Archive for September, 2011

Drinking Pattern Linked to Alcohol’s Effect on Heart Health

For the first time, new research shows that patterns of alcohol consumption – a drink or two every night, or several cocktails on Friday and Saturday nights only – may be more important in determining alcohol’s influence on heart health than the total amount consumed.

In the journal Atherosclerosis, scientists found that daily moderate drinking – the equivalent of two drinks per day, seven days a week – decreased atherosclerosis in mice, while binge drinking – the equivalent of seven drinks a day, two days a week – increased development of the disease. Atherosclerosis, or the hardening and narrowing of arteries, is a serious condition that can lead to a heart attack or stroke.

Binge Drinking and Vascular Disease

While population studies support an association between alcohol and cardiovascular disease, they’ve relied on self-reported data, which is not always accurate or reliable. According to study authors, this is the first study to provide concrete evidence linking drinking patterns to the development of vascular disease, and the nearly 15 percent of Americans who binge drink – as estimated by the Centers for Disease Control and Prevention – should take note.

“People need to consider not only how much alcohol they drink, but the way in which they are drinking it,” said lead study author John Cullen, Ph.D., research associate professor in the Department of Surgery at the University of Rochester Medical Center. “Research shows that people have yet to be convinced of the dangers of binge drinking to their health; we’re hoping our work changes that.”

Scientists don’t yet understand how moderate alcohol consumption benefits cardiovascular health or how heavy drinking episodes hurt it.

A Standard Drink

The National Institute on Alcohol Abuse and Alcoholism defines binge or “at-risk” drinking as consuming more than four drinks on any day for men, and more than three drinks on any day for women. Understanding how much alcohol is in a “standard” drink is also critical, something the institute is promoting through its new “Rethinking Drinking” campaign.

Health care professionals also need to be aware that drinking style matters and should address the issue when discussing alcohol consumption with patients, especially those who are at higher risk of atherosclerosis or who have suffered a heart attack in the past, added Cullen.

“This evidence is very interesting because it supports a pattern of drinking that is emerging in clinical studies as both safe and seemingly most protective against heart disease – frequent consumption of limited amounts of alcohol. This certainly backs up widespread clinical guidelines that limit drinking to one drink daily for non-pregnant women and two drinks daily for men,” said Kenneth Mukamal, M.D., M.P.H., Associate Professor of Medicine at Harvard Medical School who studies the role of dietary and lifestyle factors, particularly alcohol consumption, on the incidence of cardiovascular and neurovascular disease.

Mice on High-Fat Diet

In the study, mice in the “daily-moderate” group were fed ethanol equivalent to two drinks every day of the week, mice in the “weekend-binge” group were fed approximately seven drinks on two days of the week and mice in the control group were fed a non-alcoholic cornstarch mix. All mice were put on an atherogenic diet, which Cullen equates to a high-fat Western diet – think fried food every day – to encourage the development of atherosclerosis, which forms when fatty deposits or plaque collect on the inner walls of the arteries, causing them to narrow.

Levels of LDL or “bad” cholesterol plummeted 40 percent in the daily-moderate drinking mice, but rose 20 percent in the weekend-binge drinking mice, compared to the no-alcohol controls. High levels of bad cholesterol increase the risk of heart disease, and past studies show that every 10 percent increase in LDL results in a 20 percent increase in atherosclerosis risk.

Surprisingly, levels of HDL or “good” cholesterol went up in both the moderate and binge drinking groups, which Cullen speculates is an acute or short-term effect.

Narrowing of the Arteries

The volume of plaque, as well as the accumulation of immune cells that promote inflammation and consequently contribute to the narrowing of arteries, decreased in the moderate mice compared to no-alcohol mice. The opposite occured in the binge-drinking mice: Plaque volume and the number of inflammatory immune cells grew.

Another unexpected yet noteworthy finding was that the binge drinking mice gained significantly more weight than the moderate and control mice. Though all mice started at approximately the same weight and consumed similar amounts of food over the course of the study, the binge mice gained more than three times as much weight as the moderate mice and about twice as much weight as the control mice.

Building on this study, Cullen is investigating genes that are turned on or off following moderate and binge drinking episodes to determine if they influence outcomes.

Binge Drinker Have Increased Risk

The research was supported in part by the Founders Affiliate of the American Heart Association, which supports research exploring new ideas to combat cardiovascular disease. Founders Affiliate research committee chair Lucy Liaw, Ph.D. said these first-time findings could have far-reaching public health implications. “The discoveries of Dr. Cullen’s group show that binge drinkers may have increased risk of developing atherosclerosis and experiencing weight gain. Because obesity is also a risk factor for disease, binge drinking may have a strong negative impact on cardiovascular health,” said Liaw, who is also a member of the AHA national research committee.

The study was also funded by the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health. In addition to Cullen, Weimin Liu, M.D., Ph.D., Eileen Redmond, Ph.D. and David Morrow, Ph.D. from the Medical Center contributed to the research.

September 8th, 2011  in Alcohol No Comments »

Decrease in smoking reduces death rates within months

A study by the University of Liverpool has found that a decrease in smoking rapidly reduces mortality rates in individuals and entire populations within six months.

Research by Professor Simon Capewell and Dr Martin O’Flaherty at the Institute of Psychology, Health and Well-being, examined evidence from clinical trials and natural experiments. They found that a reduction in smoking has a positive impact on mortality rates in both individuals and populations within six months. Likewise, dietary improvements get very positive results within one to three years.

Benefits Happen Quickly

Professor Capewell said:”Our research found that smoking bans and diet improvements powerfully and rapidly reduce chronic disease in both individuals and in the wider population. This actually happens quickly, within a far shorter timescale than had previously been assumed; within months and years rather than decades. This discovery means that policies such as smoking bans or reducing saturated fats are effective at improving health and would save the NHS millions very rapidly.”

The study found that policies that reduce smoking consistently have a rapidly positive effect on mortality rates and hospital admissions in countries and communities around the world. After smoke-free legislation was introduced in Scotland in 2006, hospital admissions for acute coronary syndrome decreased by 17% with a 6% decrease in out-of-hospital cardiac deaths.

Similarly, when smoke-free legislation was introduced in Helena, an isolated community in the US, it resulted in a 40% drop in admission rates for acute coronary syndrome within six months in one hospital. When the law was repealed the coronary admissions returned to previous levels within six months.

Diet Changes Help Too

Changes to diet also have a rapid and positive impact on the reduction of mortality rates for coronary heart disease. Coronary death rates rose steadily during the 20th Century, peaking in the 1970s in the UK, US and Western Europe. However, closer scrutiny of national trends revealed a notch in the early 1940s. This has been attributed to sudden decreases in dietary meat and animal fats due to food rationing during the Second World War.

More recently, a study of coronary disease in Poland found that death rates from heart disease had been rising steadily. From 1990, however, they quickly dropped by 25% after meat and animal fat subsidies from the communist countries ceased and cheap vegetable oils and fruit flooded the market. A study of other central European countries confirmed very similar trends.

September 6th, 2011  in Tobacco No Comments »

Heavy drinkers have poor dietary habits

Excessive drinking and an unbalanced diet are two preventable contributors to health problems in the developed world. Different studies have found varying linkages between amounts of alcohol consumed and quality of diet. A new study of adults in Spain has found that heavy drinking, binge drinking, a preference for spirits, and drinking alcohol at mealtimes were associated with a poor adherence to major food consumption guidelines.

Results will be published in the November 2011 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

“Drinking alcohol may reduce maintaining a healthy diet, leading to adverse metabolic effects which in turn add to those directly produced by alcohol,” said José Lorenzo Valencia-Martín, a doctor at the Universidad Autónoma de Madrid and corresponding author for the study. “The specific influence of alcohol on diet may depend upon the overall quantity of alcohol ingested, frequency of consumption, beverage preference, and whether alcohol intake takes place during the meals. Alcohol may indirectly contribute to several chronic diseases such as obesity, diabetes mellitus, cardiovascular disease, or cancer.”

Careless Dietary Habits

“Unhealthy lifestyles tend to cluster together, but this is not a ‘necessary’ association,” added Miguel A. Martínez-González, chair of the department of preventive medicine and Public Health at the University of Navarra. “On average, people who drink excessive alcohol are more likely to be careless in their dietary habits. A high alcohol intake is especially unhealthy with respect to liver disease. A high-energy food pattern rich in trans fats – such as ‘fast-foods’ or items from a commercial bakery – is also likely to be related to liver disease. In this sense, if both unhealthy lifestyles cluster together, they can act synergistically to produce very adverse effects.”

“In Spain, alcohol is frequently drunk during meals, particularly lunch and dinner,” said Valencia-Martín. “Because of this, and the lower prevalence of abstainers, our findings apply to most adults in Spain and in other Mediterranean countries in Europe. Our results are of relevance because they show that drinking at mealtimes is associated with insufficient intake of healthy foods, such as fruits and vegetables, and with excessive intake of animal protein.”

Unintended Consequences

From 2000 to 2005, the researchers carried out a telephone survey of 12,037 adults (5850 men, 6187 women) considered representative of 18-to-64-year-olds in the region of Madrid. Binge drinking was defined as equal to or more than 80 grams of alcohol for men and equal to or more than 60 grams for women during one drinking session; the threshold between moderate and heavy drinking was 40 grams of alcohol per day for men and 24 grams per day for women. Food consumption was measured using a 24-hour recall.

“Excessive drinkers, either with or without binge drinking, showed a poor adherence to dietary recommendations,” said Valencia-Martín. “Although drinking at mealtimes has traditionally been considered a safe or even a healthy behavior, our results point to some unintended consequences that the general populations should be aware of. In particular, drinking at mealtimes is associated with poor adherence to most of the food consumption guidelines. Also, not all types of alcoholic beverages are equal with regard to their dietary effects; our results suggest that a preference for spirits is associated with a poorer diet. Lastly, the above implications apply to both men and women.”

“I believe the key finding of this study is the suggestion of a harmful effect of binge drinking on healthy eating habits,” said Martínez González. “Binge drinking prevalence was found to be relatively high – greater than 10 percent – in a representative sample of Spanish population. This is very bad news. Alcohol misuse has become a priority public-health problem in Spain, especially because of rising rates of binge drinking and especially because of the abandonment of the traditional Mediterranean pattern of moderate alcohol drinking, in little amounts, generally red wine during meals. Recent changes, especially among young Spanish people, include a pattern of high amounts of spirits during weekends. This excellent study adds another unfortunate consequence of this change: the impairment of eating habits.”

Alcohol Replaces Healthy Calories

Martínez González added that both alcohol researchers and clinicians need to pay more attention to the dietary pattern of binge drinkers, and also consider that some of the detrimental effects attributed to alcohol might in fact be consequences of a poor diet.

“Don’t forget that alcohol is addictive, that it replaces healthy calories from other foods by empty calories, meaning these calories are devoid of minerals and vitamins,” said Martínez González. “Keep also in mind that the drinking pattern might be more important than the total amount consumed. The unhealthiest pattern is to consume high amounts – three to four drinks per day – of spirits or beer exclusively during the weekends. Conversely, the healthiest use of alcohol may be red wine, no more than one glass per day for women and two per day for men, and consumed during meals in a regular daily pattern.”

September 4th, 2011  in Alcoholism No Comments »

Alcohol interferes with the restorative functions of sleep

Large amounts of alcohol are known to shorten sleep latency, increase slow-wave sleep, and suppress rapid eye movement (REM) during the first half of sleep. During the second half of sleep, REM increases and sleep becomes shallower. A study of the acute effects of alcohol on the relationship between sleep and heart rate variability (HRV) during sleep has found that alcohol interferes with the restorative functions of sleep.

Results will be published in the November 2011 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

Alcohol affects overall sleep architecture,” said Yohei Sagawa, a medical doctor in the department of neuropsychiatry at the Akita University School of Medicine. “Normally, during physiologic nocturnal sleep in humans, the parasympathetic nervous system, responsible for ‘rest-and-digest’ activities, is dominant over the sympathetic nervous system, responsible for stimulating activities. We wanted to investigate how alcohol may change this complementary relationship.”

Unique Sleep-Alcohol Study

“I believe that the approach used in this study is unique,” added Seiji Nishino, director of the Sleep & Circadian Neurobiology Laboratory at Stanford University School of Medicine. “Although there are several studies monitoring HRV during sleep, as far as I know there is no report describing the effects of alcohol on autonomic nervous system during sleep using this parameter.”

Sagawa and his colleagues gave 10 healthy, male university students with a mean age of 21.6 years three different alcohol beverages at three week intervals: 0g (control), 0.5g (low dose), or 1.0g (high dose) of pure ethanol/kg of body weight. On the day of the experiment, a Holter electrocardiogram was attached to the subject for a 24-hour period; the subject was instructed to drink one of the three alcoholic beverages 100 minutes before going to bed; and polysomnography was then performed for eight hours. Power spectral analysis of the HRV was performed using the maximum entropy method, and the low- and high-frequency components along with their ratios were calculated.

“Our study showed that alcohol suppresses the high-frequency power during sleep in a dosage-dependent manner,” said Sagawa. “Although the first half of sleep after alcohol intake looks good on the EEG, the result of the assessment regarding the autonomic nerve system shows that drinking leads to insomnia rather than good sleep.”

Heart Rate Increase

More specifically, as alcohol consumption increased, the heart rate increased and the spectral power of HRV measured at each frequency range decreased. Also, the low-frequency/high-frequency ratio that is considered an index of the balance between the sympathetic and parasympathetic systems was increased. This suggests that alcohol, in a dosage-dependent manner, suppresses the high-frequency component of HRV that is an indicator of parasympathetic nerve activity during sleep.

“The current study evaluates the acute effects after only a single dose of alcohol intake, and subsequently found a negative health consequence,” observed Nishino. “Many subjects habitually drink alcohol, and if the reduction of parasympathetic nerve activity during sleep chronically occurred, negative health consequences may be much larger and may induce various diseases. It is reported that habitual drinkers with hypertension are often associated with reductions of parasympathetic nerve activities.”

Many Alcoholics Have Insomnia

Sagawa agreed. “Many alcoholics and habitual drinkers suffer from insomnia,” he said. “Suppressed parasympathetic nerve activity is the result of alcohol drinking. Thus, it is inferred that suppressed parasympathetic nerve activity is associated with insomnia, which includes difficulty getting to sleep, early-morning awakening, lack of a sense of deep sleep, and difficulty maintaining sleep.”

“It is generally believed that having a nightcap may aid sleep, especially sleep initiation,” said Nishino. “This may be true for some people who have small amounts of alcohol intake. However, it should be noted that large amounts of alcohol intake interfere with sleep quality and the restorative role of sleep and these negative consequences may be much larger during chronic alcohol intake.”

Sagawa added that it is important for clinicians who are treating physical and psychological disorders related to alcohol to consider the disturbing effects on sleep’s restorative effects that habitual drinking can have.

September 4th, 2011  in Alcohol No Comments »