Rich –
I agree that the evidence points toward a dose-dependent relationship between alcohol use and it’s detrimental effects.
No one questions that heavy alcohol use causes significant health problems.
However, one of the limitations of medicine is that it has focused more on extreme conditions, i.e. disease, as opposed to health optimization, e.g. vitamin deficiency vs. optimal intake. We know you can get too little Vitamin C, and we know you can get too much Vitamin C; but what level of Vitamin C intake is optimal for you? Same with alcohol: clearly immoderate use (defined differently by different investigators) has detrimental effects. But the consequences (beneficial or otherwise) of modest alcohol use are less well understood. Is there an optimal ‘dose’?
Think for a moment about how alcohol is metabolized. There are several pathways by which alcohol is cleared from the body (interesting to note that your liver views alcohol as a toxin that needs to be cleared.). The predominant pathway is the enzymatic conversion of Ethanol (the specific alcohol we drink, as found in Highland Park or Macallan) to Acetaldehyde. Acetaldehyde (same chemical group as formaldehyde) is subsequently converted to Acetyl CoA. Acetyl CoA is converted to Fat.
Here’s the catch. Everyone’s level of enzymes is different, but in general the conversion of ethanol to acetaldehyde is faster than the conversion of acetaldehyde to fat. So, acetaldehyde accumulates, waiting for the next available enzyme. Unfortunately, acetaldehyde is a severe irritant and a precursor molecule of several different carcinogens. That is one mechanism by which alcohol causes cancer. Oral, esophageal, stomach, hepatic, colon, rectal, and breast cancer. Men can get breast cancer too. Alcohol creates fat, fat increases your estrogen level, estrogen further increases your risk of some breast cancers. Party on.
Now the odds are—and it’s just odds—the less alcohol you consume, the fewer carcinogens you are exposed to, and the less the risk of developing rectal cancer you incur.
So how little alcohol is safe? Zero, none, nada. Acetaldehyde may be converted to a carcinogen at any time. Every time you drink alcohol, you create acetaldehyde.
The Framingham study is one of the oldest and most revered studies in medicine. It is starting to reveal some other conclusions about alcohol use. The good news is that there seems to be a consistent finding that modest alcohol use (1-2 standard drinks for women, 2-3 for men) is somewhat protective against some cardiovascular disease. But increasingly there is evidence that even moderate or low alcohol use results in diminished brain volume. I’m stupid enough; I don’t need a smaller brain. Or cancer.
Alcohol disrupts sleep architecture, even small amounts. Do you need sleep? I know some of the tough guys out there think they don’t. Think again. Sleep is crucial for mental health, weight management, and is the time when you release growth hormone. Growth hormone is crucial for muscle recovery and healing.
So can you have a couple drinks after a workout or roadmarch and still function the next day? Why yes; I can’t remember a rugby game that didn’t end with beer, and I made it through practice the next day. But the question is not if you can do it, but are you optimizing your performance? The answer would seem to be ‘No.’ (Although I doubt a couple beers is why I never went on to play for USA. )
If you are OK with a sub-optimal performance, drink. These are probably small effects we are seeing anyway. But be aware you are making a choice and there is a lot we still don't understand about how alcohol interacts with our bodies.
Now where’d I put my Talisker?
