Health for life

As a class, people who dont drink at all have a higher mortality risk than light drinkers. But nondrinkers are a diverse bunch, and the reasons people have for abstaining affects their individual mortality risk, in some cases lowering it on par with the risk for light drinkers, according to a University of Colorado study.

Multiple studies have shown that the likelihood of dying for people who drink increases as they consume more alcohol. Those same studies have shown that a persons mortality risk also increases at the other end of the spectrum — among people who choose not to drink at all — though the risk is still much less than for heavy drinkers.

Some researchers have hypothesized that the increased mortality among nondrinkers could be related to the fact that light alcohol consumption — drinking, on average, less than one drink a day — might actually protect people from disease and reduce their stress levels.

But researchers at the University of Colorado Boulder, working with colleagues at the University of Colorado Denver, decided to examine whether characteristics of different subgroups of nondrinkers could explain the increased mortality risk.

"Among nondrinkers, people have all sorts of background reasons for why they dont drink," said sociology Professor Richard Rogers, director of CU-Boulders Population Program in the Institute of Behavioral Science. "We wanted to tease that out because its not really informative to just assume that nondrinkers are a unified group."

For the new study, published in last months issue of the journal Population Research and Policy Review, Rogers and his colleagues relied on data collected in 1988 by the National Health Interview Survey about the drinking habits of more than 41,000 people from across the United States. The researchers also had access to information about which respondents died between taking the survey and 2006.

During the survey, nondrinkers were asked to provide their reasons for not drinking. Possible answers ranged from "dont socialize very much" to "am an alcoholic" to "religious or moral reasons."

The research team divided nondrinkers into three general categories: "abstainers," or people who have never had more than 12 drinks in their lives; "infrequent drinkers," or people who have fewer than 12 drinks a year; and "former drinkers." Each category was further divided using a statistical technique that grouped people together who gave similar clusters of reasons for not drinking.

The team then calculated the mortality risk for each subgroup compared with the mortality risk for light drinkers, and they found that the risks varied markedly.

Abstainers who chose not to drink for a cluster of reasons that included religious or moral motivations, being brought up not to drink, responsibilities to their family, as well as not liking the taste, had similar mortality risks over the follow-up period to light drinkers.

"So this idea that nondrinkers always have higher mortality than light drinkers isnt true," Rogers said. "You can find some groups of nondrinkers who have similar mortality risks to light drinkers."

The other subgroup of abstainers — whose largest reason for not drinking appeared to be a dislike of the taste and to a lesser degree family responsibilities, religious or moral motivations or upbringing — had a 17 percent higher mortality risk over the follow-up period compared with light drinkers.

The scientists also found that infrequent drinkers generally had a slightly higher mortality risk than light drinkers. Former drinkers, however, had the highest mortality risk of all nondrinkers. Former drinkers whose cluster of reasons for not drinking now included being an alcoholic and problems with drinking, for example, had a 38 percent higher mortality risk than light drinkers over the follow-up period.

By comparison, people who drink between one and two drinks per day, on average, have a 9 percent higher mortality rate than light drinkers, while people who drink between two and three drinks per day have a 49 percent higher mortality. People who consume more than three drinks per day had a 58 percent higher mortality risk over the follow-up period compared with light drinkers.

Despite confirming that some subgroups of nondrinkers have a higher mortality rate than light drinkers, it doesnt necessarily follow that those peoples mortality rates would fall if they began drinking, Rogers said. For example, people who were problem drinkers in the past might increase their mortality risk further by starting to drink again.

Also, people who dont drink at all, as a group, have lower socioeconomic characteristics than light drinkers, which could be one of the underlying causes for the mortality differences, Rogers said. In that case, starting to drink without changing a persons socioeconomic status also would not likely lower mortality rates.

"I think the idea that drinking could be somewhat beneficial seems like its overstated," Rogers said. "There may be other factors that lower mortality for light drinkers. Its not just the act of drinking."

A large study of nearly half a million older adults followed for about 12 years revealed a clear trend: as coffee drinking increased, the risk of death decreased. Study author Neal Freedman, PhD, MPH, National Cancer Institute, discusses the significance of these findings and the potential links between coffee drinking, caffeine consumption, and various specific causes of disease in an interview in Journal of Caffeine Research, a peer-reviewed journal from Mary Ann Liebert, Inc., publishers. The article is available on the Journal of Caffeine Research website.

"Epidemiology of Caffeine Consumption and Association of Coffee Drinking with Total and Cause-specific Mortality" presents an in-depth interview exploring the many factors that could contribute to the association between coffee, disease, and mortality.

Dr. Freedman examines the relationship between coffee drinking and behaviors such as smoking and alcohol abuse, the physiological effects of caffeine on blood pressure and cardiac function, and the importance of differentiating between the effects of coffee and caffeine.

A Loyola University Chicago Stritch School of Medicine study suggests that omega-3 fish oil might help protect against alcohol-related dementia.

Previous studies have shown that long-term alcohol abuse increases the risk of dementia. The Loyola study found that in the brain cells of rats exposed to high levels of alcohol, a fish oil compound protected against inflammation and cell death.

The study by Michael A. Collins, PhD, and colleagues was reported Sept. 8 at the 14th Congress of the European Society for Biomedical Research on Alcoholism in Warsaw.

An earlier analysis by Collins and Loyola colleague Edward J. Neafsey, PhD, which pooled the results of 143 studies, found that moderate social drinking may reduce the risk of dementia and cognitive impairment. (Moderate drinking is defined as a maximum of two drinks per day for men and 1 drink per day for women.)

It appears that small amounts of alcohol might, in effect, make brain cells more fit. Alcohol in moderate amounts stresses cells and thus toughens them up to cope with major stresses down the road that could cause dementia. But too much alcohol overwhelms the cells, leading to inflammation and cell death.

In the new study, Collins and colleagues exposed cultures of adult rat brain cells to amounts of alcohol equivalent to more than four times the legal limit for driving. These cell cultures were compared with cultures of brain cells exposed to the same high levels of alcohol, plus a compound found in fish oil called omega-3 docosahexaenoic acid (DHA).

Researchers found there was about 90 percent less neuroinflammation and neuronal death in the brain cells exposed to DHA and alcohol than in the cells exposed to alcohol alone.

Further studies are needed to confirm whether fish oil protects against alcohol-related dementia. "Fish oil has the potential of helping preserve brain integrity in abusers," Collins said. "At the very least, it wouldnt hurt them."

But Collins added that best way for an alcohol abuser to protect the brain is, if possible, to quit drinking or cut back to moderate amounts. "We dont want people to think its okay to take a few fish oil capsules and then continue to go on abusing alcohol."

A cup of beetroot juice a day may help reduce your blood pressure, according to a small study in the American Heart Association journal Hypertension.

People with high blood pressure who drank about 8 ounces of beetroot juice experienced a decrease in blood pressure of about 10 mm Hg. But the preliminary findings dont yet suggest that supplementing your diet with beetroot juice benefits your health, researchers said.

"Our hope is that increasing ones intake of vegetables with a high dietary nitrate content, such as green leafy vegetables or beetroot, might be a lifestyle approach that one could easily employ to improve cardiovascular health," said Amrita Ahluwalia, Ph.D., lead author of the study and a professor of vascular pharmacology at The Barts and The London Medical School in London.

The beetroot juice contained about 0.2g of dietary nitrate, levels one might find in a large bowl of lettuce or perhaps two beetroots. In the body the nitrate is converted to a chemical called nitrite and then to nitric oxide in the blood. Nitric oxide is a gas that widens blood vessels and aids blood flow.

"We were surprised by how little nitrate was needed to see such a large effect," Ahluwalia said. "This study shows that compared to individuals with healthy blood pressure much less nitrate is needed to produce the kinds of decreases in blood pressure that might provide clinical benefits in people who need to lower their blood pressure. However, we are still uncertain as to whether this effect is maintained in the long term."

The study involved eight women and seven men who had a systolic blood pressure between 140 to 159 millimeters of mercury (mm Hg), did not have other medical complications and were not taking blood pressure medication. The study participants drank 250 mL of beetroot juice or water containing a low amount of nitrate, and had their blood pressure monitored over the next 24 hours.

Blood pressure is typically recorded as two numbers. Systolic blood pressure, which is the top number and the highest, measures the pressure in the arteries when the heart beats. Diastolic blood pressure, the bottom and lower number, measures blood pressure in the arteries between heart beats.

Compared with the placebo group, participants drinking beetroot juice had reduced systolic and diastolic blood pressure -- even after nitrite circulating in the blood had returned to their previous levels prior to drinking beetroot. The effect was most pronounced three to six hours after drinking the juice but still present even 24 hours later.

In the United States, more than 77 million adults have diagnosed high blood pressure, a major risk factor for heart diseases and stroke. Eating vegetables rich in dietary nitrate and other critical nutrients may be an accessible and inexpensive way to manage blood pressure, Ahluwalia said.

Getting people to eat more fruits and vegetables is challenging, but results of the study offer hope, she said. "In the U.K., the general public is told that they should be eating five portions of fruit or vegetables a day but this can be hard to do. Perhaps we should have a different approach to dietary advice. If one could eat just one (fruit or vegetable) a day, this is one more than nothing and should be viewed as positive."

The USDA recommends filling half your plate with fruits and vegetables, and the American Heart Association recommends eating eight or more fruit and vegetable servings every day.

Drinking a couple of glasses of wine each day has generally been considered a good way to promote cardiovascular and brain health. But a new Rutgers University study indicates that there is a fine line between moderate and binge drinking -- a risky behavior that can decrease the making of adult brain cells by as much as 40 percent.

In a study posted online and scheduled to be published in the journal Neuroscience on November 8, lead author Megan Anderson, a graduate student working with Tracey J. Shors, Professor II in Behavioral and Systems Neuroscience in the Department of Psychology, reported that moderate to binge drinking -- drinking less during the week and more on the weekends -- significantly reduces the structural integrity of the adult brain.

"Moderate drinking can become binge drinking without the person realizing it," said Anderson."In the short term there may not be any noticeable motor skills or overall functioning problems, but in the long term this type of behavior could have an adverse effect on learning and memory."

Shors and Anderson worked with postdoctoral fellow Miriam Nokia from the University of Jyvaskyla in Finland to model moderate to heavy drinking in humans using rodents that reached a blood alcohol level of 0.08 percent -- the legal driving limit in the United States and many other countries -- and found that brain cell production was affected negatively.

The researchers discovered that at this level of intoxication in rats -- comparable to about 3-4 drinks for women and five drinks for men -- the number of nerve cells in the hippocampus of the brain were reduced by nearly 40 percent compared to those in the abstinent group of rodents. The hippocampus is a part of the brain where the new neurons are made and is also known to be necessary for some types of new learning.

This level of alcohol intake was not enough to impair the motor skills of either male or female rats or prevent them from associative learning in the short-term. Still, Anderson said, th

is substantial decrease in brain cell numbers over time could have profound effects on the structural plasticity of the adult brain because these new cells communicate with other neurons to regulate brain health.

"If this area of your brain was affected every day over many months and years, eventually you might not be able to learn how to get somewhere new or to learn something new about your life," said Anderson, a graduate fellow in the Department of Neuroscience and Cell Biology. "Its something that you might not even be aware is occurring."

According to the National Institute of Alcohol Abuse and Alcoholism, men who drink 14 drinks a week and women who drink seven are considered at-risk drinkers. Although college students commonly binge drink, according to the institute, 70 percent of binge drinking episodes involved adults age 26 and older.

"This research indicates that social or daily drinking may be more harmful to brain health than what is now believed by the general public," she said.

A new study has found that drinking-related hypertension has a higher risk in flushers than in non-flushers, and the risk of hypertension was significantly increased when flushers consumed more than four drinks per week.

Excessive drinking is a known risk factor for hypertension. Drinking that results in facial flushing indicates high sensitivity or even intolerance to alcohol. A study of the relationship between drinking and these two conditions has found that drinking-related hypertension has a lower threshold value and higher risk in flushers than in non-flushers.

Results will be published in the April 2014 online-only issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

"Facial flushing after drinking is always considered as a symptom of high alcohol sensitivity or even intolerance to alcohol, unless a patient is taking special medicine," said Jong Sung Kim, head of the department of family medicine at Chungnam National University School of Medicine. "The facial flushing response to drinking usually occurs in a person who cannot genetically break down acetaldehyde, the first metabolite of alcohol."

"Facial flushing after alcohol drinking differs across gender, age, and ethnic groups," added Kyung Hwan Cho, president of the Korean Academy of Family Medicine. "In general, it is more common in women, the elderly, and East Asians versus Westerners."

Cho noted that it is well known that excessive alcohol consumption is associated with elevated blood pressure and the likely development of hypertension. "This association persists regardless of beverage type and shows a dose-response relationship, which means excess drinking for weeks or months can increase blood pressure," he said. "However, the relationship may vary by gender, race/ethnicity, or presence of other risk factors for cardiovascular disease. Conversely, many studies have reported that meaningful blood pressure reductions occur after reductions in alcohol drinking."

"To my knowledge," noted Kim, "there has been no detailed research that has analyzed the relationship between drinking and hypertension while considering individual responses to alcohol."

Kim and his colleagues collected data from the medical records of 1,763 men (288 non-drinkers, 527 flushing drinkers, 948 non-flushing drinkers) who had received a health check-up. The risk of hypertension related to the weekly drinking amount by non-flushers and flushers was analyzed and compared with the risk of hypertension among non-drinkers.

"Our results indicate that hypertension associated with drinking has a lower threshold value and higher risk in flushers than in non-flushers," said Kim. "After adjusting for age, body mass index, exercise status, and smoking status, the risk of hypertension was significantly increased when flushers consumed more than four drinks per week. In contrast, in non-flushers, the risk increased with consuming more than eight drinks per week".

Kim added that these results indicate that facial flushing after drinking may potentially serve as a marker of risk for hypertension associated with drinking. "Our research findings suggest that clinicians and researchers should, respectively, consider evaluating their patients flushing response to alcohol as well as drinking amount in a daily routine care, and researching hazard by drinking."

"Thus, if you or your patient have facial flushing, the risk of hypertension can increase even if you drink less than those who do not have facial flushing," said Cho. "[Under these circumstances, I would] recommend limiting your or their drinking amount even more to prevent the development of hypertension."