Drinking Women

We
shall herein survey recent research in this field as it
relates to women, particularly women who drink moderately.
(It is a given that immoderately heavy drinking is very
harmful to all.)

To begin with,
the not so new: for some years it has been observed that it
takes less alcohol, in any form, to cause trouble such as
liver or heart damage, for women compared to men. Among
explanations posited (without evidence) were women’s small
size, higher proportion of body fat, and hormonal
differences. It turned out that the major difference resides
in the stomach lining, the gastric mucosa. The body’s first
response to alcohol after it is swallowed is to begin to
neutralize it, break it down in the stomach by means of the
enzyme alcohol dehydrogenase before it is absorbed into the
bloodstream. Women’s stomachs contain only about 6O percent
as much alcohol dehydrogenase as do men’s, and so can
neutralize only about 6O percent as much alcohol, which
leads to a substantially higher blood level for the same
drink. This is the basis for the recommended safe limit for
women of half that of men. (But women may eliminate alcohol
from the blood faster than men.)

Cardiovascular
disease (atherosclerosis), our most disabling and deadly
disorder, carries the greatest weight of evidence in both
sexes of the beneficial effects of moderate drinking. These
benefits, which include large reductions of the risks of
heart attack and stroke, and of deaths therefrom, appear to
come about by a complex of mechanisms stimulated by alcohol
and by the antioxidant polyphenols of wine.

The benefits
have been shown to be related to both the quantity (within
the moderate range) and frequency of drinking. We were
surprised by a recently published study from Copenhagen and
the Beth Israel Deaconess Medical Center in Boston, which
indicates that the primary determinant of risk reduction in
women is quantity consumed, while that in men depends on
frequency of drinking. Women in a particular subgroup had
only about one quarter the risk of coronary heart disease of
abstainers; others had risk reductions of 2O to more than 35
percent. These women drank from one to more than fourteen
drinks per week. Frequency of drinking had little effect.
The maximum benefit in men was a 4O percent reduction in
coronary risk among those who drank five to seven days
weekly, even if only a drink or two. Thus far, there is no
ready explanation for the difference between women and men,
but, obviously, the research continues.

While it has
been clear that the risks of developing several cancers are
multiplied by excessive drinking, the possibility that
modest consumption might modestly increase the risks of
particular cancers continues to elude definitive solution.
The results of studies of breast and colorectal cancers
vis-a-vis alcohol are conflicting. Even in those showing a
slight increase in breast cancer incidence associated with
drinking, this increase was seen only in women deficient in
the vitamin folic acid (folate), found in abundance in
liver, various green leafy vegetables, some beans, and other
sources. Work recently reported from Australia and from
Denmark indicates that ensuring adequate folate intake (4OO
micrograms per day) eliminates any alcohol-related increase
of risk. We should remember that, despite its fearsome
prospect, breast cancer ranks well behind heart disease as
the prime cause of death of women, so the cardiovascular
benefits of moderate drinking are likely to overwhelm any
slight increase in cancer risk, if such an increase
exists.

Recognition of
the fetal alcohol syndrome more than 3O years ago led to a
nearly panicked aversion to any alcohol at all by women who
were or who might be pregnant. With understanding that the
only heavy binge drinkers, likely with other liabilities,
risked the syndrome for their babies, the pendulum swung
toward complacency. With more recent research, it has swung
back a little. Let me summarize current understanding of
alcohol’s effects upon reproduction.

Abuse of alcohol
in either sex can impair fertility, especially in women, who
may lose their menstrual periods. Even modest drinking may
be a bad idea for those trying to conceive and during early
pregnancy. Both men and women consuming ten or more drinks
during the week of conception increase the risk of early
pregnancy loss. Women who consume four or more drinks per
week increase risk of premature delivery. The female
offspring of rats fed low to moderate amounts of alcohol
during pregnancy develop more breast tumors than those of
abstinent pregnancies. Some adolescent children of human
mothers who had averaged even fewer than one drink daily
during pregnancy continue to exhibit growth
deficit.

The notorious
heartburn of pregnancy is often exacerbated by wine, though
not by spirits, a rare instance of a drinking adversity not
caused by alcohol.

A report from
Baltimore finds that current alcohol use, even of minimal
degree, reduces hot flashes in women transitioning to
menopause. The mechanism is unclear, for sex hormone levels
are not affected.

It might
surprise some to learn that the brains of women and men
differ. New research adds weight to the notion. Despite the
heightened sensitivity to alcohol mentioned above of females
versus males, Duke University researchers have demonstrated
that adult female rats are less sensitive than males to
sedative effects of alcohol. This difference appears to be
related in some way to the rats’ sex cycle (hmm). Yet, both
human observations and animal studies are suggestive of a
differential increased susceptibility of females to brain
damage from alcohol abuse. This difficulty may also apply to
dependence on and withdrawal from alcohol. Interestingly,
women derive more benefit from moderate drinking than do men
in mental function (cognition). Finally, I must allude to
bones, the strength of which may be of critical importance
to women of at least middle age. The data on drinking’s
influence on calcium metabolism and bone strength (or its
opposite, osteoporosis) remains conflicted and
confusing.

Don’t worry,
most of these uncertainties will eventually be ironed out.
‘Til then, be aware that sex counts.