Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
20 Nov

Alcohol: The Good and the Bad

What do we make of alcohol? In sufficient amounts, it’s a poison. It’s incredibly addictive. It destroys entire communities. It tears families apart and compels otherwise reasonable, upstanding individuals to commit terribly senseless acts. On the other hand, it’s a powerful social lubricant. The good stuff tastes great and can enhance the healthfulness of certain foods while inhibiting the unhealthfulness of others. It’s fun, it’s pleasurable, and it brings real (if chemically enhanced) joy to people. Moreover, we have a long and storied history with alcohol; it’s been an integral part of human culture and society for thousands, if not tens of thousands, of years.

So, what’s the deal? Is it good, or is it bad? Is it poison, or is it a gift? Let’s take a look at both sides of the story, which, as is often the case, isn’t exactly black and white:

First, the downsides.

It’s toxic.

Our ability to break alcohol down into less toxic metabolites didn’t arise because of our tendency to seek out fermented fruits. Over the course of an average day, the average human digestive system produces about three grams of ethanol just from the gut flora fermenting the gut’s contents. If we didn’t have the ability to metabolize and detoxify ethanol, those three grams would add up real quick and represent a huge toxin load on our bodies. After alcohol is consumed, a number of enzymatic reactions ensue. In the liver, an enzyme called alcohol dehydrogenase converts the ethanol to acetaldehyde, an incredibly toxic compound that’s been implicated in causing many hangover symptoms. An enzyme called acetaldehyde dehydrogenase converts the acetaldehyde into acetic acid, or vinegar (which is harmless unless you’re a cucumber). From there, you’re good to go. Sounds simple enough, right? Just let the enzymes do their thing. As long as you make those enzymes, the alcohol will be safely and effectively metabolized into table vinegar which can then be extracted to form a delicious salad dressing (that last part isn’t true).

Unfortunately, not everyone produces the same amount and quality of detoxifying enzymes. Many people of East Asian descent possess a dominant mutation in the gene that codes for aldehyde dehydrogenase, making it less effective. While they’re less likely to be alcoholics, folks with the mutation (characterized by a “flushing” upon ingestion) are at an elevated risk of liver damage and esophageal cancer.

It can give you fatty liver (and worse).

Around these parts, we usually talk about non-alcoholic fatty liver, a disease associated with sugar and fat intake coupled with inadequate choline to support the liver’s function. But notice that we have to qualify it with “non-alcoholic.” That’s because the most-studied type of fatty liver is alcoholic fatty liver. The mechanisms behind alcoholic fatty liver are myriad and multifaceted, but it ultimately comes down to the fact that you’re bathing your liver in a known toxin. Liver alcohol metabolism increases the NADH/NAD+ ratio, thereby promoting the creation of liver fat cells and a reduction in fatty acid oxidation; the result is added fat in the liver and impaired fat burning. Acetaldehyde, especially if it lingers for too long, also induces inflammation in the liver, which can ultimately progress to full cirrhosis and liver failure.

It can be carcinogenic.

Excessive alcohol intake is an established epidemiological risk factor for several cancers, including stomach, liver, and colon cancer (to name just a few; more than a dozen cancers are linked to alcohol abuse). In the stomach and liver, alcohol dehydrogenase converts ethanol into acetaldehyde, which is inflammatory and toxic. Alcohol that makes it through the stomach into the small intestine is also oxidized into acetaldehyde, this time by gut flora. While the liver produces the necessary enzymes to break down acetaldehyde into acetic acid, our gut microbes aren’t so well equipped and the acetaldehyde is allowed to linger longer.

It’s addictive.

While I’d argue that being addicted to anything will have a negative effect on your life, if not your physical health, being addicted to alcohol is particularly harmful because of how toxic it is – especially the more you drink. To get an idea of just how addictive it is, check out the results of this study: alcohol is less addictive than nicotine, crystal meth, and crack, but more addictive than heroin, intranasal amphetamine, cocaine, and caffeine. One’s susceptibility to alcohol addiction is often hereditary, too, meaning some people will be far more likely to become addicted than others.

It disrupts sleep.

A nightcap is a misnomer. Sure, it’ll help you fall asleep, but your sleep won’t be any better. In fact, as plenty of people reminded me in the comment section of last week’s post on sleep, alcohol is a serious disrupter of sleep quality. It increases the incidence of sleep disruptions, and it perturbs the healthy sleep cycles.

It affects judgment and perception.

Even though alcohol destroys a person’s ability to safely maneuver a motor vehicle, one in three car accidents that result in death involve drunk drivers. Everyone knows that you shouldn’t drive drunk, but why does it keep happening? A recent study even showed that just a single drink caused subjects to find “intentionality” in other people’s actions (PDF). Subjects who got the alcohol were less likely to view simple actions as accidental, rather than intentional. Thus, when you’re under the influence of alcohol, you’re more likely to take personal offense at the guy bumping into your shoulder, the lady stepping on your shoe, or the person “staring” at you from across the bar. Because, after all, they “meant” to do it, right? The title of the study sums it up quite nicely: “‘There’s No Such Thing as an Accident,’ Especially When People are Drunk.”

It promotes bad eating.

Everyone who’s ever gotten at least a buzz from a glass or two of wine or a mixed drink has felt the often irresistible urge to snack, to order something salty, crunchy, and sweet from the menu, to beg the driver to swing by the greasiest nastiest fast food drive-thru. This is a well-documented phenomenon. Alcohol affects both active overeating and passive overeating. Active overeating describes the conscious decision to “get some grub.” Passive overeating describes the amount you eat once the food is in front of you. Both are enhanced by alcohol. This wouldn’t be such a bad thing if you’re drinking at a Primal meet-up, where you’re surrounded by relatively healthy food, but that’s not where most drinking occurs.

It gives hangovers.

What’s worse than a bad hangover? I’m unaware of anything, at least on a physical scale. Sure, you can mitigate the damage, but the fact that a hangover even exists tells us that whatever we’re ingesting that gave us the hangover is bad for us (in the amount we ingested, at least).

But what about the positives?

It improves endothelial function (with a catch).

Impaired release of nitric oxide from the endothelial cells is strongly associated with cardiovascular disease. Ethanol actually increases the production of nitric oxide, which dilates blood vessels, regulates blood pressure, induces vascular smooth muscle relaxation, and basically improves endothelial function. If you want good cardiovascular health, you want good endothelial function. However, it’s important to note that large doses of ethanol seem to decrease endothelial function, so caution is obviously warranted.

It can reduce stress.

A lot of people use a glass of wine or beer to “wind down” after a hard day. This sounds bad on the surface – “you’re relying on alcohol to stay sane!” – but really, if you have to choose between stewing in your stress hormones all day and night and having a drink or two to settle yourself down, I think the drink can be a better option for some people – particularly if the stress is going to impair your sleep and affect your relationships. You’ll want to identify and deal with the original source of the stress, of course, but some people may find a net benefit from having that drink.

It promotes socializing.

Humans are social animals, and we are happiest and healthiest when we have friends, loved ones, and spend quality time with them. Social isolation is a consistent and strong risk factor for increased mortality and morbidity (meaning it’s linked with earlier death and worse health in the days up until that death). You shouldn’t base your socialization entirely on drinking alcohol, but it can certainly be a powerful enhancer of your social life, and if you’re having a couple of glasses of wine as you host dinner parties, hang out with friends, enjoy a candlelit dinner with your significant other, or throw a BBQ with your social circle, it will likely have a net positive effect on your health. Of course, this isn’t to say that alcohol is any way needed to have a good time in a social setting.

It can reduce post-prandial blood sugar and lipid peroxidation (when taken with a meal).

Just like it says above, drinking alcohol (like wine, for example) with food can reduce postprandial blood glucose and the susceptibility of blood lipids to peroxidation (PDF).

It can lower iron absorption if you’ve got iron overload.

Although the conventional push is to increase the intake of iron from foods (especially via fortified grains), some people don’t actually need the added iron. If you have hemochromatosis, a genetic condition that probably arose in Europeans as a survival response to the bubonic plague, you are a hyper-absorber of dietary iron. Luckily, ethanol seems to inhibit the absorption of heme iron, the kind you find in red meat. Red wine is also effective at reducing non-heme iron absorption, an effect most likely due to the polyphenols present. That said, the entirely non-alcoholic black tea also inhibits iron absorption and has even been shown to reduce the frequency of blood-draws required in patients with iron overload. Coffee works, too.

If you’re going to drink:

Have it with food.

When you eat a meal, and your stomach is “full,” the pyloric sphincter – which controls the passage of food and drink from the stomach into the small intestine – closes up until your stomach can break down its contents. Any alcohol added to a full stomach will also spend more time being broken down by the relevant enzymes. If you drink on an empty stomach, the pyloric sphincter is wide open, and a greater proportion of alcohol will make it to the small intestine for immediate absorption. Plus, as I mentioned earlier, drinking alcohol with food can reduce postprandial blood glucose and the susceptibility of blood lipids to peroxidation (PDF). Keeping your drinking around meals will let you take advantage of these benefits.

Focus on alcoholic drinks with greater fluid content.

Shots of plastic bottle vodka (or even the best vodka) are concentrated sources of ethanol, and as long as we’ve been nibbling on fermented fruits and brewing up Paleolithic moonshine from mushrooms and honey, consuming concentrated, distilled ethanol in the form of rum, gin, whiskey, vodka, and other hard liquors is a relatively recent practice. Some accounts suggest that the Chinese were distilling rice liquor in 800 BC, while others say it wasn’t until the 12th century AD that distillation became commonplace across the “known” world. At any rate, one could certainly argue that alcohol with a low fluid content is an evolutionarily novel food item. Less fluid means less “stuff” in your stomach, which means a more open and allowing pyloric sphincter, which means faster absorption through the small intestine. More fluid means more “stuff” in your stomach and a more restrictive pyloric sphincter and slower absorption. You could even make like the ancient Greeks and water down your wine, which some people seem to think actually improves the wine.

Choose your drinking companions wisely.

Even among voles, peer pressure-induced binge drinking is a reality. If that super cool vole with the sweet facial hair is double fisting acorn shells filled with dandelion wine, you’ll be subconsciously drawn to do the same. If your group of friends gets absolutely obliterated every time you go out with them, you’re more likely to join in on the “fun.”

Drink moderate amounts.

All the research suggesting health benefits to drinking revolves around “moderate drinking,” which is one, two, or three drinks a day. They’re not talking about pounding shots, or drinking Long Island iced teas, or doing Jello shots (although the gelatin might help matters). They’re talking about a glass or two of something.

Have everything else in line.

If you want to drink and remain healthy, you should strive to eat healthy, exercise well, reduce stress, walk a lot, experience nature, hang out with friends and loved ones, get sun when available, avoid nighttime light exposure as much as possible, and every other lifestyle prescription I recommend. In short, alcohol can augment (or at least fail to impact either way) an already healthy lifestyle, but it probably won’t make a bad situation better.

Full disclosure: I drink. My drink of choice is red wine, and I might do a glass or two most nights, but I never get drunk. Heck, I don’t even really get “buzzed.” I’d never recommend that people take up drinking or continue drinking, but I also don’t see it as a great evil in and of itself. The dose and frequency make the poison; it’s just that depending on a number of factors, the dose that makes alcohol a poison might be lower or higher for you than for me. If your sleep is affected or you are the least bit “off” the next day, you probably surpassed your ability to effectively process it and you should factor that in to your choice and approach to drinking again. And remember, alcoholism is a serious issue for some people and I am in no way suggesting there is any “workaround” or excuse herein for someone with those issues, or that drinking, even in moderation, is necessary or optimal for healthy living.

Okay, that’s about it for me. Let’s open it up to you guys, now. I want to hear your thoughts on alcohol, especially whether it’s had a positive, negative, or neutral effect on your life and the life of those you care about. I want to hear how you’ve integrated alcohol into your otherwise healthy lifestyle (or not). Thanks for reading!

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. A very well written article.

    I don’t consume alcohol and do not support its consumption for any reason. Its health and stress benefits are achieved with other methods without the negatives of alcohol consumption.
    I don’t suffer maladies from the deficiency of alcoholic beverages, therefore I don’t use them for mitigation regarding my health.

    the sage wrote on November 26th, 2012
  2. I am surprised no one has commented on the affects of grain alcohol on their systems…
    For years I was a scotch and bourbon drinker. When I went 100% primal, bourbon and scotch started making me “loopy” after just one drink.
    Not putting 2 and 2 together, but not liking the feeling, I started drinking only wine, brandy (distilled wine) and tequila which did not have the same “loopy” affect.
    Eventually it occurred to me in may be the distilled grains that were causing it, as I no longer have any tolerance to them. Recently Dr. Mercola published an article supporting the same theory.
    I know I’m crazy, but could I also be correct?

    Erik wrote on November 27th, 2012
  3. Hm, I am a HUGE martini girl and I don’t think I’m gonna stop. I drink 3-4 in any given week.

    Besides, who can argue with this? (*tongue in cheek*)

    locogirlp wrote on December 7th, 2012
  4. I think the term “moderate drinking” is a vague term. There’s a BIG difference between a “light” beer and what I like (Russian Imperial Stout…9%-10% alcohol). I usually have one after work…. and two on a day OFF from work. If I ever have three, in retrospect, I see it as a mistake !

    Ted Harazda wrote on May 10th, 2013
  5. There are some advantages or disadvantages of drinking wine :
    Advantages: It is useful for reducing stress , Heart disease,
    If anybody drink too much wine then it will be harmful for his/her body.
    Disadvantages: Sometimes it gives hangover, disrupts our sleep.
    Thanks for sharing, keep updating.

    Rusty Solomon wrote on May 17th, 2013
  6. I’ve just decided (two days ago) to quit drinking AGAIN, so I went to search out MDA for some inspiration. I’m torn, because of course there are great upsides (the social aspect primarily for me) and terrible downsides. But once again I’ve reached the point where the latter outweigh the former. I am torn between leaving a mental door open for the OCCASIONAL drink at a special event…however that’s a door that in the past I’ve ended up swinging wide open all over again. So right now I’m thinking about setting a firm rule with a hard date – i.e. no booze from now to Labour Day – and then see how I feel once I get there.

    Poor sleep, low mood and bad eating decisions when I drink are all downsides for me, but the main one not mentioned in the posts above is that it aggravates my already-terrible IBS. A couple of drinks just completely sabotages all my other efforts to get my symptoms under control. Massive colon cramping and pain the next few days – pretty much a whole weekend wrecked for a few hours of escape on a Friday night. Just too large a tax on my life.

    Renee wrote on May 20th, 2013
    • OMG Renee!! I swear I can relate to poor eating decisions, poor sleep, low mood and aggravated GI symptoms after indulging in alcohol…especially after overindulging during girls-night-out sleepover on Friday. I totally get it regarding quitting drinking…”AGAIN.” Not to mention slowed weight loss; no weight gain, but still.

      Paulette Gordon wrote on May 20th, 2013
  7. I will usually have a glass or two of wine with dinner. That’s just what I do. I think it’s cultural, to have wine with dinner, that is.

    This article has taught me something about the empty stomach though. I will wait until I’m done cooking to pour a glass from now on!

    Kathleen wrote on November 20th, 2013
  8. I’ll be honest – I have an addiction problem with booze and can’t quit it. On a food level, I’ve been primal for two years – there have mainly been positive effects to my health:
    – less bloating
    – not as hungry
    – better skin
    – better energy

    However, it’s not surprising that I’ve not lost any weight as I’m eating low carb but droning almost every day – so this results in a high fat high carb diet.

    Does anyone have any tips on reducing alcohol consumption?


    Dan wrote on November 20th, 2013
    • With friends and family, I have often said that carbs are addicting. When I have some carbs (crackers or sweets), I always want more. Same with having a drink. It’s hard for me to have just one drink too, though it’s not hard for me to stop after 2-3. (But then my insulin resistance kicks in, and I also get hungry…)

      People in AA will say that can’t have one drink without having many more. So the best thing is to just not have one. That’s what I try to do with carbs, and with alcohol on most days.

      I suggest this: Decide how many days/week you want to let yourself drink. Have drinks on just those days, and don’t overdo it just because it’s a drinking day. (I’m down to 3 days/week.)

      I know, it’s hard to go through the usual routine, when you normally drink, and then not drink. So it might also help to do something different. (Go to the store. Go for a walk or a bike ride. Do a craft or chore. In other words, do something affirmative. Don’t just avoid a negative.)

      At least, that’s what has worked for me. Good luck!

      Richard S. wrote on November 20th, 2013
  9. I’d like to see alcohol discussed from a hormetic perspective – in other words, as a stressor that – within certain bounds – promotes health as the body adapts to the insult.

    perelmanfan wrote on November 20th, 2013
  10. I and several of my mother’s family members suffer from the “Asian Flush”, although we are predominantly of European descent. As far as I know all of my distant relatives were Caucasian with only strong European roots. But one thing I do know is that it is rampant in our gene pool. It is decreasing through the generations, but my mother and 2 of her 3 siblings react when having at least one drink. I am the only 1 of my mother’s 4 children who reacts this way, and it is about the same 1 in 3 or 4 ratio across the rest of my cousins.

    Until recently, I didn’t even know what it was. My family always thought of it as an allergic reaction. Until I found primal/paleo and my health awareness was raised, did I really look into what happened to me when I drank. I found similar literature describing the mutation my gene pool obviously has.

    I think you should patent a Primal blueprint alcohol flush remedy Mark! Think of the potential outreach, $$$.
    just kidding.

    I’ve wised up and realized I should just lay off booze permanently. On top of the head-to-toe flushing, my heart rate also redlines as a reaction to the acetaldeyde poisoning that occurs. Too bad this came a few years post collage..where I found that if I would just pace out my drinking over the life of the festivities and sneak in a glass of water (or five) the flushing would eventually go away, along with all the “dude did you get wind burned or sun burned today? Or, “OMG!! What’s wrong with your face?!?!” Comments.

    Luther wrote on November 20th, 2013
    • Post college, wow long day. Good night.

      Luther wrote on November 20th, 2013
  11. Can you supplement acetaldehyde dehydrogenase to help break down acetaldehyde? I did a quick google search and found one product that had mixed reviews. Does it not pass through your stomach well?

    Rob wrote on November 21st, 2013
  12. I’ve been primal for around 10 years, look better, healthier than in 20. I love red wine, but HATE the fact that it makes me sleepy. Is there any way around this. I’d like to enjoy my wine and still be away enough for DVR’d Walking Dead after the kiddo goes to bed.

    Mia wrote on November 21st, 2013
  13. Does anyone experience an “after glow” effect after a night of drinking?

    After a night of drinking with friends (for reference I am 115lb, 5’4″, female, 24 years old that can tolerate alcohol well so I will usually have around 7 drinks if it’s a long night out followed by food — sidenote: I know that is more than I “should” have but I don’t do it frequently. The amount is enough to be “drunk” but not sick or unable to remember the night’s events…) I wake up the next morning feeling REFRESHED, HAPPY, and RELAXED… much better able to make decisions, feel more satisfied with my life, and better able to stay on and complete tasks.

    I’ve read that alcohol effects GABA and some think that could be contributing to the “after glow” some experience. Some say sleep depravation but after a night of drinking I will sleep around 8-9 hours (even though my sleep will be a bit more restless) but I do not think that is the cause…

    I’m extremely interested in hearing everyones thoughts. I’d like to try and figure out which mood chemicals are affected so I can try to better balance my diet to increase whichever could be making me feel so good.

    Thanks so much in advance! :)

    Kayleigh wrote on March 19th, 2014
  14. On alcohol and endothelial function, I think I can provide anecdotes for the good and the bad. If I’m buzzed, but not quite drunk (as in overtly clumsy), my cardio performance seems to get a boost. Occasionally I turn to moderate amounts of alcohol as a performance enhancer when going on a long bike ride or extended hike, such as leg-powered traveling. It also makes the experience more fun.
    On the other hand, one day I definitely drank more than I should have and had my SpO2 tested. It was at 91%. That’s the lowest I’ve ever seen it. Usually it doesn’t go lower than 98% and often sits at 100% so when I saw it at 91% I was horrified.

    Animanarchy wrote on March 25th, 2014

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