HEALTHY ALCOHOL USE; WHERE SHOULD WE DRAW THE LINE ?

Personally I cannot say when I had my first drink because I believe I was just too young to remember. I believe I must have been three or four years old then because it was definitely before I went to any sort of school.   My grandmother who was very influential in my early life believed that children who are given the opportunity early in life are less likely to have problems with alcohol use in adulthood. I dont know from experience if she was right or wrong on her untested hypothesis of alcohol abuse though and it unlikely anyone would attempt to prove this in a clinical study.

Clearly though alcohol is one of the oldest beverage known to man. Some scientist believed that over the years in the pre-industrial age before good sanitation drinking more alcoholic drinks rather than water may have allowed humans to live longer. Alcoholic drinks may have protected their users from water borne infections that killed many individuals in pre-industrial cultures.  This may explain why variants of the aldehyde dehydrogenase enzyme are more common in the tea drinking cultures in the far east who had another widely available safe alternative to water warm tea. If this theory is true then natural selection has selected for humans who can tolerate alcohol over the course of several thousands of years.

Almost all cultures used alcohol in one form or another for human consumption. In islamic theocracies though severe penalties have been attached to alcohol use and as such alcohol social alcohol use is limited in these settings. Unlike the bible which leaves a lot of grey areas on the benefits and harms of alcohol all the three mentions of alcohol in the Koran clearly state that the harms of alcohol far outweighs its benefits. As a christian man who drinks occasionally I love to wallow in the grey areas of the christian faith were we can all enjoy our drinks with a joyful heart.  Ecclesiastics 9:7: Go, eat your food with gladness, and drink your wine with a joyful heart, for God has already approved what you do. 

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Jesus Christ transforms water into wine at a wedding in Cana, Galilee (John 2:7)

The medical field is just as bad or maybe I should say as good as the christian faith on issues related to drinking of alcohol. On this account the question on what is safe drinking whilst easily answered in  medicine by limiting women to 7 drinks a week and men to 14 drinks a week may require a much more nuanced response in most cases.

One thing that we must not forget is binge drinking, this is described as having three or more drinks in a sitting for a woman or 4 or more drinks in a sitting for a man. The easy way to look at this is to try to imagine deciding to have all your food for 3 days in one meal, this would just put your stomach and digestive system under a lot of stress and that is similar to the stress that the liver has to accommodate with binge drinking. Overall for most individuals that could make them very sick however individual who have been doing this for some time may tolerate it but the stress on the liver can have significant health consequences.

Though I rarely do so, I occasionally find myself advising certain patients on drinking moderately.  In this post I would attempt to shed light on a few grey areas with regards to alcohol and health. Moderate drinking has been shown to be beneficial to good health in most instances however this advice is not for everyone.

Some of us just need to stay away from alcohol as much as possible for health reasons; see the list below are be well advised

  1. Anyone with liver disease, ie hepatitis B or C or any disease affecting the liver
  2. Those who have heart failure
  3. Individuals with sleep apnea
  4. Pregnant women
  5. Those who have history of alcohol abuse
  6. Anybody taking narcotic pain pills
  7. Women with osteoporosis (weak bones)
  8. Men with erectile dysfunction
  9. Those with pancreatitis
  10. Peptic ulcer disease

Whilst I decided to stop at 10 there are many conditions that drinking alcohol can only make worse. Moderate drinking is beneficial in a healthy adult with good eating habits.  Individuals who are mal-nourished either because of disease or poor eating habits are highly susceptible to the harmful effects of alcohol on our bodies. Most people believe that the beneficial qualities of alcohol use are more pronounced in those who drink with food.

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Jesus Christ was criticized according to Matthew for drinking but it appears he was not the only ancient philosopher who did not absolutely forbid drinking. Confucius said, “Only wine drinking is not limited, but not so much as to make you confused.”

There is one problems that problem drinkers tend to face that we should all be aware of; alcohol withdrawal syndrome; this tends to occur in those who have been drinking significant amounts of alcohol daily. These patients can get very sick when they stop drinking suddenly. Because this can be fatal if not well managed those who plan to quit drinking must discuss this with their doctors to determine if they would require admission to a substance abuse treatment unit to support them through the initiation phase of the process leading to abstinence from alcohol.

To conclude I would like to say that when it comes to use of alcohol as with all things on this earth we should remember that moderation is the key to safe use. Those who from experience are aware they are incapable of moderate use should abstain completely. Nature has a way of punishing those among us who wantonly waste her resources.  We should all therefore make sure we use the earth’s resources sparingly.

By Dr. Leonard Sowah, an internal medicine physician in Baltimore, Maryland 

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