Long-term effects of alcohol
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{{alcohealth}}
Regularly having more than two drinks a day increases the risk of developing [[alcoholism]], [[alcoholic liver disease]], and some forms of [[cancer]]. Having between one to two alcoholic drinks a day has been shown to have positive effects on [[health]], unless contraindicated,<ref>Yuan, Jian-Min; Ross, Ronald K; Gao, Yu-Tang; Henderson, Brian E; Yu, Mimi C [http://bmj.bmjjournals.com/cgi/content/full/314/7073/18 Follow up study of moderate alcohol intake and mortality among middle aged men in Shanghai, China] ''British Medical Journal'', 1997, ''314'', 18-23.</ref> chiefly because of its [[cardiovascular]] effects.<ref>Hennekens, C.H. Alcohol and risk of coronary events. In: Zakhari, S., and Wassef, M., eds.'' Alcohol and the Cardiovascular System'' NIAAA Research Monograph No. 31. NIH Pub. No. 96-4133. Washington, DC: U.S. Govt. Print. Off., 1996. pp. 15-24.</ref><ref> Kowalski, R. E. ''The New 8-Week Cholesterol Cure''. NY: HarperCollins, 2002, page 91 </ref><ref> National Institute on Alcohol Abuse and Alcoholism. ''Alcohol Alert'', No. 45, October, 1999; Blackwelder, W. C., ''et al''. Alcohol and mortality. The Honolulu Heart Study. ''American Journal of Medicine'', 1980, ''68(2)'', 164-169.</ref><ref> Rimm ''et al''., Trevisan ''et al''.</ref> A few researchers have questioned the extent of positive effects as most studies compare moderate drinkers health to non-drinkers, but fail to take into account the amount of people who abstain because they are already ill, rather than lack of alcohol causing their ill-health.<ref>[http://news.bbc.co.uk/2/hi/health/377381.stm BBC News | Health | Alcohol benefits debunked<!-- Bot generated title -->]</ref>
==Scientific studies==
===History===
The relationship between [[alcohol]] consumption and [[health]] has been the subject of formal [[scientific research]] since at least [[1926]], when Dr. [[Raymond Pearl]] published his book, ''Alcohol and Longevity''.<ref>[[Raymond Pearl|Pearl, Raymond]]. Alcohol and Longevity. NY: Knopf, 1926.</ref> Since that time data have come in from all over the world. Studies have focused on both men and women, various age groups, and people of many ethnic groups. Published papers now total in the many hundreds, but many studies are not simply correlated, or time sequenced in nature. Some of the ways alcohol affects cardiovascular health are now understood. <ref> Vliegenthart, R. ''et al''. Alcohol consumption and coronary classification in a general population. ''Archives of Internal Medicine'', 2004 (November), ''164'', 2355-2360; Koppes, L. ''et al''. Blood cholesterol levels of 32-year-old consumers better than that of nonconsumers. ''Pharmacology, Biochemistry and Behavior'', 2000, ''66(1)'', 163-167; Albert, M.A. ''et al''. Alcohol consumption and plasma concentrations iof C-reactive protien. ''Circulation'', 2003, ''107'', 433-447; Baer, D.J. ''et al''. Moderate alcohol consumption lowers rik factors for cardiovascular disease in postmenopausal women fed a controlled diet. ''American Journal of Clinical Nursing'', 2002, ''75'', 593-599; Catena, C. ''et al''. Serum lipoprotein(a) concentrations and alcohol consumption in hypertension. ''Journal of Hypertension'', 2003, ''21(2), 281-288 </ref>
===Modern understanding===
Research in various countries has found the all-cause mortality rates range from 16 to 28% lower among moderate drinkers than among abstainers.<ref>Boffetta, P., and Garfinkel, L. [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2078609&dopt=Citation Alcohol drinking and mortality among men enrolled in an American Cancer Society prospective study] ''Epidemiology'' 1990 Sep;1(5):342-8</ref><ref>Coate, D [http://www.ajph.org/cgi/content/abstract/83/6/888 Moderate drinking and coronary heart disease mortality: evidence from NHANES I and the NHANES I Follow-up] ''American Journal of Public Health'' Vol 83, Issue 6 888-890</ref><ref>Fuchs CS, Stampfer MJ, Colditz GA, Giovannucci EL, Manson JE, Kawachi I, Hunter DJ, Hankinson SE, Hennekens CH, Rosner B [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7708067&dopt=Abstract Alcohol consumption and mortality among women] ''New England Journal of Medicine'' 1995 May 11;332(19):1245-50</ref><ref>Klatsky AL, Friedman GD, Siegelaub AB [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7258861&dopt=Abstract Alcohol and mortality. A ten-year Kaiser-Permanente experience] ''Annals of Internal Medicine'' 1981 Aug;95(2):139-45</ref>
The medical studies establishing this relationship are large (some include over 200,000 people), cross-cultural (have been conducted in countries around the world), and are sometimes long-term (the longest beginning in 1948 and continuing to this day).<ref>[http://www2.potsdam.edu/hansondj/HealthIssues/1106591095.html Alcohol and Longevity Facts & Information]</ref>
=====Quantity recommended=====
{{main|Recommended maximum intake of alcoholic beverages}}
The U.S. [[National Institute on Alcohol Abuse and Alcoholism]] (NIAAA) has completed an extensive review of current scientific knowledge about the health effects of moderate alcohol consumption. It found that the lowest death rate from all causes occurs at the level of one to two drinks per day. That is, moderate drinkers have the greatest longevity.<ref>[http://www2.potsdam.edu/hansondj/InTheNews/MedicalReports/Longevity/1088617919.html U.S. Government: Moderate Drinking Benefits Health]</ref><ref>Ellison, R. C. [http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1336884 ''Does Moderate Alcohol Consumption Prolong Life?''] American Council on Science and Health, New York: 1993. (link is to review of book)</ref>
A 23-year [[prospective study]] of 12,000 male [[United Kingdom|British]] [[physician]]s aged 48–78, found that overall mortality was significantly lower in the group consuming an average of 2–3 "units" (British unit = 8 g) per day than in the non-alcohol-drinking group ([[relative risk]] 0.81, [[confidence interval]] 0.76–0.87, P = 0.001).<ref>Doll ''et al'' [http://ije.oxfordjournals.org/cgi/content/full/34/1/199 Mortality in relation to alcohol consumption: a prospective study among male British doctors] ''International Journal of Epidemiology'' 2005;34:199-204</ref> The authors noted that the causes of death that are already known to be augmentable by alcohol accounted for only 5% of the deaths (1% liver disease, 2% cancer of the mouth, pharynx, larynx, or oesophagus, and 2% external causes of death) and were significantly elevated only among men consuming >2 units/day.
In a 1996 [[American Heart Association]] scientific statement, Thomas A. Pearson, MD, PhD noted:
<blockquote>A large number of observational studies have consistently demonstrated a U-shaped relation between alcohol consumption and total mortality. This relation appears to hold in men and women who are middle aged or older. The lowest mortality occurs in those who consume one or two drinks per day. In teetotalers or occasional drinkers, the rates are higher than in those consuming one or two drinks per day. In persons who consume three or more drinks per day, total mortality climbs rapidly with increasing numbers of drinks per day.
</blockquote>
==Cardiovascular system==
The cardiovascular effects of consistent, moderate alcohol intake are perhaps the most studied and the most widely-accepted. The [[World Health Organization]] Technical Committee on Cardiovascular Disease asserted that the relationship between moderate alcohol consumption and reduced death from heart disease could no longer be doubted.<ref> Wilkie, S. Global overview of drinking recommendations and guidelines. ''AIM Digest'', Supplement, June 1997, ''2-4'', p. 4</ref> Consumption of [[red wine]] may be particularly favourable, since red wines contain certain [[polyphenol antioxidant]]s associated with [[cardiovascular]] health. One study determined that the potential long-term benefits of moderate alcohol consumption on cardiovascular health surpassed all other factors except the cessation of smoking.<ref name="curtis">Ellison, R. Curtis Here's to your health. ''Wine Spectator'', October 31, 1998, 34-46.</ref>
Alcohol appears to be [[hormesis|hormetic]].<ref>{{cite news|title=Here's to Your Health|last=Roberts|first=Russell|publisher=[[St. Louis Post Dispatch]]|date=2003-01-09|url=http://www.invisibleheart.com/Iheart/PolicyHealth.html|accessdate=2007-02-02}}</ref> Medical research demonstrates that, consumed in moderation, alcohol increases [[High density lipoprotein|HDL]] (“good [[cholesterol]]”), decreases [[thrombosis]] (blood clotting), reduces [[fibrinogen]] (a blood clotter), increases [[fibrinolysis]] (clot dissolving), reduces [[artery]] spasm from stress, increases coronary blood flow and increases [[insulin]] sensitivity -- all good for heart health.<ref name=Mennen>Mennen LI, Balkau B, Vol S, Caces E, Eschwege E. [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=Display&DB=pubmed Fibrinogen may explain in part the protective effect of moderate drinking on the risk of cardiovascular disease]. ''Arteriosclerotic and Thrombodic Vascular Biology'' 1999 Apr;19(4):887-92</ref><ref>Paassilta Marita; Kervinen, Kari; Rantala, Asko O; Savolainen, Markku J; Lilja, Mauno; Reunanen, Antti; Kesäniemi, Y Antero [http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28464 Social alcohol consumption and low Lp(a) lipoprotein concentrations in middle aged Finnish men: population based study] ''[[British Medical Journal]]'' 1998 February 14; 316(7131): 594–595</ref> Additionally, [[Thrombosis]] is lower among moderate drinkers than teetotalers. <ref> Lacoste, L. ''et al''. Acute and delayed antithrombotic effects of alcohol in humans. ''American Journal of Cardiology'', 2001, ''87'', 82-85; Pahor, M., ''et al''. Alcohol consumption and risk of deep venous thrombosis and pulmonary embolism in older persons. ''Journal of the American Geriatric Society'', 1996, ''44(9)'', 1030-1037; Ridker, P., ''et al''. Moderate alcohol intake may reduce risk of thrombosis. American Medical Association press release, September 22, 1994; Ridker, P. The Pathogenesis of Atherosclerosis and Acute Thrombosis . In: Manson, J., ''et al''. (Eds.) ''Prevention of Myocardial Infarction''. NY: Oxford University Press, 1996. </ref>
===Cardiovascular disease===
{{main|Alcohol and cardiovascular disease}}
Moderate drinkers are less likely to suffer [[heart attack]]s than total abstainers or heavy drinkers. The first scientific study of the relationship between alcohol consumption and [[atherosclerosis]] was published in the Journal of the American Medical Association in 1904. An review of major heart disease studies has found that:
<blockquote>"Alcohol consumption is related to total mortality in a U-shaped manner, where moderate consumers have a reduced total mortality compared with total non-consumers and heavy consumers"
</blockquote>
The risk of a heart attack among moderate drinkers with diabetes is 52 percent lower than among nondrinkers and that the risk of dying in the four years after a heart attack is 32 percent lower among those who were moderate drinkers in the year before the attack.
====Coronary Heart Disease====
Pearson reviewed the evidence supporting the effect of alcohol consumption on [[coronary heart disease]] (CHD): "More than a dozen prospective studies have demonstrated a consistent, strong, dose-response relation between increasing alcohol consumption and decreasing incidence of CHD. The data are similar in men and women in a number of different geographic and ethnic groups. Consumption of one or two drinks per day is associated with a reduction in risk of approximately 30% to 50%. Studies of coronary narrowings defined by cardiac catheterization or autopsy show a reduction in atherosclerosis in persons who consume moderate amounts of alcohol. In general, the inverse association is independent of potential confounders, such as diet and cigarette smoking. Concerns that the association could be an artifact due to cessation of alcohol consumption in persons who already have CHD have largely been disproved."<ref>Pearson, Thomas A. "Alcohol and Heart Disease." {{cite web|title=
''Circulation'' 1996;94:3023-3025|url=http://circ.ahajournals.org/cgi/content/full/94/11/3023|accessdate=2006-1-30}}</ref>
Another study found that when men increased their alcohol intake from very low to moderate, they significantly reduced their risk of coronary heart disease. The study monitored the health of 18,455 males for a period of seven years. <ref> Sesso, H.D., ''et al''., Seven-year changes in alcohol consumption and subsequent risk of cardiovascular disease in men. ''Archives of Internal Medicine'', 2001, ''160'', 2505-2612 </ref>
====Coronary Vascular Disease====
Moderate drinking has been found to reduce the risk of [[angina pectoris]].<ref>
Camargo CA Jr, Stampfer MJ, Glynn RJ, Grodstein F, Gaziano JM, Manson JE, Buring JE, Hennekens CH [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9054281&dopt=Abstract Moderate alcohol consumption and risk for angina pectoris or myocardial infarction in U.S. male physicians] ''Archives of Internal Medicine'' 1997 Mar 1;126(5):372-5</ref> In heart attack patients, treated with alcohol, the tissues affected by low blood flow are healthier and stronger, than those who receive no alcohol, because of alcohol's positive effects on artery walls.<ref>[http://www.newswise.com/articles/view/506828/ Alcohol Helps Reduce Damage After Heart Attack]</ref> Drinking alcoholic beverages in moderation may help patients recover from coronary stenting, as healing appears to be promoted by its anti-inflammitory effects. <ref> Zairis, M.N., ''et al''. C Reactive protein, moderate alcohol consumption, and long term prognosis after successful coronary stenting: four year results from the GENERATION study. ''Heart'', 2004, ''90'', 419-424 </ref>
====Peripheral Arterial Disease====
"Moderate alcohol consumption appears to decrease the risk of PAD in apparently healthy men.".<ref>Camargo Carlos A; Stampfer, Meir J; Glynn, Robert J; Gaziano, J. Michael; Manson, JoAnn E; Goldhaber, Samuel; Hennekens, Charles H [http://www.circ.ahajournals.org/cgi/content/full/95/3/577 Prospective Study of Moderate Alcohol Consumption and Risk of Peripheral Arterial Disease in US Male Physicians] ''Circulation'' 1997;95:577-580</ref> "In this large population-based study, moderate alcohol consumption was inversely associated with peripheral arterial disease in women but not in men. Residual confounding by smoking may have influenced the results. Among nonsmokers an inverse association was found between alcohol consumption and peripheral arterial disease in both men and women."<ref>Vliegenthart, Rozemarijn; Geleijnse, Johanna M; Hofman, Albert; Meijer, Wouter T; van Rooij, Frank J. A; Grobbee, Diederick E; Witteman, Jacqueline C. M. [http://aje.oxfordjournals.org/cgi/content/full/155/4/332 Alcohol Consumption and Risk of Peripheral Arterial Disease: The Rotterdam Study] ''American Journal of Epidemiology'' Vol. 155, No. 4 : 332-338</ref><ref>Mingardi, R; Avogaro, A; Noventa, F; Strazzabosco, M; Stocchiero, C; Tiengo, A; Anderle, G "Alcohol intake is associated with a lower prevalence of peripheral vascular disease in non-insulin dependent diabetic women" ''Nutrition Metabolism and Cardiovascular Disease'' 7(4): 301– 308, 1997. (No abstract found online.)</ref>
==== Intermittent Claudication (IC)====
In a study of 18,339 observatios, researchers found that drinking alcohol in moderation significantly reduces the risk of intermittent claudication. IC is associated with a 200% to 400% increased risk of death from cardiac disease. (Djousse, L., et al. Alcohol consumption and risk of intermittent claudicating in the Framingham Heart Study. Circulation, 2000, 102, 3092)
===Heart attack and stroke===
Drinking in moderation has been found to help those who have suffered a [[heart attack]] survive it.<ref> Gaziano, J. ''et al''. Potential mortality benefits for drinkers with previous heart attacks. ''The Lancet'', 1998, ''332'', 1882-1885; Mulkamal, K.J. ''et al''. Prior alcohol consumption and mortality following acute myocardial infarction. ''Journal of the American Medical Association'', 2001, ''285(15)'', 1965-1970 </ref><ref>[http://www.newswise.com/articles/view/506828/ Alcohol helps reduce damage after heart attacks]</ref> To determine if moderate drinkers have fewer heart attacks because they might lead more healthful lifestyles than do abstainers or heavy drinkers, Harvard scientists recently reported their study of only healthy men who led healthful lifestyles. For up to 16 years the doctors monitored the health of 8,867 men who did not smoke, were of normal weight, exercised at least 30-60 minutes per day, and ate a balanced healthful diet. Among these healthy men with healthy lifestyles, those who consumed anywhere from 1/2 to two alcoholic drinks of beer, wine or liquor per day had significantly decreased risk of heart attacks. Those who averaged slightly more (one to two drinks per day) had the lowest risk.<ref> Mulkamal, K.J., ''et al''. Alcohol consumption and risk of coronary heart disease in men with healthy lifestyles. ''Archives of Internal Medicine'', 2006 (October), ''166(19)'', 2145-2150 </ref>
Compared to abstaining, drinking in moderation is associated with a reduced risk of [[stroke]], whereas abusing alcohol is associated with an increased risk of stroke.<ref>Rodgers, H. et al. [http://stroke.ahajournals.org/cgi/content/abstract/strokeaha;24/10/1473 Alcohol and stroke. A case-control study of drinking habits past and present] ''Stroke'', 1993. ''24(10''), 1473-1477.</ref> A study of over 22,000 male physicians aged 40-84 years old over an average of 12 years, concluded, "Light-to-moderate alcohol consumption reduces the overall risk of stroke and the risk of [[ischemic stroke]] in men. The benefit is apparent with as little as one drink per week. Greater consumption, up to one drink per day, does not increase the observed benefit."<ref>Berger ''et al'' [http://content.nejm.org/cgi/content/abstract/341/21/1557 Light-to-Moderate Alcohol Consumption and the Risk of Stroke among U.S. Male Physicians] ''New England Journal of Medicine'' 341(21):1557-1564, November 18, 1999</ref>
===Cardiomyopathy===
Large-quantity consumption of alcohol can lead to alcoholic [[cardiomyopathy]], commonly known as "holiday heart syndrome." Alcoholic cardiomyopathy presents in a manner clinically identical to idiopathic [[dilated cardiomyopathy]], involving hypertrophy of the musculature of the heart that can lead to a form of [[cardiac arrythmia]]. These electrical anomales, represented on an [[EKG]], often vary in nature, but range from nominal changes of the PR, QRS, or QT intervals to paroxsysmal episodes of [[ventricular tachycardia]]. The pathophysiology of alcoholic cardiomyopathy has not been firmly identified, but certain hypotheses cite an increased secretion of [[epinephrine]] and [[norepinephrine]], increased sympathetic output, or a rise in the level of plasma free fatty acids as possible mechanisms.<ref>[http://www.emedicine.com/med/topic1024.htm eMedicine - Holiday Heart Syndrome : Article by Adam S Budzikowski<!-- Bot generated title -->]</ref>
===Hematologic diseases===
Alcoholics may have [[anemia]] from several causes;<ref name="pmid3747828">{{cite journal |author=Savage D, Lindenbaum J |title=Anemia in alcoholics |journal=Medicine (Baltimore) |volume=65 |issue=5 |pages=322–38 |year=1986 |pmid=3747828 |doi=}}</ref> they may also develop [[thrombocytopenia]] from direct toxic effect on [[megakaryocytes]], or from [[hypersplenism]].
==Nervous system==
===Strokes===
A [[meta-analysis]] of 35 previous studies of the effect of alcohol consumption on stroke risk found that:
<blockquote>"Compared with abstainers, consumption of more than 60 g of alcohol per day (i.e., over four standard drinks -- heavy drinking) was associated with an increased relative risk of total stroke, 1.64 (95% confidence interval [CI], 1.39-1.93); ischemic stroke, 1.69 (95% CI, 1.34-2.15); and hemorrhagic stroke, 2.18 (95% CI, 1.48-3.20), while consumption of less than 12 g/d was associated with a reduced relative risk of total stroke, 0.83 (95%, CI, 0.75-0.91) and ischemic stroke, 0.80 (95% CI, 0.67-0.96), and consumption of 12 to 24 g/d was associated with a reduced relative risk of ischemic stroke, 0.72 (95%, CI, 0.57-0.91). The meta-regression analysis revealed a significant nonlinear relationship between alcohol consumption and total and ischemic stroke and a linear relationship between alcohol consumption and hemorrhagic stroke."<ref>Reynolds ''et al'' [http://jama.ama-assn.org/cgi/content/full/289/5/579?ijkey=fee253e510816697eebb5a8c64b917bfb678a579#TABLEJMA20035T1 Alcohol Consumption and Risk of Stroke] ''JAMA'' 2003;289:579-588</ref>
</blockquote>
These findings have been disputed. A 2003 [[John Hopkins]] study has linked moderate alcohol use to brain shrinkage and did not find any reduced risk of stroke among moderate drinkers.<ref>[http://www.sciencedaily.com/releases/2003/12/031205052952.htm Moderate Alcohol Consumption Linked To Brain Shrinkage<!-- Bot generated title -->]</ref>
===Brain development===
Consuming large amounts of alcohol over a period of time can impair normal brain development in humans.<ref>White AM, Bae JG, Truesdale MC, Ahmad S, Wilson WA, Swartzwelder HS [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12170104&dopt=Abstract Chronic-intermittent ethanol exposure during adolescence prevents normal developmental changes in sensitivity to ethanol-induced motor impairments] ''Alcoholism: Clinical and Experimental Research'' 2002 Jul;26(7):960-8</ref><ref>Tapert SF, Brown GG, Kindermann SS, Cheung EH, Frank LR, Brown SA [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=11236838&query_hl=14&itool=pubmed_docsum fMRI measurement of brain dysfunction in alcohol-dependent young women] ''Alcoholism: Clinical & Experimental Research'' 2001 Feb;25(2):236-45</ref> Deficits in retrieval of verbal and nonverbal information and in visuospatial functioning were evident in youths with histories of heavy drinking during early and middle adolescence.<ref>Brown SA, Tapert SF, Granholm E, Delis DC [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10698367 Neurocognitive functioning of adolescents: effects of protracted alcohol use] ''Alcoholism: Clinical and Experimental Research'' 2000 Feb;24(2):164-71</ref>
Heavy alcohol consumption inhibits new brain cell development.<ref>American Association for the Advancement of Science [http://www.eurekalert.org/pub_releases/2004-11/uonc-nbc110504.php New brain cells develop during alcohol abstinence, UNC study shows]</ref>
Nearly half of chronic alcoholics may have [[myopathy]].<ref name="pmid2913506">{{cite journal |author=Urbano-Marquez A, Estruch R, Navarro-Lopez F, Grau JM, Mont L, Rubin E |title=The effects of alcoholism on skeletal and cardiac muscle |journal=N. Engl. J. Med. |volume=320 |issue=7 |pages=409–15 |year=1989 |pmid=2913506 |doi=}}</ref> Proximal muscle groups are especially affected. Twenty-five percent of alcoholics may have [[peripheral neuropathy]], including [[autonomic neuropathy|autonomic]].<ref name="pmid7826275">{{cite journal |author=Monforte R, Estruch R, Valls-Solé J, Nicolás J, Villalta J, Urbano-Marquez A |title=Autonomic and peripheral neuropathies in patients with chronic alcoholism. A dose-related toxic effect of alcohol |journal=Arch. Neurol. |volume=52 |issue=1 |pages=45–51 |year=1995 |pmid=7826275 |doi=}}</ref>
===Cognition and dementia===
Research has found moderate drinking to be associated with lower risk of [[dementia]], including [[Alzheimer’s disease]]. A study concluded, "Compared with abstention, consumption of 1 to 6 drinks weekly is associated with a lower risk of incident dementia among older adults."<ref>Mukamal, Kenneth J.; Kuller, Lewis H.; Fitzpatrick, Annette L.; Longstreth, W. T.; Mittleman, Murray A.; Siscovick, David S. [http://jama.ama-assn.org/cgi/content/abstract/289/11/1405 Prospective Study of Alcohol Consumption and Risk of Dementia in Older Adults] ''Journal of the American Medical Association'', 2003 (March 19), 289, 1405-1413.</ref> Another study concluded, "These findings suggest that light-to-moderate alcohol consumption is associated with a reduced risk of dementia in individuals aged 55 years or older. The effect seems to be unchanged by the source of alcohol."<ref>Annemieke Ruitenberg, John C van Swieten, Jacqueline CM Witteman, Kala M Mehta, Cornelia M van Duijn, Albert Hofman and Monique MB Breteler [http://www.thelancet.com/journals/lancet/article/PIIS0140673602074937/abstract Alcohol consumption and risk of dementia: the Rotterdam Study] ''The Lancet'' 2002; 359:281-286
DOI:10.1016/S0140-6736(02)07493-7</ref> "In a representative elderly cohort over an average of 7 years, a pattern of mild-to-moderate drinking, compared to not drinking, was associated with lesser average decline in cognitive domains over the same period." <ref>M. Ganguli, J. Vander Bilt, J. A. Saxton, C. Shen, and H. H. Dodge [http://www.neurology.org/cgi/content/abstract/65/8/1210 Alcohol consumption and cognitive function in late life: A longitudinal community study] ''Neurology'' 2005;65:1210-1217</ref> "Alcohol drinking in middle age showed a U shaped relation with risk of mild cognitive impairment in old age. Risk of dementia increased with increasing alcohol consumption only in those individuals carrying the apolipoprotein e4 allele."<ref>Tiia Anttila, Eeva-Liisa Helkala, Matti Viitanen, Ingemar Kåreholt, Laura Fratiglioni, Bengt Winblad, Hilkka Soininen, Jaakko Tuomilehto, Aulikki Nissinen, Miia Kivipelto [http://bmj.bmjjournals.com/cgi/content/abstract/329/7465/539 Alcohol drinking in middle age and subsequent risk of mild cognitive impairment and dementia in old age: a prospective population based study] ''British Medical Journal'' 2004;329:539 (4 September), doi:10.1136/bmj.38181.418958.BE</ref> "Alcohol abuse is associated with increased prevalence of cognitive dysfunction among older subjects; however, a daily alcohol consumption of less than 40 g for women and 80 g or less for men might be associated with a decreased probability of cognitive impairment. This possible protective effect of alcohol consumption should be further assessed by prospective studies."<ref>Giuseppe Zuccalà, Graziano Onder, Claudio Pedone, Matteo Cesari, Francesco Landi, Roberto Bernabei, Alberto Cocchi (2001) [http://www.blackwell-synergy.com/doi/abs/10.1111/j.1530-0277.2001.tb02185.x Dose-Related Impact of Alcohol Consumption on Cognitive Function in Advanced Age: Results of a Multicenter Survey] ''Alcoholism: Clinical and Experimental Research'' 25 (12) , 1743–1748 doi:10.1111/j.1530-0277.2001.tb02185.x</ref> "This study suggested that light to moderate alcohol drinking might protect against dementia and Alzheimer's disease among old people, although the possibility that such an association may be due to information bias cannot be totally ruled out."<ref>Wenyong Huanga, Chengxuan Qiua, Bengt Winblada and Laura Fratiglioni [http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T84-479R6FH-3&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=05933f092be264527794c4257fe7c25c Alcohol consumption and incidence of dementia in a community sample aged 75 years and older] ''Journal of Clinical Epidemiology'' Volume 55, Issue 10, October 2002, Pages 959-964</ref> "Our data suggest that in women, up to one drink per day does not impair cognitive function and may actually decrease the risk of cognitive decline."<ref>Stampfer MJ, Kang JH, Chen J, Cherry R, Grodstein F. [http://www.ncbi.nlm.nih.gov/pubmed/15659724 Effects of moderate alcohol consumption on cognitive function in women] ''New England Journal of Medicine'' 2005 Jan 20;352(3):245-53.</ref> "Moderate levels of alcohol intake are associated with somewhat better cognition, which may be expressed most strongly in functions related to verbal knowledge and phonemic fluency. However, our observational study cannot rule out confounding associations with unmeasured factors."<ref>Espeland MA, Coker LH, Wallace R, Rapp SR, Resnick SM, Limacher M, Powell LH, Messina CR; Women's Health Initiative Study of Cognitive Aging [http://www.ncbi.nlm.nih.gov/pubmed/16717476 Association between alcohol intake and domain-specific cognitive function in older women] ''Neuroepidemiology'' 2006;27(1):1-12. Epub 2006 May 24</ref> "The moderate drinkers reported less depression, had higher self-reported health, performed better on instrumental everyday tasks, had stronger memory self-efficacy, and used more strategies to improve memory performance. In addition, these women had higher performance on tests of executive function: attention, concentration, psychomotor skills, verbal-associative capacities, and oral fluency."<ref>Teena Zimmerman, Graham J. McDougall Jr, Heather Becker [http://www3.interscience.wiley.com/cgi-bin/abstract/109700521/ABSTRACT Older women's cognitive and affective response to moderate drinking] ''International Journal of Geriatric Psychiatry'' Volume 19, Issue 11 , Pages 1095 - 1102 10.1002/gps.1216</ref>
"In patients with mild cognitive impairment, up to 1 drink/day of alcohol or wine may decrease the rate of progression to dementia."<ref>V. Solfrizzi, A. D’Introno, A. M. Colacicco, C. Capurso, A. Del Parigi, G. Baldassarre, P. Scapicchio, E. Scafato, M. Amodio, A. Capurso, F. Panza [http://www.neurology.org/cgi/content/abstract/68/21/1790 Alcohol consumption, mild cognitive impairment, and progression to dementia] ''Neurology'' 2007;68:1790-1799</ref>
<!-- Studies have found the risks of Alzheimer's disease to be as much as 75% lower among drinkers than among teetotalers. A study of found that those who drank regularly, including those who consumed in excess of U.S. recommend levels (one drink per day for women and two for men) had a significantly lower risk of Alzheimer’s disease than did non-drinkers. <ref> Cupples, LA; Weinberg, J; Beiser, A; Auerbach, SH; Volicer, L; Cipolloni, PB; Wells, J; Growdon, JH; DAgostino, RB; Wolf, PA; Farrer, LA Effects of smoking, alcohol and APOE genotype on Alzheimer disease: The MIRAGE study Alzheimer Report, 2000, 3, 105-114. </ref> -->"…there is no medical rationale to advise people over 65 to quit drinking wine moderately, as this habit carries no specific risk and may even be of some benefit for their health. Advising all elderly people to drink wine regularly for prevention of dementia would be however premature at this stage."<ref>Orgogozo JM, Dartigues JF, Lafont S, Letenneur L, Commenges D, Salamon R, Renaud S, Breteler MB. [http://www.ncbi.nlm.nih.gov/pubmed/9296132 Wine consumption and dementia in the elderly: a prospective community study in the Bordeaux area] ''Revue neurologique'' (Paris) 1997 Apr;153(3):185-92</ref>
<!-- A review of existing research to identify how dementia can be reduced found that that both abstaining from alcohol and abusing it are risk factors for cognitive decline and dementia. <ref> Andel, R., Hughes, T.F., & Crowe, M.G. (2005). Strategies to reduce the risk of cognitive decline and dementia. Aging Health, 1(1),107-116. </ref> -->
"Researchers found that people who were heavy drinkers [defined as more than two drinks per day] developed Alzheimer’s 4.8 years earlier than those who
were not heavy drinkers."<ref>[http://www.aan.com/globals/axon/assets/3980.pdf Alzheimer’s Starts Earlier for Heavy Drinkers, Smokers]</ref>
<blockquote>"Of people who reported drinking alcohol in the past year, those who consumed at least one drink in the past week, compared with those who did not, were significantly less likely to have poor cognitive function. … However, the relations were weakened when social position was added to the model. The authors concluded that for middle-aged subjects, increasing levels of alcohol consumption were associated with better function regarding some aspects of cognition. Nonetheless, it is not proposed that these findings be used to encourage increased alcohol consumption."<ref>Britton, Annie; Singh-Manoux, Archana; Marmot, Michael [http://aje.oxfordjournals.org/cgi/content/full/160/3/240 Alcohol Consumption and Cognitive Function in the Whitehall II Study] ''American Journal of Epidemiology'' 2004 160(3):240-247; doi:10.1093/aje/kwh206</ref>
</blockquote>
Another study concluded:
<blockquote>"After adjustment for age, education, and smoking status, men with CVD [cardiovascular disease]/diabetes and low-to-moderate alcohol intake had a significantly lower risk for poor cognitive function (MMSE £ 25) than abstainers (odds ratios of 0.3 for less than one drink and 0.2 for one to two drinks per day). Alcohol intake was not associated with cognitive decline. … Alcohol may result in an acute beneficial effect on cognitive function among those with CVD/diabetes. However, selection bias and unmeasured confounding should be of concern when evaluating these results."<ref>Launer, LJ; Feskens, EJM; Kalmijn, S; and Kromhout D [http://aje.oxfordjournals.org/cgi/reprint/143/3/219 Smoking, Drinking, and Thinking: The Zutphen Elderly Study] ''American Journal of Epidemiology'' 1996 Feb 1;143(3):219-27</ref>
</blockquote>
<blockquote>A further study concluded, "We report a positive association between moderate alcohol intake among middle-aged men and subsequent cognitive performance in later life. However, it is possible that the health risks associated with drinking outweigh any potential benefits for many elderly persons.<ref>Galanis, Daniel J.; Joseph, Carol; Masaki, Kamal H.;
Petrovitch, Helen; Ross, G. Webster; and White, Lon [http://www.ajph.org/cgi/reprint/90/8/1254 A Longitudinal Study of Drinking and Cognitive Performance in Elderly Japanese American Men: The Honolulu–Asia Aging Study] ''American Journal of Public Health'' Vol 90, Issue 8 1254-1259</ref>
</blockquote>
A French study concluded:
<blockquote>"Among men, neuropsychological test scores were not associated with alcohol consumption in either univariate or multivariate analysis; nor did
the proportion of high cognitive performers vary by alcohol consumption. In contrast, among women, significant positive associations between alcohol consumption and cognitive performance were observed for most tests in multivariate analysis. … These findings suggest that, among women, moderate alcohol consumption may have a beneficial effect on cognitive function.<ref>Dufouil, Carole; Ducimetière, Pierre; Alperovitch, Annick [http://aje.oxfordjournals.org/cgi/reprint/146/5/405.pdf Sex Differences in the Association between Alcohol Consumption and Cognitive Performance] ''American Journal of Epidemiology'' Vol. 146, No. 5: 405-412</ref>
"Abstainers have poorer cognitive function than light drinkers and further investigation is needed to determine what factors contribute to this."<ref>Rodgers, Bryan; Windsor, Timothy D.; Anstey, Kaarin J.; Dear, Keith B. G.; F. Jorm, Anthony; Christensen, Helen [http://www.ingentaconnect.com/content/bsc/add/2005/00000100/00000009/art00017 Non-linear relationships between cognitive function and alcohol consumption in young, middle-aged and older adults: the PATH Through Life Project] ''Addiction'' 2005, 100(9), 1280-1290</ref> "A range of demographic and physical function measures were found to explain partially the finding of abstainers having lower cognitive test scores. The effects of independent variables were largest in the 60–64-year-old age group with a trend for physical variables such as lung function and grip strength to become more important in the older age groups. In the 20–24-year-olds, the majority of the effect remained unexplained. There is evidence that poorer cognitive test performance by abstainers reflects in part selection effects and poorer physical functioning, but does not appear to be due to mental or physical health conditions or personality."<ref>Anstey, Kaarin J.; Windsor, Timothy D.; Rodgers, Bryan; Jorm, Anthony F.; Christensen, Helen [http://www.ingentaconnect.com/content/bsc/add/2005/00000100/00000009/art00018 Lower cognitive test scores observed in alcohol are associated with demographic, personality, and biological factors: The PATH Through Life Project] ''Addiction'' Volume 100, Number 9, September 2005 , pp. 1291-1301(11) DOI: 10.1111/j.1360-0443.2005.01159.x</ref></blockquote>
Both abstaining from alcohol and abusing it are risk factors for cognitive decline and dementia, according to areview of existing research evidence. (Andel, R., et al. Strategies to reduce the risk of cognitive decline and dementia. Aging Health, 2005, 1(1),107-116)
===Essential tremor===
[[Essential tremor]]s can be temporarily and dramatically relieved in up to two-thirds of patients by drinking small amounts of alcohol, thus avoiding the serious side effects of the most effective and expensive medications or the dangers of surgery. <ref>Charles P. D., ''et al''. Classification of tremor and update on treatment. ''American Family Physician'', 1999, ''59(6)'', 565-72; Bain, P. G., ''et al''. A study of hereditary essential tremor. Brain, 1994, ''117 (Pt 4)'', 805-24 ; Lou, J.S., & Jankovic J. Essential tremor: clinical correlates in 350 patients. ''Neurology'', 1991, ''41 (2 Pt 1)'', 234-8; Singer C, ''et al''. Gait abnormality in essential tremor. ''Movement Disorders'', 1994, ''9(2)'', 193-6; Wasielewski PG, ''et al''. Pharmacologic treatment of tremor. ''Movement Disorders'', 1998, ''13 (Suppl 3)'', 90-100; Boecker, H., ''et al''. The effect of ethanol on alcoholic-responsive essential tremors: a positron emission tomography study. ''Annals of Neurology'', 1996, ''39'', 650-658, 1996; Setting a steady course for benign essential tremor. ''The Johns Hopkins Medical Letter'', 1999 (December), ''11(10)''.</ref>
===Wernicke-Korsakoff syndrome===
Wernicke-Korsakoff syndrome is a manifestation of [[thiamine]] deficiency, usually as a secondary effect of alcohol abuse.<ref name="pmid15303623">{{cite journal
|author=Martin PR, Singleton CK, Hiller-Sturmhöfel S
|title=The role of thiamine deficiency in alcoholic brain disease
|journal=Alcohol Res Health
|volume=27
|issue=2
|pages=134–42
|year=2003
|pmid=15303623
|doi=
|url=
}}</ref> The syndrome is a combined manifestation of two eponymous disorders, [[Korsakoff's syndrome|Korsakoff's Psychosis]] and [[Wernicke's encephalopathy]], named after Drs. [[Sergei Korsakoff]] and [[Carl Wernicke]]. Wernicke's encephalopathy is the acute presentation of the syndrome and is characterised by a [[confusion]]al state while Korsakoff's psychosis main symptoms are [[amnesia]] and [[executive functions|executive dysfunction]].<ref name="pmid6806017">{{cite journal
|author=Butters N
|title=The Wernicke-Korsakoff syndrome: a review of psychological, neuropathological and etiological factors
|journal=Curr Alcohol
|volume=8
|issue=
|pages=205–32
|year=1981
|pmid=6806017
|doi=
|url=
}}</ref>
==Psychological effects==
Studies have shown that alcohol dependence relates directly to [[craving]]s and [[irritability]].<ref name="med-sci">{{cite journal |author=Jasova D, Bob P, Fedor-Freybergh P |title=Alcohol craving, limbic irritability, and stress |journal=[[Med. Sci. Monit.]] |volume=13 |issue=12 |pages=CR543–7 |year=2007 |month=December |pmid=18049433 |doi= |url=http://www.medscimonit.com/fulltxt.php?ICID=563763 |issn= |accessdate=2008-05-13}}</ref> Another study has shown that alcohol use is a significant predisposing factor towards [[antisocial behavior]] in children.<ref name="antisocial">{{cite journal |author=Young R, Sweeting H, West P |title=A longitudinal study of alcohol use and antisocial behaviour in young people |journal=[[Alcohol Alcohol.]] |volume=43 |issue=2 |pages=204–14 |year=2008 |pmid=17977868 |doi=10.1093/alcalc/agm147 |url=http://alcalc.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=17977868|accessdate=2008-05-13}}</ref> Psychosis is secondary to several alcohol-related conditions including acute intoxication and withdrawal after significant exposure.<ref name="emedicine">{{cite web |url=http://www.emedicine.com/med/TOPIC3113.HTM |title=Alcohol-Related Psychosis |accessdate=2008-05-13 |last=Larson |first=Michael |coauthors=Jennifer S Berg |date=2006-03-30 |publisher=eMedicine}}</ref> Prominent [[hallucination]]s and/or [[delusion]]s are usually present when a patient is intoxicated or recently withdrawn from alcohol.<ref name="emedicine"/> [[DSM-IV-TR]] criteria for a alcohol-related psychotic disorder are as follows:<ref name="emedicine"/>
:*Hallucinations or delusions are present. Hallucinations are false sensations and are often visual. Delusions are false ideas. [[Paranoia]] and occasionally grandiosity may be the delusions engaged here.
:* Evidence from the [[Medical history|history]], [[physical examination]], or laboratory findings indicates either that the hallucinations or delusions developed during or within a month of substance intoxication or withdrawal or that medication use is etiologically related to the disturbance.
:* The disturbance is not better accounted for by a [[psychotic disorder]] that is not substance-induced. Evidence that the symptoms are better accounted for by a psychotic disorder that is not substance-induced might include the following:
:::*The symptoms precede the onset of the substance or medication use.
:::*The symptoms persist for a substantial period of time after [[cessation]] of acute withdrawal or severe intoxication, or the symptoms are substantially in excess of what would be expected given the type or amount of the substance use or the duration of use.
:::*Other evidence suggests the existence of an independent non–substance-induced psychotic disorder.
:*The disturbance does not occur exclusively during the course of a delirium.
==Digestive system and weight gain==
{{seealso|Alcohol and weight}}
{{seealso|Alcoholic liver disease|Alcoholic hepatitis|Fatty liver|Cirrhosis}}
Except from pancreatitis and liver disease, there is uncertainty whether alcohol is detrimental or beneficial to the gastrointestinal system. Its impact on weight-gain is contentious: some studies find no effect, <ref>Cordain, L;, Bryan, E D; Melby, C L; Smith, M J [http://intl.jacn.org/cgi/content/abstract/16/2/134 Influence of moderate daily wine consumption on body weight regulation and metabolism in healthy free-living males] ''Journal of the American College of Nutrition'' 1997, Vol 16, Issue 2 134-139.</ref> others find decreased<ref> (Arif, A. A. & Rohrer, J. E. [http://www.biomedcentral.com/1471-2458/5/126 Patterns of Alcohol Drinking and its Association with Obesity: Data from the Third National Health and Nutrition Examination Survey, 1988-1994] ''BMC Public Health'', 2005 [[5 December]]), ''(5)'', 126.)</ref> or increased effect on weight gain.
Alcohol use increases the risk of chronic [[gastritis]] (stomach inflammation);<ref>[[National Institute on Alcohol Abuse and Alcoholism]] (NIAAA) ''Alcohol Research & Health'' Vol. 24, No. 1, 2000 [http://pubs.niaaa.nih.gov/publications/arh24-1/05-11.pdf Health Risks and Benefits of Alcohol Consumption] (PDF)</ref><ref name=bode1>Bode, Christiane; Bode, J. Christiane [https://webapps.ou.edu/alcohol/docs/12EtohGastroinstestinalTractDisorders76.pdf Alcohol’s Role in Gastrointestinal Tract Disorders] ''Alcohol Health & Research World'' Vol. 21, No. 1, 1997</ref> it is one cause of [[cirrhosis]], [[hepatitis]], and [[pancreatitis]] in both its [[Chronic pancreatitis|chronic]] and [[Acute pancreatitis|acute]] forms.
===Metabolic Syndrome===
Analysis of data from 8,125 participants in the Third National Health and Nutrition Examination Study revealed that drinkers had a 43 percent lower chance of having Metabolic Syndrome than did abstainers or non-drinkers. After controlling for, sex, race, education, income, tobacco use, physical activity, and diet, the researchers found that subjects who consumed 1-19 alcoholic drinks per month had a 35% reduction in risk, and those who had 20 or more drinks each month had a 66% reduction in risk of Metabolic Syndrome.(Freiberg, M, et al. Alcohol consumption and the prevalence of the Metabolic Syndrome in the US: A cross-sectional analysis of data from The National Health and Nutrition Examination Survey, Diabetes Care, 2004, 27(11), 2954-2959)
===Gallbladder disease===
Consumption of alcohol is unrelated to gallbladder disease.<ref>Sahi T, Paffenbarger RS Jr, Hsieh CC, Lee IM [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9554603&dopt=Abstract Body mass index, cigarette smoking, and other characteristics as predictors of self-reported, physician-diagnosed gallbladder disease in male college alumni] ''American Journal of Epidemiology'' 1998 Apr 1;147(7):644-51</ref> However one study suggested that drinkers who take [[Vitamin C]] ([[ascorbic acid]]) might reduce their risk. "After adjustment for potential confounding variables, use of ascorbic acid supplements among drinkers was associated with a decreased prevalence of gallbladder disease … and cholecystectomy …. Use of ascorbic acid supplements among non-drinkers was not significantly associated with either prevalence of gallbladder disease or cholecystectomy. Further study is necessary to confirm our findings and, specifically, to examine the combined effects of ascorbic acid and alcohol on cholesterol metabolism."<ref>Simon JA, Grady D, Snabes MC, Fong J, Hunninghake DB [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9495691&dopt=Abstract Ascorbic acid supplement use and the prevalence of gallbladder disease. Heart & Estrogen-Progestin Replacement Study (HERS) Research Group] ''Journal of Clinical Epidemiology'' 1998 Mar;51(3):257-65</ref>
===Gallstones===
Research has found that drinking reduces the risk of developing [[gallstones]]. Compared with alcohol abstainers, the relative risk of gallstone disease, controlling for age, sex, education, smoking, and body mass index, is 0.83 for occasional and regular moderate drinkers (< 25 ml of ethanol per day), 0.67 … for intermediate drinkers (25-50 ml per day), and 0.58 … for heavy drinkers. This inverse association was consistent across strata of age, sex, and body mass index."<ref>La Vecchia C, Decarli A, Ferraroni M, Negri E [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7986868&dopt=Abstract Alcohol drinking and prevalence of self-reported gallstone disease in the 1983 Italian National Health Survey] ''Epidemiology'' 1994 Sep;5(5):533-6</ref> Frequency of drinking also appears to be a factor. "An increase in frequency of alcohol consumption also was related to decreased risk. Combining the reports of quantity and frequency of alcohol intake, a consumption pattern that reflected frequent intake (5-7 days/week) of any given amount of alcohol was associated with a decreased risk, as compared with nondrinkers. In contrast, infrequent alcohol intake (1-2 days/week) showed no significant association with risk.”<ref>Leitzmann MF, Giovannucci EL, Stampfer MJ, Spiegelman D, Colditz GA, Willett WC, Rimm EB [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10371403 Prospective study of alcohol consumption patterns in relation to symptomatic gallstone disease in men] ''Alcohol: Clinical and Experimental Research'' 1999 May;23(5):835-41</ref>
==Other systems==
===Urinary system: Kidney stones ===
Research indicates that drinking alcohol is associated with a lower risk of developing [[kidney stones]]. One study concludes, "Beer consumption was inversely associated with risk of kidney stones; each bottle of beer consumed per day was estimated to reduce risk by 40% …. Since beer seemed to be protective against kidney stones, the physiologic effects of other substances besides ethanol, especially those of hops, should also be examined."<ref>Hirvonen, Tero; Pietinen, Pirjo; Virtanen, Mikko; Albanes, Demetrius; Virtamo, Jarmo [http://aje.oxfordjournals.org/cgi/reprint/150/2/187 Nutrient Intake and Use of Beverages and the Risk of Kidney Stones among Male Smokers] ''American Journal of Epidemiology'' Vol. 150, No. 2: 187-194</ref> "…consumption of coffee, alcohol, and vitamin C supplements were negatively associated with stones."<ref>Soucie, J. Michael; Coates, Ralph J; McClellan, William; Austin, Harland; Michael Thun [http://aje.oxfordjournals.org/cgi/reprint/143/5/487 Relation between Geographic Variability in Kidney Stones Prevalence and Risk Factors for Stones] ''American Journal of Epidemiology'' Vol. 143, No. 5: 487-495</ref> "After mutually adjusting for the intake of other beverages, the risk of stone formation decreased by the following amount for each 240-ml (8-oz) serving consumed daily: caffeinated coffee, 10%; decaffeinated coffee, 10%; tea, 14%; beer, 21%; and wine, 39%."<ref>Curhan GC, Willett WC, Rimm EB, Spiegelman D, Stampfer MJ [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8561157&dopt=Abstract Prospective study of beverage use and the risk of kidney stones] ''American Journal of Epidemiology'' 1996 Feb 1;143(3):240-7</ref> "…stone formation decreased by the following amount for each 240-mL (8-oz) serving consumed daily: 10% for caffeinated coffee, 9% for decaffeinated coffee, 8% for tea, and 59% for wine." ([[Confidence interval|CI]] data excised from last two quotes.).<ref>Curhan GC, Willett WC, Speizer FE, Stampfer MJ [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9518397&dopt=Abstract Beverage use and risk for kidney stones in women] ''Annals of Internal Medicine'' 1998 Apr 1;128(7):534-40</ref>
=== Endocrine system: Diabetes===
Moderate drinkers may have a lower risk of [[diabetes]] than non-drinkers. "Alcohol intake increases insulin sensitivity and may partly explain both the J-shaped relationship between the prevalence of diabetes and the amount of alcohol consumption and the decreased mortality for myocardial infarction."<ref>Avogaro A, Watanabe RM, Dall'Arche A, De Kreutzenberg SV, Tiengo A, Pacini G. [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15161790&dopt=Abstract Acute alcohol consumption improves insulin action without affecting insulin secretion in type 2 diabetic subjects] ''Diabetes Care'', 2004 (June 6), ''27(6)'', 1369-1374</ref> "Compared with abstainers men who drank 30.0-49.9 g of alcohol daily had a [[relative risk]] of diabetes of 0.61."<ref>Rimm EB, Chan J, Stampfer MJ, Colditz GA, Willett WC [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=7888928 Prospective study of cigarette smoking, alcohol use, and the risk of diabetes in men] ''British Medical Journal'' 1995 Mar 4;310(6979):555-9</ref> "Consumption of 30 g/d of alcohol (2 drinks per day) has beneficial effects on insulin and triglyceride concentrations and insulin sensitivity in nondiabetic postmenopausal women."<ref>Davies, Michael J; Baer, David J; Judd, Joseph T; Brown, Ellen D; Campbell, William S; Taylor, Philip R [http://jama.ama-assn.org/cgi/content/abstract/287/19/2559 Effects of Moderate Alcohol Intake on Fasting Insulin and Glucose Concentrations and Insulin Sensitivity in Postmenopausal Women: A Randomized Controlled Trial] ''Journal of the American Medical Association'', 2002, ''287(19)'', 2559-2562.</ref> After adjustment for age, randomized treatment assignment, smoking, physical activity, and [[body mass index]], the relative risk estimates of diabetes for those reporting alcohol use of rarely/never were 1.00 (referent), 1 to 3 drinks per month 1.03, 1 drink per week 0.89, 2 to 4 drinks per week 0.74, 5 to 6 drinks per week 0.67, and 1 or more drinks per day 0.57.<ref>Ajani, Umed A; Hennekens, Charles H; Spelsberg, Angela; Manson, JoAnn E [http://archinte.ama-assn.org/cgi/content/abstract/160/7/1025 Alcohol Consumption and Risk of Type 2 Diabetes Mellitus Among US Male Physicians] ''Archives of Internal Medicine'', 2000, ''160'', 1025-1050</ref> "The results of this study suggested that moderate alcohol consumption may reduce the risk of type 2 diabetes. On the other hand, binge drinking and high alcohol consumption may increase the risk of type 2 diabetes in women."<ref>Sofia Carlsson, Niklas Hammar, Valdemar Grill, and Jaakko Kaprio [http://care.diabetesjournals.org/cgi/content/full/26/10/2785 Alcohol consumption and the incidence of type 2 diabetes: a 20-year follow-up of the Finnish Twin Cohort Study] ''Diabetes Care'', 2003, ''26(10)'', 2785-2786.</ref>
===Endocrine system: Rheumatoid arthritis===
Alcohol consumption is associated with decreased risk of rheumatoid arthritis. <ref> http://arc.org.uk/arthinfo/patpubs/6033/6033.asp</ref> <ref> Myllykangas-Lusojarvi, R. Reduced Incidence of Alcohol related Deaths in subjects with Rheumatoid Arthritis, Ann. Rheum. Dis,, 2000, 75-76</ref> <ref> C. Nagata. Systemic Lupus-Erythematosis, Int. J. Derm, 1995, 34(5), 333-7 </ref> <Aho, K, & Heloivaara, M. Alcohol, Androgens and Arthritis, Ann. Rheum. Dis. 1993, 52, 897</ref> <ref> http://ard.bmj.com/cgi/content/abstract/57/8/451</ref> Two recent studies report that the more alcohol consumed, the lower the risk of developing rheumatoid arthritis. Among those who drank regularly, the one-quarter who drank the most were up to 50% less likely to develop the disease compared to the half who drank the least. <ref> H. Kaalberg, Alcohol Consumption is Associated with decreased Risk of Rheumatoid Arthritis: Results from Two Scandinavian Cas-Control Sttudies, Ann. Rheum. Dis, Pub. Online First: 5 June 2008. doi:10.1136/ard.2007.086314</ref>
The researchers noted that moderate alcohol consumption also reduces the risk of other inflammatory processes such as cardiovascualar disease. Some of the biological mechanisms by which ethanol reduces the risk of destructive arthritis and prevents the loss of bone mineral density (BMD), which is part of the disease process.<ref> I-M Jonsson. Ethanol Prevents Development of Destructive Arthritis, Proceedings of the National Academy of Sciences, January 2, 2007, 104 (1), 258-263</ref>
===Skeletal system===
A study concluded, "Alcohol either protects from RA [[rheumatoid arthritis]] or, subjects with RA curtail their drinking after the manifestation of RA".<ref>Myllykangas-Lusojarvi, R., Aho, K., Kautiainen, H., and Hakala, M. [http://ard.bmj.com/cgi/content/abstract/59/1/75 Reduced incidence of alcohol related deaths in subjects with rheumatoid arthritis] ''Annals of Rheumatoid Diseases'', 2000, ''59'', 75-76;</ref> Another study found, "Postmenopausal women who averaged more than 14 alcoholic drinks per week had a reduced risk of rheumatoid arthritis… "<ref>Voight, L., ''et al''. [http://www.jstor.org/pss/3702208 Smoking, obesity, alcohol consumption and the risk of rheumatoid arthritis] ''Epidemiology'', 1994, ''5'', 525-532.</ref>
Moderate alcohol consumption is associated with higher [[bone mineral density]] in postmenopausal women. "…alcohol consumption significantly decreased the likelihood [of [[osteoporosis]]]."<ref>Siris, Ethel S; Miller, Paul D; Barrett-Connor, Elizabeth; Faulkner, Kenneth G; Wehren, Lois E; Abbott, Thomas A; Berger, Marc L; Santora, Arthur C; Sherwood, Louis M [http://jama.ama-assn.org/cgi/content/abstract/286/22/2815 Identification and Fracture Outcomes of Undiagnosed Low Bone Mineral Density in Postmenopausal Women] ''Journal of the American Medical Association'', 2001;286:2815-2822</ref> "Moderate alcohol intake was associated with higher BMD in postmenopausal elderly women."<ref>Rapuri, Prema B; Gallagher, J Christopher; Balhorn, Kurt E; Ryschon, Kay L [http://intl.ajcn.org/cgi/content/abstract/72/5/1206 Alcohol intake and bone metabolism in elderly women] ''American Journal of Clinical Nursing'' Vol. 72, No. 5, 1206-1213, November 2000</ref> "Social drinking is associated with higher bone mineral density in men and women [over 45]."<ref>Holbrook TL, Barrett-Connor E [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8518677&dopt=Abstract A prospective study of alcohol consumption and bone mineral density] ''British Medical Journal'' 1993 Jun 5;306(6891):1506-9</ref>
===Respiratory System===
Moderate drinkers have been found to have higher resistance than do alcohol abstainers to five strains of the common cold virus. Those who drank less often than every day had a 30% lower risk than abstainers, those who consumed one to two drinks daily had a 65% lower risk, and dthose who consumed two to three drinks each day had an 85% lower risk than abstainers.(Cohen, S., et al. Smoking, alcohol consumption and susceptibility to the common cold. American Journal of Public Health, 1993, 83(9), 1277-1283)
==Immune system, bacterial contamination, and cancer==
===Bacterial infection===
Drinking strong alcoholic beverages with a meal may offer some protection against bacterial contamination. The antibacterial activity of red and white wine against enteropathogens, (e.g. [[Shigella]] or [[Salmonella]]<ref>Desenclos JA, Klontz KC, Wilder MH, Gunn RA [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1637901&dopt=Abstract The protective effect of alcohol on the occurrence of epidemic oyster-borne hepatitis A] ''Epidemiology'' 1992 Jul;3(4):371-4</ref>) may protect against bacterial diarrhoea in a similar way to bismuth salicylate. <ref>Weisse, Martin E; Eberly, Bardwell; Person, Donald A [http://bmj.bmjjournals.com/cgi/content/full/311/7021/1657?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=Weisse&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT Wine as a digestive aid: comparative antimicrobial effects of bismuth salicylate and red and white wine] ''[[British Medical Journal]]'' 1995;311:1657-1660 (23 December)</ref>
There is a protective effect of alcohol consumption against active infection with ''H pylori''<ref>Brenner, Hermann; Rothenbacher, Dietrich; Bode, Günter; Adler, Guido [http://bmj.bmjjournals.com/cgi/content/full/315/7121/1489 Relation of smoking and alcohol and coffee consumption to active ''Helicobacter pylori'' infection: cross sectional study] ''British Medical Journal'' 1997;315:1489-1492 (6 December)</ref> In contrast, alcohol intake (comparing those who drink > 30 gm of alcohol per day to nondrinkers) is not associated with higher risk of duodenal ulcer <ref>Aldoori WH, Giovannucci EL, Stampfer MJ, Rimm EB, Wing AL, Willett WC [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9209857&dopt=Abstract A prospective study of alcohol, smoking, caffeine, and the risk of duodenal ulcer in men] ''Epidemiology'' 1997 Jul;8(4):420-4.</ref>
===Cancer===
{{Main|Alcohol and cancer}}
The NIAAA states that "Although epidemiologic studies have found a clear association between alcohol consumption and development of certain types of cancer, study findings are often inconsistent and may vary by country and by type of cancer."<ref name=alert21/> The [[United States Department of Health and Human Services|U.S. Department of Health & Human Services’]] National [[Toxicology]] Program listed alcohol as a ''known [[carcinogen]]'' in 2000 .<ref>National Toxicology Program [http://ntp.niehs.nih.gov/ntp/roc/eleventh/profiles/s007alco.pdf Alcoholic Beverage Consumption: Known to be a human carcinogen] First listed in the ''Ninth Report on Carcinogens'' (2000)(PDF)</ref>
The [[National Institute on Alcohol Abuse and Alcoholism]] (NIAAA) reports that "Although there is no evidence that alcohol itself is a carcinogen, alcohol may act as a cocarcinogen by enhancing the carcinogenic effects of other chemicals. For example, studies indicate that alcohol enhances tobacco's ability to stimulate tumor formation in rats (Garro & Lieber). In humans, the risk for mouth, tracheal, and esophageal cancer is 35 times greater for people who both smoke and drink than for people who neither smoke nor drink (Blot ''et al''.), implying a cocarcinogenic interaction between alcohol and tobacco-related carcinogens (Garro & Lieber)."<ref name=alert21>National Institute on Alcohol Abuse and Alcoholism [http://pubs.niaaa.nih.gov/publications/aa21.htm Alcohol Alert No. 21 PH 345 July 1993]</ref> One study determined that "3.6% of all cancer cases worldwide are related to alcohol drinking, resulting in 3.5% of all cancer deaths."<ref>
[http://www.oncolink.com/resources/article.cfm?c=3&s=8&ss=23&id=13383&month=08&year=2006 Burden of alcohol-related cancer substantial]</ref> The NiAAA suggests that "considerable evidence suggests a connection between heavy alcohol consumption and increased risk for cancer, with an estimated 2 to 4 percent of all cancer cases thought to be caused either directly or indirectly by alcohol."<ref name=alert21/>
The WCRF panel report ''Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective'' finds the evidence "convincing" that alcoholic drinks increase the risk of the following cancers: mouth, pharynx and larynx, oesophagus, colorectum (men), breast (pre- and
postmenopause).<ref name=WCRF>WCRF [http://www.dietandcancerreport.org/downloads/Second_Expert_Report.pdf Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective]</ref>
==Alcohol's effect on the fetus==
{{main|Fetal alcohol syndrome|Fetal Alcohol Spectrum Disorder}}
[[Fetal alcohol syndrome]] or FAS is a disorder of permanent [[birth defect]]s that occurs in the offspring of women who drink [[alcohol]] during pregnancy. Drinking heavily or during the early stages of prenatal development has been conclusively linked to FAS; the impact of light or moderate consumption is not yet fully understood. Alcohol crosses the [[placental barrier]] and can stunt fetal growth or weight, create distinctive facial stigmata, damaged [[neurons]] and brain structures, and cause other physical, mental, or behavioural problems.<ref name="pmid4504588">{{cite journal |author=Ulleland CN |title=The offspring of alcoholic mothers |journal=Ann. N. Y. Acad. Sci. |volume=197 |issue= |pages=167–9 |year=1972 |month=May |pmid=4504588 |doi= |url= |issn= |accessdate=2008-05-15}}</ref> Fetal alcohol exposure is the leading known cause of [[mental retardation]] in the Western world.<ref name="pmid3545731">{{cite journal |author=Abel EL, Sokol RJ |title=Incidence of fetal alcohol syndrome and economic impact of FAS-related anomalies |journal=Drug Alcohol Depend |volume=19 |issue=1 |pages=51–70 |year=1987 |month=January |pmid=3545731 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/0376-8716(87)90087-1 |issn= |accessdate=2008-05-15}}</ref>
==See also==
* [[Short-term effects of alcohol]]
* [[French paradox]]
* [[Impact of alcohol on aging]]
==References==
{{reflist|2}}
<!-- not actually referenced *Walsh, C. R., et al. Alcohol consumption and risk of congestive heart failure in the Framingham Heart Study. ''Annals of Internal Medicine'', 2002, ''136(3)'', 181-191. -->
*Trevisan, M., et al. Drinking pattern and mortality: a longitudinal study; Gaziano, J. M., et al. A prospective cohort study of moderate alcohol consumption and sudden death in the Physicians' Health Study. Abstract . ''The Canadian Journal of Cardiology'', June, 1997, volume 13, Supplement B.
==External links==
*[http://www.bu.edu/act/alcoholandhealth/index.html Alcohol and Health: Current Evidence. Boston University/National Institute on Alcohol Abuse and Alcoholism Journal]
*[http://apps.nccd.cdc.gov/ardi/Report.aspx?T=AAM&P=9d3057a6-5cda-416d-ba10-41e7b8ebd521&R=c22869f8-a1d3-48a8-8095-9142c6de5baf&M=1d04dc84-f775-4032-9ab3-75bc10221b2b&L=&F=AAMCauseGenderNew&D=A Alcohol-Attributable Deaths Report, United States 2001]
[[Category:Alcohol]]
[[Category:Alcohol abuse]]
[[es:Beneficios del consumo moderado de alcohol]]
[[sv:Alkoholkonsumtion och hälsa]]