How Do I Read Mixed Messaging on Alcohol and Health?

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Many choices you make to lower risk of cancer pack an extra health-protective punch, because they also lower risk of heart disease. But trying to make a smart choice about alcohol can be confusing. The American Heart Association recently released its first-ever scientific statement on the intersection of cardiovascular disease and breast cancer, and alcohol is singled out as the only lifestyle choice as having somewhat mixed effects.
Alcohol — especially wine — has an image as a heart-healthy choice, and fewer than 4 in 10 people are aware that alcohol poses cancer risk. But it does, and the link should be of special concern to women, since increased breast cancer risk starts at relatively low amounts of alcohol.


In observational studies that follow large groups of people for many years, those who drink moderate amounts of alcohol have lower risk of heart disease compared to people who drink large amounts and compared to those who don’t drink alcohol. However, in observational studies like these, which can’t establish cause-and-effect, some of the people with little or no alcohol consumption are people who have health problems that led them to avoid alcohol.

Guidelines focused on heart health emphasize that you should not drink alcohol specifically in hopes of cardiovascular benefits.

A closer look shows that alcohol actually stands on a thin line when it comes to heart health: Blood triglyceride levels can rise with too much alcohol. People often focus on potential benefit in reports that alcohol can raise HDL (“good”) cholesterol. However, high blood triglycerides raise heart disease risk, and too much alcohol can send these up.

Blood pressure may rise with excessive alcohol. For most people, one to two drinks a day don’t pose a problem for blood pressure, but drinking more than two or three standard drinks a day can raise it. A healthy blood pressure plays an enormous role in heart health, so if you are having trouble keeping yours under control, discuss with your healthcare provider whether you should try reducing alcohol.

Weight gain and excess body fat promote chronic low-grade inflammation that threatens heart health (and risk of cancer). People who have major problems with alcohol addiction may skip eating and become underweight. But as a registered dietitian nutritionist, many people I have worked with have found that the extra calories in alcohol lead to weight gain.

Each standard size alcoholic drink contains at least 100 to 150 calories from the alcoholic beverage itself, and mixers in cocktails can add even more. Many people find that after a drink or two, they are less likely to withstand impulses to indulge in foods or portion sizes that they would normally be more cautious about limiting, leading to a further increase in calorie consumption.

Binge drinking is not moderate drinking, regardless of whether it “averages out” over the course of a week to the same total amount of alcohol defined as moderate drinking. Binge drinking raises risk of heart disease.

Alcohol’s Link to Cancer Risk

Evidence is stronger than ever linking alcohol to increased risk of breast cancer. In the U.S., one standard drink is defined as one providing 14 grams of pure alcohol (ethanol). That is equivalent to 5 ounces of wine, 12 ounces of beer or a 1 ½-ounce shot of 80-proof liquor. Just 10 grams of pure alcohol consumed daily raises the risk of premenopausal breast cancer 5 percent, and risk of postmenopausal breast cancer 9 percent.

While risk of breast and esophageal cancers increases at even low levels of consumption, alcohol beyond moderation also raises risk of cancers of the colorectum, stomach, liver, mouth, pharynx, and larynx.

Increased circulating estrogen seems to be an important reason for alcohol’s link to breast cancer, and explains why risk of Estrogen Receptor-positive breast cancer (the most common form) particularly rises with alcohol consumption. Women often ask about whether certain foods may be “estrogenic,” yet completely overlook this effect of alcohol.

DNA damage can occur from the free radicals formed as alcohol is metabolized, forming acetaldehyde, a recognized carcinogen. Alcohol may also act as a solvent, increasing other carcinogens’ ability to damage cells.

Finding Common Ground

What is moderate drinking? The same amount of alcohol poses more risk for women because differences in alcohol metabolizing enzymes and total body water make alcohol more concentrated in the blood and more slowly eliminated.

The same concerns seem to apply to older adults of both genders. Binge drinking is not moderate drinking, regardless of whether it “averages out” over the course of a week to the same total amount of alcohol defined as moderate drinking. Binge drinking raises risk of heart disease.

Despite some differences in how alcohol affects risk of heart disease and cancer, there is agreement about a commonsense approach. Guidelines focused on heart health emphasize that you should not drink alcohol specifically in hopes of cardiovascular benefits.

Whether focused on heart health or lower cancer risk, recommendations agree that for those who choose to drink, it is best if women limit themselves to no more than one alcoholic drink per day, and men to no more than two.


    Can Prevent Breast Cancer by Reducing Alcohol Intake

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    Breast cancer is the most common cancer among women worldwide, as well as in the United States (except for non-melanoma skin cancer). On the occasion of Cancer Prevention month, I want to highlight the growing amount of evidence generated by AICR’s Continuous Update Project on breast cancer and how important it is to understand how lifestyle choices – like drinking alcohol and being physically active – affect risk for this cancer.

    It’s the amount you drink that matters, not the type of alcohol. AICR advises for cancer prevention, it is best not to drink alcohol.

    AICR research estimates that one of every three breast cancer cases occurring annually in the US could be prevented by limiting alcohol intake, increasing activity and being a healthy weight. The most updated report on breast cancer finds that consumption of alcoholic drinks increases risk of both pre and postmenopausal breast cancer.

    I presented this report on behalf of World Cancer Research Fund/American Institute for Cancer Research CUP Panel at The Breast Cancer and the Environment Research Program (BCERP) annual meeting recently. My poster presentation outlined the results of the Continuous Update Project (CUP), specifically regarding breast cancer and alcohol consumption.

    A main theme of the meeting was “Windows of Susceptibility,” which highlighted key times of growth throughout a woman’s life span that may influence and impact her risk for breast cancer. These critical “windows of susceptibility” include pre-conception, the post-natal period, puberty, menarche, pregnancy, transition to menopause, and menopause. At each of these stages of development, our environment and lifestyle choices play a central role in the initiation, promotion, or progression of cancer. Speakers at the meeting focused on how toxic environmental factors (including endocrine disruption, lifestyle factors, and other environmental exposures) can increase breast cancer risk during these susceptible periods.

    Dr. Linda Birnbaum, Director of the NIEHS (The National Institute of Environmental Health Sciences), emphasized that disease occurrence is always the result of the interaction between genes and environment and is always context-dependent (depends upon each situation and its associated factors). In addition, early exposures may have late and long-standing effects, elaborating that “what happens early in life impacts the rest your life.” Other speakers echoed the sentiment that “a bad start can last a lifetime.” This further emphasizes the need for cancer prevention steps to being as early as possible, and the fact that it is never too late to start.

    For alcohol, recent study results suggest that, for women, it’s the total amount of alcohol consumed throughout a lifetime that may influence breast cancer risk. It’s the amount you drink that matters, not the type of alcohol. AICR advises for cancer prevention, it is best not to drink alcohol.

    AICR’s expert report and Continuous Update Project have found for each standard drink a day, postmenopausal breast cancer risk increases by about 11 percent. Standard drink sizes include a 12-ounce beer, 5-ounce glass of wine or 1.5-2 ounce shot of spirits (depending on the amount of alcohol in the liquor).

    Experts at the meeting also talked about the importance of physical activity between the ages of 5-19 years and its association with decreased risk for breast cancer. The teen years are a critical age, as other studies have shown that breast tissue is highly vulnerable to exposures between menarche and first pregnancy.

    Research also shows that breast cancer risk increases with age, with 75% of cases developing in the age group above 50 years age, and decreases after 80 years of age. The greatest increase in rates of breast cancer is during the perimenopausal and early menopausal periods.

    To help you get started with other daily actions that can help reduce risk for breast and other cancers, download AICR’s free 30-day cancer prevention checklist.


      Time to talk about alcohol

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      I am in that phase of life where my age puts me at higher risk for breast cancer, and as the mother of two teenage daughters I am acutely aware of the lifestyle factors that affect their risk for breast and other cancers.

      Alcohol is one factor that is giving me increasing cause for concern. From our own AICR research I know that there is strong evidence that alcohol is linked to six different cancers and this is supported by research from other authoritative bodies, such as American Society of Clinical Oncology (ASCO) and American Cancer Society (ACS).

      This in itself is worrying, but what is truly alarming is the perilous rising trend in alcohol consumption and the dangers of binge drinking. This, coupled with a lack of awareness about the alcohol cancer link – over 60% of Americans in our survey were unaware – and the belief that moderate drinking may protect against heart disease – is like a ticking time bomb. Read more… “Time to talk about alcohol”