and......alcohol

Everyone wants to know the 'best' alcohol for weight loss and for health.

In fact, epidemiological studies seem to show that people who have a daily alcoholic drink (beer, wine or spirit) per day do accrue some health benefits.

Figure 1: An elderly Sardinian hand harvests some purple grapes for the village wine. These grapes have some of the highest content of polyphenols that can be found anywhere and is partly attributed to the health benefits of wine from this part of the world.

Figure 1: An elderly Sardinian hand harvests some purple grapes for the village wine. These grapes have some of the highest content of polyphenols that can be found anywhere and is partly attributed to the health benefits of wine from this part of the world.

Apparently, regular, moderate red wine consumption is linked with a reduced risk of cardiovascular disease and all cause mortality (the chances of dying from anything)1. It is proposed that the artery scrubbing 'polyphenols' found in these wines, most notably procyanidins, particularly those produced in Southwest France and Sardinia help prevent atherosclerosis. These people also tend to live longer with Sardinia widely known as one of Buettners (2012) Blue Zones (highest rates of centenarians)2. In fact, all the pockets around the world where people live the longest have a strong connection with daily alcohol, from red wine in Sardinia to Sake (rice wine) in Okinawa - Japan.

Figure 2: Japanese Sake, white rice wine.

Figure 2: Japanese Sake, white rice wine.

Alcohol for the large part however is identified by the body as a toxin and has several metabolic pathways for getting rid of it - discussed in great detail here. 3

Alcohol in large amounts can be extremely toxic to the brain, liver and other organs. In this scenario any health benefits are significatly outweighed by the risks. Moderation seems to be key again here as there is much more of a cultural and societal attachement to the glass of wine in Sardinia or Okinawa. These people would tend to come together in their villages after a physical day of manual labour and unwind with wine, a good belly laugh and relax with frineds. As a side note, the manual labour they were doing was often harvesting the grapes to make the wine for their community, connection with food anyone??! Could it be that the positive context of the wine (pyscho-social) holds greater weight in its health benefits than the biological balancing act?? (artery scrubbing polyphenol benefits versus toxic overdose).

Theres drink for thought.

Figure 3: Not being a wine connoisseur myself, I trust some of the most artery scrubbing wines come from Sardinia and nearby regions. Apparently they taste great too :)

Figure 3: Not being a wine connoisseur myself, I trust some of the most artery scrubbing wines come from Sardinia and nearby regions. Apparently they taste great too :)


Many of my readers however will not be so interested in the health implications of alcohol as they are their waist line. What follows is a little literature on the topic. :)

USEFUL FACT

Whether or not an alcoholic beverage is going to be fattening or not depends on much more than just the content of the actual drink (reductionism again). The main consideration appears to be whether they are consumed as part of a net caloric surplus or deficit. Given the context of a sustained calorific deficit (a diet), it is literally impossible for anything in the diet - including alcoholic drinks - to contribute to fat gain.4

Per gram, alcohol contains 7 calories of energy. Compare this to our other macronutrients

  • 1g Protein = 4 Kcal
  • 1g Carbohydrate = 4Kcal
  • 1g Alcohol = 7kcal
  • 1g Fat = 9kcal

The relationship between alcohol and net energy balance, as predicted has several factors that fuzz a nice straight forward picture.

The extent to which a nutrient 'costs' to actually break it down and metabolize it is referred to as the thermic effect of food [TEF] and was written about here. The TEF of protein is 25-30%. The higher the TEF, the greater the metabolic cost, or energy expended in simply breaking down the food. When we recall that the TEF of carbohydrates is 6-8% and fats come in at 2-3% it reminds us one of the major reasons increasing protein intake can benefit fat loss - we increase our basal metabolic rate / metabolism. Cue spanner in the works. 

Alcohol has been found to have a TEF almost as high as protein, 22.5% according to Suter et al5, begging the question; does calories from alcohol, simply dissapear??

Wouldn't that be a nice headline - "Alcohol found to have NO detrimental calories!". I would certainly read it with optimism. 

Alcohol found to have NO detrimental calories!

Back to reality. What implications can this really have. Whilst protein and alcohol appear to have a similar TEF, alcohol has not been found to be as satiating (filling) in the same way as protein. What most studies show is that when alcohol is consumed either before, or during meals, we eat more6, although this is debatable.

Observational research has collectively shown that drinking alcohol in moderation is not linked to long term weight gain7, whereas, rather logically, heavy drinking is4.

Aragon (2016) discusses how observational research is useful for seeing trends, but cannot tell us anything about causation. Randomised controlled trials (RCTs) are our best method to tease out if X causes Y (alcohol causes obesity) or simply X happens with Y (obese people tend to drink more).  

Aragon cites a classic study by Crouse and Grundy8:

In this study the authors confined 12 subjects to a metabolic ward for 4 weeks, tightly controlling energy intake. Despite adding 630 kcal of alcohol per day to maintenance levels, 8 of the 12 subjects lost weight (a range of 0.1 to 2.6kg) with the other 4 gaining weight (0.2 to 1.8kg). The authors speculated that the weight loss could be due to a decreased absorption of other energy nutrients or due to alcohol induced diuresis (water loss), this may have been a transient observation had the trial ran longer than 4 weeks.

Some studies have actually shown similar findings over longer durations. For example a 12 week diet was supplemented with 10% extra calories from either grape juice or white wine with no significant differences found in body composition9. I mentioned earlier that it was debatable as to whether adding red wine to dinner consistently predicted weight gain because that is exactly what Cordain et al.10 noticed over a 6 week trial. Here, they added two glasses of red wine to dinner (270ml total, 13% alcohol) and found no differences in bodyweight or fat (although this study was not without limitations, their diet was self-reported, notoriously inaccurate)

Regardless, one theme that runs through all of these studies is that the alcohol studied is moderate in size. These experimental studies shed some scientific support to the observational behaviour of our longest living people, wine is central to their daily routine. 

Figure 4: As little as 500ml of beer / lager per day is positively associated with weight gain.

Beer, or lager on the other hand is not consumed by these people in observational studies and experimental findings are also condemning. A systematic review in 201311 found as little as 500ml per day (less than 1 pint - 568ml) is positively associated with weight gain. There is a sparcity of research into alcohol beverages other than beer or wine. Strong conclusions therfore cannot be drawn about your favourate spirit.


CLOSING THOUGHTS

There is not much support for regular beer consumption with the commonly used term 'beer-belly' reflecting the evidence. Alcohol is consumed, in moderation the world over in some of the healthiest, longest living people. While there might be some physiological benefit in drinking wine in the form of artery scrubbing polyphenols, it seems that the health benefits could be superimposed over the fact that drinking the wine brings people together where they relax and have fun in good company. The body processes alcohol as a poison but this could be a situation where the 'psycho-social' benefits significantly outweigh the biological implications. A reward outweighing the risk to give a net beneficial activity, as far as health is concerned. 

With regards to body composition, long term studies do not support a fattening effect of moderate alcohol consumption (2 glasses per day). There is even evidence that added calories from alcohol can perform a so called "dissapearing act" by not resulting in weight gain. This has been attributed to the TEF but exact mechanisms remain poorly understood. Health and fitness are not one and the same as pursuit of extremely low body fat levels is associated with a host of mental health issues12. In these people, one could perhaps strongly argue that the addition of alcoholic calories could provide a physiological benefit!

Stop drinking your calories unless you want to include a glass (or two) of red wine in the evening if it doesn’t send you over your daily calorie goal, but even then it might be ok as in some people the calories seem to disappear. But thats a mouthful
— Luke R. Davies

The long and short is that some alcohol seems to be no problem, in fact it can be good. It appears to be worthwhile considering the calorific value of your alcohol of choice and if it is having a detrimental influence on your total calorific deficit. For what it is worth I advise clients to 'stop drinking calories' as this is one easy behaviour change to help effortlessly lose fat. In truth, the real magic here is becoming mindful of what enters your mouth, so my advice could be;


USEFUL FACTS

  • 330ml beer - 153kcal - 13.9g alcohol
  • 330ml light beer - 103kcal - 11g alcohol
  • 148ml red wine - 125kcal - 15.6g alcohol
  • 148ml white wine - 121kcal - 15.1g alcohol
  • 89ml sake (rice wine) - 117kcal - 14.1g alcohol
  • 44ml liquor - 40% alcohol - 97kcal - 14g alcohol

"stop drinking your calories unless you would like to include a glass (or two) of red wine in the evening if it doesn't send you over your daily calorie goal, but even then it might be ok as in some people the calories seem to disappear"

That however, is a mouthful. Generally - don't drink calories and be mindful of what you consume and use common sense - seems to be fair advice. Remember some people will get away with more, some with less, see it as one of your beautiful idiosyncracies and make amendments as you go. Check this great animated video out by Dr Mike Evans on our relationship with alcohol.

I bet you did not expect the conclusion of this post to be that moderation would come in king again.

I like to keep my readers guessing.

I better 'scrub' up on my red wine (pun intended), and find some friends to drink it with  :)


HOW DOES LUKE R. DAVIES APPROACH ALCOHOL?

I try to apply both knowledge and intuition toward achieving balance in this area. Generally I will enjoy a recreational red wine with my family and girlfriend and I will try to be calorie sensitive if having a few more drinks at an occasion. Gin, slimline tonic and freshly cut lime is my personal favourite. For periods where i get on the bus and have a set training goal or body composition goal, I will go completely alcohol free for that period.....6, 8, 12, 24 weeks, whatever it takes. Similarly, if i have a reunion with old friends (they get further apart as we get older), I will allow myself to enjoy wherever the occasion takes us. If that violates 'drinking recommendations' in one sitting then it is my opinion that the psychosocial benefits of such occasions significantly outweigh the consequences, and I have research to support it! :)

Find your balance. 

 

Figure 5: Potentially the real therapeutic benefit to alcohol (wine) is the way it brings loved ones together for fun, games and generally good down time. 

Figure 5: Potentially the real therapeutic benefit to alcohol (wine) is the way it brings loved ones together for fun, games and generally good down time. 

 

Luke R. Davies :)


REFERENCES

1. Corder, R., Mullen, W., Khan, N. Q., Marks, S. C., Wood, E. G., Carrier, M. J. and Crozier, A. (2006). Oencology: Red Wine Procyanidins and Vascular Health, Nature, 444.

2. Buettner, D. (2012). The Blue Zones, 2nd Edition: 9 lessons for living longer, National geographic Partners, Washington, USA.

3. Zakhari, S. (2006). Overview: How is Alcohol Metabolised by the Body? NIH Publication, Alcohol Research and Health, 29(4), P.245-55.

4. Aragon, A. (2016). Alan Aragon Research Review (AARR), o Alcohol Calories Count or do they just Disappear? 

5. Suter, P. M., Jéquier, E. and Schutz, Y. (1994). Effect of Ethanol on Energy Expenditure, merican Journal of Physiology,P266(4), P.1204-12.

6. Yeoman, M. R. (2010). Alcohol, Appetite and Energy Balance: is Alcohol Intake a Risk Factor for Obesity, Physiological Behaviour, 100(1), P.82-9. 

7. Sayon-Orea, C., Martinez-Gonzalez, M. A. and Bes-Rastrollo, M. (2011). Alcohol consumption and body Weight: A Systematic review, Nutrition Review, 69(8), P.419-31.

8. Crouse, J. R. and Grundy, S. M. (1984). Effects of Alcohol on Plasma Lipoproteins and Cholesterol and Triglyceride Metabolism in Man, Journal of Lipid Research, 25(5), P.486-96.

9. Flechtner-Mors, M., Biesalski, H. K., Jenkinson, C. P., Adler, G. and Ditschuneit, H. H. (2004). Effects of Moderate Consumption of White Wine on Weight Loss in Overweight and obese Subjects, International Journal of Obesity and Related Metabolic Disorders, 28(11), P.1420-6.

10. Cordain, L., Melby, C. L., Hamamoto, A. E., O'Neil, S. D., Cornier, M., Barakat, H. A., Israel, R. G. and Hill J. (2000). Influence of Moderate Chronic Wine Consumption on INsulin Sensitivity and Other Correlates of Syndrome X in Moderately Obese Women, Metabolism, 49(11), P.1473-78.

11. Bendsen, N. T., Christensen, R., Bartels, E. M., Kok, F. J., Sierksma, A., Raben, A. and Astrup, A. (2013). Is Beer Consumption Related to Measures of Abdominal and General Obesity? A systematic Review and Meta-Analysis, Nutrition Review, 71(2), P.67-87.

12. Helms,E. R., Aragon, A. and Fitschen, P. J. (2014). Evidence-based Recommendations for Natural Bodybuilding Contest Preparation: Nutrition and Supplementation, Journal of international Society of Sports Nutrition, 11(20)