Women and Alcohol: How Much Is Healthful?

I write this column having just returned from an all-inclusive resort in Jamaica, where sipping piña coladas throughout the day is de rigueur. Part of my pleasure, though, was replaced by apprehension that I could be increasing my breast cancer risk with every drink, news that was reported in April at the American Association of Cancer Research annual meeting. Then again, I might be strengthening my bones. That's according to a review of 33 studies published in this month's American Journal of Medicine . Strong bones or breast cancer? I wondered as I sipped all those frothy rum-based concoctions. And what about those heart benefits associated with imbibing?

I posed these questions to JoAnn Manson, chief of preventive medicine at Harvard's Brigham and Women's Hospital, since she has analyzed alcohol's various risks and benefits over the years as a researcher in the Nurses' Health Study of 120,000-plus women. "First of all," she informs me, "no one should begin drinking alcohol in order to reap health benefits, since it's very difficult to predict whether risks will outweigh benefits and vice versa." That being said, the results of the Nurses' Health Study and others suggest that women who drink moderately (a daily glass of wine, bottle of beer, or shot of tequila) live longer than those who don't; though they're more likely to die of breast cancer, they're less likely to die of heart disease, which kills more women every year.

The key is moderation, which far too many women aren't practicing. Washington University researchers reported yesterday that alcohol use and alcoholism are on the rise in women, though not in men, perhaps because it's become more socially acceptable for women to drink, and drink some more. (I didn't see too many women holding back at my hotel's swim-up pool bar.) Overindulging, however, can be particularly detrimental to their health because, compared with men, they have lower levels of alcohol dehydrogenase, an enzyme that helps to break down alcohol in the stomach before it reaches the liver and hits the bloodstream. This means, drink for drink, women suffer more liver damage than men of the same body weight. They also feel tipsier faster and may want to think twice about getting behind the wheel even after just one drink. Of course, anyone who's pregnant or trying to conceive should completely abstain because of alcohol's risks to the developing fetus, like brain damage, retarded growth, and organ damage. Those who have alcoholism in their families may want to abstain as well since they could have genes that predispose them to alcohol's addictive effects.

While most of us know that overindulging isn't good for our health, what exactly do we gain or lose from that daily beer after work? For starters, calories—about 160 for regular beer and 100 for the light versions—can add up and turn into extra pounds. In terms of long-term health benefits and risks, women need to look at their own health history and family tree to weigh one against the other.

On the plus side, alcohol appears to act like the female hormone estrogen, slowing the rate of bone loss, which typically occurs in women after they go through menopause. The American Journal of Medicine study found that postmenopausal women who had one drink a day had a 20 percent lower risk of hip fractures. "I think our research supports a large body evidence that low levels of alcohol consumption are beneficial," says study leader Karina Berg, an assistant professor of medicine at Albert Einstein College of Medicine in New York. "Family history is incredibly important with osteoporosis, so women should take that into account when weighing their options." It's possible, she adds, that a daily shot could help build bone in younger women who are still adding bone mass, but no one has studied this.

Alcohol also confers an estrogenlike benefit to the heart, probably by raising "good" HDL cholesterol levels and reducing inflammation and blood clots. In the Nurses' Health Study, moderate drinkers had about half as great a risk of heart disease as those who never drank. They were also protected against strokes caused by blood clots.

But that same estrogenlike action can have a detrimental effect on breast tissue, spurring the growth of breast tumors that feed off the hormone. The latest research presented at the AACR meeting found that compared with nondrinkers, those who consumed one to two drinks daily had a 32 percent greater risk of breast cancer and that those who had three or more daily drinks had a 51 percent greater risk. The Nurses' Health Study and more than two dozen other studies have also found an increased risk. "If a woman is at increased risk of breast cancer—she's a gene carrier, has a strong family history, previous breast biopsies, or high breast density—then she's going to want to do everything possible to minimize that risk," emphasizes Manson. "She should certainly avoid having more than one drink per day, but it's probably best for her to avoid alcohol altogether."

As I consider my own health profile, I figure I'm probably at about average risk of developing any one of these diseases, and, given that I'm 37, all are, I hope, decades away. Does it really matter to my future health how much I drink now? I ask Manson. "We don't really know," she tells me. "But it could be how much you drink over time." After hearing that, I conclude it's probably best as a rule to stick to my weekly glass of wine and occasional cocktail or two and to avoid ever drinking to the point that I feel headachy the next day. Still, I didn't feel too bad about relaxing the rules for these all-included piña coladas.