by Dr. Deborah Gordon

Sounding like a broken record, my answer to that question would be, “Well, it depends who you are and what are your goals.” The only broadly applicable truth about drinking alcohol will not surprise: alcohol in excess is never good for you (or others if you drive drunk or try to settle an argument) and there is some evidence that the moderate drinker who drinks wildly once or twice a month is actually doing more harm than the imbiber who regularly slugs back a few too many. With that settled, let’s turn to minimal to moderate drinking and focus on the specifics.

We’ve been drinking fermented—and thus alcoholic—beverages for at least 10,000 years, which makes them more recent than the Paleo era, but certainly well within the bounds of many traditional cultures, all of whom had less chronic illness than our current pattern. Alcohol, like many things, can be either a tonic or a toxin depending on the dose. We rely on good liver health to recycle alcohol and diminish its toxic effects while extracting its beneficial elements.

For general health considerations, the research seems to indicate that most people stand to benefit from regular and moderate drinking. If you enjoy one shot of liquor, five ounces of wine or 12 ounces of beer on a daily basis, you land yourself in the general group that has better heart health, less type two diabetes and less gallstones. That “better health” status means you fare better than people who drink more as well as people who drink less or not at all. So if those are your only health concerns, keep a steady tiny stream of alcohol on your daily menu. Most men can probably thrive with twice that amount of alcohol, as their livers are not so distracted with female hormones and thus better able to recycle alcohol normally.

The next category is those who would be wise to keep their alcohol intake somewhere between less than moderate to none at all. Wise alcohol minimalists would include those who are currently trying to lose body fat, address any other food addictions or restrictions, those in training to improve a particular form of physical fitness, and insomniacs. Alcohol works as an excellent and rich body fuel, requiring your body to store other fuels as body fat, oops. If you’re trying to break a compulsion to over-eat or zone out in front of the tv, remember that we each have a finite amount of will power. Good sleep and nutrition build up our will power; exhaustion and inebriation deplete our ability to make wise choices over habitual impulses. If you’re working hard to improve your CrossFit times or lifts, or prevail over a competitive sports season, alcohol will mess with your sleep cycles (knocks you out, but prevents normal sleep hormones and brain architecture from occurring) and thus your performance. The insomniacs can probably tolerate a little alcohol early in the evening, but shouldn’t take it close to bedtime, if at all.

There are those who would be better off avoiding alcohol altogether, and they include pregnant women, former alcoholics, people who have had a serious case of viral hepatitis or other liver disease, and those regularly taking medications that interact with alcohol. Develop a taste for mineral water (excellent source of trace minerals) or even club soda with some lemon or lime, which will provide nutrition and distraction from the drinkers around you.

>The most complicated question in my practice is whether alcohol is safe for a woman at increased risk for breast cancer. There is a clear increased risk for some moderate or heavy drinkers. As a higher risk woman myself (one late-in-life pregnancy, a strong family history), I’ll tell you how I resolve the dilemma. I will concede that I have had an obsessive attention to the literature on this topic since a clinical instructor told me I was certain to get breast cancer at an age younger than my mother did.

Women at risk for breast cancer might skip alcohol altogether or about half the time. When drinking, limit yourself to the amounts listed above. Very rarely, it’s okay to have twice that amount. If you are choosing to drink alcohol at all, you must have a good level of folate in your blood. Obtain folate from dark leafy greens or a supplement. Forget the folic acid form of folate: if folic acid is in your multi-vitamin, you know that your brand has settled for the oldest, cheapest and least useful form of nutrients. You want either folate, folinic acid or methylfolate to benefit from the observed protection noted: women with adequate folate levels can drink minimally or moderately and escape from the otherwise carcinogenic effects of alcohol. You know that you need the methylated folated if you’ve had genetic testing that revealed certain enzyme deficiencies in methylation.

(Genetic testing? Methylation? We’ll have to talk about that another time, but stay tuned. Learning about your own genetic realities can’t change your eye color, but proper intervention can influence the likelihood of future health, both during pregnancy and throughout middle and later years.)

So, alcohol? Use it wisely, at the level appropriate to your general health status and goals, and it will be a valuable health tonic. If you can’t use alcohol wisely, or your health goals are more consistent with sobriety, be strategic about acceptable alternatives that work for you.

Dr. Deborah practices in two places: online at DrDeborahMD.com and in person at Madrona Health Care, 1607 Siskiyou Blvd. in Ashland, ph 541 482 8333.