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On Nutrition

For many people, alcohol — in the form of wine, beer, cocktails or all of the above — is an enjoyable part of life, woven into the fabric of our social and culinary lives. But how can you tell when you’re imbibing within the boundaries of good health or when you’ve crossed the line? Can you have a drink and be healthy, too?

One common point of confusion is interpreting lack of impairment as moderation. But you can easily drink to excess without ever feeling like you shouldn’t be allowed behind the wheel of a car. Spacing out several drinks over the course of an evening or a day increases your risk of a number of chronic diseases, even if you never feel inebriated.

Given the seemingly contradictory nature of headlines about alcohol-related research, it’s no wonder people are confused, says Ginger Hultin, MS, RDN, CD, a Seattle-based registered dietitian nutritionist and spokesperson for the Academy of Nutrition and Dietetics. She points to recent headlines proclaiming “Drinking alcohol key to living past 90” and, conversely, “Young men’s drinking tied to later liver disease risk.” The devil is in the details.

Hultin, who is studying to become a sommelier, said research does suggest that low-volume drinkers tend to live longer than abstainers. In particular, women with low to moderate intake who drink more than three days per week appear to have the lowest risk of early death compared with abstainers and women who consume substantially more than one drink per day. But, while drinking alcohol in moderation is associated with reduced risk of brain diseases like Alzheimer’s and Parkinson’s and lower risk of heart disease, the tide turns when intake increases, potentially increasing the risk of dementia, heart disease and many forms of cancer.

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This is because, like it or not, alcohol is a toxin, and it’s most harmful while our body is metabolizing it. Your liver converts alcohol into the extremely toxic substance acetaldehyde before finally converting it to acetate, which your body can excrete. That also has implications for how your body handles the calories, carbohydrates, protein and fat from the food you eat.

“The body is motivated to metabolize alcohol before it gets to other macronutrients because of its damaging intermediary acetaldehyde,” Hultin said. “Plus, alcohol can absorb straight through the stomach and travel to the liver faster than other foods you’ve eaten, which need to first exit the stomach and get absorbed in the small intestine.” While the liver is busy metabolizing alcohol, it will divert calories from food to storage in fat cells, she said, which is one reason people who chronically consume large amounts of alcohol are at risk for fatty- liver disease.

You might think this flies in the face of advice to make sure you have some food in your stomach when you drink, but Hultin said some research has found that drinking alcohol on an empty stomach actually increases caloric intake at the next meal. There’s a reason that pre-dinner cocktails are called aperitifs, which means “to open the appetite.”

“Each person is different, but everyone should pay attention to how alcohol affects their appetite and intake,” she said. “There are many factors that may contribute to this, ranging from shifts in the hormones that signal a person to eat, to lowered inhibitions and drops in blood sugar. There are also effects on some areas in the brain that signal the eating response.”

Health experts agree that if you don’t drink, there’s no reason to start, but if you do choose to imbibe, the 2015-2020 U.S. Dietary Guidelines recommend that to reduce the risk of alcohol-related health problems, women should limit their intake to one drink per day, with men limiting themselves to two drinks per day. The World Health Organization (WHO) recommends not exceeding two drinks per day and having at least two non-drinking days per week, for a weekly cap of 10 drinks. One drink is 5 ounces of wine, 1.5 ounces of 80-proof spirits, or 12 ounces of beer — if it’s 5 percent alcohol by volume (ABV). That’s a critical point if you’re a fan of higher-ABV IPAs, partly due to calories.

“Because alcohol is seven calories per gram, versus four for protein and carbohydrates, the alcohol by volume really adds up,” Hultin said. For example, a serving of light beer (3-4 percent ABV) or low alcohol wine (less than 10 percent ABV) adds up to around 100 calories. When the ABV goes up to 6-8 percent for beer, or 13-15 percent for wine, one serving can approach 200 calories, which is a significant difference. And then there are the mixers. Piña coladas and many coffee-based cocktails use calorie-rich dairy or coconut cream that can significantly increase the calorie content.

“When choosing mixers, there are plenty of zero-calorie options like seltzer water, fresh lemon or lime, or diet sodas,” she said. “Regular soda or juice will contribute 30-50 calories and 10-15 carbs depending on how much is added to a drink.” Because other classic cocktails like margaritas can add up in calories thanks to simple syrup and other dense forms of added sugar, Hultin developed this tasty, lower-sugar option for her blog, www.champagnenutrition.com:

A Healthier Margarita
Serves 4

Cubed ice
2 limes, sliced into 4 wedges each
32 ounces Santa Cruz Organic Lemonade or Newman’s Own Lemonade
8 ounces silver tequila of your choice (Hultin recommends Don Julio, El Tosoro or Cazadores)
Kosher salt
4 ounces Grand Marnier

1. Muddle a slice of lime in 1 cup of ice in a shaker, then add 8 ounces lemonade and 2 ounces tequila. Shake firmly until liquid is thoroughly mixed.
2. Rub another lime wedge on the rim of the glass. Dip the edge of the glass into salt poured onto a plate so that it is thoroughly coated. Garnish the rim with the lime wedge.
3. Pour liquid into the glass, adding ice if needed. Float 1 ounce of Grand Marnier on the top in a circular motion. Serve with a straw.