ETHYL ALCOHOL, ALCOHOL AND ALCOHOLISM: EFFECTS, RISKS AND BENEFITS

INTRODUCTION
Alcoholic drinks have been prepared and consumed for millennia and traces of them can be found in practically any civilization of the past.

They have been used for purpose

doctor,
hygienic
and feed,
but in many populations they also had a convivial, aphrodisiac and artistic function, because they were able to stimulate creativity, imagination, …

From a commercial point of view, today we distinguish two major categories of spirits:

low-alcohol, such as wine and beer,
alcohol, i.e. the so-called spirits.
The scientific community has been wondering about the risk-benefit ratio of this substance for a long time and the debate is still more alive than ever today.

A few years ago most researchers shared the following thought:

alcohol is both a tonic and a poison, the difference lies almost entirely in the dose.

This sentence, which closely recalls the thought of Paracelsus (“Everything is poison: nothing exists that is not poisonous. Only the dose makes the poison have no effect.”) realizes the fact that drinking in moderate doses has certain effects positive on the heart and circulatory system , it reduces circulating cholesterol and, according to some studies, also the risk of developing type 2 diabetes and gallstones .

Alcohol abuse, in contrast, is a leading predictable cause of death in most countries and, in the United States, alcohol is the cause or one of the causes of approximately half of fatal traffic accidents.

Alcohol abuse however can

cause liver and heart damage ,
harm the fetus in pregnant women,
increase the risk of cancer (including that of breast cancer ),
contribute to the development of depression ,
encourage the adoption of violent behavior
and interfere with normal marital and social life.
The dual nature of alcohol , which many compare to Dr. Jekyll and Mr. Hyde, is not surprising, the active ingredient contained in alcoholic beverages, a simple molecule called ethanol , affects the body in different ways:

it provides energy but in the form of empty calories , despite the high energy intake, it is in itself devoid of proteins, mineral salts, vitamins, fatty acids;
it has various pharmacological effects, only to a small extent positive;
it is in fact a poison in the liver, pancreas and brain at any dose ,
causes addiction and often psychic disorders, such as
psychosis ,
anxiety ,
sexual dysfunctions ,
sleep disturbances ,…
For these reasons, the attitude of the scientific community towards these drinks has changed in recent years and it is believed that:

If you are lean, physically active, don’t smoke, eat a healthy diet, and have no family history of cardiovascular disease, drinking alcohol will NOT further decrease your risk of cardiovascular disease.

If, on the other hand, your lifestyle does not reflect this ideal model, thinking of reducing cardiovascular risk by drinking alcohol rather than by improving one’s habits would be profoundly wrong and counterproductive.

Alcohol content: what do they mean?
By alcohol content we mean the quantity of alcohol contained in an alcoholic drink; by way of example we can for example report:

beer: 4 – 12% vol
wine: 10 – 19% vol
vodka 37.5 – 55% vol
gin: 37.5 – 50% ABV
whisky: 40 – 62% vol
grappa: 37.5 – 70% vol (maximum alcohol content: 86% vol)
The alcohol content (more correctly we should speak of alcoholic strength) represents the volume of alcohol, expressed in millilitres, contained in a decilitre of a given drink; For example, consuming a beer with an alcohol content of 5% means taking 5 ml of alcohol for every 100 ml of product. A 330ml can of this beer therefore contains 16.5ml of alcohol.

Photography of various types of spirits
iStock.com/monticello

DRINK “IN MODERATION” OR… “JUST ONE GLASS”
The inappropriate use of the terms “moderation” and “glass” in many cases has inflamed the current debate regarding the impact of alcohol on health due to misunderstandings and confusion; in some studies the term moderate consumption refers to less than one glass per day, while in others it means three or four glasses per day. Even the concept of glass is extremely variable, in reality, even among researchers, a standard definition of “glass” has not been reached.

The definition of “moderate consumption” is a question of balance: there are those who propose to speak of moderate alcohol consumption when the benefits of consumption are clearly greater than the risks, but it is a definition that many researchers (particularly those engaged daily in the fight against addiction and in the treatment of tumors) do not accept, believing that there is no dose with a favorable risk/benefit ratio (remember in this regard that alcohol is not an essential nutrient, i.e. the body does not needs to survive).

An often underestimated aspect is how the amount of alcohol consumed is distributed over time, for example consuming seven glasses on a Saturday night and then not drinking for the rest of the week does not equate to drinking one glass a day from a health point of view .

In other words, it is not so much the total over the year that counts, but how it is distributed over time.

BENEFITS OF ALCOHOL
Cardiovascular diseases
The scientific literature is very rich in studies demonstrating an inverse proportionality between moderate alcohol consumption and the risk of heart attack , ischemic stroke (caused by emboli), peripheral circulation disorders , cardiac arrest and in general death due to cardiovascular causes. In all these cases the effect is relatively similar and corresponds to a risk reduction which can vary from 25 to 40 percent and probably this current of research was born with the description of the French paradox.

It has been shown that in France, despite a relatively high consumption of foods particularly rich in saturated fatty acids (i.e. fats that are inextricably linked to the risk of stroke and heart attacks ), the incidence of cardiovascular disease is lower than in countries with similar diets. According to many researchers, the explanation should be sought in the widespread consumption of red wine, but in reality there is no clear and irrefutable evidence of this theory today , which instead makes a distorted use of the available data.

Beyond this, the link between moderate alcohol consumption and decreased risk of cardiovascular disease has been observed in both men and women, for people who are not visibly affected by heart disease, and even for those who are particularly at risk of heart attack, stroke or death due to cardiovascular disorders, including patients with type 2 diabetes, hypertension and cardiovascular disease. The benefits also apply to older patients.

The idea that moderate alcohol consumption protects against cardiovascular disease makes biological and scientific sense, because the substance

Improves the patient’s lipid profile
increases the levels of high-density lipoproteins ( HDL or “good” cholesterol ),
decreases LDL (bad cholesterol) levels,
Decreases the risk of thrombosis ,
reduces the phenomenon of platelet aggregation,
reduces the amount of fibrinogen (a clotting factor) in the bloodstream,
increases fibrinolysis (the process that leads to the dissolution of clots),
and then
reduces coronary spasms in response to stress ,
increases blood perfusion in the coronary arteries (the arteries that carry oxygen and nourishment to the heart),
reduces high blood pressure ,
reduces the circulating amount of insulin ,
increases the amount of circulating estrogen (female hormone with health benefits).
Difficult therefore to pull the strings, even if the American Heart Association believes that “more than a dozen prospective studies have demonstrated a consistent, strong, dose-response relationship between increased alcohol consumption and decreased incidence of coronary heart disease . The data are similar in men and women, across many different geographic and ethnic groups. Consuming one or two drinks per day is associated with a risk reduction of approximately 30% to 50%.”

On the other hand, the CDC reports that “although previous studies have reported that moderate alcohol consumption may be associated with preventive health benefits (e.g., reducing the risk of heart disease), recent studies place more than one doubt in this regard, because to date it is not possible to conclude with certainty that if these results are certainly due to moderate alcohol consumption and not to other differences in the behaviors or genetics of the subjects involved”, citing as sources works published in prestigious scientific journals:

A healthy dose of skepticism: four good reasons to think again about protective effects of alcohol on coronary heart disease.
All cause mortality and the case for age specific alcohol consumption guidelines: pooled analyzes of up to 10 population based cohorts.
Association between alcohol and cardiovascular disease: Mendelian randomisation analysis based on individual participant data.
Cardiovascular risk factors and confounders among nondrinking and moderate-drinking US adults.
Finally, we stress that if you are thin, physically active, do not smoke, eat a healthy diet and have no family history of cardiovascular disease, drinking alcohol will NOT further decrease the risk of cardiovascular disease; if, on the contrary, your lifestyle does not reflect this model, thinking of reducing the risk by drinking alcohol rather than by improving one’s habits would instead be profoundly wrong.

Beyond the heart
The benefits of moderate use of alcohol are not limited to the heart, in various studies ( Nurses’ Health Study and Health Professionals Follow-up Study , for example), additional health benefits have emerged in the case of moderate consumption, for example

a reduction in the risk of gallstone formation,
a reduction in the risk of developing type 2 diabetes.
Finally, some researchers underline the social and psychological benefits of alcohol consumption, for example at the end of a stressful day or during a dinner with friends.

Which alcohol doesn’t make you fat? Calories and alcohol
This is a very common question on the net, but the answer is more complex than it might seem.

Let’s start from the assumption that alcohol is a food that provides a high quantity of calories, no less than 7 kcal/g, close to the 9 kcal/g of fats (and almost twice as many carbohydrates and proteins, which stop at 4 kcal/g). g).

In many cocktails there are also ingredients capable of providing additional calories in the form of:

proteins and carbohydrates (for example in beer),
fruit juice sugar
cream fats.
Complicating the situation is the observation that, since alcohol cannot be accumulated, it is transformed into triglycerides which are stored in the form of fat deposits.

In addition to these aspects, and although it has not been unequivocally demonstrated that alcohol consumption per se leads to weight gain, it is the common opinion of researchers that it can favor unhealthy food choices (during aperitifs it is common to associate the drink with salty snacks calories, while in the case of higher consumption, the reduction of inhibitions can lead to the consumption of junk-food in large quantities).

THE DARK SIDE OF ALCOHOL
If everyone who drinks were limited to one glass a day, it probably wouldn’t take so many cardiologists, liver disease specialists, psychologists, and addiction counselors.

Many factors come into play when it comes to alcohol addiction, including:

genetics,
family history of alcoholism ,
consumption at a very young age,
childhood trauma,
lack of family support,
cannabis use ,
…
Similarly, we can identify numerous variables that come into play in the individual response to alcohol, at the same dose:

age,
sex,
ethnicity,
physical condition (weight, training, …),
amount of food consumed with alcohol,
speed of consumption,
use of drugs or substances of abuse,
family history of alcoholism.
Alcohol reaches almost every cell in the body and this explains the multitude of effects it can unleash; it is in fact a central nervous system depressant molecule that is rapidly absorbed from the stomach and intestines into the blood.

It is then metabolized in the liver by specific enzymes, but the organ is only able to metabolize a small amount of alcohol at a time, leaving the excess free to continue circulating throughout the body; for this reason

the amount of alcohol consumed,
the speed of absorption (related to the time it is consumed and the presence of food in the stomach)
and body weight (or, more correctly, body volume, which is however closely related to it)
directly affect the intensity of the effects it is capable of producing.

In the short and long term there are numerous harmful effects of the substance on the body when consumed in excessive quantities:

development of chronic diseases ( alcoholic hepatitis and cirrhosis of the liver , pancreatitis , high blood pressure, mental disorders),
heart damage,
tumors
of the mouth ,
throat ( pharynx and larynx),
of the esophagus ,
breast , _
of the colon and rectum in men,
possibility that it contributes to liver and colorectal cancer in women.
possibility of accidents and injuries,
developing violent behavior
addiction .
Even moderate alcohol consumption can present some risks:

For example, alcohol can disturb the normal sleep-wake cycle.
Its ability to numb the mind is known.
Alcohol interacts in potentially dangerous ways with many different medications, including acetaminophen , antidepressants , anticonvulsants, pain relievers, and sedatives.
It is also addictive , especially in people with a family history of alcoholism.
Tumors
A recent study has caused a lot of discussion, because it concludes that:

For women, the consumption of one bottle of wine per week increased the absolute risk of developing cancer (mainly of the breast) in approximately the same way as 10 cigarettes per week.
Among men, drinking one bottle of wine a week instead increases the absolute risk like smoking five cigarettes.
Beyond the quantification of the results, it is important to underline once again how regular alcohol consumption is not only linked to the development of liver pathologies, but plausibly also represents a risk factor for the development of tumors ; as underlined by the authors of the study, there is no intention to say that drinking in a moderate way is equivalent to smoking, but instead it is useful to bring to the attention of the population that alcohol is considered a carcinogen in all respects.

Finally, it is known that the association of smoking and alcohol further worsens the risk of the two habits taken individually.

GENETICS AND ALCOHOLISM
A specialized gene for alcohol processing has been discovered in human DNA, the one that codes for the alcohol dehydrogenase enzyme; this discovery leads us to think that man has been in contact with this substance for some time, even if the evidence of voluntary and continuous consumption dates back only up to about 10 thousand years ago.

The enzyme alcohol dehydrogenase is therefore mainly responsible for the metabolism of alcohol and there are several variants, some faster and some slower, which are distributed differently in the population.

It has been observed that those who consume moderate quantities of alcohol and have a slower metabolizing capacity show more significant protective effects on the cardiovascular system; this leads us to think that the alcohol molecule is responsible for the benefits, because in these subjects it would remain in circulation longer than in those who are able to dispose of it faster.

Another aspect of fundamental importance in the relationship between alcohol and genetics is that which concerns the risk of addiction; it emerges quite clearly that alcoholism is a problem that tends to run in the same family, in particular research shows that genes are responsible for about half of the risk of developing an addiction, but the other half is usually linked to environmental factors.

But the link is even more complex, because there is no single responsible gene, on the contrary there are numerous genes that can increase the risk and numerous that can directly or indirectly decrease it. For example, some subjects of Asian origin carry a variant of the gene that alters their metabolic capacity of alcohol, causing symptoms such as hot flashes, nausea and accelerated heartbeat in case of even limited consumption; those suffering from these disorders clearly tend to avoid consumption, thus reducing the risk of developing an addiction.

Finally, it has been discovered in recent years that various factors can alter the expression of our genes (epigenetics), i.e. how the environment directly affects the way in which our body expresses what is present at the DNA level.

RISKS, BENEFITS AND AGE
The benefits and harms of moderate alcohol use change over a lifetime, in general the risks significantly outweigh the benefits until around age 60, when cardiovascular disease begins to cause an ever-increasing proportion of death and disease.

For pregnant women, unborn children, recovering alcoholics, patients with liver disease, and those taking one or more drugs that interact with alcohol, moderate alcohol use has little benefit or harm. substantial.
For a thirty-year-old man, the increased risk of accidents due to alcohol is greater than the potential benefits on the cardiovascular system (always in the case of moderate use of alcohol).
For a 60-year-old man, one drink a day may help protect against heart disease, and the benefit is likely to outweigh the potential risks (assuming he is free from alcoholism).
For a 60-year-old woman, calculating the benefit-risk ratio is more tricky. Every year ten times more women die from heart disease than from breast cancer (460,000 versus 41,000), yet research shows that women fear breast cancer far more than cardiovascular disease, which should be kept in mind. account in reasoning.
CONCLUSION
Given the complexity of the effects of alcohol on the body and the multiplicity of situations and variables, it is difficult to draw conclusions, but the scientific community is substantially in agreement on one:

If you don’t drink, there’s no good reason to start.

Moderate use of alcohol does indeed seem linked to possible health benefits, but it is NEVER without risks, for example the fact that it is a carcinogen like tobacco smoke is often ignored .

For some conditions, such as breast cancer and liver disease, there is no safe level where it can be safely and safely consumed.

As the Veronesi Foundation , which has been involved in the treatment of cancer for years, also underlines, “there are no safe quantities of alcohol consumption and, exceeding ten grams, the risk of morbidity, mortality and disability from over 200 diseases and 14 types of cancer including, notably, breast cancer in women.”

There’s no need to drink alcohol , under any circumstances, and if you don’t currently drink, it’s never necessary or helpful to start.

Along the same lines are other important organizations and associations:

AIRC , according to which 10% of all cancers affecting males and 3% of those affecting females are attributable to alcohol consumption.
World Health Organization , which for years has maintained that when speaking of alcohol “Less is better”, i.e. the less consumed, the better and
the WHO itself rightly claims that even those who use it moderately by stopping would have immediate benefits (better sleep, more energy the next day, easier control of body weight).
In light of this, the choice to drink or not to drink if made for “medical purposes” has a single shared answer: no, in principle the benefits never justify the risks involved, instead it is better to focus on the lifestyle, to improve modifiable risk factors:

If you don’t drink there’s no reason to start. For some categories of people (pregnant people, patients in treatment for alcohol addiction, patients with liver disease or in therapy with one or more drugs that interact with alcohol) the risks are enormous, while for otherwise healthy patients there are no significant benefits that justify its choice.
If you drink, do it in moderation and choose the drink you prefer. Wine, beer or spirits: each of them seems to have the same health benefits, when drunk in moderation, what matters is the total amount of alcohol consumed.
Consume plenty of fruit and vegetables every day, especially regular consumption of folate and folic acid , because alcohol tends to deplete our body’s stocks.
Ask your doctor for advice. If you think you may have a drinking problem, seek the advice of a doctor or expert who will be able to help you.
No alcohol when driving. If you went out and drank a little, give your car keys to someone who stuck to soft drinks all night.
SOURCES AND BIBLIOGRAPHY
Harvard
Alcohol & Your Health, NIH
who.int

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