Low-to-Moderate Alcohol Consumption

Heavy drinking can raise your risk of dementia while long-term use of low-to-moderate alcohol levels might protect the brain, although the evidence for protection is weak and mixed. Moderate intake is typically defined as 1 serving (equal to 15 grams of alcohol) a day for women and 2 for men.  If you have already incorporated low levels of alcohol into your diet, it is generally considered safe to continue. But it is probably not a good idea to start drinking just to prevent dementia.

with   Limited  evidence
with   Strong  evidence

Many chemicals are classified as alcohols, but the type that is safe to drink is ethyl alcohol (also known as ethanol, or more colloquially, “alcohol”). Alcohol has been a part of the human diet for at least 10,000 years [1]. In the U.S., over 65% of adults regularly have at least one alcoholic beverage a year.

Due to its influence on mental and physical activity, alcohol is classified as a drug.  Alcohol intoxication is a direct cause of over 25,000 deaths in the U.S. annually (not including accidents) [2], and heavy alcohol use is directly linked to numerous health problems, including early-onset dementia, Wernicke’s disease, Korsakoff’s syndrome, liver and heart diseases, hypertension, cancer, and stroke. Moreover, prolonged, heavy drinking can lead to alcoholism, a common issue in older adults, who are more susceptible to the effects of alcohol due to physiological changes associated with aging [3].

Did you know? The oldest written recipe ever found is almost 4000 years old and describes a process for making beer!

Alcohol is the intoxicating component of beverages such as wine, whiskey, and beer. It is produced by the fermentation of various types of sugars, such as those found in grapes (used to make wine), grains (used to make beer and whiskeys), and rice (used to make sake).

Typically, a low-to moderate amount of alcohol is defined as no more than one drink a day for women and older adults, and two for men. One drink is usually one 1/2 ounce or 15 grams of alcohol, which equals approximately 12 ounces of beer, 5 ounces of wine or 1.5 ounces of 80-proof liquor. However, this guideline must be tailored to the individual. Older adults can be more sensitive to alcohol because they metabolize it more slowly; people with a smaller body mass index are also particularly sensitive.

Most of the evidence for alcohol and the brain does not distinguish between different types of alcoholic beverages. However, some studies have suggested that the strongest protection against cognitive decline is associated with red wine.

  • Red wine and Alzheimer’s disease: Although several studies have observed that drinking low-to-moderate amounts of any form of alcohol may reduce the risk of developing Alzheimer’s disease, others have suggested that red wine has the highest potential to prevent or delay cognitive decline [4-6]. For example, one study regularly tested over 5000 older adults on learning, memory and attention tasks for seven years. Those who drank wine performed better in each tested category and demonstrated slower age-related cognitive decline compared to those who drank other forms of alcohol [7].
  • However, it is difficult to separate the effects of red wine from other factors. For example, people who drink wine tend to buy healthier foods [8], are generally better-educated [9], exercise more and maintain a healthier body mass [10,11], all of which are factors that are also associated with a lower risk of developing Alzheimer’s disease. Thus, drinking red wine may simply reflect a healthier lifestyle.
  • Red wine contains other compounds besides alcohol, including the antioxidant resveratrol, which may have potential benefits for human health. But the amount of resveratrol in red wine is so low that it is probably not relevant to human health. You can buy purified resveratrol supplements in capsule form, but the health benefits of taking these supplements are still under investigation.

Possibly, based on limited evidence.

Based on evidence from several human observational studies, drinking low-to-moderate amounts of alcohol is associated with a 50% reduced risk of developing Alzheimer’s disease, the most common form of dementia [23-25]. However, these studies suffer from many inconsistencies. Very few studies agree on the protective association with important details, like what amount of alcohol, what type of alcohol, what duration of use, and when in a person’s life is the alcohol use most associated with disease prevention.

It’s quite possible that the alcohol is not protective but that the people who use moderate to low alcohol levels share other characteristics that make them less likely to experience dementia. For example, perhaps these people are more likely to have an active social life and less likely to have health problems that lead doctors to recommend abstaining from alcohol.

Even moderately heavy alcohol use can accelerate brain aging and raise the risk of dementia [26].

Controversial, based on very limited evidence.

In people with  mild cognitive impairment (MCI), low-to-moderate levels of alcohol consumption was associated with a 50 to 85% slower rate of cognitive decline [27,28]. However, it’s possible that other factors than alcohol explain this effect. For example, patients with more health problems may have been less likely to use alcohol. In patients with Alzheimer’s disease or dementia, no evidence is available on whether alcohol use can slow the progression of the disease. Given that alcohol can acutely impair cognitive function and interact dangerously with many medications, it is unlikely a good choice for Alzheimer’s patients.

Possibly, based on very limited evidence.

The effect of low-to-moderate alcohol use on aging is ambiguous. People who consumed low to moderate alcohol levels had a 16% lower mortality rate compared to abstainers and heavy drinkers [29]. In older individuals, the results are even more striking: when examining the 20-year survival rate of people aged 55 to 65, abstainers had a 51% increased mortality rate compared to moderate drinkers [30]. However, alcohol may have nothing to do with this observation. It’s very possible that low-moderate drinkers share other characteristics that are affecting their risk of mortality. Moderately heavy alcohol use may accelerate brain aging, based on a high-quality observational study in men [31].

In terms of telomere length, a controversial marker of aging, results are mixed. One analysis found that moderate alcohol consumption did not affect telomere length in women [32], whereas a different study reported that men who drank even moderate amounts of alcohol had shorter telomeres, suggesting advanced biological age. The heaviest drinkers had the shortest telomeres [33]. The same researchers followed over 2400 middle-aged men for 30 years and reported that men who drank up to three glasses of red wine a day had a lower mortality rate, better mental health, and reported a higher quality of life [34]. Although these studies were purely observational and therefore cannot definitively connect moderate alcohol use and aging, their findings suggest that several factors, including gender and the type of alcohol consumed, play a part in the biological consequences of drinking.

Drinking too much alcohol is directly linked to numerous health problems, including early-onset dementia, liver and heart diseases, cancer, and stroke. Alcohol affects the brain by increasing release of the neurotransmitter GABA, which causes an overall “depressive” effect on brain activity, including slow and impaired thinking, movement, and reaction time.

Although some studies claim there is no association—positive or negative—between moderate alcohol consumption and mental health [12,13], others suggest that a low-to-moderate level of alcohol intake (defined as up to one drink a day for women and two for men) may protect the brain. For example, adults who regularly drank limited amounts of alcohol were less likely to develop depression [14,15] and generally scored higher on cognitive function tests compared to those who never drank [16,17].

How alcohol might produce these protective effects is not currently understood. It is possible that alcohol is not protective at all but that people who drink low-to-moderate levels share other characteristics or habits that are protective. That said, low levels of alcohol consumption can increase HDL (sometimes called the “good” cholesterol) [18] while facilitating blood circulation and decreasing inflammation [19]. Inflammation is strongly implicated in the severity and progression of diseases like Alzheimer’s [20], and experiments on isolated neurons suggest that small amounts of alcohol can “precondition” brain cells to deal with stressful conditions, helping to suppress inflammation and prevent cognitive deterioration [21,22].

Probably safe, based on strong evidence.

NOTE: This is not a comprehensive safety evaluation or complete list of potentially harmful drug interactions. It is important to discuss safety issues with your physician before taking any new supplement or medication.

The evidence suggests that drinking low-to-moderate levels alcohol is probably safe for healthy individuals. However, alcohol is a drug with potentially severe side effects. Heavy drinking (usually more than 2 drinks per day) is directly related to a number of health problems, including high blood pressure, obesity, stroke, heart and liver diseases, certain forms of cancer and may even promote cognitive decline [35,36], particularly in men [37].

Certain prescription and over-the-counter drugs can dangerously interact with alcohol. Always talk to your doctor or pharmacist to determine which medications may harmfully interact with alcohol.

Low-to-moderate alcohol intake is generally safe for healthy people. Many studies have observed that drinking up to two servings of alcohol a day can lower the risk of heart disease, even compared to those who abstain from drinking. If your daily habits already include a little alcohol, it is generally safe to continue unless otherwise advised by a doctor. However, drinking alcohol to prevent Alzheimer’s disease or dementia is not recommended. If you do use alcohol, drink it in moderation.

Prolonged, heavy alcohol use can lead to alcohol-related dementias, such as Wernicke’s disease, Korsakoff’s syndrome, or even early-onset dementia. Heavy drinking is also directly related to liver and heart diseases, hypertension, cancer, and stroke.

Each person responds to differently to alcohol. In general, women are more sensitive than men to alcohol’s effects due to having a generally smaller body size. Older adults are also more sensitive to the intoxicating effects of alcohol because they metabolize alcohol more slowly. So, the guideline for “low-to-moderate” intake must be tailored to the individual.

Many prescription and over-the-counter medications can be harmful when mixed with alcohol. Always check with your health care provider to ensure that the medicines you take will not negatively interact with alcohol before drinking.

The available evidence on alcohol use and Alzheimer’s risk is limited to a modest amount of observational data. Although expanded observations may yield new findings, groups of people who choose to drink alcohol or not will always have potentially meaningful differences beyond alcohol. Establishing a definitive role for alcohol in preventing Alzheimer’s disease or aging requires large, well-controlled clinical trials, which are not truly practical.

• A BioScience Technology article about a 2014 study that moderately heavy alcohol use accelerates brain aging in men by about 6 years

• The CDC offers extensive information on alcohol and public health

• The American Heart Association has more information on the effects of alcohol on cardiovascular health

• The Alzheimer Research Forum has more information about alcohol consumption as a risk factor. They have also included a discussion evaluating the strength of findings from several studies linking alcohol and the risk of developing Alzheimer’s disease

• The National Institute on Alcohol Abuse and Alcoholism has a partial list of medications that negatively interact with alcohol, as well as their possible effects

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22.  Collins, M. A., Neafsey, E. J., Wang, K., Achille, N. J., Mitchell, R. M. & Sivaswamy, S. (2010) Moderate ethanol preconditioning of rat brain cultures engenders neuroprotection against dementia-inducing neuroinflammatory proteins: possible signaling mechanisms. Mol. Neurobiol. 41: 420-425.

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24.  Luchsinger, J. A., Tang, M. X., Siddiqui, M., Shea, S. & Mayeux, R. (2004) Alcohol intake and risk of dementia. J. Am. Geriatr. Soc. 52: 540-546.

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27.  Xu, G., Liu, X., Yin, Q., Zhu, W., Zhang, R. & Fan, X. (2009) Alcohol consumption and transition of mild cognitive impairment to dementia. Psychiatry Clin. Neurosci. 63: 43-49.

28.  Solfrizzi, V., D'Introno, A., Colacicco, A. M., Capurso, C., Del, P. A., Baldassarre, G., Scapicchio, P., Scafato, E., Amodio, M. et al. (2007) Alcohol consumption, mild cognitive impairment, and progression to dementia. Neurology 68: 1790-1799.
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31.  Sabia, S., Elbaz, A., Britton, A., Bell, S., Dugravot, A., Shipley, M., Kivimaki, M. & Singh-Manoux, A. (2014) Alcohol consumption and cognitive decline in early old age. Neurology 82: 332-339.

32.  Sun, Q., Shi, L., Prescott, J., Chiuve, S. E., Hu, F. B., De, V., I, Stampfer, M. J., Franks, P. W., Manson, J. E. & Rexrode, K. M. (2012) Healthy lifestyle and leukocyte telomere length in U.S. women. PLoS. One. 7: e38374.

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34.  Strandberg, T. E., Strandberg, A. Y., Salomaa, V. V., Pitkala, K., Tilvis, R. S. & Miettinen, T. A. (2007) Alcoholic beverage preference, 29-year mortality, and quality of life in men in old age. J. Gerontol. A Biol. Sci. Med. Sci. 62: 213-218.

35.  Xu, G., Liu, X., Yin, Q., Zhu, W., Zhang, R. & Fan, X. (2009) Alcohol consumption and transition of mild cognitive impairment to dementia. Psychiatry Clin. Neurosci. 63: 43-49.

36.  Liu, Y., Colditz, G. A., Rosner, B., Berkey, C. S., Collins, L. C., Schnitt, S. J., Connolly, J. L., Chen, W. Y., Willett, W. C. & Tamimi, R. M. (2013) Alcohol intake between menarche and first pregnancy: a prospective study of breast cancer risk. J. Natl. Cancer Inst. 105: 1571-1578.

37.  Sabia, S., Elbaz, A., Britton, A., Bell, S., Dugravot, A., Shipley, M., Kivimaki, M. & Singh-Manoux, A. (2014) Alcohol consumption and cognitive decline in early old age. Neurology 82: 332-339.

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