Is Alcohol Good or Bad for You? It's Complicated |
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Alcohol interacts with three key neurotransmitters to produce its actions.
People who consume low to moderate amounts of alcohol often report other healthy habits.
The formation of acetate and aldehydes cause many of the negative effects of alcohol.
The brain will frequently induce you to consume things that your body will not like.
The dose makes the poison. —Paracelsus, 1538
The dose makes the poison. —Paracelsus, 1538
There are only a few molecules that humans consume that are both a nutrient and a drug. Coffee and alcohol are two excellent examples. The antioxidants in coffee offer many health benefits, while the caffeine, in sufficiently high doses, can be lethal. Obviously, dose matters. The same is true for alcohol.
How Alcohol Affects the Body and Brain
To start, let’s look at what alcohol does in the brain—particularly, how it interacts with three different neurotransmitters.
First, at low doses, it enhances the action of the neurotransmitter GABA. Why does this matter? GABA is the brain’s primary inhibitory neurotransmitter. Whenever and wherever it acts, it effectively turns off that part of the brain.
When we start drinking, the first effects we notice occur because GABA is inhibiting activity in our cortex. The initial consequence is a relief from anxiety; alterations in our personality and judgement follow with additional doses.
With higher doses, the parts of the brain that control movement and coordination are affected. Finally, at very high doses—the exact amount can vary for different people—the parts of our brain that control breathing and heart rate are inhibited and we are at risk of dying.
Second, alcohol also stimulates the release of dopamine. This action may underlie our feelings of pleasure.
Finally, at higher doses, alcohol also inhibits the neurotransmitter glutamate. This neurotransmitter is essential for producing memories. This is why we might not remember what happened when we were drunk.
Next, let’s look at what happens to the molecule of alcohol as it enters the body.
Alcohol travels to the stomach and liver, where an enzyme called alcohol dehydrogenase metabolizes it into an aldehyde—a type of organic compound comprised of carbon, oxygen, and hydrogen, often alongside other elements—that is very irritating to our tissues. This aldehyde is metabolized into acetate and then finally into carbon dioxide and water. Some of the acetate is converted into fatty acids that deposit in the liver, fat pads, and other organs.
Is Drinking Alcohol Ever Good for You?
As you read through alcohol's various physical and cognitive effects, you might wonder: Does any of the above actually benefit people who drink? To answer this question, it’s important to consider dose, sex, age and tissues involved.
According to the National Institute on Alcohol Abuse and Alcoholism, less than 7 drinks per week for women and less than 14 drinks per week for men is considered "low-risk drinking." At these dosages, numerous epidemiological studies have reported some health benefits, including:
The risk of cardiovascular disease is lowered, possibly because alcohol raises the levels of the so-called good cholesterol, HDL. This benefit was particularly seen in post-menopausal women.
Moderate alcohol consumption improves our sensitivity to insulin, lowering the risk of type 2 diabetes.
Light to moderate alcohol consumption can reduce platelet stickiness and aggregation, temporarily thinning the blood and lowering clot risk. (Note: There’s also an obvious downside to this effect—for example, if you happen to be in an accident.)
Moderate consumption may reduce the incidence of colds by 60 percent. Red, but not white, wine provides the body with enough antioxidants to help reinforce the immune system benefits.
Forty years of studies involving over 360,000 people have reported that moderate drinking reduces risk of Alzheimer’s disease by twenty-three percent. This benefit is reduced if you happen to possess two copies of the APOE-ε4 gene.
Moderate alcohol consumption reduced the risk of developing a gallstone by 33 percent.
Alcohol, especially wine, can help prevent kidney stones.
Urinating more makes urine volume go up. A higher urine volume reduces saturation of troublesome solids that produce stones, such as calcium or oxalates. (However, this only works if you drink plenty of fluids to lessen the impact of the dehydration that alcohol can induce.)
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When Does Alcohol Consumption Become Harmful?
The harmful effects are dose-, time-, and tissue-dependent as well.
Alcohol consumption, like all drugs, shows the effects of tolerance. This is usually when problems start to arise.
The body, especially the liver, quickly adapts to a person’s consumption levels—meaning larger and larger doses are required to achieve the same effect. Because the liver becomes more efficient at removing the alcohol from the blood, the brain demands greater amounts to experience the pleasurable effects of the alcohol on GABA and dopamine function.
Due to the continued presence of acetaldehyde and acetate in the liver, long-term high dose alcohol leads to inflammation and the deposition of fat inside of the liver. Over time, chronic inflammation produces a condition called cirrhosis, leading ultimately to functional failure.
The effects of the aldehyde on blood vessels underlies the linear association between alcohol consumption and the risk of hypertension. In addition to inducing extensive inflammation, the aldehydes alter the level of estrogen, increasing the risk of breast cancer; they may also damage DNA. The tissues most often affected are those directly exposed to the aldehyde, leading to colorectal, esophageal, and throat cancers.
Finally, as far as the brain is concerned, alcohol dose-dependently turns off neurons. This action leads to impaired judgement, slower reaction times and the potential for accidents and death.
What We Still Don't Know About Alcohol's Effects
There are, of course, some caveats to all this.
For one, many early alcohol studies had methodological flaws because they failed to consider that people who consume low to moderate amounts of alcohol may have other healthy habits, such as a good diet and regular exercise. Moderate drinkers are far more likely to exercise, for example, than people who don't drink.
It’s also hard to know what the control group should be: very low alcohol consumers or pure abstainers. Some people abstain due to existing health problems—and overall, abstainers have higher rates of death and chronic disease than moderate alcohol consumers.
Finally, it's important to note that young people, particularly Gen Z, are drinking much less alcohol, and less frequently, than previous generations. Apparently, these younger people are increasingly opting for marijuana over alcohol, with a significant portion preferring cannabis edibles and THC drinks.
Is this a safer choice? The alcohol vs. marijuana debate is still unfolding—but as I’ve told my students over the past few decades, the brain will frequently induce you to consume things that your body will not like.
Wenk, GL (2019) Your Brain on Food: How Chemicals Control Your Thoughts and Feelings, 3rd Ed. Oxford University Press.
Mewton L, et al., (2023) The relationship between alcohol use and dementia in adults aged more than 60 years: a combined analysis of prospective, individual-participant data from 15 international studies. Addiction, 118:412
Cha BH, et al., (2019) Alcohol consumption can reduce the risk of gallstone disease: a systematic review with a dose-response meta-analysis of case-control and cohort studies. Gut Liver. 15;13(1):114–131. doi: 10.5009/gnl18278
Minzer S, et al., (2020) The Effect of Alcohol on Cardiovascular Risk Factors: Is There New Information? Nutrients, 12(4):912. doi: 10.3390/nu12040912
Ciafrè S, et al., (2019) How alcohol drinking affects our genes: an epigenetic point of view. Biochem Cell Biol, 97(4):345-356. doi: 10.1139/bcb-2018-0248.
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