retardation), malformations of the
skull and face, and other findings.

Moderate alcohol consumption may also be harmful, although this is a matter of some controversy. There is no known benefit
of alcohol use during pregnancy. Thus, experts advise completely avoiding alcohol during pregnancy.

Perception of health and quality of life — Excessive and frequent alcohol use reduces quality of life for individuals, their
families, and others around them, potentially leading to failure at work or school, interpersonal problems, and physically
hazardous situations.

Accidents and trauma — Alcohol use increases the risks and severity of injury from motor vehicle accidents. Exposure to
alcohol is generally measured in blood alcohol concentration (BAC) rather than drinks per day or week.

In most of the United States, the legal BAC limit for driving is 0.08 percent, which corresponds to about 4 drinks for a 200
pound man and 2.5 drinks for a 150 pound woman. However, the risk of having an accident while driving doubles at a BAC of
only 0.05 percent, and driving ability is impaired with BACs as low as 0.02 percent.

Alcohol also increases the risk of injury from other sources. It has been shown to impair a pilot's ability to fly and an operator's
ability to control a boat, bicycle, and snowmobile. In addition, occupational injuries, falls, drownings, burns, and hypothermia
are more common in those who use alcohol, particularly in heavy drinkers. Alcohol is involved in more than one-quarter of all
rapes, at least one-half of serious assaults, and one-half to two-thirds of all homicides.

Suicide — Alcohol abuse is associated with an increased risk of suicide. However, moderate drinking does not appear to raise
suicide risk.

IS ALCOHOL SAFE FOR ME?

The bottom line is that it is difficult to weigh the benefits and risks of alcohol. Nevertheless, several important conclusions can
be drawn:
  Beginning to drink alcohol may be inappropriate for people who have been lifelong abstainers. There is no evidence
that abstainers who begin drinking will lower their risk of any disease.
 The diseases that may be prevented by moderate drinking (eg, coronary heart disease and ischemic stroke) are most
prevalent in older adults, men, and people with CHD risk factors (eg, hypertension, hypercholesterolemia, smoking,
diabetes mellitus). For these groups, moderate alcohol use may substantially reduce the risk of dying.
 For young to middle-aged adults, particularly women, moderate alcohol use increases the risk of the most common
causes of death, such as breast cancer and trauma. Men under age 45 years also may experience more harm than benefit
from drinking. In these younger age groups, moderate alcohol use is unlikely to reduce the risk of dying.

Consuming less than one drink daily appears to be safe (that is, if not done before or while operating a car or heavy equipment),
although even that level of drinking can be dangerous for some people (see next section).

Reasons to avoid alcohol — Alcohol use is not recommended for individuals who:

 Are younger than the legal drinking age (21 years in most states within the United States)
 Are pregnant
 Have a personal or strong family history of alcoholism
 Have a personal or strong family history of breast cancer
 Have had hemorrhagic stroke
 Have liver or pancreatic disease
 Have precancerous conditions of the digestive tract
 Operate potentially dangerous equipment or machinery (including cars, boats, planes, or construction equipment)

Wine versus other alcoholic beverages — Some research suggests that wine provides the strongest protection against
cardiovascular disease, possibly due to naturally occurring compounds known as flavonoids. In France, for example, death from
CHD is lower than would be expected from the high rate of smoking and saturated fats in the diet; this "French paradox" has
been attributed to frequent red wine consumption.

However, other studies indicate that all alcoholic beverages offer cardioprotective benefits. Whether beverage type matters for
specific diseases other than CHD remains uncertain, although most evidence suggests that it does not.

An "ideal dose" of alcohol — As mentioned above, for some people, no amount of alcohol is considered safe. However, for
individuals without such conditions, the healthiest dose of alcohol appears to be in the range of 0.5 to 1 drink of alcohol daily.

Gender differences — Established recommendations for safe levels of drinking do not address an "ideal" level of alcohol
consumption. However, they advise

 No more than two drinks daily for men

 No more than one drink daily for women

What is the best approach in my case? — The following guidelines may help in making an informed decision about alcohol use:

 Consult a healthcare provider to determine the specific risks and benefits of alcohol use. Multiple factors must be
considered in any such "risk-benefit analysis," including age, sex, personal medical history, family history, diet,
physical fitness, and certain lifestyle choices such as smoking, among others.
 If drinking alcohol is appropriate, follow recommended guidelines concerning moderate drinking, ie, limiting intake to
no more than one drink daily for women or two drinks daily for men.
 Women should not drink any alcohol during pregnancy; in addition, experts advise that women should stop drinking
when trying to conceive.
 Never consume alcohol before or while driving or operating any potentially dangerous equipment.
 Speak with your child's doctor about preventing alcohol use and abuse in children and teenagers. Unfortunately,
Americans are commonly introduced to alcohol during adolescence, around the same time that they are introduced to
automobiles; this can be a deadly combination.

Some experts suggest that we may save young lives if the drinking experience precedes legal driving; this may be done by
introducing children to the ceremonial use of low-proof alcoholic beverages at meals and providing information about
appropriate social uses of alcohol. Adults should model responsible drinking for children and adolescents by either abstaining
from alcohol or drinking in moderation. Clearly, children exposed to alcohol abuse in their parents are more likely to become
alcoholic themselves.