Saturday, January 18, 2014

Glass of Wine? - Rethinking Drinking

Americans Drink Too Much, my online medical journal simply stated. You’re telling me? I live in California where wine is poured like water.
“I am shocked at the number of elderly that drink daily,” I said during my recent trip home. “They come into the Memory Clinic concerned about their memory and they drink alcohol daily.”
“So? I drink daily,” someone said.
“Here’s the problem with that,” I said. “People develop a habit and then when they are 70, their liver is 70 and can’t detox the alcohol. Daily alcohol consumption can mimmic dementia. And drinkers have a higher incidence of dementia. My friend’s wife fell and broke her hip after several glasses of wine. That’s a preventable injury and subsequent surgery. Now she’s unstable and more prone to future falls - and she still drinks! A habit of daily drinking leads one-way.”
“That’s not true,” another defended. “What about all those European countries where people start drinking at an early age? And Germany, where they drink beer instead of water? They don’t have problems.”

Buddha said comparison is the source of all suffering and such comparisons are ludicrous in my mind. Nonetheless, I had to concede I had no knowledge of Europe’s alcohol problems excepting caricatures of Russians with Vodka and the brawling Irish. The topic is one of personal interest and angst - so it niggled and gnawed, begging to be plucked like the burr beneath the saddle.
After 35-years in nursing, (yes, University of Hawaii 1979), I realize my perspective is skewed. I have worked daily with the carnage of poor choices and unfortunate missteps. I know my lifestyle choices and judgements are shaped by the pool of human suffering in which I wallow.

Let’s start with defining the standard and the problem. Alcoholics Anonymous (AA) defines an alcoholic as one who cannot stop or one who drinks to physical, mental or social impairment.
The diagnostic medical criteria for alcohol dependence follows. A maladaptive pattern of alcohol use leading to impairment or distress as manifested by three (or more) of the following occurring at any time in the same 12-month period:
1) tolerance = need for increased amounts of alcohol to achieve intoxication or desired effect, diminished effect of alcohol with continued use.
2) withdrawal symptoms when alcohol is stopped or… the inability to stop.

A standard drink is defined as 12.0 oz of beer, 5.0 oz of wine, or 1.5 oz of liquor. A commonly cited standard developed by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) recommends that healthy adult men aged 65 years or younger have no more than 4 drinks per day and no more than 14 drinks per week and healthy adult women and all adults older than 65 years have no more than 3 drinks per day and no more than 7 drinks per week. [2]
Contrarily, The Centers for Disease Control and Prevention, defines heavy drinking as consuming more than one drink per day for women and two drinks for men. Their definition of a standard drink is consistent with that stated above.
The way to use such recommendations is as a benchmark against which to measure one’s self. Adjust alcohol consumption down to the recommendation. Why? Because there is good data that you are cruisin’ for a bruisin’ if’n you don’t.

So what about Europe?
There are countries that drink socially and moderately and there are countries that ritually binge drink. Binge drinking or heavy episodic drinking or getting shit-faced is a modern epithet for drinking alcoholic beverages with the primary intention of becoming intoxicated by heavy consumption of alcohol over a short period of time. [1] 
An almost exclusively Y-chromosomal activity favored by the collegiate, binge drinking is the source of alcohol intoxication resulting in well publicized, frat-house deaths. (As an aside, the upcoming Superbowl Sunday will provide a magnificently sanctioned opportunity to view this arm-chair, sideline sport by those well beyond frat-house pubescence.)

The Organization for Economic Co-Operation and Development assesses per capita alcohol consumption around the globe, detailing consumption of alcohol in liters per year. The most current and complete data set is from 2009. All but one of the top 16 countries are European. The US is outside the top 20. Such measures are considered non-medical determinants of public health. [3]

Luxembourg 15.3 (down from 17.7)
France 12.3
Austria 12.2 (down from 12.9)
Czech Republic 12.1
Estonia 11.9
Germany 11.7 (down from 12.4)
Hungary 11.5 (down from 13.2)
Spain 11.4 (up from 10)
Ireland 11.0 (down from 13.4)
Slovak Republic 10.7 (down from 11.0)
Slovenia 10.5 (down from 12.2)
Australia 10.3
Poland 10.2 (up from 9.1)
Portugal 10.2 (down from 12.2.)
UK 10.2 (down from 11.4)
Denmark 10.1 (down from 12.7)
Russia 9.29 (2006 - no current data)
US 8.7 (up from 8.4)

So what about Europe?
The current downtrending of alcohol consumption across Europe may be attributed to economics (Eurozone crisis and failing economies) more than any movement to curb drinking. Notice that no third-world countries appear on the list. Economically challenged countries, whose citizens have limited discretionary funds, buy food and consequently have low rates of alcohol consumption.

Alcohol abuse is considered one of the biggest social problems in Germany, where beer is about the same price as water and public imbibing is common as well as legal. Their drinking age is 14 (if drinking beer or wine in the company of parents) - one of the youngest in the world. Further, German laws regulating alcohol use and sale are some of the least restrictive worldwide. Has the ease with which people can consume cheap alcohol created a harmful drinking culture?
Alcoholism is a significant problem in Germany, according to Peter Lang, head of drug prevention and abuse at the German Center for Health Education. "A common misperception, both in Germany and the US, is that if you only drink beer or wine, you cannot be an alcoholic," he said. "This seems to be an even more prevalent attitude here in Germany where one in five Germans has an alcohol problem.”
The deaths of 73,000 people aged 35 to 65 could be traced back to “alcohol-related health problems” annually, which is about one fifth of all deaths. For men, the figure is roughly one in four.

The reputation that the French drink in moderation appears misleading after a report revealed alcohol is responsible for around 49,000 deaths in France each year - that's 134 each day. The report was published by the European Journal of Public Health.
Catherine Hill, one of the authors of the report summed up the findings simply by saying "the French drink too much”. The stats, based on the year 2009,  revealed that three times as many French men died as a result of an alcohol related health problem than women.
Forget defending American libations with European impunity. Dat dawg don’t hunt.

“Alcohol consumption is the direct cause of nearly 80,000 deaths in the Americas each year, according to a new study.”
Published in the journal Addiction (January 2014), researchers looked at alcohol as the cause of death by examining death certificates, over a two-year period in 16 North and Latin American countries. Men accounted for 84% of alcohol-related deaths.
Maristela Monteiro, study author and a senior advisor on alcohol and substance abuse at the Pan American Health Organization, says people are drinking too much and "it's killing people before they should be dying. These deaths are all 100% preventable,” she says. 
“This is just the tip of the iceberg,” Monteiro said. “Of course there are many more alcohol-related deaths from injuries, traffic accidents, violence, and also chronic conditions – where alcohol has a role but is not the only cause. But the data does not cover that.  We’re only getting the most severe cases.”
Get that? The data does not capture deaths caused by trauma related to vehicular manslaughter or homicide or suicide or chronic conditions (liver failure, cerebral encephalopathy) where alcohol was a contributor but not the primary cause of death.
Excessive drinking is associated with a profound social harm, economic costs as well as increased disease burden.
“We know how to reduce mortality – with population-based policies, controlling availability and increasing price,” Monteiro said. “We need to prevent people from getting to that stage where you have alcohol dependence or you die.”

Alcohol flows through my bloodlines. My Chinese gung-gung (grandfather) is remembered by all as a happy drunk (but a drunk nonetheless) who slept when his guzzling exceeded his liver’s capacity to detoxify. His son, my Uncle, was similarly inclined, singing and strumming his ukulele until he slept and met his early demise, the cause of which rested in his tightly clutched bottle. 
Tales tell, when drunk, my paternal grandfather was meaner than a junk yard dog. My father hated his father - who was no father to his kids, the unfortunate byproducts of another favored activity. I never met one Bacon with a kind word for Grandpa Bacon. And as hungry as his children were, they do remember Pa was never without cigarettes and booze. Fact is, moonshine killed his eldest son at the age of five and his daughter, my aunt, died prematurely from liver failure related to cirrhosis and alcoholism.
I come from a family of alcoholics - both living and dead. Any wonder why I am a controlling shrew in this regard? My past colors my future and while I am no teetotaler, I am measured and careful. I resent being handed an alcoholic beverage without consent and I have been known to return an untouched glass of wine to the bottle.
While neither of my parents were alcoholics, they were raised with alcoholic fathers and learned accommodating, enabling (co-dependent) behaviors… and passed them down. We learn these behaviors at mother’s knee and carry them into adulthood. I was a safe, accommodating place for an alcoholic to land… and I suffered. I didn’t see it for years, sometimes still don’t. More recently, I have worked diligently and methodically to remove the alcoholics from my inner circle. I find I swiftly judge people based on drinking frequency and/or impairment.
At a recent Christmas party, I met a woman who became more verbose with the hour. Toward the end of the evening, with just five people remaining, when meaningful conversations were both possible and probable, this woman hijacked every sentence into a story about self, frequently rising from her chair to enact parts of her tale. After 60-minutes, when it was clear that we were naught but the audience for her monologue and that dialogue was unlikely, I excused myself. She invited me to join her for a future evening of dancing. I don’t think so. I don’t know how much she drank nor do I care. Tis a harsh reality that I am beyond welcoming another into the fold.

People do not decide their futures, they decide their habits and their habits decide their futures.  ~ Frederick M. Alexander 

Next steps:
If you drink daily, stop. I am not instructing you to stop drinking, I am instructing you to stop drinking DAILY. If you can’t stop - get help.
Men, if you drink more than two drinks/day or 14 drinks/week - cut back. If you can’t cut back - get help.
Women, if you drink more than one drink/day or 7 drinks/week - cut back. If you can’t cut back - get help. [4]

A healthy lifestyle is nothing more than a series of healthy habits practiced over time. Its different - not difficult.

Who I am is vitality at every age and any stage 
- for me, for us, for all of us. 
Ask me how.

[1] Renaud, SC. (2001). "Diet and stroke". J Nutr Health Aging 5 (3): 167–72. PMID 11458287.