Alcohol and Chronic Diseases

Alcohol and Chronic Diseases
A hangover may be the least of your worries
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Most people know that drinking too much alcohol can lead to some unwelcome symptoms the next day. But the trademark headache, upset stomach and fatigue you experience from a hangover may be the least of your concerns. According to the World Health Organization, alcohol is the third most harmful risk factor for chronic disease (WHO, 2003).

Research indicates that drinking more than 1 standard drink per day for women and 2 for men is associated with increased risks of high blood pressure, stroke and some types of cancer. As the amount of alcohol consumed increases, the risk of these conditions also increases. “We need to clear up misconceptions that people may have about alcohol and health,” says Rebecca Kavanagh, coordinator of the Smiths Falls FOCUS Community Coalition. “The bottom line is that for healthy people who choose to drink, reducing intake will help reduce the risk for chronic disease and other alcohol-related problems.”

FOCUS communities across Ontario are conducting a province-wide campaign to raise awareness about alcohol and chronic disease, including the risk of stroke. Drinking more than 1-2 drinks per day and binge drinking (more than 5 drinks at one time) can double the risk of ischemic stroke and increase the risk of hemorrhagic stroke two to three times. Alcohol use at these levels increases the risk of stroke by raising the blood pressure and contributing to obesity.

So if you don’t drink, don’t start. But if you choose to drink alcohol on occasion, the best advice is to limit your intake to no more than one to two standard drinks a day. The weekly limit for women is nine drinks; for men, it's 14. And remember, there are some situations where you should not drink at all (e.g., pregnancy, addiction, some chronic illnesses, driving).

• Glossary
• Alcohol & Stroke
• Alcohol & Cancer
• Alcohol & Breast Cancer
• General Health Benefits

Glossary
A standard drink has 13.6 grams of alcohol e.g. 142 ml (5 oz) of wine, 43 ml (1.5 oz) of spirits, or 341 ml (12 oz) of beer. (Centre for Addiction and Mental Health, Low Risk Drinking Guidelines)

The low risk drinking guidelines include:
0 drinks – lowest risk
2 drinks – no more than 2 drinks on any day
9 drinks per week for women
14 drinks per week for men.

Moderate drinking for men is not having more than 14 standard drinks in any 7-day period and not having more than 2 standard drinks in a single day. For women it is not having more than 9 drinks in any 7-day period and no more than 2 drinks on a single day. (Centre for Addiction and Mental Health)

Heavy drinking is consuming more than 2 drinks of alcohol per day and more than 14 drinks in a 7-day period for men or more than 9 drinks in a 7-day period for women. (Centre for Addiction and Mental Health)

Binge drinking is having five or more drinks on one occasion. (CAMH, Overview on Binge Drinking in Ontario, Part 1, 2002).

Alcohol & Stroke
Binge drinking (more than 5 standard drinks at one time) significantly increases your risk for stroke.

Consuming more than 2 standard drinks per day increases your risk for high blood pressure.

Stroke

“Heavy drinking and binge drinking increases the risk of stroke.” ¹

Those who drink 12 grams of alcohol or less than 1 drink per day have a lower risk of having a stroke, than those who drink more than 60 grams or more than 5 drinks per day.²

Those who have more than 5 drinks per day are at significantly greater risk for stroke than those who do not drink alcohol. ²

The risk of stroke increases with a high intake of alcohol.³

To reduce your risk of heart disease and stroke, limit alcoholic beverages and choose other beverages. ⁴

High Blood Pressure

High blood pressure is one of the most common and important health problems facing Canadians. It is one of the main risk factors for heart disease, stroke and kidney failure. Heart disease and stroke account for 37% of all deaths.⁵
Heavy drinkers—those who have 3 or more drinks of alcohol per day—who reduce their daily intake to no more than 2, may reduce their blood pressure. Reducing alcohol intake is an important lifestyle change to prevent and treat high blood pressure among heavy drinkers.⁶
People with high blood pressure who also have a heavy intake of alcohol may be at risk of cerebral hemorrhage, which is a factor in stroke. ⁷
Reducing alcohol intake is an effective way for people who drink moderate to heavy amounts of alcohol, to reduce their blood pressure. ^{8, 9}

1.    Beilin, L. J., Puddey, I. B. (1992). Alcohol and hypertension. Clinical and experimental hypertension Part A, Theory and practice, 14(1-2):119-38.

2.     Reynolds, K., Lewis, L., Nolen, J., et al. (2003). Alcohol consumption and risk of stroke: a meta-analysis. JAMA, Vol. 289:579-588.

3.     Reims, H. M., Kjeldsen, S. E., Brady, W. E., Dahlof, B., Devereux, R. B., Julius, S., Beevers, G., De Faire, U., Fyhrquist, F., Ibsen, H., Kristianson, K., Lederballe-Pedersen, O., Lindholm, L.H., Nieminen, M. S., Omvik, P., Oparil, S., Wedel, H. (2004). Alcohol consumption and cardiovascular risk in hypertensives with left ventricular hypertrophy: the LIFE study. Journal of Human Hypertension, 18(6):381-9.

4.     Heart and Stroke Foundation – 10 Ways to improve your health, Number 9. Retrieved from http://ww2.heartandstroke.ca/Page.asp?PageID=33&ArticleID=4593&Src=living&From=SubCategory

5.        Health Canada & The Canadian Coalition for High Blood Pressure Prevention. National High Blood Pressure and Prevention Control Strategy Summary Report of the Expert Working Group, January 2000. Retrieved from: http://www.phac-aspc.gc.ca/ccdpc-cpcmc/cvd-mcv/publications/nhbppcs_e.html

6.     Xin, X., He, J., Frontini, M. G., Ogden, L. G., Motsamai, O. I., Whelton, P. K. (2001). Effects of alcohol reduction on blood pressure: a meta-analysis of randomized controlled trials. Hypertension, 38(5):1112-7.

7.     Kiyohara, Y., Kato, I., Iwamoto, H., Nakayama, K., Fujishima, M. (1995). The impact of alcohol and hypertension on stroke incidence in a general Japanese population. The Hisayama Study. Stroke, 26(3):368-372.

8.     Puddey, I. B., Beilin, L. J., Vandongen, R. (1986). Effect of regular alcohol use on blood pressure control in treated hypertensive subjects: a controlled study. Clinical and experimental pharmacology & physiology, 13(4):315-8.

9.     Maheswaran, R., Beevers, M., Beevers, D. G. (1992). Effectiveness of advice to reduce alcohol consumption in hypertensive patients. Hypertension, 19(1):79-84.

Alcohol & Cancer
Drinking more than 1 or 2 standard alcohol drinks per day can put you at risk for many types of cancer.

“Alcohol is associated with cancers of the mouth, esophagus and breast and with colorectal cancer.”¹
Alcohol increased the risks for cancers of the oral cavity, pharynx, esophagus, and larynx. “Statistically significant increases in risk also existed for cancers of the stomach, colon, rectum, liver, female breast, and ovaries. “²
Moderate alcohol consumption in combination with tobacco use increases the risk of esophageal cancer.^{3, 4, 5}
Higher alcohol-related risks were found for cancers of the upper respiratory and digestive tracts. . . “Moderate intakes, corresponding to daily consumption of two drinks or two glasses of wine (25 g / day), have shown significant risks.”⁶
“Concurrent tobacco use, which is common among drinkers, enhances alcohol’s effects on the risk for cancers of the upper digestive and respiratory tract.” ⁷
“Chronic and excessive alcohol intake is associated with an increased incidence of a variety of cancers.” ⁸
The amount of alcohol consumed appears to influence the risk of cancer, with low or moderate consumption causing slight increased risk of cancers.⁹
A Japanese study confirmed that alcohol intake and a preference for high-temperature food was associated with an increased risk of esophageal cancer and that the amount of alcohol consumed, rather than the type of alcoholic beverage, was the main risk factor. ¹⁰
“Alcohol consumption was significantly associated with increased risk of colon cancers.” ¹¹

1.       Hendriks, H.F.J. (2002). Report of the 30th International Medical Advisory Board Conference held in Brussels, Belgium, 13-16 October 2002. Alcohol Research, 7(6):239-240.

2.       Bagnardi,V.,Blangiardo,M., La Vecchia, C., Corrao, G. (2001) Alcohol consumption and the risk of cancer: a meta-analysis. British Journal of Cancer, 85 (11):1700-5.

3.       Castelleague, X., Munoz, N., De Stefani, E., Victoria, C. G., Casteletto, R. (1999). Independent and joint effects of tobacco smoking and alcohol drinking on the risk of esophageal cancer in men and women. International Journal of Cancer, 85 (5): 657-64.

4.       Yang, C.X., Wang, H. Y., Wang, Z. M., Du, H. Z., Tao, D. M., Mu, X. Y., Chen, H., G., Lei, Y. (2005). Risk factors for esophageal cancer: a case control study in Southwestern China. Asian Pacific Journal of Cancer Prevention, 6 (1): 48-53.

5.       Kato, H., Yoshikawa, M., Miyazaki, T., Nakajima, M., Fukai, Y., Tajima, K., Masuda, N., Tsukada, K., Fukuda, T., Nakajima, T., Kuwano, H. (2001). Expression of p53 protein related to smoking and alcoholic beverage drinking habits in patients with esophageal cancers. Cancer Letters, 167(1):65-72.

6.       Corrao, G; Bagnardi, V; Zambon A; Arico, S. (1999). Exploring the Dose-Response Relationship between Alcohol consumption & the risk of several alcohol-related conditions: A Meta Analysis. Addiction, 94(10):1551-1573.

7.       Bagnardi, V., Ms,C.; Blangiardo, M. MsC; LA Vecchia C M.D. Corrao G (2001). Alcohol consumption & the risk of cancer. Alcohol Research & Health; 25(4):263 – 270.

8.       Wang, X. D. Retinoids and alcohol-related carcinogenesis. (2003) [Review] Journal of Nutrition, 133(1):287S-290S.

9.       Cancer Care Ontario. (2005). Alcohol Use increases Cancer, December, Ontario Cancer Facts http://www.cancercare.on.ca/index_cancerfactsalcoholuse+cancerrisk.htm

10.   Hanaoka, T., Tsugane, S., Ando, N., Ishida, K., Kakegawa, T., Isono, K., Takiyama, W., Takagi, I., Ide, H., Watanabe, H. (1994) Alcohol consumption and risk of esophageal cancer in Japan: a case-control study in seven hospitals. Japanese Journal of Clinical Oncology, 24(5):241-6.

11.   Su, L., J., Arab, L. (2004). Alcohol consumption and risk of colon cancer: evidence from the national health and nutrition examination survey I epidemiologic follow-up study. Nutrition & Cancer, 50(2):111-9.

Alcohol & Breast Cancer
Drinking 1 or more standard drinks per day can increase your risk for breast cancer.

Risk factors for breast cancer include: age, family history, previous breast disorders, taking hormone replacement therapy for more than 5 years and drinking alcohol. According to the Canadian Cancer Society, “Most women with breast cancer don't have a family history of the disease or any of the identified risks. Researchers are trying to find out what causes breast cancer. They have made progress, but there are many unanswered questions.”¹
Among post menopausal women, an intake of more than six drinks of spirits per week increases the risk of developing breast cancer. ²
Drinking beer, wine and liquor, each increase the risk of breast cancer among post menopausal women.³
Research provides further support for a positive association between the risk of postmenopausal breast cancer and alcohol consumption.⁴
Baseline intake of alcohol is a more important determinant of postmenopausal breast cancer than earlier lifetime exposure.⁵

Dose Related Messages

Alcohol, even at moderate levels (2 drinks / day) increases the risk for both breast cancer in both premenopausal and postmenopausal women. Research shows a moderate but statistically significant association between moderate to heavy alcohol intake and the subsequent risk of developing breast cancer. Relative risk for developing breast cancer increases 7% for each additional 10 gram (1drink) consumed each day. ⁶
About 4% of the breast cancers in women are directly attributable to alcohol. The more women who drink at moderate to heavy levels, the greater the number of breast cancer cases that are likely. Conservatively, over 840 women in Canada each year might be able to prevent developing breast cancer by reducing their alcohol consumption to safer levels for women.⁷
Compared to those who reported not drinking alcohol, the risk of developing breast cancer was 32% higher among those who reported drinking 35-44 grams per day and 46% higher for those who reported drinking 45 grams per day or more. ⁸
The level of alcohol consumption is directly related to increased risk of breast cancer. There is a significantly increased risk of breast cancer for women who drink more than 2 drinks daily over a period of years.^{9, 10}
Risk of death from breast cancer increased with intakes of total alcohol of 10-20 grams per day and more than 20 grams per day. The greatest risk was associated with consumption of wine. Alcohol from spirits has a small decrease in the risk of death and the effect of beer was not significant.¹¹
The more postmenopausal women drink alcohol every day, the greater their risk of developing breast cancer. Studies show an increase in the risk of breast cancer among postmenopausal women as they increase their daily intake of alcohol. ¹²
Women who drink moderately (less than 2 drinks a day) and who are on estrogen replacement therapy for five years are at greater risk a breast cancer. They have about double the risk of developing breast cancer of women who are only on the hormone replacement therapy or women who only drink alcohol.¹³
To reduce their risk for breast cancer, women are encouraged to limit their level of drinking to lower risk levels--abstaining from alcohol or having no more than one drink a day.¹⁴

1.        Canadian Cancer Society, Breast Cancer Risk Factors, retrieved from: http://www.cancer.ca/ccs/internet/standard/0,3182,3543_10175_272579_langId-en,00.html

2.        Petri, A. L.; Tjonneland, A.; Famborg, M.; Johansen, D.; Hoidrup, S.; Sorensen, T. I., Gronbaek, M. (2004). Alcohol intake, type of beverage, and risk of breast cancer in pre and post menopausal women. Alcoholism: Clinical & Experimental Research, 28(7):1084-90.

3.        Feigelson, H.S.; Calle, E. E.; Robertson, A. S.; Wingo, P. A.; Thun, M. J. (2001). Alcohol consumption increases the risk of fatal breast cancer. Cancer, Causes & Controls, 12(10) 895-902.

4.        Lenz, S. K.; Golberg, M. S.; Labreche, F.; Parent M. E.; Valois, M. F. (2002). Association between alcohol consumption and postmenopausal breast cancer: Results of a case control study in Montreal. Cancer, Causes & Controls, 13(8):701-710.

5.        Tjonneland, A., Christensen J., Thomsen B.L., Olsen A., Stripp, C., Overvad, K. Olsen, J.H. (2004) Lifetime alcohol consumption and postmenopausal breast cancer risk in Denmark: a prospective cohort study. Journal of Nutrition, 134(1): 173-178.

6.        McTiernan, A. (2003). Behavioral Risk Factors in B.C.: Can Risk be Modified? Oncologist 8(4):326-334.

7.        Spencer, Charmaine. (2004). Alcohol and Breast Cancer. Alcohol and Seniors, Aging in Canada Retrieved from: http://www.agingincanada.ca/alcohol_and_breast_cancer.htm.

8.        Santos, Silva I. (2002). Alcohol Tobacco & Breast Cancer. British Journal of Cancer, 87(11):1195-1196.

9.        Stoll, B. A. (1999). Alcohol intake and late-stage promotion of breast cancer. European Journal of Cancer, 35(12):1653-1658, as cited in Alcohol and Breast Cancer, Aging in Canada http://www.agingincanada.ca/alcohol_and_breast_cancer.htm

10.     Horn-Ross, P. L., Canchola, A. J., West, D. W., Stewart, S. L., Bernstein, L., Deapen, D., Pinder, R., Ross, R. K., Anton-Culver, H., Peel, D., Ziogas, A., Reynolds, P, Wright, W. (2004) Patterns of alcohol consumption and breast cancer risk in the California teachers study cohort. Cancer Epidemiology, Biomarkers & Prevention, 13(3):405-411.

11.     Jain, M.G., Ferrenc, R. G., Rehm, J. T., Bondy, S. J., Rohan, T. E., Ashley, M. J., Cohe, J. E., Miller, A. B. Alcohol and breast cancer mortality in a cohort study. Breast Cancer Research and Treatment, Department of Public Health Science, University of Toronto, Canada.

12.     Tjonneland, A.; Thomsen, B. L.; Stripp, C.; Christensen, J.; Overvad, K.; Mellemkael, L.; Gronbaek, M.; Olsen, J.H. (2003) Alcohol intake; drinking patterns & risk of postmenopausal breast cancer in Denmark; a prospective cohort study. Cancer, Causes & Controls, 14(3); 277-84.

13.     Chen, W., Coldtz, G.A., Rosmer, B., Hankinson, S., Hunter, D., Manson, J., Stamptfer, M.; Willett, W., & Speizer, F. (2002). Use of Postmenopausal Hormones, Alcohol, and Risk for Invasive Breast Cancer. Annals of Internal Medicine, 137(10): 798-804, as cited in Alcohol and Breast Cancer, Aging in Canada

14. Spencer, Charmaine. (2004). Alcohol and Breast Cancer. Alcohol and Seniors, Aging in Canada http://www.agingincanada.ca/alcohol_and_breast_cancer.htm.Alcohol and Breast Cancer in Alcohol and Seniors. http://www.agingincanada.ca/alcohol_and_breast_cancer.htm

General Health Benefits
If you choose to drink alcohol, any health benefits can be obtained by drinking less than 1 standard drink per day.

If you don’t drink alcohol, don’t start.¹
Drinking 12 grams of alcohol or less than one standard drink per day is associated with a decrease in the risk of stroke.²
It is healthier to drink smaller amounts per drinking day than to drink more on fewer days, in line with current guidelines on moderate drinking. “The drinking pattern of one drink per day is much healthier than seven drinks on a weekend.”³
Because there is evidence that some alcohol consumption has beneficial health effects, safe drinking guidelines developed in Canada recognize the need for balance. Moderate risk use, for example, appears to reduce overall mortality, but not cancer-related mortality.
1. The guidelines recommend no more than 2 drinks a day, with a weekly maximum of 9 drinks for women and 14 for men.
2. Persons with a family history of cancer are encouraged to drink less.
3. In Ontario, 70% of men and 86% of women aged 19 and older report that they either drink alcohol in accordance with these guidelines, or don’t drink at all.⁴
The regular consumption of small amounts of alcohol is more healthful than the sporadic consumption of larger amounts.⁵
Because of the substantially unpredictable risk of progression to problem drinking and alcohol abuse, the most sensible advice to the general public is that heavy drinkers should drink less or not at all, that abstainers should not be indiscriminately encouraged to begin drinking for health reasons, and that light to moderate drinkers need not change their drinking habits for health reasons, except in exceptional circumstances. ⁶
“Achieving a balance between the health risks and benefits of alcohol consumption remains difficult, as each person has a different susceptibility to the adverse health consequences associated with alcohol consumption.“ ⁷
To reduce your risk of heart disease and stroke, limit alcoholic beverages and increase non-alcoholic beverages. ⁸
“If you drink alcohol, do so in moderation.” This means no more than 2 drinks per day. ⁹

1.   Reynolds, K., Lewis, L., Nolen, J., et al. (2003). Alcohol consumption and risk of stroke: a meta-analysis. JAMA, 289:579-588.

2.     American Heart Association. (2002). Alcohol, Wine and Cardiovascular Disease. Dallas, TX, American Heart Association. Retrieved from http://www.americanheart.org/presenter.jhtml?identifier=4422

3.     Russell, Marcia, Dorn, Joan, Freudenheim, Jo L., Paola, Muti, Nochajski, Thomas, Hovey, Kathy, and Trevisan, Maurizio. (2004). Heavy, lifetime alcohol users may be toasting metabolic syndrome presented at American Heart Association’s Scientific Sessions 2004. Retrieved from http://www.americanheart.org/presenter.jhtml?identifier=3026064

4.     Cancer Care Ontario. (2005). Alcohol use increases cancer. Ontario Cancer Facts Retrieved from http://www.cancercare.on.ca/index_cancerfactsalcoholuse+cancerrisk.htm

5.     Meister, K. A., Whelan, E. M., Kava, R. (2000). The health effects of moderate alcohol intake in humans: an epidemiologic review. [Review] Critical Reviews in Clinical Laboratory Sciences, 37(3):261-96.

6.     Pinder, R. M., Sandler, M. (2004) Alcohol, wine and mental health: focus on dementia and stroke. [Review] Journal of Psychopharmacology, 18(4):449-56.

7.     Mukamal, Kenneth J. and Rimm, Eric, B. (2001). Alcohol’s effects on the risk for coronary heart disease. Alcohol Research & Health, 25(4): p. 260.

8.     Heart and Stroke Foundation – 10 Ways to improve your health, Number 9. Retrieved from http://ww2.heartandstroke.ca/Page.asp?PageID=33&ArticleID=4593&Src=living&From=SubCategory

9.     American Heart Association. (2002). Alcohol, Wine and Cardiovascular Disease. Dallas, TX, Retrieved from http://www.americanheart.org/presenter.jhtml?identifier=4422