Women and Alcohol
Harvard Women’s Health Watch – July 2006

For women, there’s not much leeway between healthful and harmful drinking especially as we get older.

Currently, the work is that moderate drinking can be good for you. Various studies suggest that it promotes longevity, helps prevent cardiovascular disease, and lowers the risk for dementia and other ills. What hasn’t made as many headlines are the downsides for women, especially drinking that starts at a moderate level but eventually becomes a problem. Why this happens and to whom isn’t fully understood. Most people who drink in moderation do so with little or no risk. But 1 in 13 adults in the United States has developed a serious alcohol problem, and at least six million of them are women. According to the National Center on Addiction and Substance Abuse (CASA) at Columbia University (www.casacolumbia.org), Published figures are probably an underestimate of alcohol problems in women, in part because they don’t take into account drinking patterns that are not serious enough to be called abuse or addiction but still have damaging physical and psychosocial consequences.

At every age, women develop drinking problems at lower levels of alcohol consumption and over shorter periods of tome than men do. Women are also less likely to get medical attention for the problem, often because physicians don’t recognize the sign in women. Older women are especially susceptible to alcohol’s harmful effects and may be at particular risk. According to CASA’s analysis of substance abuse in women, Women under the influence (Johns Hopkins University Press, 2006) about half the cases of alcoholism in older women begin after age 59.

You don’t need to be addicted to alcohol to have a problem. For women, there’s a fine line between healthful and harmful drinking. Moderate drinking means no more than seven drinks per week and no more than three in a single day. But even these levels don’t guarantee safety. What constitutes moderation varies with many factors; include age, genetic makeup, and health. What’s okay in your 30s or 40s can be risky after age 60. If you have liver problems or a history of alcohol addiction, no amount of alcohol is moderate or safe.

No one should feel obligated to start drinking for health benefits. There are plenty of other ways to safeguard your health, including exercise, a nutritious diet, weight control, and not smoking. But if you enjoy alcoholic beverages, its important to know when and where to draw the line – and to be prepared to redraw it as you get older. Fortunately, there are ways to determine how much is too much and limit your intake.

A SPECIAL CONCERN FOR WOMEN

Women are more sensitive to alcohol than men are. That’s because our bodies contain proportionately less water and more fatty tissue than men’s bodies. Water dilutes alcohol in the bloodstream; fat retains it. So our brains and other organs are exposed to higher concentrations of alcohol for longer periods of time. At an given dose, even after accounting for differences in body weight, our blood levels will be higher, and we’ll be more intoxicated (and more likely to suffer a hangover). Moreover, men’s stomachs secrete more alcohol dehydrogenase, a digestive enzyme that breaks down alcohol before it reaches the bloodstream. As a result, one drink for a woman, on average, is the equivalent of two for a man.

AGE AND ALCOHOL USE

Our bodies contain even less water and more fatty tissues as we age, so blood alcohol concentration rises faster. We also metabolize and eliminate alcohol more slowly, and less effectively. And older women are more likely to take multiple medications that may interact with alcohol, further raising the risk of accidents and health problems. Women often turn to alcohol when faced with later life changes, such as the loss of a spouse or friends, health problems, financial insecurity, or empty-nest syndrome. After retirement, some women engage more in social activities that involve alcohol, or drink more in order to relieve boredom. A woman may conceal her drinking problem or seek help for its symptoms – insomnia, depression, or anxiety, without mentioning the underlying reason. Moreover, physicians may fail to recognize the problem because of cultural bias. “A woman just can’t be an alcoholic,” elaborates Nancy Waite O’Brien, a psychologist at the Betty Ford Center in Rancho Mirage, California and a speaker at a recent CASA conference on substance abuse in women. “She doesn’t look like it.” She comes from a nice family and has an education, she just can’t be.”

If the symptoms of alcohol abuse are mistaken for depression or anxiety a woman may be given a psychoactive drug that raises the risk of multiple addictions or drug-alcohol interactions.

Provided the same benefit. A recent Swedish study of women with heart disease found that wine (but not beer or spirits) improved a measure of heart risk called heart rate variability.

Not everyone is swayed by such findings. An international team of researchers, analyzing 54 studies on the relationship between alcohol consumption and mortality, reported in the May 2006 issue of Addiction Research and theory that most of the studies were flawed – because they included among the “abstainers” former drinkers who quit for health reasons. Thus, the higher death rate in this group (compared to the alcohol-imbibing group) may have had little to do with lack of alcohol consumption. When moderate drinkers were compared with long-term nondrinkers, there was no difference in mortality.

THE RISKS

Alcohol – as little as one-half drink per day – is an established risk factor for breast cancer. One explanation is that it raises estrogen levels in the blood, which can promote the growth of breast tumors. It may also stimulate a particular type of breast cancer. A study of women ages 65-79 found that those who consumed about two drinks per day were more likely than non-drinkers to develop hormone-sensitive breast cancer. Taking folate in the form of folic acid may lower the risk. Among women in the NHS who had one drink or more per day, the risk of breast cancer was higher in those with low folic acid intake. Some studies suggest that low folate also plays a role in the slight increase in colon cancer risk that has been linked to moderate alcohol consumption.

Moderate drinking for men, which is two drinks per day, is considered the threshold for heavy drinking for women. Women are quicker to become alcohol dependant and to suffer the consequences, which include brain damage, psychiatric problems, damage to the cardiovascular, musculoskeletal, gastrointestinal systems, anemia, and fatal accidents. Even if you drink fewer than seven drinks per week, you are at risk if you occasionally have four or more on a given day. Thus far, few studies have focused exclusively on women or included enough older women to provide conclusive evidence on the particular health risks that drinking has for them. Women 65 and over should be especially careful to limit themselves to one standard drink per day. When taking medications it is wise to not mix alcohol with them.

SUGGESTIONS

1)Set a goal – Decide on a drinking limit.

2) Change your pattern – Decide not to drink for several days each week. Try abstaining for 2-3 weeks and check in with how you feel. If you are used to a drink before dinner pour yourself a glass of water, seltzer, or blueberry juice instead.

3) Drink carefully – sip your drink slowly. Savor it. Set it down often. After one drink have a glass of water.

4) Find other ways to relax – Fatigue, loneliness, and stress sometimes trigger the desire for a drink. Instead, take a walk, put on a record and dance, go out to a movie, or take a class. Plan things that don’t revolve eating and drinking.

5) Measure – know what a standard drink looks like, measure 5 ounces of water and pour into a wine glass.