Who doesn’t like a good drink at the end of a long day? I’m a whiskey man, myself. There’s little better than having a good Kentucky bourbon with a friend.
Sadly, these days I find even 1-2 drinks can leave me foggy and irritated the next day. I take some solace from hearing my friends say the same (though that doesn’t always slow them down!).
Alcohol consumption is on the rise  in the U.S. during COVID, but alcohol has been taking some heat in the press lately due to health concerns. Many people think there are health benefits to having one drink a night, but some recent studies call that into question. More on that later.
How much alcohol is in “a drink?”
First, let’s start by defining what we mean by “a drink.” According to the NIH ,one drink is the equivalent of one 12-oz regular beer (5% ABV), an 8-oz malt liquor (which includes most microbrews or specialty beers), 5-6 oz of wine, or 1.5 oz of hard alcohol, such as whiskey or vodka.
These volumes are typically less than a “social drink,” which is what we are served at most restaurants and bars or what we pour for ourselves. Because of this, most people underestimate their intake.
We’re frequently told as doctors to double whatever patients tell us about their alcohol use. I once had a patient who told me she only had one bourbon a day, but thanks to my superior interrogation techniques, I was able to find out that it was one 12-ounce bourbon/day!
But what’s the big deal? Alcohol is everywhere. It is an integral part of social events, celebrations, and even religious ceremonies.
You never have to drive far to find a bar in almost any part of the country. And for many people, a drink signifies a way to relax, to be social, or as a reward for a long day.
And 1-2 drinks is probably just fine in most situations. The recommended maximum, per the CDC, is one drink daily on average for women and two drinks for men. The problem comes in when you exceed the recommended amounts, especially on a regular basis, or when even moderate drinking starts to impact your health.
Drinking and your health
We’ve all heard that one drink/day can lower your risk of heart disease. But newer studies call that into question. The original studies were based on observations in France showing poor diets but low rates of heart disease (the so-called “French Paradox”). The conclusion was that wine was protective.
Looking back, it’s more likely that the French diet is not as bad as we thought. Also, they don’t drink as much as we thought, they walk more, and have lower stress than most Americans.
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Newer, better-designed studies regarding alcohol and heart disease are equivocal and certainly haven’t shown a clear cardiac benefit with moderate drinking.
We also now know that even light or moderate drinking can increase your risk of cancer including esophageal cancer, throat cancer, breast cancer, and colon cancer. And moderate amounts of alcohol increase your risk of migraines, arrhythmias, high blood pressure, obesity, falls, osteoporotic fractures, and, as most can attest to, poor judgment.
In fact, any amount appears to be detrimental to your health. Just one drink per day for a year increases the risk of 23 alcohol-related conditions, including arrhythmias, stroke, and pneumonia, by 0.5%.
This may not seem like much, but if you continue this drinking rate year after year, the risk of these conditions becomes significant. And if you increase the amount to two drinks per day, which is considered the acceptable upper limit for men, these risks increase substantially to 7% per year.
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The Effect of drinking alcohol on your day to day life
But most importantly, alcohol can impact your quality of life. Alcohol has an immediate positive benefit of decreased stress, a feeling of happiness and well-being, and ease of falling asleep.
This comes at the cost of difficulty staying asleep, as well as feeling increased stress and a worse mood the next day. The net effect is more often negative. Even though this delayed negative impact can be worse than the benefits, the benefits are immediate, so we tend to weigh these more heavily, and therefore think drinking is a great idea.
That’s the insidious nature of alcohol. We have a few drinks one night, then have a “stressful day” the next day. Our perceived stress is often greater due to the alcohol the night before, but we blame work and other stressors. Then we have a drink again that night to relieve our stress. And the cycle continues.
Some fall down the rabbit hole as their drinking increases each night to help compensate for how poorly they feel during the day. The impact becomes greater the older we get.
I routinely see patients with insomnia or depression. However, when I address their alcohol intake, they tell me, ”It’s not the alcohol- I’ve been drinking all my adult life!”
I get it – no one wants to give up their ritual cocktail. But if you have anxiety, depression, insomnia, high-stress levels, or practically ANY psychiatric condition, alcohol makes matters worse.
Alcohol is categorized as a “depressant”, and it does its job very well. For almost anyone who drinks excessively daily, it’s typically a matter of when, not if, they become anxious and depressed.
The bottom line when it comes to drinking alcohol
This is difficult for me to write since I enjoy a good drink like most others. But I see the impressive negative impacts of alcohol on my patients every day. Having a few drinks with friends on a weekend night is fine.
However, if you drink every day, I challenge you to stop ALL alcohol for two weeks to see how you feel. I bet you sleep better, have more energy, and notice a better mood. If you notice these improvements, you have a decision to make – is the alcohol worth it?
It seems ironic now that we often toast each other by saying
“to your health.”
 Michael S. Pollard, PhD1Joan S. Tucker, PhD1Harold D. Green Jr, PhD2 Author Changes in Adult Alcohol Use and Consequences During the COVID-19 Pandemic in the US – https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2770975
 The Lancet – Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016 Open Access Published:August 23, 2018DOI: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31310-2/fulltext
 National Institute of Alcohol Abuse and Alcoholism What Is A Standard Drink?
 Centers for Disease Control and Prevention – Alcohol Use and Your Health
 Angela M Wood, PhD, Stephen Kaptoge, PhD, Adam S Butterworth, PhD, et el -The Lancet: Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies – Open Access Published:April 14, 2018DOI https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30134-X/fulltext
 William C. Shiel Jr., MD, FACP, FACR; MedicineNet, Medical Definition of French paradox
 American Cancer Center – Alcohol Use and Cancer
 Eurekalert – The Lancet: Alcohol is associated with 2.8 million deaths each year worldwide 23-August 2018
 The Lancet – What is Alcohol
Kenneth Zweig, M.D.
Kenneth Zweig, MD, is an internist at Northern Virginia Family Practice Associates (NVFP), a family medicine practice providing full-service concierge health care in the Northern Virginia area. As part of NVFP's team of skilled physicians, Dr. Zweig provides personalized preventative care that caters to individual patient needs. He specializes in sleeping disorders, hypertension, and the importance of behavioral changes to support overall health. In 18 years of working in a variety of medical settings, Dr. Zweig says no health care setting has been as patient-oriented as concierge internal medicine.
Dr. Zweig believes the majority of medical problems are caused by poor behavioral habits that have accumulated over time. He takes a preventative approach to treatment and helps patients adopt a preventative behavioral mindset before replying on medication that could inadvertently cause other medical problems.
His focus on sleep disorders and hypertension go hand in hand with his mission to improve patient health through behavioral change. Though sleep is the foundation for good health, most adults don't get the recommended seven to nine hours of uninterrupted sleep each night. Many may suffer from serious disorders such as sleep apnea — which, in turn, can lead to chronic health issues such as hypertension, heart disease, Alzheimer's, and obesity. Dr. Zweig also helps patients improve their overall mental and physical health through a holistic approach to treatment that focuses on nutrition, exercise and managing stress.
Dr. Zweig is a clinical instructor at The George Washington University Hospital and an assistant professor at Georgetown University Medical Center, where he completed his residency and was chief resident. Prior to joining NVFP, Dr. Zweig served 15 years at General Medicine Internal Group, P.C. in Arlington, and was on the board for the HealthConnect Accountable Care Organization. He volunteered with the Virginia Hospital Center Honduras Medical Brigade to provide healthcare to remote villages in Honduras. He has been named Washingtonian's Top Doctor, Northern Virginia Magazine Top Doctor, and received the Patients' Choice Award.
He received his doctorate from The Ohio State University College of Medicine. He currently resides in Arlington with his wife and daughter. In his free time, Dr. Zweig enjoys outdoor activities such as hiking, biking, and skiing with his family. For more information, please visit Northern Virginia Family Practice Associates and follow him on Twitter and LinkedIn
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