No Mention of Fetal Alcohol Risk

Toasting the new year with an alcoholic beverage is probably good for your health -- if you're a man. If you're a woman, the impact of that glass of alcohol is far more confusing.

Overall, science shows that for both men and women, drinking a small amount of alcohol each day is better for you than never drinking at all, and it likely lowers your risk of heart attack, diabetes and mental decline. But for women, moderate alcohol consumption also carries risks you may not know about.

Even small amounts of alcohol consumption are linked with higher risk for breast cancer. Women who drive after drinking are at higher risk than men of dying in a car accident, even at similar blood-alcohol concentrations. And women are at higher risk than men for serious health problems related to alcohol abuse, including liver, brain and heart damage.

The reasons alcohol appears to affect men and women so differently are complex. Women achieve higher concentrations of alcohol in the blood and become more impaired than men after drinking equivalent amounts of alcohol, even when taking into account differences in height and weight. This is likely due to the fact that a woman's stomach empties more slowly than a man's, giving the body more time to absorb the same amount of alcohol, many doctors say.

Lab studies suggest there may be gender differences in how alcohol affects the response to visual cues and other tasks related to driving performance, which may explain why it's more risky for a woman to drink and drive. And alcohol also may alter a woman's natural estrogen levels, which can influence her risk for a number of health concerns.

One of the most troubling effects of alcohol is that even small amounts increase a woman's risk for breast cancer. A pooled analysis by Harvard researchers of all the data on alcohol and breast cancer shows that a woman's risk increases by about 9% for every 10 grams of alcohol a day that she drinks. In the U.S., the typical serving of 12 ounces of beer, 5 ounces of wine or 1.5 ounces of liquor delivers about 12 grams to 14 grams of alcohol, according to the Harvard School of Public Health.

That means a woman who consumes just two drinks a day has about a 27% higher risk of getting breast cancer than a woman who doesn't drink alcohol.

It's worth noting that the absolute risk of alcohol consumption to an individual woman is slight. Consider that the typical 50-year-old woman has a five-year breast-cancer risk of about 2.1% -- so two drinks a day would boost her risk to only about 2.7%.

"It's not a huge difference to an individual woman, but it could translate into many thousands of breast cancers in a year that would not have otherwise occurred," says Walter Willett, epidemiology and nutrition professor at the Harvard School for Public Health. The alcohol-health equation "is definitely more complicated in women because of the relationship with breast cancer," says Dr. Willett.

Read Tara Parker-Pope's Health Mailbox2 where she answers readers' questions about medical studies, ailments and treatments.For many women, similar risks from other choices have proved unacceptable. For instance, recent studies have shown a woman's risk of breast cancer increases 9% to 24% if she uses the menopause hormones estrogen and progestin, a concern that has prompted millions of women to abandon hormone treatments for menopause.

Exactly why alcohol consumption alters a woman's breast-cancer risk isn't entirely clear. Several studies have shown that alcohol can raise a woman's natural estrogen levels, and high natural estrogen is linked with higher breast-cancer risk. Alcohol may enhance the negative effects of natural estrogen on the breast.

While the breast-cancer risk sounds scary, it has to be weighed against other health benefits of alcohol. Women who consume about one drink a day have a 40% lower risk for heart attack, and a 70% lower risk of stroke. In the well-known Nurses Health Study, which now follows more than 120,000 women, those with diabetes who drank at least a half-serving of alcohol a day had a 52% lower risk for heart attack than nondrinkers.

Studies also show that moderate alcohol use might protect against osteoporosis, a serious health problem that leads to brittle bones and risky fractures and affects far more women than men. Women who drink six to seven servings of alcohol a week typically have higher bone density than nondrinkers. The higher bone density is likely explained by the estrogen-enhancing effects of alcohol, doctors say.

As a result, women need to take into account family history and personal concerns. A woman with a strong family history of breast cancer or someone with a family history of alcoholism might decide to forgo alcohol altogether. But someone without those added risk factors who is worried about heart attack, diabetes or osteoporosis might consider drinking small amounts of alcohol daily.

While there's disagreement about whether any level of alcohol is good for a woman, most authorities agree that women should limit themselves to one-half to one drink a day to get the maximum health benefits of drinking and minimize the risks. For men, the maximum health benefit comes with one to two drinks a day.

And women who do choose to drink should also take a multivitamin that contains folic acid. Recent studies show folic acid seems to blunt the harmful effects of alcohol on the breast and lowers risk of breast cancer to near that of a woman who doesn't drink alcohol.

"It's all about deciding what's best for you as an individual," says Sherry Marts, vice president for scientific affairs for the Society for Women's Health Research in Washington. "For women, whether to drink alcohol is another one of those risk-benefit decisions we make every day."

Dear Ms. Parker-Pope, While I enjoyed your article about drinking and women, I was extraordinarily disappointed to see no mention about the risks of Fetal Alcohol Spectrum Disorder from women drinking. Perhaps some interpret a stigma or discrimination to write about drinking during pregnancy, but FASD is surely a more immediate and certain risk to mothers and their fetus's than are the longer term abstract risks of breast cancer and driving. A newly released Canadian study has determined (medically) that a stunning 37% of the newborn babies studied had been exposed to binge drinking. Any notion that FAS/D is "old news" is belied by the fact that doctors continue to recommend "a drink a day" to their expectant-mother patients.

It would be great to see the WSJ run an in-depth update on the tragedy and costs to society of the completely preventable FASD.

There is another hidden risk that was not addressed, and the consequences are anything but invisible. That is the risk of drinking during pregnancy.

It is known that even light drinking during pregnancy can pose a risk to the developing baby's brain, the consequences of which may not show up until school years with learning disorders and behavior problems. The risks of drinking during pregnancy are not hidden, they are right there - in the detention hall, in prison, on the street corners, in the mental institutions, on the front page of your newspaper. What is hidden is the awareness about the dangers of drinking during pregnancy.

The next time you cover a story on the dangers of alcohol, be sure to include the risk of alcohol during pregnancy. Do your homework. Read Bonnie Buxton's book Damaged Angels, she has done all the research for you. www.damagedangels.com.