Women and Alcohol Consumption
The following text is by Judith Reichman, M.D.

MSNBC Health News

"[B]ecause women are generally smaller and weigh less with less blood to dilute the alcohol, they become intoxicated more rapidly."

A NEW REPORT from the long-running Framingham Study would suggest that small amounts of alcohol, less than one and a half drinks a day, donıt increase a womanıs risk of breast cancer. But this does not mitigate earlier reports that have shown that three or more drinks a day can increase a womanıs risk for breast cancer, nor does it address the link between women who drink while on the pill or Hormone replacement and their potential vulnerability to breast cancer disease.

WHY WOMEN ARE MORE VULNERABLE First, because women are generally smaller and weigh less with less blood to dilute the alcohol, they become intoxicated more rapidly. Secondly, they also produce less enzymes in their stomachs to break down alcohol, so itıs more likely to be absorbed in its purest most potent formula, ethano or pure alcohol. Because alcohol is so easily absorbed into womensı bloodstreams it goes to our brains more rapidly. So women who consume three or more drinks a day may begin to have health problems that donıt occur in men until they have nine drinks or more. These complications also begin earlier in women ‹ after 13 years of alcohol consumption vs. 22 years in men. Women also tend to have a higher fat concentration, which keeps the alcohol in our body longer, and finally something most women may be unaware of, estrogen enhances alcohol absorption. In fact, our absorption of alcohol increases when our estrogen levels peak during the two weeks prior to our period. Also, itıs important to be aware that alcoholism is the third leading cause of death for women between the ages of 35 and 55 years of age.

WHAT IS MODERATE DRINKING? If we have two drinks in two hours and weigh 150 lbs. our blood alcohol level will be at least 0.05, which in many states is above the legal limit for driving. If moderate means that weıre not going to get legally drunk, then weıre probably talking about less than two drinks, probably only one. If we weigh less, less than two drinks will render us legally "drunk." So for most women, one or two drinks a night should be the limit. If women are drinking four or more drinks every night or on each occasion, they are considered heavy drinkers and are at greater risk for potential problems.

WHAT WOMEN NEED TO KNOW The chief debate has been our heart vs. our breasts. A study of over 85,000 women from ages 34-59 showed that women who consumed one to three drinks a week had a mortality decrease of 17 percent. The death rate was even lower for women who had less than three drinks a week. However if they drank more than three drinks per week the increased mortality was primarily due to an increase in breast cancer and cirrhosis. But itıs very important to observe that the only women who benefited from this light to moderate drinking were those who had risk factors for coronary heart disease. In other words, they had high cholesterol, diabetes, and high blood pressure and they smoked, or there was a parent who had a heart attack before the age of 60. But among women without risk factors, drinking did not help. So if youıre out there with no risk factors for heart disease, it doesnıt look like drinking is going to be beneficial to your heart. On the other hand, a pooled analysis of approximately 322,000 women showed that two to five drinks a day increased breast cancer vs. non-drinkers by 41 percent. And the risk was elevated by nine percent by each additional drink.

ALCOHOL AND BREAST CANCER Alcohol may effect the way estrogen is secreted and broken down. As I mentioned earlier, estrogen in our bodies makes us absorb alcohol more readily and break it down less. At the same rate, alcohol affects how estrogen is secreted and broken down. Thus, by drinking alcohol your estrogen levels will increase significantly both pre-menopausally and post-menopausally. As a result, after you drink you get spurts of estrogen that can be as high as 300 percent within 30 minutes of consumption. This is similar to the spurt of estrogen just prior to ovulation and may be responsible for a breast cancer-promoting effect. In other words, thereıs one thing to have a constant amount of estrogen and occasionally have a rise before you ovulate, but if you get these rises in estrogen every time you drink, this may potentiate breast cancer.

ALCOHOL, BIRTH CONTROL AND HORMONE REPLACEMENT THERAPY Women taking birth control pills or Hormone Replacement Therapy (HRT) really need to be aware that not only will they absorb alcohol better but it will stay in their bodies longer. If you go back and look at the long-running Framingham study, which showed an increase in breast cancer by over 50 percent in the women who had just three drinks a week, you start to understand why, perhaps, breast cancer increased. That same study is used by many experts to scare off women from using estrogen replacement, as it showed an increase of breast cancer ‹ 41 percent in women who took estrogen. However, if you look at the study, this 41 percent increase was not found in women who did not consume alcohol. So, perhaps when they go around saying that estrogen replacement increases breast cancer, it may only occur if you drink. We know that estrogen increases after we drink, estrogen is linked to breast cancer and estrogen is linked to breast cancer more often with women who drink.

WHAT DO YOU TELL YOUR PATIENTS WHO TAKE ORAL CONTRACEPTIVES OR ERT? I tell my patients donıt drink ‹ preferring the proven benefits of estrogen vs. the benefits of alcohol. If, however, you are hugely at risk for heart attack or stroke, and there are no risk factors for breast cancer, then moderate drinking is probably okay as well as moderate drinking while taking oral contraception or ERT. But if you are at all worried about breast cancer, and you have to choose between estrogen and alcohol, go for the estrogen.

ARE THERE OTHER RISKS FACED BY WOMEN WHO DRINK? First of all, women who are heavy drinkers are more vulnerable to liver disease and cirrohsis. In addition they are more prone to suffer from high blood pressure, stroke, heart disease, gastrointestinal hemorrhage, anemia, malnutrition, colorectal cancer, accidents and suicide. Other conditions exacerbated by heavy alcohol consumption include: menstrual irregularities, infertility and sexual dysfunction. Alcohol consumption also decreases our ability to absorb calcium, which leads to osteoporosis. And weıre more likely, when intoxicated, to fall down and break a hip. Life expectancy is cut short by an average of 15 years for women who drink heavily.

THE DANGER OF BINGE DRINKING First of all, as we mentioned earlier, the longer a woman drinks the more at risk she is. While men may be able to drink for as many as 22 years before disease catching up with them, women will suffer the same ill-effects after only 13 years. But even more important is the misperception that drinking will make women uninhibited sexually. It is more likely to lead to sexual dysfunction, sexually transmitted disease, and sexual assault, than it is to assuage inhibitions. Death from alcoholism is only exceeded by death from accidents and cancer. Alcoholism is the third leading cause of death for women between the ages of 35 and 55 years of age. According to the National Household Survey on Drug Abuse, two to five percent of American women abuse alcohol ‹ five or more drinks per occasion on five or more days in the past month. When women drink, they get sicker sooner and die faster.

MORE REASONS FOR ABUSE There are biological and genetic factors that can lead to alcohol abuse. If a parent or sibling is alcoholic, a woman is four times more likely to be at risk. Genes affect alcohol metabolism as well as pleasure thresholds. In other words, there may be a gene that doesnıt allow you to get pleasure easily, and you have to go further and try harder, and drink more in order to get pleasure. Environmental factors also increase our proclivity to drink. Women who have suffered childhood sexual abuse, were heavy college drinkers, or those who are depressed (alcoholics have a history of depression thirty to seventy percent of the time.) Another notable finding is that thirty percent of alcohol-related accidents are not caused by the "alcoholic" drinker, but by social drinkers.

DRINKING AND PREGNANCY One in four women still consume alcohol during pregnancy. Alcohol exposure is fastest and worst on a babyıs brain development early in pregnancy. Also, two or more drinks a day will increase the risk of miscarriage, low birth-rate, mortality, and fetal alcohol syndrome. There is no safe limit for alcohol and pregnancy and no such thing as moderate drinking in pregnancy.

USE OF TYLENOL OR ASPIRIN WITH ALCOHOL A new FDA warning says that the use of Tylenol or aspirin while consuming more than three drinks a day can increase the risk of liver disease, and with aspirin there is risk of ulcers and bleeding. You should consult your doctor if you take tylenol or asprin when you drink.

Judith Reichman, M.D., practices and teaches at Cedars-Sinai Medical Center and UCLA in Los Angeles. She appears regularly on the "Today" show as a contributor on womenıs health issues.