Moderate Alcohol and Women’s Health: What does the science say?

Updated: Apr 5


Let’s take a look together at the health impacts for women of moderate alcohol consumption. I’ve been wanting to write this article for a long time, but have hesitated in starting because it is such a complicated subject!

The bottom line is that the impact of moderate alcohol on women’s health is quite different from men, and I really don’t feel that this information is readily known. This article is a brief summary of the research, and written in as practical terms as possible. This is not an article that addresses binge drinking, alcoholism or other issues. I encourage you to look at the health impacts for women of moderate drinking to help you make the best choices for your health.

Serving sizes:

First let’s get clear on serving sizes, and what is considered low, moderate or high alcohol intake.

A serving of alcohol, or a “drink” is:

  1. 12-ounce or 341-millilitre beer, cider or cooler with five-per-cent alcohol content

  2. five-ounce or 142-mL glass of wine with 12-per-cent alcohol content

  3. 1.5 ounces or 43 mL of distilled alcohol (vodka, gin, rum, etc.) with 40-per-cent alcohol content (80 proof)

Classifying intake:

  1. Low intake = under 3 drinks per week

  2. Moderate intake = 3-7 drinks per week

  3. High intake = 8 or more drinks per week

In this article, we’ll investigate the impact of alcohol consumption on:

  1. Sleep

  2. Digestive health

  3. Fertility

  4. Cancer risk

  5. Diabetes, Insulin resistance & Cardiovascular health

SLEEP

Impact: overall negative

  1. Although at all doses, it takes less time to fall asleep, alcohol causes a more consolidated first half sleep, and an increase in sleep disruption in the second half of sleep. Total night REM sleep percentage decreased in the majorities of studies with moderate or high alcohol intake. (9)

  2. If you are prone to waking in the middle of the night, or waking too early and having difficulty falling back to sleep, alcohol can make this worse.

DIGESTIVE HEALTH

Impact: overall negative

  1. Moderate alcohol consumption is associated with small intestinal bacterial overgrowth (SIBO) – bloating, gas, abdominal pain, constipation and diarrhea. (14)

  2. Alcohol exposure can promote the growth of Gram negative bacteria in the intestine altering the gut micrombiome. (15).

  3. Moderate drinking can increase intestinal permeability, causing loss of tight junction integrity by interfering with production of zonulin. (15,16)

FERTILITY

Impact: mixed results

  1. A small, but significantly increased, risk of ovulatory infertility was observed for women reporting moderate alcohol intake. This risk rose considerably in those women drinking at heavier levels compared with nondrinkers. Increased risks of endometriosis were found at both levels of alcohol intake examined. (1)

  2. Women who consume more than 5 alcoholic beverages per week take longer to get pregnant. (2,3)

  3. Another recent large study found no significant effect of moderate alcohol on women’s fertility. (4)

Overall, in healthy women there is no significant impact in fertility. There appears to be a higher risk of endometriosis with both moderate and high intake of alcohol which can impair fertility.

CANCER RISK

Impact: negative

  1. Roughly three to six glasses of wine a week, raises a woman’s risk of breast cancer by 15 percent. (5, 6)

  2. These effects are cumulative: with 9-12 glasses of wine per week, the risk climbed to 25%. (5)

  3. Additional cancer types associated with alcohol intake in women: oral cavity & pharynx, rectum, esophagus, larynx and liver. (7)

  4. One review study took this relationship further stating that “There is no level of alcohol consumption that can be considered safe” from this perspective. (8)

DIABETES, INSULIN RESISTANCE & CARDIOVASCULAR HEALTH

Impact: positive

  1. In healthy women, light to moderate intake of alcohol is associated with enhanced insulin sensitivity, reduced basal insulin secretion and reduced risk of diabetes. (10,11)

  2. In women who are overweight however, moderate wine consumption did not improve or impair insulin sensitivity, nor did it change any of the known correlates of insulin sensitivity such as body weight, blood lipids or blood pressure. (12)

  3. Extensive review of the research shows a ‘J-shaped’ association between alcohol and variety of health outcomes: heart disease, diabetes, high blood pressure, congestive heart failure, stroke, dementia, Raynaud’s phenomenon, and all-cause mortality. What this means is that light alcohol intake (up to 1 drink per day for women and 1-2 drinks per day for men) is associated with better health with all of these conditions; however high alcohol intake increases their risk. Alcohol consumption confers cardiovascular protection predominately through improvements in insulin sensitivity and high-density lipoprotein (HDL) cholesterol. (13)

  4. Binge drinking in particular, even among otherwise light drinkers, increases cardiovascular events and mortality. (13)

THE BOTTOM LINE

After pouring over so much research on moderate alcohol intake with women, the bottom line is that it depends on your current health and your risk factors. If in your family and personal history cancer risk outweighs diabetes and cardiovascular risk, it would be best to minimize or avoid alcohol to protect your future health. If there is a significantly higher incidence of cardiovascular disease and diabetes, then moderate alcohol can provide some health benefits.

Please note that this article addresses only ‘moderate’ alcohol intake, and not the risks of binge drinking or alcoholism.

I hope that this summary helps you to make the best choices for your health.

REFERENCES:

  1. Grodstein et al. Infertility in Women and Moderate Alcohol Use. American Journal of Public Health. 1994; 84(9)

  2. Jensen TK, Holland NHI, Henriksen TB, Olsen J. Does moderate alcohol consumption affect fertility? Follow up study among couples planning first pregnancy. BMJ 1998; 317(7157):505-10.

  3. Grodstein F, Goldman MB, Cramer DW; Infertility in women and moderate alcohol use. Am J Public Health 1994; 84: 1429–1432.

  4. Mikkelsen EM, Riis AH, Wise LA, Hatch EE, Rothmans KJ, Cueto HT, Sorensen HT. Alcohol consumption and fecundability: prospective Danish cohort study. BMJ. 2016; 354: i4262.

  5. Chen WY, Rosner B, Hankinson SE, Colditz GA, Willett WC. Moderate alcohol consumption during adult life, drinking patterns, and breast cancer risk. JAMA. 2011;306:1884–1890.

  6. Li CI, Chlebowski RT, Freiberg M, Johnson KC, Kuller L, Lane D, Lessin L, O’Sullivan MJ, Wactawski-Wende J, Yasmeen S, Prentice R. Alcohol consumption and risk of postmenopausal breast cancer by subtype: the women’s health initiative observational study. J Natl Cancer Inst. 2010;102:1422–1431.

  7. Allen NE, Beral V, Casabonne D, Kan SW, et al. Moderate Alcohol intake and Cancer Incidence in Women. J Natl Cancer Inst. 2009; 101 (5): 296-305.

  8. Lauer MS, Sorlie P. Alcohol, cardiovascular disease, and cancer: treat with caution. J Natl Cancer Inst. 2009;101:282–283.

  9. Ebrahim IO, Shapiro CM, Williams AJ, Fenwick PB. Alcohol and Sleep I: Effects on Normal Sleep. Alcoholism: clinical & experimental research. 2013; 37(4): 539-549.

  10.  Bonnet F, Disse E, Laville M, Mari, A, et al. Moderate alcohol consumption is associated with improved insulin sensitivity, reduced basal insulin secretion rate and lower fasting glucagon concentration in healthy women. Diabetologia. 2012; 55(12): 3228-3237

  11. Joosten MM, Buelens JWJ, Kersten S, Hendriks HFJ. Moderate alcohol consumption increases insulin sensitivity and ADIPOQ expression in postmenopausal women: a randomized, crossover trial. Diabetologi. 2008; 51(8): 1375-1381

  12. Cordain L, Melby CL, Hamamoto AE, O’Neill DS, Cornier MA. Influence of moderate chronic wine consumption on insulin sensitivity and other correlates of syndrome X in moderately obese women. Metabolism. 2000; 49(11): 1473-1478.

  13. O’Keefe JH, Bybee KA, Lavie CJ. Alcohol and Cardiovascular Health: The Razor-Sharp Double-Edged Sword. 2007; 50(11): 1009-1014.

  14. American College of Gastroenterology. Moderate alcohol consumption is associated with small intestinal bacterial overgrowth, study finds. ScienceDaily. 28 November 2011.

  15. Purohit V, Bode JC, Bode C, Brenner DA, Choudhry MA, Hamilton F, Kang YJ, et al. Alcohol, Intestinal Bacterial Growth, Intestinal permeability of endotoxin, and medical consequences. Alcohol. 2008; 42(5): 349-361.

  16. Elamin E, Jonkers D, Juuti-uusitalo K, et al. Effects of ethanol and acetaldehyde on tight junction integrity: in vitro study in a three dimensional intestinal epithelial cell culture model. PLoS One. 2012; 7(4): e35008.


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