Monday, 7 May 2018

Would I be healthier if I quit drinking? My quest to understand the real tradeoffs of alcohol consumption.

The after-work gin and tonic. The bottle of wine over dinner. A few beers on the weekend. Before long, the alcohol adds up.

Is that a problem? Can drinking stand in the way of your health and fitness? Do you need to quit drinking to change your body? Or could it actually be good for you?

In this article we explore the question in a personal way.

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“Should I take a break from booze?”

Have you ever asked yourself this question?

I’ve asked it, as have many of our Precision Nutrition Coaching clients.

At the same time, like many of our clients, I’ve never really felt like I needed to quit drinking. My consumption is normal by most accounts, as is theirs. It’s “moderate.”

But boozy beverages seem to show up a lot in my life — and I know I’m not alone in that.

Maybe we like having a beer to mark the end of a work day. Maybe on Friday we get fancy with a cocktail.

Something to celebrate? Pour a little champagne. Crappy day? That Chardonnay or Cabernet will soften the edges a little bit.

The drinks can start to add up.

If we consider ourselves healthy people, alcohol is easy to justify. We exercise. We try to eat nutritious food. If we’re getting coaching, we know we’re working on our stuff.

But still. Some of us wonder…

Are we OK?

Are we justifying something we shouldn’t?

Are we ignoring the elephant in the room who’s currently dancing with a lampshade on its head and laughing a little too loud while telling off-color jokes?

Are we pretending craft beer or red wine is a health food because it’s artisanal or full of antioxidant something-something?

If we want to be healthy, fit, and functional, how does alcohol factor in?

As I discovered, the answer isn’t straightforward. (It rarely is.)

For one thing:

You may have heard that drinking is actually good for you.

Moderate alcohol intake is associated with a lower risk of diabetes, gallstones, and coronary heart disease.

Light to moderate drinking seems to be good for the heart and circulatory system, helping reduce your risk of cardiac arrest and clot-caused stroke by 25 to 40 percent.

And there have been several studies indicating that drinkers — even heavy drinkers — actually outlive people who don’t drink.

We see headlines like this every time a new study comes out, which seems fairly often, judging by my newsfeed.

An important point that seems to get buried:

If you don’t already drink, health experts recommend you don’t start.

Wait, what? If drinking is so good for you, then why not add that antioxidant-rich red wine to MyPlate — a nice goblet right where the milk used to be?

Because no one knows if any amount of alcohol is actually good for all of us.

Don’t worry, I’m not going to tell you not to drink.

That’s not what this article is about.

But, despite all the headlines and pro-drinking studies:

Most of the research on alcohol’s potential health benefits are large, long-term epidemiological studies.

This type of research never proves anything.

Rather than showing that X causes Y, it simply says that X seems to be correlated with Y.

So even though many studies suggest that light to moderate drinkers have lower rates of the above-mentioned health problems than non-drinkers, that doesn’t mean drinking causes those benefits.

Sure, it could be that alcohol consumption raises HDL (“good”) cholesterol. Or it could be that moderate drinking reduces stress.

Or it could be that drinking doesn’t cause any health benefit.

Rather, it could be that people who drink a light to moderate amount also have something else going on in their lives, unrelated to alcohol consumption, that keeps them healthier, such as:

  • robust and resilient genes
  • a lower-stress personality
  • a particular lifestyle
  • good social connections and support

We just don’t know for sure.

Any physiological effects would vary from person to person.

The amount of alcohol that may help your heart health might harm your friend’s — for instance, if they have a history of high blood pressure.

And most of the research indicates that you’d have to be a light to moderate drinker with no heavy drinking episodes (even isolated ones) to see a heart benefit.

OK, given that…

What is “moderation”, anyway?

Definitions vary around the world, but according to the United States Dietary Guidelines Advisory Committee, “moderate drinking” means, on average:

  • For women: up to seven drinks per week, with no more than three drinks on any single day.
  • For men: up to 14 drinks per week, with no more than four drinks on any single day.

And here’s a guide to health-agency classified “drinks”:

Sure, you might know you’re not a binge drinker (that’s five or more drinks for men, or upwards of four for women, within two hours).

But when was the last time you poured wine in a measuring cup, or tallied your total number of drinks at the end of the week, or calculated your weekly average in a given month, or adjusted your tally to account for that sky-high 9.9% ABV Strong Ale you love?

Studies show that people routinely, sometimes drastically, underestimate their alcohol consumption.

It’s easy to edge into the “heavy” category without realizing it.

For example, if you’re a woman:

That’s a big problem, since heavy drinking comes with a much higher risk of major health problems.

Risks associated with moderate and heavy alcohol consumption

Moderate Heavy
Heart Arrhythmias
High blood pressure
Kidney disease
Heart disease
Stroke
Brain Disinhibition
Altered judgement
Poor coordination
Sleep disruption
Alcoholism*		 Chemical dependence
Depression
Alcoholism
Neurological damage
Epilepsy
Dementia
Damage to developing brains
Immunity Infection / illness / lowered immune response
Cancer (mouth, throat, esophagus, liver, breast)
Damaged intestinal barrier
Increased inflammation / flare-ups of autoimmune disorders
Hormones Breast cancer Hormone disruption
Impaired sexual function
Impaired reproductive function
Thyroid disease
Liver Worsening of existing conditions such as hepatitis Fatty liver
Alcoholic hepatitis
Fibrosis / cirrhosis
Hepatocellular
Liver cancer
Metabolism Weight gain or stalled weight loss**
Interference with some medications		 Loss of bone density
Bone fractures
Osteoporosis
Anemia
Pancreatitis
Changes to fat metabolism
Muscle damage

*Particularly if there’s alcoholism in your family
**If drinking causes you to eat more food or opt for energy-dense meals

In young males especially, even moderate drinking increases the risk of accidental injury or death, due to the “Hey y’all, hold my beer and watch this!” effect, or simply the dangerous equation of youthful exuberance combined with less impulse control, combined with more peer pressure, combined with things like motor vehicles and machinery.

All drinking comes with potential health effects.

After all, alcohol is technically a kind of poison that our bodies must convert to less-harmful substances for us to enjoy a good buzz relatively safely.

Through a series of chemical pathways using the enzymes alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH), we convert ethanol to acetaldehyde, then to acetate. The body breaks acetate down into carbon dioxide and water.

A second system for processing alcohol, the microsomal ethanol oxidizing system (MEOS), involves cytochrome P450 (CYP), an enzyme group that chemically affects potentially toxic molecules (such as medications) so they can be safely excreted.

In light to moderate drinkers, only about 10 percent of ethanol processing is done by the MEOS. But in heavy drinkers, this system kicks in more strongly. That means the MEOS may be less available to process other toxins. Oxidative cell damage, and harm from high alcohol intake, then goes up.

The biochemistry doesn’t matter as much as the core concepts:

1. We have to change alcohol to tolerate it.

2. Our ability to process alcohol depends on many factors, such as:

  • our natural individual genetic tolerance
  • our ethnicity and genetic background (for instance, many people of East Asian ancestry have a genetically-linked aldehyde dehydrogenase enzyme deficiency, which affects their ability to properly metabolize alcohol)
  • our age
  • our body size
  • our biological sex
  • our individual combinations of conversion enzymes
  • etc.

3. Dose matters. But all alcohol requires some processing by the body.

So what’s the “sweet spot”?

What amount of alcohol balances enjoyment (and your jokes becoming funnier) with your body’s ability to respond and recover from processing something slightly poisonous?

The moderate-vs-heavy guidelines are the experts’ best guess at the amount of alcohol that can be consumed with statistically minimal risk, while still accounting for what a lot of people are probably going to do anyway: drink.

It doesn’t mean that moderate drinking is risk-free.

But drinking is fun. (There, I said it.)

In North America, we tend to separate physical well-being from our emotional state. In reality, quality of life, enjoyment, and social connections are important parts of health.

So let me say it:

I enjoy drinking.

So do a lot of other people.

In the U.S., for example, 65 percent of people say they consume alcohol. Of those drinkers, at least three quarters enjoy alcohol one or more times per week.

The wine flows at lunchtime in continental Europe (for Scandinavians, it’s the light beer lättöl). Hitting a pub or two after work is standard procedure in the UK and Japan. Northern Europeans swear by their brennivin, glögg, or akvavit (not to mention vodka). South America and South Africa alike are renowned for their red wines.

Thus, for much of the world’s population, alcohol — whether beer, wine or spirits — is something of a life staple.

And if you’re doing it right — meaning tasteful New Year’s Eve champagne toasts are more common in your life than shot-fueled bar dances to “Hotline Bling” — there are some undeniable benefits to be gained:

  • Pleasure: Assuming you’ve graduated from wine coolers and cheap tequila shots, alcoholic beverages usually taste pretty darn delicious.
  • Leisure: A bit of alcohol in your bloodstream does help you feel relaxed. And like a good meal, a good glass of wine should offer the opportunity to slow down for a minute.
  • Creativity: There’s evidence that when you’re tipsy, you may be more successful at problem-solving thanks to increased out-of-the-box thinking.
  • Social connection: Drinking may contribute to social bonding through what researchers call “golden moments” — when you all smile and laugh together over the same joke. This sense of community, belonging, and joy can contribute to your health and longevity.

If you’re going to drink, drink because you genuinely enjoy it.

Drink if it truly adds value and pleasure to your life.

Not because:

  • you’re stressed
  • it’s a habit
  • other people around you don’t want to drink alone; or
  • it’s “good for you”.

With confusing alcohol consumption categories and contradictory news headlines, many people give up trying to decide whether drinking is healthy or not.

A new study shows alcohol may be harmful? Whatever.

Or:

Drinkers live longer? I’ll hop on that horse and ride it straight to the bar!

So forget about the potential health benefits of alcohol.

There are plenty of (probably better) ways to reduce your risk of cardiovascular disease — like eating well, exercising, and not smoking.

Wanting the enjoyment of a perfect Old Fashioned or a rare sake is a legitimate — probably the best — reason to drink.

As with what you eat, what you drink should be purposeful and mindful. And delicious.

Drinking or not drinking isn’t about “healthy vs. not”. It’s about tradeoffs.

Alcohol is just one factor among many that affect physical performance, health, and fitness.

Whether to keep drinking or cut back depends on how much you drink, what your goals are, and how you want to prioritize those things.

Only you know what you are, or aren’t, willing to trade.

It may be a simple “yes” or “no”.

  • Saying “yes” to Friday happy hour might mean saying “no” to your Saturday morning workout.
  • Saying “yes” to marathon training might mean saying “no” to boozy Sunday brunches.
  • Saying “yes” to better sleep (and focus, and mood) might mean saying “no” to your daily wine with dinner.
  • Saying “yes” to moderate alcohol consumption might mean finding a way to say “no” to stress triggers (or human triggers) that make you want to drink more.

Or it may be where you’re willing to move along the continuum.

  • Maybe you’re willing to practice drinking more slowly and mindfully, but you’re not willing to decrease your total alcohol intake.
  • Maybe you’re trying to lose weight, so you’d consider drinking a little less. Like 2 beers instead of 3, but not 0.
  • Or, maybe you’re willing to stay sober during most social situations, but you’re not willing to endure your partner’s office party without a G&T on hand.

Maybe there is a “best” answer for how much alcohol is okay for everyone. But we don’t know what it is yet.

At least not for certain.

That’s OK.

You can write your own “Owner’s Manual” for YOU as a unique individual.

Guidelines for drinking don’t tell us who YOU are or what effects alcohol has on YOU.

So let’s forget about “expert” advice for just a moment.

Instead, let’s try letting your body lead.

Read its cues. Observe yourself carefully, gather data, and see how alcohol is — or isn’t — working for you.

Here’s how.

What to do next:
Some tips from Precision Nutrition

1. Observe your drinking habits.

Keep track of all the alcohol you drink for a week or two (here’s a worksheet to help you).

You don’t need to share it with anyone or feel like you need to change anything. Just collect the info.

Next, review the data. Ask:

  • Am I drinking more than I thought? Maybe you hadn’t been taking the couple of casual beers with Sunday NFL into account.
  • Is my drinking urgent, mindless, or rushed? Slamming drinks back without stopping to savor them can be a sign that drinking is habitual, not purposeful.
  • Is alcohol helping me enjoy life, or is it stressing me out? If you’re not sleeping well or feeling worried about the drinking, the cost can outweigh the benefit.
  • Does alcohol bring any unwanted friends to the party? Binge eating, drug use, texting your ex?

If any of the answers to these questions raise red flags for you, consider cutting back and seeing how you feel.

2. Notice how alcohol affects your body.

Use Precision Nutrition’s “how’s that working for you?” litmus test. Ask:

  • Do I generally feel good? Simple, but telling.
  • Am I recovering? How’s my physical performance after drinking? If I were to hit the gym on Saturday morning after a Friday night social, how would I feel and perform?
  • What happens afterwards? Do I get a hangover, upset stomach, poor sleep, puffiness/bloating and/or other discomfort?
  • How does the extra energy intake work for my goals? Is alcohol adding some calories that I don’t want? Am I trying to lose weight, for instance?
  • What do my other physiological indicators say? What did my latest medical tests suggest? How’s my blood work? My blood pressure? Any other physiological indicators that I’m watching?

If you’re unsure about whether your alcohol use is helping or hurting you, talk to your doctor and get a read on your overall health.

3. Notice how alcohol affects your thoughts, emotions, assumptions, and general perspective on life.

Again: How’s that working for you?

  • Do you feel in control of your drinking? Are you choosing, deliberately and purposefully… or “finding yourself” drinking?
  • What kind of person are you when you are drinking? Are you a bon vivant, just slightly wittier and more relaxed, savoring a craft beer with friends? Or are you thinking, Let’s make that crap circus of a workday go away, as you pound back the liquid emotional anesthetic through gritted teeth?
  • If you had to stop drinking for a week, what would that be like? No big deal? Or did you feel mild panic when you read that question?

4. Play “Let’s Make a Deal”.

To pinpoint which goals and activities in your life are the most important to you, ask yourself:

  • What am I currently saying “yes” to?
  • What am I currently saying “no” to?
  • What am I willing to say “yes” to?
  • What am I willing to say “no” to?
  • What am I prepared to say “yes” and “no” to? Why?

There are no right or wrong answers.

Just choices and compromises.

You’re a grown-up who can think long-term and weigh options rationally. Whether you drink or not is your call.

5. Disrupt the autopilot.

One of the keys to behavior change is moving from unconscious, automatic reactions to conscious, deliberate decisions.

To experiment with decreasing your alcohol intake, try these strategies:

  • Delay your next drink. Just for 10 minutes, to see if you still want it.
  • Look for ways to circumvent your patterns. If you usually hit the bar after work, try booking an alcohol-free activity (like a movie date or a yoga class) with a friend instead. If you stock up on beer at the grocery store, skip that aisle altogether and pick up some quality teas or sparkling water instead.
  • Savor your drink. Tune into the sensations in front of you. Here’s an idea: try tasting wine like a sommelier. Look at it, swirl it, sniff it, taste it.
  • Swap quantity for quality. Drink less, but when you do drink, treat yourself to the good stuff.

6. Call on the experts.

Change almost always works better with support. It’s hard to change alone.

  • Talk to your doctor about your drinking patterns and your health.
  • Consider genetic testing. Many commercial genetic testing services can tell you about your alcohol tolerance, or your risk of other chronic diseases (such as breast cancer) that are linked to alcohol intake.

7. If you choose to drink, enjoy it.

Savor it. Enjoy it mindfully, ideally among good company.

If you’re a coach, or you want to be…

Learning how to coach clients, patients, friends, or family members through healthy eating and lifestyle changes (including how to manage energy balance) — in a way that supports long-term progress — is both an art and a science.

If you’d like to learn more about both, consider the Precision Nutrition Level 1 Certification. The next group kicks off shortly.

What’s it all about?

The Precision Nutrition Level 1 Certification is the world’s most respected nutrition education program. It gives you the knowledge, systems, and tools you need to really understand how food influences a person’s health and fitness. Plus the ability to turn that knowledge into a thriving coaching practice.

Developed over 15 years, and proven with nearly 100,000 clients and patients, the Level 1 curriculum stands alone as the authority on the science of nutrition and the art of coaching.

Whether you’re already mid-career, or just starting out, the Level 1 Certification is your springboard to a deeper understanding of nutrition, the authority to coach it, and the ability to turn what you know into results.

[Of course, if you’re already a student or graduate of the Level 1 Certification, check out our Level 2 Certification Master Class. It’s an exclusive, year-long mentorship designed for elite professionals looking to master the art of coaching and be part of the top 1% of health and fitness coaches in the world.]

Interested? Add your name to the presale list. You’ll save up to 33% and secure your spot 24 hours before everyone else.

We’ll be opening up spots in our next Precision Nutrition Level 1 Certification on Wednesday, October 3rd, 2018.

If you want to find out more, we’ve set up the following presale list, which gives you two advantages.

  • Pay less than everyone else. We like to reward people who are eager to boost their credentials and are ready to commit to getting the education they need. So we’re offering a discount of up to 33% off the general price when you sign up for the presale list.
  • Sign up 24 hours before the general public and increase your chances of getting a spot. We only open the certification program twice per year. Due to high demand, spots in the program are limited and have historically sold out in a matter of hours. But when you sign up for the presale list, we’ll give you the opportunity to register a full 24 hours before anyone else.

If you’re ready for a deeper understanding of nutrition, the authority to coach it, and the ability to turn what you know into results… this is your chance to see what the world’s top professional nutrition coaching system can do for you.

References

Click here to view the information sources referenced in this article.

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