by

Charles A. Bertrand, M.D., FACP, DIM-CD (Ret.)
Associate Clinical Professor of Medicine at New York Medical College
and at the Medical University of South Carolina

ALCOHOL INTAKE AND STROKE

There are two previous articles on this web site that discuss alcohol. One, entitled, "Death in Russia," gives the dark side of alcoholism (such as suicide, homicide, accidents, etc.). It shows how life expectancy is affected by drinking too much. A second article, entitled "A Drink a Day Keeps the Doctor Away," indicates that one drink per day decreases the incidence of heart attacks. It does not completely insure you against having a heart attack, but it is one factor that helps somewhat to reduce the likelihood of having a heart attack.

Recently, on 1-06-99, another article was published regarding the protective effect of moderate alcohol consumption in preventing "ischemic stroke." This is an interesting article that originated at Columbia University College of Physicians and Surgeons and was published in the Journal of the American Medical Association (JAMA), Vol. 281, No. 1, pp. 53-60. A population in the northern Manhattan part of New York City was studied over a four year period of time. 677 persons had their first ischemic stroke and were matched to controls of 1,139 randomly selected individuals. The group studied included Caucasians, blacks and Hispanics.

One should define the term "ischemic stroke." That is a stroke due to deprivation of blood supply to the brain (example, blood clot), resulting in brain damage, and this occurs in about 80% of stroke patients. In the other 20% the mechanism is somewhat different in that it is due to hemorrhage - which also causes brain damage and may indeed cause the same clinical symptoms.

These symptoms are well described elsewhere and they consist of paralysis or weakness of an arm or leg and impairment of speech. These are the classic symptoms of a stroke, but there are many shades and variations that are more subtle. It is not the purpose of this presentation to discuss the symptoms but rather the relationship of alcohol consumption to strokes.

The key result from this study was that moderate alcohol consumption - that is, up to two drinks per day, was protective in reducing strokes. This protective effect was detected in both younger and older groups, in men and women, in whites, blacks and Hispanics. This study showed that the decreased risk encountered was confirmatory of the guidelines recently published by the National Stroke Association Stroke Prevention Group. Zeroing in on the precise amounts of alcohol, it was found that there was no particular difference whether it was liquor, wine or beer (12 ounces of beer, 5 ounces of wine, or 1.5 ounces of liquor equal one drink). Furthermore, those who drank more - such as seven drinks per day - had a very significantly increased risk of having a stroke. So this is not a case in which a little bit helps and a lot more helps even more - in fact, it's just the opposite. The more one drinks, the greater the problems that ensue and that is the bad news. In fact, if you do not drink, experts do not recommend starting. Older adults, particularly, are more vulnerable to the effects of alcohol because of the changes that occur in their systems. A given amount of alcohol is more potent for an older adult than in a younger person of comparable weight and height. In general, women are more sensitive to alcohol than men as they age because they produce less of the enzyme that breaks down alcohol. In addition, being of smaller stature in general, there may be less water in the body available to dilute the alcohol that is ingested. Therefore, it is suggested women have no more than one drink per day.

But of equal - and perhaps even greater - importance are the dangers of consuming too much alcohol. By this time these risks should be well known to the readers, but some of these factors may not be fully appreciated. The incidence of accidents goes up exponentially in persons who have consumed too much alcohol. Falls are not uncommon and fractures and other injuries may result. Drug interactions become common (even with over-the-counter medications such as aspirin or ibuprofen) and can cause considerable problems. The incidence of suicide, homicide, and violence of various forms can be in part triggered by excess drinking. Psychological disorders may occur - depression is not uncommon in subjects who drink too much. In fact, it is three times more likely to occur in those who have a drinking problem as well as in the elderly alcoholic. We know that cirrhosis of the liver may occur in patients with a chronic drinking problem. But, so too can pancreatitis and various types of cancer - cancer may occur with greater frequency in the liver, mouth, throat and esophagus. So, there are many problems associated with excess consumption of alcohol. Indeed, alcoholism is ranked as the second major cause of preventable death in the United States, surpassed only by cigarette smoking.

One can easily see the problems of too much alcohol - so what should we do? I think it is relatively straightforward. First, if you are not a drinker, do not begin. Secondly, if you take alcohol, restrict it to one drink per day. That is the safe way and it has moderate benefits as mentioned and with little risk. But, be wary of taking more than one drink per day.

This article is for general information purposes only. Readers with specific problems should see their doctor.




The advice provided on this website is intended to be general in nature and should not be relied upon for specific treatment. If you need personal medical attention please contact your physician.

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