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Perception vs. Reality: There’s More Alcohol in that Drink than You Think, and It’s Killing You

Dr. Barbara Krantz | November 5, 2019

How often have we heard, “I only had a couple of drinks?” The reality is, we often really don’t know how much alcohol we are drinking. When you go to order food, you have calorie content, fat content, and sodium content. There’s generally an understanding about what that means. However, ordering an alcoholic beverage is a different story. Serving sizes for drinks vary from location to location, and the strength of a drink may depend on the bartender. Therefore, how much alcohol is in that “one drink” is unknown. In addition, even that one drink has more of an effect on your body than you may realize.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) recommends that people drink no more than one standard drink a day. But if you asked people on the street what a “standard drink” is, I doubt most could tell you. Sure, people would say that a bottle of beer would serve as one drink, but then some beers have greater alcohol per volume (ABV) or alcohol content – some significantly so – than others. In addition, that pint glass you get at the craft brewery is also 50 percent larger than a bottle of beer. Then, how much wine is considered a standard drink? What about hard liquor? Is a margarita considered “one drink,” or is it strong enough to count as three?

What is “standard?” A standard beer is a 12-ounce regular beer with 5% alcohol – so that pint of craft beer is already well beyond the NIAAA recommendation. For hard liquor, a 1.5-ounce shot of 80-proof hard liquor is a serving, meaning a mixed drink usually contains more than one serving. A 5-ounce glass of table wine is also a serving, but most restaurant glasses are significantly larger. This guide at Rethinking Your Drinking can help visualize exactly how much alcohol a person is consuming.

Alcohol begins to affect your body immediately.

While many people understand the immediate dangers of being intoxicated – such as driving under the influence – many don’t realize the effects it has on their bodies. Alcohol increases your health risk for a variety of conditions from the very first drink. The harm increases exponentially as you drink more. Binge drinking, daily drinking, and long-term use are all behaviors that increase your health risk. Alcohol affects every organ in your body. Its toxic effects are well known, and the more you drink, and the longer you’ve been drinking, the more toxic it becomes.

Alcohol’s health effects include:

Bone marrow suppression. The medical term is pancytopenia, where the marrow no longer makes enough red and white blood cells or platelets. The lack of red blood cells causes anemia, starving the whole body of oxygen. Without white blood cells, the body’s immune system is compromised. Platelets help the blood to clot. I have two patients experiencing pancytopenia right now. Thankfully, stopping drinking often restores health.

Dementia and cognitive decline. Of course alcohol affects the brain, but the effects go far beyond inebriation. Alcohol can cause dementia, often to such an extent that its effects can be confused with the early stages of Alzheimer’s. This is not a problem of only the elderly. We see patients in their 40s with cognitive decline, and they often aren’t aware they are impaired.

Cardiovascular disease. While there is evidence that a small amount of alcohol can protect against a heart attack, it wreaks havoc with the rest of your cardiovascular system, from the very first drink. Alcohol can turn the heart muscle into mush, called cardiomyopathy, and it can trigger atrial fibrillation.

Alcohol depresses the central nervous system, and when it starts to wear off there is a rebound stimulant effect. This can cause increased blood pressure, pulse rate, tremors and seizures.

Alcohol stimulates the anterior pituitary gland, releasing the stress hormone cortisol, putting the cardiovascular system at risk. Years ago, we thought cardiovascular disease was driven by cholesterol, triglycerides, and lipids. Today we know that stress is a big factor in heart disease, and alcohol adds to the physiological stress on your cardiovascular system.

Cancer. Alcohol can put someone at a much higher risk of esophageal; liver; colorectal; and ear, nose and throat cancers. It affects the immune system and interferes with the body’s ability to recognize and destroy cancer cells.

Breast cancer. Women are much more susceptible to the damage caused by alcohol, but I don’t think many women are aware of that. There are studies showing even one drink a day puts women at increased risk of breast cancer.

GI effects. Patients come to me complaining of gastrointestinal (GI) problems, thinking they have celiac or Crohn’s disease. Many times, the changes in the bowels are due to the alcohol, causing malabsorption and alternating diarrhea and constipation.

Skin problems. I see patients with full-blown eczema and psoriasis. Thirty days after they stop drinking, their condition is significantly better. Alcohol is an immunosuppressant, so autoimmune conditions like eczema and psoriasis can be caused, or made worse, by alcohol.

We’ve learned time and time again that people’s perception of harm – or lack of it – can drive substance use disorder. When doctors believed pain was something that needed to be actively managed using opioids, we saw an explosion in opioid use. People thought it was safe because it was prescribed by their doctor. The same thing is happening with marijuana. Marijuana is on a course to be legalized, and people now have the perception that it is “safe” and even healthy. There are now more people in the U.S. with a diagnosed marijuana use disorder than addicted to opioids, yet people continue to think it is “no big deal” because it is being legalized.

Alcohol is legal, and therefore people underestimate its potential for harm. However, alcohol is the third leading preventable cause of death in the United States , ahead of opioid overdoses, automobile crashes, and gun violence. For most people, the dangers of alcohol outweigh the benefits. In fact, the World Health Organization (WHO) says there is no safe amount of alcohol. We must continue to raise awareness about this issue and help people understand just how much alcohol is really in that glass. Together, we can prevent more individuals from unknowingly putting themselves in harms away.

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