Alcohol Fights Fat (in moderation)

Alcohol consumption, weight gain, and risk of becoming overweight in middle-aged and older women. Wang L, Lee IM, Manson JE, Buring JE, Sesso HD. Arch Intern Med. 2010 Mar 8;170(5):453-61. [FREE FULL TEXT]

The obesity epidemic is a major health problem in the United States. Alcohol consumption is a source of energy intake that may contribute to body weight gain and development of obesity. However, previous studies of this relationship have been limited, with inconsistent results.

We conducted a prospective cohort study among 19 220 US women aged 38.9 years or older who were free of cardiovascular disease, cancer, and diabetes mellitus and had a baseline body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) within the normal range of 18.5 to less than 25. Alcoholic beverage consumption was reported on a baseline questionnaire. Body weight was self-reported on baseline and 8 annual follow-up questionnaires.

There was an inverse association between amount of alcohol consumed at baseline and weight gained during 12.9 years of follow-up. A total of 7942 (41.3%) initially normal-weight women became overweight or obese (BMI > or =25) and 732 (3.8%) became obese (BMI > or =30). After adjusting for age, baseline BMI, smoking status, nonalcohol energy intake, physical activity level, and other lifestyle and dietary factors, the relative risks of becoming overweight or obese across total alcohol intake of 0, more than 0 to less than 5, 5 to less than 15, 15 to less than 30, and 30 g/d or more were 1.00, 0.96, 0.86, 0.70, and 0.73, respectively (P( )for trend( )<.001). The corresponding relative risks of becoming obese were 1.00, 0.75, 0.43, 0.39, and 0.29 (P( )for trend( )<.001). The associations were similar by subgroups of age, smoking status, physical activity level, and baseline BMI.

Compared with nondrinkers, initially normal-weight women who consumed a light to moderate amount of alcohol gained less weight and had a lower risk of becoming overweight and/or obese during 12.9 years of follow-up.

My comments:

I’ve been aware of the health benefits of moderate daily alcohol consumption since college when I first read about the French paradox. At the time, I was eating 5000 calories a day to gain weight for weightlifting and wanted to make sure I didn’t have a coronary. During that time, they thought the tannins,or anti-oxidents, in the red wine was responsible for the cardio-protective effects and I went from being a teetotaler to a wine drinker. Over the years it was found that it’s the alcohol itself that improved lipid profiles, and  because of this I added a greater variety of drinks to my dinner.

I was having a conversation with someone about the health effects of alcohol and she said what about weight loss? I told them that moderate drinking was about health, not weight loss.  Still it made me wonder, so I did a pubmed search, and while I wasn’t able to find anything regarding short term weight loss, I did find a number of studies describing the prevention of weight gain over the years. So because of these findings, one might consider that ‘relative’ weight loss.

What I thought was most interesting about the above study was they not only found alcohol helped lessen weight gain and lower the risk of obesity, but they also quantified it by amount and to a lesser extent type of alcohol. Looking at all the graphs and tables in the study it was a bit of a toss up as to what amount was better, 15-30 grams per day or >30 grams per day, but those amounts were considerably better than lesser amounts and none. If it were me, I would split the difference and aim right at 30 grams per day, as less is maybe not as good, as my recollection was that research found the health consequences (like cirrhosis) start to increase as drinking becomes more than moderate. Still the general recommendation has always been 1 drink per day for women and 2 per day for men as being most healthful, but I do see the amounts creeping higher in more recent papers. So, if the standard drink in the US is 14 grams of alcohol, and that’s a standard 12 oz beer, 5 oz of wine or a 1.5 oz shot, it looks like the sweet spot for women is closer to 2 drinks per day than just one. [8-21-15 edit, that for health 1 drink per day for women, and 1-2 for men still looks ideal]

Also, the red wine seems slightly better per the human studies.  In this review, I saw it cited that rats gain less weight on red wine, however when I looked up the cited study, on the contrary to how it was cited the rats that drank regular ethanol gained slightly less weight than the ones that drank the red wine and the ethanol drinking rats had greater fat cell aromatase expression than the red wine rats, which was thought to be the primary mechanism of action, and kind of sinking the superiority of the red wine concept. It’s a good lesson to see that you can’t always trust what’s written in a review, and you can’t always trust abstracts either.

It seems to me that red wine growers have a more powerful political lobby than white wine, beer, and spirits, and it’s my suspicion that as things might play out much the same regarding the effects of alcohol on fat cells. This paper tended to show red wine was maybe ever so slightly better, but not by much, and the differences weren’t significant. A lot of people ‘seem’ to think that red wine works better, even if it doesn’t. Whenever I talk about the health effects of moderate alcohol consumption, even with evidence now being pretty overwhelming, people still look at me funny. If I say “red wine” and they are all like, “of course red wine is good for you.”  I think the meme that red wine is healthy is well established, while alcohol being healthy isn’t yet, such that if there are any real differences in health or weight gain by type of alcohol, it might be that those drinking red wine are generally more health conscious, in comparison to beer or whisky drinkers. However, wine has less calories than most beers and mixed drinks, but straight shots still have less. I suspect you don’t have to drink, as per the French paradox, with your pinky sticking out. Still, ~30 grams of alcohol, or ~2 drinks per day looks best for the prevention of obesity, at least per this paper.

As always, if you have any further questions or need for clarifications, please don’t hesitate to ask. Being aware that some of my blog ideas are contentious and occasionally a bit out of the field of my expertise, I encourage my readers to come forth with any questions/comments that are of interest or concern. Your comments are valued and welcomed.

Chad Reilly is a licensed physical therapist, located in North Phoenix, practicing science based medicine with treatment protocols unique and effective enough to proudly serve patients from Phoenix, Scottsdale, Mesa, Chandler, Tempe, Peoria, and Glendale.

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