The Impact of Alcohol on Health

The effect alcohol, including in the form of beer, might have on the overall state of healthfulness of the body. What harm might it do and might it actually do some good? And let us start from a baseline statement that alcohol is relatively non-toxic, with an oral LD50 for the rat of 13.7 g/kg (i.e. the amount of ethanol which will kill half of the animals in an experimental population) (Bakalinsky and Penner 2003) Increasingly the evidence is that there appear to be bene ts in drinking beer (and other types of alcoholic beverage). Guallar-Castillon et al. (2001) concluded that the consumption of total alcohol (wine and beer) was associated with a lower prevalence of sub- optimal health. Hospitalisation is less acute for daily moderate drinkers (Longnecker & McMahon 1988), especially for women who had consumed between 29 and 42 alcoholic beverages in the fortnight prior to lling in the questionnaire. Artalejo et al.
(2000) found that moderate drinkers in Spain were less likely than abstainers to use healthcare services. Meanwhile Wiley and Camacho (1980) showed that moderate alcohol consumption (17–45 drinks per month) was associated with the most favourable adjusted health scores.
Beer drinkers were shown by Richman and Warren (1985) to have signi cantly lower rates of morbidity (sickness) than expected – one drink per day giving 15% less disability than was the case for the general population. There will be those reading this who will not be able to countenance such ndings.
If these people nd it hard to swallow that drinkers, imbibing in moderation, could be less ill, then they might note that they have certainly not been shown to be more sick. However, we must stress always that many of these studies are dealing with correlation, not necessarily causality. Some will argue that there may be other confounding factors not explored in the studies, and that those who tend to drink in moderation may have other lifestyle attributes that are the true reason for their enhanced healthiness. However, the sheer frequency of studies that have demonstrated the bene ts of restricted alcohol intake, weigh heavily in support of the merits of sensible drinking.
In the mid-1990s, the Department of Health within the British government addressed the matter of recommended safe limits for drinking. After (we presume) careful consideration of the scienti c and medical evidence available up to that stage, they increased the recommended limit for men from 21 units to 28 units per week, with the advice to
women being to drink no more than 21 units per week (previously it had been 14). They stressed that the daily maximum should be 4 units and that binge drinking (the equivalent of taking all of the weekly allocation at one sitting) is absolutely undesirable.
Individuals differ substantially in their bodily response to alcohol. Various factors will play a role, including body weight, general state of health, amount of activity, and whether the alcohol is being consumed on its own or alongside food. The UK guidelines are precisely that: blueprints to give some guidance to people to judge sensibly what is and what is not an advisable amount of alcohol to consume. They are not recommendations to drink: they are certainly not instructions. Rather they are a common-sense judgement on what is likely to be healthful for a sensible and healthy adult. And the fact that the levels were increased is testimony to the burgeoning evidence that there is real merit in moderate consumption of alcohol.
The author of a newspaper article in California once highlighted the number of times I had invoked the word ‘moderation’ when she interviewed me. I make no apology for using the word again here (particularly as a glance at the thesaurus in my computer offers the word temperance as a suggested alternative!). As the reader should surmise from what follows, there is more than ample evidence for the harmful effects of sustained, heavy intake of alcohol in all its forms. However, it will be noted that the serious ailments are primarily associated with extreme alcoholism, and a consequence of vastly more alcohol ingestion than is the norm for the great majority of adults.

Beer: a vice or a staple part of the diet?

Were we able to transport ourselves back to the Middle Ages and enquire in England, Flanders, Bavaria or Bohemia about the key features of the popular diet, ale or beer would unquestioningly and unhesitatingly be listed alongside meat, bread, milk and vegetables. The questioner would be regarded as being mightily peculiar if he or she were to question ale’s legitimate place on the table. It was neither a comfort food nor an extravagance. It was an integral part of the food intake in all walks of society. In eighth-century England a monk might consume eight pints of ale a day. Beer in Britain has long been considered to be a key part of the diet, as much so as wine in France. Henry Brougham MP (Brougham 1830) said that ‘To the poor the beer is next to a necessity of life.’
Over 50 years ago the nutritive value of beer was emphasised. An admittedly weakish beer [3% alcohol by volume (ABV) in the austere early post-war years] was claimed to provide 200 calories and a fth of a working man’s requirement for calcium, phosphorus,nicotinic acid and ribo avin (Bunker 1947). The satisfaction of having at least part of one’s dietary intake in a pleasurable form was not sneered at then.
Perhaps the rst person to conduct a serious study of the impact of abstinence, moderation and excessive drinking on health was statistician Raymond Pearl. On the basis of interviews with over 2000 workers in Baltimore, he concluded almost 80 years ago that on average moderate drinkers lived longer than abstainers and much longer than those who were heavy drinkers (Pearl 1926).
Yet now, at the dawn of the twenty- rst century, beer-drinking is regarded in many societies as a vice. It is surely astonishing that in the United States it is possible to buy cigarettes at the age of 18, but it is not legal to purchase alcohol until the age of 21. It would be a struggle to identify any merit associated with smoking, with the possible exception of its role as an anxiety relaxant. By contrast there is accumulating evidence that alcohol, including beer, in moderation can have a bene cial impact on health and wellbeing.
In passing, let us consider the legal age at which, in the US, it is possible to partake of other activities that surely might be considered a genuine risk to health and wellbeing, not only for the partaker but also for those around them. A child may legally drive a car, with relatively few restrictions, at the age of 16. More alarmingly, 35 states in the US have no licensing or registration requirements for guns (www.soros.org/crime/ higlights.htm). Seven states lack a legal minimum age for buying a ri e or shotgun from an unlicensed dealer, while six states have no legal minimum age for a child to possess a handgun. In ve states there is a minimum age – 16 in New York, Georgia, Vermont and Alaska, and just 14 in Montana. But the minimum legal age for drinking alcohol in all 50 states is 21!
Opinions about the relative merits and de-merits of smoking, driving, guns and alcohol will of course differ between individuals. Certainly if we consider the respective virtues of smoking, weapon use and alcohol (in restraint), then it seems to this author that there may be a warped set of priorities in one country at least. Nonetheless beer is the second most popular drink in the United States, with annual average per capita consumption at 357 8-ounce servings, after sodas and other soft drinks (861) (Beverage Digest 1998). Worldwide production of beer in 1999 ran at 0.13 billion litres.

Several drugs and hormones have an effect on body weight.

Some hormones cause weight gain and others cause weight loss. Hormones that cause weight gain are of particular interest, because if researchers can study and understand how they work, they may be able to develop drugs that can interact with these hormones in a way that makes it easier for people to lose weight. Insulin is a hormone that helps turn glucose (the sugar found in food) into energy the body can use. High levels of insulin lead to weight gain, although the reason why is not fully understood. Drugs used to treat diabetes, such as insulin and medications that make the body produce more insulin, cause weight gain. Obese people often have higher levels of naturally occurring insulin than their leaner counterparts.
Female hormones, like progesterone and estrogen, are associated with weight gain. Obese women most commonly begin to gain weight after puberty, when their bodies begin to produce these hormones. Birth control pills contain estrogen and progesterone, and are associated with weight gain. Today, birth control pills cause less weight gain than in previous years because they contain lower levels of estrogen. Some women may gain more weight than usual during pregnancy, up to 110 pounds (50 kg), which may be related to differences in their hormone levels during pregnancy, as compared to other pregnant women. Women who gain excessive weight during pregnancy may never fully lose this weight. Changes in hormone levels also occur during menopause. These hormone changes lead to a change in fat distribution, including increased central obesity (fat around the midsection or waist). This fat distribution is associated with increased health risks, especially heart disease.
Thyroid hormones increase metabolism and cause weight loss. People with the disease hypothyroidism (underactivity of the thyroid gland) have a smaller amount of thyroid hormone. People with hypothyroidism are predisposed to weight gain.When these individuals are treated with a drug that contains thyroid hormones, they lose weight. Thyroid hormones are dangerous in very high levels and must be monitored closely when taken. An excess of thyroid hormones in the blood can lead to several health problems, including high blood pressure, nervousness, insomnia (trouble sleeping), menstrual cycle changes, heart palpitations (the feeling that the heart is pounding), and fever. Several hormones that may play a role in weight gain have recently been discovered. One of these is leptin, a newly discovered hormone produced in fatty tissue. Increased leptin decreases food intake and increases metabolism in rats and, according to some early studies, in humans as well. Other hormones released by the stomach—including neuropeptide Y, cholecystokinin (CCK), enterostatin, and polypeptide Y 3-36— tell the body it has consumed enough food and should stop eating. Another hormone, ghrelin, is produced by the
stomach. Ghrelin signals hunger and increases appetite.
Ghrelin concentrations increase in response to weight loss. This may make ghrelin partly responsible for people gaining weight back after a successful diet. Table 2.2 lists some of the hormones that influence body weight. Clearly, many hormones affect body weight. Some of these hormones are known, and some have not yet been discovered. By studying these hormones researchers can better understand what causes people to gain and lose weight. Eventually, researchers may be able to develop drugs that can change levels of these hormones in the body, thus giving people who are overweight or obese another weapon in the weight loss battle. Intensive study is required to identify the possible negative effects of increasing or decreasing the level of hormones in the body.