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Drink, Eat, Pray?

Posted Aug 23 2010 12:15pm
What I learned about drinking this summer.

This post is dedicated to my college-age patients, many of whom will be heading off to school over the next weeks. I will miss you all and hope that you will stay in touch through your insightful comments on these posts!
I’m great at justifying my indulgences—medium-dark roast coffee, freshly ground and French pressed, luscious dark chocolate, and fine wine, be it an “oaky” Chardonnay or a full-bodied red on a cool autumn day. So finding me rationalizing alcohol consumption should come as little surprise.  
In spite of its high calorie content, moderate drinking has its benefits. Really? This sounds as good as the news that dark chocolate is good for your heart! Yes, moderate drinking, defined as 1-2 alcoholic beverages per day may be good for your health. And one drink or alcohol equivalent is defined as 12-ounces of beer, 5-ounces of wine, or 1.25-ounces or a large “shot” of 80-proof distilled spirits or liquor (gin, rum, vodka, or whiskey).
This summer a new study revealed that normal-weight women (in the 39+ age category) who drink a light to moderate amount of alcohol gain less weight and are less likely to become overweight or obese than non-drinkers. Strange but true. And this is consistent with other studies showing that women tend to substitute alcohol for other beverages, without increasing total calorie intake (while men simply tack it on to their total intake).
Women consuming about one or two alcoholic drinks a day had the lowest risk of overweight or obesity, almost 30% lower, with the strongest link for wine. And from numerous other studies there is strong evidence to support a reduced risk of heart disease, gallbladder disease and prevention of diabetes, through improvement in insulin resistance.
But please read on. My experiences over the past several months leave me unsettled. While my client population may not be representative of the general public, I am struck by what they tell me about the amounts of alcohol being consumed. I have been enlightened about beer funnels, vodka as the mixed drink of choice and the inability to even know how much was consumed each night. And the drinking isn’t limited to a Friday or Saturday night. So the total alcohol intake is a far cry from the moderate description referred to above.
According to the National Institute on Alcohol Abuse and Alcoholism binge drinking is defined as a pattern of alcohol consumption that brings the blood alcohol concentration level to 0.08% or more. This usually corresponds to 5 or more drinks on a single occasion for men or 4 or more drinks on a single occasion for women, generally within about 2 hours. By that definition more than 1 in 3 college students are binge drinking (I haven’t dared to explore the rates among middle and high schoolers).
And the calorie cost for this drinking? Each alcohol equivalent described above provides between 100 and 150 calories, not counting mixers, depending on your beverage choice. And keep in mind that unless you’re at a bar and they are measuring it, your drink may have significantly more than the amount stated. Your vodka and crystal light may be providing a couple of hundred calories per glass, and a much greater alcohol impact. Most glasses of wine filled just halfway, will provide 6-8 ounces minimum. So two glasses provide more than just 2 alcohol equivalents.
While alcohol may be cardio-protective in moderate amounts, drinking even 1-2 drinks per day increases a woman’s risk of developing breast cancer. In one study, women who drank 27 or more drinks per week increased their risk of breast cancer 3 ½ times! And heavy alcohol drinking is linked with many undesirable conditions, including liver cirrhosis, cancers of the mouth, throat and esophagus, breast cancer, and traffic accidents, to name a few. Alcohol poisoning, from too high a blood alcohol level has the most immediate consequences, and may result in death.
The long-term risks may seem inconsequential. They are far off in the future. But what most people ask me about is this—How do I fit in alcohol while managing my eating and weight? So let’s do the math. If you are consuming a couple of large shots per glass, and drink 7-8 drinks in a night, that’s an average of 1500 calories for the evening, just from alcohol. So compensating with less food is hardly an option; you’d be starving yourself all day to allow for your night out drinking. And that recent study about the benefits of moderate drinking on weight control? It doesn’t apply to binge drinking. In fact, consuming larger amounts of alcohol is associated with decreased inhibitions around eating (forget mindful eating), and correlates with an increase in eating disorder behaviors and higher BMI.
So I fear I have failed you. Much as I can support fitting light or moderate alcohol into a healthy diet, I am at a loss to assist with fitting in the high levels you might be used to. The high alcohol intake, besides providing significant calories from the alcohol itself, leads to overeating. And a more sedentary activity level. So “Drink, Eat, Pray” might be the only option. And I don’t put a lot of faith in that as a treatment option. So please consider your options. And do drink responsibly, and not when driving. There is a middle ground (moderate drinking of a couple of drinks/day). And maybe even a health benefit to doing so.
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