Ashlee Williams, MD (Host): For years, we've been hearing mixed messages about alcohol. Some say a glass of red wine is good for your heart. Others claim that moderation is key. And then, there are the warnings that even a small amount can be risky. So, what does the science really say? How does alcohol affect our health? And is there such a thing as a healthy amount?

Welcome to the Healthier You Podcast. I'm Dr. Ashlee Williams. And today, I'm joined by Dr. Joseph Lodato, a board-certified cardiologist here at Kaiser Permanente. Together, we'll dive into the latest research, clear up common myths, and explore how alcohol impacts our health. Dr. Lodato, thank you so much for being here today.

Joseph Lodato, MD: Thank you, Dr. Williams. It is my pleasure to be here today.

Host: So, a common misconception I encounter in clinic is that people often underestimate how much they're drinking. A lot of people aren't aware of how much alcohol they're actually consuming. So, I think it's important to clarify, how do you define a standard drink?

Joseph Lodato, MD: Well, that's a great question, and takes me back actually to my days of training when I learned from my mentors that alcohol is alcohol, but drinks are not necessarily the same, and quantifying how much alcohol is in a drink is very important. Most beers run from the range of 3.5% to 5.5% alcohol. A standard beer is 12 ounces. However, you have to be careful. Some of those craft beers out there are 10%, 12% alcohol. Those are pretty potent potables. Then, there's wine. Wine generally runs around 12% alcohol. And a normal glass of wine or one serving of wine is 5 ounces. When it comes to distilled spirits, a serving of distilled spirits is one shot or one and a half ounces. So, it's very important to quantify just how many equivalents of alcohol someone is consuming in a day or in a week.

Host: I've definitely had patients come in and tell me they don't drink at all. And then, I ask more specifically about beer and wine and they'll say, "Oh, I drink like one or two beers a day." So, there's definitely a misconception out there about alcohol. So, can you talk about what the latest research tells us about alcohol and how it impacts our health?

Joseph Lodato, MD: Well, there's a lot out there right now, and I'm sure a lot of the listeners have seen the latest recommendation from the Surgeon General that no amount of alcohol is safe. There's even calls to put labels on alcoholic beverages listing all of the various health maladies that can come from drinking alcohol, much like was done for cigarettes in the past.

There is a lot of what I would say is observational data about alcohol and its effects on the health. So, we have to be careful with observational data. It doesn't necessarily mean there is causation. It just means there is an association with some level of consumption of alcohol.

What we do know about alcohol and its impact on the health, especially impact on the heart is that drinking alcohol is associated with hypertension, and certainly is associated with certain diagnoses like atrial fibrillation and other heart rhythm disorders, as well as heart failure, very serious heart conditions that no one really wants to have. And certainly, hypertension has lots of negative impacts on all of our organ systems in the body.

Host: So, currently, the recommendations are that women consume, on average, seven drinks a week or less alcoholic drinks. And for men, it's 14 drinks per week. So, can you talk about the difference between how women and men metabolize alcohol in their bodies?

Joseph Lodato, MD: Sure. Obviously, men and women are different. Their body compositions are different. Their metabolism is different. Men tend to have more muscle mass in their body. Their metabolism tends to be higher, so can process alcohol a lot faster than women can. metabolism is often, based on someone's height, someone's body size and height. So, the taller you are, generally the faster your metabolism runs. Men tend to be taller than women, not always true, obviously. But the larger the person is, generally, the more rapidly they metabolize alcohol.

It's an important point, we metabolize a serving of alcohol at about one drink per hour. And remember these are the standard equivalents of alcohol, not going and getting a Long Island iced tea, that's not one drink, that has multiple servings of alcohol in it. And I think that gets back to the first topic that we discussed and how important it is to really quantify how much alcohol it is that you're consuming.

Host: Okay. So, what about red wine? Is it actually good for our heart?

Joseph Lodato, MD: I love this. This is a myth that has gone back for many, many decades now. Again, this is observational data. Observational studies are very interesting. They generate hypotheses for us. They generate important questions that I think we need to ask as people in the medical field and scientists. We really need to know what is the true impact alcohol on someone's health.

When you look at those who consume red wine, of course, there are interesting ideas about the contents of red wine. They may have certain antioxidants in there that might be beneficial for someone's health, may have positive impacts on the heart and blood vessels, and other body systems. We have all heard about the French paradox, this way of European living where people may have a glass of wine or even two glasses of wine every day. It's just part of the culture and they generally have better health outcomes. So, this myth has generated that, "Hey, drinking a glass of red wine every day is good for your heart, is good for your body in general. However, when you take a deeper look into those observational studies, it's not clear that the benefits are truly from red wine. It may well be that it's just a way of living that is healthier than, say, the way other individuals live. So, those people that drink one or two glasses of red wine every day, are they more likely to exercise? Are they more likely to have a healthy and balanced diet? Do they get better sleep at night? Are they in a certain socioeconomic class that allows them to have better access to health care? All those things may be what's driving the benefit in those who drink one or two glasses of wine day rather than the wine itself.

Host: So, it sounds like you really need to look at the entire picture. Is there a such thing as a healthy amount of alcohol to drink?

Joseph Lodato, MD: Interesting that you ask that. The Canadians have come out with some pretty stringent guidelines, here in the last six months or so. Their conclusion is there really is no safe level of alcohol consumption. If you look at information that we know about atrial fibrillation, I would say they're probably right.

When we've looked at studies of patients who drink no alcohol at all versus those who have one drink per day, there is a much higher risk of atrial fibrillation in the group that drinks even one alcoholic beverage per day. So, there really isn't a safe level of alcohol consumption. What I tell my patients is if you're going to drink alcohol, you certainly should not be drinking every day. Limit it to one serving if you're a female, two servings if you're a male. And drink no more than three to four days per week. There's not a lot of science or evidence behind that, and we really do need more science and evidence behind alcohol consumption. But this is a happy medium between what the American guidelines and the Canadian guidelines are currently recommending.

Host: And then, for the audience who they don't know what atrial fibrillation is, it's an arrhythmia of the heart that can cause stroke, right?

Joseph Lodato, MD: That's correct. We know that drinking, even as much as one drink of alcohol per day, increases your risk of developing this irregular heart rhythm called atrial fibrillation. It also increases your risk of developing hypertension. Hypertension is the most common risk factor that is associated with a host of medical problems, but certainly most common risk factor that is associated with atrial fibrillation. so yes, it's an irregular heart rhythm. It does increase your risk of stroke. We know that consuming alcohol regularly also increases your risk of stroke, independent of developing hypertension or atrial fibrillation, another important risk factor that comes from drinking alcohol.

Host: So, it sounds like reducing our amount of alcohol consumption is probably the healthiest thing we can do.

Joseph Lodato, MD: Absolutely. And there is information here as well. We know from clinical research that if you reduce your alcohol consumption, even by one drink per day, one drink per week, any reduction in alcohol consumption results in improved medical outcomes for patients.

Host: So, let's say someone's listening to this podcast and they're ready to cut back. Do you have any tips on how you can go about cutting back?

Joseph Lodato, MD: Well, I think the first thing to do is to have a plan to really hold yourself accountable to whatever plan or goal that you want to set for reducing your alcohol consumption. If you're someone that drinks every day, perhaps you want to say, "All right, I'm going to reduce my alcohol consumption by one drink per day." Start off with something that you know you can do. If you want to get even more extreme, try stopping drinking for an entire month or an extended period of time. You will see health benefits right away. In addition to those heart outcomes we discussed like fibrillation, hypertension, and heart failure, I didn't talk about some of the other benefits of cutting back on your drinking.

Number one, going to sleep better. We know that when when you drink alcohol, it initially will be sort of a sedating, relaxing effect and might even lower blood pressure shortly after you drink it. But when your body metabolizes alcohol, it actually increases levels of stress hormones in your body, things like adrenaline and cortisol, and that causes even more stress. And once you metabolize that alcohol, once it's through your system, it actually raises your blood pressure, and can lead to things like anxiety, sleep disturbance. If you've ever had too much to drink, you might find that you wake up in the middle of the night, and you're not sure why you're awake. That's because of the metabolites of alcohol. It causes a high level of these stress hormones in your body. In addition to sleep difficulties, alcohol can lead to obesity. And from obesity, there are a whole host of other problems that can develop inside the body. So, these are more reasons why you want to try to cut back on your drinking.

Host: Thanks for this great information, Dr. Lodato. We learned a lot about how alcohol affects our bodies. Here are the top takeaways.

One, the latest research shows health risk of moderate alcohol consumption and suggests that having more than one drink per day can increase the risk of coronary heart disease. Two, physiologically, men and women process alcohol differently. This is why women may experience harmful effects at lower levels of drinking. But no matter if you are a man or a woman, the more alcohol you drink, the greater the health risk. Three, the idea that red wine has heart health benefits has been disproven. There's no evidence that wine is less harmful than any other type of alcohol. Four, no amount of alcohol is truly safe for the body. Alcohol affects almost every organ system in negative ways. And five, even the smallest reduction in alcohol consumption will have a positive impact on your overall health. It's never too late to cut back.

For more information about heart health from our experts, visit kp.org/doctor and listen to more episodes of Healthier You wherever you get your podcast. If you enjoyed this episode, please be sure to share it with others. From all of us at Kaiser Permanente, be well.