How is alcoholism bad for your health

Alcohol and health: for good?

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Dipl oec. troph. Maike Nestle

If you drink too often and too much alcohol, you endanger your health and risk becoming dependent. On the other hand, alcohol is supposed to be healthy when consumed in moderation. In fact, the health risks of even moderate alcohol consumption are mostly underestimated.

© Karel Miragaya /

Europe is the world leader in alcohol consumption. According to current WHO data, Germans aged 15 and over drink 11.8 liters of pure alcohol (ethanol) per capita per year, the Swiss 10.7 liters, Austrians 10.3 liters, and men on average slightly more than twice as much as women . In Germany and Austria, most alcohol is consumed in the form of beer (54% and 50%, respectively), followed by wine (28% and 36%) and spirits (18% and 14%, respectively). In Switzerland, wine ranks first (49%), followed by beer (32%) and spirits (18%). In Germany and Switzerland, only around 4% of men and 7% of women are abstinent for life. In Austria it is significantly more with 14% of men and 22% of women. Figures from Germany show that after the Second World War, alcohol consumption increased with increasing prosperity until 1980 (in East Germany until 1990), since then it has gradually decreased again, but is still at a high level.

Quickly absorbed, slowly degraded

Alcohol is absorbed quickly and almost completely by the body. A full stomach slows down absorption, while sugar, carbonic acid and warmth accelerate it. The maximum blood alcohol concentration is reached after just 1-2 hours. The muscles, brain and liver consume a lot of alcohol, but little fat tissue. This is also one of the reasons why women tolerate less alcohol than men: In addition to the usually lower body weight, women have on average more fat tissue and thus a lower body percentage in which the alcohol is distributed.

The blood alcohol concentration (in per mille) can be calculated approximately as follows: Men: blood alcohol concentration (‰) = alcohol intake (g) / body weight (kg) / 0.7 women: blood alcohol concentration (‰) = alcohol intake (g) / body weight (kg) / 0.6

From 0.2 ‰ alcohol has a stimulating effect, you feel freer and more relaxed. Resistance to further alcohol consumption also decreases. However, concentration, eyesight and coordination of movements are already deteriorating. At around 1 ‰ the intoxication stage begins with a silly cheerful or depressed mood and the typical balance and speech disorders such as staggering and babbling. From 2 ‰, there are memory disorders and loss of orientation. Above 3 ‰ there is a risk of acute alcohol poisoning, which can lead to death from respiratory failure. By far the largest proportion of the alcohol consumed is broken down by the body oxidatively. Only a few percent are excreted unchanged via the lungs, skin and urine. The gastric mucous membrane already contributes to a small extent to the breakdown of alcohol, but the main work has to be done by the liver. Different enzyme systems are available for this purpose, the activity of which is partially increased by alcohol. For this reason, people who drink alcohol regularly can break it down more quickly, so they don't get drunk as quickly. On average, men can break down 0.1 g alcohol per hour and women 0.085 g alcohol per kilogram of body weight (see box).

Men: alcohol consumed (in g) / (0.1 g alcohol / kg body weight / h x kg body weight) = xxx h
Women: alcohol consumed (in g) / (0.085 g alcohol / kg body weight / h x kg body weight) = xxx h
Example: A man (75 kg) and a woman (60 kg) each drink a quarter of a liter of wine (corresponds to approx. 24 g of alcohol). In men, alcohol is broken down after a good 3 hours, in women only after just under 5 hours.

In addition to large individual differences in alcohol breakdown, there are also considerable differences between ethnic groups, which are based on different genetic variants of the alcohol-breaking enzymes. In the Pacific region in particular, many people are alcohol intolerant: they have little activity of the alcohol-degrading enzymes and consequently even small amounts of alcohol can lead to nausea, nausea, feeling hot, sweating, racing heart and dizziness. The example of alcohol intolerance makes it clear that both alcohol itself and the intermediate product in the breakdown of alcohol, acetaldehyde, are cell toxins that damage the body - and not only in the case of alcohol intolerance.

Low risk at best

The list of well-known dangers of excessive alcohol consumption is long: Acute alcohol poisoning, alcohol addiction, fatty liver and liver cirrhosis, fetal alcohol syndrome, increased risk of high blood pressure, stroke, cardiac arrhythmias, heart muscle diseases, (traffic) accidents with sometimes fatal outcome. There is no general limit below which alcohol can be considered harmless to health. Experts consider it to be low-risk if healthy adults aged 21 and over do not consume more than 24 g (men) or 12 g (women) of alcohol per day. That corresponds roughly to a quarter or eighth liter of wine or a large or small beer (see table). Also, there should be two or more alcohol-free days a week so that alcohol does not become a habit.

Risky consumption patterns

It is considered to be risky if the specified quantities are exceeded or alcoholic beverages are consumed daily. According to figures from the Epidemiological Addiction Survey, this was the case for 16% of men and 13% of women in Germany in 2012. Another risky pattern of consumption is binge drinking, i.e. consuming five or more alcoholic beverages on one occasion. As part of the epidemiological addiction survey, 47% of men and 22% of women stated that they had consumed five or more alcoholic beverages on one occasion at least once in the past month. There are noticeable differences in age when it comes to binge drinking: while almost 60% of 18-20 year olds practice binge drinking, it is 23% among 60-64 year olds.

Alcohol abuse is spoken of when psychological, social or physical damage is caused or accepted as a result of risky alcohol consumption. This includes drinking and driving or acts of violence under the influence of alcohol, but also financial or family problems as a result of alcohol consumption. The transition to alcohol addiction is fluid. Characteristic of alcohol dependence (addiction) are unsuccessful attempts to control drinking, neglect of personal interests and the occurrence of withdrawal symptoms (e.g. sweating, tremors, restlessness, sleep disorders). Alcohol abuse occurs in around 1.8 million people in Germany, 1.6 million are acutely alcohol-dependent. Men are more than twice as likely to be affected as women.

Children and young people are particularly at risk

Young people need to learn to use alcohol responsibly. However, they are endangered not only because of their inexperience, but also because their organism is not yet fully developed and therefore particularly vulnerable: Alcohol as a strong cell poison can cause serious health damage, especially to the brain, especially in children and adolescents. For this reason, alcohol consumption is always a health risk for young people under the age of 21. In addition, the earlier adolescents start consuming alcohol, the higher their risk of later frequent and heavy alcohol consumption and of becoming dependent. The alcohol survey carried out by the Federal Center for Health Education (BZgA) in 2014 provides current figures on alcohol consumption among young people between the ages of 12 and 17 in Germany. According to this, less than one in four young people aged 12-15 drank alcohol in the 30 days prior to the survey. It was significantly more among the 16-17 year olds: 68% of the boys and 71% of the girls. Furthermore, 15% of the boys and 11% of the girls between the ages of 12 and 17 stated that they had drunk five or more alcoholic beverages on one occasion at least once in the 30 days prior to the survey. Fortunately, since 2007, both the number of young people who regularly consume alcohol and those who drink heavily have declined.

Does alcohol make you fat?

Several aspects suggest that increasing alcohol consumption is associated with the risk of unwanted weight gain. One gram of alcohol provides 7 kcal (29 kJ), and it is known that energy from alcoholic beverages is mostly ingested in addition to energy from solid foods. In addition, alcohol stimulates the appetite and appears to inhibit the effects of satiety hormones. In addition, during the breakdown of alcohol in the body, fat burning is inhibited at the same time and fat storage is thus promoted. However, study results regarding the relationship between alcohol consumption and weight gain or obesity are contradictory. The majority are more likely to believe that regular moderate alcohol consumption does not affect weight and could even protect against obesity, especially in women. This is probably due to the fact that moderate alcohol consumption is mainly found in people who are physically active and eat a balanced diet so that their energy balance is balanced in the long term. In contrast, binge drinking often leads to an increase in weight. To what extent this can be ascribed to alcohol or to a personality trait (binge drinking is often linked to binge eating) is still unclear. In relation to the alcohol content, the energy content of beer is around 30% higher than that of wine, as beer also contains a significant amount of carbohydrates. However, whether the so-called beer belly is caused by drinking beer has not been conclusively clarified. The study results are contradictory, especially when the beer consumption is less than 500 ml per day. Heavy beer drinkers (≥ 500 ml / day), on the other hand, developed abdominal obesity more often in the long term. The extent to which alcoholic beverages really influence weight needs to be investigated in further studies that examine alcohol intake in the context of various lifestyle factors and, in addition to total alcohol intake, also record the type of drink and consumption pattern.

Is Alcohol Healthy?

Red wine in particular enjoys the image of protecting against cardiovascular diseases when consumed in moderation. Two French scientists published their observations in the high-ranking medical journal The Lancet in 1992 that fewer people died of coronary heart disease in France compared to other Western European countries, despite a similarly unhealthy lifestyle with too much saturated fat, too much tobacco and too little exercise. The reason for this so-called French paradox was suspected to be the Mediterranean diet with plenty of vegetables, fruit, olive oil and especially red wine, which is widespread in France. Since then, many epidemiological studies have consistently described that moderate alcohol drinkers suffer or die less from cardiovascular diseases and live longer on average. The relationship is graphically described with a J-shaped curve: People who drink alcohol in moderate amounts have a lower risk of disease than those who do not drink alcohol. With increasing alcohol consumption, the curve and thus the risk of illness continue to rise.

Study results are only of limited informative value

Epidemiological studies can describe relationships between nutritional factors and diseases, but cannot prove that the observed relationships are causal. It is known that alcohol causes an increase in the "good" HDL cholesterol and improves the flow properties of the blood, which could explain the positive effect on the heart and blood vessels. However, scientists are divided on whether moderate alcohol consumption actually lowers the risk of cardiovascular disease. Some suspect that this is not a causal relationship, but rather moderate alcohol consumption is merely a marker for a healthy lifestyle and that unknown confounding factors distort the results so far. Indeed, many studies have methodological flaws and their results should be interpreted with caution. Typically, the group of people who do not drink alcohol for a lifetime is very small. For this reason, former drinkers were also included in the control group in many studies. But they could have stopped drinking alcohol because of an illness. Thus, a control group of non-drinkers, which includes the group of former drinkers, would on average be in poorer health than the group of moderate drinkers. Another weak point of many studies is the recording of alcohol intake, which was often only recorded once using questionnaires. An average daily alcohol intake is calculated from the information provided by the study participants, but this does not allow any statements to be made as to whether someone regularly drinks little or occasionally significantly too much alcohol or changes their drinking behavior over time. It is known that heavy drinkers have an increased health risk compared to moderate drinking and abstainers. In addition, various other factors are known that obscure the relationship between alcohol and health (e.g. age, gender, smoking, socio-economic status, various nutritional factors), which, however, were not adequately taken into account in the data analysis in all studies.

Is Wine Better Than Beer?

Whether wine offers a stronger protective effect against beer and spirits is also discussed controversially. The results of some studies suggest that the consumption of wine, and to a lesser extent beer, decrease the risk of cardiovascular disease, while the consumption of spirits tends to increase it. Red wine in particular contains a complex mixture of polyphenols, which are released from the skins of the grapes during maceration and have antioxidant, anticarcinogenic, anti-inflammatory and antihypertensive effects. A substance that has been intensively researched in this regard is the polyphenol resveratrol. However, a study published in 2014 found that the amount of resveratrol ingested through diet, including moderate amounts of red wine, had no notable effect on health.

Is it all just a mistake?

In order to actually prove a potential health-promoting effect of moderate alcohol consumption, randomized clinical studies would have to be carried out. These would not only be very costly to carry out, but are ruled out from an ethical point of view because of the risk of abuse and the development of addiction. Against this background, the results of a study published in 2014 are interesting, which examined the alcohol consumption and the risk of cardiovascular diseases of carriers and non-carriers of a certain variant of the gene for alcohol dehydrogenase 1B (ADH1B). Alcohol dehydrogenases are alcohol-degrading enzymes and occur in various forms in humans, including ADH1B. A variant of the gene for ADH1B means that affected people are more likely to react to alcohol with hot flashes and therefore consume less alcohol on average than non-carriers of this gene variant. In the study mentioned, carriers of the said gene variant drank 17% less alcohol compared to non-carriers, less often to the point of intoxication and more often no alcohol at all. Regardless of whether they belong to the group of non-drinkers, moderate drinkers (

Alcohol and obesity

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