(December 30, 2008 - Insidermedicine) On a recent trip to Boston, we caught up with Dr. Kenneth Mukamal, MD, MPH, who is an Associate Professor of Medicine at Harvard Medical School. Dr. Mukamal's primary research interest is the relationship of behavioral and lifestyle factors, particularly alcohol consumption, to the development and prognosis of cardiovascular and other chronic diseases
If I were a thirty year old woman, should I be concerned about my alcohol intake?
I think that as a 30 year old woman, I would want to be counseled about the fact that there is really no benefit, in terms of the standard ways the we have been thinking about it, to drinking alcohol. All of the diseases that have been linked to moderate alcohol consumption in a good way are really disease that I might get 20-30 years from now, and so I only need to be focusing on what alcohol is going to be doing to me now, not at what it could be doing to me later on down the road.
What risks are associated with drinking alcohol?
As a 30 year old drinking woman, the most important risk to be thinking about is breast cancer; that’s an important cause of death in women who are in their 30s, even if it not that common. Breast cancer is clearly increased amongst moderate drinker, probably in the range of 30-40% across the board. So you are clearly adding to your risk, and if you are already above average risk for other reasons, it might be an important thing to keep in mind in trying to decide whether one wants to continue drinking.
It’s interesting because we think that the way that alcohol consumption raises breast cancer is through some of the same hormones that we know from other studies to be linked to breast cancer. We know that in small trials, drinking alcohol directly raises levels of some female sex hormones, and since we know those to be linked to breast cancer, we have a nice mechanism for putting those together.
Another important thing that I would want to know is how is this going to affect potential pregnancy and fertility, because that is obviously an important issue in child-bearing years. I think that it is important on the one hand to be realistic that a very light amount of drinking, if somebody should happen to have been drinking before they were pregnant, probably is not a catastrophe. On the other hand, we know that alcohol consumption is not a great thing for the fetus, and so I think, firstly, I would want to be drinking cautiously, and secondly, we also know that an important thing for a developing fetus is folate, one of the B vitamins. And we should be thinking about potential supplementing folate intake even before pregnancy to get the maximum benefit. The beautiful thing is that one of the ways in which alcohol consumption causes breast cancer may be modified/reduced by adequate folate intake, so I would want to know that if I take my folate regularly which will help for other things, I may get additional benefit not only to my fetus, but also to reducing my risk for developing breast cancer.
How is moderate alcohol consumption defined?
The formal recommendations for at least what women should be drinking during most of their lives is based on the National Institute on Alcohol Abuse and Alcoholism, and the NIAAA recommends that we drink no more than one drink per day for a woman, and no more than two drinks per day for a man, and we don’t get to store those up and drink them all on Friday night, it’s capped at one or two drinks per day. Now there is really no limit on drinking frequency, so if women can limit their alcohol intake to a single drink per day, there is no limit on how many days per week as long as there is no evidence of health damage from that. On the other hand, even one of two days a week of drinking above recommended levels does seem to potentially confer risk of harm. For example, acute episodes of heavy drinking have been linked to things like violence, and trauma, so it’s important, I think, to stick to those limits which for a 30 year old woman would be a drink per day.
Is the beverage type an important consideration?
Another common question that pertains to both 30 year olds and everybody else whether there is a difference among different types of alcohol. If I were a woman, should I be drinking wine particularly, or should I be drinking something else. From our work, there doesn’t seem to be a real advantage of one over the other. Alcohol is alcohol, so if I am limiting it to a drink per day, it’s a drink per day of wine or a drink per day of beer; just because I drink red wine doesn’t mean that I should assume that I’m avoiding any of the risks, because I don’t think you are.
If I were a 30 year old woman drinking regularly, I would want, first, to know that there are a lot of health effects to even drinking that amount of alcohol, and I would probably want to talk with my doctor about understanding those and putting those together based on my family history. Second, I would want to know that there is potentially some health benefit to me of taking fulate and a multivitamin regularly both for other things that might be important for me during my child-bearing years, but also for moderating my risks from alcohol as well.