What do we make of alcohol? In sufficient amounts, it’s a poison. It’s incredibly addictive. It destroys entire communities.1 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.
If you found this article because you suspect you may have an unhealthy relationship with alcohol, visit this page for more resources. 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 part of a healthy lifestyle.
First, the downsides.
The Negative Aspects of Alcohol
Alcohol Is a Toxin That Your Body Must Metabolize and Excrete
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.2
Alcohol and Liver Damage
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,3 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.
Alcohol in moderation shouldn’t be a big concern, as long as you can limit yourself. Not everyone can.
Alcohol May Cause Cancer Under Certain Conditions
Excessive alcohol intake is an established epidemiological risk factor for several cancers,4 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.
Alcohol Is 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. Alcohol is less addictive than nicotine, crystal meth, and crack, but more addictive than heroin, intranasal amphetamine, cocaine, and caffeine.5
One’s susceptibility to alcohol addiction is often hereditary,6 too, meaning some people will be far more likely to become addicted than others.
Alcohol Consumption Disrupts Sleep (Even in Small Amounts)
A nightcap is a misnomer. Sure, it’ll help you fall asleep, but your sleep won’t be any more restorative. It increases the incidence of sleep disruptions, and it perturbs the healthy sleep cycles.7
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.8 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. 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?9
Alcohol Promotes Bad Food Choices
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 fast food drive-thru.
This is a well-documented phenomenon. Alcohol affects both active overeating and passive overeating.10
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.
Under the influence of alcohol, you tend to do more of either – or both. 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.
Alcohol Makes You Feel Hungover
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).
Okay, those were the not-so-great aspects of alchol. What about the positives?
Alcohol Does Have Positives, If You Are Able to Use It Correctly (Not Everyone Can or Should)
Alcohol Improves Endothelial Function (With a Catch)
Impaired release of nitric oxide from the endothelial11 cells is strongly associated with cardiovascular disease.12 Ethanol actually increases the production of nitric oxide,13 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,14so caution is obviously warranted.
Alcohol 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 using alcohol as a crutch! – 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.
Alcohol 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).15
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.
Alcohol May 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 may reduce postprandial blood glucose16 and the susceptibility of blood lipids to peroxidation.17
It Can Lower Iron Absorption (This Can Be Good or Bad)
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,18 the kind you find in red meat. Red wine is also effective at reducing non-heme iron absorption,19 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.20 Coffee works, too.21
Note that if you’re deficient in iron or at risk for deficiency, alcohol could be harmful for you.
How to Minimize the Negative Effects of Alcohol
Eat Food When You Consume Alcohol
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. Keeping your drinking around meals will let you take advantage of these benefits.
Choose Lower Proof Alcohol or Dilute Spirits
From an evolutionary perspective, consuming high-proof, concentrated alcohol 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.22
Choose Your Drinking Companions Wisely
Even in adulthood, peer pressure-induced binge drinking is a reality. There’s actual research that found that 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.”23
Conversely, if your friend group has a glass or two of wine with dinner or saves the “good stuff” for special occasions, you’re more likely to follow suit.
It’s the same concept as becoming an average of the five people you spend the most time with. Whose life do you want to emulate?
Drink Moderate Amounts
All the research suggesting health benefits to drinking revolves around “moderate drinking.”24 This amounts to one or two drinks a day depending on who you ask, and depending on who you are (women are affected by lower amounts of alcohol than men).
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.
What to Say If You Don’t Want to Drink
It’s tough to find yourself in a social situation as the only one not consuming alcohol. Sometimes, it makes people wonder whether your choice to eschew alcohol is a part of a larger issue – Are they not drinking ever again? Is there a drinking problem? Are they judging me and my drinking?
Some days, I’m just not really wanting an alcoholic beverage. I’ve done a 45 day no alcohol experiment, or I’ll do a dry a month or more just because.
In those cases, I don’t draw attention to it. Sometimes, people notice and ask why, in which case I’ll reply, “I’m just not drinking today.” If they press the issue, just repeat yourself.
That line works whether you’re not drinking for a day, or a month, or ever again. You don’t have to make it a big thing.
Do I Drink?
Full disclosure: I do drink (except when I don’t). My drink of choice is red wine, and I might have a glass or two in a sitting, but I never get drunk. Heck, I don’t even really get “buzzed.”
I have decided that small amounts of alcohol every now and then works with my individual biology. I don’t have any alcoholics in my family that I know of, I can stop at one or two without a second thought, and I don’t ever crave alcohol. If any of that was different, my stance on my own alcohol consumption would probably be different, too.
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.
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!
Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.