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LPI on Alcohol

SOURCE:
http://lpi.oregonstate.edu/infocenter/foods/alcohol/

SUMMARY
--moderate consumption-->lowers risk of coronary heart dz and ischemic stroke
--moderate = 2 drinks/day for men, 1 for women and elders
--some evidence for protective effect re: type 2 diabetes, dementia, and gallstones
--moderate alc consumption-->breast CA, birth defects, progression to addiction/heavy drinking
--heavy drinking--> hypertension, hemorrhagic stroke, heart rhythm disturbances, dementia, accidents, injury, violence, and damage to the heart, liver, and pancreas, cancers including oral, esophageal, liver, breast, and colorectal cancers
--combine alcohol and tobacco-->big risk of oral and esophageal cancers
--if you drink get adequate folate by taking a daily multivitamin w/ 400mcg folic acid
--risks of moderate drinking outweigh the benefits for some people
--recommend abstenance for: kids through teens, preg and women who might get preg, addicts or fam hx of alc problems, liver dz or alc related organ damage, hx of breast CA, driving or machinery operation, consider drug interactions

INTRO
--science shows benefits of moderate alc consumption
--J shaped curve btw alc and mortality: heavy drinking kills, "moderate" or light drinking is beneficial mostly to cardiovascular risks
--standard alcoholic drink = ~14 grams of alcohol = 12 oz beer, 5 oz wine, 3.5 oz fortified wine (e.g., sherry or port), or 1.5 oz liquor (distilled spirits)
--heavy drinking = over 15 drinks/week for men or 5+ in one event
--for women 8+/week or 4+ per sitting
--over 65 same as for women
--women weigh less on average, absorb and metabolize alcohol differently than men
--women have less body water than men of similar body weight
--women achieve higher blood alcohol concentrations after same amount
--women more vulnerable to adverse health effects of heavy drinking than men
--old folks may reach higher body concentrations of alc dt lower bod H2o content

REDUCTION IN CHD
finding confirmed by more than 60 epidemiological studies
meta-analysis combining 28 prospective cohort studies finds:
adults consuming average 25 grams/day of alcohol (two standard drinks)
-->20% lower CHD risk than nondrinkers
more recent data suggests risk reduction mb more like 30%
another study: 12-yrs, n=38,000+ male health professionals
those who drank 3-4x/wk had 32% less MI risk than those who drank less than 1x/wk
another study: 20-yrs, n=120,000 men and women
1-2drinks/day-->30% less CHD death risk than nondrinkers
coronary heart disease is a major cause of heart failure
study: n=21,601 men and another n=126,236 men and women
moderate alcohol intake inversely associated with heart failure, esp dt CHD

MECHANISM OF CHD REDUCTION?
mech of dz: atherosclerosis, vascular inflammation, and clot formation
moderate daily alcohol intake sig incr HDL-cholesterol levels
decreases serum levels of fibrinogen (clot forming prot)
increases levels of tissue type plasminogen activator (clot dissolver)
poss anti-inflammatory effect
lower C-reactive protein (CRP) in moderate drinkers
improved insulin sensitivity
lower serum triglycerides
reductions in abdominal obesity

RED WINE
--“French Paradox” = mortality from CHD low in France despite high saturated fat intake, and cigarette smoking-- > people decided wine was protective
--rich in phenolic compounds like resveratrol
--antioxidant, anti-inflammatory, anti-atherogenic properties in the test tube and animals
--so far protection seems to be more from alcohol content than from the phenols
--some studies say wine better than beer, others don't
--some studies say wine drinkers have more money-->better healthcare, better diet, etc
--moderate alcohol consumption consistently associated with 20-30% reductions in CHD risk
--not yet clear whether nonalcoholic compounds abundant in red wine confer any additional CHD risk reduction

ISCHEMIC STROKE
83% of all strokes (hemorrhagic is other kind)
mod alc consumption reduces ischemic but not hemorrhagic
meta-analysis combining 19 & 16 studies
1-2 drinks/day-->28% lower risk of ischemic stroke

PERIPHERAL ARTERY DZ
intermittent claudication
limited evidence that moderate alcohol consumption-->decreased risk of PAD
3 large prospective studies find mod alc use-->decr in indicators of PAD
most recent study finds inverse assoc is sig in nonsmokers but not smokers
smoking risk outweighs drinking benefit

TYPE 2 DM
--adults with moderate alcohol intakes: sig lower risk of developing DM2 than nondrinkers
--heavy alcohol consumption assoc w/ increased risk of type 2 diabetes
--moderate alcohol consumption reduces risk of type 2 diabetes by about 30%
--moderate intake mb assoc w/ decr serum insulin & improved insulin sensitivity
--heavy drinking incr risk by incr obesity esp abdominal and hurting panc and liver fx

DEMENTIA
research not clear, results conflicting
older adults w/o dementia followed 6yrs, mod drinkers sig less dementia than abstainers
11,102 women in Nurses' Health Study: moderate alcohol consumption
-->improved cognitive function and less cognitive decline over a two-year period
one study found that brain infarctions less frequ in mod drinkers
anotehr study found no correlation
brain atrophy lowest in abstainers
need more research

GALLSTONES
mod intake-->sig less risk of stones or cholecystectomy
mb dt bile less crystalline bile

HEALTH RISKS OF MODERATE ALC CONSUMPTION
1/8 US women get breast CA
incr breast CA risk in premenopausal and postmenopausal women, regardless of alc type
each 10 gram (slightly less than one drink) incr/day-->9% incr in breast CA risk
another: each 10 gram incr-->7% incr in breast CA risk
another: each 10 gram-->10% incr breast CA risk
POSSIBLE MECHANISMS
alc-->incr est-->ca
alc is one of only a few modifiable risk factors for breast ca
alc interferes with absorption, transport, and metabolism of folate
folate required for DNA methylation and DNA repair
anyone who drinks 15gm/day of alc (over 1 drink) should take 400mcg/day of folate
taking folate sig decr breast ca risk

PREGNANCY
--40,000 infants/YEAR in US born with fetal alc exposure
--Fetal alcohol syndrome = cluster of physical and mental birth defects associated with heavy alcohol consumption during pregnancy
--facial abnormalities, mental retardation, and poor growth
--moderate alcohol during preg(7-14 drinks/week)-->more subtle effects on cognitive and behavioral development: problems with memory, attention and learning, and behavior
--no safe level of alcohol consumption has been established at any stage of pregnancy

PROGRESSION TO HEAVY OR HAZARDOUS DRINKING
--recovering alcoholics and those with family histories of alcohol abuse or alcoholism may not be able to maintain moderate drinking habits
--susceptibility to alcoholism affected by genetic, psychosocial, and environmental factors
--children of an alcoholic parent-->significantly higher risk of developing alcoholism
--nature and nurture
--The National Institute on Alcohol Abuse and Alcoholism recommends that people with a family history of alcoholism, especially in a parent, approach moderate drinking carefully

DRUG INTERACTIONS
alc metabolized in liver by same enzymes as many meds
drinking alc induces enzymes that change drug metabolism
alc also may increase sedation/drowsiness
serious interactions common with heavy alc use, mod use may also be dangerous
women and elders at highest risk of interaction
meds to be concerned about include: antibiotics, anticonvulsants, anticoagulants (Coumadin), antidepressants, antidiabetic agents, antihypertensive agents, barbiturates, benzodiazepines (sedatives), histamine H2-receptor blockers, muscle relaxants, and narcotic and non-narcotic pain relievers, also some OTC and herbs incl aspirin, acetaminophen (Tylenol), ibuprofen (Advil, Motrin), and naproxen sodium (Aleve), cold and allergy medications like diphenhydramine (Benadryl) and chlorpheniramine, heartburn medications like cimetidine (Tagamet) and ranitidine (Zantac), and herbal preparations like chamomile, valerian, and kava
be honest with your doc about your drinking
separate alc and meds by 2-3 hours
see http://www.niaaa.nih.gov/ for more
National Institute on Alcohol Abuse and Alcoholism

BENEFITS OF HEAVY ALCOHOL CONSUMPTION
None

RISKS OF HEAVY ALCOHOL CONMSUMPTION
(did they define heavy?)(moderate is 1-2 drinks/day, so I guess heavy is 3+)
cardiovascular disease, HTN,
(reducing alcohol consumption-->sig decr in systolic and diastolic blood pressure)
stroke (dt anti-thrombotic effects, more likely to bleed out)
heavy drinking-->2+x risk of hemorrhagic stroke, 70% incr in ischemic
cardiomyopathy, cardiac rhythm disturbances, and coagulation disorders
cardiac Arrhythmias and Sudden Cardiac Death: “holiday heart syndrome”
usu A-fib
sudden cardiac death
alcoholic Cardiomyopathy w/ longterm boozin
two stages: early asymptomatic, later symptomatic
7+ drinks/day x5yrs-->risk of asymptomatic alcoholic cardiomyopathy-->heart failure
women may be more susceptible

LIVER DZ
Chronic excessive alcohol use = major cause of dz/death from liver disease in US
alcoholic hepatitis, cirrhosis, esophageal varices, hepatic encephalopathy, ascites
renal failure
Italian study: liver dz accumulates at: 30 grams/day of alcohol (about 2.5 drinks/day)
serious liver disease develops in approx 10% of those drinking over 60 grams/day (5 drinks)
women and hep C pts most susceptible

CANCER
dose dependent risk increase
incr risk many places incl: mouth, throat, larynx, esophagus (all places where alc touches), and breast
combo of drink and smoke-->lots worse
long term drinkers-->liver cancer
also colorectal cancer esp if low folate intake

BRAIN DZ
cerebral atrophy-->alcohol-associated dementia and cognitive impairment
may decrease after a period of abstinence (alzheimer's won't)
nutritional deficiencies esp thiamin, niacin

PANCREATITIS
sudden onset of severe upper abdominal pain, N/V
~30% of acute pancreatitis cases in the U.S. are alcohol-induced
acute bouts-->chronic pancreatitis-->progressive destruction of the pancreas-->failure
~70-90% of chronic pancreatitis cases in the U.S. and west are alc induced
uncommon at alcohol intakes less than 80 g/day (seven drinks/day) x5years
only small % of heavy drinkers get pancreatitis
also imp: hereditary and environmental factors
more common in men, blacks, smokers

ACCIDENTS, INJURY, VIOLENCE
incr risk of: motor vehicle accidents, falls, and fires
1-2 drinks in prev 6 hrs-->sig incr in risk of injury
41% of all traffic fatalities in US alc related
legal blood alcohol concentration (BAC) limit for drivers ranges from 0.08-0.10 in the U.S.
impairment of driving skills begins at a BAC of 0.05
BAC of 0.05 happens in 175-pound male after 3 drinks in 1 hour
or in 120-pound female after 2 drinks
excessive alcohol-->suicide, homicide, domestic violence, sexual assault, gang violence

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