Hi Alice,

I am a healthy, fit, 18 year old male. I have tried both ways: consuming small amounts of alcohol regularly (one standard drink a day) and consuming a lot of alcohol irregularly (10 to 20 standard drinks in one night, but only two days a month, or thereabouts).

I have tended towards drinking a lot irregularly because I have found that I can't notice any effects until I have had at least four or five drinks, 80 to 100 proof shots, usually mixed with soft drink.

I was wondering if either way was less healthy or more of a risk as the same amount of alcohol is ultimately consumed. Also, I noticed that I got a bit more of a 'beer gut' when I had one-a-day than 15 at once; is that likely or just my imagination?

Triple Shot

Dear Triple Shot,

To drink a little or a lot (and when), that is your question. Before delving into the details of healthy vs. unhealthy alcohol consumption, it may be wise to consider the psychological aspects of alcohol use. Alcohol can be a pleasant, life-enhancing libation; it can also be a misused, problematic substance. The amount of alcohol that is "unhealthy" may depend as much on the role it plays in your life as it does on physiological effects of alcohol or definitions of alcohol dependence. Have you thought about why you choose to drink alcohol? Do you use it to have a good time? To relax at the end of the day? Do you find it necessary to drink to be comfortable in certain situations? Do you find yourself not wanting to drink, but drinking anyway? Are you experiencing pressure to consume alcohol?

As for which drinking behavior is safer, many health care providers would agree that one daily drink falls on the healthier side of the spectrum, while multiple drinks, even irregularly, is headed toward less healthy and certainly more risky behavior. Higher-risk drinking can be defined as having five or more drinks in one sitting for men or four or more for women (on average, women are smaller than men and reach a higher blood alcohol content more quickly, hence the differing standard). However, moderate drinking may not pose a health problem — in fact, some studies have found health benefits in having one drink daily (wine is the most common drink studied), though not all types of alcoholic beverages provide these benefits. Remember, a standard drink is one twelve ounce beer, one five ounce glass of wine, or one 1.5 ounce shot of 80 proof distilled spirits.

Higher-risk drinking strains the body because the liver can only process a certain amount of alcohol per hour. Chronic or prolonged higher-risk drinking can lead to pancreatitis, various cancers, liver cirrhosis, high blood pressure, heart failure, and other disorders. Even on a single occasion, higher-risk drinking can be detrimental to your health or even life-threatening. For example, alcohol intoxication doubles the risk of heart arrhythmias, particularly atrial fibrillation, which can lead to heart failure and sudden death, even in those who have healthy hearts. Indeed, one quarter of sudden cardiac-related deaths in young men are due to alcohol consumption. You may also want keep in mind the other potential negative consequences of drinking a lot at once (legal troubles, injuries, deciding to have unprotected sex, etc.).

If you have any concerns about your drinking behavior, you can speak with your health care provider, a friend, or another person you trust.

Oh, and by the way, the research isn't definitive, but there is a study that suggests that drinking and a big gut are not related. On the other hand, as with any food or beverage, excessive calorie consumption (alcoholic beverages can be fairly calorie dense) can lead to weight gain. If you're concerned about your weight, and think that limiting alcohol might help you bust a developing "beer gut," then why not try it?

Ultimately, choices about drinking alcohol are up to you, but it's often worth considering why you've decided to drink (or not to drink). Cheers!


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