2.8: Is Alcohol Part of a Healthy Diet?

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Learning Objectives

Identify recommendations for alcohol intake.
Describe the health benefits and health risks associated with alcohol consumption.

When considering total calorie intake, it is important to consider alcohol. Alcohol is not a nutrient, but it does contain calories – 7 kcal/g. Calories come from alcohol itself, but also from the other ingredients that are often included in alcoholic drinks, such as juices and mixers.

Recommendations¹

It is not recommended for any non-drinker to start drinking alcohol. For those who do drink, drinking less is always better than drinking more. Moderate drinking is defined as limiting intake to:

2 drinks or less per day (for men)
1 drink or less per day (for women)

Binge drinking (5 or more drinks in two hours for men; 4 or more drinks in two hours for women) should be avoided.

People who should not drink include people who are:

pregnant
might be pregnant
younger than the legal drinking age
living with certain medical conditions
taking certain medications
recovering from an alcohol-use disorder
unable to control how much alcohol they drink

Alcohol Drink Equivalents¹

One alcoholic drink is defined as containing 14 grams of pure alcohol. As seen in Figure \(\PageIndex{1}\), one drink is equal to:

12 fluid ounces of regular beer (5% alcohol)
8-9 fluid ounces of malt liquor (7% alcohol)
5 fluid ounces of wine (12% alcohol)
1.5 fluid ounces of 80-proof distilled spirits (40% alcohol)

A graphic showing the size of United States standard drinks of different alcoholic beverages — Figure \(\PageIndex{1}\): Comparison of United States standard drinks of beer, malt liquor, wine, and spirits. (public domain; National Institutes of Health, https://www.niaaa.nih.gov/alcohols-effects-health/overview-alcohol-consumption/what-standard-drink)

Alcohol Metabolism²

The only effective way to avoid alcohol toxicity is to give the liver enough time to metabolize the alcohol that has been consumed. A legally intoxicated person takes about five hours to become sober – this is based on the rate that the liver metabolizes alcohol after drinking stops.

The majority of the alcohol consumed is metabolized by the liver. When alcohol is consumed, ~5% of the alcohol is absorbed and metabolized by cells of the gastrointestinal tract. The remaining 95% travels through the bloodstream which is why blood tests are accurate at measuring alcohol levels. Approximately 2-10% of this circulating alcohol is excreted by the lungs and kidneys. The lungs exhale alcohol as a gas. The more alcohol that a person drinks, the stronger the smell of alcohol will be on their breath. Breathalyzer tests measure the amount of alcohol exhaled from the lungs to determine the state of intoxication. The remaining circulating alcohol (85-98% of what was consumed) is metabolized by the liver.

Alcohol has the capability to suppress the anti-diuretic hormone (ADH). This action stimulates the kidneys to release water which causes an increase in urination and can lead to dehydration. Dehydration affects every cell in the body, including the brain cells. This is the cause of hangovers. When drinking or hung over, do not take Tylenol (acetaminophen) because alcohol metabolism activates an enzyme that transforms acetaminophen into a toxin that causes liver inflammation and damage. Instead, drink water with electrolytes or sports drinks to rehydrate the body’s cells.

Blood Alcohol Concentration³ (BAC) is used to measure the amount of alcohol in the bloodstream. It can be affected by the amount of alcohol consumed, a person’s weight, sex, drinking patterns, and genetics. The legal BAC limit is 0.08. This is the level that is considered illegal and unsafe to drive, because at this level, a person loses coordination, balance, speech, reaction times, and so on.

Impact of Alcohol on Health

Drinking alcohol in moderation can be beneficial for some things like appetite improvement, as well as stress and anxiety reduction. However, these benefits can be sought out by means other than alcohol. With that being said it is not recommended to encourage a non-drinker to start drinking alcohol, when the risks can far outweigh those benefits. An increase in the consumption of alcohol is related to an increased risk of death from all causes.¹

Short-term health risks associated with drinking alcohol include:

Motor vehicle crashes
Violence including homicide, suicide, sexual assault, intimate partner violence, etc.
Alcohol poisoning
Risky sexual behaviors such as unprotected sex, sex with multiple partners which can lead to STDs or unplanned pregnancies
Miscarriage, stillbirth, or fetal alcohol syndrome⁴

Long-term health risks associated with drinking alcohol include:

Cancer: Moderate to heavy alcohol consumption can significantly increase the risk of head and neck cancers, esophageal cancer, liver cancer, breast cancer, and colorectal cancer⁵.
Heart Disease⁶: Heavy drinking is linked to high blood pressure, heart failure, and stroke. Alcohol consumption can also lead to obesity and diseases associated with obesity.
Liver Disease⁷: Although not every drinker will die from liver problems, many do. This is because the liver plays a major role in filtering in the body. The liver can become extremely stressed by alcohol abuse.
Learning and memory problems (such as dementia and poor school performance), mental health problems (depression and anxiety), social problems (lost productivity, family problems, unemployment), alcohol use disorders and alcohol dependence⁴

Alcohol and Pregnancy⁷

During pregnancy, there is no safe level of alcohol consumption. When a mother drinks alcohol during pregnancy, it can cause growth, mental, and physical problems in the baby; this is known as Fetal Alcohol Syndrome. It is recommended to stop drinking alcohol 4-6 weeks before conception, if hoping to become pregnant. Alcohol consumption during the 1^st trimester of pregnancy can lead to physical damage of developing organs and tissues. During the 2^nd trimester, it can increase the risk of spontaneous abortion. During the 3^rd trimester, both body and brain growth problems can develop in the baby. Fetal Alcohol Syndrome can have many impacts on the baby including:

Poor growth in the womb and after birth
Decreased muscle tone
Poor coordination
Delayed developmental milestones

Chronic alcoholism during pregnancy can lead to multiple issues including small head circumference, narrow or receding forehead, flattened nasal bridge, short or upturned nose, underdeveloped jaw, receding chin, extra skin folds on eyelids, drooping eyelids, downward slant of eyes, short-sightedness, inability to focus, uneven or poorly formed ears, and absence of the groove in the upper lip.

Alcohol and Breastfeeding⁸

The safest option is for breastfeeding moms to avoid drinking alcohol. If a breastfeeding mother participates in heavy alcohol consumption, the infant can have issues with growth, development and sleeping patterns. After consuming alcohol, it can be found in breastmilk for 2-3 hours. The more alcohol that is consumed, the longer it will be found in the breastmilk.

Key Takeaways

There is no reason for people who do not drink alcohol to start drinking. For those who choose to drink alcohol, moderate alcohol intake is defined as 2 drinks or less per day (for men) or 1 drink or less per day (for women).
The majority of the alcohol consumed is metabolized by the liver; the only effective way to avoid alcohol toxicity is to give the liver enough time to metabolize the alcohol that has been consumed.
Drinking alcohol in moderation can be beneficial for some things, but the short-term and long-term health risks associated with drinking alcohol can outweigh the benefits.
During pregnancy, there is no safe level of alcohol consumption.
The safest option during breastfeeding is to avoid drinking alcohol because it can be found in breastmilk for 2-3 hours after consuming alcohol.

References

U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020-2025. 9th Edition. December 2020. Available at DietaryGuidelines.gov.
Alcohol Metabolism. University of Hawaii at Manoa. https://med.libretexts.org/@go/page/6801. Accessed June 9, 2021.
Monico, N. Blood Alcohol Level and Effects on the Body. American Addiction Centers. https://www.alcohol.org/effects/blood-alcohol-concentration/. Updated November 5, 2020. Accessed June 9, 2021.
Alcohol Use and Your Health. cdc.gov. https://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm. Accessed June 9, 2021.
Alcohol and Cancer Risk. cancer.gov. https://www.cancer.gov/about-cancer/causes-prevention/risk/alcohol/alcohol-fact-sheet. Accessed June 9, 2021.
Alcohol and Heart Health: Separating Fact from Fiction. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/wellness-and-prevention/alcohol-and-heart-health-separating-fact-from-fiction. Accessed June 9, 2021.
Pros and Cons of Drinking Alcohol. Foundations of Nutrition (Byerly). https://med.libretexts.org/@go/page/31634. Accessed June 9, 2021.
Alcohol. cdc.gov. https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/vaccinations-medications-drugs/alcohol.html. Accessed June 9, 2021.

Contributors

Metropolitan State University of Denver Nutrition Department: Lauren Groth and Marci Steiner

Learning Objectives

Recommendations1

Alcohol Drink Equivalents1

Alcohol Metabolism2