health and spirits. The effect of alcoholic drinks on the brain and body has simultaneously worried, impressed, and downright mystified us ever since we learned of their existence. Over the centuries, the opinion on alcohol has swung between healthful, hurtful, and everything in between. But one line of thought has remained constant for hundreds of years: if you drink, drink in moderation, because any positive health benefit from drinking a little alcohol will be watered down by the negative aspects of drinking a lot of it.
Hope in a Bottle: The Early Years
From the beginning of distillation through the eighteenth century, distilled spirits were one of the most concentrated and effective medicines known to humanity, and indeed, at most times and places where they were known, they were an important part of the physician’s pharmacopoeia, however that profession was construed. See distillation, history. The stimulant properties of concentrated alcohol were noted early on, particularly in Europe. In the 1200s, the author of a treatise attributed to Ramon Llull “admired the smell and flavor of … distilled spirit and presciently suggested that it might be an excellent stimulant for soldiers before they went into battle,” writes Rod Phillips in Alcohol: A History. Llull’s colleague, fixated on finding youth-preserving potions, believed spirits held a key to those, too. The excellent extractive and preservative properties of spirits assisted in this belief, as alcoholized extracts of medicinal herbs were easily prepared and once prepared appeared incorruptible, remaining fresh for as long as they could be kept on the shelf.
While different infusions and botanical distillations were applied to different diseases (juniper spirits, for instance, were held to be a remedy for kidney problems), there was a great deal of leeway in their prescription. Indeed, that same juniper spirit was enlisted to perk up weary soldiers, but also to fight wound infection and a hundred other things. By the 1600s, European physicians were even prescribing spirits preventatively, with a half spoonful a day prescribed to maintain general overall health. By then, physicians considered distilled beverages a fix-it for everything from forgetfulness to heart disease.
Growing Concerns
As the popularity of spirits widened, it became hard to draw the line between when spirits could be helpful and when they may be harmful. And even as physicians continued to prescribe them, alcohol’s health halo began to fade. The dangers of excess grew more apparent, particularly in the seventeenth century, when new spirits, such as rum and whisky, also entered the fray. More people imbibing meant more frequent outbreaks of drunken behavior, prompting worries over not only the effect of spirits on overall wellness but also its threat to social order and public peace.
What doctors didn’t know then, which we are understanding increasingly better now, is that the ethanol in alcoholic beverages lessens (and, in higher doses, deactivates) the brain-circuit activity that allows us to feel anxious and afraid. And depending on the dose, it can hinder the ability to control behavior and make judgments, whether it’s buying items in a store or correctly reading another person’s body language. Without realizing that hard liquor contains a higher concentration of alcohol by volume compared to fermented beverages, early drinkers would imbibe in the same amounts and succumb to more reckless behavior than with the former. By definition, a typical 45-ml shot of 40 percent ABV liquor contains almost 20 ml of pure ethanol, which is the same amount of alcohol as 350 ml of beer (5 percent ABV) or 150 ml of wine (12 percent ABV). See
In 1917, the American Medical Association drew up a resolution declaring that it “opposes the use of alcohol as a beverage” and that “the use of alcohol as a therapeutic agent should be discouraged.” True, some doctors continued to prescribe spirits even through Prohibition—a loophole for drinking—but advances in medical science meant there was finally an explanation for the strange behaviors and failing health associated for centuries with drinking too much. See Prohibition and Temperance in America.
In 1969, a hallmark paper published in the New England Journal of Medicine secured the association between heavy drinking and liver damage. Heavy drinking is now defined as more than three drinks a day or more than seven per week for women; it’s more than four drinks a day or more than 14 per week for men. According to the National Institute of Alcohol Abuse and Alcoholism (NIAAA), about 20 percent of heavy drinkers develop an enlarged liver, known as fatty liver disease. The condition is reduced or disappears when drinking is stopped, but continued overdrinking can lead to more serious problems, such as alcoholic hepatitis, where the cells in the liver can get inflamed. All this can eventually lead to a condition called cirrhosis, where scar tissue replaces normal liver tissue, blood flow is disrupted, and the organ ultimately shuts down.
A 1973 article in The Lancet, a British medical journal, introduced the term “fetal alcohol syndrome.” When a pregnant woman drinks an alcoholic beverage, the alcohol passes from her bloodstream and into the placenta and the fetus. Alcohol present in a developing baby’s bloodstream can then interfere with the development of the brain and other critical organs, as well as their structures and how they function. This can result in stunted growth, reduced muscle tone and coordination, delayed cognitive development, heart defects, and facial deformities. Scientists now theorize that this may stem from alcohol’s tendency to prevent the absorption of folate, an important nutrient for fetal development. The greatest risk for severe problems occurs when a woman binge-drinks or is a regular heavy drinker, though even lesser amounts can cause damage. According to the US Department of Health and Human Services, there is no known safe level of alcohol consumption during pregnancy.
Besides chronic overdrinking, binge-drinking carries with it its own dangers. The NIAAA defines it as a pattern of drinking alcohol that brings blood alcohol concentration (BAC) to 0.08g/dl or above—which is typically five or more drinks consecutively in males or four or more in females over the course of about two hours. Most binge drinkers are not, in fact, alcohol dependent, and they’re most commonly between the ages of eighteen and thirty-four years old. A 2011 Journal of Substance Use paper reported that underage drinkers were more likely to binge on spirits, particularly vodka, than wine or beer. Besides impaired driving (and the potential tragedies that can arise from it), extreme cases of binge drinking can lead to alcohol poisoning—a condition in which there is so much alcohol in the bloodstream that areas of the brain controlling basic life-support functions begin to shut down. Symptoms include confusion; difficulty remaining conscious; vomiting; seizures; trouble with breathing; slow heart rate; clammy skin; dulled responses, such as no gag reflex; and extremely low body temperature.
New Health Worries
More recently, scientists have investigated the effect of alcohol on the immune system. In a 2011 British Journal of Pharmacology study on mice, alcohol caused an immune response in the brain, and the researchers believe that it is these changes that underlie the more obvious symptoms of too much alcohol, such as slurred speech and stumbling. When drugs were used to block certain immune receptors in the mice, the alcoholic effects were reduced. In a 2015 University of Maryland study, when healthy subjects guzzled enough alcohol in twenty minutes or so that a breathalyzer test registered 0.1 percent, two to five hours later their blood showed a decrease in the levels of disease-fighting cells—the same kinds that appear in the bloodstream when you have an infection or get a cut—and a reduction in their ability to function. These changes suggest that even a single binge episode could weaken our ability to recover.
For breast cancer, more than 100 epidemiological studies suggest that the more you drink, the greater the risk. As the British Journal of Cancer reports: “For every 10 grams of alcohol consumed per day (slightly less than one drink) researchers observed a small (7 percent) increase in breast cancer risk.” The increased risk was 7 percent for every 10 grams for colorectal cancer. It appears that the compounds produced when alcohol is broken down (notably, the toxin acetaldehyde) can damage DNA and proteins. Alcohol also seems to interfere with the absorption of nutrients and increases the levels of estrogen, which in itself has been linked to increased breast cancer risks.
For reasons unknown, alcohol is associated with decreased risk of kidney cancer and non-Hodgkin lymphoma.
A New Positive Spin
The news on alcohol took a surprising positive turn in 1996, when Morley Safer on 60 Minutes reported on a possible explanation for the “French paradox,” the phenomenon in which fewer French suffer from heart disease despite their fattier diets. As the theory goes, it’s because they imbibe in more wine than Americans, and wine, particularly red wine, contains resveratrol, a powerful antioxidant found in the skin of dark grapes. But it later turned out that the alcohol itself—whether in wine, beer, or spirits—had its own healthful benefits.
Although wine has garnered much of the attention for its heart-health connection since that 1996 report, the revival of alcohol as a healthful (or at least not harmful) drink began many years before. A 1996 British Medical Journal paper that reviewed twenty-five of those earlier studies—which, together, covered a range of alcoholic drinks (including wine, spirits, and beer) in relation to lower risks for coronary heart disease—reported that none of the drink categories had a stronger association than the other. More than 100 prospective studies have linked moderate alcohol intake to lower rates of various types of disease and cardiovascular-related deaths.
With moderate drinking, the molecules of alcohol seem, over time, to increase the concentration of high density lipoprotein (HDL) cholesterol, often called the “good” cholesterol, in the blood; HDL helps keep the inner wall of blood vessels healthy. Sam Zakhari, head of the office of scientific affairs at the Distilled Spirits Council of the United States, reports that moderate doses of alcohol also seem to prevent blood platelets from sticking together and improve other factors that affect blood clotting.
When consumed in moderation, alcohol may cut diabetes risks. In a 2011 American Journal of Clinical Nutrition paper, women who consumed a diet high in refined carbohydrates but also moderate levels of alcohol (about two drinks a week) had a 30 percent lower chance of developing type 2 diabetes than women with similar diets who refrained from alcohol. However, heavy drinking did not offset risks for diabetes. A 2013 Annals of Epidemiology paper suggests that alcohol’s ability to increase levels of HDL may help decrease the chances of diabetes. While the verdict is still out as to the details of how alcohol lowers diabetes risks, researchers believe that it can enhance the levels of anti-inflammatory molecules, as well as proteins (ghrelin, adiponectin) associated with insulin resistance.
While heavy drinking can cause cumulative damage to the brain in the long term, including shrinkage and learning and memory problems, several studies have also linked moderate alcohol consumption to some improved aspects of cognition, at least among older adults. A 2015 American Journal of Alzheimer’s Disease and Other Dementias paper reported that adults aged sixty or over who drank alcohol in moderation had a larger hippocampal volume and better episodic memory (the ability to recall past autobiographical events and experiences) than those who refrained. No difference was seen with respect to the amount of alcohol that participants consumed during middle age. Scientists believe that light to moderate amounts of alcohol may promote the generation of nerve cells in the hippocampus as well as the levels of brain chemicals associated with memory. It’s worth noting, however, that while this research suggests moderate alcohol consumption may be beneficial to the brain during old age, consuming even small amounts of alcohol can be harmful to older adults with certain medical conditions or who are taking certain medications.
American Liver Foundation. “Alcohol Related Liver Disease.” https://liverfoundation.org/alcohol-related-liver-disease/ (accessed April 22, 2021).
“Drinking Red Wine for Heart Health? Read This Before You Toast.” American Heart Association, May 24, 2019. https://www.heart.org/en/news/2019/05/24/drinking-red-wine-for-heart-health-read-this-before-you-toast (accessed April 22, 2021).
Foster, Gerald S., and Benjamin Castleman. “Case-30-1969: Liver Disease Associated with Positive L.E.-Cell Test and Positive Rheumatoid Factor; Case Records of the Massachusetts General Hospital.” New England Journal of Medicine 281 (1969): 206–213. https://www.nejm.org/doi/full/10.1056/NEJM196907242810408 (accessed April 22, 2021).
“How Morley Safer Convinced Americans to Drink More Wine.” CBS News, August 28, 2016, https://www.cbsnews.com/news/how-morley-safer-convinced-americans-to-drink-more-wine/ (accessed April 22, 2021).
National Cancer Institute. “Alcohol and Cancer Risk Fact Sheet.” https://www.cancer.gov/about-cancer/causes-prevention/risk/alcohol/alcohol-fact-sheet (accessed April 22, 2021).
National Institute on Alcohol Abuse and Alcoholism. “Alcohol and Your Health: Research-Based Information on Drinking and its Impact.” https://www.niaaa.nih.gov/alcohol-health (accessed April 22, 2021).
Phillips, Rod. Alcohol: A History. Chapel Hill: University of North Carolina Press, 2014.
Room, Robin. “Fetal Alcohol Syndrome: A Biography of a Diagnosis.” The Lancet, June 11, 2005. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)66681-0/fulltext (accessed April 22, 2021).
By: Joanne Chen