Is "moderation" the same for older people?
The definition of moderate changes as you get older. Most experts think that after 65, moderation means half a drink a day for a woman, one drink for a man. If you're over 65, you probably can't hold your alcohol as well as you used to. That's because your body doesn't process alcohol as well, so you end up with a higher BAC than a younger person would. And you feel the effects more from a given BAC. Alcohol is doubly risky for hip fractures, too: not only does excessive drinking decrease bone density, it also increases the risk of falls in older people. Alcohol can interfere with many medications older people take, as well as increase age-related driving risks.
What about breast cancer?
The American Cancer Society lists alcohol as a risk factor for breast cancer, but most of the evidence concerns heavy drinking. Studies have yielded conflicting results about light to moderate drinking. Should a woman have a drink a day to ward off heart disease and forget about the possible breast cancer risk? Nobody should start drinking to protect the heart. But if you already have a drink a day, there's no health reason to quit.
Why does the American Cancer Society recommend restricting alcohol or abstaining?
Because even a moderate intake may increase the risk of cancers of the mouth, esophagus, liver, bladder, pancreas and colon—besides the concern about breast cancer.
Wouldn't it be okay for a pregnant or nursing woman to drink just a small amount?
If you are pregnant, trying to conceive or nursing, you should abstain. Alcohol harms the fetus and the nursing infant and is a leading cause of birth defects and mental retardation. No one has been able to determine if any level of intake—even one drink now and then—is safe.
Who, besides pregnant women, should steer clear of alcohol?
Anyone who is unable to drink moderately. This includes recovering alcoholics and possibly those with a strong family history of alcoholism.
Anyone taking sedatives, sleeping pills, antidepressants or anticonvulsants should get medical advice about whether these drugs can be safely combined with alcohol. Alcohol can interact with many other medications, too, including over-the-counter pain relievers. When you get a new prescription, ask whether it's okay to drink. With nonprescription medication, read the label carefully and abstain if necessary.
Don't drink if you are planning to drive or operate machinery within the next few hours. If you have had a drink, don't get behind the wheel.
Don't drink if you have uncontrolled hypertension, high blood levels of triglycerides, abnormal heart rhythms, peptic ulcers or sleep apnea. If diagnosed with any disorder, talk to your doctor about the advisability of drinking.
What are other risks of heavy drinking?
Heavy drinking increases the risk of liver disease, damage to the brain and pancreas and hemorrhagic stroke. It can damage heart muscle. It increases the risk of falls, injuries, car crashes (often involving pedestrians who have been drinking), workplace injuries, firearms injuries, homicides and suicides. It contributes to domestic violence and child abuse.
Should anybody start drinking for heart benefits?
Few doctors think so, particularly since much is left to learn and alcohol is so risky. If you don't drink, for whatever reason, don't feel pressured to start. There are better ways to prevent heart disease: following a heart-healthy diet, exercising regularly and vigorously, not smoking, keeping your blood pressure under control and losing weight if need be.
On medical advice, you may also want to take low-dose aspirin and, if necessary, a cholesterol-lowering drug. If you already drink moderately, you are probably getting some additional benefit. But do consider your age, sex and family history. Remember that "moderation" for a woman means no more than one drink a day, on average, two drinks for a man. And that if you are past 65, you should probably cut that amount in half.