The American Society of Clinical Oncology published a new statement recently on alcohol and cancer. This comes at a time of year when much of our attention centers on the holidays. Office parties, gatherings of friends or visiting family are a few of the holiday occasions that often include alcohol. From surviving the obligatory office event, drowning out your cantankerous uncle, or (hopefully) enjoying time spent and food shared with good friends or family, holiday cheer is all about alcohol.
The purpose of this new statement is to promote public education on the risks of alcohol and cancer. It highlights an issue that I have been pondering since the summer. As you may remember, I had a rough start to the year, but all the crap was over by late-April. As I grasped my new lease on life, I began looking forward to a favorite summer ritual, drinking gin and tonic with extra lime while basking in the evening sun by the lake. It doesn’t get any better than that. Except for this year, after surviving a brush with death, I am carefully considering my habits: and if possible, I want to make sure they are ideally both healthy and make me happy. My gin and tonic custom does make me happy but is it costing me health?
Earlier this year, I came across two additional papers on the health effects of alcohol. The first, known as CUP for Continuous Update Project was conducted by the World Cancer Research Fund. It examined the available research on cancer prevention and survival studies looking at diet, nutrition, exercise, and weight.
It looked at the results of 22 studies on alcohol intake and postmenopausal breast cancer -which when combined included 35,221 cases of breast cancer- and found a 9 percent increase in breast cancer associated with a daily intake of 10 grams of alcohol. In other words, one small drink per day increased the risk of postmenopausal breast cancer by nine percent.
And, as if that news wasn’t bad enough, the often repeated and long-standing theory that light to moderate drinking reduces heart disease may not be so after all. According to a paper published in the Journal of Studies on Alcohol and Drugs, the evidence for alcohol’s beneficial effects is poor. Yes, it’s true that moderate drinkers have less heart disease, but it is unlikely due to their alcohol consumption. As we age, we often drink less. Other health issues may force people to stop drinking. Those of us who continue drinking at older ages are healthier, to begin with, and are thus able to continue drinking. It’s not the alcohol that is making us healthier.
Increased risk of breast cancer and no benefit when it comes to heart disease. Seems like maybe I should stop drinking. Kristi Coulter wrote this excellent piece about women and alcohol. In it she describes her struggle staying sober when alcohol is all around us. Margaritas after a half marathon. (I completed a triathlon this summer and was given a free beer. One that I drank and enjoyed.) Wine tasting with lessons on knife skills. “A local kitchen shop offers a combination knife-skills and wine-tasting class — yes, wine for people who have already self-identified as being so clumsy with sharp objects that they need professional instruction.” Wine after hot yoga, champagne at the movies, wine at a baby shower. It is everywhere.
Coulter contends that women are drinking at all these events to wash away mistreatment. We are drowning out our unhappiness with alcohol, blunting our emotions such that we don’t notice how poorly we are being treated. It’s a compelling argument, although it doesn’t always resonate with me. The message I get is we need, or we think we need, alcohol to have fun. Drinking is promoted at all of these events to encourage participation by increasing the entertainment value or making them more fun.
Drinking is fun, but it’s not the only way to have fun.
As the summer flew by, and I contemplated my gin and tonic routine, which did seem to lessen the enjoyment some, I came up with a theory about alcohol and health. This is my personal opinion, let me stress opinion, I do not have any data to prove it. I think it depends on the circumstances which you are choosing to drink. If you are drinking alone, to get drunk, to escape, or to wash away a miserable day, it’s probably gonna contribute to ill health effects. Instead, if you are drinking at a social gathering with friends or as part of a delicious meal and it increases your enjoyment of those events, then I think there is benefit.
Of course, I am still talking about a small amount of alcohol, 1-2 drinks maximum for women. And just so we are all on the same page, let’s define a drink. The CDC defines one drink as 14 grams of pure alcohol which usually means 12 ounces of beer, 5 ounces of wine or 1.5 ounces of spirits. Another CDC definition to keep in mind is excessive drinking. This includes both binge drinking, defined as 4 or more drinks during a single occasion for women, 5 or more for men and heavy drinking, 8 or more drinks/week for women, 15 or more for men.
If you are generously pouring a nightly glass of wine, you’re likely consuming more than one drink; and, if that occurs every night, you’re probably getting more than eight drinks/week which is, according to the CDC, excessive or heavy drinking. As the American Society of Clinical Oncology asserts, the most significant cancer risks are in heavy drinkers. The risk of oral cavity, pharynx and esophageal cancers are five times greater in heavy drinkers. Also, risks of larynx, liver, breast and colorectal cancer are all increased with drinking. Virtually all women are wary of hormone therapy and the associated risk of breast cancer. Very few are either aware of or concerned about the association between alcohol and breast cancer which appears to confers a similar risk.
Those are some sobering stats.
The amount matters. Of course, I will never know all of the factors that contributed to my breast cancer diagnosis. I try not to spend too much time looking back, but binge drinking in my 20s and what I thought was a causal, nightly glass of wine in my 30s was probably more like 2 to 3 glasses, which for women is heavy drinking. Now I can tolerate less and less alcohol as I get older. Two drinks in an evening are too much for me. I feel lousy the next day if I drink anymore.
So why do I still think drinking alcohol has value?
Let’s consider the Roseto effect and Mediterranean Diet. Roseto is a small town in western Pennsylvania where in the early 1960s a local doctor noticed a very low mortality rate, much lower than the surrounding communities, despite many unhealthy habits like drinking, smoking cigars and eating lots of cheese and sausage. This notable difference in the burden of chronic disease was apparently due to the close-knit, supportive residents of Roseto who maintained the cultural practices of their home country, Italy.
The Mediterranean diet is often touted as being one of the healthiest in the world. But it’s probably not just the diet; it’s their entire lifestyle. People living on the Med eat a fresh whole food diet. They savor and enjoy their food. Meals are often shared with others and include wine. They are social and connected to each other. They are active and spend time outside. All of these attributes contribute to health and longevity.
On the other hand, loneliness is toxic. Healthy supportive relationships probably impact health more than anything else. So it makes sense that drinking alone, especially if you are lonely and hoping to escape or withdraw from the world, would contribute to poor health and chronic disease. Whereas drinking as a part of a delicious meal or social occasion that strengthens your bonds with others should have the opposite effect.
Life should be awesome.
Our habits should allow us to do things simply because they are pleasurable. In general, I think eating only when you are hungry is a good practice but not always. Sometimes food should be enjoyed just for the joy it brings. Same with alcohol. If it brings joy, it does a body good. Of course, the difficulty becomes determining what amount is enough vs. too much. It is a line easily crossed. And at times I have certainly failed to recognize when I have crossed the line. One drink is so good and brings so much joy; I should have another and another. More drinks will bring even more joy and happiness. We all know that’s not true. For myself I know one is usually just about right.
Alcohol does indeed appear to have some worrisome health effects, including an increased risk of breast cancer which is especially relevant to me. In light of this information, I have carefully considered whether I should be drinking at all. While I now drink less than I did when I was younger, I’m not going to give it up entirely. If you don’t drink now, there are more than enough reasons to never start. However, if you are like me, and can take pleasure in just one drink, I say do it. Enjoy it. Life should be awesome. Try to make it so.